RESUMEN
Patients with voltage-gated potassium channel (VGKC)-complex antibodies are increasingly recognized as having central, peripheral or combined phenotypes. With increasing awareness, more patients are tested and the clinical spectrum is expanding. Consequently, clinicians may be uncertain as to which patients should or should not be tested. Previous studies have identified common clinical features, but none has looked at the usefulness of these in predicting seropositive disease. We conducted a case-control study of patients tested for VGKC-complex antibodies over 10years at a regional tertiary neurology centre determining which clinical/biochemical features were associated with antibody-positive disease. We found a marked increase in the numbers tested, although the percentage positive remained low. Antibody titre was highest in central disease (p<0.001). Time from presentation to testing was shorter in those with VGKC-disease (p=0.01). Seizures were present in 11 (69%) of those with VGKC-disease versus three (18%) without (odds ratio [OR] 10.3, 95% confidence interval [CI]: 2.0-52.7, p=0.005). There was an inverse correlation between the antibody titre and serum sodium. A multivariate model selected seizures and hyponatraemia as predictive of VGKC disease (sensitivity 75% and specificity 82%); faciobrachial dystonic movements were specific but insensitive. Interestingly serum alkaline phosphatase was higher in those with VGKC-disease (p=0.016) and highest in those with peripheral disease (p=0.015). An ALP>70u/L was strongly associated with antibody positivity (OR 4.11 95% CI: 1.43-11.8, p=0.007) with a sensitivity of 74.2%. The presence of seizures, faciobrachial movements, and hyponatraemia should raise suspicion of VGKC-disease; alkaline phosphatase may represent a novel biomarker, particularly in those with peripheral disease.
Asunto(s)
Autoanticuerpos/análisis , Canales de Potasio con Entrada de Voltaje/inmunología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Fosfatasa Alcalina/sangre , Biomarcadores/sangre , Estudios de Casos y Controles , Distonía/etiología , Femenino , Humanos , Hiponatremia/etiología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Convulsiones/etiología , Adulto JovenAsunto(s)
Fístula Biliar/diagnóstico , Endoscopía , Anciano , Fístula Biliar/diagnóstico por imagen , Colangiografía , Femenino , HumanosRESUMEN
Os autores mostram um caso de fistula biliodigestiva espontanea, documentada atraves de exame endoscopico de rotina, que foi confirmado posteriormente atraves de radiografias.E comentada a raridade deste achado (fistula biliogastrica) na literatura compilada, correspondendo de 3 a 8% de todas as fistulas biliodigestivas espontaneas. E tambem mencionado o fato de nao se encontrar referencia a achados endoscopicos, nas fistulas biliodigestivas