GE Jornal Português de Gastrenterologia最新文献

{"title":"Sépsis em gastrenterologia – uma oportunidade para melhorar a nossa prática clínica","authors":"Isabelle Cremers","doi":"10.1016/j.jpg.2014.04.002","DOIUrl":"10.1016/j.jpg.2014.04.002","url":null,"abstract":"","PeriodicalId":100572,"journal":{"name":"GE Jornal Português de Gastrenterologia","volume":"21 4","pages":"Pages 129-130"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpg.2014.04.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78271960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemorragia digestiva obscura complicada de choque em Testemunha de Jeová","authors":"Susana Marques,&nbsp;Joana Carmo,&nbsp;Miguel Bispo,&nbsp;Pedro Barreiro,&nbsp;Cristina Chagas,&nbsp;Leopoldo Matos","doi":"10.1016/j.jpg.2014.03.004","DOIUrl":"10.1016/j.jpg.2014.03.004","url":null,"abstract":"<div><p>The severe gastrointestinal bleeding in a Jehovah's Witness poses a clinical challenge in which deontological and legal ethical standards are in conflict with the need of an effective and fast‐acting therapeutic approach. We present a case of a Jehovah's Witness, with a written refusal of transfusions, admitted for obscure overt gastrointestinal bleeding and acute severe anemia. The hospitalization was complicated by severe haemorrhage (minimum haemoglobin 3.5<!--> <!-->g/dL) and shock, without an identified etiology on upper gastrointestinal endoscopy and colonoscopy. An emergent angiography showed a contrast product leak in the jejunal branches of the superior mesenteric artery and a selective arterial embolization was performed. The clinical evolution was favorable, with progressive increase of the haemoglobin level. Jejunal angioectasias and aftoid erosions were observed in a videocapsule enteroscopy performed later. We discuss the ethical dilemma associated with this difficult clinical situation and present demonstrative iconography.</p></div>","PeriodicalId":100572,"journal":{"name":"GE Jornal Português de Gastrenterologia","volume":"21 4","pages":"Pages 161-164"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpg.2014.03.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91274521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disseminated histoplasmosis – Endoscopic presentation","authors":"Pedro Cardoso Figueiredo,&nbsp;Pedro Pinto-Marques,&nbsp;João Freitas","doi":"10.1016/j.jpg.2013.11.005","DOIUrl":"10.1016/j.jpg.2013.11.005","url":null,"abstract":"","PeriodicalId":100572,"journal":{"name":"GE Jornal Português de Gastrenterologia","volume":"21 4","pages":"Pages 167-168"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpg.2013.11.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79201771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An uncommon case of partial small‐bowel obstruction: Non‐steroidal anti‐inflammatory drug enteropathy","authors":"Miguel Serrano ,&nbsp;Susana Mão de Ferro ,&nbsp;Sara Ferreira ,&nbsp;Paula Chaves ,&nbsp;António Dias Pereira","doi":"10.1016/j.jpg.2014.01.003","DOIUrl":"10.1016/j.jpg.2014.01.003","url":null,"abstract":"","PeriodicalId":100572,"journal":{"name":"GE Jornal Português de Gastrenterologia","volume":"21 4","pages":"Pages 165-166"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpg.2014.01.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75060408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sépsis em gastrenterologia: uma entidade subvalorizada?","authors":"Liliana Eliseu ,&nbsp;Ricardo Cardoso ,&nbsp;Nuno Almeida ,&nbsp;Pedro Amaro ,&nbsp;Carlos Sofia","doi":"10.1016/j.jpg.2013.01.003","DOIUrl":"10.1016/j.jpg.2013.01.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Sepsis is a common disorder in all branches of Medicine, namely in Gastroenterology. Its high mortality rate can be decreased by an adequate early management, according to the international guidelines.</p></div><div><h3>Aims</h3><p>To evaluate the clinical impact of sepsis in a Gastroenterology department and to determine if it was correctly diagnosed and managed.</p></div><div><h3>Patients and methods</h3><p>Retrospective analysis based on data obtained from the clinical records. Selection of all patients admitted to a Gastroenterology department during one year presenting with sepsis criteria on hospital admission. Evaluation of demographic data and variables related to the appropriateness of the initial management – performance of blood cultures, evaluation of organ dysfunction and institution of prioritary interventions and antibiotic therapy. Statistical analysis was performed with <em>SPSS</em>® version 17 and <em>Qui-square</em> test (significance level of 0.05).</p></div><div><h3>Results</h3><p>We have identified 55 patients, in 56 hospital admissions (3.9% of the total admissions in the Gastroenterology department). All patients had infection and two or more criteria for systemic inflammatory response syndrome (SIRS), the most frequent being tachycardia (71.4%) and leukocytosis (66.1%). The biliary tract was the infectious source in 64.3% of cases. In 48.2% of the cases severe sepsis or septic shock criteria were present. The following procedures were not performed: blood pressure record in 14.3%, serum lactate measurement in 37.5%, urinary catheterization in 68.9% and central line placement in 94.6%. Blood cultures were obtained in the first 24<!--> <!-->hours in 66.1% of cases and the median time to start antibiotics was 8.8<!--> <!-->hours. Only 10.7% were admitted to an intensive care unit. The diagnosis of sepsis was established in the clinical records in only 6 cases. The mortality rate in these patients was higher than the overall mortality rate in the department (30.4% vs. 8.6%, <em>p</em> <!-->&lt;<!--> <!-->.0001).</p></div><div><h3>Conclusions</h3><p>This study found that sepsis in Gastroenterology has a high mortality rate, but it is rarely recognized and its management is not always completely adequate as shown by the lack of severity signs evaluation, delayed antibiotic therapy and low admission rate to an intensive care unit. Therefore, it is necessary to promote continuing medical education about sepsis and to implement local protocols.</p></div>","PeriodicalId":100572,"journal":{"name":"GE Jornal Português de Gastrenterologia","volume":"21 4","pages":"Pages 131-137"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpg.2013.01.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81543516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An aggressive case of anorectal melanoma","authors":"Susana Marques ,&nbsp;Raquel Silva ,&nbsp;Miguel Bispo ,&nbsp;Francisco Silva ,&nbsp;Leopoldo Matos","doi":"10.1016/j.jpg.2013.06.002","DOIUrl":"10.1016/j.jpg.2013.06.002","url":null,"abstract":"","PeriodicalId":100572,"journal":{"name":"GE Jornal Português de Gastrenterologia","volume":"21 4","pages":"Pages 169-171"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpg.2013.06.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89034078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Azatioprina na doença inflamatória intestinal: fatores preditivos da resposta sustentada a longo prazo","authors":"Ana Lúcia Sousa ,&nbsp;Paulo Caldeira ,&nbsp;Marta Eusébio ,&nbsp;Alda Martins ,&nbsp;Teresa Belo ,&nbsp;Horácio Guerreiro","doi":"10.1016/j.jpg.2014.05.002","DOIUrl":"10.1016/j.jpg.2014.05.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Azathioprine (AZA) is an option for maintenance therapy in Inflammatory Bowel Disease (IBD). However, the factors which influence or predict its response are poorly understood.</p></div><div><h3>Aim</h3><p>Evaluate the predictive factors for a successful long‐term therapeutic response of AZA.</p></div><div><h3>Methods</h3><p>Retrospective analysis of all patients with IBD followed up in our hospital treated with AZA (2‐2.5<!--> <!-->mg/Kg/day) due to steroid dependent or resistent disease or, in Crohn disease (CD), due to fistulizing behavior or post‐surgery. We recorded the type of disease (DC/ ulcerative colitis (UC), indeterminate IBD), clinical parameters, laboratory parameters (LP) – WBC, CRP, hemoglobin, platelets and MCV – before and after 3 months of treatment, as well as concomitant usage of 5‐ASA and steroids. The treatment was considered effective when patients maintained control of the disease by clinical/endoscopic criteria, with continued maintainance of AZA or cessation of therapy after 3 months of treatment, and without escalation of therapy. We excluded patients who show intolerance to AZA in the first 3 months and patients treated concomitantly with biological agents.</p></div><div><h3>Results</h3><p>72 patients (37 women and 35 men); mean age 38.0<!--> <!-->±<!--> <!-->13.8 years; 35 patients with CD, 34 with UC and 3 with indeterminate IBD. The average duration of treatment with AZA was 35.1<!--> <!-->±<!--> <!-->30.6 months. AZA was effective in 48 patients (66.7%). The age at onset of AZA predicts therapeutic sucess (R<!--> <!-->=<!--> <!-->0.303, <em>p</em> <!-->=<!--> <!-->0.019). The sex, type of disease and LP before treatment did not correlate with efficacy. The LP after 3 months of therapy correlated with therapeutic sucess in the long‐term: WBC (r<!--> <!-->=<!--> <!-->–0.295, <em>p</em> <!-->=<!--> <!-->0.013), CRP (r<!--> <!-->=<!--> <!-->–0.332, <em>p</em> <!-->=<!--> <!-->0.005), hemoglobin (r<!--> <!-->=<!--> <!-->0.307, <em>p</em> <!-->=<!--> <!-->0.010), platelets (r<!--> <!-->=<!--> <!-->–0.360, <em>p</em> <!-->=<!--> <!-->0.003) and MCV (r<!--> <!-->=<!--> <!-->0.255, <em>p</em> <!-->=<!--> <!-->0.047). In combination, LP predict the efficacy of treatment (R<!--> <!-->=<!--> <!-->0.517, <em>p</em> <!-->=<!--> <!-->0.005). There is also an association between the location of UC (r<!--> <!-->=<!--> <!-->–0.381, <em>p</em> <!-->=<!--> <!-->0.026), as well as the duration of concurrent treatment with 5‐ASA (r<!--> <!-->=<!--> <!-->0.258, <em>p</em> <!-->=<!--> <!-->0.029) and the suspension of steroids (r<!--> <!-->=<!--> <!-->0.265, <em>p</em> <!-->=<!--> <!-->0.04) with the efficacy of the treatment.</p></div><div><h3>Conclusion</h3><p>AZA proved to be an effective treatment in the majority of patients with IBD. The old age of onset of the therapy and LP at 3 months were predictive of a sustained response of AZA.</p></div>","PeriodicalId":100572,"journal":{"name":"GE Jornal Português de Gastrenterologia","volume":"21 4","pages":"Pages 147-154"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpg.2014.05.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83187839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hiperhomocisteínemia ‐ Uma ameaça oculta da doença inflamatória intestinal?","authors":"Joana Magalhães,&nbsp;Bruno Rosa,&nbsp;Maria João Moreira,&nbsp;Mara Barbosa,&nbsp;Ana Rebelo,&nbsp;Sílvia Leite,&nbsp;José Cotter","doi":"10.1016/j.jpg.2014.01.005","DOIUrl":"https://doi.org/10.1016/j.jpg.2014.01.005","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>Several recent studies have reported increased homocysteine levels in Inflammatory Bowel Disease (IBD). Hyperhomocysteinemia (hHcys) has been proved to be an independent risk factor for coronary artery disease, arterial and venous thrombosis, making it an interesting candidate as a pathogenic link in IBD. The aims of this study were to assess the prevalence of hHcys in patients with IBD and to investigate the relation between homocysteine levels and its main determinants.</p></div><div><h3>Material and methods</h3><p>Single‐center prospective study including 47 patients (29 patients with Crohn's disease and 18 patients with Ulcerative Colitis) consecutively observed in a consultation of Inflammatory Bowel Disease. Blood samples were obtained from all patients following fasting and these samples were used for determination of C reactive protein, folic acid, vitamin B₁₂ and homocysteine levels. Clinical data recorded from disease onset to the time of the homocysteine assay were analysed. Association between categorical variables and comparisons of means were tested by Fisher exact test and Student t test, respectively. To identify predictive factors of hHcys in patients with IBD, a linear regression analysis was applied. The statistical level of significance was established at 5%. Statistical analysis was performed with SPSS (version 18.0).</p></div><div><h3>Results</h3><p>In our series, 10.6% of IBD patients were found to have hHcys. Five patients (10.6%) had a previous history of thromboembolism. Compared to patients with normal homocysteine levels, those with hHcys were younger (<em>p</em> &lt;<!--> <!-->0.001), had lower levels of folic acid (<em>p</em> &lt;<!--> <!-->0.001), and had a lower illness duration (<em>p</em> &lt;<!--> <!-->0.001). In patients with hHcys there also were a statistically significant difference according to smoking status (<em>p</em> <!-->&lt;<!--> <!-->0.001). Linear regression analysis to predict homocysteine levels based on age, illness duration, vitamin B₁₂ and folic acid levels was significative (<em>p</em> <!-->=<!--> <!-->0.001) and explain 37% of the variance found in homocysteine levels of this sample. The level of folic acid was a significant predictor (<em>p</em> <!-->=<!--> <!-->0.01) of hHcys.</p></div><div><h3>Conclusion</h3><p>Hyperhomocysteinemia is a common phenomenon in patients with IBD. Preventive measures could focus on reversible risk factors correlated with hHcys, such as cessation of smoking and correction of vitamin deficiencies.</p></div>","PeriodicalId":100572,"journal":{"name":"GE Jornal Português de Gastrenterologia","volume":"21 4","pages":"Pages 155-160"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpg.2014.01.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92003956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hiperhomocisteínemia - Uma ameaca oculta da doenca inflamatória intestinal?","authors":"Joana Magalhães, Bruno Rosa, Maria João Moreira, Mara Barbosa, Ana Rebelo, S. Leite, J. Cotter","doi":"10.1016/J.JPG.2014.01.005","DOIUrl":"https://doi.org/10.1016/J.JPG.2014.01.005","url":null,"abstract":"","PeriodicalId":100572,"journal":{"name":"GE Jornal Português de Gastrenterologia","volume":"403 1","pages":"155-160"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76463515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TRÂNSITO GASTROINTESTINAL DE Rattus norvegicus (Berkenhout, 1769) (Rodentia:Muridae) APÓS ADMINISTRAÇÃO DE TEGASERODE","authors":"João Vicente Linhares Rodrigues ,&nbsp;Luiz C. Bertges ,&nbsp;Carolina F.M.G. Pimentel ,&nbsp;Priscilla O. Neves ,&nbsp;Renata L. Bormann ,&nbsp;José Ricci Júnior ,&nbsp;Pedro R. Nardelli ,&nbsp;Gabriela C. Toledo","doi":"10.1016/j.jpg.2014.02.005","DOIUrl":"10.1016/j.jpg.2014.02.005","url":null,"abstract":"<div><p>In a study conducted at the physiology laboratory of the Federal University of Juiz de Fora (UFJF), forty wistar rats were divided into two groups, one receiving saline, and the other gavage‐administered tegaserod, 1.0<!--> <!-->ml/animal, for 15 days. Thirty‐four animals, seventeen in each group, reached the end of the experiment. Tegaserod dose was 0.09<!--> <!-->mg/kg. The study aimed to assess the effects of tegaserod on the speed of gastrointestinal transit of wistar rats. Scintigraphic reading of the dissected digestive tracts (from the lower esophagus to the rectum) being used to assess intestinal transit. The scintigraphic assessment of the distance covered by the radiotracer in the dissected digestive tract of all animals did not show any statistically significant difference (<em>p</em> <!-->=<!--> <!-->0.1). We conclude that tegaserod, in the 0.09<!--> <!-->mg/kg dose, did not accelerate the intestinal transit of Wistar rats.</p></div>","PeriodicalId":100572,"journal":{"name":"GE Jornal Português de Gastrenterologia","volume":"21 4","pages":"Pages 138-146"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpg.2014.02.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73963161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}