Hepatotoxicidad grave asociada al consumo de Noni (Morinda citrifolia) / Hepatotoxicity caused by a Noni (Morinda citrifolia) preparation

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[Influence of climatic factors on the incidence of upper gastrointestinal bleeding]. / Influencia de los factores climáticos en la incidencia de hemorragia digestiva alta.

OBJECTIVES: Several studies have suggested the existence of seasonal variation in the incidence of upper gastrointestinal bleeding (UGB). However, the role of climatic factors has not been elucidated. The aim of the present study was to investigate the role of these factors in the incidence of UGB secondary to esophageal varices (EV), gastric ulcer (GU), and duodenal ulcer (DU). MATERIAL AND METHODS: Based on the use of the Minimum Data Set and the International Classification of Diseases, cases of endoscopically-confirmed UGB secondary to EV, GU and DU were retrospectively included (1998-2001). The incidence of UGB was correlated with daily climatic factors (temperature, atmospheric pressure, humidity, direction and speed of wind) in Jerez de la Frontera (Spain) during the study period. RESULTS: A total of 499 patients were included (GU = 192, DU = 199, EV = 108). No significant differences were found in the monthly or seasonal incidence of UGB. Episodes of UGB were grouped according to the climatic conditions present on the day of admission. No significant relationship was found between UGB and any of the daily climatic factors studied. DISCUSSION: The results of our study do not support the existence of a seasonal pattern in the incidence of UGB secondary to GU, DU or EV and allow us to conclude that, in our geographical area, these factors are not involved in episodes of bleeding.

Influencia de los factores climáticos en la incidencia de hemorragia digestiva alta / Influence of climatic factors on the incidence of upper gastrointestinal bleeding

Objetivos: La presencia de un patrón estacional en la incidencia de hemorragia digestiva alta (HDA) ha sido sugerida en numerosos trabajos, pero la implicación de factores climáticos aún no ha podido ser aclarada. Nuestro objetivo fue investigar el papel de estos factores en la incidencia de HDA secundaria a varices esofágicas (VE), úlcera gástrica (UG) y úlcera duodenal (UD). Material y métodos: Se incluyeron de forma retrospectiva (1998-2001) los casos de hemorragia digestiva alta comprobada endoscópicamente y secundaria a VE, UG y UD, mediante el empleo del Conjunto Mínimo Básico de Datos al Alta y la Clasificación Internacional de Enfermedades. Se correlacionó su incidencia con los factores climáticos diarios (temperatura, presión atmosférica, humedad, dirección y velocidad del viento) presentes en nuestra ciudad durante el período de estudio. Resultados: Se incluyeron 499 pacientes (UG, 192; UD, 199; VE, 108). No se constataron diferencias significativas en la incidencia mensual o estacional de la HDA. Los episodios de HDA fueron agrupados según las características climáticas presentes el día del ingreso. La correlación realizada entre los episodios de HDA y cada uno de los factores climáticos diarios estudiados no puso de manifiesto una asociación estadísticamente significativa. Discusión: Nuestro trabajo no apoya la existencia de un determinado patrón estacional en la incidencia de HDA secundaria a úlceras gastroduodenales o varices esofágicas y nos permite afirmar que, en nuestra área geográfica, los factores climáticos no están implicados en modo alguno con la aparición de los episodios de sangrado

Objectives: Several studies have suggested the existence of seasonal variation in the incidence of upper gastrointestinal bleeding (UGB). However, the role of climatic factors has not been elucidated. The aim of the present study was to investigate the role of these factors in the incidence of UGB secondary to esophageal varices (EV), gastric ulcer (GU), and duodenal ulcer (DU). Material and methods: Based on the use of the Minimum Data Set and the International Classification of Diseases, cases of endoscopically-confirmed UGB secondary to EV, GU and DU were retrospectively included (1998-2001). The incidence of UGB was correlated with daily climatic factors (temperature, atmospheric pressure, humidity, direction and speed of wind) in Jerez de la Frontera (Spain) during the study period. Results: A total of 499 patients were included (GU = 192, DU = 199, EV = 108). No significant differences were found in the monthly or seasonal incidence of UGB. Episodes of UGB were grouped according to the climatic conditions present on the day of admission. No significant relationship was found between UGB and any of the daily climatic factors studied. Discussion: The results of our study do not support the existence of a seasonal pattern in the incidence of UGB secondary to GU, DU or EV and allow us to conclude that, in our geographical area, these factors are not involved in episodes of bleeding

Anxiety during the performance of colonoscopies: modification using music therapy.

BACKGROUND AND STUDY AIMS: Colonoscopies are usually performed using pharmacological sedation. This process entails certain risks. In the search for alternative methods, some studies have analysed the effect music can have on patients during the procedure when used as a complement to sedation. We present a prospective, randomized study in which we assess the anxiolytic action music has when it is administered during a single colonoscopy. PATIENTS AND METHODS: We included 118 patients who were scheduled for ambulatory colonoscopies. They were randomly assigned to the control group (n = 55) and the experimental group (n = 63). We determined their levels of anxiety using the State-Trait Anxiety Inventory Test (STAI) form, which they filled in before and after the examination. Patients listened to music through personal headphones. RESULTS: The score on the STAI form before the examination was 25.25 +/- 10.49 and 28.16 +/- 11.43 in the control and experimental groups, respectively (P > 0.05). The decrease of the score on the STAI scale after the colonoscopy in the control and experimental groups was 6.27 (95% confidence interval, 3.26-9.28) and 11.35 (95% confidence interval, 8.64-14.05), respectively (P < 0.01). CONCLUSIONS: Listening to music during ambulatory colonoscopies decreases the level of anxiety that is inherent to the process without other anxiolytic methods.

[Pseudoachalasia and secondary amyloidosis in a patient with rheumatoid arthritis]. / Seudoacalasia y amiloidosis secundaria en paciente con artritis reumatoide.

Rheumatic diseases cover a wide spectrum of clinical syndromes and frequently present with gastrointestinal alterations. Systemic amyloidosis is associated with infectious diseases or chronic inflammatory processes such as rheumatoid arthritis and it can also affect the gastrointestinal tract. Although esophageal involvement is difficult to quantify because its course is frequently asymptomatic, systemic amyloidosis is recognized as a cause of motor disorders of the esophagus. Typical manometric patterns, including achalasia, are usually absent. Esophageal involvement due to amyloid deposits usually corresponds to primary amyloidosis as only a few cases of secondary esophageal deposits (type AA) have been described. We describe a new case of this exceptional association that first presented as dysphagia in a patient with rheumatoid arthritis. The initial suspicion of pseudoachalasia led to the definitive diagnosis of secondary amyloidosis.

[Acute necrotizing esophagitis]. / Esofagitis necrosante aguda.

Acute necrotizing esophagitis is a rare disease. Its pathogenesis is influenced by situations of low systemic perfusion, such as hypertension, heart failure or sepsis, in which other factors, such as the application of a nasal tube, infections or drugs also play a role. We present a case of acute necrotizing esophagitis in a patient with copious vomiting, renal failure, gastric hemorrhage due to Mallory-Weiss syndrome and esophageal infection due to Actinomyces. The patient was undergoing coadjuvant chemotherapy for a surgically-treated colonic neoplasia. Maintenance therapy produced favorable evolution with restoration of esophageal epithelium and no stenotic complications.

Abdominal tuberculous abscesses in AIDS patients: percutaneous treatment.

OBJECTIVE: to analyze certain epidemiological and ultrasonographic features, and the response to percutaneous treatment, of abdominal tuberculous abscesses in patients with human acquired immunodeficiency syndrome. METHODS: we reviewed the clinical records and ultrasonographic findings in 7 patients with abdominal tuberculous abscesses who were treated in our service by ultrasonography-guided percutaneous drainage. RESULTS: in 5 patients there was a previous diagnosis of AIDS. The abscesses (two in one patient) were located mainly in the retroperitoneum and appeared mottled at ultrasonography. Seven of the abscesses were drained via catheter, whereas in the remaining case aspiration puncture was used. Mycobacterium tuberculosis was found in the drained material in 6 patients, and 1 case presented superinfection by Enterococcus faecalis. Percutaneous drainage was effective in 6 patients, and in the remaining case it was only palliative. CONCLUSIONS: the incidence of abdominal tuberculous abscesses is increasing in patients with AIDS, and in some patients it is the first symptom. Abscesses are located primarily in the retroperitoneum. They can be dealt with satisfactorily by percutaneous drainage guided by ultrasonography.

Focal splenic lesions in patients with AIDS: sonographic findings.

BACKGROUND: The purpose of this study was to describe the sonographic features of the focal splenic lesions in patients with AIDS and to know the frequency and etiology of these features. METHODS: Sonographic exams of 278 AIDS patients were reviewed retrospectively. We recorded the clinical indications for sonograms and sonographic findings of those patients with focal splenic lesions. In addition, patients' histories were reviewed to determine the etiology of such lesions. Ultrasound exams were performed with a 3.5-MHz transducer. RESULTS: Sonography demonstrated focal splenic lesions in 22 patients (7.9%). Eighteen patients (81.8%) showed small, multiple, hypoechoic, rounded splenic lesions; one patient had a solitary defect with similar features. In these 19 patients (86.3%), splenic lesions were due to disseminated Mycobacterium tuberculosis infection. One case showed two large hypoechoic wedge-shaped lesions that were splenic infarctions secondary to acute bacterial endocarditis. In two patients (9%) with solitary and multiple small hypoechoic lesions, the cause of the lesions remained unknown. All patients had splenomegaly. Hepatomegaly with focal lesions, retroperitoneal lymphadenopathy, or ascites were also seen. CONCLUSION: In our area, the finding of splenomegaly with small, multiple, hypoechoic lesions in AIDS patients should make clinicians suspect splenic tuberculosis as a first possibility.