ABSTRACT
El tromboembolismo (TE) arterial y venoso, posee una elevada morbimortalidad, siendo en pacientes con enfermedades inflamatorias intestinales (EII) 3-4 veces mayor que la población general, con una prevalencia de un 2-10 por ciento. El mecanismo por el cual la actividad procoagulante está aumentada en las EII es aún desconocido, sin embargo, factores de riesgo como el grado de inflamación de la mucosa han sido descritos. Objetivos: Determinar las características clínicas de TE en un grupo de pacientes con EII. Pacientes y Métodos: Se analizaron de manera retrospectiva los antecedentes clínicos de 16 pacientes con EII que presentaron TE durante su evolución. Se evaluó edad, extensión y grado de actividad de la EII al momento del TE. Resultados: Los pacientes estudiados fueron 13 con colitis ulcerosa (CU) y tres con enfermedad de Crohn (EC), edad promedio 43 años (rango 21-72), ocho mujeres. Once pacientes tenían < 50 años al momento del TE. En CU, nueve pacientes tenían pancolitis, todos con enfermedad activa moderada-severa. En EC, dos pacientes presentaban actividad de la enfermedad al momento del TE. Tres pacientes tenían otra manifestación extraintestinal (MEI), dos de ellos artralgias y uno colangitis esclerosante primaria. Los eventos de TE son: trombosis venosa profunda de extremidades inferiores en 9 casos; TE pulmonar en 3 pacientes, trombosis mesentérica/portal (dos casos), trombosis del seno venoso longitudinal (un paciente), trombosis arteria cerebral (uno) y trombosis de arteria braquial un caso). Quince casos de TE ocurrieron entre una semana y 6 años luego del diagnóstico de EII. Cinco pacientes estaban hospitalizados al momento del TE, dos de ellos después de cirugía por su EII. Ningún paciente estaba recibiendo nutrición parenteral total o tenía catéter venoso central al momento del TE. El estudio de trombofilia realizado en cinco pacientes, no demostró alteraciones características. Todos los pacientes fueron tratados con heparina sin complicaciones, y un paciente falleció por embolia pulmonar. Ningún paciente tenía antecedentes personales o familiares de TE. Conclusiones: El tromboembolismo es otra MEI de las EII que debe ser sospechado. La remisión de la EII pudiera ser el factor más importante en la prevención de estos episodios. El uso de heparina como tratamiento del TE no está contraindicado en estos pacientes, incluso en aquellos con crisis severa con sangramiento intestinal.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Inflammatory Bowel Diseases/complications , Thromboembolism/etiology , Cerebrum , Colitis, Ulcerative/complications , Pulmonary Embolism/etiology , Crohn Disease/complications , Retrospective Studies , Risk Factors , Heparin/therapeutic use , Thromboembolism/diagnosis , Thromboembolism/drug therapy , Venous Thrombosis/etiologySubject(s)
Adult , Middle Aged , Humans , Male , Female , Peritonitis/microbiology , Ascites/complications , Bacterial Infections , Liver Cirrhosis/complications , Peritonitis/complications , Peritonitis/diagnosis , Peritonitis/mortality , Prognosis , Recurrence , Chile , Survival Rate , Prospective Studies , Liver Cirrhosis, Alcoholic/complicationsSubject(s)
Humans , Blood Donors , Hepatitis B/epidemiology , Chile/epidemiology , Prevalence , Prospective StudiesABSTRACT
Primary biliary cirrhosis is a chronic, progressive and often fatal cholestatic liver disease. We report clincial characteristics and follow up in 33 consecutive patients studied at a single university hospital during the last 10 yearas. 31 were female (94%) and the mean age was 51 ñ 2 years. At diagnosis, itching was present in 26 cases (78%). Association with autoimmune mediated diseases was frequent. Liver function tests showed marked cholestasis (alkaline phosphate levels of 439 ñ 58 IU/I, range 90-1335). High antimitochondrial antibody titers and elevation of IgM levels were shown in all cases. According to liver biopsy findings, the diagnosis of primary biliary cirrhosis was an early one during the prospective phase of the study and was made in 8 ñ 1.4% of liver biopsies performed during this period. After a follow up of 27 ñ 5 months, 10 patients have died (30%). Our experience suggests that primary biliary cirrhosis is not an uncommon cause of chronic liver diseases in Chile
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Liver Cirrhosis, Biliary/diagnosis , Cholestasis, Intrahepatic/diagnosisABSTRACT
Spontaneous intramural hematoma of the esophagus (SIHE) is a rara condition usually affecting middle-aged or elderly women. It presents as acute sbusternal or epigastric pain, typically accompanied by dysphagia or hematemesis. SIHE is not usually associated with vomiting, and is therefore clearly distinguishable from hematogenic esophageal disorders, such as the Mallory Weiss lesion and the Boerhaave syndrome. The pathogenesis is in dispute. We present a case of SHIE without a discernible muscosal breach, suggesting a primary intramural bleed as the intiating event. Its diagnosis relies on the history and a barium swallow. Instrumentation can result in further damage to the esophagus. Treatment is conservative and results in resolution of the hematoma and return to normal swallowing. A favorable prognosis is the rule
Subject(s)
Aged , Humans , Female , Hematoma/diagnosis , Mucous Membrane , EsophagusABSTRACT
We randomized 31 cirrhotic patients with tense ascites to a Group A receiving only diuretic therapy (spironolactone, furosemide, n = 14) or a Group B treated with paracentesis and intravenous albumin infusion (n = 17). Ascites was elminated in 88% of patients in Group B compared to 57% of patients in Group A (p < 0.05). Complications developed in 4 patients in Group A and 2 patients in Group B. Paracentesis was associated to a mild and transient reduction in mean arterial pressure and a significant rise in urinary output. Duration of hospital stay was 5 ñ 3 days in Group B and 22 ñ 6 Group A (p < 0.001). Survival and likelihood of rreadmission for ascites was similar in both groups. Our results suggest that paracentesis plus intravenous albumin infusion is a fast, safe and effective therapy for tense ascites in cirrhotic patients
Subject(s)
Humans , Ascites/therapy , Drainage , Albumins , Albumins/therapeutic use , Liver Cirrhosis/therapy , Ascitic Fluid/therapy , Time Factors , Infusions, Intravenous , Randomized Controlled Trials as Topic , Prospective Studies , Albumins/administration & dosage , Diuretics/therapeutic use , Drug Therapy, Combination , Liver Cirrhosis/therapyABSTRACT
In order to determine the prevalence of anti-hipatitis C viral antivbodies in chile, we determined antibody titers in preserved serum form 91 subjects using an ELISA method. The number and percentage of patients with positive titers was as follows: hemophiliacs withouth evidence of liver disease 88% (n=25); prostitutes 0% (n=25); sporadic non A non B hepatitis )% (n=12); chronic non alcoholic hepatitis with negative anti-HbsAg and anti HBc 26% (n=10); hepatomas with negative iters as indicated for the previous group 30% (n=10); post transfusion non A non B hepatitis 66% (n=3). These results suggest that transfusion of blood products may be tha main etiologic factor for hepatitis C in our population