António Murinello , Pedro Guedes , Gizela Rocha , Ana Serrano , António Figueiredo , Helena Damásio , João Freire , Fernando Cunha , Liliana Alves
{"title":"Trousseau's syndrome due to asymptomatic pancreatic adenocarcinoma","authors":"António Murinello , Pedro Guedes , Gizela Rocha , Ana Serrano , António Figueiredo , Helena Damásio , João Freire , Fernando Cunha , Liliana Alves","doi":"10.1016/j.jpg.2012.09.006","DOIUrl":"10.1016/j.jpg.2012.09.006","url":null,"abstract":"<div><p>The authors report a case of Trousseau's syndrome presenting in a previously asymptomatic 58-year-old man diagnosed with pancreatic adenocarcinoma and liver metastases during a workup prompted by migratory venous thrombosis and pulmonary embolism. It was followed by an ischaemic stroke that occurred while the patient was just one day off anticoagulant therapy with low-molecular-weight heparin to allow for liver and pancreatic biopsies. Trousseau's syndrome is defined by recurrent or migratory venous thrombosis, arterial embolism caused by non-bacterial thrombotic endocarditis, or both, in patients with underlying malignancy. Treatment relies on the lifelong administration of heparin, and its interruption – however brief – may promote new thrombotic events.</p></div>","PeriodicalId":100572,"journal":{"name":"GE Jornal Português de Gastrenterologia","volume":"20 4","pages":"Pages 172-176"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpg.2012.09.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83784395","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}
Miguel Serrano , Susana Mão de Ferro , Paula Chaves , António Dias Pereira
{"title":"Endoscopic resection combined with radiofrequency ablation for early adenocarcinoma in Barrett's esophagus","authors":"Miguel Serrano , Susana Mão de Ferro , Paula Chaves , António Dias Pereira","doi":"10.1016/j.jpg.2012.11.001","DOIUrl":"10.1016/j.jpg.2012.11.001","url":null,"abstract":"","PeriodicalId":100572,"journal":{"name":"GE Jornal Português de Gastrenterologia","volume":"20 4","pages":"Pages 183-185"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpg.2012.11.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89615588","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":"Hepatite autoimune: os critérios simplificados são menos sensíveis?","authors":"Lurdes Correia, Rita Monteiro, Adélia Simão, Emília Louro, Arsénio Santos, Armando Carvalho","doi":"10.1016/j.jpg.2012.10.004","DOIUrl":"10.1016/j.jpg.2012.10.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Autoimmune hepatitis (AIH) has variable clinical presentation and recognition can be difficult. The diagnostic criteria of the International AIH Group initially proposed for scientific purposes, are complex in clinical practice. In 2008, Henes et al. proposed simplified diagnostic criteria (SDC), with positive and negative predictive values of about 90%, but they need further confirmation.</p></div><div><h3>Objective</h3><p>To compare classic and simplified criteria in patients with AIH.</p></div><div><h3>Methods</h3><p>Retrospective analysis of clinical records and application of diagnostic criteria.</p></div><div><h3>Results</h3><p>Included 42 patients (40 females/2 males), with mean age of 38 years old (9-78). Chronic hepatitis was the form of presentation in 66.7%, acute hepatitis in 23.8% and fulminant hepatitis in 9,5%. The majority (91%) had type <span>I</span> HAI and 24% were asymptomatic. Asthenia (64%), jaundice (50%), anorexia (47%), weight loss (31%), arthralgia (29%), hepatomegaly (24%), nausea and vomit (24%) were the most frequent clinical findings; 21% had another autoimmune disease. Patients were treated with prednisolone and azathioprine (45.2%), prednisolone (35.7%) or deflazacort (2,4%); the evolution was favorable in 86% patients, 14% died. In pre-treatment, classic diagnostic criteria classified 25 patients (60%) as definite AIH and 17 (40%) as probable; applying SDC, there was agreement with classic criteria in only19 patients (45%); AIH changed from definite to probable in 14 (33%) and from probable to definite in 3 (7%); in 14% the score was inferior to 6 (definite AIH in 3 and probable in 3, in classic criteria).</p></div><div><h3>Conclusions</h3><p>In our patients, type <span>I</span> AIH (91%) and chronic hepatitis presentation form (66, 7%), were the most frequent. The majority had remission with treatment. Comparison between the diagnostic criteria revealed concordance in 45% of the cases; in 14% the SDC didn’t allow classification as HAI. In practice, faced with suspected HAI, SDC are an initial option, but classical criteria should also be used, particularly in atypical cases.</p></div>","PeriodicalId":100572,"journal":{"name":"GE Jornal Português de Gastrenterologia","volume":"20 4","pages":"Pages 145-152"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpg.2012.10.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83823804","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}
João Xavier Jorge, Luís António de Sousa, Edgard Augusto Panão, Mário Júlio Campos, António Gonçalves, Abel Cardoso do Vale, Fausto Afonso Pontes
{"title":"Fístulas biliodigestivas litiásicas (a propósito de 3 casos clínicos)","authors":"João Xavier Jorge, Luís António de Sousa, Edgard Augusto Panão, Mário Júlio Campos, António Gonçalves, Abel Cardoso do Vale, Fausto Afonso Pontes","doi":"10.1016/j.jpg.2012.07.002","DOIUrl":"10.1016/j.jpg.2012.07.002","url":null,"abstract":"<div><p>Spontaneous bilio-digestive fistulae are infrequent. We report three cases.</p></div><div><h3>Case 1</h3><p>A 59 year old male, was admitted to the Emergency Department with complaints of abdominal pain, hematoquesia and pallor. The haemoglobin was 8.4<!--> <!-->g/dl. Colonoscopy and upper gastrointestinal endoscopy were normal. He was given blood transfusion and subsequently discharged. Eighteen days later, he was readmitted to the Emergency Department with the same complaints. The exams were normal and after a transfusion, he was discharged. He was again admitted to the Emergency Department after six days. During his hospitalization he had two episodes of hematoquesia. The colonoscopy revealed a blood clot in the hepatic angle. An urgent surgery was made and revealed a cholecistocolonic fistulae, vesicular lithiasis and hemobilia.</p></div><div><h3>Case 2</h3><p>A 74 year old male was admitted with to the Emergency Department with a history of melenas with a Hb of 9.7<!--> <!-->g/dl. The upper gastrointestinal endoscopy revealed gastric and duodenal erosions and blood. The colonoscopy showed edematous and congested mucosal folds the splenic angle of the descending colon. He was given blood transfusions and subsequently discharged. Nearly 45 days later, the patient presented to the Emergency Department complaining of difficulty in evacuating stools. The proctologic examination revealed a petrous object in the rectum which was manually removed under anesthesia. The object was a large billiary stone.</p></div><div><h3>Case 3</h3><p>A 75 year old male, with obstructive jaundice and bulbar deformation was admitted to the hospital for an ERCP. The CT had revealed a dilatation of intra and extra hepatic biliary tree and aerobilia. During the ERCP, just above the papilla, a small orifice draining bile was observed along with a calculus at the end of the choledocus.</p></div><div><h3>Conclusions</h3><p>It were 3 cases of biliodigestive fistulas secondary to gallstones.</p></div>","PeriodicalId":100572,"journal":{"name":"GE Jornal Português de Gastrenterologia","volume":"20 3","pages":"Pages 119-122"},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpg.2012.07.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85417034","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}
Carlos Fernandes, Luís Alberto, Rolando Pinho, Ricardo Veloso, Teresa Pinto-Pais, João Carvalho, José Fraga
{"title":"Síndrome de Klippel-Trenaunay-Weber – Hemorragia gastrointestinal em doente jovem","authors":"Carlos Fernandes, Luís Alberto, Rolando Pinho, Ricardo Veloso, Teresa Pinto-Pais, João Carvalho, José Fraga","doi":"10.1016/j.jpg.2012.07.005","DOIUrl":"10.1016/j.jpg.2012.07.005","url":null,"abstract":"<div><p>Klippel-Trenaunay-Weber syndrome is a rare pathology characterized by the occurrence of capillary cutaneous malformations, venous and/or lymphatic anomalies, bony and/or soft tissue hypertrophy associated with arteriovenous malformations. Gastrointestinal involvement occurs in about 1/5 of affected patients and usually presents as lower gastrointestinal bleeding. Treatment is mainly symptomatic. The authors present a clinical case of a 19 year-old woman with known Klippel-Trenaunay-Weber syndrome who was referred to our Proctology outpatient clinic due to sporadic rectal bleeding since early childhood. She had venous insufficiency of her right lower limb, capillary cutaneous hemangiomas in both lower limbs and hypertrophy of the left lower limb. Proctologic examination revealed grade II haemorrhoids, which were congested but not friable. On flexible sigmoidoscopy, several varicose veins with polypoid appearance and endoscopically normal mucosa were apparent. Management with laxatives and dietary fiber increase was initiated with symptomatic improvement.</p></div>","PeriodicalId":100572,"journal":{"name":"GE Jornal Português de Gastrenterologia","volume":"20 3","pages":"Pages 128-131"},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpg.2012.07.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76547091","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 e disfunção múltipla de órgãos na cirrose hepática","authors":"Isabel Militão, Paulo Carrola, José Presa","doi":"10.1016/j.jpg.2012.12.005","DOIUrl":"10.1016/j.jpg.2012.12.005","url":null,"abstract":"<div><p>Cirrhotic patients have an increased susceptibility to infections, which worsen their prognosis, frequently progressing to sepsis and multiorgan failure.</p><p>The diagnosis of systemic inflammatory response syndrome and sepsis is difficult in these patients because of the clinical and analytical changes typical of advanced cirrhosis. The exaggerated proinflammatory response observed in these patients exacerbates the systemic dysfunction and worsens their prognosis.</p><p>The therapeutic approach in cirrhotic patients with sepsis should include early empirical antibiotic therapy, intensive clinical and hemodynamic monitoring and support of vital organ functions.</p><p>A careful assessment of prognosis is essential in establishing the probability of individual survival and management of resources. Multiple prognosis scores are used in critically ill patients, including patients with cirrhosis and multiorgan dysfunction, and it seems that the general prognosis scores are more effective in this group of patients.</p></div>","PeriodicalId":100572,"journal":{"name":"GE Jornal Português de Gastrenterologia","volume":"20 3","pages":"Pages 103-111"},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpg.2012.12.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90528019","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}
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