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Strongyloides hyper-infection causing life-threatening gastrointestinal bleeding

World Journal of Gastroenterology 2006年第39期12卷 6401-6404页

作者： lajos Csermely Hassan Jaafar Jorgen Kristensen Antonio Castella Waldemar Gorka Ahmed Ali Chebli Fawaz Trab Hussain Alizadeh b.la hunyady County Hospital Zalaegerszeg Hungary Tawam Hospital Al-Ain Abu Dhabi United Arab Emirates First Department of Medicine University of Pécs Hungary Correspondence to: Professor Béla Hunyady MD PhD DSc

A 55-year old male patient was diagnosed with strongy- loides hyper-infection with stool analysis and intestinal biopsy shortly after his chemotherapy for myeloma. He was commenced on albendazole anthelmintic therapy. After initiation of the treatment he suffered life- threatening gastrointestinal (GI) bleeding. Repeated endoscopies showed diffuse multi-focal intestinal bleeding. The patient required huge amounts of red blood cells and plasma transfusions and correction of haemostasis with recombinant activated factor Ⅶ. Abdominal aorto-angiography showed numerous micro- aneurysms (‘berry aneurysms’) in the superior and inferior mesenteric arteries’ territories. While the biopsy taken prior to the treatment with albendazole did not show evidence of vasculitis, the biopsy taken after initiation of therapy revealed leukoclastic aggregations around the vessels. These findings suggest that, in addition to direct destruction of the mucosa, vasculitis could be an important additive factor causing the massive GI bleeding during the anthelmintic treatment. This might result from substances released by the worms that have been killed with anthelmintic therapy. Current guidelines advise steroids to be tapered and stopped in case of systematic parasitic infections as they might reduce immunity and precipitate parasitic hyper-infection. In our opinion, steroid therapy might be of value in the management of strongyloides hyper- infection related vasculitis, in addition to the anthelmintic treatment. Indeed, steroid therapy of vasculitis with other means of supportive care resulted in cessation of the bleeding and recovery of the patient.

关键词： Myeloma Immunosuppression Strongyloides stercoralis Exudative enteropathy Gastrointestinal bleeding Vasculitis

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Changes of plasma fasting carnitine ester profile in patients with ulcerative colitis

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World Journal of Gastroenterology 2006年第1期12卷 110-113页

作者： Judit bene Katalin Komlósi Viktória Havasi Gábor Talián beáta Gasztonyi Krisztina Horváth Gyula Mózsik b.la hunyady b.la Melegh Mária Figler MTA PTE Clinical Genetics Research Group of Hungarian Academy of Sciences at the University of Pécs PécsHungary Department of Medical Genetics and Child DevelopmentUniversity of PécsPécsHungary Department of Medical Genetics and Child Development University of PécsPécsHungary Department of Medicine School of MedicineUniversity of PécsPécsHungary

AIM： To determine the plasma carnitine ester profile in adult patients with ulcerative culitis （UC） and compared with healthy control subjects. METHOD： Using ESI triple quadrupole tandem mass spectrometry, the carnitine ester profile was measured in 44 patients with UC and 44 age- and sex-matched healthy controls. RESULTS： There was no significant difference in the fasting free carnitine level between the patients with UC and the healthy controls. The fasting propionyl- （0.331 ± 0.019 vs 0.392 ± 0.017 μmol/L）, butyryl- （0.219 ± 0.014 vs 0.265 ± 0.012）, and isovalerylcarniUne （0.111 ± 0.008 vs 0.134 ± 0.008） levels were decreased in the UC patients. by contrast, the level of octanoyl- （0.147 ± 0.009 vs 0.114 ± 0.008）, decanoyl- （0.180 ± 0.012 vs 0.137 ± 0.008）, myristoyl- （0.048 ± 0.003 vs 0.039 ± 0.003）, palmitoyl- （0.128 ± 0.006 vs 0.109 ± 0.004）, palmitoleyl- （0.042±0.003 vs 0.031 ± 0.002） and oleylcarnitine （0.183 ± 0.007 vs 0.163 ± 0.007; P 〈 0.05 in all comparisons） were increased in the patients with UC. CONCLUSION： Our data suggest selective involvement of the carnitine esters in UC patients, probably due to their altered metabolism.

关键词： Carnitine Carnitine ester profile Ulcerativecolitis

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Evaluation of Ultrasound-based Surveillance for Hepatocellular Carcinoma in Patients at Risk:Results From a German Multicenter Retrospective Cohort Study

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Journal of Clinical and Translational Hepatology 2023年第3期11卷 626-637页

作者： Johannes Gillessen Philipp Reuken Peter-Marton hunyady Matthias Christian Reichert Lucian Lothschütz Fabian Finkelmeier Matthias Nowka Gabriel Allo Fabian Kütting Martin bürger Dirk Nierhoff Hans-Michael Steffen Christoph Schramm University Hospital Cologne Department of Gastroenterology and HepatologyCologneGermany University Hospital Jena Department of Internal Medicine IV-GastroenterologyHepatologyInfectious DiseaseJenaGermany University Hospital Frankfurt Department of Internal Medicine 1-Gastroenterology und HepatologyPulmonology und AllergologyEndocrinologyFrankfurtGermany Department of Medicine II Saarland University Medical CenterHomburgGermany Department of Gastroenterology and Hepatology University Hospital of EssenEssenGermany

background and Aims:Hepatocellular carcinoma(HCC)surveillance in patients at risk is strongly recommended and usually performed by ultrasound(US)semiannually with or without alfa-fetoprotein(AFP)*** pa-rameters except for surveillance intervals have not been strictly *** aimed to evaluate surveillance success and risk factors for surveillance ***:Patients with≥1 US prior to HCC diagnosis performed at four tertiary referral hospitals in Germany between 2008 and 2019 were retrospectively *** success was defined as HCC detection within Milan ***:Only 47%of 156 patients,median age 63(interquartile range:57-70)years,56%male,and 96%with cirrhosis,received recom-mended surveillance modality and *** fail-ure occurred in 29%and was significantly associated with lower median model for end-stage liver disease(MELD)score odds ratio(OR)1.154,95%confidence interval(CI):1.027-1.297,p=0.025)and HCC localization within right liver lobe(OR:6.083,95%CI:1.303-28.407,p=0.022),but not with AFP≥200μg/*** with surveillance failure had sig-nificantly more intermediate/advanced tumor stages(93%vs.6%,pbased HCC surveillance in patients at risk frequently fails and its failure is associated with unfavorable patient-related *** MELD score and HCC lo-calization within right liver lobe were significantly associated with surveillance failure.

关键词： Hepatocellular carcinoma Surveillance success Screening Ultra-sound.

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