Asunto(s)
Electrocirugia/métodos , Esofagoscopía , Esófago/cirugía , Anciano , Biopsia , Esófago/patología , Femenino , Humanos , MasculinoRESUMEN
A case is described in which a patient with known gastroduodenal Crohn's disease developed a picture of gastric outlet obstruction accompanied by gastric retention of many enteric-coated sulfasalazine tablets. The tablets were removed by gastric lavage with a sodium bicarbonate solution. Following this observation, an in vitro study was done in which the rate of disintegration of enteric-coated sulfasalazine tablets was found to be directly related to pH. The case report reveals a potential hazard in using enteric-coated tablets in patients with impaired gastric emptying. Intragastric sodium bicarbonate may be a useful element in the management of this complication.
Asunto(s)
Enfermedad de Crohn/complicaciones , Obstrucción Intestinal/etiología , Gastropatías/etiología , Sulfasalazina/administración & dosificación , Adulto , Enfermedad de Crohn/tratamiento farmacológico , Enfermedades Duodenales/complicaciones , Enfermedades Duodenales/tratamiento farmacológico , Femenino , Humanos , Gastropatías/complicaciones , Gastropatías/tratamiento farmacológico , ComprimidosRESUMEN
Gastroduodenal Crohn's disease usually, but not always, occurs in patients with previously established ileal and/or colonic Crohn's disease. Symptoms include postprandial epigastric pain accompanied by nausea and sometimes vomiting, weight loss, anorexia, bloating, and diarrhea. Obstruction is the most common complication. Diagnosis can usually be made radiographically or endoscopically. Certain radiographic patterns are almost diagnostic, eg, obliteration of a distinct pyloric channel and a rigidly narrowed antrum tapering into a diseased duodenal bulb. Endoscopic mucosal biopsy of abnormal areas almost always shows chronic inflammation, although granulomas are not common. In patients with symptoms other than intractable obstruction, medical management, such as intermittent corticosteroid therapy, should be attempted. Surgery is usually indicated for refractory obstruction; gastrojejunostomy is the preferred approach.
Asunto(s)
Enfermedad de Crohn/diagnóstico , Duodenitis/diagnóstico , Gastritis/diagnóstico , Enfermedad de Crohn/terapia , Diagnóstico Diferencial , Enfermedades Duodenales/diagnóstico , Duodenitis/terapia , Gastritis/terapia , Humanos , Úlcera Péptica/diagnóstico , Gastropatías/diagnósticoRESUMEN
A case of Sweet's syndrome (acute febrile neutrophilic dermatosis) is reported in a patient with long-standing rheumatoid arthritis. Although Sweet's syndrome has been described in association with leukemias, other malignancies, and a variety of inflammatory disorders, it has not been associated with rheumatoid arthritis. Sweet's syndrome is reviewed with regard to pathogenesis and associated diseases.