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Embolization of splenorenal shunt associated to portal vein thrombosis and hepatic encephalopathy

World Journal of Gastroenterology 2014年第42期20卷 15910-15915页

作者： letícia de campos franzoni Fábio Cardoso de Carvalho Rafael Gomes de Almeida Garzon Fábio da Silva Yamashiro Laís Augusti Lívia Alves Amaral Santos Mariana de Souza Dorna Júlio Pinheiro Baima Talles Bazeia Lima Carlos Antonio Caramori Giovanni Faria Silva Fernando Gomes Romeiro Internal Medicine department Gastroenterology Division Botucatu Medical School UNESP 18 618 970 Botucatu Sao Paulo Brazil Hospital do Cora??o do Instituto de Moléstias Cardiovasculares S?o José do Rio Preto Sao Paulo 15015-210 Brazil department of Internal Medicine Division of Cardiology Botucatu School of Medicine UNESP Univ Estadual Paulista

Hepatic encephalopathy(HE)is a cognitive disturbance characterized by neuropsychiatric *** occurs in acute and chronic hepatic disease and also in patients with portosystemic *** presence of these portosystemic shunts allows the passage of nitrogenous substances from the intestines through systemic veins without liver ***,the embolization of these shunts has been performed tocontrol HE manifestations,but the presence of portal vein thrombosis is considered a *** this presentation we show a cirrhotic patient with severe HE and portal vein thrombosis who was submitted to embolization of a large portosystemic *** report:a 57 years-old cirrhotic patient who had been hospitalized many times for persistent HE and hepatic coma,even without precipitant *** had a wide portosystemic shunt and also portal vein *** abdominal angiography confirmed the splenorenal shunt and showed other *** larger shunt was embolized through placement of microcoils,and the patient had no recurrence of overt *** was a little increase of esophageal and gastric varices,but no endoscopic treatment was *** portosystemic shunts are frequent causes of recurrent HE in cirrhotic patients,portal vein thrombosis should be considered a relative contraindication to perform a shunt ***,in particular cases with many shunts and severe HE,we found that one of these shunts can be safely embolized and this procedure can be sufficient to obtain a good HE *** conclusion,we reported a case of persistent HE due to a wide portosystemic shunt associated with portal vein *** the patient had other shunts,she was successfully treated by embolization of the larger shunt.

关键词： Recurrent hepatic encephalopathy Liver cirrhosis Port systemic shunt Shunt embolization Portal vein thrombosis

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Sorafenib after Arterial Chemoembolization in Child-Pugh A and B Cirrhotic Patients with Intermediate Hepatocellular Carcinoma: A Retrospective Analysis

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Journal of Cancer Therapy 2015年第3期6卷 286-292页

作者： Fernando Gomes Romeiro Luciana Yumi Odani Sigahi Matheus Alvarez Fabio da Silva Yamashiro Fábio Cardoso de Carvalho Leonardo Pelafsky Talles Bazeia Lima letícia de campos franzoni José Ricardo de Arruda Miranda Giovanni Faria Silva Gastroenterology Division Department of Internal Medicine Faculdade de Medicina de Botucatu UNESP—Univ Estadual Paulista Sao Paulo Brazil Faculdade de Medicina de Botucatu UNESP—Univ Estadual Paulista Sao Paulo Brazil department of Physics and Biophysics Instituto de Biociências de Botucatu UNESP—Univ Estadual Paulista Sao Paulo Brazil Gastroenterology Division Department of Surgery and Orthopedics Faculdade de Medicina de Botucatu UNESP—Univ Estadual Paulista Sao Paulo Brazil

Introduction: Hepatocellular carcinoma (HCC) is a leading cause of mortality among cirrhotic patients, and current guidelines recommend single-treatment modalities according to patient and liver disease classifications. New studies have shown promising results from combining locoregional and systemic treatments, but most of them were limited to Child-Pugh A patients due to toxicity concerns. Aim: The objective of this study was to analyze survival rates of Child-Pugh A and B patients with intermediate HCC tumors treated with transarterial chemoembolization (TACE) followed by full-dose sorafenib usage. Material and methods: a retrospective analysis of 37 cirrhotic patients (Child-Pugh A and B rates = 23/14) treated with TACE and TACE followed by sorafenib usage (17 and 20 patients, respectively). Results: The mean survival was 379 days in the combined treatment group and 151 days in the single-treatment group (p = 0.007). There were no differences in survival according to the Child-Pugh classification. Conclusions: sorafenib after TACE can be an option for selected cirrhotic patients with intermediate HCC tumors if this combined approach is cautiously performed on an individualized schedule. Our results suggest that the Child-Pugh classification should not be a limitation to this combined treatment.

关键词： Hepatocellular Carcinoma Cirrhosis Arterial Chemoembolization Sorafenib

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Pancreatic paracoccidioidomycosis simulating malignant neoplasia:Case report

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World Journal of Gastroenterology 2013年第34期19卷 5750-5753页

作者： Talles Bazeia Lima Maria Aparecida Custódio Domingues Carlos Antonio Caramori Giovanni Faria Silva Cássio Vieira de Oliveira Fábio da Silva Yamashiro letícia de campos franzoni Lígia Yukie Sassaki Fernando Gomes Romeiro Division of Gastroenterology Department of Internal MedicineBotucatu School of MedicineRubio JuniorDistrict S/N18618-970 So PauloBrazil department of Pathology Botucatu School of MedicineRubio Junior District S/N18618-970 So PauloBrazil

Paracoccidioidomycosis is a systemic granulomatous disease caused by fungus,and must be considered in the differential diagnosis of intra-abdominal tumors in endemic *** report a rare case of paracoccidioidomycosis in the pancreas.A 45-year-old man was referred to our institution with a 2-mo history of epigastric abdominal pain that was not diet-related,with night sweating,inappetence,weight loss,jaundice,pruritus,choluria,and acholic feces,without signs of sepsis or palpable *** ultrasonography(US)showed a solid mass of approximately 7 cm×5.5 cm on the pancreas *** computerized tomography showed dilation of the biliary tract,an enlarged pancreas(up to 4.5 in the head region),with dilation of the major pancreatic *** patient underwent exploratory laparotomy,and the surgical description consisted of a tumor,measuring 7 to 8 cm with a poorly-defined margin,adhering to posterior planes and mesenteric vessels,showing an enlarged bile *** drainage of the biliary tract,Rouxen-Y gastroenteroanastomosis,lymph node excision,and biopsies were performed,but malignant neoplasia was not *** analysis showed chronic pancreatitis and a granulomatous chronic inflammatory process in the choledochal lymph ***-alcohol resistant bacillus and fungus screening were ***-needle aspiration of the pancreas was performed under US *** smear was compatible with infection by Paracoccidioides *** report a rare case of paracoccidioidomycosis simulating a malignant neoplasia in the pancreas head.

关键词： Paracoccidioidomycosis Pancreas Fungus infection Pancreatic tumors Differential diagnosis

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Liver biopsy for visceral leishmaniasis diagnosis in pregnancy: report of 2 cases

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World Journal of Clinical Infectious Diseases 2013年第2期3卷 20-24页

作者： Talles Bazeia Lima Clarissa Ribeiro Villar Maria Aparecida Marchesan Rodrigues Júlio Pinheiro Baima Fábio da Silva Yamashiro letícia campos franzoni Carlos Antonio Caramori Giovanni Faria Silva Fernando Gomes Romeiro Lígia Yukie Sassaki department of Internal Medicine Division of GastroenterologyBotucatu School of MedicineSao Paulo18618-970Brazil department of Pathology Botucatu School of MedicineSao Paulo18618-970Brazil

Visceral leishmaniasis(VL) or kala-azar is a zoonosis caused by intracellular protozoa of the Leishmania genus and is transmitted to humans by the bite of phlebotomine sandflies. It particularly affects cells in the phagocytic mononuclear system, accompanied by disturbances of cellular and humoral immunity. VL is potentially fatal and is characterized by fever, hepatosplenomegaly, diarrhea, epistaxis, jaundice, anemia, leucopenia, thrombocytopenia, hypoalbuminemia and hyperglobulinemia. Diagnostic suspicion is based on epidemiological, clinical and laboratory data and isconfirmed by detecting the parasite in infected tissue. Splenic aspiration is the most sensitive method, followed by bone marrow aspiration(BMA) by sternal puncture, liver biopsy and lymph node aspiration; but, due to safety concerns, BMA is the most recommended method. VL is included as a target disease by players in drug research and development. Severe liver dysfunction associated with VL is uncommon. We report two VL cases in pregnant women from Bauru, Sao Paulo state, Brazil, considered an endemic area. The first of them developed hepatic failure due to fulminant hepatitis. In both cases, BMA was unable to find the protozoan; thus, liver biopsy was the only means of making the diagnosis.

关键词： Visceral Leishmaniasis Infection in pregnancy Liver biopsy Bone marrow aspirate Differential diagnosis

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