Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Jaundice icterus [keywords]
- Rapidly progressive disease in a castration-resistant prostate cancer patient after cabazitaxel discontinuation. [JOURNAL ARTICLE]
- Anticancer Drugs 2014 Oct 21.
We report the case of a 51-year-old patient with metastatic prostate cancer at diagnosis and primary refractoriness to both androgen ablation therapy and docetaxel. At the time of cabazitaxel initiation, the patient had only osseous metastases and was constrained to a wheelchair because of bone pain. Ten cycles of cabazitaxel were administered, and a remarkable response was achieved, with improvement in biochemical markers, performance status, and bone scan findings. Two months after suspension of treatment by choice, the patient developed jaundice because of massive hepatic metastases and died after a few days because of hepatic failure.
- P. vivax Malaria and Dengue Fever Co-infection: A Cross-Sectional Study in the Brazilian Amazon. [JOURNAL ARTICLE]
- PLoS Negl Trop Dis 2014 Oct; 8(10):e3239.
Malaria and dengue are the most prevalent vector-borne diseases worldwide and represent major public health problems. Both are endemic in tropical regions, propitiating co-infection. Only few co-infection cases have been reported around the world, with insufficient data so far to enhance the understanding of the effects of co-infection in the clinical presentation and severity.A cross-sectional study was conducted (2009 to 2011) in hospitalized patients with acute febrile syndrome in the Brazilian Amazon. All patients were submitted to thick blood smear and PCR for Plasmodium sp. detection, ELISA, PCR and NS1 tests for dengue, viral hepatitis, HIV and leptospirosis. In total, 1,578 patients were recruited. Among them, 176 (11.1%) presented P. vivax malaria mono-infection, 584 (37%) dengue fever mono-infection, and 44 (2.8%) were co-infected. Co-infected patients had a higher chance of presenting severe disease (vs. dengue mono-infected), deep bleeding (vs. P. vivax mono-infected), hepatomegaly, and jaundice (vs. dengue mono-infected).In endemic areas for dengue and malaria, jaundice (in dengue patients) and spontaneous bleeding (in malaria patients) should raise the suspicion of co-infection. Besides, whenever co-infection is confirmed, we recommend careful monitoring for bleeding and hepatic complications, which may result in a higher chance of severity, despite of the fact that no increased fatality rate was seen in this group.
- Isoniazid-associated hepatitis in HIV-infected adults receiving thirty-six months isoniazid prophylaxis in Botswana. [JOURNAL ARTICLE]
- Chest 2014 Oct 23.
The World Health Organization recommends 36 months of isoniazid preventive therapy (36IPT) for HIV-infected adults living in tuberculosis endemic countries. We determined the rates and risk factors for isoniazid-associated hepatitis with the use of 36IPT.1006 HIV-infected adults received 36IPT during a pragmatic randomized trial set in Botswana public health clinics providing HIV care. Enrollment exclusion criteria included jaundice or elevations of serum transaminases (EST) >2.5-fold the upper limit of normal (ULN). Participants with any CD4+ lymphocyte count were eligible and received antiretroviral therapy (ART) when CD4+ <200 cells/mm3. 36IPT was stopped for severe hepatitis (>5-fold ULN EST) but not for moderate hepatitis (2.5 to 5-fold ULN EST).Pharmacy refill records showed 2237 person-years of isoniazid receipt; 48% of participants initiated ART by 36 months. 1.9% (19/1006) of participants were diagnosed with severe hepatitis; three were jaundiced and two of these developed hepatic encephalopathy. Another 3.1% (31/1006) of participants experienced moderate hepatitis. 38% (19/50) of participants with moderate-to-severe hepatitis concomitantly received ART. Forty percent (20/50) of moderate-to-severe cases occurred within the first two months of IPT and - during this period - were not associated with receipt of ART at baseline, hazard ratio 1.49 (95% confidence interval 0.20-11.1, P=0.70).HIV-infected adults receiving 36IPT did not have an increased incidence of moderate-to-severe hepatitis or hepatic encephalopathy compared with published reports among HIV-infected or -uninfected persons in trials or public health programs. Compared with participants not receiving ART, the risk of moderate-to-severe hepatitis was not increased by ART.
- Synchronous gallbladder and pancreatic cancer associated with pancreaticobiliary maljunction. [Journal Article]
- World J Gastroenterol 2014 Oct 21; 20(39):14500-4.
We report the case of a 46-year-old woman who presented with chronic intermittent abdominal pain without jaundice; abdominal ultrasonography showed thickening of the gallbladder wall and dilatation of the bile duct. Endoscopic retrograde cholangiopancreaticography showed pancreatobiliary maljunction with proximal common bile duct dilatation. Pancreatobiliary maljunction was diagnosed. A computed tomography scan of the abdomen showed suspected gallbladder cancer and distal common bile duct obstruction. A pancreatic head mass was incidentally found intraoperative. Radical cholecystectomy with pancreatoduodenectomy was performed. The pathological report showed gallbladder cancer that was synchronous with pancreatic head cancer. In the pancreatobiliary maljunction with pancreatobiliary reflux condition, double primary cancer of the pancreatobiliary system should be awared.
- Liver resection and metabolic disorders: An undescribed mechanism leading to postoperative mortality. [Journal Article]
- World J Gastroenterol 2014 Oct 21; 20(39):14455-62.
To investigate the mechanism leading to perioperative mortality in patients undergoing major liver resection and presenting with metabolic disorders.The link between Metabolic Syndrome and non-alcoholic fatty liver disease is currently demonstrated. Various metabolic disorders and the Metabolic Syndrome (the association of ≥ 3 metabolic disorders) have been recently described as a risk factor of perioperative mortality in major liver resection. Patients who passed away during perioperative course of major liver resection and presenting with the association of ≥ 2 metabolic disorders without any other known cause of liver disorders were reviewed.From January 2001 to May 2010 in a tertiary centre, ten patients presenting with ≥ 2 metabolic disorders without any other known cause of liver disorders died during perioperative course of major liver resection. The same four-consecutive-steps sequence of events occurred, including jaundice. The analysis of this series suggested a rapidly deteriorating congestive liver resulting in an increased portal hypertension leading to hepatorenal syndrome and lately to multiorgan failure (mimicking septic collapse) as the mechanism leading to exitus. The acute portal hypertension is mainly related to the surgical procedure. The chronic portal hypertension is indeterminate. Patients with ≥ 2 metabolic disorders should be considered as potentially presenting with portal hypertension possibly evolving towards hepatorenal syndrome; thus, they should be considered as having a high perioperative risk and should be carefully evaluated before undergoing major liver resection.As fibrosis was not present or marginal in liver specimens, the real cause of portal hypertension in patients with multiple metabolic disorders should be investigated with further studies.
- Improving outcomes in pancreatic cancer: Key points in perioperative management. [REVIEW]
- World J Gastroenterol 2014 Oct 21; 20(39):14237-14245.
This review focused in the perioperative management of patients with pancreatic cancer in order to improve the outcome of the disease. We consider that the most controversial points in pancreatic cancer management are jaundice management, vascular resection and neo-adjuvant therapy. Preoperative biliary drainage is recommended only in patients with severe jaundice, as it can lead to infectious cholangitis, pancreatitis and delay in resection, which can lead to tumor progression. The development of a phase III clinical trial is mandatory to clarify the role of neo-adjuvant radiochemotherapy in pancreatic adenocarcinoma. Venous resection does not adversely affect postoperative mortality and morbidity, therefore, the need for venous resection should not be a contraindication to surgical resection in selected patients. The data on arterial resection alone, or combined with vascular resection at the time of pancreatectomy are more heterogeneous, thus, patient age and comorbidity should be evaluated before a decision on operability is made. In patients undergoing R0 resection, arterial resection can also be performed.
- A disseminated variant of pancreatic serous cystadenoma causing obstructive jaundice, a very rare entity: a case report and review of the literature. [JOURNAL ARTICLE]
- BMC Res Notes 2014 Oct 22; 7(1):749.
Microcystic adenoma or serous cystadenoma (SCA) is an uncommon tumor type, accounting for only 1-2% of pancreatic exocrine neoplasms. Usually unifocal, SCAs present as single, large, well-demarcated, multiloculated, cystic tumors, 1-25 cm in size.A 73-year-old man initially presented with epigastric abdominal pain and was diagnosed with SCA involving the whole pancreas. Eleven months later, he presented with obstructive jaundice, and total pancreatectomy was performed. The removed tissue allowed histological verification of pancreatic SCA. Histopathological examination showed both microcysts and macrocysts, lined by cuboidal epithelium, with optically clear cytoplasm and the absence of detectable mitosis or necrosis.Thus, although relatively rare, pancreatic SCA is one of the differential diagnoses of epigastric abdominal pain; we recommend early surgical intervention for symptomatic pancreatic SCA.
- Complications due to breastfeeding associated hypernatremic dehydration. [Journal Article]
- J Clin Neonatol 2014 Jul; 3(3):153-7.
The aim was to assess the incidence, presenting features, and complications of breastfeeding associated hypernatremic dehydration among hospitalized neonates.A retrospective study over a period of 18 months to identify term and near term (≥35 weeks of gestation) breastfed neonates, who were admitted with serum sodium concentration of ≥150 mEq/l and no apparent explanation for their hypernatremia other than inadequate breastmilk intake.The incidence of breastfeeding associated hypernatremic dehydration among 2100 term and near term neonates was 1.38%. The median serum sodium at presentation was 164 mEq/l (range: 151-191 mEq/l). The mean weight loss in these patients was 10.16% ±6.6%. The reasons for seeking medical attention were refusal of feeds (72.41%), lethargy (68.96%), decreased urine output (44.82%), jaundice (27.58%) and fever (24.13%). Five patients (17.24%) had seizures and three (10.34%) had coagulopathy. Other complications included hypoglycemia, hypocalcemia, acute kidney injury (AKI) (37.93%) and intraventricular hemorrhage. The mean serum creatinine was 1.82 ± 2.5 mg/dl (range: 0.19-9.6). A statistically significant association was seen between serum sodium concentration at presentation and AKI. It was also found that those patients who had AKI had a higher weight loss and had presented later to the hospital than those without AKI. One patient died within 12 h of admission. This child had disseminated intravascular coagulopathy, AKI, and hypoglycemia.Breastfeeding associated hypernatremic dehydration is a serious condition with many serious complications and even results in death if detected late. Health care providers have increasing responsibilities of promoting proper breastfeeding techniques and taking measures for early diagnosis and treatment of this problem.
- Obstructive jaundice caused by intraductal metastasis of lung adenocarcinoma. [Journal Article]
- Onco Targets Ther 2014.:1847-50.
Obstructive jaundice caused by metastases to the porta hepatis is often observed in patients with various advanced cancers; however, metastasis of lung cancer to the common bile duct with subsequent development of jaundice is rare. A 75-year-old female with lung adenocarcinoma harboring epidermal growth factor receptor (EGFR) mutation (15-bp in-frame deletion in exon 19 and T790M in exon 20) developed obstructive jaundice during therapy. Obstruction of the common bile duct caused by an intraductal tumor was identified by computed tomography, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography. Although primary cholangiocarcinoma was highly suspected according to the imaging findings, immunohistochemical evaluation of the intraductal tumor demonstrated thyroid transcription factor-1 positive adenocarcinoma. Furthermore, peptide nucleic acid-locked nucleic acid polymerase chain reaction clamp analysis showed that the tumor contained the same EGFR mutation as that in the primary lung cancer. Thus, we confirmed intraductal metastasis from a lung adenocarcinoma. To our knowledge, this is the second report of obstructive jaundice caused by intraductal metastasis of lung cancer.
- Choledochal cyst mimicking Mirizzi's syndrome A case report. [Journal Article]
- Ann Ital Chir 2014.
Choledochal cysts are cystic dilatations of the intra or extra-hepatic biliary tract with an incidence of 1 case per 150.000 live births. Cysts usually are diagnosed in childhood, but diagnosis can be delayed until adulthood in the 20-50% of cases. Clinical manifestations comprise abdominal pain with biliary or pancreatic features. Mirizzi's syndrome is a late and rare complication, that occurs in 1% of patients with cholelithiasis due to extrinsic compression of the common bile duct by stones impacted either in the gallbladder or in the cystic duct. Clinical symptoms include extrahepatic obstructive jaundice, ascending cholangitis, or, in the later course, cholecystocholedocal fistula. For both pathologies the Endoscopic Retrograde Cholangio Pancreatography and the Magnetic Resonance Cholangio Pancreatography should lead to the diagnosis with a sensibility and a specificity up to 100%. We report the case of a 66 year old patient admitted to the Emergency Department of our hospital for jaundice and abdominal pain, whom both the endoscopic and radiologic examination showed a Mirizzi's syndrome but surgery revealed a type I choledocal cyst.Choledochal cyst, Mirizzi's syndrome, ERCP, MRI.