RESUMO
Acute porphyria is a term that encompasses a group of hereditary disorders involving defects in heme metabolism, characterized by acute episodes of abdominal pain, acute hypertension, tachycardia and neuropsychiatric disorders, sometimes leading to convulsions, ascending paralysis and coma. Misdiagnosis or delayed diagnosis can seriously worsen prognosis. We report the case of a woman with subclinical acute intermittent porphyria and chronic hepatitis incidentally diagnosed due to transaminase elevation on laboratory analysis.
Assuntos
Hepatite/etiologia , Adulto , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Biópsia , Doença Crônica , Diagnóstico Diferencial , Eritrócitos/enzimologia , Feminino , Genes Dominantes , Hepatite/sangue , Hepatite/patologia , Hepatite Autoimune/diagnóstico , Humanos , Hidroximetilbilano Sintase/sangue , Achados Incidentais , Penetrância , Porfiria Aguda Intermitente/complicações , Porfiria Aguda Intermitente/diagnóstico , Porfiria Aguda Intermitente/genética , Porfiria Aguda Intermitente/metabolismoRESUMO
Resumen Las porfirias agudas (PA) son trastornos hereditarios en la síntesis del grupo hemo quese caracterizan por la aparición de episodios agudos de dolor abdominal, crisis de hipertensiónarterial, taquicardia y trastornos neuropsiquiátricos, llegando incluso a provocar convulsiones,parálisis ascendente o coma. El retraso o error en el diagnóstico puede empeorar gravemente elpronóstico. Presentamos el caso de una paciente con porfiria aguda intermitente (PAI) subclínicay hepatitis crónica diagnosticada de forma casual por una elevación de transaminasas en elestudio analítico (AU)
Abstract Acute porphyria is a term that encompasses a group of hereditary disorders involvingdefects in heme metabolism, characterized by acute episodes of abdominal pain, acutehypertension, tachycardia and neuropsychiatric disorders, sometimes leading to convulsions,ascending paralysis and coma. Misdiagnosis or delayed diagnosis can seriously worsen prognosis.We report the case of a woman with subclinical acute intermittent porphyria and chronichepatitis incidentally diagnosed due to transaminase elevation on laboratory analysis (AU)
Assuntos
Humanos , Feminino , Adulto , Porfiria Aguda Intermitente/complicações , Hepatite Crônica/complicações , Transaminases/sangue , Achados IncidentaisAssuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Benzimidazóis/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Colestase Intra-Hepática/induzido quimicamente , Tetrazóis/efeitos adversos , Idoso de 80 Anos ou mais , Compostos de Bifenilo , Humanos , MasculinoRESUMO
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No disponible
Assuntos
Humanos , Camellia sinensis/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Fatores de RiscoRESUMO
End-stage liver disease due to hepatitis C virus has become a major challenge in the management of HIV/HCV-coinfected patients. The diagnosis and management of cirrhosis and its complications in the scenario of HIV/HCV-coinfection are reviewed. Noninvasive approaches to the diagnosis of cirrhosis, such as biomarkers or transient hepatic elastography, may be considered. The clinical profile of cirrhosis decompensation in the coinfected population is different from that found in HCV-monoinfected individuals. Ascites and hepatic encephalopathy are much more frequent, whereas hepatocellular carcinoma is still uncommon, when simultaneous hepatitis B virus infection is absent. The newest and more conflicting topics on the management of these complications are also discussed. Liver transplantation seems to be a proper option of treatment in HIV/HCV-coinfected patients and should be considered early in their management, since mortality after the first hepatic decompensation is high.
Assuntos
Infecções por HIV/complicações , Hepatite C/complicações , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Ascite/etiologia , Ascite/terapia , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/virologia , Progressão da Doença , Encefalopatia Hepática/etiologia , Encefalopatia Hepática/terapia , Hepatite B/complicações , Hepatite C/virologia , Síndrome Hepatorrenal/etiologia , Síndrome Hepatorrenal/terapia , Humanos , Cirrose Hepática/cirurgia , Cirrose Hepática/terapia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/terapia , Transplante de Fígado , Peritonite/tratamento farmacológico , Peritonite/prevenção & controleRESUMO
BACKGROUND: Bleeding from gastric varices can be challenging because of its high mortality and recurrent bleeding rates. Endoscopic therapy with tissue adhesives can control acute hemorrhage, but recurrent bleeding could appear if obliteration is not achieved, and endoscopic vision could be troublesome in the case of massive hemorrhage. The glue injected could be responsible for embolic phenomena and local complications. EUS has proved useful in minimizing the risk of recurrent bleeding from gastric varices, accurately showing if they are obturated or not. The presence of perforating veins detected by EUS has been reported as a risk factor for recurrent bleeding from esophageal varices. OBJECTIVE: To assess the efficacy of EUS-guided cyanoacrylate injection in gastric varices at the entrance of the perforating veins to obtain variceal obturation. DESIGN: Open-basis case series study. SETTING: Tertiary care, academic medical center, Seville, Spain. PATIENTS: Five consecutive patients with gastric varices were enrolled from May 2005 through May 2006. INTERVENTIONS: We injected cyanoacrylate-lipiodol in gastric varices with 22-gauge needles by EUS guidance. MAIN OUTCOME MEASUREMENTS: To analyze the obliteration of gastric varices, the recurrent bleeding rate, and safety of EUS-guided cyanoacrylate-lipiodol injection. RESULTS: EUS-guided injection of the perforating veins by using cyanoacrylate-lipiodol was successful in eradicating gastric varices in the 5 patients treated, without recurrent bleeding or other complications during the study follow-up. LIMITATION: This is a single-center nonrandomized study. CONCLUSIONS: EUS-guided injection of cyanoacrylate at the level of the perforating veins in the treatment of gastric varices seems to be a safe, efficient, and accurate approach. Further controlled studies are warranted.
Assuntos
Cianoacrilatos/administração & dosagem , Endossonografia , Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/terapia , Adesivos Teciduais/administração & dosagem , Ultrassonografia de Intervenção , Hemorragia Gastrointestinal/etiologia , Hemostase Endoscópica , Humanos , Injeções , Óleo Iodado/administração & dosagemAssuntos
Inibidores da Aromatase/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Nitrilas/efeitos adversos , Triazóis/efeitos adversos , Anastrozol , Inibidores da Aromatase/uso terapêutico , Doença Hepática Induzida por Substâncias e Drogas/fisiopatologia , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Nitrilas/uso terapêutico , Triazóis/uso terapêuticoAssuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Colite/induzido quimicamente , Doenças do Colo/induzido quimicamente , Eosinofilia/induzido quimicamente , Hemorragia Gastrointestinal/induzido quimicamente , Naproxeno/efeitos adversos , Úlcera/induzido quimicamente , Adulto , Biópsia , Feminino , HumanosRESUMO
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Assuntos
Masculino , Adulto , Humanos , Injúria Renal Aguda/etiologia , Hepatite A/complicações , Icterícia/etiologia , Diarreia/etiologia , Vômito/etiologiaAssuntos
Antifúngicos/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Itraconazol/efeitos adversos , Doença Aguda , Adulto , Agricultura , Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Suscetibilidade a Doenças , Interações Medicamentosas , Herbicidas/envenenamento , Humanos , Itraconazol/uso terapêutico , Masculino , Exposição Ocupacional/efeitos adversosRESUMO
BACKGROUND AND AIMS: There are several treatment options for gastroesophageal variceal hemorrhage. In severe cases, bleeding persists and is associated with a dismal outcome. The coagulation disorders might be correlated with risk of bleeding in patients with portal hypertension. The administration of activated recombinant factor VII corrects prothrombin time transiently in nonbleeding patients with cirrhosis as well as in bleeding ones. The aim of this study was to assess the hemostatic efficacy of activated recombinant factor VII in bleeding esophageal varices. METHODS: Between May 2001 and September 2002, 112 patients with cirrhosis and an episode of acute esophageal variceal bleeding were admitted. On an open basis with a single intravenous dose of 4.8 mg of recombinant factor VII, we treated 8 patients experiencing severe and active hemorrhage from esophageal varices unresponsive to pharmacologic therapy, endoscopic therapy, or balloon tamponade. RESULTS: Eight (7%) of 112 patients met entry criteria. Hemostasis was achieved in all the cases after recombinant activated factor VII therapy. Rebleeding and mortality rates were 25% and 50% (2 and 4 patients), respectively. CONCLUSIONS: In our experience, recombinant activated factor VII achieves hemostasis in bleeding esophageal varices unresponsive to standard treatment.
