Semi-obstrução intestinal por esclerodermia: relato de caso

A esclerodermia ou esclerose sistêmica progressiva é uma doença auto-imune de causa desconhecida que se caracteriza por fibrose da pele, vasos sanguíneos e de alguns outros órgãos, como os pulmões, coração, rins e trato gastrintestinal. Sintomas atribuíveis ao comprometimento gastrintestinal podem estar presentes em até 50% dos pacientes, sendo os mais freqüentes, relacionados às manifestações esofagianas e anorretais. Anormalidades na motilidade intestinal com freqüência levam a desnutrição, supercrescimento bacteriano e quadro de pseudo-obstrução ou mesmo semi-obstrução intestinal. É apresentado um caso de paciente com esclerodermia há 43 anos, evoluindo com quadro de semi-obstrução, apresentando distensão abdominal, cólicas recorrentes e desnutrição grave. Sem resposta ao tratamento clínico foi submetida à cirurgia que evidenciou quadro obstrutivo por comprometimento ileal, o qual foi tratado por bypass íleo-cólico. Lesão intestinal por esclerodermia levando a quadro de obstrução é raramente descrita na literatura médica e, portanto, o tratamento de escolha ainda não foi definido.<br>Scleroderma or progressive systemic sclerosis (PSS) is a self-immune illness of unknown cause that is characterized by fibrosis of the skin, blood vessels and some other tissues like the lungs, heart, kidneys and gastrointestinal system. Attributable symptoms to the gastrointestinal involvement can be present in up to 50% of the patients, esophageal and anorectal manifestations being more frequent. Abnormalities in the intestinal motility frequently lead to malnutrition, bacterial over-growth and intestinal pseudo-obstruction. We report a case of scleroderma with intestinal pseudo-obstruction presenting chronic abdominal cramps, bloating and malnutrition with no response to clinical approach. Patient underwent surgery with diagnosis of intestinal obstruction by annular ileal fibrosis treated by ileocolic bypass. Intestinal injury causing obstruction is rarely described in the literature and therefore the treatment of choice is not yet defined

Systematic review of hydroxychloroquine use in pregnant patients with autoimmune diseases

<p>Abstract</p> <p>Objective</p> <p>The purpose of this study is to compare the incidence of congenital defects, spontaneous abortions, number of live births, fetal death and pre-maturity in women with autoimmune diseases taking HCQ during pregnancy.</p> <p>Methods</p> <p>The authors searched MEDLINE, Cochrane data base, Ovid-Currents Clinical Medicine, Ovid-Embase:Drugs and Pharmacology, EBSCO, Web of Science, and SCOPUS using the search terms HCQ and/or pregnancy. We attempted to identify all clinical trials from 1980 to 2007 regardless of language or publication status. We also searched Cochrane Central Library and <url>http://www.Clinical trials.gov</url> for clinical trials of HCQ and pregnancy. Data were extracted onto standardized forms and were confirmed.</p> <p>Results</p> <p>The odds ratio (OR) of congenital defects in live births of women taking HCQ during pregnancy was 0.66, 95% confidence intervals (CI) 0.25, 1.75. The OR of a live birth for women taking HCQ during pregnancy was 1.05 (95% CI 0.58, 1.93). The OR of spontaneous abortion in women taking HCQ during pregnancy was 0.92 (95% CI 0.49, 1.72). The OR of fetal deaths in women taking HCQ during pregnancy was 0.97 (95% CI 0.14, 6.54). The OR of pre-mature birth defined as birth before 37 weeks in women taking HCQ during pregnancy was 1.10 (95% CI 0.75, 1.61).</p> <p>Conclusion</p> <p>HCQ is not associated with any increased risk of congenital defects, spontaneous abortions, fetal death, pre-maturity and decreased numbers of live births in patients with auto-immune diseases.</p