RESUMO
Hepatic encephalopathy (HE) is a neuropsychiatric syndrome in patients with liver failure and/or a portal-systemic bypass. Since 2002 a new nomenclature of HE exists, that classifies HE in encephalopathy type A (associated with acute liver failure), type B (associated with portal-systemic bypass), and type C (associated with liver cirrhosis). HE type A is characterized by a rapid development to coma, cerebral edema, and a poor short-term prognosis. Therefore, these patients should be referred to a liver transplantation center. Standard treatment of HE consists of non absorbable disaccharides, non absorbable antibiotics, and a diet with an appropriate amount of proteins. In addition, the possibility of performing a liver transplantation should be evaluated. In patients with intractable HE other alternative treatments adjunct to standard treatment, like zinc, sodium benzoate, ornithine aspartate, branched chain amino acids, flumazenil, and bromocriptine should be considered.
Assuntos
Encefalopatia Hepática , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Bromocriptina/administração & dosagem , Bromocriptina/uso terapêutico , Dipeptídeos/administração & dosagem , Dipeptídeos/uso terapêutico , Agonistas de Dopamina/administração & dosagem , Agonistas de Dopamina/uso terapêutico , Eletroencefalografia , Flumazenil/administração & dosagem , Flumazenil/uso terapêutico , Moduladores GABAérgicos/administração & dosagem , Moduladores GABAérgicos/uso terapêutico , Fármacos Gastrointestinais/administração & dosagem , Fármacos Gastrointestinais/uso terapêutico , Encefalopatia Hepática/classificação , Encefalopatia Hepática/diagnóstico , Encefalopatia Hepática/dietoterapia , Encefalopatia Hepática/tratamento farmacológico , Encefalopatia Hepática/etiologia , Humanos , Lactulose/administração & dosagem , Lactulose/uso terapêutico , Falência Hepática Aguda/complicações , Transplante de Fígado , Neomicina/administração & dosagem , Neomicina/uso terapêutico , Fenômenos Fisiológicos da Nutrição , Guias de Prática Clínica como Assunto , Prognóstico , Benzoato de Sódio/administração & dosagem , Benzoato de Sódio/uso terapêutico , Terminologia como Assunto , Fatores de Tempo , Zinco/administração & dosagem , Zinco/uso terapêuticoAssuntos
Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/imunologia , Inibidor de Coagulação do Lúpus/metabolismo , Antivirais/efeitos adversos , Quimioterapia Combinada , Feminino , Hepatite C Crônica/sangue , Humanos , Interferon alfa-2 , Interferon-alfa/efeitos adversos , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial , Proteínas Recombinantes , Ribavirina/efeitos adversosRESUMO
AIMS: We tried to show the demographic characteristic and alcohol intake habits among our outpatients. We study the influence of age, sex, habitat and socioeconomical status on alcoholic habit. DESIGN: Retrospective and institution based study. Patients. 164 patients who were followed up for alcohol liver disease in our outpatient section. RESULTS: Average age to start drinking alcohol was 18.6 (7.36) years, years of alcoholism were 35.4 (13.5) years, average daily alcohol intake was 161.2 (116.7) grams of pure alcohol. Only 16 men (8%) drank less than 60 grams a day. 5 (35.7%) women drank less than 40 grams a day. Life-cumulative alcohol intake was correlated with Maddrey's score at the end of the study (r = +0.407). Average daily alcohol intake was correlated with ultrasonographic features of the liver (r = +0.283), we appreciated that Prothrombin Time was also correlated with ultrasonographic features of the liver (r = +0.301). The percentage of patients who suffer, at least one decompensation of their disease was 39%. CONCLUSIONS: Average age to start drinking is about legal age. Life-cumulative alcohol intake was related to Prothrombin Time and ultrasonographic features of the liver.
Assuntos
Alcoolismo/epidemiologia , Assistência Ambulatorial , Alcoolismo/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , EspanhaRESUMO
OBJECTIVE: to determine the changes in acid output before and after eradication therapy in patients with duodenal ulcer associated with Helicobacter pylori infection. METHOD: the subjects of this prospective study were 16 patients with acute duodenal ulcer at endoscopy and H. pylori infection determined by rapid urease test and histology. They were randomly assigned to receive treatment with pantoprazole 40 mg b.i.d., clarithromycin 500 mg b.i.d. and amoxicillin 1 g b.i.d. during 7 or 14 days. Endoscopic examination and biopsy were repeated 4 weeks after treatment ended. The changes in acid output before and after treatment were calculated by the morphometric quantification of parietal cell canaliculi from the gastric corpus. To this end 20 parietal cells from the medial glandular zone were selected and canalicular index was calculated, before and after eradication therapy, with a morphometric method based on automatic analysis of histological images. RESULTS: canalicular index was 26.4 +/- 1.4 (mean +/- standard error of the mean) before treatment, and 20.5 +/- 1 (p < 0.01) after therapy. CONCLUSIONS: morphometric analysis showed a decrease in acid output in patients with duodenal ulcer associated with H. pylori infection 4 weeks after eradication therapy with clarithromycin, amoxicillin and pantoprazole.
Assuntos
Úlcera Duodenal/fisiopatologia , Ácido Gástrico/metabolismo , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , 2-Piridinilmetilsulfinilbenzimidazóis , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Antiulcerosos/uso terapêutico , Benzimidazóis/uso terapêutico , Claritromicina/uso terapêutico , Quimioterapia Combinada , Úlcera Duodenal/tratamento farmacológico , Úlcera Duodenal/microbiologia , Infecções por Helicobacter/complicações , Humanos , Omeprazol/análogos & derivados , Pantoprazol , Células Parietais Gástricas/metabolismo , Células Parietais Gástricas/ultraestrutura , Penicilinas/uso terapêutico , Sulfóxidos/uso terapêuticoAssuntos
Úlcera Duodenal/tratamento farmacológico , Medicina Baseada em Evidências , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Úlcera Gástrica/tratamento farmacológico , Antibacterianos/uso terapêutico , Antiulcerosos/uso terapêutico , Quimioterapia Combinada , Úlcera Duodenal/microbiologia , Humanos , Úlcera Gástrica/microbiologiaRESUMO
Endometriosis localized in the intestinal wall is not an infrequent finding. Diagnosis is difficult given the diverse symptomatology presented with unspecific abdominal pain being the most common. Implantation of endometrial tissue in the intestinal wall may involve the mucosa and present as rectorhagia, with colonscopic exploration providing diagnosis by biopsy of the affected area. In other cases this may only involve the intestinal wall producing very varied symptomatology. Presentation as a picture of colon obstruction is little reported. The main problem is its difficult differential diagnosis with neoplasm which, in most cases, leads to surgery. A case of colon obstruction provoked by implantation of endometrial tissue in the wall of the sigma which was surgically resolved is herein presented.
Assuntos
Doenças do Colo/diagnóstico , Endometriose/diagnóstico , Obstrução Intestinal/etiologia , Doenças do Colo/complicações , Doenças do Colo/cirurgia , Diagnóstico Diferencial , Endometriose/complicações , Endometriose/cirurgia , Feminino , Humanos , Obstrução Intestinal/cirurgia , Pessoa de Meia-IdadeRESUMO
Hereditary angioneurotic edema (HAE) is an infrequent autosomal dominant disorder characterized by a decrease in the levels or a dysfunction of the complement C1 inhibitor factor (C1 inh). The clinical presentation varies widely and involves any area of the organism. Gastrointestinal involvement is usually as abdominal pain and may be accompanied by ascites. De novo diagnosis of HAE with abdominal pain and ascites as a form of presentation is difficult with differential diagnosis with abdominal pain of unknown origin. The appearance of ascites is rare with few cases reported in the literature. Both abdominal pain and ascites disappear a few days after initiation of medical treatment. Occasionally exploratory laparotomy has been required. A new case of abdominal pain and ascites as manifestations of HAE is herein reported.