Assuntos
Doenças do Ceco , Ceco , Endoscopia do Sistema Digestório/métodos , Nicorandil/efeitos adversos , Úlcera , Idoso de 80 Anos ou mais , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/efeitos adversos , Biópsia/métodos , Doenças do Ceco/induzido quimicamente , Doenças do Ceco/diagnóstico , Doenças do Ceco/fisiopatologia , Doenças do Ceco/terapia , Ceco/diagnóstico por imagem , Ceco/patologia , Humanos , Hipertensão/tratamento farmacológico , Masculino , Nicorandil/administração & dosagem , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Úlcera/induzido quimicamente , Úlcera/diagnóstico , Úlcera/fisiopatologia , Úlcera/terapia , Suspensão de TratamentoAssuntos
Estenose Esofágica/diagnóstico , Líquen Plano/diagnóstico , Biópsia , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/terapia , Diagnóstico Diferencial , Estenose Esofágica/terapia , Feminino , Gastroscopia , Humanos , Líquen Plano/terapia , Pessoa de Meia-Idade , RecidivaRESUMO
A case of amoebic colitis and liver abscess is described in a previously fit 59-year old man who had been given the incorrect diagnosis of ulcerative colitis. His symptoms were so severe that a colectomy was being considered. The patient had a significant travel history including trips to Morocco, the Gambia and Cape Verde, putting him at risk of acquiring amoebic disease. However, this history was not ascertained until much later on in the disease process. The case highlighted crucial learning points including the importance of taking a lifelong travel history, the difficulties in telling ulcerative colitis and amoebic colitis apart both clinically and histopathologically, and the importance of sending multiple stool samples for parasitological microscopy analysis in patients being investigated for inflammatory bowel disease.
Assuntos
Colite Ulcerativa/diagnóstico , Erros de Diagnóstico , Disenteria Amebiana/diagnóstico , Entamebíase/diagnóstico , Abscesso Hepático Amebiano/diagnóstico , Terapia Combinada , Diagnóstico Tardio , Diagnóstico Diferencial , Drenagem , Disenteria Amebiana/tratamento farmacológico , Disenteria Amebiana/parasitologia , Disenteria Amebiana/patologia , Entamoeba histolytica/isolamento & purificação , Entamebíase/tratamento farmacológico , Entamebíase/parasitologia , Entamebíase/cirurgia , Fezes/parasitologia , Humanos , Abscesso Hepático Amebiano/tratamento farmacológico , Abscesso Hepático Amebiano/cirurgia , Masculino , Anamnese , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Nutrição Parenteral Total , Paromomicina/uso terapêutico , Doença Relacionada a ViagensRESUMO
AIM: The purpose of this survey was to ascertain reporting habits of pathologists towards sessile serrated adenomas/polyps (SSA/P). METHODS: A questionnaire designed to highlight diagnostic criteria, approach and clinical implications of SSA/P was circulated electronically to 45 pathologists in the UK and North America. RESULTS: Forty-three of 45 pathologists agreed to participate. The vast majority (88%) had a special interest in gastrointestinal (GI) pathology, had great exposure to GI polyps in general with 40% diagnosing SSA/P at least once a week if not more, abnormal architecture was thought by all participants to be histologically diagnostic, and 11% would make the diagnosis if a single diagnostic histological feature was present in one crypt only, while a further 19% would diagnose SSA/P in one crypt if more than one diagnostic feature was present. The vast majority agreed that deeper sections were useful and 88% did not feel proliferation markers were useful. More than one-third did not know whether, or did not feel that, their clinicians were aware of the implications of SSA/P. CONCLUSIONS: 98% of pathologists surveyed are aware that SSA/P is a precursor lesion to colorectal cancer, the majority agree on diagnostic criteria, and a significant number feel that there needs to be greater communication and awareness among pathologists and gastroenterologists about SSA/P.
Assuntos
Adenoma/patologia , Pólipos do Colo/patologia , Neoplasias Colorretais/patologia , Padrões de Prática Médica , Atitude do Pessoal de Saúde , Conscientização , Biópsia , Comunicação , Consenso , Comportamento Cooperativo , Pesquisas sobre Atenção à Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , América do Norte , Valor Preditivo dos Testes , Prognóstico , Inquéritos e Questionários , Reino UnidoRESUMO
We present the case of a 16 year old girl who developed an aggressive colitis in the context of a prior biopsy proven autoimmune pancreatitis, which presented with obstructive jaundice at the age of 13 year. This history prompted prospective investigation and the discovery of compelling evidence to make a diagnosis of IgG4-related sclerosing disease with extra-pancreatic colonic involvement on the basis of raised serum IgG4 levels and a florid colonic IgG4 plasma cell infiltrate with over 20 IgG4 positive plasma cells/hpf. The colitis was resistant to conventional therapy but responded dramatically to treatment with the anti-TNFα monoclonal antibody, adalimumab. This is the first case to report both the effectiveness of adalimumab in treating IgG4 positive colitis in a patient with IgG4-related sclerosing disease, and to prospectively record resolution of an IgG4 positive colonic infiltrate with immunosuppression.