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Mastroroberto M.,Unit of Liver Transplantation | Berardi S.,Unit of Liver Transplantation | Fraticelli L.,Unit of Liver Transplantation | Pianta P.,Unit of Liver Transplantation | And 3 more authors.
Journal of the Pancreas | Year: 2012

Context The sarcoidosis is an idiopathic multisystem inflammatory disease characterized by the presence of non-caseating granulomas in the affected organs. The clinical picture includes non-specific systemic symptoms and organ-specific symptoms, but it is frequently asymptomatic. Although not fully understood, a clear association between sarcoidosis and malignancies has been reported. In neoplastic patient, beside classical sarcoidosis, cases of sarcoid-like reaction have been extensively described, a condition characterized by the presence of non-caseating granulomas in the lymph nodes draining the tumor or, less commonly, in the distant lymph nodes; this is considered a benign non progressive condition, potentially regressive following neoplasm eradication. Case report We report the first case of sarcoidosis/sarcoid-like reaction associated with neuroendocrine tumors of the pancreas. Conclusion This clinical case highlights the difficulty and importance of differential diagnosis of lymphadenopathy in the management of neoplastic disease, and in view of the evolving clinical picture, if a distinction between sarcoidosis and sarcoid-like reaction is a clinical reality or if they is just represent different stage of the same disease. Therefore, we believe that a follow-up is necessary even in case of sarcoid-like reaction, since no data are reported in the literature on the long-term of this condition once treated the associated tumor. Source

Santos G.R.,Unit of Liver Transplantation | Boin I.F.S.F.,Unit of Liver Transplantation | Pereira M.I.W.,Unit of Liver Transplantation | Bonato T.C.M.P.,Unit of Liver Transplantation | And 3 more authors.
Transplantation Proceedings | Year: 2010

Introduction: Anxiety can be considered an emotional state that does not present itself at the same intensity in all patients, and can be classified into 3 levels: mild, moderate, and severe. The patient, upon entering the waiting list for transplantation, reflects on the decision taken, which leaves him constantly anxious about the idea of possible death. Objective: This study had the aim of evaluating the degree of anxiety observed in orthotopic liver transplantation (OLT) candidates and whether there was a correlation between anxiety and etiologic diagnosis. Methods: This study was a prospective study where the patients underwent psychological evaluation by Beck Anxiety Inventory (BAI). The anxiety level was minimal, mild, moderate, or severe. The Model for End-Stage Liver Disease (MELD) score and etiology were recorded. Results: The level of anxiety found were as follows: 55% minimal, 27% mild, 12% moderate, and 7% severe. The correlation between level of anxiety and etiologic diagnosis showed that 71% of patients with alcoholic cirrhosis and 60% of those with liver cancer showed a minimal degree of anxiety and 27% of patients with autoimmune cirrhosis had severe anxiety. Conclusion: We found that in patients with autoimmune hepatitis, the degree of anxiety was more pronounced. It is believed that the absence of physical symptoms is an important factor when observing anxiety in OLT candidates. © 2010 Elsevier Inc. All rights reserved. Source

Ataide E.C.,Unit of Liver Transplantation | Dos Santos I.N.,University of Campinas | Martins D.L.,University of Campinas | Pereira T.S.,University of Campinas | And 4 more authors.
Transplantation Proceedings | Year: 2013

Hepatoportal sclerosis (HPS), first reported by Mikkelsen et al in 1965, is a pathologic condition that does not cause cirrhotic portal hypertension. The primary hepatic lesion in HPS is found in portal vein branches with preserved synthetic function. Rarely do patients with HPS need liver transplantation. The aim of this study was to describe the clinical and pathologic features of 6 HPS cases who underwent liver transplantation (OLT). From 2000 to 2008, 6 OLT candidates were diagnosed with HPS: 3 displayed bleeding varices and 4 ascites. Child-Pugh evaluation was class B (n = 4) or C (n = 2). The Model for End-stage Liver Disease scores were 18 (n = 2), 20 (n = 3), and 22 (n = 1). Cirrhosis resulted from presumed diagnoses of alcohol n = (1), autoimmune n = (2) or cryptogenic cirrhosis n = (3). On histologic examination, there was marked phlebosclerosis in all cases, including nonocclusive portal vein thrombosis (n = 3), intense portal fibrosis (n = 1), moderate portal fibrosis (n = 5), and uniform moderate sinusoidal dilatation without megasinusoid formation, but with ductal biliary proliferation and ductal biliary fibrosis in all cases. Cholestasis was observed in 1 and incomplete septal cirrhosis in 4 cases. None of the subjects showed histological features of the presumed underlying liver disease. The overall survival of this group was no different from that of other OLT patients. HPS causing hepatic failure may require liver transplantation. Fhlebosclerosis andportal fibrosis may contribute to the loss of hepatic synthesis leading to the need for hepatic transplant. Significant portal fibrosis and phlebosclerosis can contribute to hepatic parenchymal and posterior synthetic loss. © 2013 Elsevier Inc. All rights reserved. Source

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