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A case of Noonan syndrome and Whipple's disease in the same patient

World Journal of Gastroenterology 2009年第12期15卷 1524-1527页

作者： Sundip S karsan hetal a karsan Anand S karsan James Ian McMillen Cedars-Sinai Medical Center 8700 Beverly BlvdRoom 5512Los AngelesCaliforniaCA 90048United States Emory University School of Medicine and Atlanta Gastroenterology Associates AtlantaGA 30322United States University of California San DiegoCA92093United States Atlanta Clinical Care and Atlanta Specialty Research AtlantaGA 30322United States

We report the first known case of both Noonan syndrome and Whipple's disease occurring in the same patient.A 36-year-old female with history of Noonan syndrome developed fatigue,anorexia,arthritis of the knees and hands with a diffuse hyperpigmented rash,night sweats,and an unintentional fifteen pound weight loss over 4 *** bowel enteroscopy demonstrated mild edematous yellowish mucosa without *** small bowel biopsies revealed extensive periodic acid-Schiff positive material within the foamy *** was treated with a 12 mo course of trimethoprim-sulfamethoxazole DS with clinical improvement to baseline status.

关键词： Whipple's disease Noonan syndrome Tropheryma whipplei Periodic acid-schiff stain PTPN11 gene

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Management of alcoholic hepatitis:Current concepts

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World Journal of Hepatology 2012年第12期4卷 335-341页

作者： hetal a karsan Samir Parekh Atlanta Gastroenterology Associates Emory UniversityAtlantaGA 30342United States Emory University Liver Transplant Program AtlantaGA 30322United States

Alcoholic hepatitis is a devastating form of acute liver injury seen in chronic alcohol abusers with significant morbidity and *** is a multisystem disease that is precipitated by ingesting large quantities of alcohol with genetic and environmental factors playing a *** criteria have been developed to predict disease severity and these criteria can serve as indicators to initiate medical *** therapy remains abstinence and supportive care,as continued alcohol abuse is the most important risk factor for disease *** cornerstone of supportive care remains aggressive nutritional support,and although acute alcoholic hepatitis has been extensively studied,few specific medical therapies have been *** remain the most effective medical therapy available in improving short term survival in a select group of patients with alcoholic hepatitis;however,the long-term outcome of drug therapies is still not entirely clear and further clinical investigation is *** liver transplantation for acute alcoholic hepatitis have demonstrated promising results,this practice remains controversial and has not been advocated universally,with most transplant centers requiring a prolonged period of abstinence before considering *** liver support devices,although still experimental,have been developed as a form of liver support to give additional time for liver *** have the potential for a significant therapeutic option in the future for this unfortunately dreadful disease.

关键词： Alcholic hepatitis Acute liver injury Abstinence Nutrition Corticosteroids Transplantation Extracorporeal liver support

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Transjugular intrahepatic porto-systemic shunt in the elderly:Palliation for complications of portal hypertension

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World Journal of Hepatology 2012年第2期4卷 35-42页

作者： Mubin I Syed hetal karsan Hector Ferral Azim Shaikh Uzma Waheed Talal Akhter Alan Gabbard Kamal Morar Robert Tyrrell Dayton Interventional Radiology DaytonOH 45409United States Department of Radiological Sciences Wright State University School of Medicine Department of Hepatology Emory University Department of Interventional Radiology Rush University Medical Center Department of the College of Medicine Northeast Ohio Medical University Department of Gastroenterology Springfield Regional Medical Center

AIM:To present a dedicated series of transjugular intrahepatic porto-systemic shunts(TIPS) in the elderly since data is sparse on this population ***:A retrospective review was performed of patients at least 65 years of age who underwent TIPS at our institutions between 1997 and *** patients were referred for *** deemed that 2 patients were not considered appropriate candidates due to their markedly advanced liver *** the 23 patients suitable for TIPS,the indications for TIPS placement was portal hypertension complicated by refractory ascites alone(n = 9),hepatic hydrothorax alone(n = 2),refractory ascites and hydrothorax(n = 1),gastrointestinal bleeding alone(n = 8),gastrointestinal bleeding and ascites(n = 3).RESULTS:Of these 23 attempted TIPS procedure patients,21 patients had technically successful TIPS procedures.A total of 29 out of 32 TIPS procedures including revisions were successful in 21 patients with a mean age of 72.1 years(range 65-82 years).Three of the procedures were unsuccessful attempts at TIPS and 8 procedures were successful revisions of our existing *** of 21 patients who underwent successful TIPS(excluding 5 patients lost to follow-up) were followed for a mean of 14.7 *** and/or hydrothorax was controlled following technically successful procedures in 12 of 13 *** was controlled following technically successful procedures in 10 out of 11 ***:We have demonstrated that TIPS is an effective procedure to control refractory complications of portal hypertension in elderly patients.

关键词： Transjugular intrahepatic porto-systemic shunt Portal hypertension Elderly Ascites Cirrhosis

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