RESUMO
The effect of 1 week of treatment with indomethacin 150 mg/day on human gastric prostanoid synthesis was correlated with its effect on gastric and duodenal mucosa. Before and following 1 week of treatment, endoscopic appearance of the mucosa was evaluated and scored. Following 1 week of treatment with indomethacin, antral PGE2 and 6-keto-PGF1 alpha were significantly lower than in normal subjects, but similar in patients with significant or with no mucosal damage. Co-treatment with ranitidine 150 mg b.d. or with cimetidine 400 mg b.d. reduced the mean mucosal damage score but did not affect gastric prostanoid synthesis, which was similar irrespective of the presence or absence of mucosal damage. It is therefore suggested that there is no correlation between indomethacin-induced inhibition of gastric prostanoid synthesis and its induction of mucosal damage.
Assuntos
Mucosa Gástrica/metabolismo , Indometacina/efeitos adversos , Mucosa Intestinal/metabolismo , Úlcera Péptica/induzido quimicamente , Prostaglandinas/biossíntese , Adolescente , Adulto , Idoso , Duodeno/efeitos dos fármacos , Duodeno/metabolismo , Feminino , Mucosa Gástrica/efeitos dos fármacos , Humanos , Mucosa Intestinal/efeitos dos fármacos , Masculino , Pessoa de Meia-IdadeRESUMO
Primary sclerosing cholangitis is a chronic, fibrosing, inflammatory condition of unknown origin of extra and intrahepatic bile ducts. Recurrent cholangitis and jaundice are the most frequent clinical manifestation in symptomatic patients. We report a patient with primary sclerosing cholangitis presented with recurrent attacks of acute pancreatitis. Such a combination was not reported till now in the literature. The acute pancreatitis was probably due to reflux of bile and sludge into the pancreatic duct due to stricture of the distal part of a common bile and pancreatic ducts. Endoscopic insertion of a biliary stent managed to prevent jaundice and recurrent pancreatitis.
Assuntos
Colangite Esclerosante/diagnóstico , Pancreatite/etiologia , Doença Aguda , Colangiopancreatografia Retrógrada Endoscópica , Colangite Esclerosante/complicações , Colangite Esclerosante/terapia , Humanos , Masculino , Pessoa de Meia-Idade , StentsRESUMO
We evaluated the efficacy of wide 14F endoprostheses endoscopically placed in en patients with malignant extrahepatic bile duct stenosis. Large-bore stents were successfully placed in all patients. There were no early complications. Stent clogging occurred in two patients after one month and after three months in another patient. Seven patients remained free of symptoms after a mean follow-up period of 4.5 months.
Assuntos
Colestase Extra-Hepática/terapia , Cuidados Paliativos/instrumentação , Neoplasias Pancreáticas/terapia , Stents , Idoso , Ductos Biliares Extra-Hepáticos/diagnóstico por imagem , Colestase Extra-Hepática/diagnóstico por imagem , Colestase Extra-Hepática/etiologia , Duodenoscopia , Falha de Equipamento , Humanos , Cuidados Paliativos/efeitos adversos , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico por imagem , Radiografia Intervencionista , Stents/efeitos adversos , Fatores de TempoRESUMO
UNLABELLED: The aim of this paper is to compare the efficiency between standard plastic stents and polyurethane stents used in biliary tract malignant obstruction. The main problem of the plastic prosthesis is their early occlusion. On the other hand there is the hypothesis that due to the less porousness of the polyurethane surface, there might be lesser adherence and consequently a late occlusion. Thirty-eight patients in two groups of 19 were evaluated prospectively and at random in the Jerusalem Hadassah Hospital and the HIGA San Martín La Plata. They had biliary tract obstruction due to inoperable tumors. Biliary endoprosthesis (plastic standard or polyurethane 10 French diameter) were placed, according to the randomization, after a previous staging with clinical examination, laboratory analysis and images. The follow-up with the same parameters was monthly done. Twelve of the 38 patients were female and 26 male; age average 62.73 (range 81-49). The stents were placed in 17 patients with biliary cancer, 14 pancreatic cancer, 2 papila cancer, 2 gallbladder cancer with bile duct invasion and 3 liver metastasis with biliary tract compression. The clinical and laboratory parameters in 36 patients at 30 days improved. On the contrary, 2 (1 plastic standard and 1 polyurethane stent) did not improve. There were 29 deaths due to the basic illness and not related to the endoscopic method. The mean obstruction occurred at 12.76 weeks (range 32-4) in the standard stents and 12.05 (range 24-2) in the polyurethane ones. CONCLUSION: There were no significant differences in the two groups patients.
Assuntos
Neoplasias do Sistema Biliar/complicações , Materiais Biocompatíveis , Colestase/terapia , Poliuretanos , Stents , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/complicações , Estudos ProspectivosRESUMO
Substance P content was determined by radioimmunoassay in rectal mucosa of 17 children with idiopathic constipation and 9 with normal bowel movements who were used as controls. In children with chronic idiopathic constipation, rectal mucosa substance P levels were lower than levels in the control group: 47.6 +/- 11 vs. 79.4 +/- 11 pg/mg net weight respectively (differences not statistically significant). Substance P levels in rectal mucosa of children with soiling (11/17) did not differ from those of chronically constipated children without soiling (46.0 +/- 16 vs. 50.5 +/- 19 pg/mg net weight). In children with constipation, substance P levels did not correlate either with age or duration of symptoms. Substance P levels in normal controls were similar to levels previously observed in non-constipated adults, whereas levels in constipated children were intermediate between levels observed in healthy subjects and levels in adults with chronic constipation. These findings may point to a motility derangement as a possible factor in the pathogenesis of chronic constipation in childhood.
Assuntos
Constipação Intestinal/metabolismo , Mucosa Intestinal/química , Substância P/análise , Estudos de Casos e Controles , Criança , Pré-Escolar , Doença Crônica , Constipação Intestinal/etiologia , Constipação Intestinal/terapia , Feminino , Seguimentos , Humanos , Lactente , Masculino , RadioimunoensaioRESUMO
INTRODUCTION: Endoscopic sphincterotomy (ES) is commonly used to remove bile-duct stones and to treat other problems. We prospectively investigated complications and mortality of endoscopic retrograde cholangiopancreatography (ERCP). PATIENTS AND METHODS: Between june 6, 1998 and june 6, 1999 553 ERCP were performed in our centers. Inclusion criteria for protocol were: ERCP indication, complete follow-up and informed consent. We prospectively studied complications of ECRP in consecutive patients treated at 2 institutions (San Martin Hospital, La Plata, Argentina and Hadassah University Hospital, Jerusalem, Israel). The follow-up was done during 365 days with a clinical examination, laboratory test and ultrasonography to determine the possible complications. RESULTS: Of 553 ERCP, 43 had a complications; including pancreatitis in 16 cases, cholangitis in 12, hemorrhage in 5, perforation in 3 and miscellaneous in 7. 3-1) ES frequency: 241 patients (pts). 3-2) FOLLOW-UP: 365 days in 504 pts. 3-3) Sex and age: women 274 pts, men 230 pts. Age range 1 month to 90 year old. 3-4) Final diagnoses: choledocholitiasis (38.8%), strictures (18%), pancreatic cancer (4.3%), ampullary cancer (2.3%) and normal ERCP (24.4%). CONCLUSIONS: The rate of complications after ES can vary in different circumstances and is primarily related to the indication for the procedure and to endoscopic technique. Our percentage of complications (7.53%) coincide with consulted studies. Today, diagnostic ERCP has been challenged by magnetic resonance cholangiography (MRC). MRC provides images of the billary and pancreatic ducts that are nearly equal to those of ERCP without the procedural risk associated.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
The differential diagnosis between neonatal hepatitis and biliary atresia in the newborn is difficult and has therapeutic implications. Despite important advances in diagnostic tools, 10-20% of newborns with jaundice remain without definitive diagnosis. In recent years ERCP has played a decisive role in achieving definitive anatomic diagnosis, thus avoiding unnecessary exploratory laparotomy. We present our experience with ERCP using a pediatric duodenoscope in 18 newborns with inconclusive diagnoses of neonatal cholestasis.
Assuntos
Atresia Biliar/diagnóstico , Colangiopancreatografia Retrógrada Endoscópica , Colestase/diagnóstico , Diagnóstico Diferencial , Humanos , Recém-NascidoRESUMO
Esophageal sclerotherapy was the treatment of choice for bleeding esophageal varices in the past decade. It is effective for treating acute variceal bleeding, as well as eradicating esophageal varices for secondary prevention of bleeding. However, in more than 20% of patients sclerotherapy involves complications, some of which are serious. The high complication rate suggested the development of a new method that should be at least as effective and as easy to perform as sclerotherapy, but with fewer complications and side-effects. Endoscopic variceal ligation was developed at the University of Colorado and described in 1986. It is reported to control active variceal bleeding in about 90% of patients, and to eradicate varices in about 80% of surviving patients. Complications are rare. We have adapted the method in our unit and here describe out preliminary experience in 11 patients.
Assuntos
Varizes Esofágicas e Gástricas/terapia , Ligadura/métodos , Humanos , Ligadura/instrumentação , BorrachaAssuntos
Transplante de Pulmão , Estado Nutricional , Adolescente , Adulto , Criança , Feminino , Gastroscopia , Gastrostomia , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Doenças Biliares/diagnóstico , Doenças Biliares/etiologia , Colangiopancreatografia Retrógrada Endoscópica , Transplante de Fígado , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Adolescente , Adulto , Idoso , Doenças Biliares/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Mucosa Gástrica/metabolismo , Úlcera Péptica/etiologia , Prostaglandinas E Sintéticas/uso terapêutico , Prostaglandinas/biossíntese , Antiulcerosos/uso terapêutico , Células Cultivadas , Úlcera Duodenal/etiologia , Humanos , Úlcera Péptica/tratamento farmacológico , Úlcera Péptica/metabolismo , Úlcera Gástrica/metabolismoRESUMO
Constipation is common but diarrhea is very rare in myxedematous patients. We report a young woman with myxedema in whom chronic diarrhea was the dominant symptom. A fasting breath hydrogen test was positive, indicating bacterial overgrowth as the cause of the diarrhea. Antibiotic treatment was successful. We conclude that bacterial overgrowth due to hypomotility may be the etiology of the diarrhea in such patients.
Assuntos
Infecções Bacterianas/complicações , Diarreia/etiologia , Mixedema/complicações , Infecções Oportunistas/complicações , Adulto , Testes Respiratórios , Feminino , Humanos , Peristaltismo/fisiologiaRESUMO
Duodenal carcinoid tumors are rare. We report two patients with isolated duodenal carcinoid tumors diagnosed accidentally by endoscopy, who were not operated, and were followed for more than 2 yr without evidence of metastasis. Because duodenal carcinoid tumors are slow growing and have a relative benign course, a conservative approach is recommended in old patients with relative contraindications to surgery.
Assuntos
Tumor Carcinoide/diagnóstico , Neoplasias Duodenais/diagnóstico , Idoso , Duodenoscopia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Non-Hodgkin's lymphoma often involves the gastrointestinal tract, but primary lymphoma of the colon is rare. Primary lymphoma of the colon masquerading as inflammatory bowel disease is even rarer. We report a patient with an initial diagnosis of Crohn's colitis, who later appeared to have had non-Hodgkin's lymphoma of the colon. We review the diagnosis and treatment of this rare disease.
Assuntos
Neoplasias do Colo/patologia , Linfoma não Hodgkin/patologia , Adulto , Biópsia , Colo/patologia , Doença de Crohn/patologia , Diagnóstico Diferencial , Humanos , Linfonodos/patologia , Metástase Linfática , Masculino , Necrose , Úlcera/patologiaRESUMO
Somatostation has been postulated to have a paracrine modulating role in gastrin and gastric acid secretion. We applied the organ culture technique to examine somatostatin release by explants of human gastric mucosa taken from patients with active duodenal ulcer, from control subjects, and from patients with pernicious anemia. Somatostatin was found to be released at a constant rate by antral explants during 3 h of incubation. In active duodenal ulcer antral and fundic 2-h somatostatin release (18.7 +/- 2.6 pg/mg tissue (means + SE), n = 75; and 27 +/- 3 pg/mg tissue, n = 94, respectively) was significantly lower than release by control antral and fundic mucosa (83 +/- 17 pg/mg tissue, n = 39, and 72 +/- 16 pg/mg tissue, n = 42, respectively) (P less than 0.01). Somatostatin release by antral and fundic mucosa of patients with pernicious anemia was also significantly decreased (20 +/- 8 pg/mg tissue, n = 12, and 7.6 +/- 2 pg/mg tissue, n = 12, respectively) (P less than 0.05). These results imply possible impairments of the paracrine release of somatostatin in peptic ulcer disease and in pernicious anemia.
Assuntos
Anemia Perniciosa/fisiopatologia , Úlcera Duodenal/fisiopatologia , Mucosa Gástrica/metabolismo , Somatostatina/metabolismo , Humanos , Técnicas de Cultura de ÓrgãosRESUMO
A 61-yr-old man with Burkitt's lymphoma who presented with 6 months of diarrhea was found, at ileoscopy, to have inflammation of the mucosal narrow lumen, deep linear ulcerations, and a "cobblestone" appearance of the terminal ileum. Endoscopic biopsies were diagnostic of Burkitt's lymphoma, and no laparotomy was necessary. Presentation with diarrhea and the age of the patient were unusual, and the endoscopic features and diagnosis of the disease in the terminal ileum made by ileoscopy have not been previously reported.
Assuntos
Linfoma de Burkitt/diagnóstico , Diarreia/etiologia , Endoscopia , Neoplasias do Íleo/diagnóstico , Fatores Etários , Linfoma de Burkitt/complicações , Linfoma de Burkitt/patologia , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
An unusual side effect of amphetamine-like drugs is described. A patient with acute cardiomyopathy was discovered to have been taking Fenfluramine and Mazindol at the prescribed dose. Within a week after abstention from the drugs and appropriate cardiac treatment her cardiomyopathy resolved. The authors suggest that this effect is due to the combination of the two drugs and represents a drug interaction.
Assuntos
Cardiomiopatias/induzido quimicamente , Fenfluramina/efeitos adversos , Indóis/efeitos adversos , Mazindol/efeitos adversos , Adulto , Interações Medicamentosas , Eletrocardiografia , Feminino , HumanosRESUMO
Penicillin and its derivatives are known to cause several dermatologic and pulmonary hypersensitivity reactions. This report describes a patient who presented with combined generalized exfoliative dermatitis and severe pneumonitis caused by penicillin and aggravated by ampicillin, methicillin and mezlocillin. Antibiotic challenges with penicillin caused immediate reappearance of the dermatological manifestation; reactivation of the pneumonitis was probably prevented by immediate discontinuation of the drug.
Assuntos
Dermatite Esfoliativa/induzido quimicamente , Hipersensibilidade a Drogas , Penicilinas/efeitos adversos , Fibrose Pulmonar/induzido quimicamente , Adulto , Feminino , HumanosRESUMO
We describe a perplexing asthmatic patient who had chronic lymphatic leukemia that developed recurrent severe and prolonged attacks of asthma which required almost continuous hospitalization. Clinical findings of fever, leukocytosis, right lower lobe infiltrate and mouth candidiasis were suggestive of bronchopulmonary candidiasis. No further diagnostic tests were done and the patient responded favorably to amphotericin B therapy. A review of bronchopulmonary candidiasis in adults is discussed briefly. Lung biopsy should be reserved only for the most obscure and problematic cases.