RESUMO
Thromboembolic complications during the course of inflammatory bowel disease are infrequent but are mainly found in young patients and are associated with a high morbimortality. The etiopathogenesis of these complications has been widely debated and the existence of coagulation alterations and fibrinolysis have been suggested. Nonetheless, the mechanism must be complex since not only do not all the patients with these alterations present this complication but neither do all the patients with thromboembolism have recognized coagulation disorders. The most common clinical presentation is deep vein thrombosis with pulmonary embolism with arterial thrombosis being rare. Five patients with Crohn's disease and two with ulcerative colitis who presented a total of new thromboembolic episodes, six arterial (1 in primitive iliac artery, 1 in common femoral artery, 1 in humeral-axillary artery, 2 in internal carotid and 1 in superior mesenteric artery) and three of venous localization (1 in brachyocephalic-subclavian trunk, 1 axillary and 1 iliac-femoral/pulmonary thromboembolism) are reported. An updated review of the etiopathogenesis, presentation, treatment and prophylaxis of the thromboembolic complications of inflammatory bowel disease is presented.
Assuntos
Doenças Inflamatórias Intestinais/complicações , Tromboembolia/etiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Local hepatic tuberculosis without active pulmonary or miliary tuberculosis is an uncommon diagnosis. Even less common is the finding of a nodular form of local hepatic tuberculosis. There is a growing incidence of the disease related to human immunodeficiency virus. The authors report a case of pseudotumoral hepatic tuberculosis in a patient without AIDS, manifesting as prolonged fever, diagnosed previously as metastatic liver. Imaging studies of the liver and laparoscopic findings suggested metastatic disease. The correct diagnosis was made by histology of biopsies obtained in laparoscopy, which is an easy and cheap method, with less morbidity and mortality than surgical intervention. The case report illustrates the difficulty in reaching the correct diagnosis, most often confused with carcinoma of the liver, primary or metastatic. A greater awareness of this rare clinical entity may prevent needless surgical intervention since the majority of patients respond well to antituberculous chemotherapy.
Assuntos
Laparoscopia , Neoplasias Hepáticas/diagnóstico , Tuberculose Hepática/diagnóstico , Idoso , Biópsia , Diagnóstico Diferencial , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Tomografia Computadorizada por Raios X , Tuberculose Hepática/diagnóstico por imagem , Tuberculose Hepática/patologiaRESUMO
UNLABELLED: Porphyria cutanea tarda (PCT) is caused by reduced activity of hepatic uroporphyrinogen decarboxylase. However extrinsic factors such as alcohol abuse and drug intake are required for the clinical manifestation of the disease. Hepatitis C virus antibodies have been detected in a high percentage of patients with PCT. Hepatitis C virus is probably the main pathogenetic factor of liver damage in patients with PCT. AIM: To study the association between hepatitis C virus and PCT in our patients with PCT. MATERIAL AND METHODS: We have investigated six patients diagnosed of PCT in order to detect the presence of hepatitis C virus and other possible causes of the disease. RESULTS: We have found that 66% of our patients had hepatitis C virus antibodies, 50% ethanol abuse, of which 2/3 presented hepatitis C virus antibodies, and one case of HIV.
Assuntos
Hepacivirus/imunologia , Anticorpos Anti-Hepatite C/análise , Hepatite C/complicações , Hepatite Crônica/complicações , Porfiria Cutânea Tardia/complicações , Adulto , Alcoolismo/complicações , Biópsia , Ensaio de Imunoadsorção Enzimática , Soropositividade para HIV/complicações , Hepacivirus/genética , Hepacivirus/isolamento & purificação , Hepatite C/diagnóstico , Hepatite Crônica/diagnóstico , Humanos , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Porfiria Cutânea Tardia/diagnóstico , RNA Viral/análiseRESUMO
Wegener's granulomatosis is a necrotizing granulomatous vasculitis often characterized by involvement of the upper respiratory tract, lungs and kidney, although any organic system can be affected. We present the case of a female patient with Wegener's granulomatosis diagnosed by biopsy of the kidney, and severe gastrointestinal bleeding with fatal course. Endoscopic findings of the colon and the histopathology of the biopsy are discussed.
Assuntos
Gastroenteropatias/etiologia , Granulomatose com Poliangiite/complicações , Doença Aguda , Biópsia , Feminino , Gastroenteropatias/patologia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/patologia , Granulomatose com Poliangiite/patologia , Humanos , Rim/patologia , Pessoa de Meia-IdadeRESUMO
We reviewed 46 cases of Crohn's disease diagnosed during the period between 1978-1988, with the intention to analyse the age, sex, presentation, evolution, complications and diagnosis. The majority of patients were women, with a mean age of 39. In the last years we have seen an increment in our number of cases. The mean time to diagnosis was about 3.5 years. The main symptoms were abdominal pain, diarrhoea and loss of weight. The complications was of 40% in colonic disease and 75% when the affection was in ileum and colon. During the evolution 4 patients died, 2 of them from their Crohn's disease. One patient had a colonic carcinoma. In 15% of the cases there was a previous appendectomy. The most frequent radiological findings were in the small intestine: lack of haustration and cobblestone appearance. In the colon: lack of haustration and ulceration. The most frequent endoscopical findings were ulcers and a cobblestone appearance.
Assuntos
Doença de Crohn/epidemiologia , Adolescente , Adulto , Idoso , Doença de Crohn/complicações , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologiaRESUMO
Three patients afflicted with inflammatory bowel disease (1 UC, 1 Crohn's disease, 1 non-filiated colitis), who did not respond to the aggressive treatment from Oxford (3) were treated with immunosuppression therapy with cyclosporin. The dosage was 5-7 mg/day, to obtain seric levels (RIA) between 100-125 ng/ml during 3 months. All patients showed complete remission which was maintained for 6 months after the halt in treatment in the cases of the UC and non-filiated colitis. Parameters of cholestasis appeared with a transient increase of transaminase levels in 1 patient. Another patient suffered a pericarditis sicca which may not necessarily be related to the treatment.