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1.
Rev Esp Enferm Dig ; 2020 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-33267595

RESUMO

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.

2.
Gastroenterol Res Pract ; 2020: 4060648, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32411197

RESUMO

Methods: A multicenter cross-sectional study involving seven referral centers from three cities of Argentina was undertaken. Patients with a diagnosis of ulcerative colitis (UC), Crohn's disease (CD), or indeterminate colitis (IBDU/IC) were invited to answer an anonymous survey, which included a 5-point Likert scale to evaluate adherence to therapies. Independent variables associated with inadequate adherence were evaluated. Results: Overall, 447 UC/IBDU and 135 CD patients were enrolled. Median age was 37 years (range 21-72); 39.8% were male; median time from diagnosis was 6 years (0.5-35). 91.4% were under treatment with at least one oral medication; 50.3% of patients reported inadequate adherence to oral medications. Patients with UC/IBDU had a lower risk of inadequate adherence when compared to patients with CD (OR 0.57 (0.37-0.87)). 21.8% reported inadequate adherence to biologics; subcutaneous administration was significantly associated with inadequate adherence to biologics (OR 4.8 (1.57-14.66)). Conclusion: Inadequate treatment adherence is common among patients with IBD, and potentially modifiable factors were identified.

3.
Acta Gastroenterol Latinoam ; 46(1): 22-29, 2016 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-29470880

RESUMO

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.


Assuntos
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
4.
Acta Gastroenterol Latinoam ; 44(2): 125-8, 2014 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-25199307

RESUMO

This case report describes a 37-year-old woman who develops an intraparenchymal hepatic haematoma after an endoscopic retrograde cholangiopancreatography with papillotomy and stone extraction. The procedure requires the passage of a guidewire. The patient develops acute abdominal pain 72 hours later and a magnetic resonance shows a hematoma of 124 x 93 mm. She remains under observation. Twenty one days later she complains of upper right abdominal pain and fever. Consequently, a percutaneous drainage is performed isolating Citrobacter freundii and Klebsiella pneumoniae BLEE. The patient has a good evolution.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Coinfecção/microbiologia , Infecções por Enterobacteriaceae/etiologia , Hematoma/microbiologia , Hepatopatias/microbiologia , Adulto , Citrobacter freundii , Feminino , Humanos , Klebsiella pneumoniae
5.
Acta gastroenterol. latinoam ; 44(2): 125-8, 2014 Jun.
Artigo em Espanhol | LILACS-Express | LILACS, BINACIS | ID: biblio-1157440

RESUMO

This case report describes a 37-year-old woman who develops an intraparenchymal hepatic haematoma after an endoscopic retrograde cholangiopancreatography with papillotomy and stone extraction. The procedure requires the passage of a guidewire. The patient develops acute abdominal pain 72 hours later and a magnetic resonance shows a hematoma of 124 x 93 mm. She remains under observation. Twenty one days later she complains of upper right abdominal pain and fever. Consequently, a percutaneous drainage is performed isolating Citrobacter freundii and Klebsiella pneumoniae BLEE. The patient has a good evolution.

6.
Acta Gastroenterol. Latinoam. ; 44(2): 125-8, 2014 Jun.
Artigo em Espanhol | BINACIS | ID: bin-133452

RESUMO

This case report describes a 37-year-old woman who develops an intraparenchymal hepatic haematoma after an endoscopic retrograde cholangiopancreatography with papillotomy and stone extraction. The procedure requires the passage of a guidewire. The patient develops acute abdominal pain 72 hours later and a magnetic resonance shows a hematoma of 124 x 93 mm. She remains under observation. Twenty one days later she complains of upper right abdominal pain and fever. Consequently, a percutaneous drainage is performed isolating Citrobacter freundii and Klebsiella pneumoniae BLEE. The patient has a good evolution.

7.
Acta Gastroenterol Latinoam ; 40(4): 361-6, 2010 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-21381411

RESUMO

Primary hepatic lymphoma (PHL) is confined to the liver with no evidence of extrahepatic lymphomatosis. Histopathologically, the PHL belongs to the group of non-Hodgkin's lymphomas and the most common subtype is the diffise large B-cell lymphoma. We present a 72-year-old woman, with no relevant antecedents and the following symptoms: early satiety, abdominal discomfort and rapid weight loss. Liver function tests are normal, erythrocyte sedimentation rate is accelerated and LDH progressively increases during the hospitalization. Imaging studies (ultrasound, CT scan, nuclear magnetic resonance) show a multilobued mass of around 12 cm of diameter in the right hepatic lobe. Tumoral and virological markers are negative. The pathology of an echo-guided biopsy informs a massive infiltration by a diffuse large B-cell lymphoma. The immunohistochemical study shows CD20+, CD45+ and negative CD3, CKAE1, AE3, Hepatocyte and HMB45. The citology of pleural liquid is negative for atypia, peripheral blood smear shows no signs of leukemia, bone marrow biopsy is negative for lymphomatous infiltration, and gallium scintigraphy and body CT scan do not reveal extrahepatic lesions. The patient starts chemotherapy with cyclophosphamide and methylprednisolone but worsens and dies two weeks after beginning treatment. We conclude that our patient had a rare disease with an unresectable lesion, poor prognostic factors and high recurrence risk. Chemotherapy is the treatment of choice in these cases.


Assuntos
Neoplasias Hepáticas/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Idoso , Antineoplásicos Alquilantes/uso terapêutico , Biomarcadores Tumorais/sangue , Ciclofosfamida/uso terapêutico , Evolução Fatal , Feminino , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Prednisona/uso terapêutico
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