RESUMEN
El síndrome de Goldenhar es una rara condición, de aparición esporádica, y con componente genético débil. Se caracteriza por un espectro de malformaciones faciales, especialmente deformaciones oculares (ausencia o hipotrofia ocular) y malformaciones auriculares, que característicamente comprometen una hemicara, con presencia o ausencia de anomalías vertebrales. Se presenta un caso clínico de la asociación de Síndrome de Goldenhar y embarazo.
Asunto(s)
Femenino , Embarazo , Adulto , Humanos , Anomalías Múltiples , Complicaciones del Embarazo/etiología , Síndrome de Goldenhar/complicaciones , Anomalías del Ojo/etiología , Cesárea , Cara/anomalías , Oído/anomalías , Resultado del Embarazo , Tercer Trimestre del Embarazo , Enfermedades RarasRESUMEN
BACKGROUND: Endoscopic ligation is the treatment of choice for bleeding esophageal varices. The usefulness of additional sclerotherapy is not clear. AIM: To assess the effectiveness of ligation followed by sclerotherapy in the treatment of variceal bleeding. PATIENTS AND METHODS: Forty eight patients with variceal bleeding admitted for emergency treatment and 73 patients admitted for elective treatment were studied. Varices were ligated until a significant reduction in size was achieved. Eradication was completed with the injection of 1% polidocanol. RESULTS: In 34 of 48 patients admitted for emergency treatment, the site of variceal rupture was identified. In all these subjects, and in 13 of 14 patients in whom the rupture site was not identified, hemorrhage was stopped with the procedure. Varices were eradicated in 108 of the 121 patients. Hemorrhage recidivated in 12.5% of patients admitted for emergency treatment, in a period of 14 months of follow up and in 9.6% of those admitted for elective treatment, in a period of 16 months follow up. Mortality was 14, 18 and 57% among patients classified as Child Pugh A, B or C, respectively. CONCLUSIONS: Endoscopic ligation is effective in the treatment of variceal bleeding. Adding sclerotherapy, variceal eradication is achieved in a high percentage of patients. Survival depends on hepatic function.
Asunto(s)
Várices Esofágicas y Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Escleroterapia/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Procedimientos Quirúrgicos Electivos , Tratamiento de Urgencia , Várices Esofágicas y Gástricas/complicaciones , Femenino , Estudios de Seguimiento , Hemorragia Gastrointestinal/etiología , Humanos , Ligadura/métodos , Masculino , Persona de Mediana Edad , Prevención Secundaria , Resultado del TratamientoRESUMEN
BACKGROUND: Sclerosis, injection of cianoacrylate and rubber band ligation are the most commonly used endoscopic techniques for the treatment of bleeding esophageal varices. AIM: To assess the effectiveness of cianoacrylate and polidocanol in the treatment of bleeding esophageal varices. PATIENTS AND METHODS: Sixty eight patients with active variceal bleeding were studied. Bleeding varices were classified as thin, thick or gastric. Bleeding from thin varices was treated with polidocanol. Bleeding from thick or gastric varices was treated with cianoacrylate. Variceal eradication was done with polidocanol. RESULTS: Bleeding came from thin esophageal varices in 23% of patients and endoscopic treatment stopped bleeding in 95% of them, from thick esophageal varices in 62% and endoscopic treatment was successful in 94% of these, and from gastric varices in 12% and treatment stopped bleeding in 87% of these (in 3% bleeding was considered subcardial). Twenty-five percent of patients bled again during variceal eradication, 12% died due to uncontrollable bleeding and 20% died due to liver failure. During variceal eradication 59% of patients classified as Child Pugh C, died. CONCLUSIONS: Treatment of bleeding esophageal varices with cianoacrylate or polidocanol is effective. Patients classified as Child Pugh C have a had prognosis.
Asunto(s)
Cianoacrilatos/uso terapéutico , Várices Esofágicas y Gástricas/tratamiento farmacológico , Hemorragia Gastrointestinal/tratamiento farmacológico , Polietilenglicoles/uso terapéutico , Soluciones Esclerosantes/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Várices Esofágicas y Gástricas/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Polidocanol , RecurrenciaRESUMEN
Risk of perforation is a major impediment to the use of polyvinyl bougies in palliative dilation of cancerous strictures of the esophagus. We encountered 23 patients with complex malignant strictures in whom initial dilation with Savary-Gilliard bougies was thwarted because attempts to pass a conventional Eder-Puestow guide wire were unsuccessful. As a recourse, we probed these strictures with a very flexible guide wire of the type used to implant prostheses in the biliary tract. The purpose was to establish a passage through which a standard guide wire could then be inserted. The procedure was successful in all but 4 of the 23 patients. We conclude that in such cases the preliminary use of the very flexible guide, even though time-consuming, improves the chance of effective dilation with minimal added risk.
Asunto(s)
Neoplasias Esofágicas/complicaciones , Estenosis Esofágica/terapia , Dilatación/instrumentación , Dilatación/métodos , Estenosis Esofágica/etiología , Humanos , Cuidados PaliativosRESUMEN
The prevalence of hepatitis C antibody was studied using the EIA 2 Abbott assay in patients and staff of the San Juan de Dios Hospital Hemodialysis Unit. The antibody was detected in 29.8% of patients, no member of the staff had positive antibodies. Patients with a positive antibody had been on hemodialysis for a longer time than those with a negative test (53.3 +/- 18.8 vs 37.9 +/- 33.5 months respectively). No differences in the number of transfusions received were observed between patients with positive or negative antibodies. Hepatitis B surface antigen was detected in 2 patients, with negative hepatitis C virus antibody. No clinical evidence of liver disease was found among patients with positive antibodies.