Editor-in-Chief, Deputy Editor 2017-2019

 

Editor-in-Chief:

Tom MOREELS

 

Deputy Editor:

Nicolas LANTHIER

 

Letters



Atypical acute appendicitis and its complications : A rare location of the appendix in the periduodenum


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Acute appendicitis is a common and easily diagnosed disease. However, variation in the location of the appendix may make it difficult to diagnose acute appendicitis (1). Left-sided or subhepatic acute appendicitis has been reported due to adhesion or developmental anomalies (2,3). Periduodenal acute appendicitis, as seen in our case, is rare and may lead to delay in diagnosis. [Product Details...]



Disseminated histoplasmosis causing splenic rupture in a patient receiving infliximab


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Infection with the soil fungus Histoplasma capsulatum accounts for the most prevalent endemic mycosis in the United States but it rarely results in serious and fatal disease (1). The usual manifestation of histoplasmosis is in the form of pulmonary disease, but in immunocompromised individuals it may present as a disseminated infection (2). Hepatomegaly and splenomegaly with variable degrees of severity are known clinical manifestations in disseminated disease, but these are usually uncomplicated. We present the first reported case of disseminated histoplasmosis complicated by splenic rupture. [Product Details...]



Dose escalation of octreotide LAR is safe and effective in patients with advanced gastrointestinal neuroendocrine tumours for control of symptoms and tumor progression


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Octreotide is a powerful drug for patients with gastroentero-pancreatic neuroendocrine tumors (GEPNET). We recently reviewed in this Journal the role of somatostatin analogs as antiproliferative agents, but so far no results from randomized controlled trials were available (1). Meanwhile, the PROMID-study has established that a monthly dose of 30 mg octreotide-Long Acting Release (LAR) controls tumor growth in patients with advanced midgut neuroendocrine tumors, resulting in an important benefit in progression free survival compared to placebo (14.3 versus 6 months, hazard ratio = 0.34 ; 95% CI, 0.20 to 0.59 ; p = 0.000072) (2). It is important to recall that this somatostatin analogue mainly exerts its actions through the somatostatin-2 and 3- receptors, but saturation is incomplete at the classical doses of octreotide-LAR of up to 30 mg monthly (3). [Product Details...]



Facial hyperpigmentation during pegylated interferon alpha therapy for chronic hepatitis B infection


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Adverse skin reactions with the use of interferon (IFN) alpha alone or in combination with ribavirin have been described in previous reports (1). Hyperpigmen - tation associated with both standard and also pegylated IFN alpha has also been reported in recent years (2-7). However, all patients had chronic hepatitis C, hyperpigmentation being mostly at tongue and injection sites, and they were on a combination treatment with ribavirin in these reports. In this article, we present, to our knowledge, the first case of facial hyperpigmentation during pegylated IFN alpha therapy in a patient with chronic hepatitis B infection. [Product Details...]



Metachronous splenic metastasis in an anal squamous cell carcinoma


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Although the spleen is a highly vascularised organ, metastasis remains a very rare situation, with an incidence ranged between 0.3 and 7.3% (1). They mainly occur in a context of multivisceral metastatic cancer at terminal stage and present as multiple and asymptomatic lesions diagnosed by incidental radiological assessment performed either in the regular follow-up of patients with cancer or in the workup at the time of the primary tumor diagnosis. Anal squamous cell carcinoma (ASCC), a relatively rare gastrointestinal malignancy, mainly associated with liver and lymph nodes metastases, has not been described yet as a potential primary tumor associated with spleen metastases (2). [Product Details...]



Should we consider Addison’s disease in the differential diagnosis of persistent hypertransaminasemia ? A case report


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A 29 year-old Caucasian male was admitted to our department in order to investigate persistent hypertransaminasemia (3-4-fold the normal values) for at least 1 year, along with a symptomatology of progressive fatigue and weight loss (6 kg/6 months). No remarkable data were revealed from the individual and family history. Physical examination demonstrated hyperpgimentation, atrophy of the upper and lower limbs, hypotension (100/70 mmHg on supine and 80/50 mmHg on upright position) and enlargement of cervical lymph nodes. [Product Details...]



Unusual cause of biliary obstruction : hepatobiliary fascioliasis


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We report a 30-year old female who presented to our clinic with severe abdominal pain, irradiating to the back, weight loss, fatigue and anorexia. The laboratory findings revealed increased levels of alanine trans - aminase, aspartate transaminase and bilirubin. The patient underwent abdominal ultrasonography (US) and magnetic resonance imaging (MRI). US showed hypoechoic areas located mainly in the subcapsular region of the liver. On MRI, hypointense lesions on T1- weighted images and hyperintense nodular lesions on T2-weighted images were seen within the liver (Fig. 1). Nodular lesions were peripherally enhancing in gadolinium- enhanced images. According to the US and MRI results hepatobiliary fascioliasis was considered as a diagnosis. Subsequently, endoscopic retrograde cholangiopancreatography (ERCP) was performed and fasciola flukes were extracted from extrahepatic bile ducts. [Product Details...]


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