Eficacia del tinidazol en la profilaxis terapéutica de la colitis amebiana en pacientes con leucemia aguda de novo que reciben quimioterapia intensiva / Efficacy of tinidazole in the therapeutic prophylaxis of amoebic colitis in patients with de novo acute leukemia receiving intensive chemotherapy

Resumen Introducción: En México la seroprevalencia de la Entamoeba histolytica es del 8.4%. La amebiasis intestinal en pacientes con leucemia aguda de novo posterior al inicio de quimioterapia (QT), en el Servicio de Hematología del CMN 20 de Noviembre, es del 12%, aún si muestran test coprológico negativo basal. Objetivo: Averiguar si la administración de tinidazol, en pacientes con leucemia aguda y coprológico negativo, al principio de la QT, disminuye la incidencia de colitis amebiana durante la inducción a la remisión. Método: Prospectivo y no comparativo. Enfermos con diagnóstico de leucemia aguda de novo que inician QT de inducción y coprológico inicial. Se indicó tinidazol, 2 g/día durante 5 días en la primera semana de comenzada QT. Se vigilaron hasta que la inducción concluyó y se inició la recuperación hematopoyética. Resultados: 38 pacientes, 15 mujeres y 23 hombres con edad media de 44 años (16-72). Con leucemia aguda linfoblástica 19, con mieloblástica 16 y con promielocítica 3. Casos sin y con amebiasis intestinal, 35 y 3, respectivamente. Los pacientes con amebiasis solo recibieron tinidazol durante 3 días y se dio después de 2 días de empezada la QT. Conclusión: El tinidazol, en pacientes con leucemia aguda de novo que inician QT de inducción, es efectivo en la prevención de la amebiasis intestinal, durante la etapa de inducción, si se administra a 2 g/día, durante cinco días, a partir del día 1 de la QT.

Abstract Introduction: In Mexico, seroprevalence of Entamoeba histolytica is 8.4%. The intestinal amebiasis in patients with acute leukemia of novo, after the start of chemotherapy (CT) in the Hematology Service of the CMN 20 de Noviembre is 12%, even if patients show a negative baseline coprological test. Objective: To find out if the administration of tinidazole, in patients with acute leukemia and negative coprological test, at the beginning of the CT, decreases the incidence of amoebic colitis during the induction to remission. Method: Prospective and not comparative study. Patients with de novo diagnosis of acute leukemia who initiate induction and initial coprological CT. Tinidazole was indicated, 2 g/day for 5 days in the first week of CT started. They were monitored until the induction was concluded and hematopoietic recovery started. Results: 38 patients, 15 women and 23 men with a mean age of 44 years (16-72), with acute lymphoblastic leukemia 19, myeloblastic 16 and promyelocytic 3. Cases without and with intestinal amebiasis were 35 and 3, respectively. Patients with amebiasis only received tinidazole for 3 days and it was given 2 days after the CT started. Conclusion: Tinidazole, in patients with acute de novo leukemia who initiate induction CT, is effective in the prevention of intestinal amebiasis, during the induction stage, if administered at 2 g/day, for five days, starting on day 1 of the CT.

Role of Colonoscopy in Patients with Hematochezia / 대한소화기학회지

BACKGROUND/AIMS: Although colonoscopy is not indicated in patients with hematochezia, many surgeons, internists, and physicians are recommending colonoscopy for these patients in Korea. The aim of this study is to evaluate the diagnostic value of colonoscopy for patients with hematochezia. METHODS: We retrospectively reviewed the data of colonoscopy between January 2010 and December 2010. A total of 321 patients among 3,038 colonoscopies (10.6%) underwent colonoscopy to evaluate the cause of hematochezia. The patients with previous colorectal surgery (2) or polypectomy (5) were excluded. We analyzed endoscopic diagnoses. Advanced neoplastic polyps were defined as adenomas with villous histology or high grade dysplasia, or adenomas more than 10 mm in diameter. RESULTS: Hemorrhoid was the most common diagnosis (217 cases, 67.6%). Polyps were detected in 93 patients (29.0%), but advanced neoplastic polyps were found in only 14 cases (4.4%). Colorectal cancers were diagnosed in 18 patients (5.6%) including 14 rectal cancers. There was no cancer located above sigmoid-descending junction. Diverticuli were detected in 41 patients (12.8%) but there was only one case of suspected diverticular bleeding. Colitis was diagnosed in 24 patients (7.5%). Other lesions included acute anal fissure, rectal tumor, stercoral ulcer, and radiation proctitis. CONCLUSIONS: The colonoscopy had little value in patients with hematochezia because the most pathologic lesions were located below sigmoid colon. The first choice of diagnosis in patients with hematochezia is sigmoidoscopy.

Chronic Radiation Colitis with Rectopelvic Fistula Diagnosed 30 Years after Radiation Therapy / 대한소화기학회지

No abstract available.

A Case of Necrotizing Colitis Presenting with Hepatic Portal Venous Gas and Pneumatosis Intestinalis / 대한소화기학회지

Hepatic portal venous gas is a very rare radiologic sign which is characterized by gas accumulation in the portal venous circulation. Pneumatosis intestinalis is also very rare and is characterized by multiple air cysts in the serosal or submucosal layers of the gastrointestinal tract walls. These two findings are caused by various pathological conditions and can develop individually or simultaneously. The latter is clinically more significant because it is frequently related to bowel ischemia or necrosis, and represents a poor prognosis. However, prognosis is more influenced by the severity of underlying disease rather than hepatic portal venous gas or pneumatosis intestinalis itself. If bowel ischemia or necrosis is the primary cause, emergency operation is very important to improve patient's prognosis. Herein, we report a case of necrotizing colitis presenting as hepatic portal venous gas and pneumatosis intestinalis which was successfully managed by early surgery.

Apendagitis epiploica primaria: Clínica y evolución de 73 casos

La apendagitis epiploica primaria es una enfermedad relativamente infrecuente dentro de los diagnósticos diferenciales del abdomen agudo. Describimos las características clínicas y evolución de una serie de 73 casos de apendagitis epiploica primaria. Se realizó una búsqueda de imágenes ecográficas y tomográficas con diagnóstico de apendagitis en el sistema de información hospitalario electrónico del Hospital Alemán entre abril del 2007 y julio del 2013 y posteriormente se revisaron sus historias clínicas. Se incluyeron 73 casos; la edad promedio fue de 45 años (± 16), 54 (74%) eran varones. El motivo de consulta fue dolor abdominal: en fosa ilíaca izquierda en 65 (el 89% de los casos); en fosa ilíaca derecha en seis (8%) y en otras localizaciones en dos (3%). Se les realizó ecografía abdominal a 44 (60%), tomografía computarizada a 21 (29%), y ambos estudios a 8 (11%). En el 49% de los casos se solicitó interconsulta con el servicio de cirugía. Recibieron tratamiento con antibióticos 15 (21%) pacientes, de los cuales el 73% fue indicado por un médico clínico. Recibieron tratamiento ambulatorio con antiinflamatorios no esteroides 67 (92%); dos requirieron cirugía laparoscópica, dos internación y dos opiáceos. La apendagitis epiploica es infrecuente dentro de los diagnósticos diferenciales de abdomen agudo, pero es una entidad que no debe ser desconocida por los médicos para prevenir intervenciones innecesarias y el uso excesivo de antibióticos.

Primary epiploic appendagitis is a relatively rare disease in the differential diagnosis of acute abdomen, nonetheless it is an entity that should not be ignored by physicians and surgeons in order to prevent unnecessary interventions and overuse of antibiotics. To substantiate this concept a search was conducted at the Hospital Aleman, Buenos Aires between April 2007 and July 2013. The aim was clinical histories containing sonographic and tomographic images with diagnosis of omental appendagitis; and subsequently their electronic medical records were reviewed. The clinical features and outcome of a case series of 73 primary omental appendagitis were selected; the mean age was 45 years (± 16); 54 (74%) were men. Abdominal pain (left lower quadrant in 89% of cases) was the most common symptom. Abdominal ultrasound was performed on 44 (60%) of patients, computed tomography on 21 (29%), and both studies on 8 (11%) of cases in this series. In 49% of cases surgery consultation was requested. Fifteen patients (21%) were treated with antibiotics, 73% of them were prescribed by a clinician. Sixty seven patients (92%) were treated as outpatients with non steroidal anti-inflammatory drugs (NSAIDs); two required laparoscopic surgery, two required hospitalization and two others were treated with opioids. Epiploic apendagitis is uncommon in the differential diagnosis of acute abdomen, but is an entity that should not be ignored by physicians to prevent unnecessary interventions and overuse of antibiotics.

Perfuração do colo por colite amebiana invasiva durante terapia anti-TNF para espondiloartrite / Colonic perforation due to invasive amebic colitis during anti-TNF therapy for spondyloarthritis

O bloqueio do TNF tem tido sucesso no tratamento de algumas doenças reumáticas, como a espondiloartrite. Relatam-se muitas complicações infecciosas com a terapia anti-TNF, principalmente infecções bacterianas, micobacterianas, virais e fúngicas. A Entamoeba histolytica é um protozoário extracelular que causa principalmente colite e abscesso hepático, sendo que a perfuração intestinal é uma complicação rara, com alta mortalidade. O TNF é considerado o principal mediador da imunidade celular contra a amebíase. Inicialmente, é quimiotático para a E. histolytica, potencializando sua adesão ao enterócito por meio da lectina galactose-inibível, e depois ativando os macrófagos para matarem a ameba pela liberação de NO; assim, o bloqueio do TNF poderia ser prejudicial, aumentando a virulência amebiana. Descreve-se o caso de uma mulher de 46 anos com espondiloartrite que apresentou uma perfuração do colo por colite amebiana invasiva durante uso de anti-TNF.

TNF blockade has been successful in the treatment of some rheumatic diseases such as spondyloarthritis. Many infectious complications have been reported with anti-TNF therapy, mainly bacterial, mycobacterial, viral and fungal infections. Entamoeba histolytica is an extracellular protozoan parasite that mainly causes colitis and hepatic abscess; bowel perforation is an uncommon complication with high mortality. TNF is considered the principal mediator of cell immunity against amebiasis. Initially, it is chemotactic to E. histolytica, enhancing its adherence to enterocyte via galactose inhibitable lectin, and then activating macrophages to kill ameba though the release of NO, so that TNF blocking could be harmful, increasing amebic virulence. We describe the case of a 46-year-old woman with spondyloarthritis who presented a colonic perforation due to invasive amebic colitis during anti-TNF use.

Compromiso intestinal por Mycobacterium avium en un paciente con VIH/ SIDA / Intestinal disease due to Mycobacterium avium in a patient with HIV/AIDS

amos el primer caso de colitis por Mycobacterium avium en un paciente peruano con infección por VIH /SIDA.

We report the first case of colitis due to Mycobacterium avium in a Peruvian patient with HIV/AIDS.

Colitis eosinofílica y colitis linfocítica: ¿diferentes manifestaciones histológicas de un mismo proceso en pacientes con diarrea crónica? / Eosinophilic and linphocitic colitis: diferent histological manifestations of a same process in a patients with chronic diarrhea

Objetivos: 1) Determinar la prevalencia de incremento de eosinófilos en mucosa colónica en pacientes con colitis linfocítica (CL). 2) Determinar la coexistencia de colitis eosinofílica (CE) en pacientes con CL. Materiales y métodos: Las biopsias colónicas de pacientes adultos con diarrea crónica diagnosticados como CL en el hospital Daniel A. Carrión durante octubre 2009 a marzo 2012 fueron revisadas de forma independiente por 2 patólogos. Microscópicamente, se investigó y cuantificó la presencia de eosinófilos en mucosa colónica. Resultados: Se incluyeron 68 casos de CL, de los cuales 76,5% tuvieron eosinófilos elevados en la mucosa colónica y en 51,4% se pudo hacer el diagnóstico de CE según los criterios establecidos. Conclusión: Tres de cuatro pacientes con CL presentan eosinófilos elevados y 1 de cada 2 pacientes con CL cumple criterios para CE.

Objectives: 1) To determine the prevalence of increased number of eosinophils in colonic mucosa of patients with lymphocytic colitis (LC). 2) To determine the coexistence of eosinophilic colitis (EC) in patients with lymphocytic colitis. Materials and methods: slides of adult patients with cronic diarrhea with diagnosis of LC were reviewed between October 2009 and March 2012. The number of eosinophils was quantified. Results: Sixty eight patients with LC were included. Elevated eosinophils were found in 76.5 and in 51.4% a diagnosis of EC was established. Conclusion: 3 out of 4 patients with LC had elevated eosinophils and 1 of 2 patients with LC had criteria for EC.

A Case of Segmental Colitis Associated with Diverticular Disease / 대한소화기학회지

Segmental colitis associated with diverticular disease (SCAD) is a colonic inflammatory disorder with localized non-granulomatous inflammation at sigmoid colon, and associated with colonic diverticulosis. SCAD is an apparently uncommon disorder in Western. We experienced a rare case of SCAD in a 46-year-old woman who visited the hospital due to abdominal discomfort. Colonoscopic examination showed multiple sigmoid diverticula in association with a segment length colitis. Colonoscopic biopsies of the sigmoid colon demonstrated cryptitis and crypt abscess along with chronic inflammatory cells infiltration. The biopsies of the rectum was histologically normal. The patient was given the diagnosis of SCAD and treated with oral mesalamine. This is the first case of SCAD reported in Korea.

Triptolide downregulates Rac1 and the JAK/STAT3 pathway and inhibits colitis-related colon cancer progression

Triptolide, a diterpenoid triepoxide from the traditional Chinese medicinal herb Tripterygium wilfordii Hook. f., is a potential treatment for autoimmune diseases as well a possible anti-tumor agent. It inhibits proliferation of coloretal cancer cells in vitro and in vivo. In this study, its ability to block progress of colitis to colon cancer, and its molecular mechanism of action are investigated. A mouse model for colitis-induced colorectal cancer was used to test the effect of triptolide on cancer progression. Treatment of mice with triptolide decreased the incidence of colon cancer formation, and increased survival rate. Moreover, triptolide decreased the incidence of tumors in nude mice inoculated with cultured colon cancer cells dose-dependently. In vitro, triptolide inhibited the proliferation, migration and colony formation of colon cancer cells. Secretion of IL6 and levels of JAK1, IL6R and phosphorylated STAT3 were all reduced by triptolide treatment. Triptolide prohibited Rac1 activity and blocked cyclin D1 and CDK4 expression, leading to G1 arrest. Triptolide interrupted the IL6R-JAK/STAT pathway that is crucial for cell proliferation, survival, and inflammation. This suggests that triptolide might be a candidate for prevention of colitis induced colon cancer because it reduces inflammation and prevents tumor formation and development.

Apendagite epiplóica: aspectos clínicos e radiológicos / Epiploic appendagitis: clinical and radiological aspects

Apendagite epiplóica é uma doença inflamatória abdominal incomum. Foram avaliados, retrospectivamente, os prontuários de 44 pacientes com diagnóstico de apendagite epiplóica atendidos no Hospital Barra D’Or, Rio de Janeiro, RJ, no período entre fevereiro de 2005 e setembro de 2006, sendo 82 por cento homens e 18 por cento mulheres, com média de idade de 44,7 anos. Buscou-se caracterizar o quadro clínico-laboratorial e radiológico desses pacientes. As alterações laboratoriais mais freqüentes foram piúria e leucocitose, cada uma presente em 5 por cento dos casos. O diagnóstico foi feito por tomografia computadorizada de abdome com achado de lesão ovóide em cólon descendente em 52 por cento dos pacientes. A resolução do quadro clínico foi obtida com tratamento conservador.

Epiploic appendagitis is an uncommon inflammatory abdominal disease. Data of 44 patients with a clinical diagnosis of appendagitis were retrospectively evaluated regarding laboratory and imaging findings. They were admitted to Barra D’Or Hospital, Rio de Janeiro, RJ, from February 2005 to September 2006. Eighty-two percent were male and 18 were female, with median age of 44.7 years. The most frequent laboratory findings were hematuria in urinalysis and leucocitosis, presenting in 5 percent of cases each. Diagnosis was obtained through computed tomography showing paracolic oval lesions, mainly over the descending colon in 52 percent of patients. Patients were treated with analgesics and anti-inflammatory in an outpatient basis. Recovery was uneventful under conservative treatment.

Tolerância à sulfassalazina em pacientes com retocolite ulcerativa (RCUI) em Salvador-Bahia / Sulphasalazine tolerability in patients with ulcerative colitis in Salvador-Bahia

A sulfassalazina (SSZ) é amplamente utilizada para tratamento da retocolite ulcerativa idiopática. Estudos relatam frequência de efeitos colaterais em torno de 20-45%, os quais em geral são dose-dependentes e relacionados com altos n¡veis séricos de sulfapiridina, ocorrendo principalmente nos pacientes com baixa capacidade genética de acetilação hepática da medicação. Embora seja droga utilizada há muito tempo, a escassez de dados em nosso meio motivou a realização de um levantamento da tolerância desse medicamento em pacientes do Programa Estadual de Medicamentos de Alto Custo da Secretaria de Saúde da Bahia. Métodos: Estudo retrospectivo com avaliação de prontuários de pacientes em acompanhamento ambulatorial que fizeram uso de SSZ. Foram levantados dados epidemiológicos, dados sobre a extensão da doença, exames laboratoriais, dose, tempo de uso e suspensão da SSZ, relatos de queixas espontâneas dos pacientes com relação a eventos adversos gastrointestinais, hematológicos, dermatológicos, neurológicos e urinários. Resultados: Foram avaliados 100 pacientes com média de idade de 44,1 anos (13-87), sendo 73% do sexo feminino. Apresentaram efeitos colaterais 37% dos pacientes, havendo necessidade de suspensão da medicação em 47,4% (18/37) dos casos, redução da dose em 18,4% (7/37) e hospitalização em 7,8% (3/37). Os efeitos colaterais mais frequentes nos pacientes com colite distal, predominando cefaléia (11 %), epigastralgia (11 %) e náuseas em 9% dos pacientes. Conclusões: A frequência de eventos adversos foi semelhante … relatada em outros estudos, com baixa frequência de reações adversas graves. Não foi observada relação entre a frequência e gravidade dos efeitos colaterais e a extensão da doença.

Acute abdomen due to eosinophilic colitis with liver abscess.

Eosinophilic colitis is an uncommon condition and rarely presents as acute abdomen. We report a 65-year-old man who presented with acute abdomen-- severe pain in upper abdomen, with pyrexia, tachycardia, guarding and right-sided intercostal tenderness--secondary to eosinophilic colitis and was successfully managed. He had additional problems in form of cirrhosis, chronic hepatitis, cholangitis, pyogenic liver abscesses and gout.

Pneumatosis Intestinalis and Hepatic Portal Venous Gas Caused by Necrotizing Colitis / 대한소화기학회지

No abstract availble.

Pneumatosis Intestinalis and Hepatic Portal Venous Gas Caused by Necrotizing Colitis / 대한소화기학회지

No abstract availble.

Colitis en niños: alergicas infecciosas o enfermedad inflamatoria intestinal subyacente / Child in colitis: allergy infectious or underlying intestinal inflammatory disease

La colitis en pediatría, constituye una patología relativamente frecuente, en nuestro país existen pocos datos publicados respecto a su etiología y comportamiento en el tiempo. Evaluar casos de colitis de primera aparición, correlacionando características, endoscópicas, e histológicas con su etiología. Estudio descriptivo, prospectivo, en niños, que ameritaron realización de endoscopia digestiva inferior con diagnósticos de colitis. Se incluyeron 38 niños entre 1 mes y 13 años, no hubo diferencias en cuanto a sexo y predominó el grupo de los lactantes. El síntoma más común fue evacuaciones con moco y sangre (84,21 por ciento). Predominó el dx. Endoscópico de colitis reactiva inespecífica. La etiología mas frecuente fue de origen alérgico (72,2 por ciento), predominando en niñas. Los gérmenes implicados en las colitis infecciosas fueron Salmonella, Shigella, C. yeyuni más E. Histolítica, y Tricocefalos. El tratamiento fue básicamente dieta de exclusiòn. La evolución fue hacia la mejoría en casi todos los casos. Se observó persistencia de los síntomas en 5,26 por ciento por no cumplir la dieta. En el 5,26 por ciento se observaron recaídas (ameritando el uso de esteroides y/o sulfasalizine) lo cuál nos alerta en el seguimiento de estos casos y su posible evolución a Enfermedad Inflamatoria intestinal. No observamos diferencias significativas entre sexo y hallazgos endoscópicos, histológicos o la etiología. Se evidenció que existe relación significativa entre etiología y hallazgos histológicos y no existe relación entre hallazgos endoscópicos e histológicos ni entre hallazgos endoscópicos y etiología.

Colitis microscópica: valor predictivo de la sospecha clínico-endoscópica en nuestro medio / Microscopic colitis: predictive value of clinical/endoscopical approach

Introducción. El estudio y tratamiento de la diarrea crónica es complejo y de múltiples etapas. En pacientes portadores de diarrea crónica acuosa no sanguinolenta, con estudio normal, se debe considerar la posibilidad de una lesión histológica, aún con aspecto macroscópico normal a la colonoscopía: la Colitis Microscópica (CM). Esta entidad clínico-patológica involucra dos conceptos, la colitis linfocítica (CL), que compromete a la mucosa/submucosa de revestimiento del colon con infiltrado de linfocitos CD8 citotóxicos, o bien la colitis colágena (CC) ,que compromete la membrana basal. Ante la sospecha de CM, obtener biopsias secuenciales en colon derecho e izquierdo para su correcto diagnóstico de acuerdo a patrones histológicos. Objetivos. Conocer la frecuencia de esta entidad clínica en pacientes con diarrea crónica acuosa no sanguinolenta, con colonoscopía y biopsias, y evaluar la relación entre la sospecha clínica y la confirmación histológica. Pacientes y métodos. Se incluyen pacientes estudiados por diarrea crónica acuosa no sanguinolenta en el período enero 2003-febrero 2005, que fueron referidos a colonoscopía. Requisito era estudio completo normal de acuerdo a protocolo de diarrea crónica (leucocitos fecales, estudio malabsorción, intolerancia al glúten, función tiroidea, tolerancia a la lactosa, serología VIH, parasitosis, coprocultivo y cultivos especiales, Toxina A de C. difficile, evaluación psiquiátrica, uso de fármacos, etc). En las íleocolonoscopias se efectuaron biopsias secuenciales colon derecho, izquierdo y recto. El estudio histológico se realizó con Hematoxilina y Eosina, rojo congo, Masón y tricrómico para colágeno. Se excluyeron los pacientes con causa conocida de diarrea crónica o hallazgos de lesión a la colonoscopía. Resultados: De 1.145 colonoscopías, cumplen con los criterios de inclusión 16 pacientes, los que son el objetivo del estudio (1,3 por ciento). Corresponden a 8 varones y 8 mujeres, edad promedio de 60,7 años (47-87). En 10 casos las muestras fueron informadas como Colitis leve (62,5 por ciento); un paciente como colitis moderada (6,25 por ciento) y 4 con alteraciones leves e inespecíficas. Sólo 1 paciente (6,25 por ciento) cumplía con los criterios histológicos exigidos para colitis linfocítica. Conclusiones. La frecuencia en esta serie es inferior a lo referido en la literatura, con un solo caso que cumple con los criterios histológicos de 16 pacientes sospechados.