Juanmartiñena-Fernández JF, Fernández-Urién-Sainz I, Zabalza-Ollo B, Saldaña-Dueñas C, Montañés-Guimera M, Elosua-González A, Vila-Costas JJ. Gastroduodenal lesions detected during small bowel capsule endoscopy: incidence, diagnostic and therapeutic impact. Rev Esp Enferm Dig 2018;110 (2) ABSTRACTBackground: Capsule endoscopy was primarily designed for the investigation of the small bowel. However, it may also identify lesions in other segments of the gastrointestinal tract. The aim of the current study was to evaluate the incidence of gastroduodenal abnormalities during small bowel capsule endoscopy and its impact on patient diagnosis and management.
Common variable immunodeficiency (CVI) gives a major risk of principally respiratory and digestive infections. It is associated with autoimmune diseases, granulomatous process and neoplasias. The digestive clinic is common, in 10% of patients it is the only symptom, and 60 % present chronic diarrhea. Clinically it can be confused and related with other pathologies such as inflammatory bowel disease which is infrequent (2-13%). We present the case of a patient with CVI with digestive symptoms being diagnosed of Crohn-like disease with extent ileal affectation. The main treatment of these patients is the same as classical Crohn disease although in the most severe cases, as this one, the use of immunosupresors is necessary. At this time the patient remains on clinical remmision with infliximab. She presented a previous adverse reaction with adalimumab. The few case series in this pathology makes the treatment with immunomodulators in this immunodeficiency a real diagnostic and therapeutic challenge.
notas clínicas0Gastric ischemia due to critical stenosis of the celiac trunk Isquemia gástrica secundaria a estenosis crítica del tronco celíaco doi.org/10.23938/ASSN.0248 c. saldaña Dueñas, a. Elosua González, a. Guerra lacunza abstract Gastric ischemia (GI) results from diffuse or localized vascular insufficiency caused by different aetiologies such as systemic hypotension, vasculitis, disseminated thromboembolism and celiac or mesenteric stenosis. We present a case of gastric ischemia due to critical stenosis of the celiac artery treated using endovascular therapy. The celiac artery is the first major branch of the abdominal aorta and provides some of the blood supply to the stomach through the left gastric artery and other organs like the spleen (splenic artery branch) and the liver. Although the collateral blood supply to the stomach is protective, systemic hypotension or occlusion of the main arteries, as in the case of our patient, may result in gastric ischemia. The stent placement is an alternative to surgery in patients with high comorbidity and with good outcomes. The clinical awareness of this syndrome will allow gastroenterologists and radiologists to appropriately diagnose and manage affected patients.Keywords. Gastric ischemia. Gastric ulcer. Celiac trunk stenosis. Endovascular stent. rEsumEnLa isquemia gástrica resulta de la insuficiencia vascular difusa o localizada causada por diferentes etiologías como la hipotensión sistémica, la vasculitis, el tromboembolismo diseminado y la estenosis mesentérica o celíaca. Presentamos un caso de isquemia gástrica secundaria a estenosis crítica del tronco celíaco tratada endovascularmente. El tronco celíaco es la primera rama de la aorta abdominal y aporta gran parte del flujo de sangre al estómago a través de la arteria gástrica izquierda y de otros órganos como el bazo (a través de la rama esplénica) y el hígado. Aunque las colaterales que irrigan el estómago son protectoras, la hipotensión sistémica o la oclusión de las principales ramas como en el caso que presentamos, pueden llevar a la isquemia gástrica. La colocación de stents endovasculares es una alterativa terapéutica a la cirugía en pacientes con gran comorbilidad y con buenos resultados. La sospecha clí-nica de este síndrome puede llevar tanto a gastroenterólogos como a radiólogos a un correcto diagnóstico y tratamiento de los pacientes afectos.Palabras clave. Isquemia gástrica. Úlcera gástrica. Estenosis del tronco celíaco. Stent endovascular.
REsUMEnLos quistes pericárdicos son lesiones poco frecuentes que se presentan como hallazgo casual en estudios radiológicos realizados por otros motivos.La mayoría son asintomáticos (>50%) pero su localización y relación con estructuras vecinas determinan las manifestaciones clínicas (tos persistente, disnea, dolor torácico...) Presentamos el caso de un paciente con dolor torácico opresivo a las dos semanas de un traumatismo torácico con una imagen sospechosa en la placa de tórax.Palabras clave. Pericardio. Fibrilación auricular. Quiste. aBstRactPericardial cysts are uncommon lesions usually found incidentally upon the radiologic investigation of some other condition.
TW4-response indicates the probability of achieving SVR to currently used DAA-based therapy in HCV genotype 3-infected individuals with cirrhosis. This finding may be useful to tailor treatment strategy in this setting.
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