Subject(s)
Bevacizumab/adverse effects , Epistaxis/chemically induced , Aged, 80 and over , Angiogenesis Inhibitors/administration & dosage , Angiogenesis Inhibitors/adverse effects , Bevacizumab/administration & dosage , Female , Humans , Intravitreal Injections , Macular Degeneration/drug therapy , Receptors, Vascular Endothelial Growth Factor/antagonists & inhibitorsABSTRACT
Fulminant hepatic failure (FHF) is a rare but often fatal disease in children. Clinical and laboratory predictors of liver regeneration and recovery, however, have not been well established. We hypothesized that hypophosphatemia may indicate recovery of liver synthetic function in children with FHF. We retrospectively reviewed the medical records of children with FHF who were admitted to UCLA and recovered hepatic function either spontaneously or by liver transplantation (LTx). Serum phosphate (Ph) and prothrombin time or international normalized ratio (INR) were compared over the patient's clinical course. Records of 39 children who spontaneously recovered experienced profound hypophosphatemia that resolved as liver synthetic function improved. Similar patterns were seen in the 84 children who recovered after LTx. We found that hypophosphatemia precedes the recovery of liver synthetic function in children with FHF who recovered with or without transplantation, and that Ph levels return to normal as liver synthetic function improves. These data suggest that hypophosphatemia may be a useful laboratory indicator of recovering liver function in children with FHF.
Subject(s)
Hypophosphatemia/physiopathology , Liver Failure, Acute/blood , Liver/physiopathology , Adolescent , Biomarkers , Child , Child, Preschool , Humans , Hypophosphatemia/etiology , Infant , Infant, Newborn , Liver Failure, Acute/physiopathology , Liver Transplantation , Retrospective StudiesABSTRACT
PURPOSE: Report of a neuroendocrine carcinoma of the caruncle as the first sign of a metastatic lung carcinoma. DESIGN: Interventional case report. METHODS: Excision of a rapidly growing caruncular tumor in a 76-year-old woman with a history of breast cancer. RESULTS: Pathology revealed a large cell neuroendocrine carcinoma, consistent with metastatic lung carcinoma. Computerized tomography of chest, abdomen, and a bone scan disclosed signs of malignancy in the lungs, liver, and bones, originally considered as metastatic breast cancer. However, this diagnosis was excluded on the basis of histopathological findings and clonality analysis. A primary neuroendocrine (Merkel cell) carcinoma was ruled out on morphologic and immunohistochemical grounds. CONCLUSION: We present a unique case of a metastatic large cell neuroendocrine carcinoma of the caruncle.
