RESUMO
We present a family with several cases of eosinophilic esophagitis. Some cases of eosinophilic esophagitis in the same family have been previously described. Patients with eosinophilic esophagitis present frequently atopy, and atopy has a strong family association due to complex interactions between genetic and environment. However, eosinophilic esophagitis has a stronger genetic component than other atopic diseases. Eosinophilic esophagitis has been linked to variations in genes like eotaxin-3, TSLP and its receptor and CAPN14, although the inheritance pattern has not yet well defined.
Assuntos
Transtornos de Deglutição/etiologia , Esofagite Eosinofílica/complicações , Família , Transtornos de Deglutição/genética , Feminino , Humanos , Masculino , Adulto JovemRESUMO
We present the case of a 59-year-old patient with malabsorption syndrome which started with polyneuropathy. Capsule endoscopy and enteroscopy show villous denudation. Histological study confirms diaphragm disease of the small bowel. Diaphragm disease is a rare disease characterized by the presence of multiple thin diaphragms, such as septa, that narrow the intestinal lumen. The clinical features can be iron deficiency anemia, intestinal obstruction, change in bowel habits or acute abdomen secondary to perforation. It is usually generally with sustained use of high doses of non-steroidal anti-inflammatory drugs. The diagnosis usually requires the use of a capsule endoscopy or enteroscopy with biopsies.
Assuntos
Endoscopia por Cápsula , Obstrução Intestinal , Síndromes de Malabsorção , Diafragma , Humanos , Intestino Delgado , Síndromes de Malabsorção/diagnóstico , Síndromes de Malabsorção/diagnóstico por imagem , Pessoa de Meia-IdadeRESUMO
A 72-year-old female presented with abdominal pain and constipation and intestinal dilation was found. Abdominal computed tomography showed two areas of thickening and stenosis in the proximal jejunum and preterminal ileum, with an unknown etiology. Exploratory laparotomy was proposed but the patient suffered a sudden and progressive decrease in consciousness. Cranial computed tomography showed an ischemic area and a midline shift. Brain biopsies suggested infection by Aspergillus Fumigatus. Despite antifungal drugs, the patient had a progressive clinical deterioration and died. The autopsy concluded a systemic infection due to Aspergillus Fumigatus. Invasive aspergillosis is a serious fungal infection and usually occurs in immunocompromised patients. It mainly affects the lungs, followed by the gastrointestinal tract. The most frequent location in gastrointestinal involvement is the small bowel. Gastrointestinal involvement is more frequent in invasive disease. Although, there are case reports of isolated gastrointestinal aspergillosis, even in immunocompetent patients without risk factors. The prognosis is poor.
Assuntos
Aspergilose , Idoso , Antifúngicos/uso terapêutico , Aspergilose/complicações , Aspergilose/diagnóstico por imagem , Aspergilose/tratamento farmacológico , Feminino , Humanos , Hospedeiro Imunocomprometido , Intestino DelgadoRESUMO
We present abdominal computed tomography and enteroscopy images of a 48-year-old male patient with a previous melanoma who presented with epigastric pain. The pain was not controlled with medical management. Abdominal computed tomography and a histological study of biopsies form enteroscopy confirmed the diagnosis of metastatic melanoma. The gastrointestinal involvement of melanoma is usually metastatic. Symptomatic gastrointestinal involvement occurs in less than 5% of melanomas, although postmortem analyses have reported up to 70%. The clinical presentation is variable and usually presents as abdominal pain. The diagnosis of small intestinal involvement of melanoma is a challenge due to its poor accessibility. The enteroscopy has a fundamental role as it allows a direct visualization and biopsies to be taken for histological study.
Assuntos
Laparoscopia , Melanoma , Dor Abdominal/etiologia , Endoscopia Gastrointestinal , Humanos , Masculino , Melanoma/diagnóstico por imagem , Melanoma/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
ERCP is an endoscopic procedure with a complication risk ranging from 2.5 to 8%. The most frequent complications are pancreatitis, cholangitis, hemorrhage or perforation. Hepatic hematoma after ERCP is a potentially serious, rare complication. Not many cases are reported in the literature. We present here two new cases of hepatic hematoma following ERCP along with a review of the literature and possible therapeutic options.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Hematoma/etiologia , Hepatopatias/etiologia , Adulto , Feminino , Cálculos Biliares/complicações , Cálculos Biliares/terapia , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The eradication of Helicobacter pylori (HP) using clarithromycin (CLA)-based triple therapy depends on the resistance of HP to antibiotics. The Maastricht III conference recommends the implementation of locoregional surveillance programmes for primary resistance of HP to CLA. In Andalusia, there are no previous data in this respect. The aim of this study was to determine the prevalence of the primary resistance of HP to CLA and levofloxacin (LF) in southern Spain. METHODS: Multicentre cross sectional study was carried out in 6 hospitals in Andalusia. Patients of both sexes numbering 401 were included (male 48%), aged 18-80 years and naïve to HP eradication. Resistance of HP to CLA (CLAr) and LF (LFr) was assessed by determining mutations by PCR: mutations of the 23S rRNA gene define CLAr and mutations of the gene gyrA define LFr. Four hundred one gastric samples were collected. CLAr was detected in 72 patients (17.9%) and LFr was detected in 56 patients (13.9%). Heteroresistance was detected for both antibiotics: CLA 37/72 (51.3%) and LF 28/56 (50%). Variability for CLAr was detected among the centres, ranging from 11.5% to 24.7% without statistical significance (p = 0.12). Female sex was related to CLAr. CONCLUSIONS: In Andalusia, there is a high rate of primary CLAr and LFr. CLA-based triple therapy should be avoided as the primary eradication regimen in this region. There is a wide variability in the rate of CLAr among centres.
Assuntos
Antibacterianos/farmacologia , Claritromicina/farmacologia , Erradicação de Doenças , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Levofloxacino/farmacologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Claritromicina/uso terapêutico , Estudos Transversais , Feminino , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/genética , Humanos , Levofloxacino/uso terapêutico , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mutação , Reação em Cadeia da Polimerase , Prevalência , RNA Bacteriano/genética , RNA Ribossômico 23S/genética , Espanha/epidemiologia , Adulto JovemAssuntos
Anemia Ferropriva/etiologia , Intestino Delgado/diagnóstico por imagem , Anti-Inflamatórios não Esteroides , Endoscopia por Cápsula , Constrição Patológica/complicações , Constrição Patológica/diagnóstico por imagem , Gastrite/diagnóstico por imagem , Humanos , Intestino Delgado/patologia , Masculino , Pessoa de Meia-IdadeAssuntos
Transtornos de Deglutição/etiologia , Esôfago/anormalidades , Esôfago/diagnóstico por imagem , Pré-Escolar , Meios de Contraste , Transtornos de Deglutição/complicações , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/diagnóstico por imagem , Diagnóstico Diferencial , Acalasia Esofágica/diagnóstico , Junção Esofagogástrica/diagnóstico por imagem , Feminino , Gastroscopia , Humanos , Músculo Liso/anormalidades , Músculo Liso/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Vômito/etiologiaAssuntos
Hemorragia Gastrointestinal/etiologia , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/diagnóstico por imagem , Idoso , Angiografia/métodos , Feminino , Humanos , Tomografia Computadorizada por Raios XAssuntos
Esofagite/etiologia , Esofagoplastia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Adulto , Anastomose Cirúrgica , Cáusticos , Colo/cirurgia , Transtornos de Deglutição/etiologia , Esofagite/cirurgia , Feminino , Humanos , Complicações Pós-Operatórias/terapia , Tomografia Computadorizada por Raios XRESUMO
Liver cirrhosis is a risk factor for osteoporosis. Nevertheless, little is known about the mechanisms of bone mass loss in patients with viral cirrhosis. TNFalpha is a potent bone-resorbing agent. Serum concentrations of soluble TNF receptor p55 (sTNFR-55) correlate with clinical activity in liver cirrhosis. Our aim was to evaluate the possible role of sTNFR-55 in the pathogenesis of osteoporosis in patients with viral cirrhosis and its relationship with bone turnover markers. We studied 40 consecutive patients with viral cirrhosis and no history of alcohol intake and 26 healthy volunteers. Bone mineral density (BMD) was measured by dual x-ray absorptiometry in the lumbar spine (LS) and femoral neck (FN). Patients with viral cirrhosis had reduced BMD (expressed as the z-score) in all sites [LS, -1.5 +/- 0.22 (P < 0.001); FN, -0.37 +/- 0.15 (P < 0.01)]. Serum concentrations of sTNFR-55 and urinary deoxypyridinoline, a biochemical marker of bone resorption, were significantly higher in patients with osteoporosis than in patients without osteoporosis (P < 0.001 and P < 0.05, respectively). Serum levels of sTNFR-55 correlated inversely with BMD in LS (r = -0.62; P < 0.005) and FN (r = -0.47; P < 0.05) and positively with urinary deoxypyridinoline (r = 0.72, P < 0.001). Our findings show that high serum concentrations of sTNFR-55 play a role in the pathogenesis of viral cirrhosis-associated bone mass loss and provide evidence of increased bone resorption related to the high serum sTNFR-55 levels.
Assuntos
Densidade Óssea , Proteínas de Transporte/sangue , Hepatite B/complicações , Hepatite C/complicações , Cirrose Hepática/complicações , Osteoporose/etiologia , Receptores do Fator de Necrose Tumoral/sangue , Adulto , Idoso , Osso e Ossos/metabolismo , Calcifediol/sangue , Humanos , Fator de Crescimento Insulin-Like I/análise , Cirrose Hepática/metabolismo , Masculino , Pessoa de Meia-Idade , Receptores Tipo I de Fatores de Necrose Tumoral , Análise de Regressão , Receptores Chamariz do Fator de Necrose TumoralRESUMO
La colangiopancreatografía retrógrada endoscópica (CPRE) es una técnica endoscópica con un riesgo de complicaciones secundarias que oscila del 2,5-8%. Las complicaciones que con más frecuencia se presentan son la pancreatitis, procesos infecciosos, hemorragia o perforación. El hematoma hepático secundario a CPRE es una rara y potencialmente grave complicación con pocos casos descritos en la literatura. A continuación presentamos dos casos de hematomas hepáticos secundarios a la realización de CPRE, realizando una revisión de la bibliografía y de las posibles opciones terapéuticas (AU)
ERCP is an endoscopic procedure with a complication risk ranging from 2.5 to 8%. The most frequent complications are pancreatitis, cholangitis, hemorrhage or perforation. Hepatic hematoma after ERCP is a potentially serious, rare complication. Not many cases are reported in the literature. We present here two new cases of hepatic hematoma following ERCP along with a review of the literature and possible therapeutic options (AU)
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Colangiopancreatografia Retrógrada Endoscópica/complicações , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Colangiopancreatografia Retrógrada Endoscópica/métodos , Coledocolitíase , Transfusão de Eritrócitos , Enterobacter cloacae/isolamento & purificação , Angiografia , Embolização Terapêutica/métodosRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Esofagite Eosinofílica/genética , Esofagite Eosinofílica/dietoterapia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/genéticaRESUMO
No disponible