ABSTRACT
BACKGROUND: Cyclosporine (CsA) use has been associated to the development of cholelithiasis in transplant recipients. We herein explored the role of time under CsA on this association in asymptomatic adult kidney transplant recipients (KTR). METHODS: A cross-sectional study was conducted in 140 KTR with variable post-transplant follow-up (PTFU), and without history of symptomatic biliary disease. Upper abdominal ultrasound was performed in all patients. According to the immunosuppressive schedule, patients were classified in three groups: Azathioprine + prednisone (group 1, n = 37), azathioprine + prednisone < 24 months CsA (group 2, n = 58), or azathioprine + prednisone > or = 24 months CsA (group 3, n = 45). Age at time of ultrasound performance, gender, PTFU, chronic viral liver disease, parity, oral contraceptives, serum lipids, diabetes and body mass index were analyzed concomitantly. RESULTS: Median age was 38, 31, and 36 years in groups 1, 2, and 3, respectively. The male:female ratio in the same groups was 1.5:1, 1:1, and 2:1. Mean PTFU was 130, 48, and 53 months, respectively (p = 0.0001). Gallstones were found in three (8%) group 1 KTR, in nine (16%) group 2 KTR, and in 10 (22%) group 3 KTR (p = 0.214). Adjusting for PTFU, the association between length of CsA and prevalence of lithiasis was significantly stronger among those with longer use of CsA (odds ratio = 6.1, p = 0.046). No significant differences were found among groups in the other variables. CONCLUSIONS: KTR receiving CsA for more than two years show increased prevalence of gallstones.
Subject(s)
Cholelithiasis/chemically induced , Cyclosporine/adverse effects , Immunosuppressive Agents/adverse effects , Kidney Transplantation , Azathioprine/therapeutic use , Bile/metabolism , Cholelithiasis/diagnostic imaging , Cholelithiasis/epidemiology , Comorbidity , Confounding Factors, Epidemiologic , Contraceptives, Oral/adverse effects , Cross-Sectional Studies , Cyclosporine/administration & dosage , Cyclosporine/pharmacokinetics , Cyclosporine/therapeutic use , Diabetes Mellitus/epidemiology , Drug Therapy, Combination , Follow-Up Studies , Graft Rejection/prevention & control , Hepatitis, Viral, Human/epidemiology , Humans , Hyperlipidemias/epidemiology , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/pharmacokinetics , Immunosuppressive Agents/therapeutic use , Mexico/epidemiology , Obesity/epidemiology , Parity , Prednisone/therapeutic use , Prevalence , Time Factors , UltrasonographyABSTRACT
Pseudomelanosis duodeni is a rare entity characterized by dark pigmentation of duodenal mucosa of uncertain etiology and clinical significance. We report a case with endoscopic and pathologic correlation. Some aspects about etiology, clinical and histopathologic characteristics are discussed.
Subject(s)
Duodenal Diseases/pathology , Melanosis/pathology , Adult , Duodenoscopy , Duodenum/pathology , Female , HumansABSTRACT
Ogilvie's syndrome or acute colonic pseudo-obstruction is a motility disorder characterized by acute and progressive colonic distension. This syndrome occurs in hospitalized patients with several medical or surgical diseases with an unclear pathophysiology. Diagnosis is established by the clinical history, physical examination and radiological findings on plain abdominal X-ray. Treatment includes: 1. general measures to reduce colonic distension, 2. drugs that improve colon motility, 3. endoscopic colonic decompression and 4. surgery. Age, associated diseases, elapsed time and diameter of cecal dilatation, presence of necrosis and perforation are the main prognostic factors. Recurrence after medical treatment is 20-50 percent; intrahospital mortality is 30 percent. A practical algorithm for the management of these patients is proposed.
