RESUMO
We have read with interest the recently published case on splenic rupture after colonoscopy. Although this complication is being observed more frequently, in the case presented here, the particularity lies in the myocardial ischemia caused as a consequence of stasis at coronary level, determining a situation of extreme gravity, a diagnostic challenge and a therapeutic emergency.
Assuntos
Doença da Artéria Coronariana , Infarto do Miocárdio com Supradesnível do Segmento ST , Ruptura Esplênica , Colonoscopia/efeitos adversos , Doença da Artéria Coronariana/complicações , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Ruptura Esplênica/complicações , Ruptura Esplênica/etiologiaRESUMO
Although digestive endoscopy is considered to be a safe procedure, both the growing complexity of the techniques and the underlying diseases of patients increase the risk of adverse events during the procedure. Cardiorespiratory events are the most frequent complications, and can occur in patients with or without sedation, although they appear more often when the patient is sedated. The body's physiological response to stress is what causes these adverse events, which are generally mild and transient, although they can be serious. They are more frequent in patients with cardiopulmonary diseases, which logically increase risk. The autonomic nervous system, through its sympathetic and parasympathetic branches, is primarily responsible for these alterations. Patients with asthma or chronic obstructive pulmonary disease have a higher risk of hypoxemia, bronchospasm, and arrhythmia during the endoscopic procedure. Patients with arrhythmia and ischemic heart disease have a higher risk of myocardial ischemia and heart rhythm disturbances. The risk of adverse events during the procedure can be reduced by reviewing the patient's medical history along with a basic clinical examination before endoscopy. A brief interrogation about symptom control can also help the safety of endoscopy.
Assuntos
Anestesia , Endoscopia Gastrointestinal , Sedação Consciente/efeitos adversos , Humanos , HipóxiaAssuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Fármacos Dermatológicos/efeitos adversos , Toxidermias/etiologia , Psoríase/induzido quimicamente , Adulto , Anticorpos Monoclonais Humanizados/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Humanos , Doenças Inflamatórias Intestinais , Masculino , Índice de Gravidade de DoençaRESUMO
Esophageal anastomotic strictures are a non-negligible cause of benign strictures and secondary dysphagia. It should be noted that these are often complex strictures, with a large ischemic-fibrotic component. Thus, they are difficult to treat due to their recurrence, despite endoscopic dilation. Endoscopic incisional therapy appears as a therapeutic alternative in this type of patient, which allows the elimination of the stenotic ring, with a good efficacy and safety profile. We present the case of a patient with postoperative esophageal strictures refractory to treatment with dilation and endoscopic prosthesis, who was finally satisfactorily treated with incisional therapy.
Assuntos
Eletrocirurgia/métodos , Estenose Esofágica/cirurgia , Adenocarcinoma/terapia , Idoso , Transtornos de Deglutição/etiologia , Dilatação/instrumentação , Dilatação/métodos , Eletrocirurgia/instrumentação , Neoplasias Esofágicas/terapia , Estenose Esofágica/complicações , Estenose Esofágica/diagnóstico por imagem , Humanos , Masculino , Recidiva , StentsRESUMO
Peutz-Jeghers' syndrome is an uncommon polyposis syndrome characterized by the presence of hamartomatous polyps in the gastrointestinal tract and mucocutaneous pigmentation (especially in the oral-nasal and perianal areas and hands and feet). Inheritance is autosomal dominant, caused by a germline mutation in the STK11 (LKB1) gene. The risk of breast and gastrointestinal cancer is increased in this syndrome. Lynch's syndrome is also known as hereditary non-polyposis colorectal cancer. This syndrome is caused by a mutation in DNA mismatch repair genes and increases the risk of colon and endometrial cancer, as well as that of other neoplasms (ovary, upper urological tract, gastric, small intestine, pancreas, skin and brain). We present the case of a young woman with colorectal cancer and the coexistence of both syndromes. This association has not previously been reported in the literature.
Assuntos
Proteínas Adaptadoras de Transdução de Sinal/genética , Adenocarcinoma/genética , Neoplasias do Colo/genética , Neoplasias Colorretais Hereditárias sem Polipose/complicações , Proteínas Nucleares/genética , Síndrome de Peutz-Jeghers/complicações , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirurgia , Adulto , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/cirurgia , Pólipos do Colo/genética , Colonoscopia , Neoplasias Colorretais Hereditárias sem Polipose/genética , DNA de Neoplasias/genética , Éxons/genética , Feminino , Genótipo , Humanos , Obstrução Intestinal/etiologia , Doenças do Jejuno/complicações , Doenças do Jejuno/genética , Melanose/genética , Instabilidade de Microssatélites , Proteína 1 Homóloga a MutL , Mutação de Sentido Incorreto , Síndrome de Peutz-Jeghers/genética , FenótipoRESUMO
Toxic-induced liver disease is uncommon, although the true proportion of cases of hepatotoxicity is unknown, as this entity is underdiagnosed and underreported. The main reasons why toxic-induced liver disease goes unnoticed is the lack of pathognomonic data and the lack of spontaneous reporting by doctors and pharmacists. In some cases, the toxic substance can leave its «signature¼ in the form of clinical semiology suggestive of an underlying toxic cause. We present a case of hepatotoxicity induced by drinking water (chlorinated), which produced a reactive metabolites syndrome (trihalomethanes from the reaction of chlorine with organic products). Although the clinical presentation was typical, the case posed a diagnostic challenge for the various professionals involved.