ABSTRACT
Hemorragia digestiva alta é uma condição grave e potencialmente fatal associada com muitas doenças sistêmicas e gastrointestinais. Embora a mortalidade varia de acordo com a etiologia do sangramento, em geral, é cerca de 10%. Metade desses pacientes têm mais de 60 anos de idade, e neste grupo etário de mortalidade é ainda maior. que podem ser provenientes de várias fontes, principalmente: úlcera péptica, hypertesion portal, anomalias vasculares e neoplasias. Avaliação inicial inclui a estabilização do quadro hemodinâmico e de reposição de sangue sempre que necessário. Endoscopia desempenha um papel importante no diagnóstico e tratamento da maioria das condições de sangramento. O tratamento farmacológico inclui agentes anti-secretores octreotide, e vasopressina. A cirurgia é eventualmente necessário.
Upper gastrointestinal bleeding is a serious and potentially life threatening condition associated with many systemic and gastrointestinal diseases. Although mortality varies according to the etiology of the bleeding, in general, it is around 10%.Half of these patients are over 60 years of age, and in this age group mortality is even higher. it may originate from a number of sources, mainly: peptic ulcer disease, portal hypertesion, vascular anomalies and neoplasms. Initial evaluation includes stabilization of the hemodynamic status and blood replacement whenever necessary. Endoscopy plays an important role in diagnosis and treatment of most bleeding conditions. Pharmacological treatment includes anti-secretory agents, octreotide and vasopressin. Surgery is eventually necessary.
Subject(s)
Humans , Male , Female , Hemorrhage , Gastrointestinal Hemorrhage , Melena , Endoscopy , Gastrointestinal Hemorrhage/diagnosis , Hemorrhage/diagnosisABSTRACT
A Giardia lamblia é um parasita intestinal cuja detecçäo pelo exame de fezes repetido pode falhar de 30 a 50 por cento dos casos. Nessa situaçäo, aspirado, citologia e biópsia duodenais säo considerados os melhores métodos para sua identificaçäo. Neste estudo, pesquisou-se a presença de G. lamblia em aspirado, citologia e biópsia duodenais de 90 pacientes näo selecionados que fizeram endoscopia digestiva alta de rotina, que foi encontrada em 5,9 por cento dos casos, no aspirado duodenal. A citologia e a histopatologia näo detectaram cistos ou trofozitos deste parasita. Em quatro pacientes com exame parasitológico de fezes negativo (EPF), o aspirado foi positivo, ratificando sua importância quando há suspeita clínica de giardíase e o EPF é negativo.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Giardia lamblia , Giardiasis/parasitology , Giardia lamblia , Feces , Biopsy, Needle , Endoscopy, Digestive SystemABSTRACT
Abstract: The authors describe the case of a young Brazilian woman who was treated of ileocolonic Crohn's disease sparing rectum, as confirmed by colonoscopy and histopathological examination. After a 4-years course of sulfasalazine treatment, she presented with skin facial lesions in vespertilio, fever, arthralgias and high titers of anti-ANA and LE cells. A sulfasalazine-induced lupus syndrome was diagnosed, because ofter sulfasalazine withdrawal and a short course of prednisone, the clinical symptoms disappeared and the laboratory tests returned to normal. Mesalazine 3 g/day was started and patient remained well for the next 3 years, when she was again admitted with fever, weakness, arthralgias, diplopy, strabismus and hypoaesthesia in both hands and feet, microhematuria, haematic casts, hypocomplementemia and high titers of autoimmune antibodies. A diagnosis of associated systemic lupus erythematosus was made. Although a pulsotherapy with methylprednisolone was started, no improvement was noticed. A cyclophosphamide trial was tried and again no positive results occurred. The patient envolved to severe clinical manifestation of general vasculitis affecting the central and peripheral nervous system and lungs, havaing a fatal evolution after 2 weeks. Although uncommon, the association of both disease may occur, and the authors call attention to this possibiliti, making a brief review of literature.
Subject(s)
Humans , Female , Adult , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Crohn Disease/drug therapy , Lupus Erythematosus, Systemic/chemically induced , Mesalamine/adverse effects , Sulfasalazine/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Fatal Outcome , Mesalamine/therapeutic use , Sulfasalazine/therapeutic useABSTRACT
Os autores revisam, brevemente, a ocorrência e o diagnóstico da infecçäo na necrose pancreática, bem como o papel dos antibióticos na profilaxia de infecçöes na pancreatite aguda.