Volume 82 - 2019 - Fasc.4 - Letters
Calcium polystyrene sulfonate-induced gastrointestinal tract necrosis and perforation
Hyperkalaemia is defined as a high serum potassium level requiring urgent and specific treatments to prevent life-threatening complications. Cation-exchange resin, such as calcium polystyrene sulfonate (CPS), promotes potassium excretion in the intestinal/colonic lumen and is a treatment of choice when less aggressive treatment is allowed (1). We herein present three cases of CPS- induced gastrointestinal tract necrosis or perforation.
Cystotome assisted stent recanalization : an alternative way of regaining access to occluded metal biliary stents
Increased survival of patients with malignant biliary strictures can present endoscopic challenges over time, as local tumor progression or in-stent granulation tissue may hamper biliary access (1,2). A 63-year-old male was referred to our endoscopy department following an episode of cholangitis (bilirubin level 2.2, upper limit of normal 1.0 mg/dl). One year earlier, diagnosis of a metastatic cholangiocarcinoma (Klatskin type IIIa) was made. Following triple stenting in Y-shaped configuration, with the upper two SEMS (Self Expandable Metal Stents) in juxtaposition, chemotherapy was initiated. Oncological reevaluation had recently shown disease regression, although in retrospect reduced patency of the left biliary stent could be suspected. ERCP was repeated, identifying a patent uncovered metal stent in the right biliary system. Despite multiple reintroductions, application of a rigid dilator and use of a balloon, the 0.025-inch guidewire could not be advanced into the left biliary system
Coexistence of ampulla Vater tumor and Castleman's disease: a rare case report
Castleman's disease (CD), which is localized in the pancreatic region, is a rare clinical condition, and it is usually quite difficult to diagnose it and to distinguish it from pancreatic malignancies and pancreatic adeno- carcinoma metastases.
Here, a 58-year-old patient with dyspeptic complaints was presented, and a periampullary localized 3x3.5 cm diameter tumor and periportal, celiac, portacaval localized multiple lymphadenomegaly were detected by EUS and computerized tomography (Figure 1). Benign cytology was detected by EUS-guided biopsy. The patient underwent pancreaticoduodenectomy (Whipple procedure) (Figure 2). Histopathological examination showed poorly differentiated adenocarcinoma in the ampulla vater, and 19 lymph nodes with diameters ranging from 2.5 to 7.5 cm were mixed type CD and that none of them had metastasis. The patient has been followed without any problem for 11 months.
How will the welfare state cope with welfare diseases such as NASH?
Last year, it was stated in this journal that Non- Alcoholic Fatty Liver Disease (NAFLD) is becoming the biggest cause of liver disease in western countries (1). NAFLD may gain importance as Non-Alcoholic Steatohepatitis (NASH), a specific and serious form of NAFLD, is on the rise. It is estimated that in Belgium 3-4% of the population are affected by NASH, and it is projected that the prevalence will double by 2030 (2). Currently, over 90 drugs are being developed to treat NASH.
NASH is associated with a 30% or more loss in quality of life of the patient and may lead to death. Current treatments for NASH are based on lifestyle interventions (i.e. diet, physical activity) (1). Unfortunately, it has been estimated that less than 10% of the patients manage to maintain these changes in order for the hepatic fibrosis to regress. Due to the global obesity epidemic and complications of NASH, economic analyses indicate growing costs for the healthcare system and society overall. For instance, liver cirrhosis is associated with a 19% absenteeism rate and a 45% presenteeism rate. A rough estimate for NASH in Belgium shows direct annual medical cost to range between 100 to 400 million euro (3).
Autoimmune hepatitis in a patient with thymectomy: the benefit of histology and MUM-1 immunostaining
A 61 years-old female patient, with a history of myaesthenia gravis since 1992, for which she underwent a thymectomy and is treated by pyridostigmine 60 mg once daily, was referred to our outpatient clinic by her general practioner for symptoms of nausea, lack of appetite and pyrosis. Abdominal clinical examination and upper gastrointestinal tract endoscopy were normal. Routine biological testing showed an important liver enzyme perturbation, with a typical hepatocellular injury pattern: aspartate aminotransferase level (AST) at 1449 U/L, alanine aminotransferase level (ALT) at 1856 U/L, alkaline phosphatase level (ALP) at 211 U/L, gamma-glutamyl transpeptidase level (GGT) at 211 U/L, lactate dehydrogenase level (LDH) at 796 UI/L, total bilirubinemia was 5.85 mg/dL, direct bilirubinemia was 5.18 and ferritinemia was above 2000 ng/ml. Peripheral blood cells showed 2670 leucocytes/µL (with 46.3% of neutrophils and 25.7% of lymphocytes). Abdominal ultrasound was normal.
