Utilidad de la tomografía computarizada de 64 detectores en el diagnóstico y el manejo de los pacientes con cardiopatías congénitas

Introduction and ObjectivesAlthough congenital heart defects are the most common major congenital abnormalities, the associated mortality has been decreasing due to improvements in their diagnosis and treatment. We assessed the usefulness of 64-multidetector computed tomography in the diagnosis and management of these patients.MethodsThis 5-year observational, analytical, retrospective, cohort study included a total of 222 tomographic studies of patients with congenital heart disease. Computed tomography scans were read twice and medical records were reviewed. We assessed the complexity of the disease, patient, and radiological technique, and evaluated the contribution of new data in relation to clinical suspicion and diagnostic change. A confidence interval was set at 95% and a P value of < .05 was used as the cutoff for statistical significance.ResultsIn 35.1% of patients, the treatment procedure was performed after computed tomography without other tests. Additional diagnostic catheterization was performed in 12.5% of patients. There were new findings in 77% of patients (82.9% with complex disease), which prompted a change in patient management in 35.6%. All unexpected reports described new findings. No significant differences were found by age, sex, study period, urgency of the test order, patient complexity, or difficulty of the technique.ConclusionsUse of 64-detector computed tomography yields good diagnostic performance in congenital heart disease, prompts changes in management in more than one-third of patients, and reveals new findings in relation to the presumed diagnosis in 77% of patients.Full English text available from: www.revespcardiol.org/en     

Recomendaciones SER sobre el manejo de los pacientes con fibromialgia. Parte I: diagnóstico y tratamiento

ObjectiveTo prevent the impairment of fibromyalgia patients due to harmful actions in daily clinical practice that are potentially avoidable.MethodsA multidisciplinary team identified the main areas of interest and carried out an analysis of scientific evidence and established recommendations based on the evidence and “formal evaluation” or “reasoned judgment” qualitative analysis techniques.ResultsA total of 39 recommendations address diagnosis, unsafe or ineffective treatment interventions and patient and healthcare workers’ education. This part I shows the first 27 recommendations on the first 2 areas.ConclusionsEstablishing a diagnosis improves the patient's coping with the disease and reduces healthcare costs. NSAIDs, strong opioids and benzodiazepines should be avoided due to side effects. There is no good evidence to justify the association of several drugs. There is also no good evidence to recommend any complementary medicine. Surgeries show a greater number of complications and a lower degree of patient satisfaction and therefore should be avoided if the surgical indication is not clearly established.     

Seguridad en el diagnóstico y tratamiento de la enfermedad inflamatoria intestinal

The presentations at Digestive Disease Week 2013 emphasized treatment safety. Anti-tumor necrosis factor (TNF) agents and thiopurines are reasonably safe in breastfeeding and pregnancy. Several studies indicate that controlling the risk of tuberculosis when anti-TNF agents are planned presents several problems, both in the initial diagnosis of latent tuberculosis and in subsequent patient follow-up, given that cases of tuberculosis continue to occur, despite recommendations. Thiopurines increase the risk of lymphoma, but there is no residual risk when these drugs are withdrawn. Despite increasing knowledge of the risks and recommendations on how to avoid them, there remain considerable shortfalls in the application of preventive measures and, more specifically, in vaccinations. Infliximab and cyclosporin produce similar results when used to treat severe outbreaks of ulcerative colitis. Thromboembolism prevention continues to be deficient, and the barriers to effective prevention concern not only physicians but can also involve nursing staff, for example. There is still a wide margin for improvement in safety. New drugs under study (vedolizumab, golimumab) have not shown any hitherto unknown signs of significant toxicity.     

Papel de la RMN en el diagnóstico y evolución de las espondiloartritis

The introduction of magnetic resonance imaging in spondyloarthritis constitutes the main improvement in imaging over the past two decades. X-rays remains the cornerstone of diagnosis, although magnetic resonance imaging is more sensitive in early stages of the disease. The primary advantage of magnetic resonance imagingI is its ability to visualize soft tissue inflammation and inflammatory lesions within bone in three dimensions. Studies continue to appear describing its diagnostic utility, its sensitivity in early disease, its reliability, its predictive value for the detection of damage progression and its value in the assessment of certain complications. In this paper we review the characteristics of this imaging technique and the advantages and limitations of magnetic resonance imaging in spondyloarthritis.     

Normativa sobre la valoración y el diagnóstico de las bronquiectasias en el adulto

In 2008, the Spanish Society of Pulmonology (SEPAR) published the first guidelines in the world on the diagnosis and treatment of bronchiectasis. Almost 10 years later, considerable scientific advances have been made in both the treatment and the evaluation and diagnosis of this disease, and the original guidelines have been updated to include the latest scientific knowledge on bronchiectasis. These new recommendations have been drafted following a strict methodological process designed to ensure the quality of content, and are linked to a large amount of online information that includes a wealth of references. These guidelines cover aspects ranging from a consensual definition of bronchiectasis to an evaluation of the natural course and prognosis of the disease. The topics of greatest interest and some new areas are addressed, including epidemiology and economic costs of bronchiectasis, pathophysiological aspects, the causes (placing particular emphasis on the relationship with other airway diseases such as chronic obstructive pulmonary disease and asthma), clinical and functional aspects, measurement of quality of life, radiological diagnosis and assessment, diagnostic algorithms, microbiological aspects (including the definition of key concepts, such as bacterial eradication or chronic bronchial infection), and the evaluation of severity and disease prognosis using recently published multidimensional tools.     

Normativa para el diagnóstico y seguimiento de la silicosis

Silicosis is one of the occupational respiratory diseases most commonly encountered in our setting. It is caused by inhalation of crystalline silica that triggers a fibrotic response in the lung parenchyma. It presents as diffuse interstitial disease and clinical expression ranges from asymptomatic forms to chronic respiratory failure. Diagnosis is based on clinical history and radiological findings. There is no effective treatment, and once diagnosed, the patient must avoid all sources of occupational exposure. In these guidelines, the clinical, radiological and functional aspects of silicosis are reviewed, and strategies for diagnosis, monitoring and classification of patients are proposed, along with recommendations regarding the occupational implications of this disease.     

Evaluación y manejo de emergencias en el paciente con cirrosis

The approach to and management of critically ill patients is one of the most versatile themes in emergency medicine. Patients with cirrhosis of the liver have characteristics that are inherent to their disease that can condition modification in acute emergency treatment. Pathophysiologic changes that occur in cirrhosis merit the implementation of an analysis as to whether the overall management of a critically ill patient can generally be applied to patients with cirrhosis of the liver or if they should be treated in a special manner. Through a review of the medical literature, the available information was examined, and the evidence found on the special management required by those patients was narratively synthesized, selecting the most representative decompensations within chronic disease that require emergency treatment.     

Indicaciones y rendimiento diagnóstico de la cápsula endoscópica en el anciano

Introduction and Aims

The growing elderly population and wide use of capsule endoscopy have led to a higher number of procedures in those patients. The aim of the present study was to assess the usefulness of capsule endoscopy in older patients.

Retraso y recorrido diagnóstico de pacientes con artritis psoriásica en España

Introduction and objectivesDelayed diagnosis results in a worse prognosis in patients with psoriatic arthritis. Our objective is to determine the diagnostic delay, the specialties consulted and the referral points of patients with psoriatic arthritis in our environment.Patients and methodsWe distributed a survey to members of the Spanish association Acción Psoriasis inquiring about the objectives of the study.ResultsA total of 503 surveys were analysed. The diagnostic delay was 4.01 ± 1.42 years. The proportion of patients who had consulted, before diagnosis, primary care was 79.9%, traumatology 33.8% and the emergency department was 30.2%. The proportion of referrals that eventually led to diagnosis came from primary care in 29.3% of cases, traumatology 15.8% and the emergency department 3.5%.Discussion and conclusionsThe delay in diagnosis far outweighs other European results. Emergency departments are an important transit point for these patients, but the proportion of referrals is very low. We believe that focusing on the importance of early diagnosis in this particular medical sector could resolve a large part of diagnostic delay.     

Consenso mexicano de diagnóstico y manejo del carcinoma hepatocelular

IntroductionThere has been an increase in the incidence of hepatocellular carcinoma (HCC) worldwide and information on this disease is limited in Mexico.AimsTo analyze the available evidence on the diagnosis and treatment of HCC in the Mexican population.Material and methodsThe Mexican Association of Hepatology organized a meeting that 24 medical specialists interested in HCC attended. An electronic database search was carried out to identify documents published from 2000 with the keywords «Hepatocellular carcinoma» and «Mexico», «epidemiology», «diagnosis», and «treatment».ResultsThe incidence of HCC in Mexico has increased over the last few decades. The mean age of disease presentation is in patients from 60 to 70 years old, and the man:woman ratio appears to be equal. HCC is frequently associated with underlying hepatopathy and the primary cause reported in our country is chronic hepatitis C virus) infection. Surveillance is recommended for high-risk groups in Child-Pugh stages A and B, and for those in stage C if the patient is on a waiting list or regarded as a candidate for liver transplantation. HCC should be evaluated by a multidisciplinary team of experts in the field.ConclusionsHCC is a neoplasia that is on the rise in Mexico, with epidemiologic characteristics similar to those of other populations. Diagnosis and treatment should be individualized in accordance with these Consensus guidelines.