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1.
Rev. méd. Maule ; 38(1): 71-76, jun. 2023. ilus
Artigo em Espanhol | LILACS | ID: biblio-1562384

RESUMO

The biliary pathology, is undoubtedly one of the most frequent surgical pathologies in Chile, statistical data establish the incidence of biliary pathology in over 20 years 30% of women have biliary lithiasis, of these 10% will present some complication as it is coledocolithiasis. On the other hand, hepatic fascioliasis or dystomatosis is a disease caused by hepatic fasciola, or duela, sabuaypé or Distomun hepaticum, corresponds to a flatworm, trematode of the digenea class, with affinity to stay in liver tissue, which when performing the biological cycle of the parasite can be the cause of choledocholithiasis, cholecystitis, cholangitis, pancreatitis, among others. We present a clinical case of chronic intracholedocianfasciolitis diagnosed by ERCP3,4. METHODS: Descriptive observational study, in addition to a systematic review in databases such as Pub-Med/MEDLINE, Elsevier, Cochrane and manually through the Internet in journals and public bodies. This work seeks to collect information from different authors regarding its incidence, management and established treatments. RESULTS: Inclusion and exclusion criteria were defined to analyze the characteristics of the selected articles. We present the clinical case of a 47-year-old female patient, with a history of hypertension, type 2 diabetes mellitus and egg allergy who went to the Emergency Department due to a picture characterized by epigastralgia of 3 days of evolution. During endoscopic retrograde cholangio-pancreatography (ERCP), 2 suggestive images of lyte are seen inside that finally result in 2 apparent live parasites.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Doenças do Ducto Colédoco/parasitologia , Doenças do Ducto Colédoco/diagnóstico por imagem , Endossonografia/métodos , Fasciolíase/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica/métodos , Doenças do Ducto Colédoco/tratamento farmacológico , Técnicas de Laboratório Clínico , Fasciola hepatica , Fasciolíase/tratamento farmacológico
2.
Cancer Res Treat ; 53(2): 424-435, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33171024

RESUMO

PURPOSE: This study evaluated the efficacy of adjuvant chemotherapy (AC) in patients with resected ampulla of Vater (AoV) carcinoma. MATERIALS AND METHODS: Data from 646 patients who underwent surgical resection at Asan Medical Center between 2000 and 2017 were retrospectively reviewed. RESULTS: The median age of the patients was 62 years, and 54.2% were male. Patients were classified into AC group (n=165, 25.5%) and no AC group (n=481, 74.5%). With a median follow-up duration of 88 months, in patients with stage I, II, III, median recurrence-free survival (RFS) was not reached, 44 months, and 15 months, respectively, and the median overall survival (OS) were not reached, 88 months and 35 months, respectively. Despite no statistical significance, RFS and OS were better in stage II patients with AC than in those without AC (median RFS, 151 months vs. 38 months; p=0.156 and median OS, 153 months vs. 74 months; p=0.299). In multivariate analysis for RFS and OS, TNM stage, R1 resection status, presence of lymphovascular invasion, and perineural invasion remained significant factors, whereas AC (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.54 to 1.00; p=0.052) was marginally related with RFS. After propensity score matching in only stage II/III patients, RFS and OS with AC were numerically longer than those without AC (HR, 0.80; 95% CI, 0.60 to 1.06; p=0.116 and HR, 0.77; 95% CI, 0.56 to 1.06; p=0.111). CONCLUSION: AC with fluoropyrimidine did not improve survival of patients with resected AoV carcinoma. However, multivariate analysis with prognostic factors showed a marginally significant survival benefit with AC.


Assuntos
Ampola Hepatopancreática/patologia , Carcinoma/tratamento farmacológico , Doenças do Ducto Colédoco/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/mortalidade , Carcinoma/patologia , Doenças do Ducto Colédoco/mortalidade , Doenças do Ducto Colédoco/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida
3.
Indian J Tuberc ; 65(3): 266-267, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29933873

RESUMO

Localized hepatic tuberculosis (TB) with or without bile duct involvement is a rare form of hepatobiliary tuberculosis; accounting for less than 1% of all tuberculous infections. We report an uncommon case of cholestatic jaundice with disseminated TB in an immunocompetent male who presented with simultaneous involvement of liver and biliary system.


Assuntos
Doenças do Ducto Colédoco/diagnóstico , Tuberculose Hepática/diagnóstico , Antituberculosos/uso terapêutico , Biópsia por Agulha Fina , Colestase/etiologia , Doenças do Ducto Colédoco/complicações , Doenças do Ducto Colédoco/diagnóstico por imagem , Doenças do Ducto Colédoco/tratamento farmacológico , Constrição Patológica/complicações , Constrição Patológica/diagnóstico , Diagnóstico Diferencial , Humanos , Icterícia/etiologia , Masculino , Tuberculose Hepática/complicações , Tuberculose Hepática/tratamento farmacológico , Tuberculose Hepática/patologia , Adulto Jovem
8.
BMJ Case Rep ; 20142014 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-25432915

RESUMO

Temozolomide, an oral alkylating agent, is used in the treatment of glioblastoma. We describe a case of a 62-year-old woman developing jaundice with significant derangement of liver function tests on day 17 of focal radiotherapy with concomitant temozolomide. There was no structural abnormality on imaging and liver biopsy was performed. Pathology revealed absence of small terminal bile ducts affecting up to 60% of sampled portal tracts and senescence of many of the remaining small bile ducts, in keeping with a diagnosis of acute vanishing bile duct syndrome. This is a rare syndrome. It has been documented in association with Hodgkin's lymphoma and viral causes. Drugs implicated as precipitating this condition include antiseizure medications, some antibiotics, ibuprofen and antifungals. Temozolomide was stopped. The patient received supportive care, ursodeoxycholic acid 750 mg daily and cholestyramine 4 g twice daily. She was otherwise asymptomatic and her blood results returned to normal by day 129.


Assuntos
Antineoplásicos Alquilantes/efeitos adversos , Neoplasias Encefálicas/tratamento farmacológico , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Doenças do Ducto Colédoco/induzido quimicamente , Dacarbazina/análogos & derivados , Glioblastoma/tratamento farmacológico , Antineoplásicos Alquilantes/uso terapêutico , Biópsia por Agulha , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirurgia , Doença Hepática Induzida por Substâncias e Drogas/patologia , Resina de Colestiramina/uso terapêutico , Doenças do Ducto Colédoco/tratamento farmacológico , Doenças do Ducto Colédoco/patologia , Dacarbazina/efeitos adversos , Dacarbazina/uso terapêutico , Feminino , Seguimentos , Glioblastoma/diagnóstico , Glioblastoma/cirurgia , Humanos , Imuno-Histoquímica , Icterícia/diagnóstico , Icterícia/etiologia , Testes de Função Hepática , Pessoa de Meia-Idade , Síndrome , Temozolomida , Resultado do Tratamento , Ácido Ursodesoxicólico/uso terapêutico
9.
Eur Rev Med Pharmacol Sci ; 17(10): 1305-10, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23740441

RESUMO

INTRODUCTION: Cholestatic liver diseases are characterized by impaired hepatocellular secretion of bile, resulting in intracellular accumulation of bile acids which result in a shift in the oxidant/prooxidant balance in favor of increased free radical activity and injury of different tissues including liver and intestine. The aim of this research was to study protective effect of lipoic acid (LA) as a potent antioxidant in cholestsis induced hepatic and intestinal injury in rats. MATERIALS AND METHODS: Forty five adult male Wistar rats were randomly assigned to four groups each containing fifteen rats as follows: sham operation (SO) (control), bile duct ligating (BDL), and BDL+LA (25 mg/kg). After fourteen days hepatic and intestinal tissue sampled and blood serum sampled for pathologic and biochemical studies. RESULTS: Levels of SOD and GPx antioxidant enzymes were higher in BDL+LA group comparing to BDL group, levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ-glutamyltranspeptidase (GGT), and pathologic scores in liver and intestine were lower in BDL+LA group comparing to BDL group significantly, but there is no significant difference in concentrations of total bilirubin between groups. CONCLUSIONS: Our results showed the protective potential of LA with liver and intestine damage. Despite improvements in operative technique and the development of potent, broad-spectrum antibiotics, biliary tract surgery in patients with obstructive jaundice is still associated with high morbidity and mortality rates In summary, our results show that BDL induced hepatic and intestinal injury were significantly attenuated by LA administration and the administration of LA could effectively diminish this damage.


Assuntos
Antioxidantes/uso terapêutico , Colestase/tratamento farmacológico , Doenças do Ducto Colédoco/tratamento farmacológico , Intestinos/patologia , Fígado/patologia , Ácido Tióctico/uso terapêutico , Animais , Colestase/patologia , Doenças do Ducto Colédoco/patologia , Glutationa Peroxidase/metabolismo , Peroxidação de Lipídeos/efeitos dos fármacos , Masculino , Ratos , Ratos Wistar , Superóxido Dismutase/metabolismo
10.
Int J Rheum Dis ; 16(1): 93-7, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23441778

RESUMO

We describe a 42-year-old man who presented with painless obstructive jaundice, organomegaly and lymphadenopathy. Biopsy of the ampulla of Vater revealed the presence of increased populations of plasma cells which stained positively for immunoglobulin G4. He was treated with prednisolone and demonstrated significant clinical improvement 1 month later. A further case is described and a review of the literature is also provided.


Assuntos
Doenças Autoimunes/diagnóstico , Doenças do Ducto Colédoco/patologia , Hipergamaglobulinemia/diagnóstico , Imunoglobulina G/sangue , Transtornos Linfoproliferativos/diagnóstico , Esclerose/diagnóstico , Adulto , Ampola Hepatopancreática/metabolismo , Ampola Hepatopancreática/patologia , Doenças Autoimunes/tratamento farmacológico , Doenças Autoimunes/imunologia , Doenças do Ducto Colédoco/tratamento farmacológico , Doenças do Ducto Colédoco/imunologia , Diagnóstico Diferencial , Glucocorticoides/uso terapêutico , Humanos , Hipergamaglobulinemia/tratamento farmacológico , Hipergamaglobulinemia/imunologia , Icterícia Obstrutiva/diagnóstico , Icterícia Obstrutiva/tratamento farmacológico , Icterícia Obstrutiva/imunologia , Doenças Linfáticas/diagnóstico , Doenças Linfáticas/tratamento farmacológico , Doenças Linfáticas/imunologia , Transtornos Linfoproliferativos/tratamento farmacológico , Transtornos Linfoproliferativos/imunologia , Masculino , Plasmócitos/metabolismo , Plasmócitos/patologia , Prednisolona/uso terapêutico , Esclerose/tratamento farmacológico , Esclerose/imunologia , Resultado do Tratamento
15.
Intern Med ; 48(12): 945-52, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19525579

RESUMO

OBJECTIVE: To evaluate the effects of localized irrigation with epinephrine saline after endoscopic retrograde cholangiopancreatography (ERCP). PATIENTS AND METHODS: One hundred and fourteen patients who underwent ERCP in our institute were treated with or without irrigation using epinephrine diluted in saline after ERCP to prevent post-ERCP pancreatitis. The serum amylase levels, white blood cell counts, and urine amylase levels were measured at 24 and 48 hours after ERCP. RESULTS: The treatment resulted in improvements in all items. A univariate analysis of the explanatory variables between the treatment and untreated groups revealed the treatment to be effective, but not statistically significant. Gender and cannulation of the pancreatic duct were the only variables with significant partial regression coefficients in the multiple regression model with all explanatory variables (p=0.045). When a stratified analysis was conducted using gender as a moderator variable, the treatment became a significant preventive factor (p=0.038), and cannulation of the pancreatic duct was a significant risk factor (p=0.027) in female patients. CONCLUSION: We suggest that irrigating with epinephrine saline into the papilla may be effective for preventing pancreatitis in female patients who received ERCP with cannulation of their pancreatic duct.


Assuntos
Agonistas Adrenérgicos/uso terapêutico , Ampola Hepatopancreática/patologia , Amilases/sangue , Colangiopancreatografia Retrógrada Endoscópica , Doenças do Ducto Colédoco/tratamento farmacológico , Edema/tratamento farmacológico , Epinefrina/uso terapêutico , Agonistas Adrenérgicos/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Doenças do Ducto Colédoco/sangue , Doenças do Ducto Colédoco/patologia , Edema/sangue , Edema/patologia , Epinefrina/administração & dosagem , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pancreatite/prevenção & controle , Análise de Regressão , Estudos Retrospectivos , Irrigação Terapêutica , Resultado do Tratamento
18.
Gastrointest Endosc ; 69(6): 1111-6, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19243765

RESUMO

BACKGROUND: The therapeutic approach in patients with sphincter of Oddi (SO) dysfunction (SOD) aims to reduce the resistance to the flow of bile or pancreatic juice. Vardenafil inhibits the activity of phosphodiesterase type 5 (PDE-5), which degrades cyclic guanossine monophosphate (cGMP) and results in relaxation of smooth muscle. OBJECTIVE: The present study was performed to determine the effects of vardenafil on SO motility in patients with suspected SOD. DESIGN: Prospective study. SETTINGS: Single university center. PATIENTS AND INTERVENTIONS: Twenty consecutive adult patients with suspected SOD were scheduled to undergo ERCP and SO manometry by standard methods. A second recording was performed in the same position 20 minutes after administration of 10 mg vardenafil dissolved in 10 mL saline solution into the duodenum through a conventional catheter. SO pressures and motor function were compared in all patients with suspected SOD before and after administration of vardenafil. RESULTS: After administration of 10 mg of vardenafil, the mean basal sphincter pressure was reduced from 59.5 to 26.9 mm Hg (P < .001), and the mean phasic amplitude was reduced from 132.2 to 66.2 mm Hg (P < .001). The mean phasic wave frequency was not changed after administration of vardenafil (7.2/min vs 6.6/min, respectively, P = .07). These results did not differ between SOD types. No significant difference in manometric data were detected before and after administration of vardenafil between cholecystectomy and gallbladder in situ groups. Transient headache was observed in 1 patient, and the procedure-related complication was post-ERCP pancreatitis (n = 2 [10%]). LIMITATIONS: The small sample size and uncontrolled study. CONCLUSION: Vardenafil inhibits SO motility in patients with suspected SOD and reduces basal SO pressure, without significant adverse effects.


Assuntos
Doenças do Ducto Colédoco/tratamento farmacológico , Imidazóis/uso terapêutico , Inibidores da Fosfodiesterase 5 , Inibidores de Fosfodiesterase/uso terapêutico , Piperazinas/uso terapêutico , Esfíncter da Ampola Hepatopancreática/efeitos dos fármacos , Vasodilatadores/uso terapêutico , Administração Tópica , Adulto , Idoso , Colangiopancreatografia Retrógrada Endoscópica , Constrição Patológica/tratamento farmacológico , Feminino , Humanos , Imidazóis/efeitos adversos , Masculino , Manometria , Pessoa de Meia-Idade , Inibidores de Fosfodiesterase/efeitos adversos , Piperazinas/efeitos adversos , Síndrome Pós-Colecistectomia/tratamento farmacológico , Estudos Prospectivos , Esfinterotomia Endoscópica , Sulfonas/efeitos adversos , Sulfonas/uso terapêutico , Triazinas/efeitos adversos , Triazinas/uso terapêutico , Dicloridrato de Vardenafila , Vasodilatadores/efeitos adversos
20.
Pancreas ; 35(4): e51-60, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18090232

RESUMO

OBJECTIVES: To evaluate the clinical significance of a swollen main duodenal papilla and the associated immunohistopathologic findings in patients with autoimmune pancreatitis (AIP). METHODS: Seventeen consecutive patients with AIP registered between April 2001 and October 2005 who underwent both endoscopic retrograde cholangiopancreatography and endoscopic biopsy were enrolled in this study. The endoscopic features, stromal inflammatory cell infiltrate (SICI), and results of immunohistochemical examination of the duodenal papilla using IgG4, CD3, and CD79a antibodies were retrospectively reviewed. These findings in the AIP patients were compared with those in 12 patients with chronic alcoholic tumor-forming pancreatitis (CAP). The numbers of cells in the SICI and of IgG4-positive plasma cells per high-power field were counted in all the histopathologic specimens. RESULTS: A swollen main duodenal papilla was observed in 11 (11 [64.7%]/17) patients with AIP and 4 (4 [33.3%]/12) patients with CAP (P < 0.05). Resolution of the swollen main duodenal papilla was observed in all of these 11 patients with AIP (11 [100%]/11) in response to treatment with corticosteroids. On the other hand, the 6 patients without elevated serum IgG4 or a swollen duodenal papilla, but with a swollen pancreas, improved even without corticosteroid treatment. The number of cells in the SICI in the AIP patients was significantly higher than that in the CAP patients. Although in 13 of 17 AIP patients, infiltration by IgG4-positive plasma cells was detected in the duodenal papilla, no such significant infiltration of the duodenal papilla by IgG4-positive plasma cells was observed in the patients with CAP (P < 0.05). More predominant T-cell infiltration of the duodenal papilla was recognized in the AIP patients than in the CAP patients (P < 0.05). CONCLUSIONS: These results suggest that a swollen main duodenal papilla with IgG4-positive plasma cell and T-cell-dominant infiltration and an abundant stromal cell infiltrate are characteristic findings in AIP. We suggest that these findings may be valuable adjuncts to the diagnosis of AIP as well as for selecting suitable candidates for corticosteroid therapy.


Assuntos
Ampola Hepatopancreática/patologia , Doenças Autoimunes/patologia , Doenças do Ducto Colédoco/patologia , Pancreatite Alcoólica/patologia , Pancreatite Crônica/patologia , Pancreatite/patologia , Corticosteroides/uso terapêutico , Idoso , Ampola Hepatopancreática/imunologia , Anti-Inflamatórios/uso terapêutico , Doenças Autoimunes/tratamento farmacológico , Doenças Autoimunes/imunologia , Complexo CD3/análise , Antígenos CD79/análise , Colangiopancreatografia Retrógrada Endoscópica , Doenças do Ducto Colédoco/tratamento farmacológico , Doenças do Ducto Colédoco/imunologia , Feminino , Humanos , Imunoglobulina G/análise , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Pancreatite/tratamento farmacológico , Pancreatite/imunologia , Pancreatite Alcoólica/tratamento farmacológico , Pancreatite Alcoólica/imunologia , Pancreatite Crônica/tratamento farmacológico , Pancreatite Crônica/imunologia , Seleção de Pacientes , Plasmócitos/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Células Estromais/patologia , Linfócitos T/patologia , Resultado do Tratamento
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