RESUMEN
Gastrointestinal involvement occurs in approximately 4% of cases of systemic amyloidosis. The most common site of amyloid deposition is small bowel, followed by stomach, colorectum and esophagus. Although rare, gastrointestinal amyloidosis may be associated with severe complications including gastrointestinal bleeding or perforation and may be mistaken for malignancy. (AU)
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Humanos , Amiloidosis/complicaciones , Amiloidosis/diagnóstico por imagen , Enfermedades Gastrointestinales/complicaciones , Enfermedades Gastrointestinales/diagnóstico por imagen , Estómago/patología , PacientesRESUMEN
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Humanos , Masculino , Anciano de 80 o más Años , Enteritis/diagnóstico , Isquemia/diagnóstico , Hematemesis/etiología , Anastomosis Quirúrgica , Gastrectomía , Complicaciones PosoperatoriasRESUMEN
Background and aim: The human papilloma virus is the leading cause of anal squamous cell carcinoma. Cytological screening may reduce the associated morbidity and mortality. The aim of the study was to estimate the agreement between anal cytological examination, histopathology and anoscopic visual impression. Methods: A prospective study of patients who underwent anal dysplasia screening between 2011 and 2015, in a proctology clinic of a tertiary referral center. Results: During the study period, 141 patients (91% men, 87% with HIV infection) underwent 175 anal cytology tests. Of these, 33% were negative for intraepithelial lesions or malignancy (NILM), 22% were atypical squamous cells of uncertain significance (ASCUS), 33% were low-grade squamous intraepithelial lesion (LSIL) and 12% were high-grade squamous intraepithelial lesion (HSIL). With regard to anoscopic visual impression, 46% of patients had no lesions and excision/biopsy of the identified lesions was performed in the remaining patients. The weighted kappa-agreement between abnormal cytological results and anoscopic visual impression was moderate (k = 0.48). The weighted kappa-agreement between simultaneous anal cytological examinations and anal histopathologic findings was low (kappa = 0.20). With regard to the histological examination of cases with HSIL or superficially invasive squamous cell carcinoma, 64% of patients had dysplasia of a lower grade according to the cytological analysis (6 ASCUS, 18 LSIL and 4 NILM). Conclusion: There was a poor correlation between anal cytology, histopathology and anoscopic visual impression and a high number of histological studies of HGD that were of a lower dysplastic degree according to the cytological examination. Therefore, anal cytology screening should not be used as the sole method of anal dysplasia screening (AU)
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Asunto(s)
Humanos , Técnicas Citológicas , Neoplasias del Ano/patología , Infecciones por Papillomavirus/patología , Infecciones por VIH/epidemiología , Papillomaviridae/patogenicidad , Endoscopía GastrointestinalAsunto(s)
Humanos , Toxinas Botulínicas , Esfínter Esofágico Inferior , Unión Esofagogástrica , Manometría , PacientesRESUMEN
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Humanos , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colangitis/complicaciones , Colangitis/cirugía , Antibacterianos/uso terapéutico , Coledocolitiasis/complicaciones , Ictericia Obstructiva/complicaciones , Dolor Abdominal/complicaciones , Dolor Abdominal/etiología , Tiempo de Internación/tendenciasRESUMEN
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Humanos , Masculino , Adulto , Hepatitis/complicaciones , Hepatitis/patología , Fiebre Q/complicaciones , Fiebre Q/diagnóstico , Granuloma/diagnóstico , Granuloma/patología , Biopsia , Coxiella burnetii , Coxiella burnetii/aislamiento & purificación , Doxiciclina/uso terapéutico , Técnica del Anticuerpo Fluorescente Indirecta/métodosRESUMEN
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Humanos , Masculino , Adulto , Cuerpos Extraños/cirugía , Cuerpos Extraños , Endoscopía/métodos , Impactación Fecal/complicaciones , Colon Sigmoide/lesiones , Colon Sigmoide/cirugía , Colon SigmoideRESUMEN
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Humanos , Masculino , Adulto , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/patología , Colitis Ulcerosa/cirugía , Entamoeba histolytica , Entamoeba histolytica/aislamiento & purificación , Metronidazol/uso terapéutico , Endoscopía/métodos , Colon/patología , Colon/cirugía , Colon , Mucosa Gástrica/lesiones , Mucosa GástricaRESUMEN
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Humanos , Femenino , Persona de Mediana Edad , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Nandrolona/efectos adversos , Biopsia , Terapia de Reemplazo de Estrógeno/efectos adversosRESUMEN
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Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Proctocolitis/epidemiología , Isquemia/epidemiología , Enfermedad Aguda/epidemiología , Factores de Riesgo , Hemorragia Gastrointestinal/etiologíaRESUMEN
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Humanos , Masculino , Anciano , Adenocarcinoma/complicaciones , Adenocarcinoma/cirugía , Adenocarcinoma , Recurrencia Local de Neoplasia/complicaciones , Recurrencia Local de Neoplasia , Gastrectomía/métodos , Gastrectomía/tendencias , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Endoscopía Gastrointestinal/instrumentación , Endoscopía Gastrointestinal/métodos , Tracto Gastrointestinal/patología , Tracto GastrointestinalRESUMEN
Glycogenic hepatopathy is a rare and underecognized complication in long-standing poorly controlled type 1 diabetes mellitus patients. This is a distinct entity from other causes of hepatomegaly and elevated liver enzymes in diabetics, such as nonalcoholic fatty liver disease. Glycogenic hepatopathy is characterized by the combination of poorly controlled diabetes, acute liver injury with marked elevation in serum aminotransferases, and the characteristic histological features on liver biopsy. It is important to distinguish this entity as it has the potential for resolution following improved glycemic control. In this report, we describe four cases of adult patients presenting elevated serum transaminases and hepatomegaly with a history of poorly controlled type I diabetes mellitus. One of the patients had also elevated amylase and lipase in the serum, without clinical or imagiologic evidence of acute pancreatitis. Liver biopsy was performed in all patients and revealed glycogenic hepatopathy. Clinicians awareness of glycogenic hepatopathy should prevent diagnostic delay or misdiagnosis and will provide better insight and management for this condition (AU)
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Asunto(s)
Humanos , Glucógeno Hepático/análisis , Hepatitis/etiología , Diabetes Mellitus Tipo 1/complicaciones , Transaminasas/sangre , Amilasas/sangre , Lipasa/sangreRESUMEN
BACKGROUND: videocapsule endoscopy (VCE) is currently the most sensitive diagnostic tool to detect early small bowel inflammation. A Lewis score (LS) of ≥ 135 as the cutoff value for the presence of significant inflammatory activity in patients undergoing VCE for suspected Crohn's disease (CD) has been suggested as a useful tool for the diagnosis of CD. The aim of this study was to evaluate the diagnostic and prognostic accuracy of the LS in patients with suspected CD undergoing VCE. METHODS: a retrospective single-center study was performed that included patients who underwent VCE for suspected CD between January 2010 and December 2015. Inflammatory activity was assessed with the LS. Patients were grouped according to the criteria of the International Conference on Capsule Endoscopy (ICCE) for the definition of suspected CD; group 1: patients not fulfilling ICCE and group 2: patients with ≥ 2 ICCE criteria. RESULTS: one hundred and ninety-one patients were included, 61% were female and the mean age was 39 ± 14 years. VCE detected significant inflammatory activity (LS ≥ 135) in 81 patients (42%); 24 patients from group 1 (32%) and 57 patients from group 2 (50%) (p = 0.014). During a mean follow-up period of 41 ± 21 months (12-79), a CD diagnosis was determined in 60 patients (31%); 55 patients with LS ≥ 135 (92%) and five patients with LS < 135 (5%) (p < 0.001). The LS showed a good diagnostic accuracy with an AUROC of 0.93 (p < 0.001). During the first year after diagnosis, there was a significant association between a higher LS and the need for immunomodulatory therapy, biological therapy, bowel resection surgery or hospital admission due to a CD flare-up. CONCLUSIONS: the LS (cutoff ≥ 135) is very useful in the diagnosis of CD in patients undergoing VCE. Moreover, higher values of this score was associated with prognostic variables
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Enfermedad de Crohn/diagnóstico , Endoscopios en Cápsulas , Endoscopía Capsular , Índice de Severidad de la Enfermedad , Reproducibilidad de los Resultados , Estudios Retrospectivos , Pronóstico , Curva ROCRESUMEN
BACKGROUND: Malignant colorectal obstruction (MCRO) by advanced colonic cancer occurs in 8-13% of colonic cancer patients. Emergent surgery carries a high mortality and morbidity risk. Endoscopic self-expanding metal stents (SEMS) may be used in acute MCRO. AIM: Evaluate clinical outcome of SEMS in acute MCRO and efficacy of SEMS placement considering fluoroscopy guidance. METHODS: Retrospective study of patients with acute MCRO that placed SEMS in a 3 years period. RESULTS: SEMS were placed in 47 patients, followed-up for a median time of 150 days. The intent of stenting was bridge to definitive surgery in 40% of the patients (n = 19) and palliation in the remaining 60% (n = 28). The location of the tumor did not influence the presence of lymph node involvement (p = 0.764) nor metastasis (p = 0.885). Mortality rate at year 1 was 61%. Survival was significantly higher in patients submitted later to combination therapy compared to chemotherapy, surgery or symptomatic treatment (p < 0.001). Fluoroscopy was used in 57% of the procedures. Clinical success was 79%. A second SEMS was needed during the procedure in 6% of the patients. Rate of early and late complications was 11% and 5%, respectively. Fluoroscopy guidance did not influence the occurrence of immediate (p = 0.385), early (p = 0.950) or late complications (p = 0.057). Thirty-three percent of patients underwent surgery at a later stage, with neo-adjuvant therapy in 18%. CONCLUSIONS: SEMS provide a relative safe and successful treatment in a palliative or bridge-to-surgery indication. No significant differences were found in SEMS placement success, early complications or late complications considering fluoroscopy guidance
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Femenino , Humanos , Masculino , Persona de Mediana Edad , Cirugía Colorrectal/métodos , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/cirugía , Endoscopía/métodos , Fluoroscopía/instrumentación , Fluoroscopía/métodos , Fluoroscopía , Estudios RetrospectivosRESUMEN
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Humanos , Masculino , Adulto , Antirreumáticos/efectos adversos , Enfermedades del Íleon/diagnóstico , Infliximab/efectos adversos , Pólipos Intestinales/diagnóstico , Trasplante de Riñón , Leishmaniasis Visceral/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Antirreumáticos/uso terapéutico , Enfermedad de Crohn/tratamiento farmacológico , Diagnóstico Diferencial , Glomerulonefritis por IGA/complicaciones , Glomerulonefritis por IGA/cirugía , Enfermedades del Íleon/complicaciones , Enfermedades del Íleon/patología , Enfermedades del Íleon/parasitología , Infliximab/uso terapéutico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresRESUMEN
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