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Transmission of cryptococcosis by liver transplantation:A case report and review of literature

World Journal of Hepatology 2020年第5期12卷 253-261页

作者： Gustavo de Sousa Arantes Ferreira Andre Luis Conde Watanabe Natalia de Carvalho Trevizoli Fernando Marcus Felippe Jorge Carolina de Fatima Couto Priscila Brizolla de Campos Gabriel Oliveira Nunes Caja department of Liver Transplantation Instituto de Cardiologia do Distrito FederalBrasilia 70673900Brazil

BACKGROUND Cryptococcosis is a fungal infection caused by the yeast-like encapsulated basidiomycetous fungus of the Cryptococcus neoformans(C.neoformans)species complex.These fungi are ubiquitous in soil and bird droppings,and infection by them is an important global health concern,particularly in immunosuppressed patients,such as organ transplant recipients and those infected by the human immunodeficiency virus.The fungus usually enters the body through the respiratory tract,but extremely rare cases of infection acquired by transplantation of solid organs have been reported.CASE SUMMARY We report a case of disseminated cryptococcosis in a liver transplant recipient,diagnosed 2 wk after the procedure.The patient initially presented with fever,hyponatremia and elevated transaminase levels,manifesting intense headache after a few days.Blood cultures were positive for C.neoformans.Liver biopsy showed numerous fungal elements surrounded by gelatinous matrix and sparse granulomatous formations.Magnetic resonance imaging of the brain showed multiple small lesions with low signal in T2,peripheric enhancement and edematous halo,diffuse through the parenchyma but more concentrated in the subcortical regions.Treatment with amphotericin B for 3 wk,followed by maintenance therapy with fluconazole,led to complete resolution of the symptoms.The recipients of both kidneys from the same donor also developed disseminated cryptococcosis,confirming the transplant as the source of infection.The organ donor lived in a rural area,surrounded by tropical rainforest,and had negative blood cultures prior to organ procurement.CONCLUSION This case highlights the risk of transmission of fungal diseases,specifically of C.neoformans,through liver graft during liver transplantation.

关键词： Cryptococcosis Liver transplantation Cryptococcus neoformans Case report Immunosuppression Fungal infection

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Leukocytoclastic vasculitis caused by hepatitis C virus in a liver transplant recipient: A case report

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World Journal of Hepatology 2019年第4期11卷 402-408页

作者： Gustavo de Sousa Arantes Ferreira Andre Luis Conde Watanabe Natalia de Carvalho Trevizoli Fernando Marcus Felippe Jorge Luiz Gustavo Guedes Diaz Milla Carolina Costa Lafeta Araujo Gabriela de Campos Araujo Amanda de Castro Machado department of Liver Transplantation Instituto de Cardiologia do Distrito Federal Curso de Medicina Universidade Catolica de Brasilia

BACKGROUND Infection by the hepatitis C virus(HCV) is currently considered to be a global health issue, with a high worldwide prevalence and causing chronic disease in afflicted individuals. The disease largely involves the liver but it can affect other organs, including the skin. While leukocytoclastic vasculitis has been reported as one of the dermatologic manifestations of HCV infection, there are no reports of this condition as the first symptom of HCV recurrence after liver transplantation.CASE SUMMARY We report here a case of leukocytoclastic vasculitis in a liver transplant recipient on maintenance immunosuppression. The condition presented as a palpable purpura in both lower extremities. Blood and urine cultures were negative and all biochemical tests were normal, excepting evidence of anemia and hypocomplementemia. Imaging examination by computed tomography showed a small volume of ascites, diffuse thickening of bowel walls, and a small bilateral pleural effusion. Skin biopsy showed leukocytoclasia and fibrinoid necrosis.Liver biopsy was suggestive of HCV recurrence in the graft, and HCV polymerase chain reaction yielded 11460 copies/mL and identified the genotype as 1 A. Treatment of the virus with a 12-wk direct-acting antiviral regimen of ribavirin, sofosbuvir and daclatasvir led to regression of the symptoms within the first 10 d and subsequent complete resolution of the symptoms.CONCLUSION This case highlights the difficulties of diagnosing skin lesions caused by HCVinfection in immunosuppressed patients.

关键词： Hepatitis C Liver transplantation Leukocytoclastic vasculitis Immunosuppression Direct-acting antivirals Case report

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Management of portopulmonary hypertension:New perspectives

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World Journal of Gastroenterology 2013年第45期19卷 8252-8257页

作者： Luigi Mancuso Francesca Scordato Michela Pieri Eliana Valerio Andrea Mancuso Department of Cardiologia Ospedale Cervello90100 Palermo Italy cardiologia Clinica Candela 90100 Palermo Italy Epatologia e Gastroenterologia Ospedale Niguarda Cà Granda Milano 20162 Milano Italy Medicina Interna 1 ARNAS Civico 90100 Palermo Italy

Portopulmonary hypertension(PPHTN)is a known complication of cirrhosis.Moderate-to-severe PPHTN implies an extremely poor prognosis.It occurs in 5%-10%of patients referred for liver transplantation(LT),and probably with an higher incidence in patients with large portosystemic shunts.Patients with moderate-tosevere pulmonary hypertension have been previously excluded from LT because of the extremely high surgical risk and since the post-transplant outcome reported was poor.Recently,new perspectives in the management of patients with portopulmonary hypertension are emerging.In fact,some pulmonary vasoactive drugs have become routine in the treatment of patients with idiopathic pulmonary hypertension.These drugs,particularly epoprostenol,have been recently introduced in the treatment of patients with PPHTN,and have been shown to be effective in reducing pulmonary artery pressure as well as pulmonary vascular resistances.Furthermore,recent studies seem to demonstrate that treatment with pulmonary vasoactive drugs could allow liver transplantation with acceptable surgical risks and excellent survival.Although there are not large series nor prospective studies addressing this topic,the clinical scenario of patients with PPHTN seems to be positively changing.

关键词： Portopulmonary hypertension Cirrhosis Liver transplantation Management Epoprostenol

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Serum uric acid as a prognostic marker in the setting of advanced vascular disease： a prospective study in the elderly

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Journal of Geriatric Cardiology 2015年第5期12卷 515-520页

作者： Giuseppe Di Stolfo Sandra Mastroianno Domenico Rosario Potenza Giovanni De Luca Carmela d'Arienzo Michele Antonio Pacilli Mario Fanelli Aldo Russo Raffaele Fanelli Cardiovascular department Ospedale Casa Sollievo della Sofferenza viale Cappuecini San Giovanni Rotondo Italy cardiologia Universitaria University of Foggia Ospedali Riuniti Di Foggia viale Luigi Pinto Foggia ltaly

BackgroundMany 流行病学的研究分析在 hyperuricemia 和心血管的结果之间的关系。这观察未来的研究调查有在一张老人口的不利心血管的事件和死亡的尿酸(SUA ) 层次由百和 76 个老病人由先进动脉粥样硬化影响了的先进 atherosclerosis.M... 详细信息

BackgroundMany 流行病学的研究分析在 hyperuricemia 和心血管的结果之间的关系。这观察未来的研究调查有在一张老人口的不利心血管的事件和死亡的尿酸(SUA ) 层次由百和 76 个老病人由先进动脉粥样硬化影响了的先进 atherosclerosis.MethodsTwo 影响了的浆液的协会(217 男性和 59 女性；71.2 ±；7.8 年) 被包括。所有病人为心血管的疾病，癌症，肥胖和传统的风险因素的历史被估计。病人们为约 31 ± 被跟随；11 个月。主要事件在后续，定义同样心肌的梗塞，服的局部缺血，心肌或外部的 revascularization 和 death.ResultsMean SUA 期间被记录水平是 5.47 ±；1.43 mg/dL；然后，我们进一步在二个组划分了人口，根据中部的价值(5.36 mg/dL ) 。在期间一中部列在后面在上面 31，月(5 ～ 49 个月) ， 66 个心血管的事件， 9 个致命的心血管的事件和 14 癌症相关的死亡发生了。有增加的 SUA 水平的病人介绍了全部的心血管的事件的更高重要的发生(HR：1.867， P = 0.014， 95% CI：1.134-3.074 ) 。一样的病人显示出癌症相关的死亡的重要增加的风险(HR：4.335， P = 0.025， 95% CI：1.204-15.606 ).ConclusionsIncreased SUA 层次独立地并且显著地与心血管的事件的风险被联系，癌症在外部 vasculopathy 影响的主要老的病人的一张人口联系了死亡。

关键词：尿酸血症老年人血管疾病事件记录预后晚期血清动脉粥样硬化

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Multiple hepatic infarctions secondary to diabetic ketoacidosis:A case report

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World Journal of Hepatology 2022年第11期14卷 1977-1984页

作者： Vitoria Mikaelly da Silva Gomes Gustavo de Sousa Arantes Ferreira Luise Cristina Torres Rubim de Barros Barbara Moreira Ribeiro Trindade dos Santos Lorenna Paulinelli Bahia Vieira department of General Surgery Hospital das Clinicas da Universidade Federal de Minas GeraisBelo Horizonte 30130100Minas GeraisBrazil Instituto de cardiologia do Distrito Federal Brasilia 70673900Distrito FederalBrazil department of General Surgery Hospital Metropolitano Doutor Celio de CastroBelo Horizonte 30620090Minas GeraisBrazil

BACKGROUND Hepatic infarctions(HI)are ischemic events of the liver in which a disruption in the blood flow to the hepatocytes leads to focal ischemia and necrosis.Most HI are due to occlusive events in the liver’s blood vessels,but non-occlusive HI may occur.They are associated with disruption of microvasculature,such as in diabetic ketoacidosis.While HI usually presents as peripheral lesions with clear borders,irregular nodular lesions may occur,indistinguishable from liver neoplasms and presenting a diagnostic challenge.CASE SUMMARY We report a case of multiple extensive HI in a patient with poorly controlled diabetes mellitus,who first presented to the emergency room with diabetic ketoacidosis.He then developed jaundice,thrombocytopenia,and a marked elevation of serum aminotransferases.An ultrasound of the liver showed the presence of multiple irregular lesions.Further investigation with a computerized tomography scan confirmed the presence of multiple hypoattenuating nodules with irregular borders and heterogeneous appearance.These lesions were considered highly suggestive of a primary neoplasm of the liver.While the patient was clinically stable,his bilirubin levels remained persistently elevated,and he underwent an ultrasound-guided percutaneous biopsy of the largest lesion.Biopsy results revealed extensive ischemic necrosis of hepatocytes,with no signs of associated malignancy.Three months after the symptoms,the patient showed great improvement in all clinical and laboratory parameters and extensive regression of the lesions on imaging exams.CONCLUSION This case highlights that diabetic ketoacidosis can cause non-occlusive HI,possibly presenting as nodular lesions indistinguishable from neoplasms.

关键词： Hepatic infarction Non-occlusive infarcts Diabetic ketoacidosis Pseudotumor of the liver Liver infarcts Case report

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Cardiac Complications in Maroteaux-Lamy Syndrome： Case Report

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Journal of Pharmacy and Pharmacology 2018年第4期6卷 410-414页

作者： Ricardo Siqueira Gongalves Claudia Aparecida Marques Landim Jesuita Mendes Cornelio Joaquim Tomaz da Silva Graduating in Medicine. Universidade do Estado de Mato Grosso--UNEMAT Liga Academica de cardiologia e Cirurgia department of Cardiology and Intensive Medicine--Universidade do Estado de Mato Grosso--UNEMAT Liga Academica de cardiologia e Cirurgia Cardiovascular (LACCIC) Caceres--MT 78200-000 Brazil department of Pediatric Nursing--Hospital Municipal de Unai-MG (HMU) Unai-MG 38610-000 Brazil department of General Surgery~Hospital Municipal de Unai-MG (HMU) Unai--MG 38610-000 Brazil

MLS (Maroteaux-Lamy syndrome) or MPS VI (mucopolysaccharidosis VI) is an autosomal recessive pathology in which there is absence or low activity of the enzyme N-Acetylgalactosamine-4-Sulfatase, which hydrolyzes GAGs (glycosaminoglycans) in the body (mainly dermatan sulfate). Consequently, there occurs lysosomal deposition of GAGs in connective tissue multisystemic. Myocardium and heart valves are frequently affected structures, presenting a direct correlation with the reports of complications and deaths. Case report: RGS, male, 3 years and 2 months, diagnosed with MPS VI from the first month of life, in weekly ERT (enzyme replacement therapy) since 4 months of age (inconstant). At physical examination: normotensive, with holosystolic heart murmur 3+/6+ in mitral focus. Complementary tests: normal electrocardiogram, echocardiogram with pronounced mitral regurgitation, concentric left ventricular hypertrophy of moderate degree and mild aortic insufficiency. Discussion: Mitral valve disease is common in patients with MLS. Conditions such as cardiomyopathy, fibroelastosis, aneurysm and pulmonary hypertension may occur in these patients, indicative of morbidity and mortality. Early and constant ERT may be useful in slowing a progression of heart disease. Conclusions: follow-up with a cardiologist is important to evaluate the progression of cardiac complications in MPS VI. Constant and early ERT provides better prognosis for these patients.

关键词：并发症心脏病症候群案例 MPS ERT 结缔组织 MLS

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Transcatheter mitral valve repair in nonagenarians

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Journal of Geriatric Cardiology 2022年第1期19卷 90-94页

作者： Pedro Luis Cepas-Guillén Isaac Pascual Eulogio Garcia Pilar Jimenez-Quevedo Alfonso Jurado-Roman Tomás Benito-González Rodrigo Estevez-Loureiro Pedro Li Dabit Arzamendi Bruno Melica Eduardo Infante de Oliveira Pedro Martín Lorenzo Felipe Fernández-Vázquez Guillermo Galeote Luis Nombela-Franco Leire Unzue Pablo Avanzas Manel Sabate Xavier Freixa Cardiology department Cardiovascular Institute(ICCV)Hospital ClinicIDIBAPSUniversity of BarcelonaBarcelonaSpain Interventional Cardiology Unit Hospital Universitario Central de AsturiasDepartment of MedicineUniversity of OviedoOviedoSpain Servicio de Hemodinámica y Cardiología Intervencionista HM CIEC-Centro Integral de Enfermedades CardiovascularesHospital Universitario HM MontepríncipeHM HospitalesMadridSpain Facultad de Medicina Universidad CEU San PabloMadridSpain Cardiology department Cardiovascular InstituteHospital Clínico San CarlosIdISSCMadridSpain Division of Interventional Cardiology University Hospital La PazIdiPAZCIBER-CVMadridSpain department of Cardiology University Hospital of LeónLeónSpain Interventional Cardiology Unit HospitalÁlvaro CunqueiroVigoSpain Interventional Cardiology Unit Hospital Sant Pau i Santa CreuBarcelonaSpain Serviço de cardiologia Centro Hospitalar de Vila Nova de Gaia/Espinho-EPEVila Nova de GaiaPortugal Serviço de cardiologia Hospital de Santa MariaCentro Hospitalar Lisboa NorteCentro Académico Médico de LisboaLisboaPortugal Servicio de Cardiología Hospital Universitario de Gran Canaria Dr.NegrínLas Palmas de Gran CanariaSpain

Given the increase in life expectancy indeveloped countries,nonagenarian population will become clinically and numerically relevant in our daily routine practice in the near future.Age has been observed to exert a profound influence on the prevalence of severe mitral regurgitation (MR) in the population.[1]Mitral valve surgery remains the gold standard of care for patients with symptomatic severe MR.

关键词： mitral routine surgery

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Compression of Left Main Coronary Artery in Patients with Pulmonary Artery Aneurysm and Pulmonary Hypertension

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World Journal of Cardiovascular Diseases 2019年第9期9卷 649-656页

作者： Diana Isabel Katekaru-Tokeshi , Zoila Ivonne Rodríguez-Urteaga Moises Jimenez-Santos Nilda Espinola-Zavaleta Cardiology department Hospital Nacional Dos de Mayo Lima Peru Cardiology department Instituto Nacional Cardiovascular (INCOR) Lima Peru Computed Tomography department Instituto Nacional de Cardiologia Ignacio Chavez Mexico City Mexico Nuclear Cardiology department Instituto Nacional de Cardiologia Ignacio Chavez Mexico City Mexico Echocardiography department Centro Medico ABC I.A.P. Mexico City Mexico

Background: Pulmonary artery aneurysm (PAA) is an unusual finding and its association with left main coronary (LMCA) compression is even more infrequent. Cardiac CT evaluates of presence and size of PAA and the degree of LMCA compression. The aim of this study is to describe two cases of adults with compression of LMCA with PAA associated with PDA and pulmonary hypertension. Case presentation: The first case is a 27-year-old man with PAA (78 mm diameter) and LMCA compression of 70% between the aortic sinus and the PAA. He presented angina as a manifestation of the LMCA compression. During follow-up the patient died. The second case is a 28-year-old man with PAA (110 mm diameter) that compresses LMCA in 55%, he rejected surgical treatment, but he is in close follow-up with medical treatment. Conclusion: Cardiac computed tomography played an important role both in the diagnosis and identification of high-risk PAA patients.

关键词： Left Main Coronary Artery Compression Pulmonary Artery Aneurysm Patent Ductus Arteriosus Pulmonary Hypertension

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Cardiovascular autonomic neuropathy in diabetes:Pathophysiology,clinical assessment and implications

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World Journal of Diabetes 2021年第6期12卷 855-867页

作者： Alice Duque Mauro Felippe Felix Mediano Andrea De Lorenzo Luiz Fernando Rodrigues Jr Education and Research department Instituto Nacional de CardiologiaRio de Janeiro 22240006RJBrazil Laboratory of Clinical Research on Chagas Disease Evandro Chagas National Institute of Infectious DiseasesOswaldo Cruz FoundationRio de Janeiro 21040360RJBrazil department of Physiological Sciences Biomedical InstituteFederal University of the State of Rio de JaneiroRio de Janeiro 22240006RJBrazil

Cardiovascular autonomic neuropathy(CAN)is a debilitating condition that mainly occurs in long-standing type 2 diabetes patients but can manifest earlier,even before diabetes is diagnosed.CAN is a microvascular complication that results from lesions of the sympathetic and parasympathetic nerve fibers,which innervate the heart and blood vessels and promote alterations in cardiovascular autonomic control.The entire mechanism is still not elucidated,but several aspects of the pathophysiology of CAN have already been described,such as the production of advanced glycation end products,reactive oxygen species,nuclear factor kappa B,and pro-inflammatory cytokines.This microvascular complication is an important risk factor for silent myocardial ischemia,chronic kidney disease,myocardial dysfunction,major cardiovascular events,cardiac arrhythmias,and sudden death.It has also been suggested that,compared to other traditional cardiovascular risk factors,CAN progression may have a greater impact on cardiovascular disease development.However,CAN might be subclinical for several years,and a late diagnosis increases the mortality risk.The duration of the transition period from the subclinical to clinical stage remains unknown,but the progression of CAN is associated with a poor prognosis.Several tests can be used for CAN diagnosis,such as heart rate variability(HRV),cardiovascular autonomic reflex tests,and myocardial scintigraphy.Currently,it has already been described that CAN could be detected even during the subclinical stage through a reduction in HRV,which is a non-invasive test with a lower operating cost.Therefore,considering that diabetes mellitus is a global epidemic and that diabetic neuropathy is the most common chronic complication of diabetes,the early identification and treatment of CAN could be a key point to mitigate the morbidity and mortality associated with this long-lasting condition.

关键词： Cardiovascular autonomic neuropathy Cardiac autonomic neuropathy Diabetes mellitus Heart rate variability Sympathetic autonomic nervous system Parasym-pathetic autonomic nervous system

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Avocado and Cardiovascular Health

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Open Journal of Endocrine and Metabolic Diseases 2015年第7期5卷 77-83页

作者： Camila Weschenfelder Júlia Lorenzon dos Santos Priscilla Azambuja Lopes de Souza Viviane Paiva de Campos Aline Marcadenti Postgraduate Studies Program in Cardiology Instituto de Cardiologia/Fundacao Universitária de Cardiologia do Rio Grande do Sul (IC/FUC) Porto Alegre Brazil department of Nutrition Federal University of Health Sciences of Porto Alegre (UFCSPA) Porto Alegre Brazil

Avocado is a fruit which had a caloric density of 1.7 kcal per gram and a half unit (~70 g) is composed by 114 kcal, 4.6 g of fibers, 345 mg of potassium, 19.5 mg of magnesium, 1.3 mg of vitamin E and 57 mg of phytosterols. Approximately 75% of fiber’s avocado contents are considered insoluble and 25% are soluble. The avocado contains lipids that consist of 71% from monounsaturated fatty acids (MUFA), 13% from polyunsaturated (PUFA) and 16% from saturated fatty acids (SFA). Recent researches have shown that avocado may improve hypercholesterolemia and may be useful in the treatment of hypertension and type 2 diabetes mellitus (T2DM). This way, avocado plays an important role in the cardiovascular health. This review summarizes the potential benefits of avocado consumption in the prevention of cardiovascular risk factors and metabolic diseases.

关键词： Persea Diabetes Mellitus Type 2 Dyslipidemias Nutritional Status Blood Pressure

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