A retrospective study was carried out, analyzing the diagnostic and therapeutic problems in 80 patients with acute cholangitis at the time of hospitalization. 23% of the 17 patients with pus in the bile duct showed Reynolds' pentad, which was observed in 10% of patients with nonsuppurative acute cholangitis. Common bile duct lithiasis was responsible in 80% of cases presenting with Reynolds' pentad and in 66% of postoperative mortality. In 75% of patients with tumors, the clinical picture showed a rapid development following PTC. 79% of patients responded positively to antibiotic therapy with subsequent elective surgery, while in 21% of patients who did not respond to antibiotic therapy, biliary drainage was the treatment of choice. Mortality in patients with shock or hypotension was 30% while it was 17% in those undergoing early (less than 72 hours) surgery. On the basis of the results, it is concluded that, since it is not possible to assess preoperatively whether a patient belongs to the group of suppurative acute cholangitis or to that of nonsuppurative acute cholangitis, the different severity of the clinical picture should be based on clinical and biochemical parameters. The most severe developments were observed in common bile duct lithiasis or in patients with tumors who underwent PTC. In case of failure to respond to antibiotic therapy, decompression was shown to be the most suitable treatment. The mortality rate is related to the severity of the clinical picture (presence or not of shock) as well as to a prompt surgical treatment.

Acute Disease↗

PubMed1966

Gastric ulcer perforating the thoracic aorta with fatal hemorrhage ten years after esophagitis. A case report.

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Aortic Diseases↗

PubMedDate not supplied

Effect of low-dose heparin treatment on fibrinolysis in patients with previous myocardial infarction.

The present study was designed to investigate whether medium-term, low-dose heparin treatment is able to affect the fibrinolytic system. In a randomized cross-over study 10 asymptomatic patients with previous (1-6 years) myocardial infarction underwent two sequential 15-day treatments, respectively, on heparin and on placebo (saline solution), preceded and separated by 10-day wash-out periods. Heparin (as calcium heparin, 12,500 IU in 0.5 ml) and saline (0.5 ml) were subcutaneously administered once a day at 8 a.m. Blood samples for fibrinolysis studies were withdrawn on the first and 15th day of each period immediately before and 4 h after heparin or saline administration before and after 10 min venous occlusion (VO) respectively. Four hours after the first heparin administration tissue plasminogen activator antigen (t-PA ag) levels significantly increased with respect to saline administration (p < 0.01 and p < 0.05, respectively). After 15-day heparin treatment a decrease in euglobulin lysis time (p < 0.05) and an increase in t-PA activity (act) (p < 0.05) and in t-PA ag (p < 0.01) in comparison with placebo were observed before VO. No statistically significant changes in plasminogen activator inhibitor-1 (PAI-1) levels were found. The variations of fibrinolytic system activity induced by heparin treatment were more marked when evaluated after VO. These results indicate that medium-term low-dose heparin treatment increases t-PA ag formation and/or release with consequent t-PA act increase.

Adult↗

PubMedDate not supplied

[Vesico-ureteral reflux: diagnostic and therapeutic procedures].

The vesico ureteral reflux (VUR) is the most common uropathy associated to urinary tract infections (UTI). The identification of V.U.R. is very important to avoid reflux nephropathy and it's complications. To avoid the exposure to unnecessary and injurious x-rays, the authors propose patient selection based on the presence or absence of distal ureteral dilatation and on the time elapsed between typical or atypical symptoms of u.t.i. and fever. First of all, it is essential to diagnose pielonephritis. After ultrasound and radionuclide scintigram with DMSA they select the infants who need cystourethrography. The infants with V.U.R. undergo antibiotic prophylaxis until spontaneous or surgical recovery. The duration of prophylaxis depends on the degree of V.U.R. and the age of the infant at diagnosis.

Age Factors↗

PubMedDate not supplied