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1.
Indian J Gastroenterol ; 27(1): 22-8, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18541934

RESUMO

AIMS: To study the profile of irritable bowel syndrome (IBS), and the frequency of such symptoms among the general population, in India. METHODS: In this prospective, multi-center study, data were obtained from 2785 patients with chronic lower gastrointestinal symptoms (complainants) with no alarm feature and negative investigations for organic causes visiting physicians at 30 centers, and from 4500 community subjects (non-complainants), using separate questionnaires. RESULTS: Most complainants were middle-aged (mean age 39.4 years) and male (1891; 68%). The common symptoms were: abdominal pain or discomfort (1958; 70%), abdominal fullness (1951; 70%); subjective feeling of constipation (1404 of 2656; 53%), or diarrhea (1252 of 2656, 47%), incomplete evacuation (2134; 77%), mucus with stools (1506; 54%), straining at stools (1271; 46%), epigastric pain (1364; 49%) and milk intolerance (906; 32%). Median stool frequency was similar in patients who felt they had constipation or those who felt they had diarrhea. Information to subtype symptoms using standard criteria was available in 1301 patients; of these, 507 (39%) had constipation-predominant IBS ( 3 3 stools/day) and 744 (57%) had indeterminate symptoms. Among non-complainants, most subjects reported daily defecation frequency of one (2520 [56%]) or two (1535 [34%]). Among non-complainants, 567 (12.6%) reported abdominal pain, 503 (11%) irregular bowel, 1030 (23%) incomplete evacuation, 167 (4%) mucus and 846 (18%) straining at stools; a combination of abdominal pain or discomfort relieved by defecation, and incomplete evacuation was present in 189/4500 (4.2%) community subjects. CONCLUSIONS: Most patients with IBS in India are middle-aged men, and have a sense of incomplete evacuation and mucus with stools. Abdominal pain or discomfort is frequent but not universal. Importantly, stool frequency was similar irrespective of whether the patients felt having constipation or diarrhea. Most (90%) non-complainant subjects had 1 or 2 stools per day; symptoms complex suggestive of IBS was present in 4.2% of community subjects.


Assuntos
Síndrome do Intestino Irritável/epidemiologia , Adulto , Feminino , Gastroenterologia , Humanos , Índia/epidemiologia , Síndrome do Intestino Irritável/fisiopatologia , Masculino , Estudos Prospectivos , Sociedades Médicas
5.
Eur J Clin Microbiol Infect Dis ; 24(6): 428-30, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15928909

RESUMO

The study presented here was performed to evaluate the need for aspiration in patients with amebic liver abscess (ALA). Patients older than 12 years with a diagnosis of ALA based on clinical features, ultrasound results, and positive amebic serology were included in the study (n=144). Serological testing was performed to detect the presence of immunoglobin G antibody against Entamoeba histolytica, and a value of more than 0.4 optical density units was considered positive. All patients were given intravenous metronidazole (500 mg every 8 h) and their clinical progress and need for abscess aspiration was documented. Fever, pain in the upper abdomen, and tender hepatomegaly was seen in 133 (92.3%), 128 (88.8%), and 144 (100%) patients, respectively. Multiple abscesses were seen in 40 (27.7%) patients. Six (4.1%) patients died. Seventy-one (49.3%) patients responded to metronidazole alone. A total of 73 (50.69%) patients required aspiration of the abscess. This study shows that almost 50% of the patients with amebic liver abscess failed to respond to metronidazole and required aspiration.


Assuntos
Abscesso Hepático Amebiano/terapia , Adolescente , Adulto , Idoso , Antiprotozoários/uso terapêutico , Feminino , Humanos , Masculino , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Estudos Prospectivos , Sucção
8.
Trop Gastroenterol ; 24(1): 25-6, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12974211

RESUMO

The commonest causes of acute pancreatitis are cholelithiasis and alcohol. Rare causes include various viral infections, among which mumps is the commonest. Hepatitis A, hepatitis B and, recently, hepatitis E have been reported to cause acute but mild pancreatitis in patients with acute viral hepatitis. This report describes a case of severe acute pancreatitis caused by hepatitis A.


Assuntos
Hepatite A/complicações , Pancreatite/virologia , Doença Aguda , Adolescente , Diagnóstico Diferencial , Hepatite A/diagnóstico , Hepatite A/terapia , Humanos , Masculino , Pancreatite/diagnóstico , Pancreatite/terapia
9.
Br J Surg ; 85(3): 326-9, 1998 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-9529484

RESUMO

BACKGROUND: Varices can develop in and around the bile duct in the presence of portal hypertension, especially when it is caused by extrahepatic portal vein thrombosis. The term 'portal biliopathy' is used to describe changes in the bile duct due to these varices, which may cause bile duct obstruction. This paper reviews experience of the surgical management of patients with symptomatic portal biliopathy. METHODS: Nine patients with extrahepatic portal vein obstruction with symptomatic portal biliopathy. were reviewed retrospectively. RESULTS: Eight patients presented with jaundice, two had abdominal pain and one had recurrent cholangitis. Endoscopic retrograde cholangiography revealed abnormality of the bile duct wall, with stricture in eight patients and bile duct calculi in two. Portasystemic shunting relieved jaundice in five of seven patients, and in two a second-stage hepaticojejunostomy was required. CONCLUSION: Symptomatic biliary obstruction in patients with extrahepatic portal hypertension may be relieved by a portasystemic shunt. Rarely biliary bypass may be required and is rendered safer by previous portasystemic shunting to decompress the pericholedochal varices. A direct approach to the biliary tract without a preliminary shunt may be hazardous and is frequently unnecessary.


Assuntos
Colestase/etiologia , Hipertensão Portal/complicações , Veia Porta , Trombose/complicações , Varizes/complicações , Adolescente , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Colestase/cirurgia , Feminino , Ducto Hepático Comum/cirurgia , Humanos , Jejunostomia/métodos , Masculino , Derivação Portossistêmica Cirúrgica , Estudos Retrospectivos , Trombose/cirurgia , Varizes/cirurgia
10.
Trop Gastroenterol ; 18(1): 27-9, 1997.
Artigo em Inglês | MEDLINE | ID: mdl-9197171

RESUMO

The argyrophilic technique (AgNOR) was applied to paraffin sections of 10 acute self-limited colitis, 15 ulcerative colitis (UC), 5 ulcerative colitis with indefinite dysplastic change, 10 adenomatous polyps, 20 colorectal adenocarcinomas and 10 normal colorectal mucosa. The mean number of nucleolar organiser regions (NORs) per nucleus ranged between 1.62-2.00 (95% CI 1.77-1.93) for normal colon, 2.47-3.80 (95% CI 2.71-3.21) for acute colitis, 1.66-2.75 (95% CI 2.13-2.44) for UC, 3.60-4.00 (95% CI 3.67-3.94) for UC with indefinite dysplasia, 3.00-4.04 (95% CI 3.41-3.81) for adenomatous polyps and 3.59-6.70 (95% CI 4.04-4.72) for colorectal adenocarcinoma. The differences observed were statistically significant. There was a significant difference of AgNOR counts between adenomatous polyp and UC with indefinite dysplasia in comparison to those observed in regenerative epithelium of acute colitis and UC without dysplasia. Hence the technique may be used as an adjunct to routine histology for delineating dysplastic changes in colonic epithelium.


Assuntos
Colo/patologia , Doenças do Colo/patologia , Região Organizadora do Nucléolo/patologia , Colo/anatomia & histologia , Corantes , Humanos , Mucosa Intestinal/patologia
11.
Dis Colon Rectum ; 39(10): 1126-9, 1996 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-8831528

RESUMO

PURPOSE: Segmental colonic tuberculosis commonly involves the ascending, transverse, or sigmoid colon. Rectal involvement in tuberculosis is uncommon and poorly characterized. This study describes the clinical presentation, endoscopic features, and outcome of isolated rectal tuberculosis. METHODS: Isolated rectal tuberculosis was defined as focal lesions of the rectum in the absence of radiologically demonstrable lesions in the small and large bowel on barium contrast studies. Diagnosis of rectal tuberculosis was based on characteristic endoscopic appearance of lesions, histopathologic features of tuberculosis in biopsy/ resected material, and response to antitubercular therapy. RESULTS: Eight patients with rectal tuberculosis were seen during a four-year period at our hospital. Hematochezia was the most common presenting feature (88 percent), followed by constitutional symptoms (75 percent) and constipation (37 percent). Rectal examination revealed a tight stricture within 10 cm of the anal verge in seven patients. Barium enema showed stricture of variable length, with focal areas of deep mucosal ulceration and increase in presacral space. Proctoscopic findings were tight stricture (7), nodularity with ulceration (6), and multiple aphthous ulcers (1). Granulomatous infiltration was detected in seven of eight patients in biopsy material obtained at endoscopy (6) or surgery (1). Cessation of hematochezia, resolution of constitutional symptoms, and weight gain were seen in all patients following treatment with antitubercular drugs. CONCLUSION: Our data suggest that tubercular involvement of rectum, although uncommon, is an important cause of rectal strictures in India. Response to antitubercular chemotherapy is uniformly good, and surgery is seldom required in these patients.


Assuntos
Antituberculosos/uso terapêutico , Doenças Retais/diagnóstico , Doenças Retais/tratamento farmacológico , Tuberculose Gastrointestinal/diagnóstico , Tuberculose Gastrointestinal/tratamento farmacológico , Adolescente , Adulto , Biópsia , Criança , Quimioterapia Combinada , Etambutol/uso terapêutico , Feminino , Humanos , Isoniazida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Proctoscopia , Rifampina/uso terapêutico , Resultado do Tratamento
12.
Br J Surg ; 83(2): 186-8, 1996 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-8689160

RESUMO

Choledochal cysts in children and adults may behave differently. To identify these differences the records of 49 patients (22 children and 27 adults) who underwent surgery for choledochal cysts over a period of 7 years were analysed retrospectively. In two adult patients who had undergone a previous cholecystectomy an acquired malformation could not be excluded. Cholangitis was more common in adults. Choledochal cysts in children were predominantly Type I cystic lesions, whereas Type IV cysts were more common in adult patients. Anomalies of the pancreatic duct and associated hepatobiliary problems were seen exclusively in adults and the latter can make excision of the cyst more difficult and complicated. To prevent the development of complications choledochal cysts should be excised as soon as they are detected.


Assuntos
Cisto do Colédoco/patologia , Adolescente , Adulto , Idoso , Anastomose em-Y de Roux , Colangiopancreatografia Retrógrada Endoscópica , Cisto do Colédoco/complicações , Cisto do Colédoco/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Gastrointest Endosc ; 43(2 Pt 1): 121-3, 1996 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-8635704

RESUMO

BACKGROUND: Carcinoma of the gallbladder is a major cause of malignant obstructive jaundice in India. It usually presents at an advanced stage and endoscopic palliation is the mainstay of treatment. We prospectively studied our results with endoscopic stenting in patients with carcinoma of the gallbladder. METHODS: Patients unfit for surgery were included in the study. Straight 10F plastic prostheses were placed endoscopically. Patients were assessed for procedure success, early and late complications, and stent patency. RESULTS: The success rate of stent placement was 84% (27 of 32). The five failures were caused by an inability to pass the guide wire across the stricture. Relief of pruritus and reduction in jaundice was seen in 25 of 27 (92%) patients. Double stents were placed in three patients. Four patients (11%) developed cholangitis in the first 30 days. Stent occlusion was detected in four patients after longer follow-up. The 30-day mortality was 5 of 27 (18%). There were no procedure-related deaths. CONCLUSION: Endoscopic endoprosthesis is a safe and relatively effective palliative measure for the majority of patients with unresectable carcinoma of the gallbladder.


Assuntos
Endoscopia/métodos , Neoplasias da Vesícula Biliar/cirurgia , Cuidados Paliativos/métodos , Stents , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida
14.
Indian J Gastroenterol ; 14(4): 122-3, 1995 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-8868351

RESUMO

OBJECTIVE: Our experience in treating large common bile duct stones using Olympus basket mechanical lithotripter (BML 2Q) and Soehendra lithotripter is reported. METHODS: Between July 1990 and December 1993, twenty two patients with common bile duct stones too large to be extracted by Dormia basket or balloon were treated with BML lithotripter or Soehendra lithotripter. RESULTS: The stone diameters ranged from 1.5 to 2.8 cm. Fourteen patients required one session of lithotripsy, four patients two sessions each, and two patients three sessions each. BML lithotripter was used in 14 patients. In the remaining eight patients the stones were fragmented with Soehendra lithotripter when the basket got impacted while attempting extraction. Mechanical lithotripsy was successful in 20 patients (91%). Indwelling stent was used in one patient; one patient underwent surgery. CONCLUSION: Mechanical lithotripsy is safe for the treatment of large common bile duct stones, with a success rate above ninety percent.


Assuntos
Cálculos Biliares/terapia , Litotripsia/métodos , Adulto , Endoscopia do Sistema Digestório , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Arch Pathol Lab Med ; 118(9): 891-4, 1994 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-8080358

RESUMO

We present a morphometric analysis of findings from a histopathologic study of duodenal giardiasis in relation to the trophozoite count in the duodenal aspirate. Of 30 patients with giardiasis whose conditions were studied, a mean trophozoite count of 10(3)/mL or greater was found in 21, and a mean trophozoite count of less than 10(3)/mL was found in nine--these two types of trophozoite counts in these 30 patients represented the acute phase (group 1) and the clearance phase (group 2) of giardiasis, respectively. Group 1 patients had a low mean villus height that was significantly less than that found in the control subjects. Group 2 patients had a high mean crypt depth that was significantly greater than that found in the control subjects. Partial villus atrophy was seen in only seven of the group 1 patients, including five with villus epithelial cell lesions. Groups 1 and 2 showed minor differences of an inflammatory response that was significantly greater than that shown in the control subjects.


Assuntos
Duodenopatias/patologia , Duodeno/patologia , Giardíase/patologia , Adulto , Biópsia , Duodenopatias/parasitologia , Duodeno/parasitologia , Giardíase/parasitologia , Humanos , Pessoa de Meia-Idade
17.
Zentralbl Bakteriol ; 277(1): 106-11, 1992 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-1520960

RESUMO

Giardia lamblia specific secretory immunoglobulin A (sIgA) levels in the duodenal fluid of adult giardiasis cases are reported for the first time. The sIgA levels in the study group were found to be significantly higher (p less than 0.01) than in the 20 age- and sex-matched controls comprising cases classified as non-ulcerative dyspepsia who did nor reveal any G. lamblia in their stools and the duodenal fluid. An inverse relationship between the clinical severity of giardiasis and the level of sIgA in the duodenal fluid was noted. Cases with a higher trophozoite load in duodenal aspirate tended to be associated with envanescent G. lamblia-specific antibodies.


Assuntos
Duodeno/parasitologia , Giardia lamblia/imunologia , Giardíase/imunologia , Imunoglobulina A Secretora/metabolismo , Secreções Intestinais/parasitologia , Adulto , Animais , Duodeno/imunologia , Giardíase/parasitologia , Humanos , Secreções Intestinais/imunologia , Pessoa de Meia-Idade
19.
Indian J Gastroenterol ; 10(2): 54-5, 1991 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-2040514

RESUMO

Histopathological changes in the esophagus and gastric antrum were studied in 47 patients with duodenal ulcer. Twenty three (49%) patients complained of heartburn. Esophagitis was present in 87% of the patients with heartburn and in 71% of the patients with no heartburn. In the majority, esophagitis was of mild to moderate severity. Gastritis was present in 83% (atrophic type in 22%) of patients with heartburn compared to 96% (25% atrophic type) of patients without heartburn. There was no statistical difference in the incidence of esophagitis and gastritis between the heartburn and no heartburn groups. This study suggests that histologic esophagitis and gastritis occur frequently in patients with duodenal ulcer and the presence of heartburn is not related to these histologic changes.


Assuntos
Úlcera Duodenal/patologia , Esofagite/patologia , Gastrite/patologia , Azia/etiologia , Adulto , Úlcera Duodenal/complicações , Esofagite/etiologia , Estudos de Avaliação como Assunto , Feminino , Gastrite/etiologia , Humanos , Masculino , Estudos Prospectivos
20.
Indian J Gastroenterol ; 9(4): 309-10, 1990 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-2258218

RESUMO

We report a patient with primary sclerosing cholangitis and associated pancreatitis. She had exocrine and endocrine pancreatic insufficiency.


Assuntos
Colangite Esclerosante/complicações , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Colangite Esclerosante/diagnóstico por imagem , Doença Crônica , Feminino , Humanos , Pancreatite/complicações
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