RESUMO
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Humanos , Feminino , Idoso , Coledocolitíase/fisiopatologia , Antígeno CA-19-9/análise , Biomarcadores Tumorais/análise , Fumar , Consumo de Bebidas Alcoólicas , Diagnóstico DiferencialAssuntos
Antígeno CA-19-9/análise , Coledocolitíase/sangue , Idoso , Biomarcadores , Colecistectomia , Coledocolitíase/complicações , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Icterícia Obstrutiva/etiologia , Neoplasias/diagnóstico , Esfinterotomia Endoscópica , Tomografia Computadorizada por Raios XRESUMO
INTRODUCCIÓN: La hemorragia digestiva alta por varices esofagogástricas (HDA por VEG) puede desencadenar una isquemia hepática aguda (IHA). El objetivo de este estudio fue analizar la incidencia de IHA tras una HDA por VEG, los factores de riesgo y su mortalidad. PACIENTES Y MÉTODOS: Estudio retrospectivo sobre pacientes cirróticos con HDA por VEG. Se clasificaron en 2 grupos, determinados por el desarrollo o no de una IHA. Definimos IHA como AST y ALT por encima de 10 veces el valor basal, descartando otras causas de hepatitis aguda. El tratamiento inicial estándar fue soporte hemodinámico, endoscopia urgente con ligadura con bandas y/o escleroterapia, somatostatina y antibióticos. En caso de fracaso de estas medidas, se recurrió a la implantación de una derivación portosistémcica percutánea intrahepática (DPPI). Ambos grupos (IHA y no-IHA) fueron comparados. RESULTADOS: Durante un periodo de 5 años, se recogieron 68 pacientes con HDA por VEG. La incidencia de IHA fue del 16,2%. Tras el análisis univariante, los factores asociados con IHA fueron la diabetes mellitus (OR: 7,5; IC: 1,9-29), shock (OR: 8,5; IC: 2,06-34) y la persistencia de la hemorragia (OR: 9, IC: 1,6-49, p = 0,03). En el análisis multivariante solo mostraron significación estadística la diabetes mellitus (OR: 8,61; IC: 1,4-52,5) y el shock (OR: 7,58; IC: 1,26-45,51). La mortalidad del grupo de IHA fue mayor (45%) que en el grupo no-IHA (10,5%) (p = 0,012). CONCLUSIONES: La IHA tras una hemorragia digestiva por VEG en el paciente cirrótico ocurrió en el 16,2%, asociándose con un peor pronóstico y una mortalidad del 45%. Nuestros resultados sugieren que la diabetes mellitus y el shock hipovolémico son factores de riesgo para el desarrollo de IHA. La detección precoz de estos pacientes en riesgo podría por tanto ayudar a prevenir la IHA
INTRODUCTION: Variceal upper gastrointestinal bleeding (UGIB) can trigger acute hypoxic hepatitis (AHH). The aim of this study was to analyse the incidence, associated risk factors and mortality of AHH after variceal UGIB. PATIENTS AND METHODS: Retrospective study of cirrhotic patients with variceal UGIB, classified into 2 groups according to the development of AHH. AHH was diagnosed when AST and ALT reached levels 10 times above the upper limit of normal, after ruling out other causes of hepatitis. The standard initial treatment consisted of haemodynamic support, emergency endoscopy with rubber band ligation, somatostatin and antibiotics. In the case of failure of primary haemostasis, a transjugular intrahepatic portosystemic shunt (TIPS) was implanted. Both groups (AHH and non-AHH) were compared. RESULTS: Sixty-eight cirrhotic patients with variceal UGIB admitted to the gastroenterology department of Hospital Ramón y Cajal between January 2007 and March 2012 were analysed. Eleven of these patients (16.2%) developed AHH. Univariate analysis showed the following items as risk factors: diabetes (OR: 7.5; CI: 1.9-29), shock (OR: 8.5; CI: 2.06-34) and persistent bleeding (OR: 9.0, CI: 1.6-49, P = .03). However, multivariate analysis confirmed only diabetes (OR: 8.61; CI: 1.4-52.5) and shock (OR: 7.58; CI: 1.26-45.51) as risk factors. Mortality rate in the AHH group was 45%, compared to 10.5% in the non-HAA group (P = .012). CONCLUSIONS: AHH after variceal UGIB occurred in 16.2% of cirrhotic patients and was associated with a poorer prognosis, with a mortality rate of 45%. Our findings suggest that diabetes and shock are risk factors for the development of AHH. Early identification of at-risk patients could therefore help prevent AHH
Assuntos
Humanos , Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/etiologia , Isquemia/etiologia , Fatores de Risco , Hepatopatias/etiologia , Estudos Retrospectivos , Falência Hepática Aguda/etiologia , Hipertensão Portal/complicaçõesRESUMO
INTRODUCTION: Variceal upper gastrointestinal bleeding (UGIB) can trigger acute hypoxic hepatitis (AHH). The aim of this study was to analyse the incidence, associated risk factors and mortality of AHH after variceal UGIB. PATIENTS AND METHODS: Retrospective study of cirrhotic patients with variceal UGIB, classified into 2 groups according to the development of AHH. AHH was diagnosed when AST and ALT reached levels 10 times above the upper limit of normal, after ruling out other causes of hepatitis. The standard initial treatment consisted of haemodynamic support, emergency endoscopy with rubber band ligation, somatostatin and antibiotics. In the case of failure of primary haemostasis, a transjugular intrahepatic portosystemic shunt (TIPS) was implanted. Both groups (AHH and non-AHH) were compared. RESULTS: Sixty-eight cirrhotic patients with variceal UGIB admitted to the gastroenterology department of Hospital Ramón y Cajal between January 2007 and March 2012 were analysed. Eleven of these patients (16.2%) developed AHH. Univariate analysis showed the following items as risk factors: diabetes (OR: 7.5; CI: 1.9-29), shock (OR: 8.5; CI: 2.06-34) and persistent bleeding (OR: 9.0, CI: 1.6-49, P=.03). However, multivariate analysis confirmed only diabetes (OR: 8.61; CI: 1.4-52.5) and shock (OR: 7.58; CI: 1.26-45.51) as risk factors. Mortality rate in the AHH group was 45%, compared to 10.5% in the non-HAA group (P=.012). CONCLUSIONS: AHH after variceal UGIB occurred in 16.2% of cirrhotic patients and was associated with a poorer prognosis, with a mortality rate of 45%. Our findings suggest that diabetes and shock are risk factors for the development of AHH. Early identification of at-risk patients could therefore help prevent AHH.
Assuntos
Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/complicações , Isquemia/etiologia , Fígado/irrigação sanguínea , Adulto , Idoso , Carcinoma Hepatocelular/epidemiologia , Comorbidade , Complicações do Diabetes/epidemiologia , Feminino , Humanos , Isquemia/mortalidade , Hepatopatias Alcoólicas/epidemiologia , Neoplasias Hepáticas/epidemiologia , Masculino , Pessoa de Meia-Idade , Veia Porta , Recidiva , Estudos Retrospectivos , Fatores de Risco , Trombose/epidemiologiaRESUMO
INTRODUCCIÓN: El tratamiento de la hepatitis crónica B antígeno e negativa (HCB HBeAg negativa) con antivíricos orales (AO) suele prolongarse de forma indefinida debido a que la pérdida del antígeno de superficie como objetivo para su suspensión es un hecho infrecuente. Recientemente han aparecido las primeras evidencias que sugieren finalizar la terapia con AO en casos seleccionados. OBJETIVOS: Analizar la tasa de rebote virológico en pacientes con HCB Age negativa que suspendieron el tratamiento con AO. MATERIAL Y MÉTODOS: Estudio retrospectivo observacional que incluyó 140 casos de HCB HBeAg negativa. Veintidós pacientes, que recibieron exclusivamente AO, los suspendieron por diversos motivos realizándose un seguimiento posterior. Todos presentaban transaminasas normales, ADN indetectable y ausencia de cirrosis o comorbilidades importantes al finalizar el tratamiento. RESULTADOS: Doce pacientes presentaron rebote virológico (54,54%), transcurriendo una media de 6,38 meses (± 1,9) desde la suspensión hasta el rebote (el 75% dentro de los 12 primeros meses tras la suspensión). Cinco recibieron adefovir, uno lamivudina más adefovir, uno tenofovir y 5 lamivudina. La duración media del tratamiento, desde el inicio hasta la suspensión, fue de 38,5 meses (± 4,5). El grupo con respuesta sostenida presentaba una edad media y duración del tratamiento superior a los sujetos con rebote, si bien estas diferencias no resultaron estadísticamente significativas. CONCLUSIONES: Los resultados sugieren que es posible suspender la terapia con AO en casos seleccionados de HCB Age negativa, siempre que no exista cirrosis, se cumpla un tiempo mínimo de tratamiento, las transaminasas sean normales y el ADN indetectable de forma mantenida. En estos casos, se debe realizar un seguimiento estrecho durante el primer año y posteriormente de forma indefinida
BACKGROUND: Treatment of HBeAg-negative chronic hepatitis B (CHB) with nucleos(t)ide analogues (NA) is usually indefinite, since the loss of HBsAg, as a criterion for its discontinuation, is a rare event. Recent evidence suggests that discontinuing NA therapy may be feasible in selected patients. OBJECTIVES: To analyze the rate of virological relapse in patients with HBeAg-negative CHB who discontinued treatment with NAs. METHODS: We performed a single-center observational study that included 140 patients with HBsAg-negative CHB. Twenty-two patients, who received only NAs, discontinued treatment for different reasons and were subsequently monitored. All had normal ALT and AST, undetectable DNA and absence of cirrhosis or significant comorbidities before stopping treatment. RESULTS: Twelve patients showed virologic relapse (54.54%). The mean interval between discontinuation and relapse was 6.38 months (± 1.9) (75% relapsed during the first 12 months after discontinuation). Five received adefovir, 1 lamivudine and adefovir, 1 tenofovir and 5 lamivudine alone. The mean treatment duration in this group was 38.5 months (± 4.5). The sustained response group had a higher mean age and longer treatment duration than patients with virologic relapse but these differences were not statistically significant. CONCLUSIONS: The results suggest that NA treatment can be stopped in selected patients with CHB as long as they are not cirrhotic, have completed a minimum period of treatment, have normal ALT and sustained undetectable DNA. These patients should be closely monitored during the first year and then indefinitely
Assuntos
Humanos , Antivirais/uso terapêutico , Hepatite B Crônica/tratamento farmacológico , Suspensão de Tratamento , Vírus da Hepatite B/patogenicidade , Efeito Rebote , Antígenos da Hepatite B , Carga Viral , Estudos RetrospectivosAssuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/secundário , Neoplasias Hepáticas/patologia , Neoplasias Orbitárias/diagnóstico por imagem , Neoplasias Orbitárias/secundário , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios XRESUMO
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Assuntos
Humanos , Feminino , Idoso , Carcinoma Hepatocelular/patologia , Hepatite C Crônica/complicações , Neoplasias Hepáticas/patologia , Metástase Neoplásica , Neoplasias Orbitárias/secundárioRESUMO
BACKGROUND: Treatment of HBeAg-negative chronic hepatitis B (CHB) with nucleos(t)ide analogues (NA) is usually indefinite, since the loss of HBsAg, as a criterion for its discontinuation, is a rare event. Recent evidence suggests that discontinuing NA therapy may be feasible in selected patients. OBJECTIVES: To analyze the rate of virological relapse in patients with HBeAg-negative CHB who discontinued treatment with NAs. METHODS: We performed a single-center observational study that included 140 patients with HBsAg-negative CHB. Twenty-two patients, who received only NAs, discontinued treatment for different reasons and were subsequently monitored. All had normal ALT and AST, undetectable DNA and absence of cirrhosis or significant comorbidities before stopping treatment. RESULTS: Twelve patients showed virologic relapse (54.54%). The mean interval between discontinuation and relapse was 6.38 months (± 1.9) (75% relapsed during the first 12 months after discontinuation). Five received adefovir, 1 lamivudine and adefovir, 1 tenofovir and 5 lamivudine alone. The mean treatment duration in this group was 38.5 months (± 4.5). The sustained response group had a higher mean age and longer treatment duration than patients with virologic relapse but these differences were not statistically significant. CONCLUSIONS: The results suggest that NA treatment can be stopped in selected patients with CHB as long as they are not cirrhotic, have completed a minimum period of treatment, have normal ALT and sustained undetectable DNA. These patients should be closely monitored during the first year and then indefinitely.
Assuntos
Alanina Transaminase/sangue , Antivirais/uso terapêutico , Antígenos E da Hepatite B/imunologia , Hepatite B Crônica/tratamento farmacológico , Nucleotídeos/uso terapêutico , Adulto , Idoso , Aspartato Aminotransferases/sangue , DNA Viral/isolamento & purificação , Quimioterapia Combinada , Feminino , Vírus da Hepatite B/genética , Vírus da Hepatite B/imunologia , Vírus da Hepatite B/isolamento & purificação , Hepatite B Crônica/imunologia , Humanos , Cirrose Hepática/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Recidiva , Resultado do TratamentoRESUMO
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Humanos , Masculino , Idoso , Doença Celíaca/induzido quimicamente , Doença Celíaca/complicações , Doença Celíaca/diagnóstico , Angiotensina I/efeitos adversos , Angiotensina I/uso terapêutico , Angiotensina II/efeitos adversos , Angiotensina II/uso terapêutico , Diarreia/complicações , Diarreia/diagnóstico , Diarreia/tratamento farmacológico , Hipertensão/complicações , Hipertensão/diagnóstico , Clostridioides difficile/isolamento & purificação , Microscopia de Fluorescência/métodos , Técnica Direta de Fluorescência para Anticorpo , Diagnóstico DiferencialRESUMO
No disponible
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Humanos , Feminino , Adulto , Tratamento por Radiofrequência Pulsada/métodos , Síndromes de Compressão Nervosa/terapia , Amitriptilina/uso terapêutico , GABAérgicos/uso terapêutico , Sobrepeso/complicaçõesAssuntos
Anti-Hipertensivos/efeitos adversos , Imidazóis/efeitos adversos , Síndromes de Malabsorção/induzido quimicamente , Tetrazóis/efeitos adversos , Idoso , Anti-Hipertensivos/uso terapêutico , Atrofia , Doença Celíaca/diagnóstico , Doença Crônica , Diagnóstico Diferencial , Diarreia/induzido quimicamente , Diarreia/patologia , Duodeno/imunologia , Duodeno/patologia , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Imidazóis/uso terapêutico , Imunofenotipagem , Mucosa Intestinal/ultraestrutura , Subpopulações de Linfócitos/imunologia , Síndromes de Malabsorção/diagnóstico , Síndromes de Malabsorção/patologia , Masculino , Microvilosidades/patologia , Tetrazóis/uso terapêuticoAssuntos
Amilases/sangue , Atorvastatina/efeitos adversos , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Lipase/sangue , Corticosteroides/uso terapêutico , Atorvastatina/uso terapêutico , Erupção por Droga/sangue , Erupção por Droga/diagnóstico , Erupção por Droga/tratamento farmacológico , Erupção por Droga/etiologia , Síndrome de Hipersensibilidade a Medicamentos/sangue , Síndrome de Hipersensibilidade a Medicamentos/tratamento farmacológico , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Edema/induzido quimicamente , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Pessoa de Meia-IdadeAssuntos
Síndromes de Compressão Nervosa/terapia , Manejo da Dor/métodos , Tratamento por Radiofrequência Pulsada , Abdome/inervação , Adulto , Aminas/uso terapêutico , Amitriptilina/uso terapêutico , Anestésicos Locais/uso terapêutico , Terapia Combinada , Ácidos Cicloexanocarboxílicos/uso terapêutico , Emergências , Feminino , Gabapentina , Humanos , Bloqueio Nervoso , Síndromes de Compressão Nervosa/tratamento farmacológico , Pele/inervação , Triancinolona Acetonida/uso terapêutico , Ácido gama-Aminobutírico/uso terapêuticoRESUMO
Syphilis is a chronic systemic infection mainly transmitted through sexual contact that shows a great variety of clinical manifestations. Liver involvement is an unusual complication mainly reported in HIV patients. In this case report we present a case of a 42-year-old immunocompent man with acute cholestatic hepatitis who was finally diagnosed of luetic hepatitis. Liver disease was the only manifestation of syphilis infection difficulty it's diagnostic. We emphasize the importance of including syphilis in the differential diagnosis of abnormal liver function tests in patients at risk of sexually transmitted diseases due to its resolution with appropriate antibiotic treatment.
Assuntos
Hepatite/microbiologia , Sífilis/complicações , Doença Aguda , Adulto , Hepatite/diagnóstico , Humanos , Imunocompetência , Masculino , Sífilis/diagnósticoRESUMO
INTRODUCCIÓN: La globalización y los movimientos migratorios hacen que la hepatitis crónica B Age+ (HCBe+) cobre cada día mayor relevancia en nuestro entorno. Objetivo Analizar las características epidemiológicas, evolución y respuesta al tratamiento con antivirales orales (AO) de los pacientes con HCBe+.Material y métodosSe analizaron 436 casos de infección crónica por el virus de la hepatitis B atendidos en el Hospital Universitario Ramón y Cajal desde 1990 hasta junio del 2012.ResultadosSesenta y cinco (14,9%) presentaban HCBe+. Siete pacientes en fase de tolerancia inmune no fueron tratados; los 58 restantes, sí. Fueron excluidos 4: 2 hepatitis agudas graves, una coinfección por VHC y otro por virus Delta. De los 54 restantes, 19 recibieron interferón con o sin AO y 35 solo Dos tratados durante menos de un mes no fueron incluidos en el análisis. Este se realizó finalmente en 33 pacientes. Duración media del tratamiento: 46,81 meses (6-138). Lamivudina fue el fármaco más prescrito (39,39%), seguida de tenofovir (24,24%) y entecavir (21,21%). Edad media: 42,08 ± 14 años; varones 75,75% (25/33). El 57,57% (19/33) seroconvirtió el antígeno e y el 27,27% (9/33) eliminó el antígeno de superficie. No se objetivó la reaparición de este último tras un seguimiento medio de 35,6 meses. Resistencias: 8 casos en 7 pacientes, 7 a lamivudina y uno a adefovir. CONCLUSIONES: El 15% de las HCB en nuestro medio son e+. El tratamiento con AO logra una elevada tasa de seroconversión (57,57%) y un considerable porcentaje de pérdida del antígeno de superficie (27,27%)
INTRODUCTION: Due to globalization and migratory movements, HBeAg+ chronic hepatitis B isbecoming increasingly important in Spain. OBJECTIVE: To analyze the epidemiological features, progression, and treatment response to oral antiviral agents (OA) in HBeAg+ chronic hepatitis B patients in our area. MATERIAL AND METHODS: We analyzed 436 patients with chronic hepatitis B infection followed up at the Ramón y Cajal Hospital from 1990 to June 2012. RESULTS: Sixty-five patients (14.9%) had HBeAg+ chronic hepatitis B. Seven patients in the immunotolerant phase were not treated, while the remaining 58 received treatment. Four patients were excluded: two due to severe acute hepatitis, one due to hepatitis C virus coinfection and another because of a Delta virus coinfection. Of the remaining 54 patients, 19 received interferon with or without OA, and 35 received only OA. Two patients treated for less than 1 month were not included in the analysis. The analysis was finally performed in 33 patients. The mean duration of treatment was 46.81 months (6-138). Lamivudine was the most frequently prescribed drug (39.39%) followed by tenofovir (24.24%) and entecavir (21.21%). The mean age was 42.08 ± 14 years and 75.75% (25/33) of the patients were male. Nineteen of 33 patients (57.57%) achieved seroconversion to anti-HBe, and 27.27% (9/33) showed clearance of HBsAg. There was no evidence of HBsAg reversion after a mean follow-up of 35.6 months. There were 8 cases of resistance in 7 patients: 7 to lamivudine and 1 to adefovir. CONCLUSIONS: Approximately 15% of chronic hepatitis B patients in our area are HBeAg+. Treatment with OA achieves a high seroconversion rate (57.57%) and a considerable percentage of HBsAg clearance (27.27%)
Assuntos
Humanos , Hepatite B Crônica/tratamento farmacológico , Antivirais/uso terapêutico , Antígenos de Hepatite/isolamento & purificação , Emigração e Imigração/estatística & dados numéricos , /epidemiologia , Epidemiologia DescritivaRESUMO
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Humanos , Feminino , Pessoa de Meia-Idade , Paniculite Peritoneal/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Dor Abdominal/etiologia , Doença Crônica , Tamoxifeno/uso terapêuticoRESUMO
INTRODUCTION: Due to globalization and migratory movements, HBeAg+ chronic hepatitis B is becoming increasingly important in Spain. OBJECTIVE: To analyze the epidemiological features, progression, and treatment response to oral antiviral agents (OA) in HBeAg+ chronic hepatitis B patients in our area. MATERIAL AND METHODS: We analyzed 436 patients with chronic hepatitis B infection followed up at the Ramón y Cajal Hospital from 1990 to June 2012. RESULTS: Sixty-five patients (14.9%) had HBeAg+ chronic hepatitis B. Seven patients in the immunotolerant phase were not treated, while the remaining 58 received treatment. Four patients were excluded: two due to severe acute hepatitis, one due to hepatitis C virus coinfection and another because of a Delta virus coinfection. Of the remaining 54 patients, 19 received interferon with or without OA, and 35 received only OA. Two patients treated for less than 1 month were not included in the analysis. The analysis was finally performed in 33 patients. The mean duration of treatment was 46.81 months (6-138). Lamivudine was the most frequently prescribed drug (39.39%) followed by tenofovir (24.24%) and entecavir (21.21%). The mean age was 42.08±14 years and 75.75% (25/33) of the patients were male. Nineteen of 33 patients (57.57%) achieved seroconversion to anti-HBe, and 27.27% (9/33) showed clearance of HBsAg. There was no evidence of HBsAg reversion after a mean follow-up of 35.6 months. There were 8 cases of resistance in 7 patients: 7 to lamivudine and 1 to adefovir. CONCLUSIONS: Approximately 15% of chronic hepatitis B patients in our area are HBeAg+. Treatment with OA achieves a high seroconversion rate (57.57%) and a considerable percentage of HBsAg clearance (27.27%).
Assuntos
Antivirais/administração & dosagem , Hepatite B Crônica/tratamento farmacológico , Administração Oral , Adulto , Idoso , Feminino , Antígenos E da Hepatite B/sangue , Hepatite B Crônica/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
No disponible