RESUMO
Celiac disease, celiac sprue, or gluten-sensitive enteropathy, is a generalized autoimmune disease characterized by chronic inflammation and atrophy of the small bowel mucosa. It is caused by dietary exposure to gluten and affects genetically predisposed individuals. In Mexico, at least 800,000 are estimated to possibly have the disease, prompting the Asociación Mexicana de Gastroenterología to summon a multidisciplinary group of experts to develop the "Clinical guidelines on the diagnosis and treatment of celiac disease in Mexico" and establish recommendations for the medical community, its patients, and the general population. The participating medical professionals were divided into three working groups and were given the selected bibliographic material by the coordinators (ART, LUD, JMRT), who proposed the statements that were discussed and voted upon in three sessions: two voting rounds were carried out electronically and one at a face-to-face meeting. Thirty-nine statements were accepted, and once approved, were developed and revised by the coordinators, and their final version was approved by all the participants. It was emphasized in the document that epidemiology and risk factors associated with celiac disease (first-degree relatives, autoimmune diseases, high-risk populations) in Mexico are similar to those described in other parts of the world. Standards for diagnosing the disease and its appropriate treatment in the Mexican patient were established. The guidelines also highlighted the fact that a strict gluten-free diet is essential only in persons with confirmed celiac disease, and that the role of gluten is still a subject of debate in relation to nonceliac, gluten-sensitive patients.
Assuntos
Doença Celíaca/diagnóstico , Doença Celíaca/terapia , Dieta Livre de Glúten , Doença Celíaca/dietoterapia , Doença Celíaca/genética , Suscetibilidade a Doenças , Humanos , México , Cooperação do PacienteRESUMO
Five patients with active disseminated vitiligo were given 1g of a chimeric (murine/human) monoclonal antibody to CD20 in a single intravenous infusion and followed-up for 6 months. Three of the patients showed an overt clinical and histological improvement of the disease, one presented slight improvement and the remaining patient showed no changes. Improvement was neither associated with changes in laboratory parameters nor to a specific human leucocyte antigen D-related (HLA-DR) phenotype. We believe that these preliminary results are encouraging, and further clinical trials should be undertaken. An important aim should be the finding of a marker with a good response to this therapeutic approach.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Antígenos CD20/imunologia , Vitiligo/terapia , Animais , Anticorpos Monoclonais/administração & dosagem , Biomarcadores Farmacológicos/sangue , Progressão da Doença , Seguimentos , Antígenos HLA-DR/metabolismo , Humanos , Infusões Intravenosas , Camundongos , Projetos Piloto , Proteínas Recombinantes de Fusão/administração & dosagem , Proteínas Recombinantes de Fusão/uso terapêutico , Equilíbrio Th1-Th2 , Resultado do TratamentoRESUMO
UNLABELLED: Massive hepatobiliary fascioliasis. Report of two cases. INTRODUCTION: Liver fascioliasis is the most frequent parasitic disease of the biliary tract in Mexico. Massive infestation is common in sheep and bovines and rarely occurs in humans. Only two previous cases of massive fascioliasis has been reported and we present here in two additional cases. Case reports. Both cases presented in alcohol-related liver disease patients who had eaten watercress Nasturium officinalis. Upper abdominal pain, obstructive jaundice, and choledochal dilatation were the salient manifestations. Diagnosis was made by surgical exploration and adult fluke identification. One patient died due to progressive liver failure and the other, is alive and received praziquantel treatment. CONCLUSIONS: Since 1935, approximately fifty cases of massive hepatobiliary fascioliasis have been reported in Mexico, most misdiagnosed as cholelithiasis; however, a history of watercress ingestion has been recorded in most of these cases.
Assuntos
Fasciolíase/patologia , Idoso , Idoso de 80 Anos ou mais , Anti-Helmínticos/uso terapêutico , Colecistite/complicações , Doença Crônica , Terapia Combinada , Diabetes Mellitus Tipo 2/complicações , Fasciolíase/complicações , Fasciolíase/tratamento farmacológico , Fasciolíase/epidemiologia , Fasciolíase/cirurgia , Evolução Fatal , Feminino , Contaminação de Alimentos , Parasitologia de Alimentos , Humanos , Hipertensão/complicações , Cirrose Hepática Alcoólica/complicações , Falência Hepática/etiologia , Masculino , Pessoa de Meia-Idade , Plantas Comestíveis/parasitologia , Praziquantel/uso terapêuticoRESUMO
A patient with a stage IV high-grade non-Hodgkin's lymphoma who developed a fatal hemophagocytic syndrome is presented: When the patient had achieved complete remission and receiving fludarabine and chlorambucil/prednisone, she developed miliary tuberculosis, the CD4+ T-cell count then being 50/microL; the hemophagocytic syndrome ensuing at this point was fatal. Speculations about the predisposing factors that could have led to this complication are discussed focusing on the severe cellular immunosuppression which developed probably related to the use of fludafabine: it could be useful in the future to use anti-tuberculous prophylaxis in selected patients treated with this purine nucleoside analog.
Assuntos
Antineoplásicos/uso terapêutico , Histiocitose de Células não Langerhans/etiologia , Imunossupressores/uso terapêutico , Linfoma não Hodgkin/complicações , Linfoma não Hodgkin/tratamento farmacológico , Tuberculose/complicações , Vidarabina/análogos & derivados , Adulto , Evolução Fatal , Feminino , Histiocitose de Células não Langerhans/fisiopatologia , Humanos , Vidarabina/uso terapêuticoRESUMO
A twenty six year old woman was admitted suffering an anemia syndrome, postprandial vomiting and intermittent melena of six months evolution. The hemoglobin was 3.5 g/dL: an endoscopy detected a large tumor in the duodenum with a 90% obstruction of the lumen. A biopsy reported an erosive, acute and chronic duodenitis. Subsequently a surgical exploration with duodenotomy showed a large nodular polyp attached to a stalk that was removed: a hamartomatous polyp of Brunner's glands was reported. It coursed with gastrointestinal bleeding and symptoms of duodenal obstruction, which are two of the most common symptoms of this rare tumor.
Assuntos
Glândulas Duodenais , Duodenopatias/complicações , Hemorragia Gastrointestinal/etiologia , Hamartoma/complicações , Pólipos Intestinais/complicações , Adulto , Anemia/etiologia , Glândulas Duodenais/patologia , Diagnóstico Diferencial , Duodenopatias/diagnóstico , Neoplasias Duodenais/diagnóstico , Duodenite/complicações , Feminino , Hamartoma/diagnóstico , Humanos , Obstrução Intestinal/etiologia , Pólipos Intestinais/diagnóstico , Leiomioma/diagnóstico , Melena/etiologiaRESUMO
A 31-year-old patient with a clinical picture of obstructive jaundice had surgical treatment, and a primary carcinoid of the ampulla of Vater (VA) was found. The tumor was studied with light microscopy, immunohistochemistry, and electron microscopy. The neoplasm had histopathologic and cytopathologic features similar to those encountered in typical neuroendocrine neoplasms. It is interesting that immunohistochemical techniques disclosed the presence of vasointestinal polypeptide, cholecystokinin, and bombesin; however, unlike most neuroendocrine neoplasms arising in VA, no somatostatin-immunoreactive cells were found.