ABSTRACT
OBJECTIVES: Pyogenic liver abscess is a rare condition in the general population. The source of infection is most often biliary, and more rarely gastrointestinal via the portal tract, or even hematogenic. Other than in special contexts (scarring after radiofrequency ablation), focal liver lesions are not a usual risk factor for hepatic abscesses in patients with a history of bile duct procedures (sphincterotomy, biliary stenting, biliary enteric anastomosis). MATERIALS AND METHOD - RESULTS: We report four cases of focal liver lesions (two patients with benign lesions of the biliary cyst type and two other patients with lesions due to pancreatic cancer) complicated by a superinfection in patients with a history of bile duct procedures. There were no predisposing factors other than a context of cancer or diabetes. CONCLUSION: Superinfection of a focal liver lesion should be considered when there is a suggestive clinical picture and a change in the appearance of the lesion in patients with a history of bile duct procedures in a context of cancer or diabetes.
Subject(s)
Adenocarcinoma/surgery , Biliopancreatic Diversion , Liver Abscess/diagnosis , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy , Postoperative Complications/diagnosis , Superinfection/diagnosis , Adenocarcinoma/secondary , Aged , Chemotherapy, Adjuvant , Enterococcus , Escherichia coli Infections/diagnosis , Escherichia coli Infections/therapy , Female , Humans , Klebsiella Infections/diagnosis , Klebsiella Infections/therapy , Liver Abscess/surgery , Liver Neoplasms/diagnosis , Liver Neoplasms/secondary , Liver Neoplasms/therapy , Male , Palliative Care , Streptococcal Infections/diagnosis , Streptococcal Infections/therapy , Streptococcus anginosus , Superinfection/therapy , Tomography, X-Ray ComputedABSTRACT
Hepatocellular carcinoma and other tumours of the liver are extremely rare in Wilson's disease. We report a patient who presented with a cholangiocarcinoma associated with Wilson's disease. The literature review underlines that patients with Wilson's disease should be considered at risk of hepatocellular carcinoma, cholangiocarcinoma and undifferentiated carcinoma in the liver. Risk factors seem to be long disease duration and probably a poor observance to therapy. A liver imaging should be included in the follow-up of patients with Wilson's disease.
Subject(s)
Bile Duct Neoplasms/complications , Bile Ducts, Intrahepatic , Cholangiocarcinoma/complications , Hepatolenticular Degeneration/complications , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bile Duct Neoplasms/diagnosis , Bile Duct Neoplasms/drug therapy , Cholangiocarcinoma/diagnosis , Cholangiocarcinoma/drug therapy , Fatal Outcome , Hepatolenticular Degeneration/diagnosis , Hepatolenticular Degeneration/drug therapy , Humans , Male , Risk FactorsABSTRACT
We report a case of massive pulmonary embolism during cyanoacrylate glue endoscopic injection in a patient with gastric varices from portal hypertension. A review of the literature and results in an animal model show the physiopathology and risk factors associated with this endoscopic procedure.
Subject(s)
Cyanoacrylates/adverse effects , Esophageal and Gastric Varices/therapy , Pulmonary Embolism/chemically induced , Acute Disease , Cyanoacrylates/administration & dosage , Fatal Outcome , Humans , SclerotherapyABSTRACT
Bleeding from a pseudoaneurysm is a rare complication of chronic pancreatitis. We present two cases of ruptured pseudoaneurysms of the hepatic arteries. The first case involved a pancreatic pseudocyst that ruptured in the duodenum and the second resulted in an intrahepatic hematoma that compressed the bile tract causing secondary hemobilia. Angiographic embolization was the primary treatment in both cases, with surgery for the first patient and later radiological drainage in the second. The hemorrhage was controlled in both cases despite the severe prognosis and high mortality in these cases.
Subject(s)
Aneurysm, False/etiology , Hepatic Artery/pathology , Pancreatitis, Chronic/complications , Adult , Aneurysm, Ruptured/etiology , Duodenal Ulcer/etiology , Embolization, Therapeutic , Hematoma/etiology , Hemobilia/etiology , Humans , Liver Diseases/etiology , Male , Middle Aged , Pancreatic Pseudocyst/complications , Pancreaticoduodenectomy , Peptic Ulcer Hemorrhage/etiologyABSTRACT
AIMS: To assess the characteristic features of epileptic patients treated for the first time with oral anti-epileptic treatments. Patients and methods. All outpatients (adults and children), who consulted for epileptic attacks and for whom an oral anti-epileptic treatment was necessary, as a first time prescription, were enrolled consecutively in this study from April 2001 up to January 2003. Data were available from a structured questionnaire delivered to all participating neurologists. RESULTS: Two hundred sixty neurologists included 2220 patients (1162 males, 1057 females with a mean age of 41 years (from 1 month to 96 years). Forty-one percent of these patients were referred by a general practitioner and 22 percent by emergency departments. Four hundred and thirty-seven patients (19.7 percent) had only experienced a single seizure at treatment initiation. Patients were classified according to focal epilepsy (43.9 percent of patients), generalized epilepsy (46.4 percent of patients), or non-classified epilepsy (9.7 percent of patients). Sixty-six percent of patients had a biological check-up. Ninety-three percent of patients underwent an EEG and 80.7 per cent a CT scan or brain MRI. The high risk of recurrence was the main reason given by neurologists for instituting anti-epileptic treatment. The reason for initiating treatment was syndromic diagnosis in 23.7 percent of patients with multiple seizures. The most frequently prescribed drug was valproic acid (58.2 percent of patients) chosen because of its practical use and broad anti-epileptic spectrum. CONCLUSION: This study provides a considerable amount of epidemiological and clinical information with a special emphasis on epilepsy syndromes, diagnostic assessment and factors that influence the initiation of treatment or not.
Subject(s)
Anticonvulsants/therapeutic use , Epilepsy/drug therapy , Administration, Oral , Adult , Electroencephalography , Epilepsies, Partial/drug therapy , Epilepsy/classification , Epilepsy, Generalized/drug therapy , France , Humans , Seizures/etiology , Seizures/physiopathology , Seizures/prevention & control , Socioeconomic Factors , Time FactorsABSTRACT
AIMS: We aimed to evaluate the effects of several peptides (substance P, VIP, neuropeptide Y, bombesin, glucagon and somatostatin) on the proliferation, migration and differentiation of human endothelial cells and their modulation by an anti-angiogenic factor, endostatin. METHODS: Human endothelial cells (HUVEC) were isolated from umbilical veins. Their proliferation was measured by the incorporation of tritiated thymidine. Their migration was evaluated by using an haptotactic assay performed in Boyden chambers, after metabolic labeling of HUVEC through (35) S-methionin. Differentiation was evaluated as the capacity for HUVEC to form capillaries. RESULTS: Endothelial cell proliferation was increased by neuropeptide Y, bombesin and glucagon. Somatostatin induced a significant decrease in basal and stimulated endothelial cell proliferation. The migration of HUVEC increased in the presence of substance P, VIP, neuropeptide Y, bombesin, glucagon and somatostatin. The number of capillaries was increased by substance P and VIP and decreased by neuropeptide Y, bombesin and somatostatin. Endostatin induced a significant decrease in endothelial cell proliferation in the basal state and after stimulation by neuropeptide Y and bombesin. Endostatin had no additive effect on the anti-proliferative action of somatostatin. CONCLUSIONS: Our results suggest a role for endocrine peptides in the regulation of tumor angiogenesis. The potent anti-angiogenic effect of somatostatin may promote new therapeutic strategies.
