RESUMO
Pseudomelanosis duodeni (PD) is a rare dark speckled appearance of the duodenum associated with gastrointestinal bleeding, hypertension, chronic heart failure, chronic renal failure and consumption of different drugs. We report four cases of PD associated with chronic renal failure admitted to the gastroenterology outpatient unit due to epigastric pain, nausea, melena and progressive reduction of hemoglobin index. Gastroduodenal endoscopy revealed erosions in the esophagus and stomach, with no active bleeding at the moment. In addition, the duodenal mucosa presented marked signs of melanosis; later confirmed by histopathological study. Even though PD is usually regarded as a benign condition, its pathogenesis and clinical significance is yet to be defined.
Assuntos
Duodenopatias/etiologia , Duodenopatias/patologia , Duodeno/patologia , Mucosa Intestinal/patologia , Falência Renal Crônica/complicações , Falência Renal Crônica/patologia , Melaninas/metabolismo , Adulto , Idoso , Feminino , HumanosRESUMO
Background - Upper gastrointestinal bleeding is a frequent and potentially severe complication of most digestive diseases of the upper gastrointestinal tract. Upper endoscopy has a crucial role in the diagnosis and treatment of upper gastrointestinal bleeding, however epidemiological studies are still limited in our country. Aims - To assess the clinical characteristics, endoscopic accuracy, treatment efficiency and clinical outcome of patients admitted to the endoscopic unit with upper gastrointestinal bleeding. Methods - A retrospective study of consecutive records from patients who underwent emergency endoscopy for upper gastrointestinal bleeding was performed during a period of 2 years. Results - Most patients were male 68.7 percent, with a mean age of 54.5 ± 17.5 years. A bleeding site could be detected in 75.6 percent of the patients. Diagnostic accuracy was greater within the first 24 hours of the bleeding onset, and in the presence of hematemesis. Peptic ulcer was the main cause of upper gastrointestinal bleeding (35 percent). The prevalence of variceal bleeding (20.45 percent) indicates a high rate of underlying liver disease. Endoscopic treatment was performed in 23.86 percent of the patients. Permanent hemostasis was achieved in 86 percent of the patients at the first endoscopic intervention, and in 62.5 percent of the patients after rebleeding. Emergency surgery was seldom necessary. The average number of blood units was 1.44 ± 1.99 per patient. The average length of hospital stay was 7.71 ± 12.2 days. Rebleeding was reported in 9.1 percent of the patients. The overall mortality rate of 15.34 percent was significantly correlated with previous liver disease. Conclusions - Diagnostic accuracy was related to the time interval between the bleeding episode and endoscopy, and to clinical presentation. Endoscopic therapy was an effective tool for selected patients. The resulting increased duration of hospitalization and higher mortality rate in the patients submitted to therapeutic endoscopy were attributed to a higher prevalence of variceal bleeding and underlying liver disease
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Endoscopia Gastrointestinal , Hemorragia Gastrointestinal , Úlcera Péptica , Brasil , Distribuição de Qui-Quadrado , Hemorragia Gastrointestinal , Hemostase Endoscópica , Tempo de Internação , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Upper gastrointestinal bleeding is a frequent and potentially severe complication of most digestive diseases of the upper gastrointestinal tract. Upper endoscopy has a crucial role in the diagnosis and treatment of upper gastrointestinal bleeding, however epidemiological studies are still limited in our country. Aims - To assess the clinical characteristics, endoscopic accuracy, treatment efficiency and clinical outcome of patients admitted to the endoscopic unit with upper gastrointestinal bleeding. METHODS: A retrospective study of consecutive records from patients who underwent emergency endoscopy for upper gastrointestinal bleeding was performed during a period of 2 years. RESULTS: Most patients were male 68.7%, with a mean age of 54.5 +/- 17.5 years. A bleeding site could be detected in 75.6% of the patients. Diagnostic accuracy was greater within the first 24 hours of the bleeding onset, and in the presence of hematemesis. Peptic ulcer was the main cause of upper gastrointestinal bleeding (35%). The prevalence of variceal bleeding (20.45%) indicates a high rate of underlying liver disease. Endoscopic treatment was performed in 23.86% of the patients. Permanent hemostasis was achieved in 86% of the patients at the first endoscopic intervention, and in 62.5% of the patients after rebleeding. Emergency surgery was seldom necessary. The average number of blood units was 1.44 +/- 1.99 per patient. The average length of hospital stay was 7.71 +/- 12.2 days. Rebleeding was reported in 9.1% of the patients. The overall mortality rate of 15.34% was significantly correlated with previous liver disease. CONCLUSIONS: Diagnostic accuracy was related to the time interval between the bleeding episode and endoscopy, and to clinical presentation. Endoscopic therapy was an effective tool for selected patients. The resulting increased duration of hospitalization and higher mortality rate in the patients submitted to therapeutic endoscopy were attributed to a higher prevalence of variceal bleeding and underlying liver disease.
Assuntos
Endoscopia Gastrointestinal/normas , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Úlcera Péptica/complicações , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Feminino , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/cirurgia , Hemostase Endoscópica/métodos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de RiscoRESUMO
Relata-se um caso de síndrome de choque tóxico por lesäo focal cutânea. o diagnóstico foi feito baseado em critérios clínicos de acordo com a definiçäo do Centro de Controle de Doenças em Atlanta (EUA). Faz se a revisäo do tema, discutindo-se o quadro clínico e laboratorial, bem como a importância do diagnóstico diferencial. O uso de corticosteróides e fibronectina teve efeito benéfico no curso da doença