ABSTRACT
Background: The pathophysiological hallmark of the hepatorenal syndrome (HRS) is renal vasoconstriction. Doppler ultrasonography can be used to assess the vascular resistance in small renal intraparenchymal vessels through analysis of the Doppler waveform by a parameter termed Resistive Index (RI). We postulated that the RI could be important for the diagnosis and prognosis of HRS. Aims: to assess the RI in cirrhotic patients with ascites, with and without HRS. Patients and methods: We studied 48 cirrhotics with ascites, of whom 12 were with and 36 without HRS and other 23 were normal subjects. We measured the intrarenal arterial RI (Resistive index = Peak systolic velocity - Minimum diastolic velocity/Peak systolic velocity) with color Doppler ultrasonography after visualization of interlobular or arcuate arteries. It was considered abnormal when higher than 0.70. Results: The RI values, mean and SD) were: normal subjects: 0.58 ñ 0.05, cirrhotics with ascites: 0.65 ñ 0.05 and cirrhotics with ascites and HRS: 0.78 ñ 0.11. Patients with HRS had significantly higher values than those without HRS (p < 0.001). The Relative Risk of developing the HRS in patients with a RI ü 0.70 were 3.32 (CI 95 percent = 1.79 - 6.2) Conclusions: The RI was useful in patients with cirrhosis and ascites for the prognosis of HRS and could suggest diagnosis of HRS with values of 0.78 or higher, if other clinical conditions that produce renal vasoconstriction are excluded
Subject(s)
Humans , Male , Female , Ultrasonography, Doppler , Liver Cirrhosis , Ascites , Case-Control Studies , Liver Cirrhosis/complications , Hepatorenal Syndrome/diagnosis , Liver Function Tests , Kidney Function TestsABSTRACT
A forty three-year-old female, born in a rural area of southern Chile, at the age of 30 presented pain and limitation of motility of the righ shoulder. Later on, she presented an increasing of volume at the right scapular region. A radiography showed an osteolytic lesion of the scapula. In a biopsy an osseous hydatidosis was found and a hydatid cyst was extirpated from the soft tissues. Four years later, as she presented again pain and volume increasing in the same anatomical area, albendazole was given to her, and a CAT practiced revealed osteolytic lesions of the bone, several periosteal ruptures and multiple cyst in the muscles. She was submitted so surgery again in order to extirpate cyst. After two years the patient presented the same clinical manifestations and radiological and CAT images previously observed. In considering all these facts a radical surgery was decided
Subject(s)
Humans , Female , Adult , Echinococcosis/diagnosis , Scapula/parasitology , Dogs/parasitology , Echinococcosis/pathology , Echinococcosis/surgery , Echinococcosis/transmission , Scapula/surgery , Scapula/pathologySubject(s)
Humans , AIDS-Related Opportunistic Infections/diagnosis , Diarrhea/etiology , Mycobacterium avium-intracellulare Infection/diagnosis , Salmonella Infections/diagnosis , Salmonella Infections/drug therapy , Adenoviridae Infections/diagnosis , Campylobacter Infections/diagnosis , Campylobacter Infections/drug therapy , Cryptosporidiosis/diagnosis , Cryptosporidiosis/drug therapy , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/drug therapy , Dysentery, Bacillary/diagnosis , Dysentery, Bacillary/drug therapy , Microsporidiosis/diagnosis , Microsporidiosis/drug therapyABSTRACT
La Biopsia Hepática (BH) es un procedimiento de alto valor diagnóstico con mínimas complicaciones y escasa mortalidad Método. Revisión retrospectiva de 349 BH realizadas en el Hospital de la Universidad de Chile en un período de cinco años (1990-1994). Resultados. El 55 por ciento de las biopsias se realizó en mujeres y el 45 por ciento en hombres con una edad promedio general de 50 años. Las pruebas de coagulación promedio fueron tiempo de protrombina de 74 por ciento y recuento plaquetario de 190000. Las principales indicaciones fueron por daño hepático crónico de origen necroinflamatorio (alcohólico, viral o autoinmune) en un 47 por ciento y tumor hepático en un 22 por ciento. El 93 por ciento de las muestras se obtuvo por vía percutánea y el resto por vía transyular, laparoscópica o quirúrgica. El diagnóstico histológico se obtuvo en el 97,5 por ciento de los casos siendo los más frecuentes cirrosis y hepatitis crónica (35 por ciento), esteatosis hepática (13 por ciento) y la colestasis crónica (13 por ciento). Las complicaciones observadas fueron tres casos de hemoperitoneo, dos casos de hemo-neumotórax y un caso de biliperitoneo por punción vesicular. No hubo mortalidad en esta serie. Conclusiones: En el presente trabajo se confirma el valor diagnóstico y seguridad de la BH.
Subject(s)
Liver , Biopsy , Diagnostic Techniques and Procedures/statistics & numerical data , Diagnostic Techniques and Procedures/instrumentationABSTRACT
The clinical case of an apparently healthy 63-year-old man from a rural area, with previous contact with dogs, who had a pathological fracture of the right humerus in presented. Initially he presented slight local pain, and functional discapacity. Eigh months later, after a radiological study and surgery (curettage), diagnosis of hydatid disease was made. Later on, after receiving two courses with albendazole, the parient continued in similar conditions for seven years, when his situation became complicated with bacterial, fistula and extraoseous hydatidosis. The humeral was resected and a segmentary prothesis was successfully set