RESUMO
Five patients with primary antibody deficiency were investigated because of intermittent but persistent diarrhoea of several years duration despite immunoglobulin replacement therapy. We found no evidence of Giardia lambia or other intestinal pathogens to explain their gastrointestinal symptoms. All five had definite radiological evidence of small bowel Crohn's disease and three had histological specimens available with abnormalities consistent with Crohn's disease. One patient had a non-caseating granuloma in an oral ulcer. A second patient with stricturing disease in the small bowel had a mucosal inflammatory infiltrate with non-caseating granulomas. A third had transmural inflammation but no granulomas. All five patents were diagnosed as having Crohn's disease and have responded symptomatically to steroid therapy.
Assuntos
Doença de Crohn/imunologia , Síndromes de Imunodeficiência/imunologia , Adulto , Doença de Crohn/tratamento farmacológico , Diagnóstico Diferencial , Diarreia/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esteroides/uso terapêuticoRESUMO
A total of 124 subjects who were undergoing routine endoscopy were randomly assigned to one of three groups. All three groups received lignocaine throat spray. The first group additionally received midazolam, the second received hypnosis, whilst the third only received lignocaine throat spray. Although hypnotized patients were deemed by an independent observer to be less agitated than the other two groups (p < 0.03), they reported the gastroscopy to be significantly more uncomfortable (p < 0.042) and scored higher in their memory for the procedure (p < 0.001). They also took slightly longer to induce than the midazolam group. The midazolam group on the other hand rated the procedure as significantly more comfortable although paradoxically were seen by an independent observer as being more agitated. They were also significantly more amnesic. The endoscopist encountered more procedural difficulties with this group but this did not reach levels of significance. Hypnosis was not shown to be an effective alternative to intravenous sedation in gastroscopy.
Assuntos
Gastroscopia/métodos , Hipnose Anestésica , Hipnóticos e Sedativos , Midazolam , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais , Feminino , Gastroscopia/psicologia , Humanos , Hipnose Anestésica/métodos , Lidocaína , Masculino , Pessoa de Meia-IdadeRESUMO
This article covers the causes of haematemesis, discusses how to resuscitate the patient and addresses the gastroenterologist's approach to commonly encountered causes of haematemesis such as peptic ulcers and oesophageal varices.
