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Volume 79 - 2016 - Fasc.2 - Letters

Case of a successful liver transplantation from a living donor with focal nodular hyperplasia

The number of patients awaiting liver transplantation is increasing, whereas the donors are few. Thus, the donor pool must be optimized. Due to the increasing demand for liver donations, the eligibility criteria have been reviewed and "extended donor criteria" have been suggested with the aim of expanding the donor pool. Generally, applicants with hepatic lesions identified by using different imaging methods are excluded from the list. However, mass lesions in the liver should not consti- tute a definitive contraindication to donation. Evaluation as to whether a donor applicant meets the extended dona- tion criteria is possible via imaging techniques and/or histopathological assessment. In this article, we present a case of a successful liver transplantation from a living donor with a focal nodular hyperplasia (FNH) identified by imaging techniques.


A rare case of abdominal tuberculosis with vomiting : letter to the editor

A 40-year-old female patient presented with vomiting, consisting of bile and food consumed the previous night, approximately 1 hour after each meal. She had experi- enced this symptom for 4 months, and the vomiting had increased in severity during the previous 2 months. The patient had not experienced abdominal pain, abdominal distension, jaundice or fever. An oesophago-gastro-duo- denoscopy revealed two distal duodenal ulcers. Biopsies (Figs. 1 and 2) revealed non-specific inflammation. The patient was treated with proton pump inhibitors and alu- minium phosphate gel for 2 months, but the vomiting did not improve. A barium meal (Fig. 3) was then adminis- tered, and a colonoscopy (Fig. 4) was performed despite the absence of lower gastrointestinal (GI) symptoms. The barium meal revealed one long stricture in the descend- ing part of the duodenum, and a colonoscopy revealed persistent narrowing of the ascending colon and a cir- cumferential ulcer. In addition, nodular ileitis was noted in the terminal ileum. A biopsy revealed non-specific inflammation, and acid-fast bacilli (AFB) staining was negative.


Abdominal pain and fullness in young patient

A 25-year-old man presented with abdominal pain and fullness within four months. On physical examination he was afebrile, with a blood pressure of 130/75 mm/Hg, a pulse of 74 beats per minute. The abdominal physical ex- amination revealed soft, distended abdomen with left up- per abdominal palpable mass. Blood tests showed the white-cell count was 11.400 per cubic millimeter (with normal eosinophils range), the hemoglobin level 16.2 g/dl (reference range : 13.6-17.2 g/dl), the platelet count 437000 per cubic millimeter, erythrocyte sedimen- tation 38 mm/h and C-reactive protein 45 mg/L (refer- ence range : 1.0-3.0 mg/L). Hepatic and renal function tests were all normal. Testing was negative for hepatitis B, hepatitis C and human immunodeficiency virus (on polymerase-chain-reaction assay). An ultrasonographic examination of the abdomen showed the vertical size of liver was 12 cm, mild increase in liver echo density with no gall stones. Ultrasonography also revealed a giant well defined, non-multilocular cystic lesion of the spleen with a size of 165 × 110 mm. Indirect hemagglutination test for hydatid cysts was positive in the titer 1:256.


Fecal transplant for Clostridium difficile infection relapses using “pooled" frozen feces from non-related donors

Clostridium difficile infection (CDI) is associated with high morbidity and mortality (1). About 20-50% of pa- tients develop relapses after antibiotic treatment (2,4). Fecal microbiota transplantation (FMT) is an effective, inexpensive and secure treatment option for these pa- tients(1,3), even in immunosuppressed patients(5). Conventional FMT (from fresh or frozen feces) from a healthy related donor (2), has shown effectiveness in approximately 90% of CDI relapses (1,3,4).


Esophageal and gastric ulceration due to synchronous herpes simplex virus, cytomegalovirus and Epstein-Barr virus infection

The authors report the case of a man of 71 years-old, with a previous history of type 2 diabetes mellitus, hyper- tension, and renal transplantation in 2013 due to chronic kidney disease. He was under immunosuppression with prednisolone, mycophenolate mofetil and tacrolimus. The patient was admitted by worsening of his health sta- tus lasting for one month, with progressive asthenia, an- orexia weight loss, and marked backache with movement limitation. Analytically he presented with microcytic anemia de novo (hemoglobin 9.6 g/dL), hypoalbumin- emia and a slight increase of liver tests. Initially a thora- co-abdominal computerized tomography was performed and revealed the presence of multiple nodules in the liver parenchyma, suggestive of metastases. In this context it was decided to carry out endoscopic work-up for malig- nancy screening. The upper endoscopy showed two -superficial-and-longitudinal-ulcers-in-the-distal-esophagus and in the gastric antrum there were two other larger ulcers with regular edges (Figs. 1 and 2). Histological evaluation- revealed- the- presence- of- morphological- find- ings compatible with ulcerated lesions (Fig. 3), with immunohistochemical analysis inconclusive for cyto- megalovirus (CMV), while the evaluation by molecular biology (polymerase chain reaction - PCR) strongly positive for herpes simplex virus (HSV) type 1, CMV and Epstein-Barr virus (CMV) synchronous infection. Later it was performed a colonoscopy that revealed the presence of a malignant neoplasm in sigmoid colon, con- firmed-after-histological-evaluation.-The-patient-was-then referred for symptomatic treatment.