Asunto(s)
Bezoares , Duodeno , Intususcepción/diagnóstico , Estómago , Bezoares/diagnóstico , Bezoares/diagnóstico por imagen , Bezoares/cirugía , Preescolar , Diagnóstico Diferencial , Enfermedades Duodenales/diagnóstico , Duodenoscopía , Femenino , Cuerpos Extraños , Gastroscopía , Gastrostomía , Humanos , Intususcepción/diagnóstico por imagen , Radiografía Abdominal , Síndrome , UltrasonografíaRESUMEN
BACKGROUND: In patients with cirrhosis, pharmacologic or endoscopic treatment may control variceal bleeding. However, the effects of early administration of a somatostatin analogue followed by endoscopic treatment are unknown. METHODS: We studied the effects of treatment with vapreotide, a somatostatin analogue, begun before endoscopic treatment in 227 patients with cirrhosis who were hospitalized for acute upper gastrointestinal bleeding. The patients were randomly assigned to receive vapreotide (a 50-microg intravenous bolus followed by an infusion at a rate of 50 microg per hour for five days) or placebo within a mean (+/-SD) of 2.3+/-1.5 hours after admission. All the patients received endoscopic treatment a mean of 2.6+/-3.3 hours after the infusion was begun. After the exclusion of 31 patients whose bleeding was not caused by portal hypertension, there were 98 patients in each group. RESULTS: At the time of endoscopy, active bleeding was evident in 28 of 91 patients in the vapreotide group (31 percent), as compared with 43 of 93 patients in the placebo group (46 percent) (P=0.03). During the five-day infusion, the primary objective--survival and control of bleeding--was achieved in 65 of 98 patients in the vapreotide group (66 percent) as compared with 49 of 98 patients in the placebo group (50 percent) (P=0.02). The patients in the vapreotide group received significantly fewer blood transfusions (2.0+/-2.2 vs. 2.8+/-2.8 units, P=0.04). Overall mortality rates at 42 days were not significantly different in the two groups. CONCLUSIONS: In patients with cirrhosis and variceal bleeding, the combination of vapreotide and endoscopic treatment is more effective than endoscopic treatment alone as a method of controlling acute bleeding. However, the use of combination therapy does not affect mortality rates at 42 days.
Asunto(s)
Várices Esofágicas y Gástricas/tratamiento farmacológico , Hemorragia Gastrointestinal/tratamiento farmacológico , Cirrosis Hepática/complicaciones , Somatostatina/análogos & derivados , Somatostatina/uso terapéutico , Transfusión Sanguínea , Terapia Combinada , Endoscopía , Várices Esofágicas y Gástricas/etiología , Várices Esofágicas y Gástricas/mortalidad , Várices Esofágicas y Gástricas/terapia , Femenino , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/mortalidad , Hemorragia Gastrointestinal/terapia , Humanos , Hipertensión Portal/complicaciones , Cirrosis Hepática/mortalidad , Masculino , Persona de Mediana Edad , Análisis Multivariante , Escleroterapia , Prevención SecundariaAsunto(s)
Colecistectomía/efectos adversos , Enfermedades del Conducto Colédoco/etiología , Enfermedades del Conducto Colédoco/cirugía , Tuberculosis Hepática/diagnóstico , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Constricción Patológica/etiología , Constricción Patológica/cirugía , Femenino , Humanos , Tuberculosis Hepática/etiología , Tuberculosis Pulmonar/complicacionesRESUMEN
The authors report a patient with concomitant Sjögren's syndrome and chronic hepatitis C. Close associations between autoimmune liver disease, chronic hepatitis C, and Sjögren's syndrome have been demonstrated. The most likely hypothesis involves triggering of an autoimmune cascade by the hepatitis C virus. Prevalence of hepatitis C virus infection in patients with Sjögren's syndrome and potential therapeutic implications of this disease combinations remain to be determined.
