ABSTRACT
Hepatitis C virus (HCV) infection is the most common blood-borne chronic infection in the United States. Chronic lymphocytic sialadenitis and sicca syndrome have been reported in chronic HCV infection. Up to 55% of these patients may have xerostomia; the mechanisms of the xerostomia and salivary gland (SG) hypofunction remain controversial. The objectives of this project are to establish if xerostomia associates with SG and HCV infection and to characterize the structural changes in SG and saliva composition. Eighteen HCV-infected patients with xerostomia were evaluated for SG dysfunction; 6 of these patients (patients 1-6) were further evaluated for SG histopathological changes and changes in saliva composition. The techniques used include clinical and laboratory assessment, SG ultrasonography, histological evaluation, sialochemical and proteomics analysis, and RNA in situ hybridization. All the HCV patients had low saliva flow, chronic sialadenitis, and SG fibrosis and lacked Sjögren syndrome (SS) characteristic autoantibodies. Further evaluation of a subgroup of 6 HCV patients (patients 1-6) demonstrated diffuse lymphocytic infiltrates that are predominantly CD8+ T cells with a significant increase in the number of inflammatory cells. Alcian Blue/periodic acid-Schiff staining showed significant changes in the ratio and intensity of the acinar secretory units of the HCV patients' minor SG. The submandibular glands showed significant ultrasonographic abnormalities in the parenchyma relative to the parotid glands. Significant changes were also observed in the concentration of sodium and mucin 5b. Although no significant correlation was observed between the lymphocytic infiltrates and the years of HCV chronic infection, a positive correlation was observed between HCV RNA-positive epithelial cells and the years of HCV infection. Consistent with the low saliva flow and xerostomia, patients showed changes in several markers of SG acinar and ductal function. Changes in the composition of the saliva suggest that HCV infection can cause xerostomia by mechanisms distinct from SS.
Subject(s)
Hepatitis C , Sialadenitis , Sjogren's Syndrome , Xerostomia , CD8-Positive T-Lymphocytes/pathology , Hepacivirus , Hepatitis C/complications , Humans , Inflammation , RNA , Saliva , Salivary Glands/pathology , Sjogren's Syndrome/complications , Xerostomia/etiologyABSTRACT
La metayodobencilguanidina radiomarcada es un análogo de la norepinefrina que se utiliza en la localización de tumores que expresan transportadores de dicha neurohormona, especialmente los derivados de la cresta neural y de origen neuroendocrino, y en el tratamiento de sus metástasis cuando estas no son quirúrgicas. En la literatura revisada se encuentran mejorías sintomáticas, asociadas a un descenso de los niveles hormonales, en un porcentaje no despreciable de casos tras el tratamiento con 131I-MIBG. Sin embargo, la remisión tumoral completa se ha descrito en muy pocas ocasiones y casi nunca en presencia de metástasis óseas. Presentamos un caso de feocromocitoma maligno que tras el tratamiento con 131I-MIBG (600 mCi) alcanzó una respuesta hormonal y metabólica completa a pesar de la existencia de metástasis óseas (AU)
Radiolabeled metaiodobenzylguanidine is an analogue of norepinephrine used to localize tumors that express the neurohormone transporters, specifically those derived from the neural crest having a neuroendocrine origin. It is also used to treat non-surgical metastases derived from them. A review of the literature revealed symptomatic improvements associated to a decrease in hormone levels in a significant percentage of patients after 131I-MIBG treatment. However, complete tumor remission has been described only in very few cases and hardly ever when bone metastases exist. We present a case of a patient diagnosed of malignant pheochromocytoma who achieved complete hormonal and metabolic response after 131I-MIBG treatment (600 mCi) in spite of the presence of bone metastases (AU)
Subject(s)
Humans , Male , Adult , 3-Iodobenzylguanidine/therapeutic use , Pheochromocytoma/complications , Pheochromocytoma , Radionuclide Imaging/instrumentation , Radionuclide Imaging/methods , Magnetic Resonance Imaging/instrumentation , Magnetic Resonance Imaging/methods , Tomography, Emission-Computed/instrumentation , Tomography, Emission-Computed/methods , Tomography, Emission-Computed , Nuclear Medicine/methods , Nuclear Medicine/standardsABSTRACT
Radiolabeled metaiodobenzylguanidine is an analogue of norepinephrine used to localize tumors that express the neurohormone transporters, specifically those derived from the neural crest having a neuroendocrine origin. It is also used to treat non-surgical metastases derived from them. A review of the literature revealed symptomatic improvements associated to a decrease in hormone levels in a significant percentage of patients after (131)I-MIBG treatment. However, complete tumor remission has been described only in very few cases and hardly ever when bone metastases exist. We present a case of a patient diagnosed of malignant pheochromocytoma who achieved complete hormonal and metabolic response after (131)I-MIBG treatment (600 mCi) in spite of the presence of bone metastases.
Subject(s)
3-Iodobenzylguanidine/therapeutic use , Adrenal Gland Neoplasms/drug therapy , Antineoplastic Agents/therapeutic use , Pheochromocytoma/drug therapy , Adrenal Gland Neoplasms/metabolism , Adrenal Gland Neoplasms/pathology , Bone Neoplasms/secondary , Humans , Male , Neurotransmitter Agents/biosynthesis , Pheochromocytoma/metabolism , Pheochromocytoma/secondary , Remission Induction , Young AdultABSTRACT
Changes in magnetic resonance imaging (MRI) during neoadjuvant chemotherapy (NAC) have been reported as predictive of pathology outcome in triple-negative and HER2-positive breast cancer. The purpose of our study was to evaluate the relevance of breast cancer subtype for MRI response in 24 women before and during NAC in our centre. Our results show that a reduction greater than 23% is associated with a pathological complete response (pCR) in Her-2-positive and ER-negative/Her2-negative breast cancer, and suggest a trend correlation between higher ADC values and pCR in these subtypes in comparison with ER-positive/Her2-negative breast cancers. Higher proliferating tumours respond better to chemotherapy and our study suggests that changes in MRI during NAC are predictive of pCR in these breast cancer subtypes (AU)
Subject(s)
Humans , Female , Breast Neoplasms/therapy , Magnetic Resonance Imaging , Neoadjuvant Therapy , /metabolismABSTRACT
Post-radiotherapy cystitis is a high morbidity entity that involves difficult-to-treat haematurias and sometimes results in death. Percutaneous arterial embolization is an accepted approach for haemorrhages of pelvic origin. Selective, percutaneous embolization of both vesical arteries could be an alternative treatment to control severe haematurias caused by radiation. Presentation of our experience in two cases and proposal of this approach as a valid option in post-radiotherapy haemorrhagic cystitis.
Subject(s)
Cystitis/complications , Embolization, Therapeutic/methods , Hematuria/therapy , Radiation Injuries/complications , Female , Gelatin Sponge, Absorbable , Hematuria/etiology , Humans , Middle AgedABSTRACT
We herein describe the ultrasonographic findings of 19 patients with clinical suspicion of acute diverticulitis. The criteria considered as evidence of the disease included the identification of the diverticuli, thickening of the wall of the loop, alteration of local mesenterium and selective pain. Diagnosis was complemented by CT scan, barium enema and, in determined cases, colonoscopy. Of the 19 cases studied, 18 corresponded to acute diverticulitis of the sigma and one to acute salpingitis. The former 18 cases were correctly diagnosed by ultrasonography (uncomplicated diverticulitis) and the posterior CT scan did not provide additional information. In conclusion, ultrasonography is a highly sensitive and specific technique for the diagnosis of acute diverticulitis when the sigmoid colon is involved.
Subject(s)
Diverticulitis, Colonic/diagnostic imaging , Sigmoid Diseases/diagnostic imaging , Adult , Aged , Aged, 80 and over , Diverticulitis, Colonic/diagnosis , Female , Humans , Male , Middle Aged , Prospective Studies , Sigmoid Diseases/diagnosis , UltrasonographyABSTRACT
BACKGROUND AND STUDY AIMS: The aim of the present study was to review endoscopic findings, treatment, and clinical outcomes in patients with severe upper gastrointestinal bleeding due to tumors. PATIENTS AND METHODS: A retrospective analysis was made of prospectively gathered data on all patients with severe upper gastrointestinal bleeding who were admitted to two large referral centers during a 45-month period. RESULTS: Nine hundred thirty-five patients had severe upper gastrointestinal bleeding, of whom 42 (5%) were found to have tumors. Histologically, nearly all of the tumors were of a malignant type. Fifty-two percent of the patients had acute severe upper gastrointestinal bleeding as the initial presentation of their tumor. The most common tumor was gastric adenocarcinoma, and all of these cases were at advanced stages. Endoscopic hemostasis with thermal probes or epinephrine injection, or both, was carried out in seven patients (17%), with successful hemostasis in all of the tumors. Regardless of the treatment given, patients with upper gastrointestinal tumor bleeding, had a 30-day surgery rate of 43%, a 30-day rebleed rate of 33%, a 30-day mortality rate of 10%, and a 1-year mortality rate of 89%. CONCLUSIONS: Most tumors that cause severe upper gastrointestinal bleeding are of a malignant histologic type and are already at an advanced stage. Endoscopic hemostasis of bleeding upper gastrointestinal tumors is safe and initially effective, and may provide time for elective surgical palliation. Regardless of therapy, upper gastrointestinal tumors with severe bleeding have a poor one-year survival.
Subject(s)
Endoscopy, Digestive System , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/therapy , Gastrointestinal Neoplasms/diagnosis , Hemostasis, Endoscopic/methods , Female , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Neoplasms/complications , Humans , Male , Middle Aged , Prospective Studies , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
Internal hemorrhoids are the most common cause of lower gastrointestinal bleeding. Although new anoscopic therapies are available, few comparative randomized studies have evaluated them in regard to long-term efficacy, recurrence rates, and safety. Our purpose was to compare the treatment of internal hemorrhoids with direct current (Ultroid, Cabot Medical, Langhorn, Pa.) and bipolar (BICAP, Circon ACMI, Stamford, Conn.) hemorrhoid probes. One hundred patients with symptomatic internal hemorrhoids were randomized: 50 to direct current electrocoagulation and 50 to bipolar electrocoagulation. Follow-up and treatment were at 3- to 4-weekly intervals; two to three hemorrhoid segments were treated at each session until relief of symptoms (bleeding, prolapse, and discharge) and a reduction in hemorrhoid size to grade 1 or 0 were noted. The hemorrhoids of 98% of all patients studied were grade 2 or 3; 2% of patients had grade 1 hemorrhoids and none had grade 4 hemorrhoids. At 1 year after treatment, most patients had no (69%) or only mild (23%) recurrence, and a few had severe, symptomatic (8%) hemorrhoid recurrence. A greater recurrence rate was noted after direct current treatment (34%) than bipolar treatment (29%). In contrast, rebleeding at 1 year occurred less frequently after direct current treatment (5%) than after bipolar treatment (20%). Our conclusions were as follows: (1) Both direct current and bipolar probes were effective for control of chronic bleeding from grade 1 to 3 internal hemorrhoids. (2) Bipolar probe was significantly faster than direct current probe. (3) Direct current treatment produced fewer complications than bipolar treatment (12% versus 14%). (4) Recurrence rates were low after 1 year with either device (8%).(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Electrocoagulation/methods , Gastrointestinal Hemorrhage/surgery , Hemorrhoids/surgery , Electrocoagulation/adverse effects , Female , Gastrointestinal Hemorrhage/etiology , Hemorrhoids/pathology , Humans , Male , Middle Aged , Postoperative Complications , Prospective Studies , RecurrenceABSTRACT
Se describen nueve casos de ureterocele simple o ureterocele tipo del adulto. Se comentan los aspectos más interesantes de la semiologia radiológica y se discuten nuestros resultados con los obtenidos por otros autores. Por último, tras hacer una revisión de la bibliografía a nuestro alcance, se valora la sintomatología clínica por la que el paciente se explora radiográficamente
Subject(s)
Adolescent , Adult , Middle Aged , Humans , Male , Female , UreteroceleABSTRACT
Two cases of congenital duodenal diaphragm were discovered during a review of 2.724 duodenal X-rays performed over the past 3 years. An analysis is made of the total of 40 cases published in the literature. The duodenal diaphragm is a thin wall located into the duodenal lumen with excentric perforation and which undergoes a progressive sacculation. Its embryologic development and close relationship to intraduodenal diverticulum are described. Clinical manifestations are few and unspecific, and the condition can easily be overlooked during surgery even when external palpation or digital exploration of the duodenal lumen is performed following duodenotomy. Special emphasis is placed on the significance of the X-ray images, though they are only orientative when dealing with this condition. Congenital duodenal diaphragm should be kept in mind as a possibility whenever chronic stenosis of the duodenum is diagnosed.
