1/8. Coexistent cutaneous Aspergillus and cytomegalovirus infection in a liver transplant recipient.Cutaneous infections are a significant cause of morbidity in solid organ recipients. These infections may be complex with multiple pathogens occurring in the same lesion. We describe the unusual association of cutaneous Aspergillus and cytomegalovirus (CMV) infections in a liver transplant recipient. Cutaneous CMV infection is rare and often indicates severe systemic involvement, whereas Aspergillus is a frequent cause of opportunistic cutaneous fungal infection. Seven weeks after liver transplantation, our patient had hemorrhagic, eroded plaques develop on his arms. The results of routine histology, immunoperoxidase staining for CMV antibody, and fungal culture revealed coexistent cutaneous aspergillus flavus and CMV infections. The patient was treated with ganciclovir, amphotericin b, and topical terbinafine cream; however, 2 weeks after the development of the cutaneous lesions, the patient died.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/8. mycobacterium avium complex peritonitis in the setting of cirrhosis: case report and review of the literature.mycobacterium avium complex is a rare cause of peritonitis. We report here the fourth case in the literature of MAC peritonitis associated with cirrhosis in the absence of AIDS, and discuss the possibility of different etiologies in persons with and without AIDS.- - - - - - - - - - ranking = 5keywords = complex (Clic here for more details about this article) |
3/8. Abrikosoff's tumor of the esophagus: case report and review of literature.Abrikosoff's tumor or granular cell tumor is a neoplasm of neural origin, usually located in the head and neck region. A majority of these neoplasms are benign. Only 4-6% of granular cell tumors are located in the gastrointestinal tract. It is extremely unusual for these tumors to be located in the esophagus. This case is being reported in view of the rarity of this lesion. A brief review of literature with stress on diagnostic evaluation and management issues is also included.- - - - - - - - - - ranking = 10.646822737603keywords = neoplasm (Clic here for more details about this article) |
4/8. Noninvasive imaging of unusual regenerating nodules in the cirrhotic liver.Despite the common occurrence of regenerating liver nodules, little has been written regarding their ultrasound or computed tomographic appearance. In the great majority of cases, they have an echo texture and CT number identical to surrounding hepatic parenchyma. Exceptionally, as in the 2 cases described, they can mimic a malignant neoplasm. Because radionuclide imaging almost always demonstrates uptake over a regenerating nodule, this modality should be used in suspicious cases in conjunction with either ultrasound or computed tomography in order to exclude a malignancy.- - - - - - - - - - ranking = 5.3234113688014keywords = neoplasm (Clic here for more details about this article) |
5/8. Caudate lobe resection to reduce inferior vena caval hypertension prior to portacaval shunt.Coexistent caval and portal hypertension was recognized on preoperative angiographic study of a patient with cirrhosis and variceal bleeding. This hemodynamic situation can preclude adequate reduction of portal hypertension by portasystemic shunt and can result in fatal postoperative bleeding. Resection of a very large caudate lobe effectively reduced caval pressure and allowed a direct solution to the problem by portacaval anastomosis, rather than by more complex shunts or by nonshunting procedures previously suggested as alternatives.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
6/8. Improvement of hepatorenal syndrome by transjugular intrahepatic portosystemic shunt.hepatorenal syndrome (HRS) is a functional renal failure occurring in advanced liver cirrhosis with ascites. It is due to renal cortical vasoconstriction resulting from complex hemodynamic disturbances related to cirrhosis and portal hypertension. There is no consistently effective therapy except for liver transplantation. We report a case of severe HRS in a patient with advanced liver cirrhosis and portal hypertension. Three sessions of hemodialysis were performed because of severe renal failure (serum urea 83 mg/dl, serum creatinine 6 mg/dl). Creation of an intrahepatic portosystemic shunt reduced the portocaval gradient from 18 to 7 mm Hg. Spectacular improvement of the renal function was observed soon after the procedure, with spontaneous recovery of diuresis and a return of serum urea and creatinine to baseline values. The patient unfortunately died 2 months later from adult respiratory distress syndrome post emergency surgery for a massive bleed related to a duodenal ulcer. Throughout this episode, the renal function remained stable. The postmortem examination showed histologically normal kidneys. We conclude that the intrahepatic portosystemic shunt can improve renal function in cirrhotic patients with HRS; it could be used in patients awaiting liver transplantation to reverse preoperative renal failure.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
7/8. Ischemic hepatitis secondary to the spontaneous rupture of a hepatocellular carcinoma in a patient with cirrhosis.A patient with alcoholic cirrhosis who developed fatal ischemic hepatitis induced by hemorrhagic shock, due to the spontaneous rupture of a hepatocellular carcinoma, is reported. This was the first manifestation of the hepatic neoplasm. To our knowledge, this is the first case report of ischemic hepatitis of this origin.- - - - - - - - - - ranking = 5.3234113688014keywords = neoplasm (Clic here for more details about this article) |
8/8. Computed tomographic angiography with three-dimensional reconstruction in patients with complex diverticular disease and portal hypertension: report of a case.We report a case of a patient with portal hypertension secondary to alcoholic cirrhosis (child's Class C) who initially presented with a colovaginal fistula secondary to acute sigmoid diverticulitis. The patient had a prior history of hepatic cirrhosis with ascites, coagulopathy, and portal hypertension. Computed tomography of the abdomen and pelvis demonstrated a large diverticular phlegmon and ascites. Computed tomographic angiography demonstrated a large left anterior abdominal wall varix in the region of the anticipated sigmoid resection. Three-dimensional reconstruction of the computed tomographic angiography further delineated the path of this large varix, confirming the increased risk from surgical intervention. Following initial conservative treatment with intravenous antibiotics, parenteral nutrition, and percutaneous abscess drainage, a transjugular intrahepatic portosystemic shunt procedure was performed to decompress the portal system varices. A repeat computed tomographic scan with three-dimensional reconstruction confirmed decompression of the varix. A successful sigmoid resection was subsequently performed. Preoperative computed tomographic angiography with three-dimensional reconstruction is a useful adjunct in planning the operative strategy in patients with complex intraabdominal pathology and collateral portovenous flow secondary to portal hypertension.- - - - - - - - - - ranking = 5keywords = complex (Clic here for more details about this article) |