RESUMO
AIM: To evaluate the sensitivity, specificity, and predictive values of dipstick testing (DT) for detecting spontaneous bacterial peritonitis (SBP), defined by an ascites neutrophil polymorphonuclear cell count > or = 250/mm3, in patients with cirrhosis. METHODS: The study includes all patients with cirrhosis and ascites admitted to our general hospital on the southern outskirts of the Paris metropolitan area (France) from June 2003 to May 2004 (n = 47:27 men and 20 women). Diagnostic abdominal paracentesis was performed on admission, and a Multistix SG (Bayer Pharma) reagent strip was immersed in one ascitic sample from each patient. Readings after 120 s were either negative (DT-) or positive (DT+, with 4 levels of positivity: trace, +, ++, or +++). In case of cytologically-proven SBP, patients were treated with cefotaxime, and subsequent paracentesis with DT and cytologic testing took place every 48 hours, until recovery. RESULTS: Six of the 47 patients had proven SBP, all with clinical signs of SBP (fever and/or abdominal pain); five of these patients were DT+ and one was DT-. In the five patients initially DT+, the DT became negative at the same time as the cytologic criteria for SBP disappeared. Forty-one patients did not meet the cytologic criteria for SBP: 34 were DT- and 7 were DT+ (traces: 4, ++: 2, +++:1); two of these had clinical signs suggestive of SBP. CONCLUSION: Although the sensitivity (83%), specificity (83%) and negative predictive value (97%) of DTwere satisfactory, its positive predictive value (42%) was low. Dipstick testing of ascitic fluid is easy to perform and inexpensive and may be recommended for diagnosis and follow-up of SBP, especially in emergency settings.
Assuntos
Ascite/diagnóstico , Cirrose Hepática/complicações , Peritonite/diagnóstico , Fitas Reagentes , Idoso , Antibacterianos/uso terapêutico , Cefotaxima/uso terapêutico , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neutrófilos/citologia , Paracentese , Peritonite/tratamento farmacológico , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: On-demand treatment may be an alternative in the long-term treatment of non-severe gastro-oesophageal reflux disease in patients with frequent symptomatic relapses. AIM: To compare the efficacy of on-demand treatment with rabeprazole 10 mg versus continuous treatment in the long-term treatment of patients with frequent symptomatic relapses of mild to moderate gastro-oesophageal reflux disease. METHODS: This randomized, open-label study enrolled patients diagnosed with non-erosive reflux disease or oesophagitis grade 1 or 2 (Savary-Miller classification) reporting frequent symptomatic relapses (requiring > or =2 courses of antisecretory therapy during the previous year), whose intensity is rated at least moderate (>2 on a 5-point Likert scale). After a 4-week selection phase with rabeprazole 10 mg once daily, patients reporting symptom relief (Likert score < or =2) were randomized to receive either rabeprazole 10 mg continuous treatment or on-demand treatment for 6 months. The main evaluation criterion was the rate of symptom relief (scored on the Likert scale) after 6 months. RESULTS: One hundred and seventy-six patients were enrolled in the 4-week selection phase (men, 53%; mean age, 49 years; non-erosive reflux disease, 36.4%; gastro-oesophageal reflux disease 1, 53.4%; gastro-oesophageal reflux disease 2, 10.2%). Rabeprazole relieved symptoms in 88.6% of patients. Of this group, 152 were randomized to the comparative phase to receive rabeprazole 10 mg continuous treatment (once daily) or on-demand treatment (continuous treatment, n = 81; on-demand treatment, n = 71). At month 6 (end point), the symptom relief rate was slightly higher for patients in the continuous treatment group compared with those in the on-demand treatment group: 86.4% versus 74.6%, respectively. This difference was not statistically significant (P = 0.065). For the overall quality of life score, there was no difference between the continuous treatment and on-demand treatment groups (86.25 and 84.94). Mean daily consumption of rabeprazole was significantly lower in the on-demand treatment group versus the continuous treatment group (0.31 tablets versus 0.96 tablets; P < 0.0001). CONCLUSION: On-demand therapy with rabeprazole 10 mg provides an alternative to continuous therapy in patients with mild to moderate gastro-oesophageal reflux disease suffering from frequent symptomatic relapses.
Assuntos
Antiulcerosos/administração & dosagem , Benzimidazóis/administração & dosagem , Omeprazol/análogos & derivados , Omeprazol/administração & dosagem , 2-Piridinilmetilsulfinilbenzimidazóis , Adulto , Idoso , Antiulcerosos/efeitos adversos , Benzimidazóis/efeitos adversos , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Omeprazol/efeitos adversos , Cooperação do Paciente , Rabeprazol , Prevenção Secundária , Resultado do TratamentoAssuntos
Doença Hepática Induzida por Substâncias e Drogas/etiologia , Toxidermias/etiologia , Fenofibrato/efeitos adversos , Hipertrigliceridemia/tratamento farmacológico , Hipolipemiantes/efeitos adversos , Doença Aguda , Adulto , Alanina Transaminase/sangue , Bilirrubina/sangue , Biópsia , Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Doença Hepática Induzida por Substâncias e Drogas/metabolismo , Toxidermias/diagnóstico , Toxidermias/metabolismo , Monitoramento de Medicamentos , Febre/induzido quimicamente , Humanos , Icterícia/induzido quimicamente , Masculino , gama-Glutamiltransferase/sangueRESUMO
Acute colitis occurring in patients suffering from psychiatric illnesses is believed to be linked to the intake of psychotropes. From 1983 to 1989, the authors observed, in three Hepato-gastroenterology units, 10 cases of acute colitis in patients suffering from serious psychiatric disorders, most of them inpatients of mental hospitals. The detailed study of 7 of these cases emphasized a certain number of common features: there was no previous history of digestive disease, the psychiatric illness was serious and longstanding, acute colitis was severe, and there was no recurrence during clinical and endoscopic follow-up averaging 4.3 years. Of these 7 patients, 2 were not taking psychotropes at the time of colitis or after, 2 had discontinued their treatment for a few days, and 2 had not stopped taking psychotropes. One patient died. The short-term and long-term evolution in these cases was not influenced by the intake or not of psychotropes. The pathogeny of this colitis is yet to be determined: infection is the most likely origin.
Assuntos
Antidepressivos Tricíclicos/efeitos adversos , Antipsicóticos/efeitos adversos , Colite/induzido quimicamente , Transtornos Psicóticos/tratamento farmacológico , Doença Aguda , Corticosteroides/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Antipsicóticos/uso terapêutico , Colite/psicologia , Colite/terapia , Terapia Combinada , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral , Estudos Retrospectivos , Sulfassalazina/uso terapêuticoRESUMO
In familial adenomatous polyposis, sulindac-induced polyp regression has been reported by several authors. In this study, the goal was to confirm these results by a randomized, placebo-controlled, double-blind crossover study in 10 patients with rectal polyps that had been previously treated by colectomy and ileorectal anastomosis. Patients received sulindac, 300 mg/day, or placebo during two 4-month periods separated by a 1-month wash-out phase. One patient was not compliant and was excluded. With sulindac, the authors observed a complete (6 patients) or almost complete (3 patients) regression of the polyps. With placebo, the authors observed an increase (5 patients), no change (2 patients), and a relative decrease (2 patients) in the number of polyps. The difference between sulindac and placebo was statistically significant (P less than 0.01). In biopsy specimens of polyps and normal rectal mucosa of 6 patients, the authors conducted an immunohistochemical study of the cellular proliferation index using the Ki 67 monoclonal antibody (Ki 67 index), at the beginning and at the end of each treatment period. They were not able to show a sulindac-induced modification of the Ki 67 index. The authors conclude that sulindac is effective in inducing the regression of rectal polyps in familial adenomatous polyposis.
Assuntos
Polipose Adenomatosa do Colo/tratamento farmacológico , Neoplasias Retais/tratamento farmacológico , Sulindaco/uso terapêutico , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Neoplasias Retais/química , Indução de RemissãoAssuntos
Anticorpos/análise , Vacinas Bacterianas/uso terapêutico , Cirrose Hepática Alcoólica/imunologia , Hepatopatias Alcoólicas/imunologia , Infecções Pneumocócicas/imunologia , Adulto , Idoso , Doença Crônica , Ensaio de Imunoadsorção Enzimática , Humanos , Pessoa de Meia-Idade , Infecções Pneumocócicas/prevenção & controle , Valores de Referência , Streptococcus pneumoniae/imunologiaAssuntos
Hidrotórax/tratamento farmacológico , Cirrose Hepática Alcoólica/complicações , Respiração Artificial/métodos , Tetraciclina/uso terapêutico , Adulto , Idoso , Feminino , Humanos , Hidrotórax/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tetraciclina/administração & dosagemRESUMO
The effects of ursodeoxycholic acid (UDCA, 750-1250 mg/day) were evaluated prospectively in 15 patients with primary sclerosing cholangitis (PSC). Five patients had associated inflammatory bowel disease. After 6 months of treatment, the proportion of patients suffering from fatigue or pruritus decreased from 60% to 20% and from 33% to 20%, respectively. No exacerbation of associated disorders was observed. Serum alkaline phosphatase levels (normal less than 100 IU/l) decreased from 401 +/- 53 to 222 +/- 42 (mean +/- S.E.; p less than 0.001), those of gamma-glutamyl transpeptidase, (normal less than 40 IU/l) from 520 +/- 89 to 185 +/- 32 (p less than 0.001) and those of alanine aminotransferases, (normal less than 30 IU/l) from 79 +/- 12 to 42 +/- 6 (p less than 0.02). In three patients, the discontinuation of UDCA was associated with an aggravation of the liver test results. In conclusion, this study shows that 6 months of treatment with UDCA leads to clinical and biochemical improvements in patients with PSC. These results suggest that UDCA could be an effective treatment for PSC, and may justify a controlled therapeutic trial.
Assuntos
Colangite Esclerosante/tratamento farmacológico , Ácido Desoxicólico/análogos & derivados , Ácido Ursodesoxicólico/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Fosfatase Alcalina/sangue , Colangite Esclerosante/sangue , Colangite Esclerosante/patologia , Feminino , Humanos , Fígado/efeitos dos fármacos , Fígado/enzimologia , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Transaminases/sangue , Ácido Ursodesoxicólico/efeitos adversos , gama-Glutamiltransferase/sangueRESUMO
A case of idiopathic portal hypertension associated with connective disease resembling systemic lupus erythematosus is described. The patient was a 50-year-old woman with splenomegaly, ascites, esophageal varices, and pancytopenia, but without extrahepatic portal obstruction or cirrhosis of the liver. Electron microscopy of the liver showed perisinusoidal fibrosis. High titers of autoantibodies against proliferating cell nuclear antigen (PCNA) were found in the sera as well as in ascites; anti-DNA antibodies appeared after anti-PCNA antibodies and remained thereafter at a moderate titer. The possibility of an immunological process in the pathogenesis of idiopathic portal hypertension is discussed.
Assuntos
Doenças do Tecido Conjuntivo/complicações , Hipertensão Portal/complicações , Anticorpos Antinucleares/análise , Doenças do Tecido Conjuntivo/imunologia , Feminino , Humanos , Fígado/ultraestrutura , Lúpus Eritematoso Sistêmico/imunologia , Pessoa de Meia-Idade , Proteínas Nucleares/análise , Antígeno Nuclear de Célula em ProliferaçãoAssuntos
Hipertensão Portal/etiologia , Hepatopatias/complicações , Adulto , Doença Crônica , HumanosRESUMO
We report the case of a 51 year-old man who developed candidiasis of the small bowel associated with intestinal perforation. This condition is very rarely recognized ante mortem. Here, the diagnosis was established by pathological examination of a surgically resected specimen of small bowel at the time of surgery. A complete work-up failed to disclose any predisposing condition to digestive candidiasis. Antifungal therapy resulted in complete recovery.
Assuntos
Candidíase/complicações , Enteropatias/etiologia , Perfuração Intestinal/etiologia , Intestino Delgado , Humanos , Enteropatias/complicações , Enteropatias/patologia , Intestino Delgado/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
We report 20 cases of alcoholic cirrhosis with superimposed episodes of acute viral hepatitis. Four had acute type B hepatitis and 16, presumed non A non B hepatitis. Before hepatitis, 17 patients had stopped drinking and only four had a complicated cirrhosis. Eighteen patients had received a blood transfusion within the 6 months before the occurrence of hepatitis (mean: 52 days). All patients developed jaundice, 7 encephalopathy, and 5 ascites. The ASAT/ALAT ratio was greater than 1 in 18 patients. Two patients died of hepatic failure. Follow-up was known in 17 of the 18 surviving patients: in all patients jaundice disappeared and transaminases returned to values less than 3 times the upper limits of normal. In our experience, the prognosis is good when viral hepatitis occurs in patients with non complicated alcoholic cirrhosis.
Assuntos
Hepatite Viral Humana/mortalidade , Cirrose Hepática Alcoólica/complicações , Doença Aguda , Adulto , Idoso , Feminino , Hepatite Viral Humana/diagnóstico , Hepatite Viral Humana/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
Agreement among six physicians for 18 clinical signs in 50 alcoholic patients was prospectively studied. Twenty patients had alcoholic cirrhosis, 14 noncirrhotic alcoholic liver disease, and 16 alcoholics had no clinical or biochemical abnormalities. Agreement was assessed by kappa index for categorical variables and by intraclass correlation coefficient for the others. A good agreement was observed for ascites (r = 0.75) and splenomegaly (r = 0.75). It was fair for jaundice (r = 0.65), Dupuytren's contracture (r = 0.65), and vascular spiders (r = 0.64). However, it was poor for white nails (r = 0.27) and hepatic consistency (r = 0.11). Agreement was better among senior physician's than junior physicians. In order to assess which signs contributed to differentiate the three groups of patients, a stepwise discriminant analysis was realized; it identified three variables: vascular spiders (P less than 0.001), splenomegaly (P less than 0.001), and abdominal wall collateral veins (P less than 0.01). These results suggest that studies based on physical findings must be cautiously considered.
Assuntos
Hepatopatias Alcoólicas/diagnóstico , Exame Físico , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Cirrose Hepática Alcoólica/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
A 63 year old man was followed up for chronic pancreatitis. After 2 years, he developed features of primary sclerosing cholangitis associated with Sjögren's syndrome. A review of the literature revealed 38 previous cases of chronic pancreatitis associated with sclerosing cholangitis; a sicca complex was also demonstrated in 3 of these cases. Chronic pancreatitis is mostly asymptomatic and the diagnosis is usually made at laparotomy or postmortem. Retrograde pancreatograms are abnormal in 15-75 p. 100 of patients with primary sclerosing cholangitis. The relationship between the two diseases is not a coincidence. On the other hand, the significance of the association with the Sjögren's syndrome remains controversial.