ABSTRACT
The biphosphonate, alendronate sodium (e.g. Fosamax) is a bone resorption inhibitor used to treat posmenopausal osteoporotic women and osseous Paget's disease. Esophaghitis is one of the adverse effects (AE) associated to its use. Five (5) patients with alendronate-associated esophagitis assisted in the Gastroenterologic Center, Rosario, Argentina, between October 1996 and December 1999 are described. The aim is to correlate the clinical, endoscopic and histopathological findings in 5 women (ages 57-71) complained for upper digestive symptoms (disphagia, epigastrialgia, retroesternal pain). All had osteoporosis treated with alendronate 10 mg/day and received detailed instructions about how to take the medication. The time from the beginning of alendronate intake and the appearence of the symptoms was elapsed 30, 35, 67, 85 and 90 days. The esophagitis was graded according to the Savary-Miller Classification. The videoscopy disclosed esophagitis of III and IV grades. Three patients has also antral and antroduodenal lesions, one of them associated to Helicobacter pylori. Anatomopathological findings confirm esophagitis and esophagic ulceration. Some authors claim that disphosphonates as a new class of gastrotoxic drugs with AE similar to aspirin. Even when it is administrated according to the instructions of the manufactures it should be used with caution. Our contribution emphazise the importance of this AE and suggest measures to diminish or suppres them, and take into consideration those patients who are taking aspirin. With alendronate, as well as with other potentially corrosive agents, is very important to take in mind the measures to prevent AE.
Subject(s)
Humans , Female , Middle Aged , Alendronate/adverse effects , Esophagitis/chemically induced , Postmenopause , Alendronate/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Aspirin/adverse effects , Esophagitis/diagnosis , Osteoporosis, Postmenopausal/drug therapy , Time FactorsABSTRACT
La picadura de loxosceles puede causar ulceraciones de la piel, hemolisis intravascular y muerte. Se presenta un caso clinico de una lactante de 44 dias de edad, con diez lesiones ulcero-necroticas en abdomen inferior, zona perineal y zona dorso lumbar. Presento ademas fiebre, plaquetopenia, anemia y esplenomegalia. Se hace un resumen de los procesos patologicos conocidos, hallazgos clinicos y metodos recomendados de tratamiento. Se senala la importancia de la falta de correlacion entre la sintomatologia dermica que fue grave y los sintomas generales, moderados. Se resalta la importancia del conocimiento del cuadro clinico ya que la arana es raramente encontrada y muy dificil su identificacion