ABSTRACT
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Subject(s)
Aged , Aged, 80 and over , Male , Humans , Sulfonamides , Anti-Inflammatory Agents, Non-Steroidal , Chemical and Drug Induced Liver InjurySubject(s)
Drug Therapy, Combination/therapeutic use , Klebsiella Infections/drug therapy , Pancreatitis, Acute Necrotizing/drug therapy , Aged , Ciprofloxacin/therapeutic use , Combined Modality Therapy , Gentamicins/administration & dosage , Humans , Imipenem/therapeutic use , Klebsiella Infections/diagnosis , Klebsiella Infections/pathology , Klebsiella pneumoniae/isolation & purification , Male , Pancreatitis, Acute Necrotizing/diagnosis , Pancreatitis, Acute Necrotizing/microbiology , Pancreatitis, Acute Necrotizing/pathology , Pancreatitis, Acute Necrotizing/therapy , Parenteral Nutrition, Total , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic useABSTRACT
Previous studies suggest that low bone mass is a complication of alcoholic liver disease. Nevertheless, little is known about bone mass and bone metabolism in viral cirrhosis. To evaluate the prevalence and magnitude of hepatic osteopenia in these patients, bone remodeling status, and its relationship with the severity of liver disease and serum levels of insulin-like growth factor I (IGF-I), we studied 32 consecutive patients with viral cirrhosis and no history of alcohol intake. Bone mineral density (BMD) was measured by dual x-ray absorptiometry in the lumbar spine (LS) and femoral neck (FN), and the values were expressed as the z score. Bone metabolism markers and hormone profiles were measured. Patients with viral cirrhosis showed reduced BMD in all sites (LS: -1.27 +/- 1.06, P < .001; FN: -0.48 +/- 0.96; P < .01). Of the 32 patients, 53% met the diagnostic criteria for osteoporosis. In patients, urine deoxypyridinoline (D-Pyr) as a marker of bone resorption and serum bone alkaline phosphatase (b-AP) as a marker of bone formation were significantly higher than in control subjects (P < .001 and P < .01, respectively). Serum IGF-I was lower than in control subjects (P < .001), and significant differences were also found between patients with and without osteoporosis (P < .05). BMD in LS correlated with severity of the disease, with serum levels of IGF-I, and with urine D-Pyr. Our findings show that viral cirrhosis is a major cause of osteoporosis in men, and that low serum IGF-I levels seem to play a role in the bone mass loss in these patients. The biochemical markers of bone remodeling suggest high-turnover osteoporosis in patients with viral cirrhosis.
Subject(s)
Bone Density , Bone and Bones/metabolism , Hepatitis B/metabolism , Hepatitis C/metabolism , Insulin-Like Growth Factor I/analysis , Liver Cirrhosis/metabolism , Adult , Aged , Alkaline Phosphatase/blood , Amino Acids/urine , Humans , Male , Middle Aged , Osteoporosis/etiology , Parathyroid Hormone/bloodABSTRACT
Langerhans cells granulomatosis is a rare disease characterized by the clonal proliferation of the Langerhans cell, a cell element pertaining to the mononuclear phagocytes system. Hepatic involvement may be presented, particularly in the multifocal or disseminated form, together with the remaining surrounding organs. Radiologic findings have recently been reported including echographic, computerized tomography and magnetic resonance of the hepatic lesion of the disease. The case of a patient whose initial radiographic study suggested the existence of hepatic metastasis and which was later diagnosed with multifocal granulomatosis of Langerhans cells with hepatic involvement is reported. Radiologic and histologic images are provided and the data reported in the literature concerning this disease are reviewed.
Subject(s)
Histiocytosis, Langerhans-Cell/diagnosis , Liver Diseases/diagnosis , Liver Neoplasms/diagnosis , Adult , Biopsy , Diagnosis, Differential , Histiocytosis, Langerhans-Cell/pathology , Humans , Liver/pathology , Liver Diseases/pathology , Magnetic Resonance Imaging , Male , Tomography, X-Ray ComputedABSTRACT
Sarcoidosis is a systemic granulomatous disease of unknown etiology which may present multiple clinical manifestations. Liver involvement is observed among 21-79% of the cases. Nonetheless, hepatic sarcoidosis is usually asymptomatic and the finding of cholestasis is an infrequent complication. In the last few years, the presence of multiple hypodense nodules in the liver and spleen has been described in 5-15% of these patients following the application of dynamic intravenous techniques in abdominal CT scan. Although the histopathologic study of these nodules suggests that their formation is due to the coalescence of the microscopic granulomas, the cause of this aggregation remains unknown. A case of hepatic sarcoidosis presenting chronic cholestasis and whose abdominal tomographic study with intravenous contrast demonstrated the existence of hypodense lesions in the liver and spleen suggesting malignant disseminated disease is reported.