The aim of the study is to evaluate the effect of simvastatin in erectile dysfunction (ED) secondary to endothelial dysfunction. This study is a double-blind, randomized, placebo-controlled, clinical trial in patients with ED and endothelial dysfunction. Patients were randomized to receive 20 mg simvastatin (n ¼ 21) or placebo (n ¼ 20) daily for 6 months and subsequently 10 mg of vardenafil on demand for 4 weeks. Serum cholesterol, hormone profile, ultrasensitive C-reactive protein, the International Index of Erectile Dysfunction (IIEF) and the ED Index of Treatment Satisfaction were evaluated. There was a significant reduction in serum cholesterol in the treatment group. The hormonal profile remained unaltered. There was no difference in the IIEF between the groups at follow-up, although, at the beginning, 26% of the patients of both groups presented with mild ED and 74% with moderate-to-severe ED; at the end of the 7th month, all patients from the simvastatin group progressed to mild ED, compared with only 83% in the placebo group. There was no statistically significant difference in penile erection after intake of simvastatin or placebo. This study does not support the use of simvastatin as erectogenic medication. Further studies are necessary to verify if simvastatin has any beneficial effect on ED.
BACKGROUND: Angiodysplasia is a distinct mucosal vascular lesion associated with acute or chronic gastrointestinal bleeding. It occurs most frequently in the right colon and is extremely rare. Its etiology is unknown, but theories of its pathogenesis have evolved from its similarity to colonic angiodysplasia and the lesion appears to be associated with renal insufficiency. CASE REPORT: Sixty-five-year-old woman with repeated melena and severe anemia due to angiodysplasia in the first portion of the duodenum. The diagnosis was done by upper endoscopy. As the patient presented repeated gastrointestinal bleeding with hemodynamic instability and recurrent anemia, surgery was indicated. At laparotomy the lesion was identified and resected with an Y-en-Roux reconstruction. The patient went on well at the immediate and late (four years) postoperative periods with no more recurrent gastrointestinal bleeding. CONCLUSION: Although most of the patients suffering from gastrointestinal angiodysplasia goes on well with conservative management, there is a small portion of them that will need a more aggressive approach, as in this case.
BACKGROUND: Small cell carcinoma of the esophagus is a rare disease, characterized by aggressive progression, which is similar in appearance and behavior to its counterpart of the lung. It has a high incidence of metastatic disease at presentation and a poor prognosis. Treatment protocols are not well established because of the small number of cases and lack of large studies. CASE REPORT: 66 year-old woman, was admitted to the hospital with persistent dysphagia. Radiologic and endoscopic examination revealed an stenosing tumor in the lower third of the esophagus. The biopsy specimen was diagnosed as small cell carcinoma of the esophagus. The patient underwent an esophagectomy with esophagogastric anastomosis. CONCLUSION: The role of surgery remains controversial and the improvement of life quality is to be considered. Therapeutic approach is mainly esophageal resection.
The authors present two cases of leiomyoma of the upper esophagus. Both of the cases presented with dysphagia, and one patient complained of pyrosis. An upper gastrointestinal endoscopy showed midesophageal narrowing without mucosal irregularity, suggestive of leiomyoma. The patients were successfully treated by thoracoscopic enucleation of the leiomyoma, using four thoracic trocars. In one patient (Case 1), the azygus vein had to be divided. Both of the patients are asymptomatic in the late-postoperative period.
A fasciolose hepática é causada por um trematodaFasciola hepatica -que raramente é responsável por doenças em seres humanos, sendo sua infecção acidental. Por outro lado, sabe-se que as zonas de alta prevalência de fasciolose humana não coincidem com aquelas em que tal enfermidade constitui um problema veterinário relevante.Alguns casos esporádicos têm sido relatados na literatura apontando a fasciolose hepática como determinante de obstrução biliar ocasionando icterícia obstrutiva 1-5 . A possibilidade de termos tratado uma paciente portadora de fasciolose hepática com obstrução biliar motivounos ao presente relato. RELATO DO CASOUma paciente, 53 anos, agricultora, procedente da zona rural do Rio Grande do Sul, procurou o ambulatório de Cirurgia Geral da nossa Instituição com história médica pregressa de colecistectomia por incisão de Kocher há 10 anos, seguida de papilotomia endoscópica três anos após, por suspeita de coledocolitíase (o laudo da colangiopancreatografia trazido pela paciente era dado como vias biliares difusamente dilatadas e cuja exploração não evidenciou presença de cálculos). Presentemente, queixava-se de episódios repetidos de dor no hipocôndrio direito, por vezes associados com náuseas e vômitos, icterí-cia flutuante, colúria e acolia, bem como astenia e tontura. Negava emagrecimento ou outras queixas. Apresentavase anictérica e com mucosas hipocoradas. A paciente trazia consigo exames laboratoriais que demonstravam anemia persistente (hemoglobina de 7,9g/dL), eosinofilia (7,3%) e provas de função hepática dentro dos limites da normalidade. Negava viagens a outros estados do Brasil ou a outros países.A ecografia abdominal demonstrava dilatação da via biliar intra e extra-hepática, ducto colédoco com 14 mm, com conteúdo ecogênico no seu interior compatível com cálculos.A tomografia abdominal evidenciou idêntica dilatação da via biliar intra e extra-hepática, bem como redução brusca do calibre hepatocoledociano junto à inserção do ducto cístico, preenchido por bile aparentemente densa. Além disso, nos segmentos hepáticos sete e oito identificava-se uma área de aspecto infiltrativo, contendo calcificação.Com o diagnóstico de dilatação da via biliar principal e a evidência tomográfica de redução brusca do calibre coledociano, aventamos como hipóteses diagnósticas litíase residual ou primária de colédoco, estenose cicatricial ou ascaridíase. Tendo a paciente já sido submetida a papilotomia endoscópica, optou-se por levá-la à laparotomia por incisão de Kocher. No trans-operatório, a colangiografia evidenciou dilatação das vias biliares, defeitos de enchimento da via biliar principal e ausência de passagem de contraste para o interior do duodeno (Figura 1). À coldecocotomia foi identificada a presença de Fasciola hepatica no seu interior, sendo retiradas 25 unidades deste trematoda por intermédio de coledocoscopia e pinça de preensão (Figura 2). A coledocoscopia evidenciou o epitélio da via biliar com lesões infiltrativas com pontos hemorrágicos. Realizou-se lavagem abundante da via biliar e sua ...
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