Obstrucción biliar por adenocarcinoma de la papila de Vater en un paciente con trasplante hepático ortotópico / Biliary obstruction due to adenocarcinoma of the ampulla of Vater ten years after orthotopic liver transplantation

Las principales causas de mortalidad en trasplantados hepáticos son las derivadas del propio injerto. Dado el aumento de la supervivencia de este grupo de pacientes, está aumentando los casos de neoplasias de novo en otras localizaciones.Se presenta el caso de un varón de 60 años, trasplantado hepático ortotópico hace 10 años por cirrosis terminal causada por virus de la hepatitis B. Los estudios radiológicos realizados demostraron dilatación de la vía biliar intra y extrahepática, sin que hubiera evidencia de litiasis, estenosis anastomótica ni otras complicaciones biliares usuales en trasplantados hepáticos. El diagnóstico definitivo se hizo con colangiopancreatografía retrógrada endoscópica.El adenocarcinoma de la papila de Vater es una causa de obstrucción biliar que se debe considerar en pacientes con trasplante hepático ortotópico (AU)

The main causes of death in patients with liver transplants are derived from the graft itself. Given the increased survival in this group of patients, the rate of de novo neoplasms in other locations is increasing. We present the case of a 60-year-old man who underwent orthotopic liver transplantation 10 years earlier for terminal cirrhosis caused by hepatitis B. Imaging studies showed dilation of the intra- and extra-hepatic bile ducts with no evidence of lithiasis, anastomotic stenosis, or other biliary complications that are common in patients with liver transplants. The definitive diagnosis was reached by endoscopic retrograde cholangio pancreatography. Adenocarcinoma of the ampulla of Vater should be considered among the causes of biliary obstruction in patients with orthotopic liver transplants (AU)

[Biliary obstruction due to adenocarcinoma of the ampulla of Vater ten years after orthotopic liver transplantation]. / Obstrucción biliar por adenocarcinoma de la papila de Vater en un paciente con trasplante hepático ortotópico.

The main causes of death in patients with liver transplants are derived from the graft itself. Given the increased survival in this group of patients, the rate of de novo neoplasms in other locations is increasing. We present the case of a 60-year-old man who underwent orthotopic liver transplantation 10 years earlier for terminal cirrhosis caused by hepatitis B. Imaging studies showed dilation of the intra- and extra-hepatic bile ducts with no evidence of lithiasis, anastomotic stenosis, or other biliary complications that are common in patients with liver transplants. The definitive diagnosis was reached by endoscopic retrograde cholangiopancreatography. Adenocarcinoma of the ampulla of Vater should be considered among the causes of biliary obstruction in patients with orthotopic liver transplants.

[Rapidly evolving pulmonary bullous degeneration in HIV-infected patients. Description of 4 cases and review of the literature]. / Degeneración bullosa pulmonar de rápida evolución en pacientes infectados por el VIH. Descripción de cuatro casos y revisión de la literatura.

Cavitary lung lesions are common in intravenous drug-addicts (IVDA) and in AIDS patients. Four cases are reported of IVDA patients with HIV positive serology who developed an initially thick-walled lesion, which grew rapidly and evolved into bullous lesions. The negative results in microbiological investigations for Pneumocystis carinii, Nocardia spp., staphylococci; the topographic superposition on a previous tuberculous lesion; a prolonged asymptomatic period; and a particularly rapid evolution in all cases led us to consider the rapidly evolving bullous degeneration to be more than a casual finding. Previous infection with M. tuberculosis in AIDS patients might somehow influence on the later development of a rapidly growing, fatal, bullous degenerative lesion. The elucidation of the pathogenic mechanisms of these lesions was hampered by the lack of pathological studies.