RESUMO
En muchas ocasiones la posibilidad de que una intoxicación aguda tenga una buena evolución viene condicionada por las medidas terapéuticas que se realicen en los primeros minutos. Dichas medidas son básicamente de tres tipos: soporte vital, técnicas encaminadas a impedir la absorción del tóxico y favorecer la eliminación del ya absorbido, y la administración de antídotos. En los últimos años se ha puesto en duda la eficacia de las técnicas de descontaminación gástrica cuando el tiempo transcurrido tras la ingestión del tóxico es mayor de una hora. Esto hace que en un gran número de pacientes intoxicados sólo sea posible su realización en el contexto de Atención Primaria ya que es únicamente en este nivel asistencial donde es posible atenderlos con un margen de tiempo menor del referido. Por otra parte, también es necesario plantearse cuál es el arsenal de antídotos del que se debe disponer en el ámbito de la asistencia primaria (AU)
Assuntos
Humanos , Intoxicação/terapia , Atenção Primária à Saúde , Carvão Vegetal/uso terapêutico , Esvaziamento Gástrico , Lavagem Gástrica , Antídotos/uso terapêutico , Antídotos/classificação , Intoxicação/classificaçãoRESUMO
A review was made of 60 angiodysplasias of the colon (AD) found retrospectively among 2,750 colonoscopies. The most frequent clinical manifestation was rectal bleeding (65%); mean patient age was 63 years. More than a fourth of the angiodysplasias (26.6%) was located in the left colon, as compared to 66.6% in the cecum and ascending colon. Most of the lesions were multiple and less than 5 mm in diameter. Twenty-two percent of the patients were cirrhotics and 15% had an aortic valvular lesion. The most outstanding aspects of the process are reviewed.
Assuntos
Malformações Arteriovenosas/diagnóstico , Colo/irrigação sanguínea , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/patologia , Colonoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
We present 13 patients with 15 episodes of colonic volvulus, who underwent colonoscopy to decompress and/or devolvulate. Colonoscopic exploration demonstrated a non obstructive dilatation in three cases. In the remaining 10 patients, with 12 episodes of volvulus, decompression was obtained in 83.3% and devoluvulation in 41.6%. There were two failures, due to peritoneal metastases and adhesions which fixed the volvulus. In 40% of the cases there were mild ischemic signs. Forty per cent of the patients were submitted to elective surgery and the two failures (20%) were operated in emergency. The remaining 4 patients declined surgical treatment. At is allows differential diagnosis, we think that, for these patients, colonoscopy should be the first therapeutic approach; it also allows decompression and/or devolvulation and an early diagnosis of the associated ischemia.
Assuntos
Doenças do Colo/terapia , Colonoscopia , Obstrução Intestinal/terapia , Doenças do Colo Sigmoide/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Colo/diagnóstico , Diagnóstico Diferencial , Dilatação Patológica/diagnóstico , Dilatação Patológica/terapia , Humanos , Obstrução Intestinal/diagnóstico , Pessoa de Meia-Idade , Doenças do Colo Sigmoide/diagnósticoRESUMO
The effects of a new angiotensin I-converting enzyme inhibitor (ACEI), enalapril via sublingual was studied in 16 patients (median age 60.5 +/- 8.7 years). 10 were female and 6 male with hypertension crisis defined as systolic pressure (SP) greater than or equal to 220 mmHg and/or diastolic pressure greater than or equal to 120 mmHg (DP). We observed a significant decrease of SP and DP 20 min after the enalapril administration, without affecting the cardiac rate (p less than 0.001). This decrease was maintained during 30 and 60 min (p less than 0.001). Secondary effects were not observed. We concluded that sublingual enalapril can be a useful drug in hypertension crisis when not an urgent life compromising situation in elderly patients, because of its gradual hypotensive and maintained effect, allowing the commencement of an oral treatment.
Assuntos
Enalapril/administração & dosagem , Hipertensão/tratamento farmacológico , Doença Aguda , Administração Sublingual , Idoso , Pressão Sanguínea/efeitos dos fármacos , Determinação da Pressão Arterial , Avaliação de Medicamentos , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
In a review of our experience with the extraction of foreign bodies using the fiberendoscope in 57 patients who ingested true foreign bodies and had food bolus impaction, we found 17 of the foreign bodies to be big metallic wires. The extraction technique used and the complications as a result of the object or the technique are given herein.
