ABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Portal Vein/physiopathology , Hypertension, Portal/complications , Venous Thrombosis/etiology , HIV Infections/complications , Melena/etiologyABSTRACT
Epiploic appendicitis is a benign and self-limited disease, due to inflammation of the epiploic appendices. The diagnosis is established by imaging techniques, avoiding treatments, interventions and unnecessary hospitalizations. Management is conservative. Complications are rare and chronicity is exceptional.
Subject(s)
Appendicitis/pathology , Abdominal Pain/etiology , Adipose Tissue/pathology , Appendectomy , Appendicitis/diagnostic imaging , Appendicitis/surgery , Female , Fibromyalgia/complications , Humans , Laparoscopy , Middle Aged , Renal Colic/complications , Tomography, X-Ray ComputedABSTRACT
No disponible
Subject(s)
Female , Humans , Middle Aged , Peritoneal Cavity/pathology , Peritoneal Cavity , Appendicitis/complications , Appendicitis/surgery , Appendicitis , Adrenal Cortex Hormones/therapeutic use , Anti-Bacterial Agents/therapeutic use , Appendectomy/methods , Appendectomy , Abdominal Pain/etiology , Abdominal Pain , Laparoscopy/methods , Adipose Tissue/pathology , Adipose Tissue/surgery , Adipose TissueABSTRACT
La fístula pancreaticopleral es una rara complicación de la pancreatitis aguda o crónica, que requiere de tratamiento médico (análogos de somatostatina), endoscópico o quirúrgico para su resolución, siendo el primero de estos de elección. Presentamos el caso de un varón de 64 años que presenta disrupción completa del conducto de Wirsung, diagnosticada mediante ecoendoscopia y complicada con colección subfrénica, perforación diafragmática y posterior empiema. En este caso se ensayó sin éxito tratamiento médico y posteriormente endoscópico, que permitió finalmente la resolución de la lesión anatómica. El paciente precisó además una intervención quirúrgica para conseguir la evacuación de la colección pleural (AU)
Pancreaticopleural fistula is a rare complication of acute or chronic pancreatitis, requiring medical (somatostatin), endoscopic or surgical treatment, with medical treatment being the first option. We describe the case of a 64-year-old man who showed complete disruption of Wirsung's duct that was diagnosed through ultrasound endoscopy and was complicated by the development of a subphrenic collection, diaphragm perforation and subsequent empyema. Medical therapy was attempted without success, and anatomical restoration of the duct was achieved after endoscopic treatment. The patient also required surgery to evacuate the pleural collection (AU)
Subject(s)
Humans , Male , Middle Aged , Pleural Effusion/etiology , Pancreatic Fistula/complications , Pancreatitis, Acute Necrotizing/complications , Cholangiopancreatography, Endoscopic Retrograde , Endosonography , Somatostatin/therapeutic use , DrainageABSTRACT
Pancreaticopleural fistula is a rare complication of acute or chronic pancreatitis, requiring medical (somatostatin), endoscopic or surgical treatment, with medical treatment being the first option. We describe the case of a 64-year-old man who showed complete disruption of Wirsung's duct that was diagnosed through ultrasound endoscopy and was complicated by the development of a subphrenic collection, diaphragm perforation and subsequent empyema. Medical therapy was attempted without success, and anatomical restoration of the duct was achieved after endoscopic treatment. The patient also required surgery to evacuate the pleural collection.
Subject(s)
Pancreatic Fistula/complications , Pancreatitis/complications , Pleural Effusion/etiology , Respiratory Tract Fistula/complications , Acute Disease , Humans , Male , Middle Aged , Pleural Diseases/complicationsABSTRACT
En el presente estudio determinamos los citados anticuerpos a 463 pacientes con DM1 y, a los que presentaban positividad para alguno de ellos, se les propuso la realización de una endoscopia con toma de biopsias de duodeno distal, y se clasificaron las lesiones histológicas, cuando existieron, según la clasificación de Marsh.Sesenta y dos de los 463 (13,4%) pacientes presentaron al menos uno de los 3 anticuerpos positivo y, de ellos, 42 accedieron a la realización de la endoscopia. En 14 pacientes (3% de los diabéticos) se encontraron alteraciones histológicas compatibles con EC. La mayoría de estos 14 pacientes no refería síntomas relacionados con la enfermedad, aunque varios presentaban alteraciones analíticas presentes frecuentemente en la EC. La existencia de datos clinicoanalíticos compatibles con EC fue independiente del grado de lesión histológica. Al analizar la sensibilidad y el valor predictivo positivo para cada anticuerpo, los ATG y EMA fueron los más sensibles, si bien la facilidad técnica de detección de los ATG mediante técnicas de ELISA hace, en nuestra opinión, que sea el de elección para la realización del cribado(AU)
Celiac disease (CD) presents a wide clinical spectrum. There are asymptomatic or oligosymptomatic forms, which are difficult to diagnose. Since patients with untreated CD can develop severe complications, early diagnosis of these forms is important. Consequently, in groups at risk for CD, such as patients with type 1 diabetes (DM1), screening through determination of antigliadin (AGA), anti-tissue transglutaminase (ATG) and antiendomysial antibodies (EMA) is recommended. In the present study, 463 DM1 patients were screened for these antibodies. Patients who were positive for one or more were offered an upper endoscopy to obtain distal duodenum biopsies. Histological lesions, when present, were classified using Marsh's classification. Of the 463 patients, 62 (13.4%) were positive for at least one of the three antibodies, and 42 accepted to undergo an endoscopy. Fourteen patients (3% of the DM1 patients) were histologically diagnosed with CD. Most of these patients had no symptoms of CD, although some showed laboratory findings frequent in CD. The presence of clinical or analytical data compatible with CD was independent of the grade of histological lesions. Finally, we calculated the sensitivity and positive predictive value for each antibody. The most sensitive were ATG and EMA. Because of the technical simplicity of determining ATG with ELISA, in our opinion, this test should be the option of choice for screening (AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Celiac Disease/diagnosis , Celiac Disease/epidemiology , Diabetes Mellitus, Type 1/complications , Celiac Disease/complications , PrevalenceABSTRACT
Celiac disease (CD) presents a wide clinical spectrum. There are asymptomatic or oligosymptomatic forms, which are difficult to diagnose. Since patients with untreated CD can develop severe complications, early diagnosis of these forms is important. Consequently, in groups at risk for CD, such as patients with type 1 diabetes (DM1), screening through determination of antigliadin (AGA), anti-tissue transglutaminase (ATG) and antiendomysial antibodies (EMA) is recommended. In the present study, 463 DM1 patients were screened for these antibodies. Patients who were positive for one or more were offered an upper endoscopy to obtain distal duodenum biopsies. Histological lesions, when present, were classified using Marsh's classification. Of the 463 patients, 62 (13.4%) were positive for at least one of the three antibodies, and 42 accepted to undergo an endoscopy. Fourteen patients (3% of the DM1 patients) were histologically diagnosed with CD. Most of these patients had no symptoms of CD, although some showed laboratory findings frequent in CD. The presence of clinical or analytical data compatible with CD was independent of the grade of histological lesions. Finally, we calculated the sensitivity and positive predictive value for each antibody. The most sensitive were ATG and EMA. Because of the technical simplicity of determining ATG with ELISA, in our opinion, this test should be the option of choice for screening.
Subject(s)
Celiac Disease/diagnosis , Celiac Disease/epidemiology , Diabetes Mellitus, Type 1/complications , Adolescent , Adult , Aged , Aged, 80 and over , Celiac Disease/complications , Female , Humans , Male , Middle Aged , Prevalence , Young AdultABSTRACT
Acute generalized exanthematous pustulosis (AGEP) comprises a group of eruptions characterized by several small sterile pustules over an erythematous-edematous skin. These eruptions are usually drug induced and show some characteristics that suggest an immunologic background. Treatment is based on withdrawal of the drug causing the eruption. Prognosis is generally good and the skin lesions usually resolve in a few days with characteristic postpustular pin-point desquamation. We report three cases of AGEP induced by omeprazole, a drug with a good safety profile. Some adverse cutaneous reactions have been described as secondary effects. However, to our knowledge, no cases of omeprazole-induced AGEP have previously been reported. AGEP related to other proton pump inhibitors is exceptional.
Subject(s)
Drug Eruptions/etiology , Exanthema/chemically induced , Omeprazole/adverse effects , Proton Pump Inhibitors/adverse effects , Skin Diseases, Vesiculobullous/chemically induced , Acute Disease , Aged , Aged, 80 and over , Female , Humans , Male , Middle AgedABSTRACT
La pustulosis exantemática aguda generalizada (PEAG) englobaun subgrupo de erupciones, caracterizadas por la apariciónde numerosas pústulas estériles sobre un fondo eritematosoedematoso.Generalmente, son inducidas por fármacos y suscaracterísticas indican un trasfondo inmunológico. El tratamientoconsiste en la supresión del fármaco responsable. Engeneral, el pronóstico es bueno, y la lesión cutánea se resuelveen unos pocos días, con su peculiar descamación.Presentamos 3 casos de PEAG inducidos por omeprazol, unfármaco con un excelente perfil de seguridad, entre cuyosefectos secundarios se han descrito varios tipos de lesionescutáneas, sin que hayamos encontrado en la revisión bibliográficaninguna referencia a casos de PEAG por este fármaco.La PEAG relacionada con otros inhibidores de la bombade protones es excepcional (AU)
generalized exanthematous pustulosis (AGEP) comprisesa group of eruptions characterized by several smallsterile pustules over an erythematous-edematous skin. Theseeruptions are usually drug induced and show some characteristicsthat suggest an immunologic background. Treatmentis based on withdrawal of the drug causing the eruption.Prognosis is generally good and the skin lesions usuallyresolve in a few days with characteristic postpustular pinpointdesquamation.We report three cases of AGEP induced by omeprazole, adrug with a good safety profile. Some adverse cutaneous reactionshave been described as secondary effects. However,to our knowledge, no cases of omeprazole-induced AGEPhave previously been reported. AGEP related to other protonpump inhibitors is exceptional (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Omeprazole/adverse effects , Exanthema/chemically induced , Proton Pump Inhibitors/adverse effectsABSTRACT
BACKGROUND AND OBJECTIVE: The prognosis of hepatopulmonary syndrome (HPS) has been only rarely investigated. PATIENTS AND METHOD: We investigated the survival of 32 cirrhotic patients, 14 (44%) with HPS and 18 with a normal gaseous exchange (NGE), and the associated factors. RESULTS: During a mean (standard deviation) of 56 (27) months, 9 patients in the HPS group (relative risk: 0.64) and 4 patients in the NGE group (relative risk: 0.22) died. The odds ratio was 6.42 (p < 0.01; 95% confidence interval, 0.04-0.80). Patients in the HPS group died after 44 (31) months, while patients in the NGE group died 65 (21) months after inclusion (p < 0.05). Overall, 46% of deaths were liver related. Factors associated with death were the right to left shunting and the increased plasmatic renin levels. Of note, the plasmatic volume and diffusing capacity were protective. CONCLUSIONS: The coexistence of HPS worsens the prognosis in liver cirrhosis.
Subject(s)
Hepatopulmonary Syndrome/complications , Liver Cirrhosis/complications , Female , Hepatopulmonary Syndrome/mortality , Humans , Liver Cirrhosis/mortality , Male , Middle Aged , PrognosisABSTRACT
Fundamento y objetivo: El significado pronóstico del síndrome hepatopulmonar (SHP) se ha estudiado en pocas ocasiones. Pacientes y método: Observación de la supervivencia de 32 pacientes cirróticos, 14 (44%) de ellos con SHP y 18 con intercambio gasesoso normal (IGN), y estudio de los factores asociados. Resultados: Durante una media (desviación estándar) de 56 (27) meses fallecieron 9 pacientes (riesgo relativo de 0,64) del grupo SHP y 4 (riesgo relativo de 0,22) de los pacientes con IGN (odds ratio = 6,42; p < 0,01; intervalo de confianza del 95%, 0,04-0,80). Los pacientes con SHP fallecieron una media de 44 (31) meses tras la inclusión y los pacientes con IGN, 65 (21) meses tras la inclusión (p < 0,05). No todos los fallecimientos estuvieron relacionados con enfermedad hepática o disfunción pulmonar. Los factores asociados a mortalidad fueron el grado de shunt pulmonar y los valores plasmáticos de renina, mientras que el volumen plasmático y la capacidad de difusión de monóxido de carbono fueron factores de protección. Conclusiones: El SHP empeora el pronóstico de la cirrosis hepática
Background and objective: The prognosis of hepatopulmonary syndrome (HPS) has been only rarely investigated. Patients and method: We investigated the survival of 32 cirrhotic patients, 14 (44%) with HPS and 18 with a normal gaseous exchange (NGE), and the associated factors. Results: During a mean (standard deviation) of 56 (27) months, 9 patients in the HPS group (relative risk: 0.64) and 4 patients in the NGE group (relative risk: 0.22) died. The odds ratio was 6.42 (p < 0.01; 95% confidence interval, 0.04-0.80). Patients in the HPS group died after 44 (31) months, while patients in the NGE group died 65 (21) months after inclusion (p < 0.05). Overall, 46% of deaths were liver related. Factors associated with death were the right to left shunting and the increased plasmatic renin levels. Of note, the plasmatic volume and diffusing capacity were protective. Conclusions: The coexistence of HPS worsens the prognosis in liver cirrhosis
Subject(s)
Male , Female , Humans , Hepatopulmonary Syndrome/etiology , Hepatopulmonary Syndrome/mortality , Liver Cirrhosis/complications , Liver Cirrhosis/mortality , Survival Analysis , Cohort Studies , Prognosis , SpainABSTRACT
BACKGROUND AND OBJECTIVE: The hepatopulmonary syndrome (HPS) causes an increased alveolar to arterial gradient of oxygen and in advanced phases hypoxemia, as the result of pulmonary vasodilation. In liver cirrhosis, it has been demonstrated the existence of splachnic vasodilation and also in other vascular beds. Our main objectives were to know the hemodynamic status, the renal function and the condition of some humoral systems in patient diagnosed of HPS. PATIENTS AND METHOD: We studied consecutively 32 cirrhotic patients Divided in two groups, a group of 18 cirrhotic patients with normal gaseous exchange (NGE), and another group of 14 cirrhotic patients diagnosed of HPS by contrast-enhanced transthoracic echocardiography and/or lung and brain scintigraphy with 99Tc albumin macroaggregates. They were all in rest in bed, upon alcohol and tobacco abstinence and on a diet of 50 mEq of sodium. Cardiovascular drugs were all withheld during 4 days in order to reach steady state. RESULTS: Patients of the HPS group were characterized by a more advanced index of Child-Pugh and presence of clubbing and vascular spiders. They presented a greater degree of hypoxemia in a sitting position, greater hypocapnia and smaller transference factor values (TLCO). They also showed a hyperkinetic circulatory condition characterized by smaller arterial blood pressure, greater cardiac index, smaller vascular resistances and greater femoral flows, with smaller clearance of creatinine, elimination of urinary sodium, urinary volume/24 h and an increased plasmatic volume, accompanied with a greater activation of the renin-angiotensin-aldosterone axis and a greater urinary elimination of nitrites and nitrates. CONCLUSIONS: The pulmonary vasodilation that explains the HPS is a constitutive part of the systemic vasodilation occurring in liver cirrhosis, and it is related to the degree of liver dysfunction as measured by the classification of Child-Pugh. The greater activation of the renin-aldosterone system and the rise of the plasmatic volume express a highest grade of arterial underfilling caused by an increment in the nitric oxide production.
