RESUMO
AIM: To analyze the indications, efficacy and safety of sphincteroplasty in our centre. METHODS: A retrospective study of sphincteroplasty in 53 cases of papilla at high risk was performed in 2004-2006. The procedure consisted of duodenoscopy with Olympus TJF 145 Videoduodenoscope, approach to the biliary tract using a catheter with a guidewire, and dilatation of the papilla with a dilatation balloon catheter using a syringe with a manometer for control of the filling pressure. RESULTS: The indications included intradiverticular papilla in 26 patients (49%), stenosis of a previous sphincterotomy in 19 patients (35.8%), small size of the papilla in 4 patients (7.5%), Billroth II gastrectomy in 3 patients (5.6%), and coagulopathy in one patient (1.9%). The efficacy was 97.8%, with all the calculi extracted from the common bile duct in 84.4% of the patients, even though 21 of the patients (39.6%) had calculi with a diameter equal to or greater than 10 mm. Seven patients (13.2%) presented complications: haemorrhage in 1 patient (1.9%) and mild pancreatitis in 6 patients (11.3%). The mean hospital stay in case of complications was of 3 +/- 0.63 d. CONCLUSION: Sphincteroplasty is highly effective, with a complication rate similar to that of sphincterotomy, furthermore, the complications are of low clinical importance. The use of the 10 mm balloon makes it possible to extract calculi with a diameter of over 15 mm and to extract more than 3 calculi without increasing the rate of complications and reduces the need to resort to lithotripsy or rescue sphincterotomy.
Assuntos
Ampola Hepatopancreática/anormalidades , Cálculos Biliares/cirurgia , Esfincterotomia Transduodenal/métodos , Idoso , Idoso de 80 Anos ou mais , Ampola Hepatopancreática/cirurgia , Ductos Biliares/anormalidades , Ductos Biliares/cirurgia , Cateterismo , Colangiopancreatografia Retrógrada Endoscópica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Esfíncter da Ampola Hepatopancreática/anormalidades , Esfíncter da Ampola Hepatopancreática/cirurgia , Esfincterotomia Transduodenal/efeitos adversos , Esfincterotomia Transduodenal/instrumentaçãoRESUMO
BACKGROUND: Hepatitis C virus (HCV) translation is initiated in a cap-independent manner by an internal ribosome entry site (IRES) located within the 5' untranslated region (5'UTR). Sequence changes in this region could affect translation efficiency and presumably viral replication. AIM: To determine translation efficiency of 5'UTR variants developing during post-transfusion hepatitis C in two immunocompetent subjects and in two immunosuppressed liver recipients with recurrent HCV. METHODS: Sequential samples were screened for 5'UTR changes by single-strand conformation polymorphism followed by cloning and sequencing whenever band pattern suggested sequence changes. 5'UTR variants were tested for IRES activity using a bicistronic dual luciferase expression plasmid transfected into HepG2 and Huh7 cell-lines. RESULTS: In the transfused patients, translation efficiency of 5'UTR variants from early post-transfusion samples was 5.1- to 13.7-fold higher than that of predominant variants found in late follow-up samples. Post-transplant variants in the other two patients had 2.6- to 5.9-fold higher translation efficiency than those present only in pretransplant samples. CONCLUSION: In the immunocompetent host there may be selection of low translation efficiency HCV variants over the course of infection. However, in immunosuppressed subjects the opposite seems to be true as low translation efficiency variants are superseded by high translation efficiency variants.
Assuntos
Regiões 5' não Traduzidas/genética , Hepacivirus/genética , Hepatite C/virologia , Transplante de Fígado/efeitos adversos , Reação Transfusional , Adulto , Sequência de Bases , Feminino , Hepatite C/etiologia , Humanos , Pessoa de Meia-Idade , Dados de Sequência Molecular , Conformação de Ácido Nucleico , Biossíntese de ProteínasAssuntos
Consumo de Bebidas Alcoólicas , Mortalidade , Causas de Morte , Humanos , Medicina Preventiva , VinhoRESUMO
No disponible
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Humanos , Consumo de Bebidas Alcoólicas , Doenças Cardiovasculares , MortalidadeRESUMO
BACKGROUND: Inflammatory bowel disease impairs patients' perception of health and has a negative impact on health-related quality of life (HRQOL). Most studies include patients from a single hospital. This may bias limit results through the use of small patient samples and/or samples within a restricted disease spectrum. METHODS: HRQOL was measured in patients with ulcerative colitis (UC) and Crohn's disease (CD) from 9 hospitals located in different geographical areas in Spain using 2 questionnaires: the Spanish version of the Inflammatory Bowel Disease Questionnaire (IBDQ) and the EuroQol. Results are expressed as medians. RESULTS: The study included 1156 patients (528 patients with UC and 628 with CD; median age, 35 yr; slight predominance of women, 617 versus 539). HRQOL worsened in parallel with disease severity to a similar extent in both UC (IBDQ scores of 6.1, 4.7, and 4.0 for the 3 disease severity groups, respectively) and CD (IBDQ scores of 6.1, 5.0, and 4.1, respectively). A similar inverse relation between clinical activity and quality of life was observed when EuroQol preference values were used. All 5 dimensions of the IBDQ showed significantly lower scores in patients with active UC and CD than in patients in remission. The pattern of scores by IBDQ dimensions differed between patients in relapse (who scored worse on the digestive symptoms dimension) and patients in remission. Variables related with disease activity, time of evolution since diagnosis and female sex, were significantly associated with having a worse perception of HRQOL. The type of disease or geographical area of residence did not influence results on the IBDQ. CONCLUSIONS: UC and CD impair patients' HRQOL, and the degree of impairment depends on disease activity but is independent of the type of disease and place of residence.
Assuntos
Colite Ulcerativa/fisiopatologia , Colite Ulcerativa/psicologia , Doença de Crohn/fisiopatologia , Doença de Crohn/psicologia , Nível de Saúde , Qualidade de Vida , Adulto , Emoções , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Autoimagem , Índice de Gravidade de Doença , EspanhaAssuntos
Amilases/sangue , Doença Celíaca/diagnóstico , Adulto , Doença Celíaca/complicações , Feminino , HumanosRESUMO
Ehlers-Danlos syndrome is an inherited connective tissue disease characterized by articular laxity, hyperelastic skin and tissue fragility. The syndrome is genetically, biochemically and clinically heterogeneous and several well-defined subtypes have been identified. We describe a patient with the type IV variant of this syndrome who developed acute spontaneous pancreatitis.
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Síndrome de Ehlers-Danlos/complicações , Pancreatite/complicações , Doença Aguda , Adulto , Evolução Fatal , Humanos , MasculinoRESUMO
No disponible
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Humanos , Feminino , Adulto , Colestase Intra-Hepática , Colestase Intra-Hepática , RecidivaRESUMO
OBJECTIVE: to determine the clinical, microbiological, diagnostic and therapeutic characteristics of pyogenic liver abscesses of bacterial origin. METHODS: retrospective analysis of pyogenic liver abscesses diagnosed at the Aránzazu Hospital in San Sebastián (northern Spain) between 1989 and 1998. RESULTS: we studied 45 patients with pyogenic liver abscesses of bacterial origin (30 men, 15 women, mean age 61 years 11 months). The site of the liver abscess was biliary in 28.9% of the patients, portal in 11.1%, and unknown in 33.3%. Elevated erythrocyte sedimentation rate (95.5%), leukocytosis (86.7%) and fever (82.2%) were the most frequent clinical and laboratory findings. The abscesses were solitary in 55. 5% of the patients. Echography was diagnostic in 68.4% of patients, and computed tomography was diagnostic in 100%. Cultures of pus from the abscess and blood were positive in 77.1% and 50% respectively. Of the abscesses diagnosed as being of bacterial origin, 44.4% involved multiple organisms. Escherichia coli and Streptococcus milleri were the germs isolated most frequently. Percutaneous drainage was done in 22 patients (48.9%), with satisfactory results in 18. Overall mortality related with abscesses was 15.5%. CONCLUSIONS: the clinical presentation of pyogenic liver abscess did not vary during the study period. Computed tomography is fundamental for diagnosis and treatment. Percutaneous drainage associated with early antibiotic therapy is the treatment of choice.
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Abscesso Hepático/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Abscesso Hepático/diagnóstico , Abscesso Hepático/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , SupuraçãoAssuntos
Pancreatite/microbiologia , Infecções por Salmonella , Salmonella enteritidis , Doença Aguda , Adulto , Feminino , HumanosRESUMO
Autoimmune hepatitis is a necro-inflammatory disease of unknown etiology. An acute or fulminant presentation is rare. We report a 18-year-old man presented with acute variceal hemorrhage. The patient was treated with endoscopic sclerotherapy, somatostatin, balloon tamponade and TIPS. The patient died within a week of massive bleeding and hepatic failure. This patient's history strongly suggests that autoimmune hepatitis can be presented as fulminant hemorrhage. The importance of diagnosis and treatment is emphasized to improve prognosis.
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Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/etiologia , Hepatite Autoimune/complicações , Doença Aguda , Adolescente , Terapia Combinada , Emergências , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/terapia , Evolução Fatal , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Hepatite Autoimune/diagnóstico , Hepatite Autoimune/terapia , Humanos , MasculinoRESUMO
OBJETIVOS: conocer las características clínicas, microbiológicas, diagnósticas y terapéuticas de los abscesos hepáticos piógenos de origen bacteriano. PACIENTES Y MÉTODOS: análisis retrospectivo de los abscesos hepáticos piógenos diagnosticados entre 1989 y 1998 en el Hospital Aránzazu de San Sebastián. RESULTADOS: se estudiaron 45 casos de abscesos hepáticos piógenos de origen bacteriano (30 varones y 15 mujeres; edad media: 61 años y 11 meses). El absceso hepático fue de origen biliar en el 28,9 por ciento, portal en el 11,1 por ciento y desconocido en el 33,3 por ciento. La elevación de la VSG (95,5 por ciento), la leucocitosis (86,7 por ciento) y la fiebre (82,2 por ciento) fueron los datos clínicos y analíticos más frecuentes. Los abscesos fueron solitarios en el 55,5 por ciento. La ecografía fue diagnóstica en el 68,4 por ciento de los casos la TAC en el 100 por ciento. Los cultivos de pus del absceso y los hemocultivos fueron positivos en el 77,1 por ciento y 50 por ciento respectivamente. El 44,4 por ciento de los abscesos con diagnóstico bacteriológico fueron polimicrobianos. E coli y S milleri fueron los gérmenes más habitualmente aislados. Se hizo drenaje percutáneo en 22 pacientes (48,9 por ciento), 18 con resultado satisfactorio. La mortalidad global, relacionada con la patología asociada del enfermo fue del 15,5 por ciento. CONCLUSIONES: el absceso hepático piógeno no ha variado en su presentación clínica. La TAC es fundamental tanto para el diagnóstico como para el tratamiento. El drenaje percutáneo asociado a la antibioterapia temprana es el tratamiento de elección (AU)
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Pessoa de Meia-Idade , Adulto , Idoso de 80 Anos ou mais , Idoso , Masculino , Feminino , Humanos , Supuração , Estudos Retrospectivos , Abscesso HepáticoRESUMO
No disponible
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Adulto , Feminino , Humanos , Infecções por Salmonella , Salmonella enteritidis , Pancreatite , Doença Aguda , PancreatiteRESUMO
Bronchogenic lung carcinoma, melanoma and breast cancer are the neoplasms which have most frequently been reported to metastasize to the stomach. These lesions are usually located on the fundus and on the upper part of the gastric body. They are usually asymptomatic with the diagnosis being made at necropsy. We present a patient who developed gastrointestinal bleeding as the first symptom of squamous lung cancer secondary to a gastric metastasis.
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Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/secundário , Hemorragia Gastrointestinal/etiologia , Neoplasias Pulmonares/patologia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/secundário , Carcinoma de Células Escamosas/complicações , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/complicaçõesRESUMO
In order to analyse the prevalence and significance of cryoglobulinaemia in patients with chronic hepatitis C virus (HCV) infection and the possible relationship of cryoglobulinaemia with the genotypes of HCV, we studied 89 patients with chronic HCV infection, 42 healthy controls and 22 patients with alcoholic cirrhosis. The patients with HCV were divided into three different groups according to the presence of cirrhosis and alanine aminotransferase levels. Moreover, in 20 patients with HCV and cryoglobulinaemia, HCV RNA sequences were quantified in serum and in cryoprecipitate. Cryoglobulins were detected more frequently in patients with chronic HCV infection than in healthy controls (42.6% vs. 4.7%; P<0.0001). Cryoglobulins were present in 68.4% of patients with HCV-related cirrhosis, which was nearly twice the figure in noncirrhotic HCV-infected patients and alcoholic cirrhotic patients. There were no differences in age, sex, aminotransferase levels or HCV genotype distribution in HCV-infected patients with or without cryoglobulinaemia. Only 13% of patients with chronic HCV infection and cryoglobulins showed symptoms of cryoglobulinaemia. There was a linear association between HCV RNA concentration in sera and in cryoprecipitates (P<0.0005). Patients with chronic HCV infection had a high prevalence of cryoglobulinaemia, especially in advanced forms of the disease, but clinical findings are few. There was no relationship with the genotype of HCV. The presence of HCV RNA in cryoprecipitates supported the hypothesis on the aetiological role of HCV in mixed cryoglobulinaemia.
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Crioglobulinemia/epidemiologia , Crioglobulinemia/virologia , Hepacivirus/genética , Hepatite C Crônica/epidemiologia , RNA Viral/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Comorbidade , Ensaio de Imunoadsorção Enzimática , Feminino , Genótipo , Hepacivirus/isolamento & purificação , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/virologia , Humanos , Cirrose Hepática Alcoólica/diagnóstico , Cirrose Hepática Alcoólica/epidemiologia , Cirrose Hepática Alcoólica/virologia , Masculino , Pessoa de Meia-Idade , Prevalência , Valores de Referência , Sensibilidade e Especificidade , Espanha/epidemiologiaRESUMO
OBJECTIVE: We aimed to investigate the modifications of HCV RNA (genomic and antigenomic strands) in peripheral blood mononuclear cells (PBMCs) of long-term responder patients to alpha-interferon therapy, and their usefulness as criteria of definitive HCV eradication. METHODS: We studied 10 patients with chronic hepatitis C with > 1 yr of sustained response after alpha-interferon therapy (normal alanine aminotransferase [ALT] and negative serum HCV RNA). Serum HCV RNA and genotyping were determined. Approximately 2 and 4 yr after completion of treatment we investigated the presence of HCV RNA (genomic and antigenomic strands) in PBMCs. Eight of 10 patients were rebiopsed 2 yr after discontinuation of treatment. RESULTS: The mean follow-up was 46.6 +/- 4.6 months (range, 39-51 months). In this period, all patients remained in sustained response. In the first determination, all patients had HCV RNA genomic strands and two patients had antigenomic strands detectable in PBMCs. Two years later only two patients had genomic and none had antigenomic strands detectable. After 4 yr of sustained response, eight of 10 patients lost HCV RNA from PBMCs. CONCLUSIONS: In the long-term follow-up, the majority of patients with chronic hepatitis C with sustained response after alpha-interferon therapy progressively lost HCV RNA from PBMCs. This determination in PBMCs is not a predictor of response.
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Antivirais/uso terapêutico , Hepacivirus/isolamento & purificação , Hepatite C Crônica/virologia , Interferon-alfa/uso terapêutico , Leucócitos Mononucleares/virologia , RNA Viral/sangue , Adolescente , Adulto , Feminino , Seguimentos , Genótipo , Hepacivirus/genética , Hepatite C Crônica/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Bacteriemia is a frequent infection in patients with hepatic cirrhosis, which is associated with a high mortality. Spontaneous bacteriemia is generally caused by gramnegative bacilli. We present an episode of Salmonella hadar's spontaneous bacteriemia in a patient with cirrhosis of the liver and transjugular intrahepatic portosystemic shunt. The role of the prosthesis in the pathogenesis of bacteriemia in hepatic cirrhosis is discussed.