Objective: hepatocellular carcinoma (HCC) is a dreadful complication of liver cirrhosis. Aim was to study the effect of sarcopenia on the survival in patients with HCC. Methods: we included 262 patients and were followed up for 12 months. Sarcopenia was calculated by skeletal muscle index (SMI). Sarcopenia was defined by SMI ≤39 cm 2 /m 2 for women and ≤50 cm 2 /m 2 for men. Results: patients with sarcopenia (n= 113, 43.1%) were older, mainly males, Child-Pugh class B and smokers. Patients with sarcopenia had lower survival than those without (10.09 vs. 11.72 months). Survival was also lower in Barcelona clinic liver cancer stage C than B and A (9.02 vs. 11.21 vs. 11.89 months). Age and sarcopenia were hazardous of mortality (p<0.05). There was statistically significant difference of serial SMI in patients without baseline sarcopenia unlike patients with baseline sarcopenia. On follow up patients with sarcopenia had higher incidence of ascites (45% vs. 20.4%), spontaneous bacterial peritonitis (21.7% vs. 11.6%), hepatic encephalopathy (28% vs. 11.5%) and bleeding (22.9% vs. 12.7%). Totally patients with sarcopenia had higher incidence of progressive HCC (39% vs. 25.5%). Conclusion: Sarcopenia is associated with lack of response to therapy, liver decompensation and higher mortality in hepatocellular carcinoma patients.
Introduction Primary focal segmental glomerulosclerosis (FSGS), a major cause of end-stage kidney disease (ESKD) in adolescents and young adults, is attributable to recognized genetic mutations in a minority of cases. For the majority with idiopathic primary FSGS, the cause of the disease is unknown. We hypothesize that extracellular vesicle (EVs), that carry information between podocytes and mesangial cells, may play a key role in disease progression. Material & methods A total of 30 participants (20 primary nephrotic syndrome/ 10 healthy controls) were enrolled in this study. Primary nephrotic syndrome subjects were grouped based on pathologic diagnosis. The FSGS group was compared to healthy control subjects based on demographic and clinical findings. EVs were isolated from the urine of each group before being characterized by Western blotting, transmission electron microscopy, and nanoparticle tracking analysis. The effects of the EVs from each group on normal human mesangial cells and activation of certain pathways were then investigated. Results Based on demographic and clinical findings, mean serum creatinine was significantly higher in the FSGS group than the normal healthy control group. The mean size of the EVs in the FSGS group was significantly higher than the healthy control group. The mesangial cells that were challenged with EVs isolated from FSGS patients showed significant upregulation of STAT-3, PCNA, Ki67, and cell proliferation. Discussion Our data demonstrate that EVs from FSGS patients stimulate mesangial cell proliferation in association with upregulation of the phospho-STAT-3 pathway. Additional studies are planned to identify the molecular cargo within the EVs from FSGS patients that contribute to the pathogenesis of FSGS.
Child-Pugh (CTP) class A. the baseline focal lesion size was 5-10cm in 45% of patients and mostly bilobar. Stable disease was detected in 27 patients, however, 18 and 21 patients had progression in the embolized lesions, and progression with new lesion formation, respectively. The 1-and 2-year survival was 80% and 56.6%, respectively.The Barcelona clinic liver cancer (BCLC) model is based on various parameters as the Child-Pugh score, performance status, focal lesion size, number, metastasis, vascular invasion, and portal hypertension. BCLC
Background. Drug-induced lupus (DIL) is an autoimmune phenomenon where the patient develops lupus-like symptoms after exposure to a long-term medication. Case Summary. Here we describe a 10-year-old female with absence seizures who developed a lupus-like syndrome after being on ethosuximide for three months. She presented with nephrotic syndrome (NS) and acute kidney injury. Four weeks prior to presentation, she had been prescribed a seven-day course of oral amoxicillin for submental swelling after dental extraction. Investigations showed high titer of antinuclear antibody (ANA) and anti-double stranded DNA, elevated serum IgE level, and positive Coombs’ test, along with positive anti-histone antibodies. Renal biopsy showed features of acute tubulointerstitial nephritis (TIN) and partial podocyte foot process effacement without evidence of lupus nephritis. The patient had an excellent response to the steroid therapy with remission within two weeks. The patient remained in remission for two months as evaluated during the most recent follow-up; the autoimmune antibodies and immunoglobulin E trended down. Ethosuximide has been reported to cause DIL, however its possible association with TIN has not been reported. Although amoxicillin could have caused the TIN and NS in this patient, a possible novel association of ethosuximide with this nephrotic-nephritic presentation (NNP) cannot be ruled out. Conclusions. A renal histology is important to determine the accurate etiology of NNP in patients with DIL. Further studies are necessary to determine any possible causal effect of ethosuximide with NNP.
Background Developmental venous anomaly (DVA) is probably the most common anomaly of the intracranial vasculature. DVAs consist of multiple, radially oriented dilated medullary veins that converge into a transcerebral vein. Susceptibility-weighted imaging (SWI) is a high spatial resolution 3D gradient-echo MRI sequence with phase post-processing that accentuates the paramagnetic properties of blood products such as deoxyhemoglobin, intracellular methemoglobin, and hemosiderin. Its high sensitivity to hemorrhagic particles by means of susceptibility dephasing effects within the veins allow for the accurate detection, grading, and monitoring of brain venous anomalies. In this review, we evaluated the prevalence of the brain DVAs identified by SWI in many patients who had undergone magnetic resonance imaging (MRI) with contrast administration. All images were independently reviewed by two radiologists who were blinded to other MR imaging finding. It is hoped that as SWI becomes more widely available, it will provide additional diagnostic and prognostic information that will improve the care and outcome of patients with DVAs. Results A total of 29 DVAs were observed with its prevalence 2.8%. The DVA caputs had mostly deep localization in about 44.8% of our DVA cases. SWI proved excellent demonstration of DVAs with the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were significantly higher than the other non-contrast MR sequences. On SWI, DVA is delineated as a signal void lesion with the normal cerebral veins. Conclusion Susceptibility-weighted imaging (SWI) is valuable in the diagnosis of DVA and should be included in routine MR assessment of the brain.
Background Diffusion-weighted MR imaging can provide physiological information complementing morphological findings from conventional MRI. It detects early tissue changes associated with changes in water content, such as changes in the permeability of cell membranes, cell swelling or cell lysis. Areas of diseased tissue are highlighted with increased signal intensity on diffusion-weighted MR imaging. A decrease in the ADC is expected with increased intracellular tissue caused by either cell swelling or increased cellular density. DWI can be performed without the need for the administration of exogenous contrast medium, so it may of use when contrast administration is contraindicated. It yields quantitative and qualitative information that reflects changes at the cellular level and indicates the integrity of cell membranes. The purpose of this study was mainly to assess the diagnostic value of DWI for the discrimination of orbital lymphoma from idiopathic orbital inflammatory pseudotumor. Results Of our 53 cases presented with proptosis or visual disturbances, 32 cases (60.4%) had found to be present with idiopathic orbital inflammatory pseudotumor and 21 cases (39.6%) had orbital lymphoma. On conventional MR imaging, ill-defined tumor margin and orbital preseptal space involvement had a significant association with orbital lymphoma, whereas intense post-contrast enhancement of lesion and radiologic evidence of sinusitis were associated with orbital inflammatory pseudotumor. The mean ADC value of orbital lymphoma was significantly lower than those of benign inflammatory pseudotumor, yielding 100% sensitivity, 99% specificity, and 90.5% accuracy for differentiating both entities. Conclusions Diffusion-weighted MR imaging (DWI) is valuable in discriminating orbital inflammatory pseudotumor from malignant orbital lymphoma that help patients to initial management.
Hydroureteronephrosis (HUN) of the renal transplant (RT) can be obstructive or non-obstructive, refluxing or non-refluxing, and can cause allograft dysfunction. HUN of the RT as a manifestation of rejection is uncommon and has not been described in children. We describe two pediatric RT recipients who presented with late-onset HUN, 5 and 10 years after transplantation. Both had new-onset HUN which occurred at the time of rejection; HUN resolved in both patients after treatment of rejection. Renal function stabilized in both patients without the need for stent or nephrostomy tube placement. There was no obstruction or vesicoureteral reflux (VUR). Edema of the uroepithelial cells leading to transient obstruction causing HUN is a most likely explanation. We conclude that treatment of rejection in patients without obstruction or VUR may lead to resolution of HUN without the need for urological interventions.
Background Iatrogenic bile duct injuries are unusual but possibly associated with fatal complications with increased incidence since the introduction of laparoscopic cholecystectomy. Appropriate estimation of these injuries is essential for proper management. Imaging is vital for the initial diagnosis, extent assessment and consequently, treatment guidance of bile duct injury with an ideal outcome. In this study, MRCP was carried out in 37 cases (28 females and 9 males, age range from 19 to 58 years) with suspected BDI following laparoscopic cholecystectomy. MRCP images were assessed for bile duct transection injury, strictures, biliary leakage, and intrahepatic biliary radicles (IHBR) dilatation. In positive cases, Strasberg classification system was used with the definitive diagnosis was done regarding the surgical findings and/or findings on endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC). Results Our study includes 37 cases with biliary injuries. On MRCP our cases were stratified regarding the Strasberg-Bismuth classification into five types (A to E). Most BDIs were type E2 (29.7%), followed by type E1 (18.9%), type A (16.2%), type E3 (10.8%), type E4 (8.2%), type C (5.4%), and type D and finally type E5 and B injuries with each one representing 2.7%. Twenty cases presented with biliary leakage and seventeen with bile duct obstruction, whether duct ligation or stricture. Conclusion MRCP is an essential imaging modality for assessment of iatrogenic BDIs enabling the radiologists to classify these injuries and helps to govern the management.
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