Hereditary angioedema presenting with recurrent ascites.
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Abdominal Pain↗
Biomedical subjects
Djordje Culafic
Publications and source records attributed to Djordje Culafic.
Hepatic tuberculomas. A case report.
BACKGROUND: The liver is often involved secondarily by sytemic/extrahepatic vascular, metabolic, infectious, granulomatous, and malignant processes. CASE REPORT: A 57-year old woman was admitted because of fatigue, malaise, night sweating and right upper abdominal quadrant pain. Physical findings revealed pale skin and mucosae, and hepatomegaly. Laboratory data showed normocytic, normochromic anemia and marked inflammatory syndrome. Real-time ultrasonography revealed one hypo-echogenic nodule, 25 mm in size, in the segment II of the liver, and three hypoechogenic nodules, 11-25 mm in diameter, in segments III and IV. Enlarged lymph nodes, 20-50 mm, were observed in the region of the pancreatic head. Histo-pathological examination of the liver and peritoneum biopsies evidenced granulomas with caseous necrosis and multinuclear Langhans' giant cells, indicating hepatic and peritoneal tuberculosis. The tuberculostatic chemotherapy (isoniazid 300 mg/24h; rifampycin 600 mg/24h and pyrazinamid 2000 mg/24h) was applied for 12 months. The patient responded well to the treatment, followed-up for 6-12 months. CONCLUSION: In the differential diagnosis of focal liver lesions, pseudotumoral hepatic tuberculomas must be considered.
Antitubercular Agents↗
Doppler hemodynamic study in portal hypertension and hepatic encephalopathy.
BACKGROUND/AIMS: The aim of our study was to evaluate and compare the differences in the parameters of portal hypertension in two groups of patients with liver cirrhosis, with and without hepatic encephalopathy (HE). METHODOLOGY: 30 patients with liver cirrhosis, 17 (56.7%) of them with HE, were investigated by clinical, neurological, laboratory, endoscopic methods and with color Doppler ultrasonography (CDU) at the Institute for Digestive Diseases, Clinical Center of Serbia, Beograde. RESULTS: Significant correlation was found between the diameters of the right liver lobe and the portal vein (p=0.01), and also between the diameters of the spleen and splenic vein (p=0.0002), in both groups of patients. Mean portal vein diameter significantly increases (p=0.01) in patients with HE (14.87 +/- 1.86mm), compared to those without HE (13.2 +/- 2.31mm), while mean splenic vein diameter was not significantly different in the two groups. In patients with ascites, CDU showed significantly lower (p=0.03) portal flow velocity (11.87 +/- 6.25cm/ sec), compared to those without ascites (14.33 +/- 4.41cm/sec). Splenic flow velocity was not significantly different (16.00 +/- 6.60cm/sec with ascites and 14.61 +/- 5.29cm/sec without ascites). In patients with HE, portal flow velocity was significantly lower (9.00 +/- 5.41cm/sec) compared to those without HE (14.0 +/- 7.03cm/sec) (p=0.04). Mean splenic flow velocity was significantly lower (p=0.03) in patients with HE (12.60 +/- 4.16cm/sec), compared to those without HE (17.77 +/- 5.91cm/sec). Portal flow velocity shows linear decrease, related to the increase of the liver damage (Child-Pugh score), while splenic velocity was not related to this parameter. CONCLUSIONS: Ultrasonographic parameters of portal hypertension show significant correlation between the diameters of liver/portal vein and spleen/splenic vein. Portal hemodynamic parameter (blood flow velocity) is significantly related to the stages of liver damage, presence of ascites and HE, while splenic hemodynamics is specific and not directly related to these parameters.
Adult↗