RESUMO
BACKGROUND AND STUDY AIMS: Several studies have suggested that nitroglycerin promotes pancreatic drainage and thereby helps to prevent pancreatitis occurring after endoscopic retrograde cholangiography (ERC). We performed a multicenter, double-blind, randomized, placebo-controlled trial to evaluate the efficacy of intravenous nitroglycerin for preventing acute pancreatitis in moderate- to high-risk patients undergoing ERC. PATIENTS AND METHODS: The patients underwent therapeutic ERC for gallstone removal, bile duct stenosis, or sphincter of Oddi dysfunction (SOD). They were randomly allocated to receive an intravenous nitroglycerin bolus of 0.1 mg, then 35 microg/kg per minute intravenously (maximum dose 9 mg) for 6 h, or an identical placebo regimen. Serum amylase and lipase levels were determined before and 24 h after ERC. RESULTS: The study was terminated after the interim analysis. The intention-to-treat population consisted of 208 patients enrolled in 20 centers, of whom 105 received nitroglycerin and 103 placebo therapy. Post-ERC pancreatitis (mild/moderate/severe) occurred in 25 patients, comprising 10 (3/5/2) in the nitroglycerin arm and 15 (5/6/4) in the placebo arm (OR 0.62, 95 % CI 0.26 - 1.45; P = 0.26). Pancreatitis-related hospital stays were similar in the two groups (median 4 days, range 2 - 13 days in the nitroglycerin group; median 5 days, range 2 - 20 days in the placebo group). The incidence of pancreatitis in patients with SOD did not differ between the groups (4/11 in the nitroglycerin arm, and 4/15 in the placebo arm). Adverse events were more frequent in the nitroglycerin group and led to cessation of drug infusion in 10 patients in the nitroglycerin arm and in 2 patients in the placebo arm ( P = 0.019). CONCLUSION: In this study, nitroglycerin offered a limited and clinically nonsignificant benefit for the prevention of post-ERC pancreatitis. Its use did not improve the technical success rate of ERC.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Nitroglicerina/uso terapêutico , Pancreatite/prevenção & controle , Vasodilatadores/uso terapêutico , Dor Abdominal/etiologia , Adulto , Idoso , Amilases/sangue , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Injeções Intravenosas , Lipase/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Pancreatite/radioterapia , Placebos , Resultado do TratamentoRESUMO
The main clinical, endoscopic and radiographic findings in thirty documented cases of colonic angiodysplasia or vascular ectasia are described. We emphasise the association with colonic diverticulosis and cardiovascular pathology, describe the histological changes, summarize the present physiopathological hypothesis, and consider the various therapeutic approaches.
Assuntos
Doenças do Colo/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagem , Idoso , Colo/patologia , Doenças do Colo/complicações , Doenças do Colo/patologia , Doenças do Colo/terapia , Colonoscopia , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/patologia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Artérias Mesentéricas/diagnóstico por imagem , Artérias Mesentéricas/patologia , Pessoa de Meia-Idade , Radiografia , Reto , Doenças Vasculares/complicações , Doenças Vasculares/patologia , Doenças Vasculares/terapiaRESUMO
The first three autochthonous cases of alveolar echinococcosis were diagnosed in the Ardennes area (France). This is the most occidental localization of this disease in Northern Europe. The authors discuss these cases with an epidemiological regard. They are looking for relationships with natural parasitic cycle in the neighbouring country Belgium and their consequences on local public health in the future.
Assuntos
Equinococose Hepática/epidemiologia , Animais , Bélgica/epidemiologia , Reservatórios de Doenças , Raposas/parasitologia , França/epidemiologia , Humanos , MasculinoRESUMO
A case of mesenteric cystic lymphangioma revealed by hypochromic anemia and abdominal pain, secondary to an intracystic hemorrhage is reported in a 4-year old child. Etiology, pathology, diagnosis, treatment and prognosis of mesenteric lymphangioma in children are reviewed.
Assuntos
Anemia Hipocrômica/etiologia , Linfangioma/cirurgia , Neoplasias Peritoneais/cirurgia , Pré-Escolar , Feminino , Humanos , Linfangioma/sangue , Linfangioma/complicações , Linfangioma/diagnóstico , Neoplasias Peritoneais/sangue , Neoplasias Peritoneais/complicações , Neoplasias Peritoneais/diagnóstico , Prognóstico , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
The authors report a case of fungating cholangiocarcinoma of the porta hepatis, revealed by jaundice in a 73-year- old cholecystectomized female. The diagnosis of obstruction of the hepatic duct junction suspected by ultrasonography and computed tomography was confirmed intraoperatively. Disobstruction was followed by laterolateral choledocoduodenostomy. An early recurrence required a second disobstruction with surgical then endoscopic insertion of a drain, with 23 months of satisfactory survival. The discussion is focused on hilar fungating cholangiocarcinoma. The extrahepatic (Klatskin tumor) or intrahepatic origin of these lesions, the circumstances and morphological investigations for the diagnosis are discussed. Particularities of the treatment are mentioned, with emphasis on the possible participation of the endoscopist for choledocho or hepaticoduodenostomy.
Assuntos
Adenoma de Ducto Biliar/diagnóstico por imagem , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Colestase Intra-Hepática/etiologia , Adenoma de Ducto Biliar/complicações , Adenoma de Ducto Biliar/patologia , Adenoma de Ducto Biliar/cirurgia , Idoso , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Colestase Intra-Hepática/cirurgia , Feminino , Humanos , Recidiva Local de Neoplasia , Reoperação , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
A 12 year old child presented with a hemorrhagic Meckel's diverticulum, gastric heterotopia without identifiable ulceration and a totally aberrant pancreas. The diagnostic value of 99m-technetium abdominal scintigraphy in patients with Meckel's diverticula and gastric heterotopia, as well as the limits of this investigation, are discussed.
Assuntos
Hemorragia Gastrointestinal/complicações , Divertículo Ileal/complicações , Pâncreas/anormalidades , Estômago/anormalidades , Criança , Feminino , Humanos , Divertículo Ileal/diagnóstico por imagem , Cintilografia , TecnécioRESUMO
The onset of subicterus in a patient revealed the presence of a congenital diverticulum of lower common bile duct of intraduodenal development. A part from the rarity of this lesion this case is of interest due to the complete range of ultrasound, endoscopic and CT scan imaging performed, the association of a common mesentery and the surgical technique employed. The latter comprised exeresis by transduodenal approach and a side-to-side choledocho-duodenal anastomosis through the intermediary of the diverticular sleeve. The nosology and differential diagnosis of diverticulum of lower common bile duct are discussed and data from a literature review used to describe diagnostic, etiopathogenic and histopathologic aspects as well as complications and treatment of this type of congenital dilatation of lower biliary tract.
Assuntos
Doenças do Ducto Colédoco/congênito , Cistos/congênito , Divertículo/congênito , Duodenopatias/congênito , Doenças do Ducto Colédoco/cirurgia , Cistos/cirurgia , Divertículo/cirurgia , Humanos , Masculino , Mesentério/anormalidades , Pessoa de Meia-IdadeRESUMO
Bouveret's syndrome is a rare form of Gallstone Ileus, characterized by its duodenal site after migration through a cholecysto-duodenal fistula in almost all cases. The two cases reported emphasize the interest of endoscopy in its early diagnosis. A therapeutic schema is proposed, based upon a systematic initial endoscopic extraction trial. The surgical treatment when needed is discussed in its modalities, and adapted to a reasonable evaluation of general and local conditions.
Assuntos
Colelitíase/complicações , Duodenopatias/cirurgia , Obstrução Intestinal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Duodenopatias/diagnóstico por imagem , Duodenopatias/etiologia , Endoscopia , Feminino , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Radiografia , SíndromeRESUMO
Quality of care has been evaluated in this study by the criterion of mortality in a Digestive and Vascular Surgery unit. The analysis over a one-year period concerned 34 dead patients among 1298 entered and 1,108 operated patients who underwent 1,248 operations. The causes of death have been studied in the 3 groups: non operated (5 patients), digestive (20 patients), vascular (9 patients), with distinction of emergency surgery. Therapeutic habits have been systematically reexamined and considered either adapted or to be modified. Punctual conclusions of such a study are interesting for the medico-surgical team but also for the nursing team. Transparency of mortality for a whole team is a factor of progress by the periodical reappraisal of the therapeutic habits based upon accurate data, and by the better collaboration in the team.
Assuntos
Departamentos Hospitalares , Centro Cirúrgico Hospitalar , Procedimentos Cirúrgicos Operatórios/mortalidade , Idoso , Doenças do Sistema Digestório/cirurgia , Emergências , Feminino , França , Hospitais Gerais , Humanos , Masculino , Doenças Vasculares/cirurgiaRESUMO
Two cases of squamous carcinoma of the anus developing from condylomata acuminata are reported. The general characteristics of condylomata acuminata are reviewed: viral etiology due to HPV virus, histological appearance and role in the the genesis of certain cancers. The association of condylomata acuminata and cancer of the anus is more particularly studied in a review of the literature: etiology, anatomoclinical aspects, treatment and current state of knowledge concerning the oncogenic role of HPV virus at this site.
Assuntos
Neoplasias do Ânus/patologia , Carcinoma de Células Escamosas/patologia , Condiloma Acuminado/patologia , Neoplasias Primárias Múltiplas/patologia , Adulto , Idoso , Neoplasias do Ânus/etiologia , Neoplasias do Ânus/terapia , Braquiterapia , Condiloma Acuminado/complicações , Condiloma Acuminado/terapia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Fístula Arteriovenosa/etiologia , Biópsia por Agulha/efeitos adversos , Artéria Hepática/lesões , Fígado/cirurgia , Veia Porta/lesões , Fístula Arteriovenosa/diagnóstico por imagem , Feminino , Artéria Hepática/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , RadiografiaAssuntos
Febre Hemorrágica com Síndrome Renal/epidemiologia , Orthohantavírus/isolamento & purificação , Adulto , Feminino , França/epidemiologia , Febre Hemorrágica com Síndrome Renal/diagnóstico , Humanos , Masculino , Nefrite Intersticial/diagnóstico , Nefrite Intersticial/epidemiologia , Testes SorológicosRESUMO
13 observations of right hemorrhagic colic angiodysplasia were detected in less than 5 years: 9 times with proctorrhagia of varying amounts, 4 times with an endoscopic aetiological evaluation of iron deficiency anemia. Colonoscopy revealed lesions in 11 patients out of 13 in the form of erythematous spots of vascular hemorrhagic appearance in 5 cases. The arteriography was positive in 5 of the 7 cases where it was performed. Treatment was endoscopic 6 times, by follow-up electrocoagulation, 2 times, by right hemicolectomy. The latter was carried out immediately in 2 other cases. In 5 cases, iron treatment was all that was necessary. These right colic angiodysplasias are often an unknown cause of digestive hemorrhage or iron deficiency anemia. The difficult diagnosis depends on the colonoscopy performed by an operator accustomed to this type of lesion. It is carried out in emergency in cases of acute bleeding. Sometimes an arteriography is also performed. Endoscopic treatment may be an alternative to standard surgical treatment in elderly high-risk patients.
Assuntos
Vasos Sanguíneos/anormalidades , Colo/irrigação sanguínea , Hemorragia Gastrointestinal/etiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The authors report a case of acute cardiac failure linked to 5 fluoro-uracil. The toxicity seen most commonly involves ischemia. The pathophysiological mechanisms are discussed as well as the role played by pharmacokinetic characteristics in the occurrence of adverse reactions. 5 fluoro-uracil (5 FU) is a compound widely used in the treatment of ENT, breast and gastrointestinal carcinomas. The finding of dose-effect relationship may lead the clinician to use different modes of administration. Continuous administration at high dose 3 g/m2/day from D1 to D5) in combination or not with cisplatin, or continuously at low dose (300 mg/m2/day from D1 to D31) can reduce hematopoietic toxicity but, in contrast, increases gastrointestinal toxicity.