RESUMO
Using ambulatory 24 hour pH monitoring, intragastric acidity was measured in 6 healthy volunteers and 8 patients with duodenal ulcer. According to a latin square design each patient was randomly assigned to receive placebo, 300 mg ranitidine at 19.00 h or 300 mg ranitidine at 22.00 h, on three separate occasions. Validation of the method was achieved by comparing the values indicated by the intragastric electrode and the pH of simultaneously aspirated gastric juice (y = 0.87x + 0.66, r = 0.93). Comparing the area under the curve of intragastric hydrogen ion activity, as well as the percent of time less than pH 5, we found a better inhibition of nocturnal acidity (20.00 h-08.00 h) with 19.00 h ranitidine than with ranitidine administered at 22.00 h (p less than 0.01). By contrast, there was no significant difference in diurnal acidity between both ranitidine regimens and placebo.
Assuntos
Úlcera Duodenal/tratamento farmacológico , Ácido Gástrico/metabolismo , Ranitidina/administração & dosagem , Adulto , Esquema de Medicação , Úlcera Duodenal/metabolismo , Feminino , Humanos , Masculino , Distribuição Aleatória , Ranitidina/uso terapêuticoRESUMO
Several sensitive and specific methods are now available for the investigation of gastro-oesophageal reflux and oesophagitis. Nevertheless, judicious medical or surgical management requires a good understanding of the pathophysiological aspects of these conditions and of the significance of the investigation results.
Assuntos
Esofagite Péptica/diagnóstico , Refluxo Gastroesofágico/diagnóstico , Esofagite Péptica/fisiopatologia , Esofagite Péptica/terapia , Refluxo Gastroesofágico/fisiopatologia , Refluxo Gastroesofágico/terapia , Humanos , MétodosRESUMO
The case of a 37-year-old patient with a history of Wegener's granulomatosis presenting with a right painless breast mass is reported. Breast mammography and sonography were poorly contributive and the inflammatory nature of the lesion was established by fine needle biopsy.
Assuntos
Doenças Mamárias/diagnóstico , Granulomatose com Poliangiite/diagnóstico , Adulto , Biópsia por Agulha , Doenças Mamárias/patologia , Neoplasias da Mama/diagnóstico , Diagnóstico Diferencial , Diagnóstico por Imagem , Feminino , Granulomatose com Poliangiite/patologia , HumanosRESUMO
Rare in the general population, gallstone ileus accounts for 25 per cent of nonstrangulated small bowel obstructions in patients over the age of 65. While mortality has declined over the years, it remains high at 12-17 per cent. This is largely due to the insidious symptoms making the diagnosis difficult and to the aged patient population, with frequent comorbid medical conditions contributing to mortality. Much better than plain radiograph and probably easier than ultrasound, CT makes the correct diagnosis of the classical triad of Rigler: distended small bowel loops, pneumobilia and an ectopic calcified gallstone. We report two cases promptly and specifically diagnosed with CT. The second case was a very rare Bouveret's Syndrome, a gastric outlet obstruction caused by a gallstone. Patients were treated by a one time associated enterolithotomy and cholecystectomy. We recommend the early use of abdominal CT scanning for the investigation of clinical bowel obstruction in the elderly, where gallstone ileus is a more common condition.
Assuntos
Colelitíase/diagnóstico por imagem , Duodenopatias/diagnóstico por imagem , Obstrução da Saída Gástrica/diagnóstico por imagem , Obstrução Intestinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Ar , Doenças dos Ductos Biliares/diagnóstico por imagem , Colecistectomia , Colelitíase/complicações , Colelitíase/cirurgia , Duodenopatias/etiologia , Duodenopatias/cirurgia , Feminino , Obstrução da Saída Gástrica/etiologia , Obstrução da Saída Gástrica/cirurgia , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , PneumotóraxRESUMO
Contrast media related reactions are numerous and of variable gravity. We report a case of pulmonary edema related to the intravenous administration of contrast media. Cardiogenic and non cardiogenic pulmonary edema are pathophysiologic possibilities. High resolution CT findings associate patchy ground glass areas and smooth thickening of subpleural septa, both rapidly disappearing.
Assuntos
Meios de Contraste/efeitos adversos , Ácido Iotalâmico/análogos & derivados , Edema Pulmonar/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Injeções Intravenosas , Ácido Iotalâmico/administração & dosagem , Ácido Iotalâmico/efeitos adversos , Edema Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodosRESUMO
We report on a case of giant necrotic ileal leiomyoma presenting uncommonly as a painful pelvic mass mimicking a sigmoid inflammatory process. The classical symptoms and clinical aspects of intestinal leiomyoma are briefly summarized. The CT and US aspects are described with peculiar attention to color Doppler which played an important role in the diagnosis of our patient.
Assuntos
Neoplasias do Íleo/diagnóstico , Leiomioma/diagnóstico , Doença Aguda , Humanos , Neoplasias do Íleo/patologia , Neoplasias do Íleo/cirurgia , Leiomioma/patologia , Leiomioma/cirurgia , Masculino , Pessoa de Meia-Idade , Necrose , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em CoresRESUMO
Bronchial lipomas are rare and benign neoplasms. Computed tomography can provide a powerful adjunct to conventional modalities in determining the nature of an endobronchial lesion. The reflex vasoconstriction can also be nicely depicted.
Assuntos
Neoplasias Brônquicas/diagnóstico por imagem , Lipoma/diagnóstico por imagem , Neoplasias Brônquicas/fisiopatologia , Feminino , Humanos , Lipoma/fisiopatologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , VasoconstriçãoRESUMO
Inflammatory fibroid polyp is a very rare tumor involving the gastrointestinal tract and especially the stomach and small bowel. It presents either as a solitary pedunculated or sessile lesion arising from the submucosa. Despite its large size and sometimes very infiltrating growth, the polyp is benign and has a good prognosis. The aetiology remains unknown but it probably represents a reactive proliferation similar in many respects to the granuloma pyogenicum. We report an ileal case which presented itself as an acute intussusception. The very typical and complete sonographic and tomodensitometric findings of this intussusception are detailed. The polyp alone does not have noteworthy radiological characteristic signs and must be included in the large and essentially histological differential diagnostic of gastrointestinal tumors.
Assuntos
Doenças do Íleo/etiologia , Neoplasias do Íleo/complicações , Pólipos Intestinais/complicações , Intussuscepção/etiologia , Adulto , Feminino , Humanos , Doenças do Íleo/diagnóstico , Neoplasias do Íleo/diagnóstico , Pólipos Intestinais/diagnóstico , Intussuscepção/diagnóstico , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Cystic adventitial disease is very rarely described in the common femoral artery, the usual location being the popliteal artery. CT in this patient shows the extension of an enlarged bursa of the psoas muscle reaching the cyst in the arterial wall.
Assuntos
Cistos/diagnóstico por imagem , Artéria Femoral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Angiografia , Prótese Vascular , Cistos/complicações , Cistos/cirurgia , Artéria Femoral/cirurgia , Humanos , Claudicação Intermitente/etiologia , Masculino , Pessoa de Meia-IdadeRESUMO
An extensive case of undifferentiated neuroendocrine carcinoma with small cells of the anorectal region is reported. The carcinoma is related to pulmonary anaplasia and quite rare in the colonic and rectal region. Its aggressivity is considerable with a strong propensity for hematogenous and lymphatic metastases and with a disastrous prognosis: 0% survival over 1 year. The incidence, the characteristic features, the histogenesis, and the anatomical pathology of this rare neoplasm are mentioned. Furthermore, the case illustrates a radiological pattern typical for major lymphatic dissemination with an intra- and extraparietal component. The mechanism of dissemination is explained by the "lymphatic block" theory. The absolute necessity of obtaining an histology in radiologically unusual and/or extensive cases is mentioned.
Assuntos
Neoplasias do Ânus/diagnóstico por imagem , Carcinoma/diagnóstico por imagem , Adulto , Neoplasias do Ânus/patologia , Neoplasias do Ânus/terapia , Sulfato de Bário , Carcinoma/patologia , Carcinoma/terapia , Terapia Combinada , Enema , Humanos , Masculino , Prognóstico , Tomografia Computadorizada por Raios XRESUMO
There is a wide variety of pathologies associated with the presence of urachal remnants. We describe a case of infected urachal cyst in a young adult male, with classical symptoms of dysuria, lower abdominal pain, and fever. Ultrasound, cystography and CT are described, ultrasound being often the modality of choice. Differential diagnosis of acute abdominal and pelvic pain or a midline lower abdominal mass at this age should include infection of an urachal remnant.
Assuntos
Cisto do Úraco/diagnóstico por imagem , Infecções Urinárias/etiologia , Adulto , Humanos , Masculino , Tomografia Computadorizada por Raios X , Cisto do Úraco/complicações , Cisto do Úraco/cirurgia , Infecções Urinárias/diagnóstico por imagem , UrografiaRESUMO
Morgagni hernia is considered to be the rarest form of all diaphragmatic hernias. It develops through a congenital defect in the retrosternal area. Usually asymptomatic, this entity can lead to life-threatening complications such as incarceration, strangulation or volvulus of the herniated viscus. We hereby report a rare case of organoaxial gastric volvulus producing through the foramen of Morgagni in a 78-year-old woman. The full diagnosis was made by upper gastro-intestinal series and multidetector computed tomography (MDCT). The basic anatomy, physiopathology, diagnostic methods, complications and surgical treatment of Morgagni hernia are briefly reviewed.
Assuntos
Hérnia Diafragmática/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Volvo Gástrico/diagnóstico por imagem , Idoso , Meios de Contraste , Diagnóstico Diferencial , Feminino , Hérnia Diafragmática/cirurgia , Humanos , Intensificação de Imagem Radiográfica/métodos , Volvo Gástrico/cirurgiaRESUMO
Colorectal cancer (CRC) is a leading cause of cancer related death in the western countries. It remains an important health problem, often under-diagnosed. The symptoms can appear very late and about 25% of the patients are diagnosed at metastatic stage. Familial adenomatous polyposis (FAP) is an inherited colorectal cancer syndrome, characterized by the early onset of hundred to thousands of adenomatous polyps in the colon and rectum. Left untreated, there is a nearly 100% cumulative risk of progression to CRC by the age of 35-40 years, as well as an increased risk of various other malignancies. CRC can be prevented by the identification of the high risk population and by the timely implementation of rigid screening programs which will lead to special medico-surgical interventions.
Assuntos
Polipose Adenomatosa do Colo/diagnóstico , Polipose Adenomatosa do Colo/epidemiologia , Programas de Rastreamento/métodos , Vigilância da População/métodos , Polipose Adenomatosa do Colo/prevenção & controle , Progressão da Doença , Humanos , Incidência , Fatores de RiscoRESUMO
Hepatic portal gas (HPG) has historically been associated with high (75% or over) mortality rates related to abdominal dramatic conditions and has served as an indicator for urgent exploratory laparotomy. Over the last two decades, the greater availability and higher speed of use of CT as well as improvement in the management of critically ill patients have increased the sensitivity of imaging HPG. HPG has been found associated with a broad range of diseases, some of which are benign and do not necessarily require urgent exploratory laparotomy in the absence of signs of intra-abdominal acute condition or systemic toxicity. We present a case of transient and rapidly resolving HPG found in a 61-year-old male admitted with hypovolemic shock due to upper gastrointestinal occlusion. HPG rapidly resolved after resuscitation of the patient with intensive re-hydration and drastic decompression of the fluid-full stomach through a nasogastric tube. The physiopathology and causes of HPG are briefly reviewed and its potential clinical significance is resituated.
Assuntos
Obstrução Intestinal/complicações , Fígado/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Meios de Contraste , Hidratação/métodos , Gases , Humanos , Obstrução Intestinal/terapia , Intubação Gastrointestinal/métodos , Pressão Negativa da Região Corporal Inferior/métodos , Masculino , Pessoa de Meia-Idade , Intensificação de Imagem Radiográfica , Choque/etiologiaRESUMO
Twenty-one adult patients with chronic hepatitis B and active viral replication as indicated by the presence of hepatitis Be antigen (HBeAg), increased DNA polymerase (DNAp) and positive hepatitis B virus DNA (HBV-DNA) for more than 6 months, were entered into a prospective trial of recombinant human interferon therapy. Ten patients had chronic persistent or chronic lobular hepatitis, 8 chronic active hepatitis and 3 postnecrotic cirrhosis. All cases were treated with 5 x 10(6) units of recombinant interferon alfa-2B given subcutaneously every other day for 12 weeks. During treatment, 18 patients (86%) showed a significant reduction of DNAp levels, which reached normal values in 10 patients (48%). Viral replication was controlled over a 10-month follow-up period in 7 out of 21 patients (33%). Of these 7, five patients became HBeAg negative and HBeAb positive. HBsAg disappeared in one patient. The only serious adverse effect was thrombocytopenia in one patient in whom rapid recovery occurred when interferon was withdrawn. Treatment was also terminated in a second patient because of local reactions at the injection sites occurring after 10 weeks of therapy. Our data indicate that relatively small doses of recombinant alfa-2B interferon given during a 12-week period induce a significant reduction in viral replication and might approximately triple the spontaneous seroconversion rate observed in patients with chronic hepatitis B.
Assuntos
Hepatite B/terapia , Hepatite Crônica/terapia , Interferon Tipo I/uso terapêutico , Interferon-alfa/uso terapêutico , Adulto , Idoso , Alanina Transaminase/sangue , Ensaios Clínicos como Assunto , DNA Polimerase Dirigida por DNA/sangue , Feminino , Seguimentos , Antígenos E da Hepatite B/sangue , Vírus da Hepatite B/efeitos dos fármacos , Vírus da Hepatite B/fisiologia , Humanos , Interferon alfa-2 , Interferon-alfa/efeitos adversos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Proteínas Recombinantes , Replicação Viral/efeitos dos fármacosRESUMO
Twenty-one adult patients with chronic hepatitis B and active viral replication as indicated by positivity for hepatitis B e antigen and hepatitis B virus DNA, with increased DNA polymerase levels for more than 6 months, were entered into a prospective trial of low-dose recombinant human alpha-interferon therapy. All patients were treated with 5 million units of recombinant interferon alfa-2b given subcutaneously every other day for 12 weeks. During treatment, 18 patients (86%) showed a significant reduction of DNA polymerase levels (p less than or equal to 0.001), which reached normal values in ten (48%). After 10 months' mean follow up, seven patients (33%) were hepatitis B e antigen negative and five (24%) subsequently became positive for antibodies to e antigen. By 27 months, nine patients (43%) were both hepatitis B e antigen negative and e antibody positive. Only one patient became permanently negative for hepatitis B surface antigen. One patient relapsed during the second year of follow up. Side effects necessitated withdrawal of therapy in two patients: one due to worsening thrombocytopenia after two doses of interferon (data omitted from the study results) and one due to a local reaction at the injection sites. Our data indicate that small doses of recombinant interferon alfa-2b given during a 12-week period induce a significant reduction in viral replication and approximately triple the spontaneous seroconversion rate observed in patients with chronic hepatitis B.
Assuntos
Hepatite B/terapia , Interferon-alfa/uso terapêutico , Alanina Transaminase/sangue , Biomarcadores/sangue , Doença Crônica , DNA Polimerase Dirigida por DNA/sangue , Seguimentos , Hepatite B/sangue , Antígenos E da Hepatite B/análise , Vírus da Hepatite B/fisiologia , Humanos , Interferon alfa-2 , Testes de Função Hepática , Estudos Prospectivos , Proteínas Recombinantes , Replicação ViralRESUMO
In 42 patients (25 men, 17 women, mean age 62 years) with severe erosive or ulcerative oesophagitis not responding to H2-receptor antagonist treatment over at least 3 months and ineligible for surgery, omeprazole was administered at an initial dose of 40 mg/day, subsequently reduced to 20 mg after healing of the lesions. Patients had monthly clinical, endoscopic, histological and laboratory assessment over the healing period, then were reevaluated 3-monthly over one year, then 6-monthly, during the maintenance treatment. Stages of oesophagitis were based on the Savary-Miller classification, modified for stage I (erosions must be present). With 40 mg omeprazole, healing was observed in 71%, 83% and 90% of the patients after 1, 2 and 3 months of treatment, respectively. After one month of treatment, a complete healing was less frequently observed in patients with stage IV oesophagitis pre-trial (55%) than in the patients with stages I, II and III pre-trial (90%) (p less than 0.05). Ninety per cent of the patients healed at one month were asymptomatic whereas 50% of the patients with incomplete healing still had symptoms, most often dysphagia, rarely heartburn. Maintenance treatment with 20 mg was sufficient in most patients, with a probability of remaining healed of 69% from 9 to 24 months after starting this dosage. In 9 patients with Barrett's oesophagus, the lengths of the circumferential metaplasia were found to be reduced after one year of treatment compared to pre-trial lengths (p less than 0.005). There was no further significant reduction of length after 2 years of treatment. Fasting gastrin was increased in most of the patients, although great inter-patient variability was observed; 50% of the patients had levels not exceeding 5 times the upper limit of normal. There was no consistent increase of enterochromaffin-like cell density in 29 patients investigated up to nearly 2 years of omeprazole administration. The treatment was well tolerated. By inducing a profound and sustained inhibition of acid secretion, as confirmed by pH monitoring, omeprazole promotes healing of the lesions of severe oesophagitis and prevents recurrence of lesions and symptoms. Omeprazole is therefore a valuable treatment for patients ineligible for surgery, particularly in the elderly.
Assuntos
Esofagite Péptica/tratamento farmacológico , Omeprazol/uso terapêutico , Adolescente , Adulto , Idoso , Esofagite Péptica/classificação , Esofagite Péptica/metabolismo , Feminino , Gastrinas/sangue , Humanos , Concentração de Íons de Hidrogênio , Estudos Longitudinais , Masculino , Pessoa de Meia-IdadeRESUMO
The authors report two cases of severe rhabdomyolysis in a 23-year-old woman following a toxic coma with muscular compression and in a 34-year-old man after a febrile state. Despite clinical and biological signs of marked muscular necrosis, oliguric acute renal failure did not occur. However, repetitive urinary dosage of N-acetyl-glucosaminidase (NAG), of retinol-binding-protein (RBP) and of beta-2-microglobulin (beta-2-m) revealed an early and long-standing tubular dysfunction not suggested by conventional laboratory data.