RESUMEN
INTRODUCTION & OBJECTIVES: Liver cirrhosis is a major cause of mortality worldwide. Adequate diagnosis and treatment of decompensating events requires of both medical skills and updated technical resources. The objectives of this study were to search the demographic profile of hospitalized cirrhotic patients in a group of Latin American hospitals and the availability of expertise/facilities for the diagnosis and therapy of decompensation episodes. METHODS: A cross sectional, multicenter survey of hospitalized cirrhotic patients. RESULTS: 377 patients, (62% males; 58±11 years) (BMI>25, 57%; diabetes 32%) were hospitalized at 65 centers (63 urbans; 57 academically affiliated) in 13 countries on the survey date. Main admission causes were ascites, gastrointestinal bleeding, hepatic encephalopathy and spontaneous bacterial peritonitis/other infections. Most prevalent etiologies were alcohol-related (AR) (40%); non-alcoholic-steatohepatitis (NASH) (23%), hepatitis C virus infection (HCV) (7%) and autoimmune hepatitis (AIH) (6%). The most frequent concurrent etiologies were AR+NASH. Expertise and resources in every analyzed issue were highly available among participating centers, mostly accomplishing valid guidelines. However, availability of these facilities was significantly higher at institutions located in areas with population>500,000 (n=45) and in those having a higher complexity level (Gastrointestinal, Liver and Internal Medicine Departments at the same hospital (n=22). CONCLUSIONS: The epidemiological etiologic profile in hospitalized, decompensated cirrhotic patients in Latin America is similar to main contemporary emergent agents worldwide. Medical and technical resources are highly available, mostly at great population urban areas and high complexity medical centers. Main diagnostic and therapeutic approaches accomplish current guidelines recommendations.
Asunto(s)
Ascitis/epidemiología , Hemorragia Gastrointestinal/epidemiología , Encefalopatía Hepática/epidemiología , Hospitalización , Cirrosis Hepática/epidemiología , Peritonitis/epidemiología , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Ascitis/etiología , Infecciones Bacterianas , Diabetes Mellitus/epidemiología , Femenino , Hemorragia Gastrointestinal/etiología , Recursos en Salud , Encefalopatía Hepática/etiología , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/epidemiología , Hepatitis Autoinmune/complicaciones , Hepatitis Autoinmune/epidemiología , Humanos , América Latina/epidemiología , Cirrosis Hepática/complicaciones , Cirrosis Hepática Alcohólica/complicaciones , Cirrosis Hepática Alcohólica/epidemiología , Masculino , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Obesidad/epidemiología , Peritonitis/etiología , Distribución por Sexo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Se presenta un caso clínico de enfermedad de Castleman localizada en el mediastino simulando um timoma. Castleman describió por primera vez la hiperplasia gigante de ganglios linfáticos. Esta entidad presenta dos tipos histopatológicos con formas de transición entre ambos. Son destacables los síntomas y signos de neuropatía periférica. Como hecho original encontramos asociado un síndrome de secreción inadecuada de hormona antidiurética que cede totalmente con la extirpación del tumor. La histología demostró una hiperplasia gigante de ganglios linfáticos tipo II (hialino-vascular) con formación de seudo-corpúsculos de Hassall