RESUMO
Two months after total endoprosthesis of the hip (Spotorno) a 60-year-old obese female patient complained about increasing hip pain. Costly diagnostic measures could not clarify the cause. Analgesic therapy administered with local cortisone injections was not satisfactory. Upon deterioration of her general condition the patient was hospitalized. A periprosthetic abscess of the hip with atypical muscle necrosis could not be controlled after several interventions. Computed tomography of the abdomen and hip revealed a jejunoacetabular fistula after mesenteric perforation with small intestine diverticulosis. It seems to be the first published case. After abdominal and hip surgery the further course was good. There was no need to replace the prosthesis. Retroperitoneal abscess with purely coxal symptomatology has been described. Diverticulitis of the small intestine has a poor prognosis. When infections with unusual necrosis resistant to therapy after hip prosthesis surgery occur, consideration must be given to retroperitoneal abscess. Abdominal tomography allows the life-saving surgery.
Assuntos
Cortisona/administração & dosagem , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/diagnóstico , Prótese de Quadril/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/etiologia , Anti-Inflamatórios/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Falha de TratamentoRESUMO
Cannabidiol is a component of marijuana that does not activate cannabinoid receptors, but moderately inhibits the degradation of the endocannabinoid anandamide. We previously reported that an elevation of anandamide levels in cerebrospinal fluid inversely correlated to psychotic symptoms. Furthermore, enhanced anandamide signaling let to a lower transition rate from initial prodromal states into frank psychosis as well as postponed transition. In our translational approach, we performed a double-blind, randomized clinical trial of cannabidiol vs amisulpride, a potent antipsychotic, in acute schizophrenia to evaluate the clinical relevance of our initial findings. Either treatment was safe and led to significant clinical improvement, but cannabidiol displayed a markedly superior side-effect profile. Moreover, cannabidiol treatment was accompanied by a significant increase in serum anandamide levels, which was significantly associated with clinical improvement. The results suggest that inhibition of anandamide deactivation may contribute to the antipsychotic effects of cannabidiol potentially representing a completely new mechanism in the treatment of schizophrenia.
Assuntos
Antipsicóticos/uso terapêutico , Ácidos Araquidônicos/fisiologia , Canabidiol/uso terapêutico , Endocanabinoides/fisiologia , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Transdução de Sinais/efeitos dos fármacos , Sulpirida/análogos & derivados , Doença Aguda , Adulto , Amidas , Amissulprida , Ácidos Araquidônicos/sangue , Método Duplo-Cego , Quimioterapia Combinada , Endocanabinoides/sangue , Etanolaminas/sangue , Feminino , Humanos , Masculino , Ácidos Oleicos/sangue , Ácidos Palmíticos/sangue , Alcamidas Poli-Insaturadas/sangue , Escalas de Graduação Psiquiátrica , Esquizofrenia/fisiopatologia , Transdução de Sinais/fisiologia , Sulpirida/uso terapêutico , Adulto JovemRESUMO
Reported in this paper is oesophagomanometry for diagnosis and assessment of early and late postoperative results in 31 achalasia patients. This method was used in a differentiated manner to prevent postoperative gastro-oesophageal reflux.
Assuntos
Acalasia Esofágica/cirurgia , Refluxo Gastroesofágico/diagnóstico , Manometria , Complicações Pós-Operatórias/diagnóstico , Cárdia/cirurgia , Seguimentos , Humanos , Estudos ProspectivosRESUMO
Functional results of 48 gastrectomies are reported. The applied techniques of the construction (jejunoplicatio) are judged for the safety of the anastomosis. 29 patients (60.5%) were examined for the degree of jejunooesophageal reflux after a survival time of 1 year. Antireflux techniques of anastomosis had good functional results measured by manometry and pH-metry.