Abstract
A 67-year-old woman suffering from rheumatoid arthritis (RA) presented with gradual exacerbation of arthralgia and/or articular swellings. She was diagnosed with RA at 62 years of age and successfully treated using methotrexate (MTX) in combination with loxonin (LOX). Three months after this treatment, cytopenia occurred as a side effect of MTX; therefore, MTX was stopped. Thereafter, RA had been largely controlled using salazosulfapyridine in combination with prednisolone and LOX for almost 4 years. On this visit, because RA became worse, clarithromycin (CAM) was added in expectation of its anti-inflammatory effects on RA. CAM treatment was effective for RA, to a certain extent; however, the RA activity was not sufficiently suppressed. In order to suppress the RA activity further, tacrolimus (TAC), an armament in the treatment for active RA in Japan, was added. Three months after initiating TAC treatment, the RA activity was considerably suppressed. This case shows that physicians should consider add-on CAM and TAC treatment when existing ant-rheumatic agents show little effects on RA.
Highlights
The rate of steatosis is the parameter that should be assessed in steatohepatitis and donor liver biopsies before transplantation
These pictures were shared with the Istanbul Hepatopancreatobiliary pathology study group
When the images were thought to represent the donor liver, only 3 pathologists succeeded in proper clinical management in all cases, while 11 of the pathologists had misdiagnosed clinical management in 1 case, 4 pathologists in 2 cases, 1 pathologist in 3 cases
Summary
Yöntem: ’Kameram’ programı ile hazırlanmış, pembe zeminde, yağlanmayı temsil eden, alan ölçüleri bilinen beyaz dairesel boşluklar içeren 9 resim, İstanbul Hepatopankreatobiliyer patoloji çalışma grubu ile paylaşıldı. Katılımcılardan her resim için yağlanma yüzdesi belirtmeleri istendi. Patologlar arası uyum steatohepatit ve verici karaciğerini değerlendirmede orta-iyi düzeydeydi (sırasıyla kappa değerleri: 0.51 ve 0.63) Sonuç: Çalışmamızda, karaciğer yağlanma oranlarının patologlar tarafından genel olarak yüksek değerlendirildiği gözlenmektedir. Steatohepatit sınıflamasında ve greft yönetimi açısından kliniği farklı etkileyen kararlar verilebileceği düşünülmüştür Patoloji rutinine her geçen gün daha fazla dahil olan bilgisayar destekli otomatize programların, patologlar arası değerlendirme farklılıkları ve klinik yansımaları nedeniyle, karaciğer yağlanma oranlarının doğru tespitinde de yeri olabileceği görülmektedir. Anahtar Sözcükler: Dijital patoloji, görüntü analizi, karaciğer, transplantasyon, steatohepatit, yağlanma
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