Symptoms suggesting gastric cancer are gastrointestinal bleeding, weight loss, and to a lesser degree anorexia and fatigue. Gastric cancer patients show a greater intensity but shorter duration of symptoms than patients with no cancer. Age and alarm symptoms cannot determine the need for upper gastrointestinal endoscopy, at least in areas of high prevalence of gastric cancer.
This is the largest CSy-IBD case series so far. Although CSy is considered to be an autoimmune disease and is associated with IBD, immunomodulatory IBD maintenance treatment and even anti-TNF therapy do not seem to prevent disease onset. Moreover, IBD disease activity does not seem to trigger CSy. However, vigilance may prompt early diagnosis and directed intervention with corticosteroids at inception may potentially hinder audiovestibular deterioration. Finally, vigilance and awareness may also offer a better setting to study the pathophysiological mechanisms of this rare but debilitating phenomenon.
: It seems that hypervolemia and vasodilatation coincide in compensated cirrhosis, but neither rank nor importance of these factors has been fully clarified in adaptive response to postural change. We studied, with gated equilibrium radionuclide angiography and thoracic electrical bioimpedance the hemodynamic status of 19 patients with compensated cirrhosis and 18 healthy subjects in upright and supine positions. In the upright position, the cirrhotic patients were hypotensive and had decreased peripheral vascular resistance despite increased cardiac output. The transition to the supine position was accompanied by a significant fall in the heart rate and an increase in the stroke volume in both controls (92±22 to 63±10 beats/min, and 38±9 to 62±19 ml/m2, respectively) and cirrhotic patients (101±20 to 79±13 beats/min, and 44±15 to 63±19 ml/m2, respectively). Besides, the diastolic arterial pressure fell in controls from 89±9 mmHg to 81 ± 11 mmHg; p <0.01, while it remained unchanged in cirrhotic patients (77±17 vs 82±13 mmHg). In the supine position, the cirrhotic patients presented tachycardia and left ventricular hyperkinesy (increased velocity of left ventricular filling and emptying). In conclusion, these results show that in compensated cirrhosis the decreased arterial tone and peripheral blood pooling are important factors of adaptive hemodynamic reaction to postural change.
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