RESUMEN
OBJECTIVES: Little has been published regarding predictors of a complicated course after Mallory-Weiss tear (MWT). The aims of this study were to identify risk factors for a Mallory-Weiss tear and factors predictive of a complicated course. METHODS: At our university hospital, we searched a computerized endoscopy database. At our Veterans Affairs hospital we manually searched printed endoscopy reports. Proposed risk factors for MWT were: history of alcohol use, recent alcohol binge, nonbloody initial emesis, anticoagulation, other coagulopathy, nonsteroidal anti-inflammatory use, and hiatal hernia. Proposed predictors of a complicated course were: age, hematemesis, melena, hematochezia, visible vessel, adherent clot, active bleeding, multiple tears, other pathology at endoscopy, admission Hct, hypotension or orthostatic changes, and coagulopathy. A complicated course was defined on the basis of >6 U of blood transfused, rebleeding, angiography, surgery, or death. Predictors of a complicated course were evaluated using the Mann-Whitney U test or Fisher exact test. RESULTS: A total of 73 cases were reviewed. The most common risk factor was alcohol use, which was found in 44% of cases. In all, 23% of patients had no risk factors. Of the patients, 17 (23%) had a complicated course. Patients with a complicated course had a lower admission Hct (p = 0.009) and active bleeding at initial endoscopy (p = 0.013). CONCLUSION: The predictive value of active bleeding supports early endoscopy for stratification and intervention.
Asunto(s)
Síndrome de Mallory-Weiss , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Síndrome de Mallory-Weiss/epidemiología , Síndrome de Mallory-Weiss/etiología , Síndrome de Mallory-Weiss/fisiopatología , Persona de Mediana Edad , Factores de RiesgoRESUMEN
Vertebral osteomyelitis rarely mimics pancreatitis. However, the potential consequences of longstanding unrecognized disease, including neurological impairment and bony deformity, should make it an item in the differential diagnosis of chronic pancreatitis. In the evaluation of our patient, four items were of particular importance: awareness of his previously documented S. aureus bacteremia, a markedly elevated ESR, an abnormal chest radiograph, and the positive bone scan.