Subject(s)
Colorectal Neoplasms, Hereditary Nonpolyposis/genetics , Mutation , Aged , Female , Humans , MRE11 Homologue Protein/genetics , Middle Aged , MutL Protein Homolog 1/genetics , Proto-Oncogene Proteins B-raf/genetics , Syndrome , Tumor Suppressor Proteins/genetics , Ubiquitin-Protein Ligases/geneticsABSTRACT
Mixed cryoglobulinemia (MC) is a small-vessel systemic vasculitis characterized by the presence of cryoglobulins, immunoglobulin complexes that precipitate at low temperatures ( < 37 ºC) inducing the inflammatory process. The most frequent etiology is hepatitis C infection (HCV) (1). Rituximab (RTX), an anti-CD20 monoclonal antibody, has recently emerged as the treatment of choice for severe MC (2). We present a case of severe hepatitis C virus-induced MC that was controlled and maintained in remission with RTX for 26 months, a remarkable prolonged period of time.
Subject(s)
Antibodies, Monoclonal, Murine-Derived/therapeutic use , Antiviral Agents/therapeutic use , Cryoglobulinemia/drug therapy , Cryoglobulinemia/etiology , Hepacivirus , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/drug therapy , Female , Humans , Middle Aged , RituximabSubject(s)
Adenomatous Polyps/diagnosis , Colonic Neoplasms/diagnosis , Duodenal Neoplasms/diagnosis , Ganglioneuroma/diagnosis , Hamartoma Syndrome, Multiple/diagnosis , Intestinal Polyps/diagnosis , Adenoma/surgery , Adenomatous Polyps/genetics , Adenomatous Polyps/pathology , Adult , Colonic Neoplasms/genetics , Colonic Neoplasms/pathology , Colonoscopy , Diagnosis, Differential , Duodenal Neoplasms/genetics , Duodenal Neoplasms/pathology , Exons/genetics , Ganglioneuroma/genetics , Ganglioneuroma/pathology , Gastroscopy , Hamartoma Syndrome, Multiple/complications , Hamartoma Syndrome, Multiple/genetics , Hamartoma Syndrome, Multiple/pathology , Humans , Hyperpigmentation/etiology , Intestinal Polyps/genetics , Intestinal Polyps/pathology , Male , Megalencephaly/etiology , Multiple Endocrine Neoplasia Type 2a/diagnosis , Mutation, Missense , PTEN Phosphohydrolase/genetics , Penile Diseases/etiology , Point Mutation , Thyroid Neoplasms/surgery , ThyroidectomySubject(s)
Diagnostic Errors , Endometriosis/diagnosis , Sigmoid Diseases/diagnosis , Sigmoid Neoplasms/diagnosis , Adult , Biopsy , Colectomy , Colonic Polyps/diagnosis , Colonoscopy , Diagnosis, Differential , Endometriosis/epidemiology , Endometriosis/pathology , Endometriosis/surgery , Female , Humans , Intestinal Obstruction/etiology , Sigmoid Diseases/epidemiology , Sigmoid Diseases/pathology , Sigmoid Diseases/surgeryABSTRACT
OBJECTIVES: To evaluate the patient characteristics, outcome, and prognosis of upper gastrointestinal haemorrhage in the elderly. MATERIAL AND METHODS: A prospective study was conducted on 103 patients aged 80 years and over, admitted to a Gastrointestinal Bleeding Unit after an episode of upper gastrointestinal bleeding. We analysed the personal history, the characteristics of the bleeding event, and whether an urgent diagnostic or therapeutic endoscopy was performed, in order to identify clinical data and endoscopic findings that may have an influence on the outcome of the haemorrhage. RESULTS: The major cause of the haemorrhage was peptic ulcer in 65.1%, and 60.2% of patients were on chronic treatment with non-steroidal anti-inflammatory drugs. An urgent diagnostic endoscopy was performed in all of them, identifying the source of bleeding in 94.2%, and treatment was carried out on 28.2%. The likelihood of rebleeding was 8%, and 4.9% of patients underwent emergency surgery, with an overall mortality rate of 5.8%. CONCLUSIONS: The performance of urgent endoscopy and the application of endoscopic haemostasis are safe and effective in stopping upper gastrointestinal bleeding in the elderly. This has significantly reduced the need for emergency surgery, improving the survival of the bleeding elderly patient and preventing recurrent bleeding.