RESUMEN
Alcoholic hepatitis is a form of acute injury to liver tissue that is also a precursor of cirrhosis, and carries significant morbidity and mortality. Severe alcoholic hepatitis in particular carries a high short-term mortality, and also places an enormous burden on stretched healthcare resources. Treatment of alcoholic hepatitis has been limited to supportive management and nutritional supplementation without clear improvements in outcome, and the timing and patient selection for hepatic transplantation is problematic. The use of corticosteroids has remained controversial for many years, but probably has a role in selected patients. Various other therapeutic strategies have been tested over the decades and none has shown any consistent benefit. Recently there have been major developments in our understanding of the mechanisms of alcoholic liver injury, including the role of cytokines and hepatocyte apoptosis. For the first time, there are exciting possibilities for specific therapies for this challenging and serious condition.
Asunto(s)
Corticoesteroides/uso terapéutico , Antineoplásicos/uso terapéutico , Hepatitis Alcohólica/terapia , Factor de Necrosis Tumoral alfa/uso terapéutico , Acetilcisteína/uso terapéutico , Diálisis/métodos , Suplementos Dietéticos , Depuradores de Radicales Libres/uso terapéutico , Hepatitis Alcohólica/tratamiento farmacológico , Humanos , Trasplante de Hígado , Estrés Oxidativo/efectos de los fármacosRESUMEN
Endoscopic retrograde cholangiopancreatography has been used successfully in diagnosis of pancreatico-biliary diseases. Over the past decade, there have been tremendous developments in radiological technologies which have led to the emergence of new and less invasive modalities like endoscopic ultrasound and spiral computed tomography and magnetic resonance cholangiopancreatography. Understandably, the usefulness of diagnostic endoscopic retrograde cholangiopancreatography is being questioned primarily because of its potential attendant complications. Therefore, this controversial question needs to be debated in the gastroenterology community. In this article, we compare the efficacy of newer diagnostic tools with existing "gold standard" modality--endoscopic retrograde cholangiopancreatography, and put forward our arguments in favour of a continuing role for endoscopic retrograde cholangiopancreatography as a diagnostic tool in certain circumstances.
Asunto(s)
Enfermedades de los Conductos Biliares/diagnóstico por imagen , Colangiopancreatografia Retrógrada Endoscópica , Enfermedades Pancreáticas/diagnóstico por imagen , Enfermedades de los Conductos Biliares/diagnóstico , Colangiopancreatografia Retrógrada Endoscópica/estadística & datos numéricos , Colangitis/diagnóstico , Colangitis/diagnóstico por imagen , Diagnóstico por Imagen , Cálculos Biliares/diagnóstico , Cálculos Biliares/diagnóstico por imagen , Humanos , Enfermedades Pancreáticas/diagnóstico , Pancreatitis/diagnóstico , Pancreatitis/diagnóstico por imagenRESUMEN
Re-establishment of the oesophageal lumen is the main focus of care in patients with dysphagia due to re-blockage of in situ expandable metal stent (EMS). A total of 51 patients aged 44-89 years were intubated with EMS for dysphagia due to inoperable oesophagogastric carcinoma. Of these patients, 25 required follow-up endoscopy at variable intervals after stent insertion; 17 patients were found to have significant tumour in-growth (9), overgrowth (4) or both (4). All these patients were treated with Nd-YAG (70 W/s) or diode laser (30-50 W, continuous) for maintenance of satisfactory swallowing. The intensity of tumour ablation was similar with both types of lasers but four patients being treated with Nd-YAG laser developed deformity of EMS. This complication was not encountered with diode laser. The timing of the stent insertion should be carefully chosen since the longer the stent is in situ, the greater is the likelihood of tumour ingrowth or overgrowth. The combination of endoscopic laser therapy (ELT) and EMS may offer the best palliation, particularly when patient survival of several months is anticipated. ELT can effectively deal with tumour in-growth and overgrowth but care must be exercised in the use of Nd-YAG which can damage the structure of the EMS.