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INTRODUCTION AND OBJECTIVES: TPE drastically reduces serum triglyceride (sTG), but its role in the treatment of hypertriglyceridemia-induced acute pancreatitis (HTG-AP) or at risk of developing it, is not well established. The objectives were to assess the effectiveness and safety of TPE in the treatment of severe HTG (sHTG), as well as to evaluate the severity of HTG-AP treated with TPE. MATERIALS AND METHODS: Observational-retrospective-single-center study, in which a descriptive analysis of sHTG treated with TPE was conducted, with the aim of treating HTG-AP or preventing its recurrence. TPE was performed if sTG≥ 1000 mg/dL after 24 hours of admission. RESULTS: 42 TPE were performed to treat 35 sHTG in 23 patients: 29 HTG-AP, and 6 sHTG with previous HTG-AP. Among the patients, 37% (13/55) were women, with 37 ± 14 years-old, 74.3% had normal BMI (25/35), 34% (12/35) were drinking > 40 g/alcohol/day and 54% (19/35) were diabetics. TPE significantly reduced the baseline sTG (4425 ± 2782 mg/dL vs. 709 ± 353 mg/dL, p < 0.001) in a single session, achieving a mean percentage reduction of 79 ± 13%; 20% (7/35) of sHTG cases required two TPE sessions to reduce sTG to < 1000 mg/dL. Adverse effects were reported in 4/42 TPE sessions (9,5%). sHTG-AP was observed in 3% of cases (1/29), and there were no deaths. sTG at 24 hours of admission showed no relation with the severity of APs. CONCLUSION: The treatment of sHTG with TPE, with the aim of treating HTG-AP or preventing its recurrence, reduces sTG quickly and safety.
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INTRODUCTION: Transabdominal ultrasound (TU) pancreatic 2D-SWE elastography is a developing technique that needs to be protocolized. OBJECTIVES: Establish a protocol for image acquisition and measurement of TU pancreatic - 2D-SWE elastography and estimate the minimum number of measurements to be performed. MATERIALS AND METHODS: Ten measurements of pancreatic elasticity were taken in healthy volunteers using TU-2D-SWE, following a strict protocol for image acquisition and measurement. RESULTS: The 70% of the participants were women, with an average age, weight, and BMI of 49.5±15.7 years, 65.9±11.9kg, and 24.5±4.2kg/m2, respectively. Measurements were taken from the body (70%), tail (16.7%), and pancreatic head (13.3%). The median mean velocity and elasticity were 1.46±0.25cm/sec and 6.46±2.87KPa, respectively. The ROI depth was 4.12±1cm and the SP-ROI distance was 5.2mm on average. There were no statistically significant differences between the 10 measurements. The reliability analysis of the measurements showed high internal consistency and repeatability. Taking 5-6 measurements ensured high concordance with the ten reference measurements. The measurements were significantly lower when the SP-ROI values were intermediate (0.3-0.6cm). The measurement accuracy was higher when performed at a depth less than 4.8cm. CONCLUSION: To measure pancreatic elasticity using TU-2D-SWE, we propose a strict protocol for image acquisition and measurement, taking a minimum of 5 measurements in the best visualized and accessible pancreatic portion, and preferably at a depth of less than 4.8cm.
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We present the endoscopic finding of a juxtapapillary duodenal pyogenic granuloma in a patient under study for chronic recurrent anemia. The images show the presence of an enlarged papilla, with an exophytic growth of erythematous and friable tissue at its lower border. Although this is a very rare entity, it is necessary to take it into account in the differential diagnosis of refractory anemia because there is an effective endoscopic treatment for it.
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Anemia , Granuloma Piogénico , Humanos , Granuloma Piogénico/complicaciones , Granuloma Piogénico/cirugía , Anemia/etiología , Duodeno , Endoscopía/efectos adversos , Diagnóstico DiferencialRESUMEN
We report the endoscopic finding of a double papilla of Vater in a patient presenting choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography (ERCP). The images showed the presence of two perfectly delimited papillary orifices, 1cm apart from each other. After cannulation of each orifice, we observed the Wirsung and the common bile duct (CBD) as completely independent ducts. Given the diagnostic challenge posed by this entity and the importance of differentiating it from a bilioenteric fistula, we believe it is worth knowing about it in order to manage it properly and to minimize secondary risks during the exploration.
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Ampolla Hepatopancreática , Coledocolitiasis , Humanos , Ampolla Hepatopancreática/diagnóstico por imagen , Colangiopancreatografia Retrógrada Endoscópica/métodos , Cateterismo/métodos , Conducto Colédoco/diagnóstico por imagen , Coledocolitiasis/diagnóstico por imagen , Coledocolitiasis/cirugíaRESUMEN
BACKGROUND: Current guidelines do not address the post-sustained virological response management of patients with baseline hepatitis C virus (HCV) cirrhosis and oesophageal varices taking betablockers as primary or secondary prophylaxis of variceal bleeding. We hypothesized that in some of these patients portal hypertension drops below the bleeding threshold after sustained virological response, making definitive discontinuation of the betablockers a safe option. AIM: To assess the evolution of portal hypertension, associated factors, non-invasive assessment, and risk of stopping betablockers in this population. METHODS: Inclusion criteria were age > 18 years, HCV cirrhosis (diagnosed by liver biopsy or transient elastography > 14 kPa), sustained virological response after direct-acting antivirals, and baseline oesophageal varices under stable, long-term treatment with betablockers as primary or secondary bleeding prophylaxis. Main exclusion criteria were prehepatic portal hypertension, isolated gastric varices, and concomitant liver disease. Blood tests, transient elastography, and upper gastrointestinal endoscopy were performed. Hepatic venous pressure gradient (HVPG) was measured five days after stopping betablockers. Betablockers could be stopped permanently if gradient was < 12 mmHg, at the discretion of the attending physician. RESULTS: Sample comprised 33 patients under treatment with propranolol or carvedilol: median age 64 years, men 54.5%, median Model for End-Stage Liver Disease (MELD) score 9, Child-Pugh score A 77%, median platelets 77.000 × 103/µL, median albumin 3.9 g/dL, median baseline transient elastography 24.8 kPa, 88% of patients received primary prophylaxis. Median time from end of antivirals to gradient was 67 wk. Venous pressure gradient was < 12 mmHg in 13 patients (39.4%). In univariate analysis the only associated factor was a MELD score decrease from baseline. On endoscopy, variceal size regressed in 19/27 patients (70%), although gradient was ≥ 12 mmHg in 12/19 patients. The elastography area under receiver operating characteristic for HVPG ≥ 12 mmHg was 0.62. Betablockers were stopped permanently in 10/13 patients with gradient < 12 mmHg, with no bleeding episodes after a median follow-up of 68 wk. CONCLUSION: Portal hypertension dropped below the bleeding threshold in 39% of patients more than one year after antiviral treatment. Endoscopy and transient elastography are inaccurate for reliable detection of this change. Stopping betablockers permanently seems uneventful in patients with a gradient < 12 mmHg.
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Antagonistas Adrenérgicos beta/uso terapéutico , Antivirales/uso terapéutico , Várices Esofágicas y Gástricas/tratamiento farmacológico , Hemorragia Gastrointestinal/prevención & control , Hepatitis C Crónica/tratamiento farmacológico , Cirrosis Hepática/tratamiento farmacológico , Anciano , Diagnóstico por Imagen de Elasticidad , Várices Esofágicas y Gástricas/diagnóstico , Várices Esofágicas y Gástricas/etiología , Femenino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/virología , Humanos , Hígado/diagnóstico por imagen , Hígado/patología , Cirrosis Hepática/complicaciones , Cirrosis Hepática/virología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Medición de Riesgo , Respuesta Virológica Sostenida , Factores de Tiempo , Presión VenosaRESUMEN
No disponible
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Humanos , Masculino , Anciano de 80 o más Años , Hemorragia Gastrointestinal/etiología , Granuloma Piogénico/diagnóstico por imagen , Neoplasias Duodenales/diagnóstico por imagen , Granuloma Piogénico/complicacionesRESUMEN
Pyogenic granulomas are lobular capillary hemangiomas, usually found on skin and oral mucosa. To date, few cases of pyogenic granuloma of the gastrointestinal tract have been reported, being duodenal involvement extremely rare. We report the case of a patient with a history of long-standing iron deficiency anemia where the endoscopy revealed an oozing redish semipedunculated polypoid lesion in the duodenum with a biopsy specimen consistent with a pyogenic granuloma. The lesion was removed by endoscopic resection, and during the follow-up hemoglobin level was maintained.
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Enfermedades Duodenales/complicaciones , Hemorragia Gastrointestinal/etiología , Granuloma Piogénico/complicaciones , Anciano de 80 o más Años , Humanos , MasculinoRESUMEN
No disponible
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Humanos , Masculino , Adulto , Sífilis/diagnóstico , Hepatitis/diagnóstico , Sífilis/complicaciones , Sífilis/tratamiento farmacológico , Serodiagnóstico de la Sífilis/métodos , Hepatitis/etiología , Treponema pallidum/patogenicidad , Penicilina G Benzatina/uso terapéuticoAsunto(s)
Hepatitis/etiología , Sífilis/complicaciones , Enfermedad Aguda , Adulto , Antibacterianos/uso terapéutico , Chancro/etiología , Hepatitis/sangre , Humanos , Masculino , Penicilina G Benzatina/uso terapéutico , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Tonsilitis/etiología , Úlcera/etiologíaRESUMEN
No disponible
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Humanos , Masculino , Persona de Mediana Edad , Hemorragia Gastrointestinal/complicaciones , Helicobacter pylori , Helicobacter pylori/aislamiento & purificación , Erradicación de la Enfermedad/métodos , Trastornos Paranoides/inducido químicamente , Psicosis Inducidas por Sustancias/complicaciones , Claritromicina/efectos adversos , Trastorno Bipolar/inducido químicamente , Trastornos Mentales/inducido químicamente , Hemorragia Gastrointestinal/diagnósticoRESUMEN
The side effects of Helicobacter pylori (H. pylori) eradication treatment are few, usually in the form of gastrointestinal or allergic complaints. However, occasionally, some antibiotics including clarithromycin, included in the classic eradication regimen, may result in reversible psychosis, a condition called "antibiomania" or "Hoigne syndrome".
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Antibacterianos/efectos adversos , Claritromicina/efectos adversos , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Psicosis Inducidas por Sustancias/psicología , Antibacterianos/uso terapéutico , Claritromicina/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Psicosis Inducidas por Sustancias/etiologíaRESUMEN
Isolated polycystic liver disease (IPLD) is a rare genetic condition characterized by the presence of multiple liver cysts with no association with polycystic kidney disease. Most patients are asymptomatic and acute complications (cyst torsion, bleeding, infection) are uncommon.Imaging techniques, including abdominal ultrasounds, computerized axial tomography, and magnetic resonance imaging, represent a vital diagnostic modality. They are also useful for therapy support in this disease. Below we report a peculiar case of a female patient recentlydiagnosed with IPLD who, having received treatment with ultrasoundguided percutaneous drainage and sclerotherapy for a giant liver cyst, showed symptom and laboratory improvement.
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Quistes/diagnóstico por imagen , Quistes/terapia , Drenaje/métodos , Hepatopatías/diagnóstico por imagen , Hepatopatías/terapia , Escleroterapia/métodos , Quistes/genética , Femenino , Humanos , Hepatopatías/genética , Persona de Mediana Edad , Ultrasonografía IntervencionalRESUMEN
La enfermedad hepática poliquística aislada (EHPA), es una rara entidad genética que se caracteriza por la presencia de múltiples quistes hepáticos, sin estar asociada a la poliquistosis renal. La mayoría de los pacientes son asintomáticos, y son infrecuentes las complicaciones agudas (torsión quística, hemorragia e infecciones). Las técnicas de imagen, como la ecografía abdominal, tomografía axial computarizada y resonancia magnética, son un método diagnóstico fundamental. Además, son útiles como apoyo terapéutico en esta enfermedad. A continuación les presentamos un caso clínico peculiar de una paciente recientemente diagnosticada de enfermedad hepática poliquística aislada, quien tras recibir un tratamiento con drenaje percutáneo de un quiste hepático gigante y escleroterapia guiada por ecografía, presentó mejoría sintomática y analítica
Isolated polycystic liver disease (IPLD) is a rare genetic condition characterized by the presence of multiple liver cysts with no association with polycystic kidney disease. Most patients are asymptomatic and acute complications (cyst torsion, bleeding, infection) are uncommon. Imaging techniques, including abdominal ultrasounds, computerized axial tomography, and magnetic resonance imaging, represent a vital diagnostic modality. They are also useful for therapy support in this disease. Below we report a peculiar case of a female patient recently diagnosed with IPLD who, having received treatment with ultrasound-guided percutaneous drainage and sclerotherapy for a giant liver cyst, showed symptom and laboratory improvement