Gregersenromero0864

We present an uncommon cause of liver transplant in a patient with a particular personal situation, who suffered loss of follow-up during his antitubercular treatment. He presented a dress syndrome with fulminant liver failure that required a liver transplant. This case demonstrates the importance of close monitoring of liver function during this treatment.The manuscript reports a rare case of duodenal spindle cell lipoma (SCL), which is a rarely reported benign lipomatous neoplasm of the gastrointestinal tract. It is less commonly observed within the duodenum. Our patient presented with gastrointestinal bleeding, which is a rare symptom of lipomas. This report describes the appearance of the neoplasm on endoscopy as well as endoscopic ultrasonography. The ulcer on the surface of the neoplasm is another rare feature. The correct diagnosis of SCL was based on its microscopic features and immunohistochemical findings. We believe that our study makes a significant contribution to the literature because this information will be of practical use to clinicians for the management of similar conditions and encourage other researchers to validate our findings.We report a case of extensive intramural hematoma of the esophagus (IHE) due to esophageal thermal injury, which is a rare disease with multiple causes. However, IHE caused by thermal injury is even rarer . A typical patient may present with a triad of chest pain, dysphagia, and vomiting of blood. The treatment of choice for IHE is conservative therapy.

reduction in calcineurin inhibitor levels is considered crucial to decrease the incidence of kidney dysfunction in liver transplant (LT) recipients. The aim of this study was to evaluate the safety and impact of everolimus plus reduced tacrolimus (EVR + rTAC) vs. mycophenolate mofetil plus tacrolimus (MMF + TAC) on kidney function in LT recipients from Spain.

the REDUCE study was a 52-week, multicenter, randomized, controlled, open-label, phase 3b study in de novo LT recipients. Eligible patients were randomized (11) 28 days post-transplantation to receive EVR + rTAC (TAC levels ≤ 5 ng/mL) or to continue with MMF + TAC (TAC levels = 6-10 ng/mL). Mean estimated glomerular filtration rate (eGFR), clinical benefit in renal function, and safety were evaluated.

in the EVR + rTAC group (n = 105), eGFR increased from randomization to week 52 (82.2 [28.5] mL/min/1.73 m2 to 86.1 [27.9] mL/min/1.73 m2) whereas it decreased in the MMF + TAC (n = 106) group (88.4 [34.3] mL/min/1.73 m2 to 83.2 [25.2] mL/min/1.73 m2), with significant (p < 0.05) differences in eGFR throughout the study. However, both groups had a similar clinical benefit regarding renal function (improvement in 18.6 % vs. 19.1 %, and stabilization in 81.4 % vs. 80.9 % of patients in the EVR + rTAC vs. MMF + TAC groups, respectively). There were no significant differences in the incidence of acute rejection (5.7 % vs. 3.8 %), deaths (5.7 % vs. 2.8 %), and serious adverse events (51.9 % vs. 44.0 %) between the 2 groups.

EVR + rTAC allows a safe reduction in tacrolimus exposure in de novo liver transplant recipients, with a significant improvement in eGFR but without significant differences in renal clinical benefit 1 year after liver transplantation.

EVR + rTAC allows a safe reduction in tacrolimus exposure in de novo liver transplant recipients, with a significant improvement in eGFR but without significant differences in renal clinical benefit 1 year after liver transplantation.We present the case of 52 years-old male without any recent travel. He was admitted to our department for a history of fever and abdominal pain. A CT scan showed a cecal thickening and liver mass with suspected cecal carcinoma with infected necrotic liver metastasis. Although the colonoscopy revealed a bulky submucosal wall thickening with a fibrined ulcer with yellow granulating located in the cecum, the percutaneous drainage revealed a positive PCR for Entamoeba histolytica, with improvement with metronidazole treatment. Ameboma are ulcerative, exophytic, inflammatory masses up to 15 cm in diameter in patients with long standing colonic amoebic infections containing granulation tissue with pseudotumor appearance. It affects less than 1.5% of colonic invasive amebiasis. Moreover, concomitant hepatic amoebic can be observed up to 30%, mimicking colonic cancer with necrotic liver metastasis. Although no epidemiological risk factor for amoebic infection was detected. We therefore highlight the awareness of amoebic infection and different manifestation even in non-endemic areas.A 38-year-old male with medical history of HIV group C3 with voluntary abandonment of antiretroviral therapy, was hospitalized due to general deterioration, abdominal pain, diarrhea and rectal bleeding without signs of acute abdomen. The patient presented anemia, renal and hepatic dysfunction, and metabolic acidosis. Abdominal CT and CT angiography were performed without observing signs of perforation or active bleeding. In the same year, he was also diagnosed of intestinal Cryptosporidiosis, cutaneous Kaposi's sarcoma and disseminated infection by Mycobacterium avium (MA) with lung, liver and bone marrow involvement. Panendoscopy was performed, showing violaceous lesions on the soft palate. In the stomach and duodenum, he presented multiple, large, well-defined and occasionally confluent red-violet lesions Colonoscopy did not show macroscopic alterations.Acute lower gastrointestinal bleeding (LGIB) is a common disorder which involves many problems in diagnosis and treatment. Concerning colonoscopy in an urgent context, guidelines are very specific in stating that unprepared colonoscopy has no place in the evaluation of patients with suspected LGIB. The purpose of this study was to evaluate the diagnosis and therapeutic effectiveness of urgent colonoscopy, without prior bowel preparation, in patients admitted at the hospital with acute LGIB. Were included 132 patients consecutively admitted at the Emergency Department for LGIB and who had undergone colonoscopy without prior bowel preparation. Despite the lack of preparation, cecal observation was possible in 10 patients (7.6%). More than two thirds of the diagnoses (69.1%) were established with the performance of just a left colonoscopy. In 63.6% of patients, a definitive diagnosis was established using this initial approach. In 35.6% of the individuals, biopsies were performed, which allowed the establishment of a histological diagnosis. Additionally, in 14 patients (16.7%) an active hemorrhagic focus was identified, and endoscopic hemostasis was performed. None of these 14 patients required additional procedures during the hospital stay. Only in 21 patients the initial colonoscopy was inconclusive and, consequently, it was necessary to repeat it after anterograde preparation. Even in these cases, no diagnosis was reached in 33.3%. This study revealed that unprepared colonoscopy in an urgent context could a useful procedure which allows an adequate guidance in more than half of the patients.Direct intestinal administration of levodopa-carbidopa gel has shown good results in selected patients with Parkinson's disease (1, 2). We want to present a complication related to the device necessary for the administration of this drug. A 58-year-old man, diagnosed with Parkinson's disease, treated for six months with levodopa-carbidopa intestinal gel, administered through a percutaneous endoscopic gastrostomy (PEG) tube with jejunal extension, presented at the emergency department for abdominal pain. CTP-656 The patient complained abdominal discomfort that lasted two months. It was described as pain around the umbilical area that radiated to the left lumbar region, worsened after ingestion, and did not subside with conventional analgesia.A clinical case of a patient from our institution under study for anemia of multifactorial origin in whom splenosis was detected as an incidental finding.We would like to correspond and share ideas on the publication "SARS-CoV-2 vaccine, a new autoimmune hepatitis trigger?." López Romero-Salazar reported a case of autoimmune hepatitis (AIH) after receiving SARS-COV2 vaccine. López Romero-Salazar et al noted that "vaccination can induce the development of autoimmune pathology in patients at risk." The possibility of a link between AIH and the SARS-CoV2 vaccine is explored. We agree that the COVID-19 vaccination has the potential to create clinical problems. The aberrant immune response could lead to a variety of health issues, including hepatitis. The vaccine recipient in this case had hepatitis, but there is no information about his or her health or liver function prior to inoculation. Other probable causes of hepatitis should be considered.Aortoesophageal fistula, a rare and potentially fatal disease, is an abnormal connection between the aorta and esophagus. We have recently identified a case of aortoesophageal fistula, but it was characterized by submucosal bulge of esophagus, not gastrointestinal bleeding. And he was treated promptly.Colorectal cancer is one of the most frequent neoplasms, with an increasing incidence in recent years. Intestinal obstruction is present at the time of diagnosis in 10-30% of patients. The aim of our study is to describe our experience in the use of colonic SEMS in the treatment of colonic stenosing neoplasia. For this purpose, we retrospectively evaluated the 92 patients treated with self-expandable metallic prostheses in our hospital between 2016 and 2021. In 66.3% of patients the prosthesis placement was bridge to curative surgery and in 33.7% with palliative attitude. The stenosis location was differentiated rectum (2.1%), rectosigmoid junction (20.7%), sigma (58.7%), left colon (8.7%), splenic angle (8.7%) and transverse colon (1.1%); being the size of the self-expandable metallic prostheses used 60x25 mm, 90x25 mm and 120x25 mm. The procedure was technically effective in 92.4% of the cases and clinically effective in 89.1%, with post-procedural perforations being detected in 9 patients (9.8%). Survival 30 days after prosthesis placement was 91.3%. No mortality directly related to the procedure was detected. In our experience, placement of self-expandable metallic prostheses is a safe and effective option in the initial management of neoplastic colon stenosis.A 71-year-old woman diagnosed with type II diabetes mellitus with severe iron deficiency anemia and positive fecal occult blood. Colonoscopy was performed, showing a soft mass (figure A) in the ascending colon, with biopsies compatible with plasmacytoma and restriction for Kappa light chains (figure C and D). After bone marrow aspiration, associated IgG multiple myeloma was detected, so chemotherapy with VMP (Bortezomib, Melphalan and Prednisone) was started. Colonoscopy six months later showed that the ulcerated lesion had a reduction in tumor size of up to 80% (figure B). A 27-year-old male with a history of kidney transplantation and symptoms of chronic diarrhea, colonoscopy was indicated with the finding of a large exophytic and ulcerated lesion in the cecum. Pathology revealed plasmacytoma with restriction of lambda light chains (Figure E and F). After ruling out lesions in other locations, the patient was treated with immunochemotherapy according to the Bortezomib-Rituximab-Dexamethasone scheme, with subsequent complete clinical and endoscopic remission.