COVID-19 was first recognized by the World Health Organization (WHO) in December 2019 and declared a global pandemic in March 2020. Although COVID-19 primarily results in pulmonary symptoms, it is becoming apparent that it can lead to multisystemic manifestations. Liver damage with elevated AST and ALT is seen in patients with COVID-19. Although the etiology of liver damage is still debated, biliary damage is rarely seen. This case demonstrates a potential complication of COVID-19 in a previously healthy patient. The patient contracted COVID-19 in March 2020 and endured a complicated course including intubation, multiple readmissions, and chronic abdominal pain. He is now awaiting a liver transplant. Our case portrays biliary damage as an additional possible complication of COVID-19 and the importance of imaging in its diagnosis.
The results presented here offer evidence that a simple two-item questionnaire is an efficient and effective method of detecting populations at-risk for oral diseases.
Pre-TIPS and post-TIPS volumes were measured (MIM software), and clinical data was retrospectively collected. Expected normal liver volume for patient size (ELV) was calculated using a validated formula (Vauthey et al., 2002). Results: Prior to TIPS, the cirrhotic liver volume exceeded the ELV in 15 patients (37.5%; 9M, 6F, P¼0.80). No statistically significant difference was seen in pre-TIPS MELD (mean 13.0 vs 14.2, P¼0.45) or TIPS indications between patients with measured liver volumes that were greater than ELV (ascites n¼4, bleed n¼8) or less than ELV (ascites n¼11, bleed n¼12) (P¼0.24). There was no correlation between liver volume and procedure time (r¼0.076, P¼0.65). After TIPS, surprisingly, the liver volume increased in 14 patients (35%, 10M, 4F, P¼0.60). TIPS indication was not a predictor of post-TIPS liver growth (ascites n¼4, bleed n¼7) or shrinkage (ascites n¼12, bleed n¼13) (P¼0.35). Change in portosystemic gradient was not a predictor of post-TIPS liver growth or shrinkage (median -10 vs -10 mm Hg, P¼0.83). There was no significant correlation between pre-TIPS MELD and post-TIPS liver growth or shrinkage (median 12 vs 13.5, P¼0.36). Performance of variceal embolization did not correlate with post-TIPS liver growth (P¼0.61). Conclusions: Liver volumes are used clinically to predict adequate function after surgery. We find in the cirrhotic pre-TIPS population that liver volume does not correlate with MELD and can exceed ELV for patient size. Surprisingly, liver size increased in 35% of patients post-TIPS and was not predicted by indication for TIPS, pre-TIPS MELD, change in PSG or performance of variceal embolization.
Pheochromocytoma is a rare catecholamine-secreting tumour that is typically located in the adrenal medulla or along the sympathetic ganglia. The typical symptoms are episodic in nature and include tachycardia, sweating and headache. These tumours can present as transient, reversible cardiomyopathy similar to takotsubo cardiomyopathy (TCM). TCM is characterised by transient hypokinesis of the left ventricular apex and is typically induced by emotional stress. We describe the case of a 26-year-old woman with a medical history significant for headaches who presented initially to her family physician with nausea, vomiting, headache and hypertension. She was started on lisinopril 10 mg daily. One week later, she presented to the emergency department with substernal severe chest pressure. Her troponin level was elevated. Coronary angiogram showed normal coronary arteries and left ventriculogram showed inverse TCM pattern. Serum catecholamines were very elevated confirming pheochromocytoma. She was successfully treated with alpha-blockers followed by surgical resection.
Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults. Cryoablation therapy, which uses rapid freeze and thaw cycles to destroy diseased tissue, is the standard nephron-sparing option for RCC treatment. This case report suggests cryoablation as an effective therapy for hematuria in RCC. A 52-year-old male patient with Stage IV RCC presented to the ED with hematuria and flank pain. He was catheterized, and several blood clots were removed from the bladder. Embolization was considered, however renal angiography failed to demonstrate a tumoral blush and no target for embolization was identified. In lieu of continued large volume hematuria, cryoablation of the tumor was offered as a potential therapy. We describe a case of successful treatment of clinically significant hematuria in a patient with RCC with cryoablation.
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