RESUMO
Pneumatic dilation (PD) has been widely used in the treatment of idiopathic achalasia with a 70-90% response. The aim of this study was to evaluate the effectiveness of PD and its predictive factors by means of clinical assessment. In addition, we evaluated its safety and the need for subsequent surgical intervention. Fifty-six patients were treated with a Witzel dilator. The response was evaluated at medium (1-5 years) and long term (>5 years). Diverse possible predictive factors to response were analyzed. After the first PD, 85.7% of the 56 patients improved and passed from clinical stage II-III to clinical stage 0-I (P < 0.005). After the second dilation, 84.6% of the patients (13) passed to clinical stage 0-I (P < 0.05). Only patients who were not young (>40 years) avoided a second dilation and/or surgery (P < 0.001). During the first 5 years of follow-up, 80% of patients maintained their response; this percentage decreased to 58% after 10 years. PD therapy of achalasia is a safe technique, with few adverse effects (4% perforations and 10% gastroesophageal reflux). It offers a medium-term response of 80% and long-term response of around 60%. Age was the only predictive response factor.
Assuntos
Cateterismo , Acalasia Esofágica/terapia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cateterismo/efeitos adversos , Acalasia Esofágica/diagnóstico , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Estudos Prospectivos , Retratamento , Resultado do TratamentoRESUMO
INTRODUCTION: To evaluate the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) and the complication rates of this procedure in patients aged 90 years and older. PATIENTS AND METHOD: A descriptive, prospective study including 42 endoscopic procedures performed from first January 2001 until first June 2004 in 36 patients (7 males and 29 females) was performed. The mean age was 91 years (range 90-96 years). All patients underwent the following: a) clinical evaluation before and after endoscopic exploration; b) evaluation of the success or failure of the endoscopic procedure and c) assessment of complications (perforation, hemorrhage, pancreatitis and infection). Concurrent associated illnesses, as well as the existence of anatomical alterations in Vaters papilla (duodenal diverticula), were also evaluated. RESULTS: ERCP was successful in 85.7% of all explorations performed. Twenty-three patients (63.8%) had one or more major associated diseases. In 15 patients (33.3%) Vaters papilla was associated with duodenal diverticula. The complication rates were as follows: 1) acute pancreatitis in 2 explorations (4.7%), one mild (2.35%) and the other moderate (2.35%); 2) hemorrhage after endoscopic sphincterotomy in 2.8% of patients (1/35); 3) bacteriemia in one patient (2.3%) and cholangitis in one patient (2.3%), with no cases of secondary cholecystitis; 4) hypoxemia in one patient. There were no perforations or deaths related to the procedure. CONCLUSION: ERCP is a safe and effective technique with a low complication rate in patients aged 90 years or older.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologiaRESUMO
AIM: To investigate the role of colonoscopy in the follow-up of patients undergoing curative resection of colorectal cancer. MATERIAL AND METHODS: A prospective study was performed of 102 patients with colorectal cancer who underwent surgery with curative intention. Postoperative colonoscopic follow-up was a minimum of 5 years. RESULTS: There were 62 males and 40 females. The mean duration of follow-up was 73.4 months. Synchronous polyps were found in 44.1% (114 in 45 patients) and metachronous polyps in 33.4% (64 in 34 patients). Synchronous carcinoma was detected in 7.8% (9 in 8 patients), metachronous carcinoma in 1.9% (2 in 2 patients) and suture recurrence in 4.9% (5 in 5 patients). Metachronous polyps developed in 55.5% of the patients with synchronous polyps and in only 15.8% of those with no synchronous polyps (p < 0.00005); the odds ratio was 6.67. Colonoscopy diagnosed 92 synchronous polyps and 64 metachronous polyps; of these, 34 were found to be significant(in 22 patients). Colonoscopy diagnosed 5 synchronous carcinomas; in 3 of these (polyps with non-invasive carcinoma) polypectomy constituted definitive therapy and in the remaining 2, curative resection was achieved. Colonoscopy diagnosed 2 stage C2 metachronous carcinomas at 63 and 94 months. Curative resection was achieved in both cases. Colonoscopic follow-up diagnosed 2 suture recurrences and resection was potentially curative. CONCLUSIONS: Colonoscopy was found to play an essential role in 30% of the patients. The technique allowed the early diagnosis of synchronous carcinomas and curative treatment of metachronous carcinomas and demonstrated that the presence of synchronous polyps increases the risk of developing metachronous polyps.
Assuntos
Colonoscopia , Neoplasias Colorretais/diagnóstico , Pólipos Intestinais/diagnóstico , Pólipos Adenomatosos/diagnóstico , Pólipos Adenomatosos/patologia , Pólipos Adenomatosos/cirurgia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Feminino , Seguimentos , Humanos , Pólipos Intestinais/patologia , Pólipos Intestinais/cirurgia , Masculino , Estadiamento de Neoplasias , Estudos ProspectivosRESUMO
Magnetic resonance cholangiopancreatography (MRCP) is a new noninvasive technique to examine the biliopancreatic tract that have a high diagnostic accuracy. Thus it becomes an appealing modality that can avoid invasive approaches. The purpose of this study was to evaluate the sensitivity and specificity of MRCP in comparison to endoscopic retrograde cholangiopancreatography (ERCP). We studied 41 patients (24 male, 17 female), median age 64.2 years (range 20 to 86 years), in which MRCP and later ERCP were performed; results of both techniques were compared. In the assessment of biliary tract (n = 39), sensitivity/specificity was 100/94.4% in normal bile ducts (n = 18); 100/100% in choledocholithiasis (n = 13); 100/100% in sphincter of Oddi dysfunction (n = 2), and 100/83.3% in neoplasm (3 ampullary tumors, 2 cholangiocarcinomas). In the evaluation of pancreatic duct (n = 32), sensitivity/specificity was 100/95.8% in normal pancreatic duct (n = 23); 80/100% in chronic pancreatitis (n = 5), and 100/75% in pancreatic carcinoma (n = 3). MRCP has very high sensitivity and specificity in the evaluation of the biliary and pancreatic ducts, and can avoid to perform purely diagnostic ERCP, although further studies are required to better assess the effectiveness of the technique.
Assuntos
Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/diagnóstico , Ductos Biliares/anatomia & histologia , Colangiocarcinoma/diagnóstico por imagem , Colangiocarcinoma/diagnóstico , Colangiopancreatografia Retrógrada Endoscópica , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/diagnóstico , Imageamento por Ressonância Magnética , Pancreatopatias/diagnóstico por imagem , Pancreatopatias/diagnóstico , Ductos Pancreáticos/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ampola Hepatopancreática , Ductos Biliares Intra-Hepáticos , Neoplasias do Ducto Colédoco/diagnóstico , Neoplasias do Ducto Colédoco/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To investigate whether omeprazole has improved morbidity-mortality among patients with upper gastrointestinal bleeding of non-variceal origin in comparison with ranitidine. MATERIAL AND METHODS: Prospective, randomized and open study. We study 519 consecutive patients admitted to our Service between June 1991 and January 1993 for upper gastrointestinal bleeding of peptic origin, dividing the patients into two randomized groups that were homogeneous in terms of age, sex, previous history of gastric disease and upper gastrointestinal bleeding, intake of non-steroidal antiinflammatory drugs, and the severity of bleeding on admittance. Thus, Group A consisted of 252 patients treated immediately upon arrival at the emergency ward with 50 mg intravenous ranitidine, followed by a further 50 mg every 6 hours. Group B in turn consisted of 267 patients initially given a bolus dose of 80 mg omeprazole intravenously, followed by an additional 40 mg every 8 hours for 48 hours. Forty mg were subsequently administered every 12 hours until hospital discharge. Endoscopy was performed in all cases within the first 24 hours following admittance, those patients with active upper gastrointestinal bleeding resulted from Forrest-type ulcer of subjected to endoscopic sclerotherapy were excluded. RESULTS: Duodenal ulcer was the most common cause of bleeding, followed by gastric ulcer and acute lesions of the mucosa. Emphasis should be placed on the high incidence of previous non-steroidal antiinflammatory drug intake in our series (54.5%). We encountered no statistically significant differences between the two groups on comparing bleeding stigmata, transfusion requirements, recurrences, emergency surgery, the duration of hospital stay, and mortality. CONCLUSIONS: Both drugs were found to possess a similar efficacy in treating upper gastrointestinal bleeding of peptic origin.
Assuntos
Hemorragia Gastrointestinal/tratamento farmacológico , Omeprazol/uso terapêutico , Ranitidina/uso terapêutico , Adolescente , Adulto , Idoso , Terapia Combinada , Emergências , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos ProspectivosRESUMO
ERCP is of great value in diagnosing malignant pathology of the biliopancreatic duct system. However, the ERCP endoscopic characteristics in malignant stenosis often lack specificity and are difficult to differentiate from those of chronic pancreatitis. In these cases histological confirmation is essential to diagnosis. With the aim of increasing the diagnostic possibilities of ERCP in pancreatic cancer--particularly when associated with chronic pancreatitis--we performed aspiration cytology of pancreatic juice obtained via endoscopic cannulation of the main pancreatic duct using ERCP in 102 patients with suspected periampullar pathology, chronic pancreatitis and/or pancreatic cancer. The diagnostic sensitivity of cytology for pancreatic malignancy was 33.3%, versus 60% for cancer of Vater's papilla. Specificity was 100% in both cancers. We observed no false positive results or complications. On combining both techniques, i.e., ERCP and cytology of the pancreatic juice, sensitivity increased to 100% for pancreatic malignancy, 77.7% for chronic pancreatitis (characteristic ERCP radiographic images and absence of neoplastic cells) and 100% in the case of ampullomas. Difficulties in the differential diagnosis between advanced chronic pancreatitis and pancreatic cancer persist with ERCP alone. In such cases aspiration cytology may secure a definitive diagnosis--particularly when neoplastic cells are demonstrated (Class IV).
Assuntos
Biópsia por Agulha/métodos , Colangiopancreatografia Retrógrada Endoscópica , Neoplasias Pancreáticas/patologia , Pancreatite/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e EspecificidadeRESUMO
A review is made of the results of long-term endoscopic sphincterotomy. We studied 81 endoscopic sphincterotomies performed between 1980 and 1985. The technique performed, its indications and immediate complications were evaluated, along with the follow-up carried out in these patients (minimum 6 years). In view of the results obtained, the patients were classified as asymptomatic or symptomatic. Thus, immediate complications (21.9%) were all minor, with the exception of one case (1.2%) of severe complication due to acute pancreatitis. One death was recorded three days after sphincterotomy, corresponding to an elderly patient with in situ gallbladder as a consequence of biliary sepsis. In turn, 91.4% of the patients followed-up at long term remained asymptomatic. The overall results show the method to be effective, with few either immediate or long-term complications.
Assuntos
Esfinterotomia Endoscópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Esfinterotomia Endoscópica/efeitos adversos , Fatores de TempoRESUMO
Hemolytic-uremic syndrome (HUS) is a newly recognized hematologic manifestation of HIV infection that may be triggered by local or systemic infections as well as by immunological disorders. We report the case of a 36-year-old HIV-positive man, an intravenous drug abuser who developed HUS during an episode of acute pancreatitis. Hematologic and clinical improvement occurred following 2 weeks of nonaggressive therapy including vitamin E and fresh-frozen plasma.
Assuntos
Infecções por HIV/complicações , Síndrome Hemolítico-Urêmica/complicações , Pancreatite/complicações , Doença Aguda , Adulto , Soropositividade para HIV , Humanos , Masculino , Pancreatite/terapia , Plasma , Abuso de Substâncias por Via Intravenosa/complicações , Vitamina E/uso terapêuticoRESUMO
We present the case of a 29 year-old cholecystectomized woman with hepatic hydatid cysts who was admitted for acute pancreatitis. Echography and abdominal CAT revealed three thydatid cysts-the one in the right liver lobe being complicated-as well as pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed the suspected diagnosis of intrabiliary hydatid cyst rupture. An endoscopic sphincterotomy was performed, posterior evolution being asymptomatic, thus permitting the postponing of surgery.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Equinococose Hepática/diagnóstico por imagem , Equinococose Hepática/cirurgia , Pancreatite/cirurgia , Adulto , Equinococose Hepática/complicações , Endoscopia , Feminino , Humanos , Pancreatite/etiologia , Esfíncter da Ampola Hepatopancreática/cirurgia , Tomografia Computadorizada por Raios XRESUMO
We describe the case of a woman with rectorrhagia and rectal tenesmus. Colonoscopy revealed a 3-4 cm-long ulcerated lesion with a reduced colon lumen 35 cm from the anus, and multiple biopsies were obtained from the ulcerated region, but histopathology was non-specific. Biopsy culture was positive for M. tuberculosis. Anti-tuberculous chemotherapy was initiated on the diagnosis of segmental tuberculosis of the colon. Subsequent evolution was favorable, both clinically and endoscopically. Emphasis is placed on the importance of colonoscopy and biopsy in the diagnosis of tuberculosis of the colon.
Assuntos
Doenças do Colo/microbiologia , Tuberculose Gastrointestinal/diagnóstico , Idoso , Biópsia , Colo/patologia , Colonoscopia , Feminino , Humanos , Mycobacterium tuberculosis/isolamento & purificaçãoRESUMO
The effects of physical exercise on the basal acid secretion of the stomach has been investigated in 10 healthy individuals and 16 hypersecretors with duodenal ulcer. The gastric basal secretion was collected during 3 hours; during the first hour the patient was at rest, during the second he realized a training exercise, according to Roskamm's formula, and in the third was at rest. While normal subjects showed a significative reduction of the acid secretion during the period of exercise, in the hypersecretory patients with ulcer the acid secretion increased significantly during exercise, from 4.25 +/- 1.52 mEq/h to 7.79 +/- 3.49 mEq/h; these figures reverted to normal values (5.45 +/- 2.21) during the recovery period. We comment the potential mechanisms of these differences in both groups of patients.
Assuntos
Úlcera Duodenal/fisiopatologia , Exercício Físico/fisiologia , Ácido Gástrico/metabolismo , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , PentagastrinaRESUMO
In view of the low incidence of hypertrophic pyloric stenosis, we present a case of this pathology in a male aged 74. Stenosis was of the diffuse type, associated with gastric ulcer and chronic atrophic gastritis. The patient was admitted to our Service with upper digestive tract hemorrhage after deterioration of the ulcer.
Assuntos
Estenose Pilórica/patologia , Idoso , Biópsia , Gastrectomia , Mucosa Gástrica/patologia , Humanos , Hipertrofia , Masculino , Estenose Pilórica/cirurgia , Piloro/patologiaRESUMO
A case is presented of mediastinal abscess secondary to esophageal perforation after bougie dilation that evolved favorably with antibiotic treatment and without surgical drainage.