BACKGROUND Paraneoplastic syndromes remain poorly understood and manifest as multifaceted clinical symptoms,making their diagnosis difficult.Cholestasis can be observed in various malignancies.In rare cases,it can be ...BACKGROUND Paraneoplastic syndromes remain poorly understood and manifest as multifaceted clinical symptoms,making their diagnosis difficult.Cholestasis can be observed in various malignancies.In rare cases,it can be a paraneoplastic manifestation,most often associated with renal cell carcinoma and other urogenital tumors,as well as with bronchial carcinoma.The classical form of Stauffer syndrome presents with a reversible anicteric increase of cholestatic liver function tests,thrombocytosis,coagulation impairment,and hepatosplenomegaly,without any proven hepatobiliary obstruction or metastases.CASE SUMMARY We report a patient who presented with elevated liver enzymes,cholestatic jaundice,weight loss and pruritus,in whom renal cell carcinoma was incidentally found during hospitalization.Clinical,laboratory,and imaging tests excluded primary hepatic cause or metastatic disease.Jaundice and laboratory abnormalities reversed completely a few months after nephrectomy.This case is an example of the many sides of renal cell carcinoma,and it focuses the clinicians’attention on the differential diagnosis of cholestasis,including Stauffer syndrome and its variant.Thus,the correct diagnosis can be straightforward and the associated malignancy can be treated promptly.All cases should be followed up with a multidisciplinary team.Interleukin(IL)-6 is proposed to contribute to the pathophysiology of the condition.The probable mechanism is proinflammatory activity by the IL-6 cytokine,causing elevation of C-reactive protein and haptoglobin and inhibition of hepatobiliary transporter gene expression,impairing biliary outflow.CONCLUSION Despite being rare,Stauffer syndrome is a potentially reversible paraneoplastic condition,when the primary cause is treatable.This syndrome should be considered by clinicians because of the remediable liver disturbance,after successful treatment of the underlying malignancy.展开更多
目的观察等离子消融髓核成形术联合神经阻滞治疗椎间盘源性腰痛的临床疗效。方法将183例椎间盘源性腰痛患者随机分为对照组91例、治疗组92例,分别予综合疗法联合神经阻滞治疗、等离子消融髓核成形术联合神经阻滞治疗,观察两组患者治疗...目的观察等离子消融髓核成形术联合神经阻滞治疗椎间盘源性腰痛的临床疗效。方法将183例椎间盘源性腰痛患者随机分为对照组91例、治疗组92例,分别予综合疗法联合神经阻滞治疗、等离子消融髓核成形术联合神经阻滞治疗,观察两组患者治疗前后目测类比疼痛(Visual Analog Scale VAS)评分、改良Stauffer-Coventry评定系统术后日常活动及满意率等指标。结果治疗组VAS评分和日常活动及满意率均优于对照组(P<0.05或P<0.001)。结论等离子消融髓核成形术联合神经阻滞治疗椎间盘源性腰痛疗效显著,值得临床推广。展开更多
We report five cases with unusual causes of intrahepatic cholestasis, including consumption of Teucrium polium （family Lamiaceae） in the form of tea, Stauffer＇s syndrome, treatment with tamoxifen citrate for breast...We report five cases with unusual causes of intrahepatic cholestasis, including consumption of Teucrium polium （family Lamiaceae） in the form of tea, Stauffer＇s syndrome, treatment with tamoxifen citrate for breast cancer, infection with Coxiella Burnetii （acute Q fever）, and infection with Brucella rnelitensis （acute brucellosis）.展开更多
文摘BACKGROUND Paraneoplastic syndromes remain poorly understood and manifest as multifaceted clinical symptoms,making their diagnosis difficult.Cholestasis can be observed in various malignancies.In rare cases,it can be a paraneoplastic manifestation,most often associated with renal cell carcinoma and other urogenital tumors,as well as with bronchial carcinoma.The classical form of Stauffer syndrome presents with a reversible anicteric increase of cholestatic liver function tests,thrombocytosis,coagulation impairment,and hepatosplenomegaly,without any proven hepatobiliary obstruction or metastases.CASE SUMMARY We report a patient who presented with elevated liver enzymes,cholestatic jaundice,weight loss and pruritus,in whom renal cell carcinoma was incidentally found during hospitalization.Clinical,laboratory,and imaging tests excluded primary hepatic cause or metastatic disease.Jaundice and laboratory abnormalities reversed completely a few months after nephrectomy.This case is an example of the many sides of renal cell carcinoma,and it focuses the clinicians’attention on the differential diagnosis of cholestasis,including Stauffer syndrome and its variant.Thus,the correct diagnosis can be straightforward and the associated malignancy can be treated promptly.All cases should be followed up with a multidisciplinary team.Interleukin(IL)-6 is proposed to contribute to the pathophysiology of the condition.The probable mechanism is proinflammatory activity by the IL-6 cytokine,causing elevation of C-reactive protein and haptoglobin and inhibition of hepatobiliary transporter gene expression,impairing biliary outflow.CONCLUSION Despite being rare,Stauffer syndrome is a potentially reversible paraneoplastic condition,when the primary cause is treatable.This syndrome should be considered by clinicians because of the remediable liver disturbance,after successful treatment of the underlying malignancy.
文摘目的观察等离子消融髓核成形术联合神经阻滞治疗椎间盘源性腰痛的临床疗效。方法将183例椎间盘源性腰痛患者随机分为对照组91例、治疗组92例,分别予综合疗法联合神经阻滞治疗、等离子消融髓核成形术联合神经阻滞治疗,观察两组患者治疗前后目测类比疼痛(Visual Analog Scale VAS)评分、改良Stauffer-Coventry评定系统术后日常活动及满意率等指标。结果治疗组VAS评分和日常活动及满意率均优于对照组(P<0.05或P<0.001)。结论等离子消融髓核成形术联合神经阻滞治疗椎间盘源性腰痛疗效显著,值得临床推广。
文摘We report five cases with unusual causes of intrahepatic cholestasis, including consumption of Teucrium polium （family Lamiaceae） in the form of tea, Stauffer＇s syndrome, treatment with tamoxifen citrate for breast cancer, infection with Coxiella Burnetii （acute Q fever）, and infection with Brucella rnelitensis （acute brucellosis）.
