common vasculitis conditions of childhood, and is characterized by nonthrombocytopenic purpura, arthritis and/or arthralgia, abdominal pain, gastrointestinal hemorrhage and renal involvement. Although the etiology of HSP is still unknown, it is considered to be an immune-mediated vasculitic disorder resulting from an immune complex reaction to various antigenic stimuli. Many bacterial and viral organisms such as streptococci, adenovirus, parvovirus, hepatitis B virus (HBV), Epstein–Barr virus, varicella and mycoplasma have been reported as predisposing factors for HSP.1 So far, HSP associated with hepatitis A virus (HAV) infection has only been reported in one other patient, as a letter to the editor.2 In the present report we describe two patients with HSP associated with acute hepatitis A.

Henoch–Schönlein purpura associated with hepatitis A infection

Infection with hepatotropic viruses is not limited to the liver and can lead to the development of various immunological disorders (the formation of cryoglobulins, rheumatoid factor, antinuclear antibodies, autoantibodies specific for autoimmune hepatitis and primary biliary cholangitis, and others), which can manifest as glomerulonephritis, arthritis, uveitis, vasculitis (cryoglobulinemic vasculitis, polyarteritis nodosa, Henoch-Schonlein purpura, isolated cutaneous necrotizing vasculitis), and other rheumatologic disorders, and be a trigger for the subsequent development of autoimmune hepatitis and primary biliary cholangitis. A further study of the association between autoimmune liver diseases and hepatotropic virus infection would be useful to assess the results of treatment of these associated diseases with antiviral drugs. The relationship of these immune disorders and their manifestations with hepatotropic viruses is best studied for chronic hepatitis B and C. Only isolated cases of these associations are described for hepatitis A. These links are least studied, and are often controversial for hepatitis E, possibly due to their relatively rare diagnoses. Patients with uveitis, glomerulonephritis, arthritis, vasculitis, autoimmune liver diseases should be tested for biomarkers of viral hepatitis, and if present, these patients should be treated with antiviral drugs.

Immune disorders and rheumatologic manifestations of viral hepatitis.

Association of Henoch-Schonlein purpura and hepatitis A.

Resume Observation. – Un garcon de dix ans a presente une hepatite A cholestatique confirmee par la presence d'anticorps anti-HAV de type IGM au decours de laquelle il a presente un tableau comportant un purpura palpable des regions declives accompagne de douleurs abdominales et d'arthralgies des genoux et des chevilles. Le diagnostic de purpura rhumatoide a ete retenu par l'association, chez ce patient, de tous les criteres de l'ACR (American College of Rheumatology). L'evolution a ete progressivement favorable avec en particulier l'absence d'atteinte renale (recul de trois ans et demi). Conclusion. – Le purpura rhumatoide est une manifestation extrahepatique exceptionnelle de l'hepatite A.

Hépatite A et purpura rhumatoïde : une association rare

Chapter 8. Natural History and Experimental Models

Acute infantile haemorrhagic oedema (AIHO) is characterised by purpura, ecchymosis and inflammatory oedema of the face and extremities. It is seen in children aged 4-24 months. The atiology is not known. We report a case of AIHO diagnosed by skin biopsy demonstrating leucocytoclastic vasculitis. Laboratory studies showed positive hepatitis A IgM and IgG antibodies. The liver function tests were normal, indicating subclinical hepatitis. Cryoglobulinaemia was detected, suggesting that the disease was related to hepatitis A.

Acute infantile haemorrhagic oedema associated with hepatitis A.

/pdf/determination-of-gastrointestinal-system-bleeding-site-and-2mwom2at.pdf

Determination of Gastrointestinal System Bleeding Site and Imaging of Meckel’s Diverticulum

Thoracic metabolic tumor volume predicts survival in advanced lung adenocarcinoma: a PET/computed tomography-based cohort study

Demonstration of therapy response to radioembolization with 90Y resin microspheres on 68Ga-PSMA PET/MRI in a patient with hepatocellular carcinoma

The aim of this study was to investigate the differences between voxel-based dosimetry and the mean absorbed doses calculated with pre-treatment Tc-99 m-MAA SPECT/CT and post-treatment Y-90 PET/MR images. We also sought to present a detailed comparison of dose-volume histograms (DVHs) calculated from pre- and post-treatment imaging. A total of 47 treatments and 41 patients were included in the analysis as six of the treatments were retreatments of the six patients. Multicompartment and voxel-based dosimetry were performed with pre-treatment Tc-99m-MAA SPECT/CT and Y-90 PET/MRI. Correlation coefficients between the two imaging methods for the mean absorbed dose of tumor, whole liver normal tissue, perfused normal tissue, T/N ratio and tumor D10, D50 and D90 values were calculated. Additionally, differences between these values were also evaluated with Bland–Altman plots. Pre-treatment Tc-99m-MAA SPECT/CT accurately predicted the dose values for healthy liver parenchyma calculated with Y-90 PET/MRI but showed lower accuracy in predicting T/N ratio and tumor doses. There were significant variations in tumor-absorbed doses for both glass and resin microspheres. Additionally, D90 values were higher when calculated with SPECT/CT than with PET/MRI, whereas D10 values were higher in PET/MRI compared to SPECT/CT. The findings in our study suggest that Tc-99m-MAA SPECT/CT had higher accuracy in predicting the dose to the healthy liver parenchyma compared to the tumor, maintaining its importance in treatment planning.

Comparative voxel-based dosimetry with pre-treatment Tc-99m SPECT/CT and post-treatment Y-90 PET/MRI for radioembolization with Y-90 microspheres

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