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Portal hypertensive biliopathy: A single center experience and literature review

World Journal of Hepatology 2013年第3期5卷 137-144页

作者： Vanessa Suárez Andrés Puerta Luisa Fernanda Santos Juan Manuel Pérez Adriana Varón Rafael Claudino Botero Gastroenterology and Hepatology service Department of Internal Medicine Fundación Cardioinfantil Department of Diagnostic Imaging Fundación Cardioinfantil

Portal hypertensive biliopathy (PHB) is characterized by anatomical and functional abnormalities of the intrahepatic, extrahepatic and pancreatic ducts, in patients with portal hypertension associated to extrahepatic portal vein obstruction and less frequently to cirrhosis. These morphological changes, consisting in dilatation and stenosis of the biliary tree, are due to extensive venous collaterals occurring in an attempt to decompress the portal venous blockage. It is usually asymptomatic until it progresses to more advanced stages with cholestasis, jaundice, biliary sludge, gallstones, cholangitis and finally biliary cirrhosis. Imaging mo-dalities of the biliary tree such as Doppler ultrasound, computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are essential to establish the diagnosis and the need of therapeutical interventions. Once the diagnosis is established, treatment with ursodesoxycholic acid seems to be beneficial. Decompression of the biliary tree to dilate, remove stones or implant biliary prosthesis by endoscopic or surgical procedures (hepato-yeyunostomy) usually resolves the cholestatic picture and prevents septic complications. The ideal treatment is the decompression of the portal system, with transjugular intrahepatic porto-systemic shunt or a surgical porto-systemic shunt. Unfortunately, few patients will be candidates for these procedures due to the extension of the thrombotic process. The purpose of this paper is to report the first 3 cases of PHB seen in a Colombian center and to review the literature.

关键词： Bile duct diseases Biliary obstruction Banti’s syndrome Cholestasis in children Portal vein obstruction Interventional endoscopy

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Clinical Presentations and Outcome of Cardiovascular Emergencies in Yaounde: A Cross-Sectional Study

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World Journal of Cardiovascular diseases 2018年第2期8卷 133-142页

作者： Ba Hamadou Yaya Toure Kalissou Ahmadou Musa Jingi Sylvie Ndongo Amougou Sandrine Edie Dikosso Rodrigue Njouoguep Samuel Kingue Department of Internal Medicine and Specialties Faculty of Medicine and Biomedical Sciences University of Yaounde 1 Yaounde Cameroon Internal Medicine service Cardiology Unit Yaounde Central Hospital Yaounde Cameroon Yaounde Emergency Center Yaounde Cameroon

Background: Cardiovascular emergencies have become a public health problem with a high burden in low-income settings. This is due to the high rates of cardiovascular risk factors that are fast reaching epidemic?proportions. There is paucity of data on cardiovascular emergencies to guide repost strategies in our setting. Our aim was to determine the clinical presentation and outcome of cardiovascular emergencies at Yaounde Emergency Center.?Methods: We carried out this cross-sectional study between June 2015 and May 2017. We included all patients with confirmed cardiovascular emergency. We consecutively collected data on socio-demography, symptoms on admission, past history, clinical findings, and final diagnosis at discharge or in the event of death. Results: Of the 8285 patients admitted for medical emergencies, 388 (4.7%) were cardiovascular emergencies. Their mean age was 59.5 ± 13.8 years, and 59% were males. The Medical Emergency Aid service was the means of transporting 4% of patients. The median time of arrival at the hospital was 48 hours. Symptoms on admission were mainly weakness of a limb (43.8%), and altered consciousness (33.5%). The most common cardiovascular emergencies were ischemic stroke (30.9%), hypertensive emergency (21.4%), and hemorrhagic stroke (16.5%). The most common comorbidity was diabetes (21.9%). The death rate in the 24 - 72 hours was 14.4%. The causes of death were hypertensive emergency (35.7%), and hemorrhagic stroke (30.3%). Conclusion: Stroke and hypertensive emergency were the most frequent cardiovascular emergencies. The early mortality was high. hemorrhagic stroke and hypertensive emergencies accounted for most cases of death.

关键词： Cardiovascular Emergencies Ischemic Stroke hemorrhagic Stroke Cameroon

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SSRI和他汀类药物可增加蛛网膜下腔出血后血管痉挛的风险

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世界核心医学期刊文摘（神经病学分册） 2005年第9期1卷 47-48页

作者： Singhal A.B. Topcuoglu M.A. Dorer D.J. 周永 Stroke service VBK-802 Massachusetts General Hospital Boston MA 02114 United States Dr.

Background: Use of medications with vasoconstrictive or vasodilatory effects can potentially affect the risk for vasospasm after aneurysmal subarachnoid hemorrhage (SAH). Methods: Using International Classification of diseases-9 diagnostic codes followed by medical record review, the authors identified 514 patients with SAH admitted between 1995 and 2003 who were evaluated for vasospasm between days 4 and 14. The authors determined risks for vasospasm, symptomatic vasospas m, and poor clinical outcomes in patients with documented pre-hemorrhagic use o f calcium channel blockers, beta-receptor blockers, ACE inhibitors, aspirin, se lective serotonin reuptake inhibitors (SSRIs), non-SSRI vasoactive antidepressa nts, or statins. Results: Vasospasm developed in 62%, and symptomatic vasospasm in 29%of the cohort. On univariate analysis, the risk for all vasospasm tended to increase in patients taking SSRIs (p=0.09) and statins (p=0.05); SSRI use in creased the risk for symptomatic vasospasm (p=0.028). The Cochran-Armitage tren d test showed that the proportion of patients taking SSRIs and statins increased significantly across three wors ening categories (none, asymptomatic, symptomatic) of vasospasm. Logistic regres sion analysis showed that SSRI use tended to predict all vasospasm (O.R. 2.01 [0 .91 to 4.45]), and predicted symptomatic vasospasm (O.R. 1.42 [1.06 to 4.33]) . Statin exposure increased the risk for vasospasm (O.R. 2.75 [1.16 to 6.50]), perh aps from abrupt statin withdrawal (O.R. 2.54 [0.78 to 8.28]). Age < 50 years, Hunt-Hess grade 4 or 5, and Fisher Group 3 independently predicted all vasospasm, symptomatic vasospasm, poor discharge clinical status, and death. Conclusion: Selective serotonin reuptake inhibitor and statin users have a higher risk for su barachnoid hemorrhagerelated vasospasm. Whether the underlying disease indicatio n, direct actions, or rebound effects from abrupt drug withdrawal account for th e associated risk warrants further investiga

关键词：蛛网膜下腔出血血管痉挛他汀类药物 SSRI 钙通道阻滞剂血管收缩抗抑郁药 β受体阻滞剂国际疾病分类天对

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Acute hemorrhagic Fever: Clinical, Epidemiological and Laboratory Aspects in São Toméand Príncipe

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Advances in Infectious diseases 2022年第4期12卷 721-744页

作者： Eula Carvalho Didiena Vilhete Clara Assunção Ana Silva Jessica Vicente Ana Cristina Cleiser Vagente Francelina Costa Celdidy Monteiro Bakissi Pina Medicine service Dr. Ayres de Menezes Hospital S&#227 o Tomé S&#227 o Tomé and Príncipe Manuel Quaresma Dias da Graç a Hospital S&#227 o Tomé S&#227 o Tomé and Príncipe Centro de Saúde de Mezochi Health Area of Mezochi S&#227 o Tomé S&#227 o Tomé and Príncipe Laboratory of Clinical Analyses Hospital Dr Ayres de Menezes S&#227 o Tomé S&#227 o Tomé and Príncipe Direction of Health Care Sector of Investigation Department of Epidemiological Surveillance S&#227 o Tomé S&#227 o Tomé and Príncipe

Background: In the last 6 months, cases of acute hemorrhagic fever (AHF) have been recorded in Sao Tome and Principe (STP). Objective: To identify the clinical, epidemiological and laboratory parameters associated with AHF cases found in patients hospitalized in STP. Methods: Descriptive and quantitative analysis of AHF cases hospitalized in STP in the period December 2021 to May 19, 2022 through the variables: demographic data;clinical data;laboratory data and clinical outcome. Results: Analyzed 18 of 22 AHF cases, 50% of them male, mean age 33.7 years, 85.7% residing in the 2 largest districts of the country, 66.7% rural workers, administrative near maritime areas, sailors and domestics. 66.7% were healthy individuals. ≥50% had a fever, asthenia/weakness, myalgia, headache, lethargy, nausea, vomiting, and diarrhea. 22.2% to 33.3% had retro-orbital pain, abdominal pain, decreased consciousness, dyspnea/hypoxia, and cough. In a smaller register (5.6% - 11.1%), exanthema, convulsion, arthralgia, low back pain, chills, and chest pain. Bleeding from the digestive tract was found in 72.2%, followed by vaginal (33.3%), urethral (27.8%), nasal (22.2%), and oral (16.7%). 50% had laboratory confirmation for dengue, and another 50% with suspected clinical diagnosis without laboratory confirmation of the etiologic agent. Despite hemorrhage, 66.7% of confirmed cases were hemodynamically non-severe, and 88.9% of suspected cases were severe. Coinfection with malaria is evidenced in 11.1% of cases. 72.2% recovered and 27.8% died (deaths in 55.5% of suspected cases). Case deaths were male (100%), resident foreigners (40%), tool store employees, sailors and students, healthy (80%), and residing in the largest district in the country (60%). All deaths were hospitalized in serious condition, 80% were hospitalized for hemorrhage and shock, with bleeding arising between day 4 - 5 of illness in 60% and hospitalization on day 5 of illness. 60% died within ≤24 hours of hospitalization. 80

关键词： Acute hemorrhagic Fever Viral hemorrhagic Fever Dengue São Tomé and Príncipe Hospitalization Epidemic Dr. Ayres de Menezes Hospital

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