RESUMEN
Chronic intestinal pseudo-obstruction is a clinical syndrome characterised by symptoms and signs of intestinal obstruction in the absence of a mechanical lesion of the intestinal lumen. The diagnosis is often difficult and relies on clinical, radiological and manometric grounds. We present here a case in which such a diagnosis was suspected, but a thorough in-depth evaluation revealed that the symptoms were due to a treatable cause--abdominopelvic adhesions.
Asunto(s)
Seudoobstrucción Intestinal/diagnóstico , Adherencias Tisulares/diagnóstico , Dolor Abdominal/inducido químicamente , Enfermedad Crónica , Cisaprida/efectos adversos , Cisaprida/uso terapéutico , Diagnóstico Diferencial , Femenino , Fármacos Gastrointestinales/efectos adversos , Fármacos Gastrointestinales/uso terapéutico , Humanos , Seudoobstrucción Intestinal/fisiopatología , Seudoobstrucción Intestinal/cirugía , Yeyuno/fisiopatología , Laparoscopía , Manometría , Persona de Mediana Edad , Adherencias Tisulares/cirugíaRESUMEN
AIM: To report our experience with empiric antimicrobial monotherapy (piperacillin/tazobactam, of which no data are available in such specific circumstances) in microbiologically-documented infections in patients with benign and malignant conditions of the biliary tract. METHODS: Twenty-three patients, 10 with benign and 13 with malignant conditions affecting the biliary tree and microbiologically-documented infections were recruited and the efficacy of empirical antibiotic therapy was assessed. RESULTS: The two groups featured similar demographic and clinical data. Overall, the infective episodes were most due to Gram negative agents, more than 60% of such episodes (mostly in malignant conditions) were preceded by invasive instrumental maneuvers. Empirical antibiotic therapy with a single agent (piperacillin/tazobactam) was effective in more than 80% of cases. No deaths were reported following infections. CONCLUSION: An empiric therapeutic approach with piperacillin/tazobactam is highly effective in biliary tract infections due to benign or malignant conditions.
Asunto(s)
Antibacterianos/uso terapéutico , Enfermedades de las Vías Biliares/tratamiento farmacológico , Enfermedades de las Vías Biliares/microbiología , Infecciones/complicaciones , Ácido Penicilánico/análogos & derivados , Ácido Penicilánico/uso terapéutico , Piperacilina/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades de las Vías Biliares/complicaciones , Neoplasias del Sistema Biliar/complicaciones , Combinación de Medicamentos , Investigación Empírica , Femenino , Humanos , Masculino , Persona de Mediana Edad , TazobactamRESUMEN
BACKGROUND: Irritable bowel syndrome is a frequent gastrointestinal disorder of which the pathophysiological basis is still not completely understood. Among the various proposed mechanisms, colonic motility may play a role, at least in a subset of patients. AIMS: To investigate the regular colonic contractile patterns in patients with irritable bowel syndrome. Our working hypothesis was that an increase of these patterns in such condition might represent a motility equivalent of the so-called 'spastic colon'. PATIENTS AND METHODS: Twelve patients of both genders were investigated by means of 24 h colonic manometry, and the results were compared to those from 20 healthy controls. Regular contractile patterns (with frequencies ranging from 2 to 8 per min) were calculated for the entire recording period and in single colonic segments. RESULTS: Overall, colonic frequency patterns were significantly more frequent in patients than controls (12.6% vs 6.4% of the total contractile activity, P < 0.001); in both groups, the 3 cycles/min frequency was predominant, especially in the sigmoid colon. More than 40% patients displayed a correlation between abdominal pain and occurrence of regular contractile frequencies. CONCLUSIONS: Abnormal colonic motility may play some role in the pathogenesis of symptoms related to irritable bowel syndrome, with an excess of regular contractile activity related to the so-called 'spastic colon'.
Asunto(s)
Colon/fisiopatología , Enfermedades Funcionales del Colon/fisiopatología , Motilidad Gastrointestinal , Adulto , Anciano , Ritmo Circadiano , Femenino , Humanos , Masculino , Manometría/métodos , Persona de Mediana EdadRESUMEN
BACKGROUND: Little is known concerning colonic motility and almost nothing is known concerning propulsive activity in pathological conditions characterized by diarrhea of both inflammatory and non-inflammatory origin. AIMS: The purpose of the present study was to investigate colonic propulsive activity in ulcerative colitis and diarrhea-predominant irritable bowel syndrome (IBS) patients. PATIENTS AND METHODS: Seven patients with active, moderate ulcerative colitis and nine diarrhea-predominant IBS patients entered the study. Sixteen healthy volunteers were recruited as a control group. In all subjects, 24-h colonic motility was recorded by a colonoscopically positioned manometric catheter. Both high- (mass movements) and low-amplitude propagated contractions were analyzed. RESULTS: High-amplitude propagated contractions were significantly increased in ulcerative colitis with respect to controls; no significant differences were found with respect to IBS patients, and between IBS and controls. Concerning amplitude, no significant difference was found between groups, although IBS patients approached the statistical difference with respect to controls. Low-amplitude propagated contractions were significantly increased in ulcerative colitis with respect to controls; no significant differences were found compared with IBS patients. The latter, however, displayed a trend toward an increase with respect to controls that approached but did not reach statistical significance. CONCLUSIONS: Both inflammatory and non-inflammatory diarrheal conditions are characterized by an overall increase of colonic propulsive activity. This observation may be useful for a better understanding of the pathophysiologic mechanisms of these disorders.