Inflammatory bowel disease (IBD) predominantly affects the gastro-intestinal tract. There is however a large array of extra intestinal manifestations (EIM) associated with these diseases. A lesser known EIM is pulmonary involvement, which has been first described in 1973. Since the introduction of HRCT more attention is guided towards this specific involvement. Awareness of pulmonary involvement in IBD-patients may lead to better screening, guide appropriate therapy, and ultimately result in better patient care. When untreated, serious and persisting complications, such as stenosis or strictures of the large airways, as well as bronchiectasis or bronchiolitis obliterans might occur.
Background and Aims: Radioembolization (RE) for unresectable hepatocellular carcinoma (HCC) can provide clinical benefit for well-selected patients, whilst in others, rapid disease progression is observed. As an alternative for this patient population, new potent systemic treatment options are emerging. We aimed to identify the clinical factors associated with rapid progression following RE and assess the feasibility of starting a systemic treatment after progression.
Methods:A retrospective cohort study of patients with unresectable HCC undergoing RE at a single referral centre between January 2009 and December 2018.Progression-free and overall survival times were calculated. Uni-and multivariate cox regression analysis was used to assess factors associated with poor outcomes. Charts were reviewed for post-progression treatment strategies.Results: Overall, 116 patients with unresectable HCC were included. Median PFS after RE was 6.7 months (95% CI 3.97-9.37), which varied significantly (P < .001) with Eastern Cooperative Oncology Group Performance Status (EGOC PS) (ECOG 0, 20.9 months [95% CI 8.6-33.2]; ECOG 1, 7.7 months [95% CI 3.1-12.1]; ECOG 2,). This association remained significant after multivariate testing, together with the number of HCC lesions (P = .017) and α-FP (P = .050). Progressive disease after RE occurred in 82 patients, of whom only 40 received subsequent systemic treatment.Again, ECOG PS at the time of progression was significantly better for patients who did receive systemic treatment versus those who did not (P = .002).
Conclusion:Patients with unresectable HCC, impaired general condition and multinodular disease have inferior outcomes after radioembolization. After RE, close monitoring of patient performance status, liver function and cancer control is warranted to allow timely initiation of systemic treatment when indicated.
This case report describes a 52-year-old male patient with important weight loss, fatigue, diarrhea and a skin eruption since 1 year. Olmesartan-induced enteropathy and skin vasculitis were diagnosed. The onset of symptoms occurred almost two years after the initiation of the angiotensin receptor blocker therapy. There was a total resolution of the symptoms after the cessation of olmesartan. Although sprue-like enteropathy and cutaneous vasculitis are very rare, clinicians should be aware of those potential adverse events, even years after the initiation of an angiotensin II receptor blocker.
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