RESUMO
A sustained virological response and improvement of liver function were achieved by low-dose interferon (IFN) therapy following curative treatment of initial and recurrent hepatocellular carcinoma (HCC) in an 83-year-old man with hepatitis C virus (HCV)-related liver cirrhosis (CLC). Although a fourth HCC episode recurred 16 months after IFN therapy, it was successfully treated. The patient is still alive 6 years and 7 months after diagnosis of the initial HCC and has been in a tumor-free state for 19 months following treatment of the last HCC. The results of this case suggest that, given sufficient consideration of adverse effects, IFN therapy for HCV and repeated local treatment for HCC contribute to improving the prognosis even in the case of a CLC patient over 80 years of age whose condition is complicated by recurrent HCC.
RESUMO
BACKGROUND AND AIMS: To investigate the utility of a new method of carrying out esophageal manometry using a narrow gauge manometry catheter via a transnasal endoscope. METHODS: The Frequency Scale for the Symptoms of gastroesophageal reflux disease (GERD) (FSSG), a GERD-specific questionnaire, was given to 45 subjects. Subjects underwent transnasal endoscopy with three dry and three wet (3 mL water) swallows. Direct observations of the primary peristaltic wave and peristaltic pressure measurement were conducted simultaneously. RESULTS: Endoscopic observation of lower esophageal motility associated with swallowing revealed dilatation of the esophageal lumen after swallowing, followed by contraction in association with the primary peristaltic wave. The peristaltic pressure was significantly lower with increased FSSG scores for dry swallows (r = -0.347, P = 0.0212), but no significant correlation was seen for wet swallows. CONCLUSIONS: The significant negative correlation between reflux symptoms and peristaltic pressure in dry swallows was thought to be that reduced pressure immediately rostral to the lower esophageal sphincter leads to decreased clearance following gastric acid reflux, playing a large part in the onset of symptoms.
Assuntos
Deglutição , Endoscopia do Sistema Digestório/métodos , Esôfago/fisiopatologia , Refluxo Gastroesofágico/diagnóstico , Manometria/métodos , Cavidade Nasal , Peristaltismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antibacterianos/sangue , Endoscópios Gastrointestinais , Desenho de Equipamento , Esôfago/microbiologia , Feminino , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/microbiologia , Refluxo Gastroesofágico/fisiopatologia , Helicobacter pylori/imunologia , Humanos , Masculino , Manometria/instrumentação , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Pressão , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto JovemRESUMO
A complete response was obtained by interferon (IFN) therapy for hepatitis C virus (HCV)-related advanced chronic hepatitis after curative treatment of initial and recurrent hepatocellular carcinoma (HCC). The patient is alive 73 months after diagnosis of initial HCC and is in a tumor-free state 53 months after diagnosis of the last HCC. This case suggest that it is possible to suppress recurrence and to prolong the life of patients with HCV-related advanced chronic hepatitis, if a complete response is obtained by means of IFN therapy after the curative treatment of the recurrent HCC.
