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1.
Rev Med Chil ; 149(1): 132-136, 2021 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-34106145

RESUMO

Primary aortoenteric fistula is the spontaneous communication between the lumen of the aorta and a portion of the digestive tract. The most common cause is the erosion of an abdominal aortic aneurysm into the 3rd or 4th portion of the duodenum. It manifests clinically as gastrointestinal bleeding, with or without abdominal pain and a pulsatile abdominal mass on physical exam. Gastrointestinal bleeding is initially recurrent and self-limiting and progresses to fatal exsanguinating hemorrhage. Endoscopic examination diagnoses only 25% of aortoenteric fistulas because these are usually located in the distal duodenum. Contrast computed tomography of the abdomen and pelvis is diagnostic in only 60% of cases. We report three cases with this condition. A 67-year-old male presenting with an upper gastrointestinal bleeding. He was operated and a communication between an aortic aneurysm and the duodenum was found and surgically repaired. The patient is well. A 67-year-old male with an abdominal aortic aneurysm presenting with abdominal pain. He was operated and anticoagulated. In the postoperative period he had a massive gastrointestinal bleeding and a new CAT scan revealed an aorto enteric fistula that was surgically repaired. The patient is well. An 82-year-old male with an abdominal aortic aneurysm presenting with hematochezia. A CAT scan revealed a communication between the aneurysm and the third portion of the duodenum, that was surgically repaired. The patient died in the eighth postoperative day.


Assuntos
Aneurisma da Aorta Abdominal , Doenças da Aorta , Ruptura Aórtica , Duodenopatias , Fístula Intestinal , Fístula Vascular , Aorta Abdominal , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Duodenopatias/complicações , Duodenopatias/diagnóstico por imagem , Duodenopatias/cirurgia , Duodeno , Hemorragia Gastrointestinal/etiologia , Humanos , Fístula Intestinal/complicações , Fístula Intestinal/diagnóstico por imagem , Masculino , Fístula Vascular/complicações , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgia
2.
Zhonghua Gan Zang Bing Za Zhi ; 29(5): 468-471, 2021 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-34107586

RESUMO

42 cases with gastroesophageal varices were prospectively included. The groups were treated with endoscopic band ligation or combined with tissue adhesive. The results showed that the left gastric vein internal diameter, average blood flow velocity and blood flow volume after the treatment of band ligation combined with tissue adhesive were significantly lower than that of the treatment of band ligation alone, and the differences were statistically significant (P < 0.05). Spleen and portal vein internal diameter, blood flow and average velocity, the liver and spleen size, shear wave velocity and liver function grade of the two groups after treatment did not change significantly (P > 0.05). The effective rate of band ligation combined with tissue adhesive in the treatment of esophageal and gastric varices (66.67%, 52.38%) were higher than that of band ligation alone (42.85%, 23.81%) (P > 0.05), and the re-bleeding rate of the latter was higher (9.52% and 19.05%, P > 0.05). Hence, it is suggested that the combined therapy is safe and more effective, and has no apparent effect on liver function and portal hypertension.


Assuntos
Varizes Esofágicas e Gástricas , Adesivos Teciduais , Varizes , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/terapia , Humanos , Ligadura , Veia Porta/cirurgia , Escleroterapia
3.
BMJ Case Rep ; 14(6)2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34108158

RESUMO

A man in his 30s was brought by ambulance to the emergency department with a complaint of frank bright red rectal bleeding and dizziness. His blood pressure was 60/18 mm Hg. He was resuscitated with intravenous normal saline and an emergency blood transfusion. Following a negative emergency oesophagogastroduodenoscopy and colonoscopy, an angiographic CT of the abdomen revealed a large tumour in the ileum. After failing to stabilise him with multiple blood transfusions, he had an emergent laparotomy and surgical resection of the tumour, which was confirmed by histocytology as gastrointestinal stromal tumour (GIST). He made full recovery and was discharged home after 10 days. We discussed the challenges of managing significant lower gastrointestinal bleeding and reviewed the current management of GIST.


Assuntos
Cavidade Abdominal , Tumores do Estroma Gastrointestinal , Angiografia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Laparotomia , Masculino
4.
BMC Gastroenterol ; 21(1): 246, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34074253

RESUMO

BACKGROUND: Small intestine duplication cysts (SIDCs) are rare congenital anatomical abnormalities of the digestive tract and a rare cause of hematochezia. CASE PRESENTATION: We describe an adult female presented with recurrent hematochezia. The routine gastric endoscope and colonic endoscope showed no positive findings. Abdominal CT scan indicated intussusception due to the "doughnut" sign, but the patient had no typical symptoms. Two subsequent capsule endoscopes revealed a protruding lesion with bleeding in the distal ileum. Surgical resection was performed and revealed a case of SIDC measuring 6 * 2 cm located inside the ileum cavity. The patient remained symptom-free throughout a 7-year follow-up period. CONCLUSION: SIDCs located inside the enteric cavity can easily be misdiagnosed as intussusception by routine radiologic examinations.


Assuntos
Cistos , Intussuscepção , Adulto , Cistos/complicações , Cistos/diagnóstico por imagem , Cistos/cirurgia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Íleo , Intussuscepção/diagnóstico por imagem , Intussuscepção/etiologia , Intussuscepção/cirurgia , Estômago
5.
BMC Gastroenterol ; 21(1): 250, 2021 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-34092231

RESUMO

BACKGROUND: Few studies have reported whether a biopsy in emergency gastroscopy (EG) increased the risk of rebleeding in patients with Forrest I acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) combined with suspected malignant gastric ulcer (SMGU). This study aims to conduct a multicenter retrospective cohort study using propensity score matching to verify whether a biopsy in EG increases the risk of rebleeding in patients diagnosed with Forrest I ANVUGIB combined with SMGU. METHODS: Using the data for propensity-matched patients, logistic regression models were fitted using rebleeding as the dependent variable. Survival time was defined as the length of time the patient experienced from visiting the emergency department to rebleeding. We used the Kaplan-Meier (KM) method to analyze the 30-day survival of the patients with and without a biopsy after matching, and the log-rank test was performed to examine the differences in survival. RESULTS: With the use of propensity score matching, 308 patients who underwent a biopsy in EG were matched with 308 patients who did not. In the five logistic regression models, there were no significant group differences in the risk of rebleeding in patients with Forrest I ANVUGIB combined with SMGU between the biopsy and no-biopsy groups. The probability of survival was not significantly different between the no-biopsy and biopsy groups. CONCLUSIONS: In this multicenter, retrospective propensity score matching cohort study, compared with patients without a biopsy, patients with a biopsy during EG had no increased risk of rebleeding, and there was no significant difference in the rate of rebleeding.


Assuntos
Úlcera Gástrica , Biópsia , Estudos de Coortes , Serviço Hospitalar de Emergência , Hemorragia Gastrointestinal/etiologia , Gastroscopia , Humanos , Recidiva , Estudos Retrospectivos , Úlcera Gástrica/complicações
8.
Medicine (Baltimore) ; 100(21): e26039, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032728

RESUMO

BACKGROUND: The benefit of beta-blockers for secondary prophylaxis of gastric variceal bleeding has limited evidence. Therefore, a systematic review and meta-analysis was conducted to systematically analyze and compare the effect of beta-blockers versus cyanoacrylate injection for patients with gastric variceal bleeding. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines will be followed to conduct the present meta-analysis. From the inception to June 2021, the Web of Science, EMBASE, PubMed, and Cochrane Library electronic databases will be searched using the key phrases "beta-blockers," "cyanoacrylate," and "gastric variceal bleeding" for all relevant English-language trials. Study included in our meta-analysis has to meet the following criteria: observational or randomized controlled trial focusing on assessing the effectiveness of beta-blockers and cyanoacrylate injection for gastric variceal bleeding; the following outcome measures are reported: bleeding from gastric variceal, overall mortality, bleed related mortality, and complications. RESULTS: This study expects to provide credible and scientific evidence for the efficacy and safety of beta-blockers versus cyanoacrylate injection for patients with gastric variceal bleeding. REGISTRATION NUMBER: 10.17605/OSF.IO/CPV9T.


Assuntos
Antagonistas Adrenérgicos beta/administração & dosagem , Cianoacrilatos/administração & dosagem , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas/efeitos adversos , Antagonistas Adrenérgicos beta/efeitos adversos , Cianoacrilatos/efeitos adversos , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/mortalidade , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Humanos , Injeções Intralesionais/efeitos adversos , Metanálise como Assunto , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto , Resultado do Tratamento
9.
BMC Gastroenterol ; 21(1): 214, 2021 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-33971821

RESUMO

BACKGROUND: Portal hypertension induced esophageal and gastric variceal bleeding is the main cause of death among patients of decompensated liver cirrhosis. Therefore, a standardized, biomarker-based test, to make an early-stage non-invasive risk assessment of portal hypertension, is highly desirable. However, no fit-for-purpose biomarkers have yet been identified. METHODS: We conducted a pilot study consisting of 5 portal hypertensive gastropathy (PHG) patients and 5 normal controls, sampling the gastric mucosa of normal controls and PHG patients before and after endoscopic cyanoacrylate injection, using label-free quantitative (LFQ) mass spectrometry, to identify potential biomarker candidates in gastric mucosa from PHG patients and normal controls. Then we further used parallel reaction monitoring (PRM) to verify the abundance of the targeted protein. RESULTS: LFQ analyses identified 423 significantly differentially expressed proteins. 17 proteins that significantly elevated in the gastric mucosa of PHG patients were further validated using PRM. CONCLUSIONS: This is the first application of an LFQ-PRM workflow to identify and validate PHG-specific biomarkers in patient gastric mucosa samples. Our findings lay the foundation for comprehending the molecular mechanisms of PHG pathogenesis, and provide potential applications for useful biomarkers in early diagnosis and treatment. Trial registration and ethics approval: Trial registration was completed (ChiCTR2000029840) on February 25, 2020. Ethics Approvals were completed on July 17, 2017 (NYSZYYEC20180003) and February 15, 2020 (NYSZYYEC20200005).


Assuntos
Varizes Esofágicas e Gástricas , Hipertensão Portal , Gastropatias , Biomarcadores , Varizes Esofágicas e Gástricas/patologia , Mucosa Gástrica/patologia , Hemorragia Gastrointestinal/patologia , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/patologia , Cirrose Hepática/patologia , Projetos Piloto , Gastropatias/patologia
10.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(2): 222-229, 2021 Apr 28.
Artigo em Chinês | MEDLINE | ID: mdl-33966702

RESUMO

Objective To analyze clinical characteristics and short-term efficacy of endoscopic hemostasis in acute duodenal hemorrhage. Methods A retrospective study was conducted for the patients who received endoscopy in the PUMC Hospital due to upper gastrointestinal bleeding and were confirmed to be on account of duodenal lesions for bleeding from January 2011 to December 2018.Clinical information of patients was collected,including demographics,comorbidities,and medication use.Endoscopic information included the origin of bleeding,the number and location of lesions,Forrest classes and size of ulcers,and endoscopic therapeutic methods.Factors that could be relative to the failure of endoscopic hemostasis or short-term recurrence of hemorrhage in these patients were analyzed. Results Among all the patients with duodenal hemorrhage,79.7%(102/128)were due to ulcers,14.1%(18/128)to tumors,3.9%(5/128)to vascular malformation,and 2.3%(3/128)to diverticulum.Fifty-three(41.4%)patients received endoscopic hemostasis,and six patients(4.7%)received surgery or interventional embolization after the endoscopic test.Among the patients receiving endoscopic hemostasis,5.7%(3/53),66.0%(35/53),and 28.3%(15/53)received injection therapy,mechanical therapy,and dual endoscopic therapy,respectively,and 94.3% of them were cured.However,10(18.9%)of them experienced recurrence of hemorrhage and 3 patients died during hospitalization.Only one patient suffered from perforation after the second endoscopic treatment.Lesions located on the posterior wall of bulb appeared to be a risk factor for the failure of endoscopic hemostasis(OR=31.333,95% CI=2.172-452.072,P=0.021).The lesion diameter≥1 cm was a risk factor of rebleeding after endoscopic therapy(OR=7.000,95% CI=1.381-35.478,P=0.023).Conclusions Peptic ulcers were always blamed and diverticulum could also be a common reason for duodenal hemorrhage,which was different from the etiological constitution of acute upper gastrointestinal hemorrhage.Lesions locating on the posterior wall of the duodenum had a higher potential to fail the endoscopic hemostasis.The lesion diameter≥1 cm was a predictive factor for short-term recurrence.Forrest classes of ulcers at duodenum did not significantly affect the endoscopic therapeutic efficacy or prognosis.


Assuntos
Úlcera Duodenal , Embolização Terapêutica , Hemostase Endoscópica , Úlcera Duodenal/complicações , Úlcera Duodenal/terapia , Endoscopia , Hemorragia Gastrointestinal/etiologia , Humanos , Recidiva , Estudos Retrospectivos
11.
Nihon Shokakibyo Gakkai Zasshi ; 118(5): 437-444, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33967128

RESUMO

Colonic diverticular bleeding often recurs and requires hospital readmission. This study aimed to examine the relationship between the rate of readmission and the number of hospitalizations due to colonic diverticular bleeding. We retrospectively studied 98 patients first admitted between January 2008 and July 2017 for the treatment of colonic diverticular bleeding. We investigated the subsequent number of hospitalizations due to colonic diverticular bleeding and classified the patients into 3 groups:those admitted for the first time (first group), those admitted for the second time (second group), and those admitted for the third time or later (third group). Generally, the readmission rate increased as the number of hospitalizations increased (P<0.01). The 1-year readmission rates were 11.6%, 23.2%, and 34.2% in the first, second, and third groups, respectively. The 2-year readmission rates were 15.1%, 50.1%, and 62.4% in the first, second, and third groups, respectively. The 3-year readmission rates were 21.7%, 50.1%, and 74.9% in the first, second, and third groups, respectively. Thus, the number of hospitalizations due to colonic diverticular bleeding could be a predictive factor for readmission. We also classified the patients into 2 additional groups:those who had been readmitted (readmission group) and those who had not (no readmission group). Furthermore, we examined background and therapeutic factors, and found hypovolemic shock on admission to be an independent risk factor (odds ratio 14.1). Preventive treatments for such high-risk patients should be considered.


Assuntos
Doenças Diverticulares , Readmissão do Paciente , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Hospitalização , Humanos , Estudos Retrospectivos
12.
Nihon Shokakibyo Gakkai Zasshi ; 118(5): 462-472, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33967131

RESUMO

A 57-year-old female with a history of Cowden's disease was referred to our hospital because of black stool, loss of consciousness, and severe anemia. Upper and lower gastrointestinal endoscopy findings could not confirm the source of hemorrhage. Capsule endoscopy (CE) of the small intestine showed an active exudative hemorrhagic site near the ileum, although a definitive diagnosis was difficult. In a double balloon enteroscopy examination, it was difficult to observe the entire small intestine due to adhesions and the responsible lesion could not be confirmed, even when ink spots were applied to the deepest observation points through the mouth and anus. Hemostasis spontaneously occurred, and then anemia occurred again approximately 1 month later and a second CE examination was performed including passage of an ink stick through the oral side, which revealed an exudative elevated polyp with erosion and a white moss appearance in the ileum. Partial ileal resection was performed and pyogenic granuloma of the small intestine was the diagnosis. We report here a case of pyogenic granuloma of the small intestine associated with Cowden's disease.


Assuntos
Granuloma Piogênico , Síndrome do Hamartoma Múltiplo , Enteroscopia de Duplo Balão , Endoscopia Gastrointestinal , Feminino , Hemorragia Gastrointestinal/etiologia , Granuloma Piogênico/diagnóstico , Granuloma Piogênico/diagnóstico por imagem , Humanos , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Pessoa de Meia-Idade
13.
BMJ Case Rep ; 14(5)2021 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-33947673

RESUMO

A 21-year-old woman visited out hospital for lower abdominal pain and bloody diarrhoea at 19 weeks of pregnancy. Endoscopic findings revealed longitudinal ulcerations with hyperaemia and oedema in the sigmoid colon. These findings and clinical presentation confirmed the diagnosis of ischaemic colitis. Conservative treatment, including fasting and intravenous hydration, was administered, and the patient made a good recovery. After discharge, there was no recurrence during pregnancy and postpartum period. It is important to make early diagnosis and treatment, and multidisciplinary teamwork between obstetricians, gastroenterologist and endoscopist is required.


Assuntos
Colite Isquêmica , Colite , Dor Abdominal/etiologia , Adulto , Colite Isquêmica/diagnóstico , Feminino , Hemorragia Gastrointestinal , Humanos , Gravidez , Sigmoidoscopia , Adulto Jovem
14.
BMC Gastroenterol ; 21(1): 205, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33962582

RESUMO

BACKGROUND AND AIMS: Gastrointestinal manifestations in patients with COVID-19 are common but the role of endoscopy in this patient population remains unclear. We investigated the need for endoscopic procedures, their findings, and impact on patient care in a systematic and geographically diverse sample of patients hospitalized with COVID-19. METHODS: As part of the North American Alliance for the Study of Digestive Manifestations of COVID-19, we identified consecutive patients hospitalized with COVID-19 at 36 medical centers in the USA and Canada. We performed a secondary analysis of patients who underwent endoscopy, collecting information on endoscopic indications, findings, interventions, staffing, procedure location, anesthesia utilization, and adverse events. RESULTS: Data were collected on 1992 patients; 24 (1.2%) underwent 27 endoscopic procedures (18 upper endoscopies, 7 colonoscopies, 2 endoscopic retrograde cholangiopancreatographies). The most common indications were: gastrointestinal bleeding (13) and enteral access (6). The most common findings were erosive or inflammatory changes. Ten patients underwent an endoscopic intervention for hemostatic therapy (2), enteral access (6), or biliary obstruction (2). Half of cases employed anesthesiology support; no sedation-related adverse events were reported. One-third of cases were performed in the intensive care setting and one quarter in the endoscopy unit. CONCLUSIONS: In this large, systematic, geographically diverse cohort of patients hospitalized with COVID-19 in North America, very few patients underwent endoscopy despite a high prevalence of gastrointestinal manifestations. Almost all endoscopic findings and interventions were thought related to critical illness rather than direct viral injury. This systematic assessment of endoscopic necessity and outcomes may help guide resource allocation in the event of ongoing and future surges.


Assuntos
Canadá , Endoscopia Gastrointestinal , Hemorragia Gastrointestinal , Humanos , Estados Unidos
15.
World J Gastroenterol ; 27(19): 2353-2365, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34040327

RESUMO

BACKGROUND: Acute severe lower gastrointestinal bleeding (LGIB) is an uncommon but challenging complication of Crohn's disease (CD). AIM: To identify the predictors of acute severe LGIB and to evaluate the impact of acute severe LGIB on the subsequent clinical course in CD patients. METHODS: A retrospective inception cohort study was conducted in 75 CD patients with acute severe LGIB and 1359 CD patients without acute severe LGIB who were diagnosed between February 1991 and November 2019 at Asan Medical Center, a tertiary university hospital in Korea. Multivariable analysis with Cox proportional hazard regression was performed to identify the risk factors for acute severe LGIB. A matched analysis using 72 patients with bleeding and 267 matched patients without within the cohort was also conducted to investigate whether acute severe LGIB is a predictor of clinical outcomes of CD. RESULTS: Multivariable Cox regression analysis revealed that early use of thiopurines [hazard ratio (HR): 0.23, 95% confidence interval (CI): 0.12-0.48; P < 0.001] and female sex (HR: 0.51, 95%CI: 0.27-0.94; P = 0.031) were significantly associated with a lower risk of acute severe LGIB. The cumulative risks of behavioral progression and intestinal resection were not significantly different between the two matched groups (P = 0.139 and P = 0.769, respectively). The hospitalization rate was higher in the bleeding group than in the matched non-bleeding group (22.1/100 vs 13.2/100 patient-years; P = 0.012). However, if hospitalizations due to bleeding episodes were excluded from the analysis, the hospitalization rate was not significantly different between the bleeding group and the matched non-bleeding group (14.5/100 vs 13.2/100 patient-years; P = 0.631). CONCLUSION: Early use of thiopurines may reduce the risk of acute severe LGIB. History of acute severe LGIB may not have a significant prognostic value in patients with CD.


Assuntos
Doença de Crohn , Doença Aguda , Estudos de Coortes , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/tratamento farmacológico , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Prognóstico , República da Coreia , Estudos Retrospectivos , Fatores de Risco
16.
J Med Case Rep ; 15(1): 290, 2021 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-34024285

RESUMO

BACKGROUND: Retroperitoneal hematoma after vaginal delivery is rare but can lead to maternal morbidity and mortality. Diagnosis of this condition is challenging due to its complexity and its nonspecific signs and symptoms. To date, studies and case reports regarding retroperitoneal hematoma are few, particularly in low-income countries where risk factors for this condition may be more prevalent and the prognosis poorer. CASE PRESENTATION: We report the case of a 37-year-old multiparous african (Congolese) woman who presented to the emergency department of a large referral hospital in Bukavu, Democratic Republic of the Congo (DRC), 2 weeks after a spontaneous nontraumatic vaginal delivery. She had abdominal pain that began immediately after delivery and progressed throughout the postpartum period. The patient had anemia, hypotension, tachycardia, and a left costo-lumbar arch distorting the body shape on a soft and depressed abdomen. She had visited a private clinic on days 3 and 7 postpartum; however, signs and symptoms of retroperitoneal hematoma went unrecognized. Using abdominal ultrasound, we diagnosed an extensive hematoma in the retroperitoneal space from the left iliac fossa to the left flank. Laparotomy was performed to evacuate the hematoma, and the patient recovered. CONCLUSION: Retroperitoneal hematoma following a nontraumatic vaginal delivery is an unusual situation in general obstetrical practice. The knowledge of this potentially life-threatening condition in resource-limited settings enables effective diagnosis and management by ultrasound and laparotomy.


Assuntos
Parto Obstétrico , Hematoma , Adulto , Feminino , Hemorragia Gastrointestinal , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Gravidez , Espaço Retroperitoneal/diagnóstico por imagem , Ultrassonografia
17.
Ann Palliat Med ; 10(5): 5494-5501, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34044566

RESUMO

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a common complication of acute ischemic stroke (AIS), but the effect of UGIB on the prognosis of middle-aged AIS patients is not clear. METHODS: Patients with AIS admitted to our hospital from January 2011 to December 2015 were eligible to be included in this study. All included patients were divided into UGIB and non-UGIB groups. Some clinical characteristics were retrospectively collected. Primary outcomes were all-cause mortality within 1, 3, and 5 years, as well as the incidence of stroke recurrence. Cox proportional hazards regression analyses were used to determine the effect of UGIB on 5-year mortality and the incidence of stroke recurrence. Logistic regression was also used to identify the predictors of UGIB in AIS patients. RESULTS: A total of 405 AIS patients were included in this study and then divided into UGIB and non-UGIB groups. The mean age of the UGIB group and non-UGIB group was 61.5±9.6 and 53.1±14.0 years, respectively (P<0.001). The baseline score of the National Institute of Health Stroke Scale (NIHSS) was significantly higher in the UGIB group than in the non-UGIB group (P<0.001). AIS patients in the UGIB group had a higher 1-, 3-, and 5-year mortality and a higher incidence of stroke recurrence (all P<0.001). Kaplan-Meier curves showed that AIS patients with UGIB had a higher 5-year mortality and a higher incidence of stroke recurrence (both P<0.001). Cox proportional hazards regression models indicated that the occurrence of UGIB, older age, a high NIHSS score, and stroke recurrence were related to a higher 5-year mortality. Similarly, the occurrence of UGIB, older age, a high NIHSS score, and hypertension increased the incidence of stroke recurrence. According to the multivariate logistic regression analysis, older age, a high NIHSS score, and previous anticoagulant use were identified as predictors of UGIB. CONCLUSIONS: UGIB has important effects on the prognosis of AIS patients. The incidence of UGIB increases with older age, a high NIHSS score, and previous anticoagulant use, which provides important evidence for the treatment and nursing of AIS patients.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Idoso , Hemorragia Gastrointestinal/etiologia , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco
18.
Adv Clin Exp Med ; 30(5): 563-570, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33974753

RESUMO

Amyloidosis is a heterogeneous group of diseases in which the extracellular deposition of abnormal fibrillar proteins disrupts tissue structure and function. Intestinal involvement is a very rare manifestation of amyloidosis compared to the most affected organs, the heart and kidneys. Damage of the gastrointestinal tract may be the only manifestation of amyloidosis, or - more often - is a component of the involvement of several organs in systemic amyloidosis. Any part of the digestive tract can be involved; however, the small bowel is the most affected part, followed by the colon. Intestinal amyloidosis is characterized by a heterogeneous clinical picture, with weight loss, chronic diarrhea, abdominal pain, intestinal bleeding, or pseudo-obstruction. Endoscopic findings are characterized by a fine granular appearance, erosions, ulcerations, mucosal friability, multiple protrusions, or tumor-like lesions. Pathologic examination allows for a definitive diagnosis using Congo red staining and a positive sample with apple-green birefringence. The disease can easily be misdiagnosed with several other diseases of the digestive tract and lead to diagnostic challenges in clinical practice. Further, the amyloid colonic deposition may mimic inflammatory bowel disease, malignancy, ischemic colitis, and collagenous colitis. Therefore, gastroenterologists need to include amyloidosis in their diagnostic work-up.


Assuntos
Amiloidose , Amiloidose/diagnóstico , Colo , Hemorragia Gastrointestinal , Humanos , Intestinos , Rim
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