Asunto(s)
Países en Desarrollo , Vena Cava Inferior/patología , Carcinoma Hepatocelular/etiología , Humanos , Neoplasias Hepáticas/etiología , Membranas/patología , Lesiones Precancerosas/congénito , Lesiones Precancerosas/etiología , Enfermedades Vasculares/congénito , Enfermedades Vasculares/etiologíaRESUMEN
Crohn's disease (CD) and tuberculosis (TB) of the gastrointestinal tract pose major diagnostic problems for clinicians where these conditions coexist. Clinically and radiologically, the diseases are similar. In the West, TB is considered in the differential diagnosis of all suspected cases of CD, particularly among Asian migrants. Earlier age of presentation, perianal disease and enteric fistulae favour a diagnosis of CD. Aphthoid ulceration, pseudopolyps and filiform mucosa at endoscopy are suggestive of CD and a negative tuberculin test us useful. The final diagnosis depends largely on histopathology and the presence or absence of acid fast bacilli. Tuberculosis is more common in developing countries and intestinal TB frequently coexists with pulmonary tuberculosis. TB is known to affect all age groups and fistulous communication, although uncommon, does occur. In addition to radiology and endoscopy, laparotomy may be required to establish the diagnosis. In developing countries, CD is uncommon and remains largely a diagnosis of exclusion. A trial of anti-tuberculosis therapy may often be prescribed before definitely diagnosing CD. The development of molecular biology techniques had led to a revival of interest in mycobacteria as a possible aetiological agent in CD. DNA from Mycobacterium paratuberculosis and Mycobacterium kansaii have both been identified in CD cases but the significance of this finding has not been established. However, in the near future polymerase chain reaction will become increasingly useful in differentiating CD from intestinal TB because it allows the amplification and identification of very small quantities of mycobacterium DNA.
Asunto(s)
Enfermedad de Crohn/diagnóstico , Tuberculosis Gastrointestinal/diagnóstico , Enfermedad de Crohn/microbiología , Enfermedad de Crohn/patología , ADN Bacteriano/aislamiento & purificación , Diagnóstico Diferencial , Humanos , Reacción en Cadena de la Polimerasa , Tuberculosis Gastrointestinal/microbiología , Tuberculosis Gastrointestinal/patologíaRESUMEN
A young girl presented with Budd-Chiari syndrome (BCS) with narrowing of the retrohepatic segment of inferior vena cava (VC). Dorsal cavoatrial bypass (DCAB) was unsuccessful due to thrombotic occlusion of the graft. A limited autopsy revealed occlusion of the retrohepatic segment of IVC and the terminal parts of the three major hepatic veins. Caval occlusion was just above the level of the superior hepatic veins, and caused by a transverse fibrous shelf. An adult filarial worm was found amidst pericaval fibrosis. Filariasis should be included as a possible aetiological factor in chronic BCS.
Asunto(s)
Síndrome de Budd-Chiari/etiología , Filariasis/complicaciones , Adolescente , Síndrome de Budd-Chiari/patología , Resultado Fatal , Femenino , Filariasis/patología , HumanosRESUMEN
To assess the risk of pancreatic cancer in subjects with tropical calcifying pancreatitis (TCP), we have followed 185 patients with TCP from the Diabetes Research Center in Madras, India for an average of 4.5 years. The diagnosis of TCP was based upon long-standing epigastric pain, laboratory tests, presence of pancreatic calculi, endoscopic retrograde cholangiopancreatography (ERCP) findings, and ultrasonography. During the follow-up period, 24 patients died from all causes, with 6 deaths (25%) from cancer of the pancreas. Three pancreatic cancers were biopsy positive. Average age at onset of pancreatic cancer was 45.6 +/- 7.3 years--considerably younger than for Western populations. When compared with the background pancreatic cancer rate, subjects with TCP appear to have a significantly increased risk of pancreatic cancer: relative risk = 100, 95% CI = 37-218. Even under the most stringent assumptions (restricting the analysis to biopsy-proven cases, assuming that the true background rate of pancreatic cancer in Madras resembles high-risk Western populations, assuming that tropical pancreatitis begins at birth) the risk is still elevated: relative risk = 5, 95% CI = 1.03-3-14.6. The exact mechanism linking various forms of pancreatitis to pancreatic cancer remains to be elucidated.
Asunto(s)
Calcinosis/complicaciones , Neoplasias Pancreáticas/epidemiología , Neoplasias Pancreáticas/etiología , Pancreatitis/complicaciones , Pancreatitis/epidemiología , Adulto , Femenino , Humanos , India , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , FumarRESUMEN
A simple, specific and economical dipstick immunobinding enzyme-linked immunosorbent assay (DIA) for detecting hepatitis B surface antigen (HBsAg) and antibodies to hepatitis delta virus (anti-HDV), utilizing cellulose nitrate membrane is described. Screening of 815 serum specimens for HBsAg by DIA and micro ELISA revealed a positivity of 22.69% and 22.94% respectively. In the detection of antibodies to delta antigen, DIA was compared with an indirect immunofluorescence technique using A3 cell line as antigen substrate and a commercial macro ELISA. Of the 143 HBsAg positive sera tested for anti-HDV, 59 (41.25%) were positive by both immunofluorescence and macro ELISA and 61 (42.65%) by DIA. While the positive and negative predictive values of DIA for HBsAg were 100% and 99.6%, for anti-HDV by DIA these were 96.7% and 100% respectively. Based on the simplicity of performance and the economical nature of the test system, DIA is recommended as a diagnostic tool for field surveys and small laboratories in developing countries.
Asunto(s)
Ensayo de Inmunoadsorción Enzimática/métodos , Anticuerpos Antihepatitis/sangre , Antígenos de Superficie de la Hepatitis B/sangre , Hepatitis B/diagnóstico , Hepatitis D/diagnóstico , Humanos , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Pruebas SerológicasRESUMEN
A woman aged 28 years with situs inversus totalis presented with chronic Budd-Chiari syndrome with symptoms of 3 years' duration. The left sided inferior vena cava was occluded below the diaphragm above a patent morphologic right hepatic vein. A dorsal cavoatrial bypass was attempted but abandoned due to bleeding from extensive collaterals. The occurrence of coarctation of the inferior vena cava in situs inversus totalis lends support to the view that it is a congenital condition and occurs due to disturbance in fusion of the hepatic segment of the inferior vena cava and the hepatocardiac channel.
Asunto(s)
Síndrome de Budd-Chiari/patología , Situs Inversus/complicaciones , Vena Cava Inferior/anomalías , Adulto , Síndrome de Budd-Chiari/complicaciones , Femenino , HumanosRESUMEN
A female aged 46, with achalasia cardia had no relief of dysphagia after pneumatic dilatation done twice. At surgery the muscle fibres were found disrupted, with submucosal adhesions and friable mucosa. Heller's cardiomyotomy could not be done. Repair similar to Mickulicz pyloroplasty was done.
Asunto(s)
Cateterismo , Acalasia del Esófago/terapia , Esófago/cirugía , Cateterismo/efectos adversos , Acalasia del Esófago/cirugía , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Tropical and alcoholic forms of chronic pancreatitis differ in their clinical, aetiological and epidemiological features. We compared the radiological appearances of pancreatic calculi seen on plain roentgenogram of the abdomen of 89 patients with tropical calcific pancreatitis (TCP) and 32 patients with alcoholic calcific pancreatitis (ACP) seen in Madras, Southern India. While TCP was characterized by the frequent occurrence of large, discrete, dense calculi, patients with ACP had typically small, speckled calculi with irregular, hazy margins. The calculi in TCP resembled those described for hereditary pancreatitis. This is the first report comparing the radiological appearances of TCP and ACP patients seen at the same centre.
Asunto(s)
Alcoholismo/complicaciones , Cálculos/diagnóstico por imagen , Pancreatitis/diagnóstico por imagen , Adulto , Cálculos/etiología , Enfermedad Crónica , Humanos , Enfermedades Pancreáticas/diagnóstico por imagen , Pancreatitis/etiología , Radiografía , Clima TropicalRESUMEN
The frequency of diabetes is much higher in tropical calcific pancreatitis (TCP) as compared with alcoholic chronic pancreatitis. We report 97 patients with tropical calcific pancreatitis and compare the profile of 21 patients without diabetes (called TCP for the purpose of this report) with that of 76 patients with diabetes, called fibrocalculous pancreatic diabetes (FCPD) according to the World Health Organization (WHO) study group classification of diabetes. TCP patients were a decade younger and had marginally higher body mass indices (BMIs) as compared with the FCPD group. Of the TCP patients, 13 had abnormal glucose tolerance tests (GTT) and the others had normal GTT. Immunoreactive insulin (IRI) responses to glucose load in the TCP group did not differ significantly from that of the control group. This study shows the existence of early stages of glucose intolerance in TCP.
Asunto(s)
Pancreatitis/patología , Estado Prediabético/patología , Adolescente , Adulto , Análisis de Varianza , Glucemia/análisis , Índice de Masa Corporal , Glucosa/farmacología , Prueba de Tolerancia a la Glucosa , Humanos , Insulina/sangre , Islotes Pancreáticos/metabolismo , Islotes Pancreáticos/patología , Islotes Pancreáticos/fisiopatología , Pancreatitis/metabolismo , Pancreatitis/fisiopatología , Estado Prediabético/metabolismo , Estado Prediabético/fisiopatología , Clima Tropical , Organización Mundial de la SaludRESUMEN
In a comparative study of tropical chronic pancreatitis (TCP) and alcoholic chronic pancreatitis (ACP) occurring in the same population, we analyzed the clinical profile of 50 patients of ACP seen over the past 3 years at our centers and compared this with the profile of our TCP patients. A majority (75%) of patients in both groups belonged to Tamil Nadu and 90% had never consumed cassava. Whereas TCP occurred in young subjects of both sexes, ACP patients were all males and presented at an older age. The frequency of pain, diabetes, and pancreatic calcification was similar in the two groups. Patients in both groups were lean, but signs of severe malnutrition were rare. Prediabetic patients had normal body mass index. There were striking differences in radiological appearance of pancreatic calculi in TCP and ACP. Malignancy of the pancreas was present in three patients with TCP. Benign bile duct stenosis was seen in three patients with ACP but not in TCP. Compared to ACP seen in the West, our ACP patients had a shorter duration of symptoms in spite of having advanced disease. TCP and ACP have distinct clinical profiles and it is possible that some environmental factors may hasten the progress of ACP in the tropics.
Asunto(s)
Alcoholismo/complicaciones , Pancreatitis/epidemiología , Dolor Abdominal/epidemiología , Dolor Abdominal/etiología , Adulto , Factores de Edad , Índice de Masa Corporal , Enfermedad Celíaca/epidemiología , Enfermedad Celíaca/etiología , Enfermedad Crónica , Diabetes Mellitus/epidemiología , Diabetes Mellitus/etiología , Femenino , Humanos , India/epidemiología , Hepatopatías/epidemiología , Hepatopatías/etiología , Masculino , Manihot/efectos adversos , Persona de Mediana Edad , Estado Nutricional , Páncreas/diagnóstico por imagen , Páncreas/patología , Neoplasias Pancreáticas/epidemiología , Neoplasias Pancreáticas/etiología , Pancreatitis/complicaciones , Pancreatitis/etiología , Prevalencia , Estudios Retrospectivos , Factores Sexuales , Clima Tropical , UltrasonografíaRESUMEN
Male aged 28, presented with coarctation of inferior vena cava (IVC) causing chronic Budd-Chiari syndrome (CBCS). The coarcted IVC was exposed by transthoracic, transdiaphragmatic, retroperitoneal approach. There was no evidence of inflammation or compression. Venotomy was done immediately below the coarctation after clamping the descending aorta above the diaphragm. Distal IVC was occluded with a Fogarty balloon catheter passed through the venotomy. There was no flow through hepatic veins. But a dry field was not obtained because of bleeding from the systemic collaterals draining into IVC above the venotomy. Hence the veno-tomy was sutured. Dorsal cavoatrial bypass (DCAB) was done anastomosing the graft, end to side of IVC at a lower level, after partial clamping of IVC. Cross clamping the descending aorta appears to be a useful technique for surgery of retrohepatic IVC to arrest blood flow from distal IVC and hepatic veins.