[Show abstract][Hide abstract] ABSTRACT: Background
Esophageal candidiasis (EC) often occurs in human immunodeficiency virus (HIV)-infected patients, but is uncommon in non-HIV-infected patients. It is known that malignancy, diabetes mellitus, previous gastric surgery, and medications (antibiotics, proton pump inhibitors, and steroids) are risk factors for esophageal candidiasis in non-HIV-infected patients. However, the relationship between liver cirrhosis and esophageal candidiasis was unclear. This study aimed to elucidate the role of liver cirrhosis in esophageal candidiasis.
A retrospective chart review study was conducted on non-HIV-infected patients with esophageal candidiasis who presented to Tri-Service General Hospital from January 2009 to December 2012. The diagnosis of EC was primarily based on endoscopic findings. The incidence of EC in cirrhotic and noncirrhotic patients was compared. Furthermore, differences in baseline characteristics, clinical variables, and mortality after antifungal treatment between the two groups were analyzed.
In this study, 43,217 non-HIV-infected patients were enrolled, 3017 of whom had liver cirrhosis. The incidence of EC in cirrhotic patients was higher than that in noncirrhotic patients (0.8% vs. 0.36%; relative risk = 2.2; p < 0.001). Multivariate logistic regression analysis identified liver cirrhosis as an independent risk factor for EC (odds ratio, 1.74; 95% confidence interval, 1.06–2.87; p = 0.029). Moreover, cirrhotic patients tended to be asymptomatic compared with noncirrhotic patients (45.8% vs. 9%; p < 0.01). The most common coexisting endoscopic finding was reflux esophagitis (83.9%). However, antifungal treatment did not decrease the mortality of patients with EC during hospitalization.
Liver cirrhosis is an independent risk factor for EC. EC may be asymptomatic in cirrhotic patients. Although antifungal treatment did not improve the outcome in this study, a prospective study is still required to investigate this issue.
[Show abstract][Hide abstract] ABSTRACT: Candida lipolytica candidemia is a rare but an emerging pathogenic yeast infection in humans. It can gain access to the bloodstream through intravascular catheterization, especially through central venous catheters in immunocompromised or critically ill patients during hospitalization. In this report, we present a noncatheter-related C. lipolytica candidemia infection in an 84-year-old man who was admitted due to acute pancreatitis. The possible pathogenesis and management of C. lipolytica candidemia are highlighted. It was an unusual infectious complication of acute pancreatitis. Clinicians should be aware that such an opportunistic pathogen can lead to invasive candidemia infection. In clinical practice, systemic antifungal therapy and the removal of the potentially infected central venous catheter might be recommended for the treatment of C. lipolytica candidemia.
No preview · Article · Jun 2013 · Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi
[Show abstract][Hide abstract] ABSTRACT: A villous adenoma is an extremely rare benign tumour in the appendix, in contrast to other benign appendiceal lesions. The clinical features are usually asymptomatic. Acute appendicitis is the most common complication with the lesion obstructing the orifice of the appendiceal lumen. Thus, a villous adenoma is usually found during surgical intervention for acute appendicitis. Mechanical obstruction induced by acute perforated appendicitis has been previously reported. Acute appendicitis caused by a villous adenoma presenting with acute intestinal obstruction has not been previously reported.
A 78-year-old woman presented to our Emergency Department with diffuse abdominal pain and tenderness. The abdominal plain film and computed tomography revealed an intestinal obstruction. After surgical intervention, the ruptured appendix was shown to be associated with intestinal obstruction. The post-operative pathologic diagnosis was an appendiceal villous adenoma.
This is the first report describing an appendiceal villous adenoma, which is an occasional cause of perforated acute appendicitis, presenting as a complete intestinal obstruction. We emphasize that in elderly patients without a surgical history, the occult cause of complete intestinal obstruction must be determined. If an appendiceal tumour is diagnosed, an intra-operative frozen section is suggested prior to selecting a suitable method of surgical intervention.
[Show abstract][Hide abstract] ABSTRACT: Acute pancreatitis is a condition that leads to destruc-tionand necrosis of pancreatic tissue and frequentdevelopment of multiple organ failure. Most cases arerelated to gallstones or heavy alcohol intake. Amongthe numerous other causes are hypertriglyceridemia,hypercalcemia, abdominal trauma, drugs, vasculitis, viralinfection, peritoneal dialysis, cardiopulmonary bypass,and endoscopic retrograde cholangiopancreatography.Approximately 2 to 5% of cases of acute pancreatitisare drug related, including such drugs as azathioprine,mercaptopurine, asparaginase, pentamidine, didanosine,valproic acid, tetracyclines, estrogen, sulfonamides,thiazides, furosemide, pentamidine, dideoxyinosine, andpossibly glucocorticoids.Tamoxifen is a nonsteroidal estrogen antagonist thathas been widely used in adjuvant hormonal therapy ofprimary breast cancer. The side effects of tamoxifenare generally mild, including effects on lipoproteinmetabolism (1-3). Tamoxifen lowers total and low-densitylipoprotein cholesterol and increases triglycerideand high-density lipoprotein cholesterol levels. However,there are some cases of marked, tamoxifen-induced,hypertriglyceridemia. Hypertriglyceridemia may occa-sionallyproduce severe, lethal pancreatitis (4-8). Here,we report a case of tamoxifen-induced severe, acutepancreatitis. The patient was a woman who had hyper-triglyceridemiaand breast cancer. After mastectomy, bothtamoxifen and antihyperlipidemic agents were adminis-tered.But she withdrew the lipid-lowering agent 2 yearslater on her own. Then she developed tamoxifen-inducedsevere hypertriglyceridemia and pancreatitis.
No preview · Article · Jul 2004 · Digestive Diseases and Sciences