ABSTRACT
In order to better understand the rectosigmoid motor activity in diverticular disease of the colon, we studied 186 patients, grouped according to their intestinal habit, the presence of diverticular disease and previous crisis of sigmoid diverticulitis. The intestinal habit was classified as: normal habit, irritable colon syndrome, diarrhea and constipation. The group of diverticulosis was classified by their intestinal habit and by diverticula localization (localized or generalized). The presence of systemic diseases or drug ingestion that could modify intestinal motility, were considered criteria for exclusion. The manometric study was preceded by food stimulus, with 650 kcal meal, by mechanic intestinal cleansing, with 500 ml of saline solution enema and by one hour resting period. A manometric catheter, was introduced by rectosigmoidoscopy, with open ended orifices situated at the sigmoid and upper rectum, respectively. The catheter was perfused by a capillary infusion system and the bowel pressures were registered for 30 minutes, in a thermal paper physiograph. We analyzed the % of activity, mean amplitude and motility index, by non parametric tests. No significant difference was observed between sexes. Difference or close to it were found for the groups with constipation, with or without diverticulosis, and for the latter in its subdivisions (localized, generalized and sigmoid diverticulitis). The rectal motor activity was similar in all groups. There was no difference for diverticulosis and its subdivision, when we take into account the several kinds of intestinal habits and the diverticula localization. The motility index averages showed low values for the sigmoid diverticulitis fact that suggests some dysfunction of this segment (hypocontractility). The key factor differentiating the groups was the presence of constipation and no influence was noted regarding the localization of diverticula or previous inflammatory process on intraluminal pressures. The fact that no difference was found in the mean amplitude or % of activity among patients with or without diverticulosis, suggests that the high pressures in a colonic segment, may not be responsible for the diverticular disease, and there must be other factors, besides motility, accounting for the development of the different forms of this disease.
Subject(s)
Colon, Sigmoid/physiopathology , Diverticulum, Colon/physiopathology , Rectum/physiopathology , Adult , Colonic Diseases, Functional/complications , Colonic Diseases, Functional/physiopathology , Constipation/complications , Constipation/physiopathology , Diarrhea/complications , Diarrhea/physiopathology , Diverticulitis, Colonic/complications , Diverticulitis, Colonic/physiopathology , Diverticulum, Colon/complications , Female , Gastrointestinal Motility , Humans , Male , Manometry , Middle AgedABSTRACT
The authors present an objective review of the main emergencies regarding peptic ulcer disease, gastric and duodenal. The complications, perforation, bleeding and pyloric stenosis, are dealt with in detail, regarding diagnosis and best therapeutic orientation, either clinical or surgical.
Subject(s)
Peptic Ulcer Hemorrhage/therapy , Peptic Ulcer Perforation/therapy , Peptic Ulcer/therapy , Emergencies , Humans , Peptic Ulcer/diagnosis , Peptic Ulcer/surgeryABSTRACT
A case of a 5 1/2 year old girl with intestinal lymphangiectasia is described. The diagnosis was established by endoscopic biopsies. The value of endoscopy is discussed and, clinical aspects and management difficulties are stressed.
Subject(s)
Endoscopy/methods , Intestines/pathology , Lymphangiectasis, Intestinal/pathology , Protein-Losing Enteropathies/pathology , Biopsy , Child, Preschool , Female , Gastroscopy , HumansABSTRACT
The course of pregnancy in 1 patient with chronic active hepatitis (CAH) and cirrhosis, and another with extrahepatic portal vein obstruction (EHPVO) is described. The management of pregnancy in these diseases associated with portal hypertension is discussed and risks of pregnancy are compared. The patient with CAH presented with anovulatory cycles, and ovulation occurred following immunosuppressive therapy. Both women experienced massive upper gastrointestinal bleeding from esophageal varices. Bleeding was difficult to control and required variceal ligation in 1. Both patients manifested features suggesting cerebral edema indicating the need for caution with fluid and electrolyte therapy. Recovery of the woman with CAH after termination of pregnancy was slow. Review of literature demonstrated that variceal bleeding occurred in 43% of women with EHPVO compared to 23% of those with CAH and cirrhosis. Additional complications including hepatocellular failure (24%) occurred in patients with CAH but not in EHPVO. The management of pregnancy in portal hypertension and advice for contraception or sterilization are discussed.
