Biomedical subjects
Publications and source records attributed to E Areias.
The authors present the case of a 32-year-old woman, with acute alcoholic hepatitis(AAH), severe ionic changes and ventricular tachycardia torsade de pointes. Treatment with magnesium sulphate and the use of corticotherapy for AAH are the subjects for discussion.
Out of 210 cases of ulcerative colitis 41 had skin and mucosal lesions: skin lesions in 23 (11%), oral ones in 11 (5.2%) and perianal in 16 (7.6%). Cutaneous lesions were: maculopapular rashes (5.2%), erythema nodosum (2.9%), pyoderma gangrenosum (1.4%), papulopustular lesions, vasculitis and erythema multiforme (1% each). Aphthae were the commonest oral complication (4.3%) and fissures and fistula the more prevalent perianal ones (4.3% and 3.4%). More than one mucocutaneous complication occurred in 17.1% of the patients and in 18 patients there were associated articular (36.6%), ocular (9.8%) and hepatic (2.4%) changes. The colitic type of arthritis and keratoconjunctivitis sicca were the commoner joint and eye manifestations.
Erythema nodosum (EN) has been reported in patients with ulcerative colitis (UC) since 1909. The reported incidence varies from 0.9 p. 100 to 18.9 p. 100. A wide range of incidence of EN has also been found in Crohn's disease (CD), with figures varying from 0.7 p. 100 to 8 p. 100 (fig. 1). Different criteria for the diagnosis of EN, UC and CD probably account for the scattering of values. A review of 324 cases of inflammatory bowel diseases revealed 21 cases with one or more episodes of EN: 6 out of 195 cases of UC (3.1 p. 100) and 15 out of 129 cases of CD (11.6 p. 100). The incidence was higher in females (5.7 p. 100 in UC, 17.5 p. 100 in CD) than in males (0 in UC, 6.9 p. 100 in CD). At the time of the eruption, patients with CD were younger (mean 24.3 years) then those with UC (mean 37.5 years). The interval between the onset of the intestinal symptoms and the nodular eruption was shorter in patients with CD (2.6 years) than in those with UC (8.2 years). The inflammatory bowel disease (whether UC or CD) started earlier in patients with EN than in EN-free patients. EN antedated the onset of intestinal manifestations in one patient with UC. In the remaining 20 patients the intestinal symptoms came first. EN was often recurrent, and the 21 patients suffered 32 episodes at varying intervals. One patient had 4 and another 3 episodes; six patients had 2 and 13 had one single episode. Three patients with UC had 2 episodes and 5 patients with CD had 2 or more episodes. The morphology and distribution of the lesions was fairly classical, except in 2 patients who had only 1 and 2 nodules respectively on one leg. The eruption subsided in all cases within 2 to 5 weeks, and no atrophy, suppuration or ulceration was observed. Most episodes of EN occurred during active phases of the intestinal disease. This was not so, however, in 2 cases in which the eruption followed an acute streptococcal throat infection. EN was more often found in total UC than in the less extensive distal and rectal types (Table I). It was also more frequent in the ileocolic form than in the exclusively ileal and colonic forms (Table II).(ABSTRACT TRUNCATED AT 400 WORDS)
Explore the source record for details and available documents.
Erythema nodosum was found on 11 out of 106 patients with Crohn's disease (10.4%), being the most common skin complication after the perianal ones. Women were affected more often than men (2.7:1) and most of the patients were above 15 and below 40 years of age. Patients with ileocolic lesions were more often affected than those with lesions confined to the small bowel. No cases of erythema nodosum were found in association with granulomatous colitis, as opposed to other authors experience. The eruption was usually related to the periods of active inflammatory bowel disease but not to the administration of salazopyrine. The morphology and evolution of the lesions was typical of erythema nodosum and joint involvement was almost constant. The differential diagnosis with other nodular eruptions that can occur in association with Crohn's disease are discussed and hypothetical common etiopathogenic factors to both Crohn's disease and erythema nodosum are briefly considered. The relevant literature is reviewed and commented upon.
Explore the source record for details and available documents.
The bile salts secretion was studied in ten normal subjects and sixteen patients with alcoholic cirrhosis, in a basal period and during 60 minutes after Secretin injection. Total bile salts were measured by a modification of the enzymatic method of Iwata and Yamasaki and the individual bile salts were separated by silica gel thin-layer chromatography. During the 60 minutes after Secretin the mean concentration was 2.88 +/- 2.58 muM/ml in normals and 1.96 +/- 1.25 muM/ml in cirrhotics. The difference is not significant. During the first 20 minutes however the concentration was higher than 3 muM/ml in 8 out of 10 normals and lower than 2 muM/ml in 10 out 16 cirrhotics. The ratios of tri-to dihydroxy bile salts was similar in both groups. The ratios between bile salts conjugated with glycine and with taurine was higher in normals, and the ratio between free to conjugated bile salts was higher in cirrhotics. The lower concentration of total bile salts immediatly after Secretin, the higher proportion of taurin conjugates and of free bile salts could be important factors in the difficulties of fact digestion and absorption frequently found in patients with alcoholic cirrhosis.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
From 388 patients with upper G.I. bleeding investigated by endoscopy, radiology or emergent surgery, one third bled from duodenal ulcer, one third oesophageal varices, and from the remain the most frequent were gastric ulcer (14%) and gastric cancer (9%). From a sample of 53 patients with liver cirrhosis, 66% bled from varices and 34% from other lesions. The proportion of patients who bled from oesophageal varices is higher under 60 yrs. The mortality was higher after 60 yrs, except when there was associated chronic liver disease or renal or cardio-respiratory failure. In this group of patients, near half in our series, the mortality is the same under and above 60 years.
Differential diagnosis concerning Crohn's Disease and intestinal tuberculosis is often difficult. The authors present an illustrative case with ileal tuberculosis and secondary amyloidosis. Diagnostic tools and therapeutic measures are described. Literature review and theoretical discussion of both pathologies are included.