RESUMO
A patient with a 15 year history of diarrhoea of unknown origin is described. Scintigraphy with technetium-99m labelled albumin suggested albumin loss at the terminal ileum and caecum; subsequent colonoscopic biopsies of these macroscopically normal looking areas showed abundant infiltration with eosinophils. A diagnosis of eosinophilic enterocolitis was made. Treatment with prednisolone had good results, but had to be stopped because of severe side effects. Oral cromoglycate and mesalazine were not effective. Budesonide (CIR), a new topically active corticosteroid with very little systemic effects, was at least as effective as prednisolone without producing side effects.
Assuntos
Diarreia/diagnóstico por imagem , Enterocolite/diagnóstico por imagem , Eosinofilia/diagnóstico por imagem , Adulto , Budesonida , Diarreia/tratamento farmacológico , Enterocolite/tratamento farmacológico , Enterocolite/patologia , Eosinofilia/tratamento farmacológico , Eosinofilia/patologia , Feminino , Humanos , Pregnenodionas/uso terapêutico , Cintilografia , Agregado de Albumina Marcado com Tecnécio Tc 99mRESUMO
For 1 year we studied the role of low-dose NSAIDs, prescribed to prevent platelet aggregation, in upper gastrointestinal bleeding in our hospital. All gastroscopies performed for obvious or suspected upper gastrointestinal bleeding were registered with regard to sex, age, mode of presentation, use of NSAIDs, diagnosis and clinical outcome. Comparing the patients using 100 mg or less acetylsalicylic acid a day with those taking analgetic or antiphlogistic doses of NSAIDs, there appear to be no significant differences with regard to the bleeding sources. However, the numbers of patients are too small for statistical analysis. In our opinion it is therefore important to ask patients with an upper gastrointestinal haemorrhage not only about the use of analgetic or antiphlogistic doses of NSAIDs but also about the use of low-dose acetylsalicylic acid.
Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Hemorragia Gastrointestinal/induzido quimicamente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/mortalidade , Humanos , Incidência , Masculino , Pessoa de Meia-IdadeRESUMO
An increasing number of severe complications associated with the use of XTC is being reported. After 11 earlier case reports we describe an acute hepatitis due to occasional use of XTC in a 25-year-old woman.
Assuntos
3,4-Metilenodioxianfetamina/análogos & derivados , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Doença Hepática Induzida por Substâncias e Drogas/patologia , Drogas Desenhadas/efeitos adversos , Icterícia/induzido quimicamente , 3,4-Metilenodioxianfetamina/efeitos adversos , Doença Aguda , Adulto , Biópsia , Doença Hepática Induzida por Substâncias e Drogas/complicações , Feminino , Humanos , N-Metil-3,4-MetilenodioxianfetaminaRESUMO
Despite the fact that hepatic involvement is frequently seen in systemic amyloidosis, major clinical symptoms or impaired hepatic functional capacity are rare. We describe a patient with primary hepatic amyloidosis, severe intrahepatic cholestasis and portal hypertension, a combination previously reported only three times in the literature. In case of an unexplained intrahepatic cholestasis or portal hypertension the possibility of amyloidosis should be considered and a Congo red staining should be performed.
Assuntos
Amiloidose/complicações , Colestase Intra-Hepática/etiologia , Hipertensão Portal/etiologia , Hepatopatias/complicações , Idoso , Feminino , HumanosRESUMO
Oesophageal varices: prophylactic treatment? Patients with oesophageal varices as a result of liver cirrhosis are at risk of bleeding from these varices. Because of the high mortality, specially from the first variceal haemorrhage, it would seem justified to pose the question: does prophylactic treatment of oesophageal varices reduce the risk of bleeding and improve life expectancy? A review of the literature shows that until now no mode of prophylactic therapy has succeeded in accomplishing these goals. It is not, therefore, possible at this time to advise the use of prophylactic treatment of oesophageal varices as a routine therapy.
Assuntos
Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/prevenção & controle , Antagonistas Adrenérgicos beta/uso terapêutico , Varizes Esofágicas e Gástricas/mortalidade , Estudos de Avaliação como Assunto , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Humanos , Cirrose Hepática Alcoólica/complicações , Derivação Portocava Cirúrgica , Prognóstico , EscleroterapiaRESUMO
Serial abdominal scanning after the oral administration of sucralphate-99mTc was performed in order to determine the extent of active inflammatory bowel disease in 15 patients with Crohn's disease and in 8 patients with ulcerative colitis. Scintigraphic data were compared with those obtained by endoscopy and radiology in all patients. True positive scans were obtained in 6 (40%) patients with Crohn's disease and in 3 (38%) patients with ulcerative colitis. Overall, sensitivity was higher in colonic disease than that in ileal disease. In 4 (17%) patients, false negative scans were obtained and in the remaining 10 (44%) patients, localisation of the inflammatory bowel disease by the isotope was completely inaccurate. Since sensitivity of the sucralphate-99mTc scintigraphy appears to be low, its widespread use in the screening for inflammatory bowel disease or in assessing the extent of disease involvement cannot be advocated at this moment.
