Subject(s)
Humans , Female , Middle Aged , Aged , Germ-Line Mutation , Colorectal Neoplasms, Hereditary Nonpolyposis/diagnosis , Colorectal Neoplasms, Hereditary Nonpolyposis/genetics , Microsatellite Instability , DNA Repair Enzymes , Colorectal Neoplasms , Inpatients , Physical Examination , Symptom Assessment , Gastroenterology , Gastrointestinal DiseasesSubject(s)
Colorectal Neoplasms, Hereditary Nonpolyposis/genetics , Mutation , Aged , Female , Humans , MRE11 Homologue Protein/genetics , Middle Aged , MutL Protein Homolog 1/genetics , Proto-Oncogene Proteins B-raf/genetics , Syndrome , Tumor Suppressor Proteins/genetics , Ubiquitin-Protein Ligases/geneticsABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Intestinal Polyposis/complications , Hamartoma Syndrome, Multiple/diagnosis , Colonic Polyps/diagnostic imaging , Colonic Polyps/surgery , Hamartoma Syndrome, Multiple/pathology , Colonoscopy/methods , Photomicrography/methods , Immunohistochemistry , Hyperplasia/complicationsSubject(s)
Adenomatous Polyps/diagnosis , Colonic Neoplasms/diagnosis , Duodenal Neoplasms/diagnosis , Ganglioneuroma/diagnosis , Hamartoma Syndrome, Multiple/diagnosis , Intestinal Polyps/diagnosis , Adenoma/surgery , Adenomatous Polyps/genetics , Adenomatous Polyps/pathology , Adult , Colonic Neoplasms/genetics , Colonic Neoplasms/pathology , Colonoscopy , Diagnosis, Differential , Duodenal Neoplasms/genetics , Duodenal Neoplasms/pathology , Exons/genetics , Ganglioneuroma/genetics , Ganglioneuroma/pathology , Gastroscopy , Hamartoma Syndrome, Multiple/complications , Hamartoma Syndrome, Multiple/genetics , Hamartoma Syndrome, Multiple/pathology , Humans , Hyperpigmentation/etiology , Intestinal Polyps/genetics , Intestinal Polyps/pathology , Male , Megalencephaly/etiology , Multiple Endocrine Neoplasia Type 2a/diagnosis , Mutation, Missense , PTEN Phosphohydrolase/genetics , Penile Diseases/etiology , Point Mutation , Thyroid Neoplasms/surgery , ThyroidectomyABSTRACT
Mixed cryoglobulinemia (MC) is a small-vessel systemic vasculitis characterized by the presence of cryoglobulins, immunoglobulin complexes that precipitate at low temperatures ( < 37 ºC) inducing the inflammatory process. The most frequent etiology is hepatitis C infection (HCV) (1). Rituximab (RTX), an anti-CD20 monoclonal antibody, has recently emerged as the treatment of choice for severe MC (2). We present a case of severe hepatitis C virus-induced MC that was controlled and maintained in remission with RTX for 26 months, a remarkable prolonged period of time.
Subject(s)
Antibodies, Monoclonal, Murine-Derived/therapeutic use , Antiviral Agents/therapeutic use , Cryoglobulinemia/drug therapy , Cryoglobulinemia/etiology , Hepacivirus , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/drug therapy , Female , Humans , Middle Aged , RituximabABSTRACT
La crioglobulinemia (CG) es una vasculitis sistémica de pequeño vaso caracterizada por la presencia de crioglobulinas, las cuales son inmunocomplejos circulantes que, a bajas temperaturas (< 37 °C), precipitan desencadenando el proceso inflamatorio. La etiología más frecuente es la infección por el virus de la hepatitis C (VHC) (1). En los últimos años el anticuerpo monoclonal anti-CD20 rituximab (RTX) se ha ido posicionando como el tratamiento de primera línea en las CG de presentación agresiva (2). Presentamos el caso de una paciente con brote grave de una CG asociada al VHC que respondió al tratamiento con RTX, manteniéndose posteriormente en remisión de manera inusualmente prolongada durante 26 meses (AU)
Mixed cryoglobulinemia (MC) is a small-vessel systemic vasculitis characterized by the presence of cryoglobulins, immunoglobulin complexes that precipitate at low temperatures (< 37 °C) inducing the inflammatory process. The most frequent etiology is hepatitis C infection (HCV) (1). Rituximab (RTX), an anti-CD20 monoclonal antibody, has recently emerged as the treatment of choice for severe MC (2). We present a case of severe hepatitis C virus-induced MC that was controlled and maintained in remission with RTX for 26 months, a remarkable prolonged period of time (AU)
Subject(s)
Middle Aged , Humans , Cryoglobulinemia/complications , Cryoglobulinemia/drug therapy , Hepatitis C/complications , Hepatitis C/physiopathology , Plasmapheresis , Exanthema/complications , Exanthema/diagnosis , Gastroscopy , Electrophysiology/methodsSubject(s)
Humans , Female , Adult , Endometriosis/diagnosis , Colonic Polyps/diagnosis , Sigmoid Neoplasms/diagnosis , Diagnosis, DifferentialSubject(s)
Diagnostic Errors , Endometriosis/diagnosis , Sigmoid Diseases/diagnosis , Sigmoid Neoplasms/diagnosis , Adult , Biopsy , Colectomy , Colonic Polyps/diagnosis , Colonoscopy , Diagnosis, Differential , Endometriosis/epidemiology , Endometriosis/pathology , Endometriosis/surgery , Female , Humans , Intestinal Obstruction/etiology , Sigmoid Diseases/epidemiology , Sigmoid Diseases/pathology , Sigmoid Diseases/surgeryABSTRACT
Objetivos. Analizar las características al ingreso, el curso evolutivo y el pronóstico de la hemorragia digestiva alta (HDA) en el paciente anciano. Material y métodos. Estudio prospectivo en el que se incluyeron 103 pacientes con edad igual o superior a 80 años, que ingresaron en una Unidad de Sangrantes por un episodio de HDA en un año. Analizamos los antecedentes personales, características de la hemorragia, realización de la endoscopia urgente diagnóstica y terapéutica y factores pronósticos asociados. Resultados. La etiología más frecuente de la HDA fue el sangrado por úlcera gastroduodenal en el 65,1%, siendo el 60,2% consumidores crónicos de antiinflamatorios no esteroideos. Se realizó endoscopia diagnóstica urgente en todos ellos, con una eficacia del 94,2% y terapéutica en el 28,2%. La tasa de resangrado fue del 8%, requiriendo cirugía urgente el 4,9%, con una mortalidad global del 5,8%. Conclusiones. La realización de endoscopia urgente y la aplicación de terapéutica endoscópica es un método seguro y eficaz para detener el sangrado por HDA en el anciano, lo cual ha reducido la necesidad de cirugía urgente, mejorando la supervivencia del enfermo anciano sangrante(AU)
Objectives. To evaluate the patient characteristics, outcome, and prognosis of upper gastrointestinal haemorrhage in the elderly. Material and methods. A prospective study was conducted on 103 patients aged 80 years and over, admitted to a Gastrointestinal Bleeding Unit after an episode of upper gastrointestinal bleeding. We analysed the personal history, the characteristics of the bleeding event, and whether an urgent diagnostic or therapeutic endoscopy was performed, in order to identify clinical data and endoscopic findings that may have an influence on the outcome of the haemorrhage. Results. The major cause of the haemorrhage was peptic ulcer in 65.1%, and 60.2% of patients were on chronic treatment with non-steroidal anti-inflammatory drugs. An urgent diagnostic endoscopy was performed in all of them, identifying the source of bleeding in 94.2%, and treatment was carried out on 28.2%. The likelihood of rebleeding was 8%, and 4.9% of patients underwent emergency surgery, with an overall mortality rate of 5.8%. Conclusions. The performance of urgent endoscopy and the application of endoscopic haemostasis are safe and effective in stopping upper gastrointestinal bleeding in the elderly. This has significantly reduced the need for emergency surgery, improving the survival of the bleeding elderly patient and preventing recurrent bleeding(AU)
Subject(s)
Humans , Male , Female , Aged, 80 and over , Gastrointestinal Hemorrhage/epidemiology , Peptic Ulcer/epidemiology , Comorbidity , Gastrointestinal Hemorrhage/complications , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/therapy , Peptic Ulcer/complications , Peptic Ulcer/prevention & control , Endoscopy/methods , Endoscopy/trends , Endoscopy , Prospective Studies , Predictive Value of TestsABSTRACT
OBJECTIVES: To evaluate the patient characteristics, outcome, and prognosis of upper gastrointestinal haemorrhage in the elderly. MATERIAL AND METHODS: A prospective study was conducted on 103 patients aged 80 years and over, admitted to a Gastrointestinal Bleeding Unit after an episode of upper gastrointestinal bleeding. We analysed the personal history, the characteristics of the bleeding event, and whether an urgent diagnostic or therapeutic endoscopy was performed, in order to identify clinical data and endoscopic findings that may have an influence on the outcome of the haemorrhage. RESULTS: The major cause of the haemorrhage was peptic ulcer in 65.1%, and 60.2% of patients were on chronic treatment with non-steroidal anti-inflammatory drugs. An urgent diagnostic endoscopy was performed in all of them, identifying the source of bleeding in 94.2%, and treatment was carried out on 28.2%. The likelihood of rebleeding was 8%, and 4.9% of patients underwent emergency surgery, with an overall mortality rate of 5.8%. CONCLUSIONS: The performance of urgent endoscopy and the application of endoscopic haemostasis are safe and effective in stopping upper gastrointestinal bleeding in the elderly. This has significantly reduced the need for emergency surgery, improving the survival of the bleeding elderly patient and preventing recurrent bleeding.
