RESUMO
We report a case of small bowel follicular lymphoma regression with hepatitis B virus treatment. Our patient underwent surveillance colonoscopy that showed profound nodularity in the terminal ileum that was consistent with non-Hodgkin's lymphoma (NHL) on biopsy. Upon further testing the patient was found to be infected with hepatitis B virus. We decided to treat hepatitis B first to prevent its reactivation if the patient underwent therapy for NHL and with the thought that NHL can be stimulated by immunological response to antigens. Our patient was started on Entecavir, and fortunately the NHL regressed with no recurrence on follow-up endoscopies and biopsies.
Assuntos
Antivirais/uso terapêutico , Guanina/análogos & derivados , Hepatite B/tratamento farmacológico , Neoplasias Intestinais/tratamento farmacológico , Linfoma Folicular/tratamento farmacológico , Colonoscopia , Guanina/uso terapêutico , Hepatite B/complicações , Hepatite B/virologia , Vírus da Hepatite B , Humanos , Neoplasias Intestinais/complicações , Neoplasias Intestinais/virologia , Intestino Delgado/virologia , Linfoma Folicular/complicações , Linfoma Folicular/virologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/virologiaRESUMO
Pseudomelanosis is a rare finding during upper gastrointestinal endoscopy, and is most commonly seen in the duodenum. Involvement of other organs in the upper gastrointestinal tract is extremely rare, with only 1 reported case involving the stomach, duodenum, and jejunum. We present a case of a 60-year-old woman with mild anemia and hematemesis, who was found to have characteristic speckled pattern of gray-black pigmentation on endoscopic examination. To the best of our knowledge, this is the second reported case of pseudomelanosis involving the stomach, duodenum, and jejunum.
Assuntos
Duodenopatias/diagnóstico , Doenças do Jejuno/diagnóstico , Melanose/diagnóstico , Gastropatias/diagnóstico , Idoso , Biomarcadores/análise , Biópsia , Duodenopatias/metabolismo , Duodenopatias/patologia , Duodeno/química , Endoscopia Gastrointestinal , Feminino , Mucosa Gástrica/química , Humanos , Mucosa Intestinal/química , Doenças do Jejuno/complicações , Doenças do Jejuno/metabolismo , Doenças do Jejuno/patologia , Jejuno/química , Melanose/metabolismo , Melanose/patologia , Pigmentos Biológicos/análise , Valor Preditivo dos Testes , Gastropatias/metabolismo , Gastropatias/patologiaRESUMO
BACKGROUND: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality among adults. Although steroids appear to be beneficial in animal models of CAP, clinical trial data in humans are either equivocal or conflicting. PURPOSE: Our purpose was to perform a systematic review and meta-analysis of studies examining the impact of steroid therapy on clinical outcomes among adults admitted with CAP. DATA SOURCES AND STUDY SELECTION: We identified randomized controlled trials (RCTs) through a systematic search of published literature up to July 2011. DATA EXTRACTION: We estimated relative risks (RR) and weighted mean differences, pooled from each study using a random effects model. DATA SYNTHESIS: Eight RCTs, comprising 1119 patients, met our selection criteria. Overall quality of the studies was moderate. Adjunctive steroid therapy had no effect on hospital mortality or length of stay in the intensive care unit, but reduced the overall length of hospital stay (RR: -1.21 days [95% confidence interval (CI): -2.12 to -0.29]). Less robust data also demonstrated reduced incidence of delayed shock (RR: 0.12 [95% CI: 0.03 to 0.41]) and reduced persistence of chest x-ray abnormalities (RR: 0.13 [95% CI: 0.06 to 0.27]). A priori subgroup and sensitivity analyses did not alter these findings. CONCLUSIONS: Moderate-quality evidence suggests that adjunctive steroid therapy for adults hospitalized with CAP reduced the length of hospital stay but did not alter mortality.
