RESUMEN
AIM OF THE STUDY: To determine diagnostic modalities and both immediate and long-term treatment of superior mesenteric venous thrombosis. PATIENTS AND METHODS: Retrospective study from 1997 to 2004 in two institutions concerning patients with superior mesenteric vein thrombosis. RESULTS: Nine patients (all males, mean age=55 years), were included. Abdominal pain (100%), vomiting (44%), and bowel activity disorders (44%) were the most common symptoms. A personal or familial thrombosis history was present in 67% of patients. A genetic predisposing factor of thrombosis was present in 78% of patients. The diagnosis was established with CT-scan in 8 cases with a mean delay of 8 days. Treatment was exclusively medical in 33% of patients and included surgery in 67%. All operated patients underwent resection for bowel infarction and only one had immediate anastomosis. All enterostomies were subsequently closed. No patient died. CONCLUSION: Diagnosis of superior mesenteric vein thrombosis is frequently delayed and relies on CT-scan with intravenous contrast. Prognosis is globally favourable but depends on early application of anticoagulation therapy. In case of surgery, bowel-sparing resection is indicated and enterostomies are often needed. Genetic disorders predisposing to thrombosis are very frequent, that may indicate prolonged even definitive anticoagulation therapy.
Asunto(s)
Oclusión Vascular Mesentérica/diagnóstico , Venas Mesentéricas/patología , Trombosis de la Vena/diagnóstico , Dolor Abdominal/diagnóstico , Enterostomía , Fibrinolíticos/uso terapéutico , Predisposición Genética a la Enfermedad , Humanos , Infarto/cirugía , Enfermedades Intestinales/diagnóstico , Intestino Delgado/irrigación sanguínea , Masculino , Oclusión Vascular Mesentérica/terapia , Persona de Mediana Edad , Estudios Retrospectivos , Trombectomía , Terapia Trombolítica , Factores de Tiempo , Tomografía Computarizada por Rayos X , Trombosis de la Vena/genética , Trombosis de la Vena/terapia , Vómitos/diagnósticoAsunto(s)
Antimetabolitos Antineoplásicos/efectos adversos , Desoxicitidina/análogos & derivados , Desoxicitidina/efectos adversos , Cardiopatías/inducido químicamente , Adenocarcinoma/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Capecitabina , Neoplasias del Colon/tratamiento farmacológico , Femenino , Fluorouracilo/análogos & derivados , HumanosAsunto(s)
Hemocromatosis/diagnóstico , Absceso Hepático/microbiología , Infecciones por Yersinia pseudotuberculosis/complicaciones , Anciano , Biopsia , Ferritinas/sangre , Genotipo , Hemocromatosis/complicaciones , Hemocromatosis/genética , Humanos , Hierro/sangre , Hígado/patología , Absceso Hepático/diagnóstico , Imagen por Resonancia Magnética , Masculino , Mutación/genética , Yersinia pseudotuberculosis/aislamiento & purificación , Infecciones por Yersinia pseudotuberculosis/diagnósticoRESUMEN
BACKGROUND: Cystic dystrophy of the duodenal wall is characterized by the development of cysts in heterotopic pancreatic tissue localized in the duodenal wall. Diagnosis is difficult and endosonography is considered as the most useful investigation. CASE REPORTS: A 40-year-old man was hospitalized for abdominal pain triggered by ingestion of alcoholic beverages and for vomiting after food intake. The diagnosis of acute atypical cephalic pancreatitis was initially made. Magnetic resonance cholangiography then magnetic resonance imaging suggested the diagnosis of cystic dystrophy of the duodenal wall in a heterotopic pancreas which was confirmed by endosonography. DISCUSSION: Magnetic resonance imaging evidenced several cystic formations within a thickened duodenal wall leading to the correct diagnosis. MRI appears to provide all the elements necessary for the diagnosis of cystic dystrophy of the duodenal wall, avoiding the need for invasive investigations.
Asunto(s)
Coristoma/congénito , Quistes/congénito , Enfermedades Duodenales/congénito , Duodeno/anomalías , Imagen por Resonancia Magnética , Páncreas , Adulto , Colangiografía , Coristoma/diagnóstico , Coristoma/patología , Quistes/diagnóstico , Quistes/patología , Diagnóstico Diferencial , Enfermedades Duodenales/diagnóstico , Enfermedades Duodenales/patología , Duodeno/patología , Humanos , Masculino , Valor Predictivo de las PruebasRESUMEN
This study assessed gastric neuropathy in type 1 diabetes mellitus and its relationships with cardiac autonomic neuropathy. Fifty-four asymptomatic type 1 patients (43 +/- 12 years) and 15 healthy subjects participated in the study. Cutaneous electrogastrography (EGG) was recorded for 4 h before, during, and 4 h after the ingestion of a standard meal. EGG frequency was divided into three bands: bradygastria [< 2 cpm), normal (2-4 cpm) and tachygastria (4-10 cpm)]. Assessment of diabetic autonomic neuropathy was based on Ewing tests and time and frequency domain indexes, which were analyzed from 24-h continuous ECG recordings. Tachygastria was significantly more common in diabetic patients than in controls throughout the recording period (38 +/- 5 vs 23 +/- 11.8%, p < 0.001), before (37 +/- 6 vs 26.5 +/- 8.9%, p < 0.001), during (41 +/- 7.8 vs 23 +/- 10.5%, p < 0.001) and after the meal (37 +/- 6.9 vs 29 +/- 9.8%, p < 0.001). The percentage of dominant frequency in the normal range was significantly lower in diabetic patients than controls (49 +/- 6 vs 63.3 +/- 11.1%, p < 0.001). Tachygastria was correlated with duration of diabetes (r = 0.234, p < 0.05), but not with glycaemic control. Abnormalities in gastric myoelectrical activity were not correlated with Ewing tests or time and frequency domain indexes.
Asunto(s)
Enfermedades del Sistema Nervioso Autónomo/diagnóstico , Neuropatías Diabéticas/diagnóstico , Electrodiagnóstico/métodos , Motilidad Gastrointestinal/fisiología , Corazón/inervación , Adulto , Anciano , Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Estudios de Casos y Controles , Neuropatías Diabéticas/fisiopatología , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Hepatitis , Fitoterapia , Plantas Medicinales , Valeriana/toxicidad , Enfermedad Hepática Inducida por Sustancias y Drogas/terapia , Femenino , Humanos , Persona de Mediana Edad , Plantas Medicinales/efectos adversos , Plantas Medicinales/toxicidad , Resultado del TratamientoRESUMEN
BACKGROUND: Lymphocytic colitis is a chronic diarrhea syndrome with no endoscopically detectable anomaly and histological colonic lesions. CASE REPORT: A 52-year-old woman was hospitalized for chronic diarrhea. She experienced 10 to 30 liquid bowel movements per day. Symptoms had begun 8 days after taking piroxicam fl-cyclodextrin. Intraepithelial cell counts on rectum and colon endoscopic biopsies showed more than 20% lymphocytes, giving the diagnosis of lymphocytic colitis. The patient was given 5ASA 3 g/24 h. Symptoms regressed in less than one week. DISCUSSION: Lymphocytic colitis is uncommon. The cause remains unknown but a secondary autoimmune mechanism triggered by drugs has been suggested. This case would implicate nonsteroidal antiinflammatory drugs. Certain authors have demonstrated that they can be involved in the development of collagen colitis.
Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Colitis/tratamiento farmacológico , Ciclodextrinas/uso terapéutico , Diarrea/inducido químicamente , Piroxicam/uso terapéutico , Antiinflamatorios no Esteroideos/efectos adversos , Enfermedad Crónica , Ciclodextrinas/efectos adversos , Femenino , Humanos , Linfocitosis/tratamiento farmacológico , Persona de Mediana Edad , Piroxicam/efectos adversosRESUMEN
BACKGROUND: Cystic lymphangioma is an uncommon congenital malformation usually encountered in children and often discovered fortuitously. CASE REPORT: A 46-year-old man was hospitalized for acute alcoholic hepatitis with edematoascitic decompensation. The abdominal and pelvic CT scan showed homogeneous hepatomegaly and a tumoral process involving the terminal ileal loops without signs of occlusion or node enlargement. Pathology reported benign mesenteric multicystic lymphangioma. DISCUSSION: Cystic lymphangiomas account for 7% of all intra-abdominal cystic formations. The ileal localization predominates with little or no clinical expression. Ultrasonography and CT scan provide complementary information on the relations with other organs. Magnetic resonance imaging is currently the gold standard allowing precise diagnosis of the anatomic relations and identifying intracystic hemorrhage. The pathology examination is required to eliminate possible benign multicystic mesothelioma which may occasionally take on an aggressive form. Complete surgical excision provides cure.
Asunto(s)
Linfangioma Quístico/diagnóstico , Quiste Mesentérico/diagnóstico , Humanos , Linfangioma Quístico/cirugía , Imagen por Resonancia Magnética , Masculino , Quiste Mesentérico/cirugía , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , UltrasonografíaRESUMEN
OBJECTIVE: The aim of this study was to characterize the features of vegetative gastric neuropathy observed in diabetic patients based on surface electrogastrographic recordings. PATIENTS AND METHODS: An electrogastrogram was recorded over an 8 hour 30 minute period in 63 patients with asymptomatic insulin-dependent diabetes and in 15 non-diabetic controls. Normal the electrical frequency of the stomach is 2 to 4 cycles per minute (cpm). Bradygastria is defined as a frequency below 2 cpm and tachygastria by a frequency above 4 cpm. RESULTS: The diabetic patients showed a below normal gastric frequency and enhanced tachygastria over the entire recording period and during the pre, per and post-prandial periods. These vagal alterations were not correlated with the principle features of diabetes. CONCLUSION: Electrogastrography confirms that vegetative gastric neuropathy occurs early in patients with asymptomatic insulin-dependent diabetes. The tachygastria could lead to the increased rate of gastroparesis reported in these patients.