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Rev Esp Enferm Dig ; 2020 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-33267595


BACKGROUND AND AIM: dermatological manifestations are normally found in one third of patients with inflammatory bowel disease. Here, we determined the prevalence, clinical characteristics, intestinal disease activity and treatment response of neutrophilic dermatoses (pyoderma gangrenosum and Sweet´s syndrome) in patients with inflammatory bowel disease. METHODS: We performed a retrospective observational study of patients with inflammatory bowel disease and neutrophilic dermatoses between March 2012 and March 2018. RESULTS: Of 444 patients analyses, 10 complied with the inclusion criteria: seven had pyoderma gangrenosum and three presented Sweet's syndrome. One patient developed both pathologies. The prevalence of neutrophilic dermatoses was 2.3% (10/444), comprising 1.6% pyoderma gangrenosum and 0.7% Sweet's syndrome. Six out of seven patients with pyoderma gangrenosum were female and had ulcerative colitis. The most frequent clinical presentation of pyoderma gangrenosum was the ulcerative subtype. Active moderate-to-severe intestinal disease was found in 71.4% of patients. Biological therapy was prescribed to three patients with partial response to corticosteroids and persistent intestinal disease activity. This therapy was not indicated in any case only for cutaneous manifestations. Three patients with moderate-to-severe Chron´s disease presented classical (n=2) and pustular (n=1) Sweet's syndrome. Complete response was achieved in all Sweet's syndrome cases treated with corticosteroids. Biological therapy was prescribed to control intestinal disease activity. CONCLUSIONS: Pyoderma gangrenosum was the most frequent cutaneous manifestation of neutrophilic dermatoses, predominantly in women with ulcerative colitis and highly associated with intestinal disease activity. Anti-tumor necrosis factor was effective in patients with partial cutaneous and intestinal disease response.

Acta Gastroenterol Latinoam ; 46(1): 22-29, 2016 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-29470880


Zenker's diverticulum (ZD) is an acquired protrusion of the esophageal wall. Treatment is reservedfor symptomatic cases. In Argentina, ZD has historically managed exclusively by surgical intervention. In 1995, Ishioka, et al and Mulder, et a1published their experience using flexible endoscopes for diverticulotomy. Since then, a wide variety ofdifferent techniques have been published. Objetive. To present technique modifications and results ofour center. MATERIAL AND METHODS: We reviewed the database of57patients (36 men), with a mean age of 71.9 years (range 37-98), with symptomatic Zenker ' diverticulum, who underwent endoscopic myotomy, from December 1997 to April 2015. All procedures were performed in our center, by the same endoscopist (HM). The most common symptom was dysphagia (94.7%), which was recorded by a 0-4 score (0=no dysphagia, 1 =solids, 2=semisolids, 3=liquids, 4=saliva). The first nine cases were done exposing the septum with a nasogastric tube, and the others with a soft diverticuloscope. Allprocedures were carried out with the patient under deep sedation, adminis- tered by an anesthesiologist. A myotomy was done in all cases with a needle-knife, using a coagulation current, to prevent bleeding. Clips were placed to close mucosalilaps, decrease the risk of unsuspected perforation and postprocedure bleeding. RESULTS: Seventy procedures were performed, in 56 patients. One patient was excluded because of incomplete myotomy due to a severe adverse event. Ninety-eight percent ofpatients had resolution or improvement of the dysphagia score, at 30 days. Three patients with regurgitation as their sole complaint completely resolved their symptom. Median follow-up was 25 months (1-99). Thirty-seven patients were followed for at least 1 year and 97.3% showed a favorable outcome. In 13 cases (22.8%) a reintervention was needed, with positive results in all cases. Bleeding occurred in one patient (1.4%), who required surgery. Another patient required surgical intervention due to technical issues. There were no perforations or infections. CONCLUSION: Treatment of ZD with flexible endoscope is a safe and effective option, with good long-term results. We need randomized clinical trials comparing different therapeutic options to be able to recommend a definitive strategy. Until then, we suggest using the technique with which each center has the most experience and feels most comfortable performing.

Endoscópios , Esofagoscopia/instrumentação , Divertículo de Zenker/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina , Esofagoscopia/métodos , Feminino , Seguimentos , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
Acta Gastroenterol Latinoam ; 42(1): 27-32, 2012 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-22616494


OBJECTIVE: To evaluate the success of the treatment with cyanoacrylate in primary hemostasis, rebleeding, and gastric varices eradication. MATERIAL AND METHODS: In this retrospective study 65 patients with gastric varices treated with N-butyl-2-cyanoacrylate (Histoacryl) were included from January 1999 to January 2008. We used a solution of 0,5 mL of cyanoacrylate and 0.9 mL of lipiodol, utilizing an average of 3.46 mL of this mixture per session (range 1 to 6 mL). Sclerosing needles of 21 gauge were used. Patients were sedated. Data were analyzed using a chi-squared test. RESULTS: Sixty-five patients were included, 42 men and 23 women with an average age of 53.8 years (range 18 to 76 years). The etiology of the portal hypertension (PH) was cirrhosis in 52 patients (80%), prehepatic PH in 7 (10.8%), and segmentary PH in 3 (4.6%), and non-classified in 3 (4.6%). Cirrhotic patients were classified as Child A in 21 cases, Child B in 25 and Child C in 6. According to the Sarin classification, 7 patients had gastric-oesophageal varices (GOV) type 1, 32 GOV2, 8 GOV1 and 2, and 8 isolated gastric varices (IGV) type 1. Fifty-six patients (86%) presented active bleeding or stigmata of recent bleeding at time of initial endoscopy. Primary hemostasis was achieved in 50 of them (89%) and the remaining 6 required a second session. Eleven patients presented rebleeding within the following 6 weeks and were again treated with cyanoacrylate. Hemostasis was achieved in 8 of them, 2 were referred for surgical management, and 1 received endovascular treatment. Follow-up was able in 53 patients for an average period of 11 months (range 1 to 81 months). During this period, 7 patients presented an episode ofrebleeding and were treated with cyanoacrylate, achieving hemostasis. Eradication of varices was documented on 21 patients (39.6%). The global rate of rebleeding was 37%. One patient developed splenic vein thrombosis as a major complication of treatment. CONCLUSION: Definitive hemostasis was achieved in 94.6% of patients, with primary hemostasis in 89%. The global rate of rebleeding was 37% and the rate of major complications associated with treatment 0.6%. Eradication of gastric varices was achieved in 35.8% of cases. As these data show, it can be concluded that butyl-cyanoacrylate constitutes an effective method for the treatment of gastric variceal bleeding.

Embucrilato/administração & dosagem , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Soluções Esclerosantes/administração & dosagem , Adolescente , Adulto , Idoso , Varizes Esofágicas e Gástricas/complicações , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem