Assuntos
Ciclismo , Colite Isquêmica/etiologia , Colo Ascendente/irrigação sanguínea , Corrida , Natação , Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Ciprofloxacina/uso terapêutico , Colite Isquêmica/diagnóstico por imagem , Colite Isquêmica/tratamento farmacológico , Colo Ascendente/diagnóstico por imagem , Colonoscopia , Humanos , Masculino , Mesalamina/uso terapêutico , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: To determine the factors associated with an increased risk for severe steatosis (SS) and establish the Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) as a screening tool. METHODS: A cross-sectional study was performed in obese children to assess the relationship between the metabolic syndrome (MetS) and glucose metabolism alterations (GMA) and the risk for severe steatosis. RESULTS: A total of 94 children (51 males) aged from six to 14 years were included. Thirteen children (14.8%) had severe steatosis (SS). The anthropometric variables associated with SS included body mass index (BMI) (SS 34.1 vs non-SS 29.7, p = 0.005), waist circumference (cm) (100 vs 92.5, p = 0.015) and hip circumference (cm) (108 vs 100, p = 0.018). The blood parameters included alanine aminotransferase (ALT) (UI/dl) (27 vs 21, p = 0.002), gamma-glutamil transpeptidase (GGT) (UI/dl) (16 vs 15, p = 0.017), fasting glycemia (mg/dl) (96 vs 88, p = 0.006), fasting insulin (UI/dl) (25 vs 15.3, p < 0.001) and HOMA-IR score (7.1 vs 3.7, p < 0.001). Eighteen children with MetS were found to be at an increased risk for severe steatosis (odds ratio [OR] 11.36, p < 0.001). After receiver operating characteristic (ROC) curve analysis, the best area under the curve (AUC) was obtained for HOMA-R of 0.862. The HOMA-R 4.9 cut-off value had a 100% sensitivity (CI 95%: 96.2-100) and 67.9% specificity (CI 95%: 57.1-78.7) for severe steatosis. CONCLUSIONS: The presence of MetS and glucose metabolism alterations are risk factors for severe steatosis. The 4.9 cut-off value for HOMA-IR may be a risk factor for severe steatosis in obese children.
Assuntos
Fígado Gorduroso/patologia , Resistência à Insulina , Síndrome Metabólica/patologia , Obesidade Infantil/patologia , Adolescente , Criança , Estudos de Coortes , Estudos Transversais , Fígado Gorduroso/etiologia , Fígado Gorduroso/metabolismo , Feminino , Humanos , Masculino , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Obesidade Infantil/complicações , Obesidade Infantil/epidemiologia , Prevalência , Fatores de RiscoRESUMO
INTRODUCTION: The most frequent causes of acute pancreatitis are biliary stones, alcohol consumption, smoking and tumors. Some of them do not have any established cause, and they are catalogued as idiopathic pancreatitis. CASE REPORT: We report the case of a 56-year-old woman with a history of bilateral adrenalectomy on hormone replacement therapy with corticosteroids, who has recurrent episodes of mild acute pancreatitis with an etiologic study (laboratory and imaging tests) without significant findings. A drug-induced etiology was suspected, so corticosteroids were removed and antihypertensive treatment was modified, but the clinical manifestations persisted. Later regular consumption of horsetail infusions was detected, and after their suspension the patient became asymptomatic and has not presented new episodes. DISCUSSION: The drug-induced acute pancreatitis is a strange cause of pancreatitis that is frequently underdiagnosed because of the difficulty to establish a relationship between the drugs and the pancreatitis. Lots of drugs have been related with acute pancreatitis, while the information available for herbal products is limited. They usually present like mild and recurrent episodes, without significant findings in both laboratory and imaging tests (abdominal ultrasound, abdominal computed tomography [CT], cholangiography and endoscopic ultrasound). It is important to detect the origin of this type of pancreatitis to prevent recurrence.
Assuntos
Equisetum/efeitos adversos , Pancreatite/induzido quimicamente , Extratos Vegetais/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica , Feminino , Humanos , Pessoa de Meia-Idade , Pancreatite/diagnóstico por imagemRESUMO
BACKGROUND: The purpose of this study is to report our initial experience with a new fully covered metallic stent with a novel design (AXIOS) to prevent migration and fluid leakage, in the drainage of pancreatic fluid collections (PFC). METHODS: We included nine patients from four Spanish centers undergoing endoscopic ultrasound (EUS)-guided drainage of PFC with placement of an AXIOS stent. The lesions were accessed via transgastric (n = 7), transesophageal (n = 1), and transduodenal (n = 1) by using a novel access device (NAVIX) in six cases or a 19-G needle in three. Patients were individually followed prospectively for procedure indications, demographic data, previous imaging techniques, technical aspects, clinical outcomes, complications, and follow-up after endoscopic drainage. RESULTS: The mean size of lesions was 105 ± 26.3 mm (range, 70-150). In six cases, cystoscopy was performed through the stent, including necrosectomy in two. Median procedure time was 25 ± 13 min. A median number of two sessions were performed. The technical success rate was 88.8 % (8/9) due to one failure of the delivery system. One patient developed a tension pneumothorax immediately after transesophageal drainage. No migrations were reported, and all stents were removed easily. All patients had a successful treatment outcome achieving complete cyst resolution. Mean time to stent retrieval was 33 ± 40 days. Mean follow-up was 50 ± 1.3 weeks (range, 45-55), and only one patient presented a recurrence 4 weeks after the stent removal. Furthermore, comparison with ten previous consecutively recruited PFC cases drained by EUS-guided using plastic pigtail stents was done. Technical and clinical successes were similar. However, two stent migrations, two recurrences, and two complications were found. The number of stents used (n = 15) and the median procedure time (42.8 ± 3.1 min) were significantly higher. CONCLUSIONS: Drainage of PFC using dedicated devices as this novel metallic stent with special design seems to be an effective, feasible and safe alternative technique.
Assuntos
Drenagem/instrumentação , Drenagem/métodos , Endossonografia , Suco Pancreático , Pseudocisto Pancreático/diagnóstico por imagem , Pseudocisto Pancreático/cirurgia , Stents , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de PróteseAssuntos
Dor no Peito/etiologia , Dispneia/etiologia , Hérnia Diafragmática/diagnóstico , Obstrução Intestinal/diagnóstico , Vômito/etiologia , Adulto , Doenças do Colo/complicações , Doenças do Colo/diagnóstico , Doenças do Colo/diagnóstico por imagem , Serviço Hospitalar de Emergência , Feminino , Hérnia Diafragmática/complicações , Hérnia Diafragmática/diagnóstico por imagem , Humanos , Obstrução Intestinal/complicações , Obstrução Intestinal/diagnóstico por imagem , RadiografiaAssuntos
Dor Abdominal/etiologia , Fístula Biliar/complicações , Cálculos Biliares/complicações , Íleus/etiologia , Fístula Intestinal/complicações , Doenças do Colo Sigmoide/etiologia , Dor Abdominal/diagnóstico , Dor Abdominal/diagnóstico por imagem , Idoso de 80 Anos ou mais , Fístula Biliar/diagnóstico por imagem , Feminino , Cálculos Biliares/diagnóstico por imagem , Humanos , Íleus/complicações , Íleus/diagnóstico por imagem , Fístula Intestinal/diagnóstico por imagem , Doenças do Colo Sigmoide/complicações , Tomografia Computadorizada por Raios XRESUMO
Drug-induced gastrointestinal tract lesions are becoming more frequent but are generally little known. Although a large number of drugs have gastrointestinal adverse effects, there are few characteristic patterns. Acute ischemic gastritis is an uncommon entity that is rarely distinguished from other forms of intestinal ischemia. We report the case of a 69-year-old woman who was diagnosed with an unusual gastric lesion in the context of an acute exacerbation of her anemia.
Assuntos
Anemia/complicações , Úlcera Gástrica/etiologia , Doença Aguda , Idoso , Feminino , HumanosRESUMO
Primary Esophageal Melanoma (PEM) is an extremely rare neoplasm, with less than 270 cases described. Although clinical presentation is similar to any other esophageal neoplasm, MEP's behavior is more aggressive and fatal in most cases. We report two new cases of MEP diagnosed through endoscopy and anatomical-pathological analysis of collected biopsies. Both samples were positive for HMB-45 and S100, so the presence of primary melanoma in other location was ruled out. The form of presentation as left miosis with no eyelid ptosis or enophthalmos should be highlighted in the first case, which was described by this early manifestation. Unfortunately, the neoplasm could not be excised when diagnosed because the thoracic artery was found to be affected through echoendoscopy. In the second case, in spite of the fact that the neoplastic extension was only local, and neoplasm was subject to transhiatal esophagectomy, the patient had multiple post-surgical complications and died nineteen days after the surgical procedure. Furthermore, bibliographic review is applied to diagnosis, treatment options, and prognosis of this exceptional neoplasm.
Assuntos
Neoplasias Esofágicas/diagnóstico , Melanoma/diagnóstico , Idoso , Anisocoria/etiologia , Transtornos de Deglutição/etiologia , Neoplasias Esofágicas/patologia , Esofagectomia , Esofagoscopia , Evolução Fatal , Gastroplastia , Humanos , Metástase Linfática , Masculino , Melanoma/patologia , Melanoma/secundário , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Complicações Pós-Operatórias , PrognósticoRESUMO
El melanoma esofágico primario (MEP) es una neoplasia extremadamente rara, con menos de 270 casos descritos. Aunque la presentación clínica es similar a cualquier otra neoplasia esofágica, su comportamiento es más agresivo y fatal en la mayoría de los casos. Presentamos dos nuevos casos de MEP diagnosticados mediante endoscopia y estudio anatomopatológico de las biopsias obtenidas, siendo en ambos casos las muestras positivas para HMB-45 y S100, descartando así mismo la presencia de melanoma primario en otra localización. En el primer caso merece destacar la forma de presentación como miosis izquierda sin ptosis palpebral ni enoftalmos, siendo el primer caso descrito con esta manifestación inicial, lamentablemente al momento del diagnóstico fue irresecable, demostrando así mismo por ecoendoscopia afectación de la aorta torácica. El segundo caso a pesar de ser una neoplasia sin extensión locorregional y sometido a esofaguectomía transhiatal presentó múltiples complicaciones postoperatorias falleciendo al decimo noveno día de la intervención. Así mismo se hace una revisión bibliográfica sobre diagnóstico, opciones de tratamiento y pronóstico de esta excepcional neoplasia.
Primary Esophageal Melanoma (PEM) is an extremely rare neoplasm, with less than 270 cases described. Although clinical presentation is similar to any other esophageal neoplasm, MEP's behavior is more aggressive and fatal in most cases. We report two new cases of MEP diagnosed through endoscopy and anatomical-pathological analysis of collected biopsies. Both samples were positive for HMB-45 and S100, so the presence of primary melanoma in other location was ruled out. The form of presentation as left miosis with no eyelid ptosis or enophthalmos should be highlighted in the first case, which was described by this early manifestation. Unfortunately, the neoplasm could not be excised when diagnosed because the thoracic artery was found to be affected through echoendoscopy. In the second case, in spite of the fact that the neoplastic extension was only local, and neoplasm was subject to transhiatal esophagectomy, the patient had multiple post-surgical complications and died nineteen days after the surgical procedure. Furthermore, bibliographic review is applied to diagnosis, treatment options, and prognosis of this exceptional neoplasm.
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Endoscopia , Melanoma , Neoplasias EsofágicasRESUMO
Eosinophilic enteritis is a rare disease characterized by eosinophilic infiltration of different wall layers of the gastrointestinal tract, from the esophagus to the rectum, by eosinophilic cells. The most frequently affected structures are the stomach and small intestine. The pathogenesis of eosinophilic enteritis is not well understood and is often related to a personal or familial history of atopy. Clinical symptoms depend on the affected layers. Thus malabsorptive syndrome, intestinal strictures or ascites depend on a mucosal, muscular or serosa layer infiltration, respectively. We present three cases of eosinophilic gastroenteritis with distinct clinical presentations.