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Volume 79 - 2016 - Fasc.4 - Letters

Succesful treatment of chronic hepatitis C virus infection with daclatasvir and asunaprevir in a transfusion dependent thalassaemia patient

Thalassaemia is one of the most common inherited hemoglobinopathies that is characterized with defective hemoglobin synthesis and ineffective erythropoiesis. Chronic transfusion therapy which increases the risk of hepatitis C virus (HCV) infection is the main treatment for severe forms of disease. Upon routine implementation of HCV screening in blood banks, chronic Hepatitis C incidance in thalassaemia patients has decreased. Nevertheless, HCV prevalence in transfusion dependent thalassemia patients, most of whom have acquired HCV prior to screening, is 23-47%. Cirrhosis occurs in about 10-20% of chronically infected patients. Iron overload associated with chronic transfusion also contributes to the development of cirrhosis in these patients. Therefore successful treatment of hepatitis C in thalassemia patients is imperative.


Primary gastric diffuse large B-cell lymphoma presenting as dysphagia

Dysphagia can be caused by various conditions such as diverticula, motor function abnormality, vascular compression, esophagitis, and neoplasm. Primary gastric diffuse large B-cell lymphoma (DLBCL) rarely initially presents as dysphagia. Most common presentation of DLBCL is abdominal pain, anorexia, and weight loss. Less commonly, ulceration and bleeding may be seen. We present a rare case of patient with DLCBL who presented with Dysphagia.


Acute hepatitis A infection in an adult and isolated thrombocytopenia as extra- hepatic manifestation: a case report description.

Usually, hepatitis A virus resolves itself in a few weeks, but uncommon types such as prolonged/biphasic acute and fulminant hepatitis A are also reported (1). In 5-8% of cases, extrahepatic manifestations are reported (2). In particular cutaneous, renal, neurological and haematologic manifestations could be diagnosed (2). In March 2015, a 31-year-old Italian woman was admitted to our Internal Medicine Department because one week before she experienced fever associated to malaise, dyspepsia and jaundice. Her personal history was negative for alcohol, drugs intake or tobacco consumption. Her past medical history was negative.


A rare cause of hematemesis: Esophageal haematoma as a complication of subclavian puncture

A 52-year-old female patient with chronic renal failure was admitted to the emergency unit with hematemesis and hypotension. She's been on haemodialysis for three years and a catheter insertion via the subclavian vein had been attempted without success some hours before ad- mission. The patient had subcutaneous haematoma on the right side of the neck and chest wall (Figure 1), hy- potension and tachycardia. Haemoglobin level was 7.5 g/dl, platelets and coagulation parameters were within normal range. oesophagogastroduodenoscopy revealed that nearly the whole oesophageal lumen was filled with intramural haematoma and there was blood in stomach (Figure 1). Haematoma was on the right wall and ex- tending to the esophagogastric junction and cardia (Fi- gure 1). There wasn't any active bleeding so the patient didn't need any intervention. CT scan showed that the haematoma was restricted within submucosa of oesopha- gus and that there wasn't any sign of vascular association or active bleeding. Subsequent endoscopic evaluations showed that haematoma improved without any compli- cations. The patient was then followed up as outpatient and at the end of three weeks, endoscopy revealed com- plete resolution of haematoma with normal esophageal mucosa (Figure 1).


An unusual cause of dyspepsia due to a retained epicardial pacing wire

Temporary epicardial pacing wire (TEPW) are fre- quently inserted in cardiac surgery. Although overall morbidity related to TEPW is low, complications related to the insertion, utilization, retrieval, and migration of these wires have been reported in the literature (1). In this report, we describe a case of gastric migration of a TEPW, which caused dyspeptic symptoms. A 74-year-old man was admitted to our gastroen- terology clinic for evaluation of worsening dyspeptic symptoms. Over the previous four months, he had suf- fered from continuous epigastric burning and pain. The patient had undergone coronary bypass grafting one year prior to the admission. Findings on abdominal exa- mination were non-specific. On upper gastrointestinal endoscopy, a blue wire was identified that had penetrated the distal anterior wall of the gastric corpus (Figure 1). Retrieval of the foreign body was attempted but failed. Thoracic and abdominal computed tomography showed the wire, which originated from the right ventricle, passing through the sternocostal triangle, entering the abdomen, and penetrating the gastric wall (Figure 2). Consultation with cardiovascular surgery confirmed this wire to be a TEPW, which was cut at the surface of the skin after the bypass procedure. Although surgical inter- vention was planned, the patient did not provide consent for surgery.


First long-term prospective case series of Percutaneous Endoscopic Gastrostomy with Jejunal Extension for drug administration

Direct jejunal feeding by Percutaneous Endoscopic Gastrostomy with Jejunal Extension (PEG-J) or direct percutaneous endoscopic jejunostomy (DPEJ) is more indicated than gastric feeding in patients with aspiration of gastric contents, gastroparesis or gastric outlet obstruction. Other indication is administration of drugs that must be directly delivered to duodenum or jejunum to achieve a precise and controlled absorption. In this setting, PEG-J may be preferable to DPEJ, despite the risk of tube dysfunction or dislocation (1, 2). There are large series describing DPEJ outcomes (3), but the long- term outcome of PEG-J is not well reported, particularly regarding drug administration.