RESUMEN
Two hundred twenty-two patients with endoscopically proven duodenal ulcers participated in a controlled trial to assess and compare the effects of two dosage regimens of sucralfate tablets on ulcer healing, i.e., 1 g four times daily (group A, n = 131) and 2 g twice daily (group B, n = 128). Healing was defined as complete re-epithelialization. Clinical and endoscopic assessments were performed after four weeks (Day 28) and, if complete healing was not achieved, after four more weeks (Day 56). After four weeks, in group A (n = 114: eight patients were lost and nine were withdrawn), the ulcers had healed in 90 patients (79 percent), and in group B (n = 108: six patients were lost and 14 were withdrawn), the ulcers had healed in 80 patients (74 percent). The cumulative healing rates after eight weeks were 94 percent in group A and 95 percent in group B. No serious adverse effect was observed in either group. These results suggest that sucralfate tablets in a dosage of 2 g twice daily are as effective as 1 g four times daily in the treatment of acute duodenal ulcers and could lead to better patient compliance.
Asunto(s)
Úlcera Duodenal/tratamiento farmacológico , Sucralfato/administración & dosificación , Adulto , Ensayos Clínicos como Asunto , Esquema de Medicación , Úlcera Duodenal/patología , Duodenoscopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Distribución Aleatoria , Fumar , Sucralfato/uso terapéutico , ComprimidosRESUMEN
Acute colitis occurring in patients suffering from psychiatric illnesses is believed to be linked to the intake of psychotropes. From 1983 to 1989, the authors observed, in three Hepato-gastroenterology units, 10 cases of acute colitis in patients suffering from serious psychiatric disorders, most of them inpatients of mental hospitals. The detailed study of 7 of these cases emphasized a certain number of common features: there was no previous history of digestive disease, the psychiatric illness was serious and longstanding, acute colitis was severe, and there was no recurrence during clinical and endoscopic follow-up averaging 4.3 years. Of these 7 patients, 2 were not taking psychotropes at the time of colitis or after, 2 had discontinued their treatment for a few days, and 2 had not stopped taking psychotropes. One patient died. The short-term and long-term evolution in these cases was not influenced by the intake or not of psychotropes. The pathogeny of this colitis is yet to be determined: infection is the most likely origin.
Asunto(s)
Antidepresivos Tricíclicos/efectos adversos , Antipsicóticos/efectos adversos , Colitis/inducido químicamente , Trastornos Psicóticos/tratamiento farmacológico , Enfermedad Aguda , Corticoesteroides/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Antidepresivos Tricíclicos/uso terapéutico , Antipsicóticos/uso terapéutico , Colitis/psicología , Colitis/terapia , Terapia Combinada , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nutrición Parenteral , Estudios Retrospectivos , Sulfasalazina/uso terapéuticoRESUMEN
Portal vein thrombosis, except in hepatocellular carcinoma and severe cirrhosis, is due to one or several prothrombotic disorders with or without a local precipitating factor. We report a case of a portal and splenic vein thrombosis, without cavernoma and varices which occurred in a 72-year-old man with abdominal pain and weakness. Three prothrombotic states including latent myeloproliferative disorder, antiphospholipid syndrome, and factor II G202101 mutation, were observed. Anticoagulant treatment resulted in complete repermeation of the portal and splenic veins without a hemorrhagic event. This illustrates that several prothrombotic states may occur in a single patient with portal vein thrombosis. Early anticoagulant therapy, in recent portal vein thrombosis, can result in repermeation.
Asunto(s)
Anticoagulantes/uso terapéutico , Síndrome Antifosfolípido/complicaciones , Trastornos Mieloproliferativos/complicaciones , Vena Porta , Protrombina/genética , Trombosis de la Vena/etiología , Anciano , Humanos , Masculino , Mutación , Vena Esplénica , Tomografía Computarizada por Rayos X , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/genéticaRESUMEN
UNLABELLED: Inflammatory bowel diseases have an important impact on the daily life of patients. This impact can be measured by the evaluation of the health related quality of life. The aim of this study was to develop and to validate a questionnaire of quality of life in a French population. METHODS: The questionnaire comprised 70 items and was completed in 15 min. It was made up of a) a general questionnaire of 36 items (SF-36) exploring daily physical and social functioning, mental and general health, body pain and vitality. A sleep module of 6 items was added. b) a specific questionnaire of 28 items (RFIPC), exploring the concerns of the patients. The questionnaire was self-administered to 101 patients with Crohn's disease (57 F. 44 M. mean age: 35 years, acute disease: 28%, inpatients: 27%), 96 patients with ulcerative colitis (38 F. 58 M. mean age: 39 years, acute disease: 53%, inpatients: 21%). Each patient was sex and age matched with a healthy control. RESULTS: The psychometric analysis confirmed the validation of the questionnaire for the item's convergent validity, internal consistency (Cronbach's coefficient being > 0.70), analyses of discrimination. Scores of each scale of SF-36 were worse in patients than in controls. Scores of patients with active disease were worse than those of patients with quiescent disease. Scores were comparable in patients with Crohn's disease and with ulcerative colitis except for score of pain which was worse in acute Crohn's disease. The most important concerns of patients were the uncertain nature of the disease, energy level and having surgery. CONCLUSION: This study allowed the validation of a questionnaire for the evaluation of the quality of life in French patients with inflammatory bowel disease and provides first indications which need to be confirmed by future epidemiological studies.
Asunto(s)
Enfermedades Inflamatorias del Intestino , Calidad de Vida , Encuestas y Cuestionarios , Adulto , Enfermedad Crónica , Colitis Ulcerosa/psicología , Enfermedad de Crohn/psicología , Estudios Transversales , Femenino , Francia , Humanos , Enfermedades Inflamatorias del Intestino/psicología , Masculino , Persona de Mediana Edad , PsicometríaRESUMEN
Reactivation of chronic infection is a serious complication during and especially after the withdrawal of cancer chemotherapy in hepatitis B virus carriers. Mortality is high, ranging from 4 to 20%. We report two cases of severe reactivation, after withdrawal of chemotherapy for chronic lymphocytic leukemia in one case and for a bladder tumor in the other. Recovery occurred with lamivudine therapy. Morbidity and mortality are common in these cases, especially when intensive chemotherapy and/or chronic hepatitis and/or precore mutants viruses are involved. Although lamivudine seems to be effective in these cases, prophylactic use has not been clearly defined and must be evaluated.
Asunto(s)
Antineoplásicos/administración & dosificación , Antivirales/uso terapéutico , Hepatitis B/tratamiento farmacológico , Lamivudine/uso terapéutico , Anciano , Femenino , Hepatitis B/complicaciones , Humanos , Leucemia Linfocítica Crónica de Células B/complicaciones , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Masculino , Recurrencia , Neoplasias de la Vejiga Urinaria/complicaciones , Neoplasias de la Vejiga Urinaria/tratamiento farmacológicoRESUMEN
The efficacy of Rioprostil (a new prostaglandin E1 analogue) is compared with that of ranitidine in the recurrence prevention of duodenal ulcer(s). Duration of treatment is 6 months. Ninety-seven patients received rioprostil, 600 micrograms once-daily orally, and 110 patients received ranitidine, 150 mg once-daily orally. On rioprostil, 14.9% of patients showed a relapse after 6 months compared to 10.1% on ranitidine. Diarrhoea occurred in 7 patients on rioprostil and 3 patients on ranitidine. Rioprostil given 600 micrograms daily in the evening is a highly effective treatment for the prevention of duodenal ulcer relapse, the efficacy not being significantly different from ranitidine 150 mg.
Asunto(s)
Antiulcerosos/uso terapéutico , Úlcera Duodenal/tratamiento farmacológico , Prostaglandinas E/uso terapéutico , Ranitidina/uso terapéutico , Adulto , Anciano , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Prostaglandinas Sintéticas/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , RioprostiloAsunto(s)
Endoscopía Gastrointestinal/métodos , Hemorragia Gastrointestinal/complicaciones , Hemangioma Cavernoso/diagnóstico , Neoplasias Intestinales/diagnóstico , Anciano , Femenino , Hemangioma Cavernoso/complicaciones , Hemangioma Cavernoso/patología , Humanos , Neoplasias Intestinales/complicacionesRESUMEN
AIM: To evaluate clinical, biological and immunological features of patients with increased duodenal intraepithelial lymphocytes (IELs), and its relation to Helicobacter pylori (HP) and coeliac disease (CD). METHODS: We have studied all patients accrued over a 4-year period with increased duodenal IELs. Those patients were recalled for biological and immunological evaluation and a second endoscopy. RESULTS: Twenty-three from a total of 639 patients were identified and 17 of them were included in the study. The median duodenal IEL count was 59 per 100 epithelial cells. Twelve (71%) patients were HP+; eight of them received HP eradication. At the second endoscopy the duodenal IEL count was significantly lower 2 months after HP eradication (73 versus 28), while the IEL count was unchanged in those patients seronegative for HP (n = 5) or those in whom it was not eradicated (n = 4) (55 versus 55). No patient had coeliac antibodies, four expressed HLA-DQ2, lower than in the general population, and the prevalence of CD was 2% (12/639 patients). CONCLUSION: In some cases an increased duodenal IEL count may be due to an inappropriate host response to HP. HP screening and eradication should be considered before recommending a gluten-free diet.
Asunto(s)
Antibacterianos/uso terapéutico , Duodeno/efectos de los fármacos , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori/efectos de los fármacos , Linfocitosis/prevención & control , Biopsia , Enfermedad Celíaca/complicaciones , Enfermedad Celíaca/inmunología , Recuento de Células , Duodeno/microbiología , Duodeno/patología , Endoscopía Gastrointestinal , Epitelio/efectos de los fármacos , Epitelio/microbiología , Epitelio/patología , Femenino , Antígenos HLA-DQ/inmunología , Cadenas beta de HLA-DQ , Antígeno HLA-DR4/inmunología , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/microbiología , Humanos , Linfocitos/patología , Linfocitosis/etiología , Linfocitosis/patología , Masculino , Estómago/efectos de los fármacos , Estómago/microbiología , Estómago/patologíaRESUMEN
We compared the yield of intraluminal fluid culture to that of biopsy specimens obtained during colonoscopy for the diagnosis of bacterial colitis in 93 immunocompetent patients with a recent episode of diarrhea and macroscopic lesions of colitis. Stool culture findings were also available for 68 patients. At least one bacterial pathogen was isolated from the biopsy specimen, intraluminal fluid, or stool from 48 patients (51.6%). Salmonella species, Clostridium difficile, Klebsiella oxytoca, Shigella species, and Campylobacter species were recovered from 16 (17.2%), 15 (16.1%), 8 (8.6%), 7 (7.5%), and 4 (4.3%) of the patients, respectively. One Shigella species and one K. oxytoca strain were isolated from biopsy specimens but not from intraluminal fluid, and intraluminal fluid was the only positive specimen in 12 cases (yielding 1 Salmonella species, 2 Shigella species, 2 K. oxytoca, and 7 C. difficile isolates). In nine cases out of 10, toxin B was detected only in intraluminal fluid. A correlation of 91.2% was observed between stool and intraluminal fluid cultures for Salmonella, Shigella, and Campylobacter species isolations. Culture of biopsy specimens adds little to the diagnosis of infectious colitis, and stools and intraluminal fluids appear to have comparable value.
Asunto(s)
Infecciones Bacterianas/diagnóstico , Colitis/diagnóstico , Colon/patología , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Bacterianas/inmunología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/patología , Biopsia , Líquidos Corporales/microbiología , Campylobacter coli/crecimiento & desarrollo , Campylobacter coli/aislamiento & purificación , Campylobacter jejuni/crecimiento & desarrollo , Campylobacter jejuni/aislamiento & purificación , Clostridioides difficile/crecimiento & desarrollo , Clostridioides difficile/aislamiento & purificación , Colitis/inmunología , Colitis/microbiología , Colitis/patología , Colon/microbiología , Colonoscopía , Diarrea/diagnóstico , Diarrea/inmunología , Diarrea/microbiología , Diarrea/patología , Femenino , Humanos , Inmunocompetencia , Klebsiella/crecimiento & desarrollo , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Salmonella/crecimiento & desarrollo , Salmonella/aislamiento & purificación , Shigella flexneri/crecimiento & desarrollo , Shigella flexneri/aislamiento & purificación , Shigella sonnei/crecimiento & desarrollo , Shigella sonnei/aislamiento & purificaciónRESUMEN
The authors found only 25 cases of calcified carcinoma of the stomach in the literature. The course in this case was rapidly fatal. Calcification within the tumour infiltrates the gastric wall and has a very characteristic miliary appearance, permitting one to make the diagnosis on a straight X-Ray of the abdomen. The mechanism of precipitation of calcium within certain mucus-secreting carcinomas has not been determined. Various theories are suggested.
Asunto(s)
Adenocarcinoma Mucinoso/diagnóstico por imagen , Calcinosis/diagnóstico por imagen , Neoplasias Gástricas/diagnóstico por imagen , Adenocarcinoma Mucinoso/complicaciones , Adenocarcinoma Mucinoso/patología , Sulfato de Bario , Calcinosis/complicaciones , Calcinosis/patología , Gastroscopía , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/patologíaRESUMEN
Cholesterol crystal embolization is a well-known disorder resulting from release of cholesterol crystals from ulcerous atherosclerotic plaques. Gastrointestinal involvement occurs in about a third of cases, but it is usually asymptomatic. We report a case of an old woman with small bowel obstruction secondary to atheromatous embolism. She was treated by acenocoumarol for atrial fibrillation and pulmonary embolism. Two weeks before admission for small bowel obstruction, she had a watery diarrhea. After 3 weeks of parenteral nutrition, she underwent resection of the involved ileum. Pathological examination showed a small bowel stricture secondary to atheromatous embolism. Cholesterol emboli should be considered as a potential cause of small bowel obstruction in old patient who has taken anticoagulant therapy or after vascular invasive procedure.
Asunto(s)
Arteriosclerosis/complicaciones , Embolia por Colesterol/complicaciones , Obstrucción Intestinal/etiología , Intestino Delgado/irrigación sanguínea , Isquemia/etiología , Acenocumarol/efectos adversos , Anciano , Anciano de 80 o más Años , Anticoagulantes/efectos adversos , Arteriosclerosis/patología , Arteriosclerosis/cirugía , Fibrilación Atrial/complicaciones , Fibrilación Atrial/tratamiento farmacológico , Embolia por Colesterol/patología , Embolia por Colesterol/cirugía , Femenino , Humanos , Embolia Pulmonar/complicaciones , Embolia Pulmonar/tratamiento farmacológicoRESUMEN
To study clinical and biological tolerability, 114 chronically constipated patients of both sexes, aged 18-70, without any organic alteration of the colon, received lactitol over a period of one or two months. Clinical tolerability was found to be good by 80 per cent of patients and biological tolerability excellent. Clinical efficacy was found correct for 80 per cent of patients with a dosage of 20 g (single dose in the evening). All patients, except one, agreed with the packaging and the taste of the product.