RESUMEN
Presentamos el caso de una mujer joven que comenzó con una hemorragia digestiva baja y que precisó intervención quirúrgica urgente ante la persistencia y gravedad de la misma. Fue diagnosticada por angiografía selectiva de arteria mesentérica superior de lesión yeyunal con sangrado activo tras haber resultado negativas otras pruebas diagnósticas. La intervención quirúrgica y la aplicación de pruebas inmunorreactivas establecieron el diagnóstico de tumor mesenquimal tipo estromal CD 34+. Revisamos las características de este tipo de tumores infrecuentes en esta localización (AU)
Asunto(s)
Femenino , Persona de Mediana Edad , Humanos , Hemorragia Gastrointestinal/etiología , Células del Estroma/patología , Neoplasias del Yeyuno/patología , Mesodermo/patología , Antígenos CD34/sangre , Tabaquismo , Aspirina/uso terapéutico , Cefalea/tratamiento farmacológicoRESUMEN
BACKGROUND: Data regarding the effectiveness of second-line treatment of Helicobacter pylori infection are limited, especially if microbiological studies are considered. METHODS AND PATIENTS: We conducted a prospective, uncontrolled study of a consecutive series of 21 peptic ulcer patients with failure of 1-week lansoprazole, amoxicillin, and clarithromycin. H. pylori status was evaluated by urease test, histology, culture, and urea breath test. Susceptibility to amoxicillin, clarithromycin, and metronidazole was studied by E-test. Cure of infection was defined as negative results from endoscopy-based tests 1 month after treatment and negative results from a urea breath test at 2 months. Treatment consisted of a 1-week combination of lansoprazole (30 mg bid), tetracycline (500 mg qid), metronidazole (500 mg tid), and bismuth subcitrate (120 mg qid). RESULTS: H. pylori was resistant to metronidazole in three cases, to clarithromycin in three cases, and to both clarithromycin and metroinidazole in an additional three patients. No resistance to amoxicillin was found. Eradication was obtained in 20 cases (95.2% confidence interval [CI], 76.2-99.9). The only patient in whom infection was not eradicated harbored a metronidazole-resistant (minimum inhibitory concentration > 32 micrograms/ml) strain. No significant side effects were reported. CONCLUSION: Quadruple therapy obtains a high eradication rate even in patients with clarithromycin- and metronidazole-resistant strains. Further randomized and controlled studies are warranted and are urgently needed.
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por Helicobacter/tratamiento farmacológico , Infecciones por Helicobacter/microbiología , Helicobacter pylori/efectos de los fármacos , 2-Piridinilmetilsulfinilbencimidazoles , Adulto , Anciano , Antibacterianos/farmacología , Claritromicina/farmacología , Claritromicina/uso terapéutico , Farmacorresistencia Microbiana , Quimioterapia Combinada , Femenino , Infecciones por Helicobacter/complicaciones , Helicobacter pylori/aislamiento & purificación , Humanos , Lansoprazol , Masculino , Metronidazol/farmacología , Metronidazol/uso terapéutico , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Omeprazol/análogos & derivados , Omeprazol/farmacología , Omeprazol/uso terapéutico , Úlcera Péptica/tratamiento farmacológico , Úlcera Péptica/microbiología , Estudios Prospectivos , Inhibidores de la Bomba de Protones , Resultado del TratamientoAsunto(s)
Abdomen , Absceso/radioterapia , Absceso/diagnóstico , Absceso/terapia , Adulto , Anciano , Cateterismo/métodos , Niño , Drenaje , Femenino , Humanos , Masculino , Persona de Mediana Edad , UltrasonografíaRESUMEN
We studied the significance of urinary enzyme measurements in diagnosing proximal tubular damage in cirrhosis of the liver. Urinary excretion (u-enzyme) and fractional urinary excretion (FEenzyme) of gamma-glutamyltranspeptidase (GGT), leucine aminopeptidase (LAP), alkaline phosphatase (AP) and beta-glucuronidase (B-GLU) were quantified in 14 control subjects (group I), 12 cirrhotics with functional renal failure (group II), 13 cirrhotics with renal tubular damage (group III) and 7 non-liver patients with renal tubular damage (group IV). Urinary enzyme excretion and fractional enzyme excretion were significantly higher in the cirrhotics of group III than in the controls or group II. In group III, these tests usually reached values within the range of group IV. The sensitivity of urinary enzyme excretion was 0.92 and specificity ranged from 0.75 (u-LAP) to 1 (u-GGT; u-B-GLU). The sensitivity of fractional enzyme excretion was between 0.61 (FEB-GLU) and 0.84 (FEGGT; FELAP), while specificity was from 0.91 (FELAP; FEAP) to 1 (FEGGT; FEB-GLU). The results indicate that measurement of urinary enzymes may be very useful in diagnosing renal tubular damage in cirrhotic patients with impaired renal function.
Asunto(s)
Lesión Renal Aguda/orina , Fosfatasa Alcalina/orina , Glucuronidasa/orina , Leucil Aminopeptidasa/orina , Cirrosis Hepática/orina , gamma-Glutamiltransferasa/orina , Lesión Renal Aguda/etiología , Adulto , Femenino , Humanos , Cirrosis Hepática/complicaciones , Masculino , Persona de Mediana EdadRESUMEN
We describe the laparoscopic findings in 5 patients with nodular regenerative hyperplasia of the liver (NRH). A nodular liver surface and signs of portal hypertension were observed, which in all cases gave rise to the laparoscopic diagnosis of liver cirrhosis. Multiple and single liver biopsies in 3 and 2 cases respectively, permitted the definitive diagnosis of the NRH lesion. The laparoscopic picture of NRH is indistinguishable from that of cirrhosis, and for this reason it is advisable to carry out liver biopsy even in cases where cirrhosis seems unquestionable.
Asunto(s)
Hígado/patología , Adulto , Anciano , Biopsia , Diagnóstico Diferencial , Femenino , Humanos , Hiperplasia , Hipertensión Portal/diagnóstico , Hipertensión Portal/patología , Laparoscopía , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/patología , Pruebas de Función Hepática , Regeneración Hepática , Masculino , Persona de Mediana EdadRESUMEN
The laparoscopic findings observed in eight patients with hereditary haemorrhagic telangiectasia are reported. Clinical signs or laboratory data suggestive of liver involvement were present in all cases and constituted the main indication for laparoscopic examination. Characteristic vascular lesions distributed at random were found in four cases. Numerous oval, round or polygonal areas of 0.5 to 1.5 cm in diameter were observed on the external surface of the liver. They were of a reddish or pink colour, flat or slightly raised, and made up of a dense vascular meshwork. In one patient macronodular cirrhosis was associated with the vascular lesions. In the remaining four cases laparoscopic examination did not show striking vascular changes, although the liver biopsy revealed a fatty liver in three cases and micronodular cirrhosis with intense inflammatory activity, steatosis and Mallory bodies in one case. In these cases the accompanying hepatic lesions could probably not be aetiopathogenically related to Osler's disease.