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D.C. Godoy-Salgado E.M. Toro-Monjaraz T. Padilla-Cortés J.F. Cadena-León F. Zárate-Mondragón A. Loredo-Mayer K. Ignorosa-Arellano R. Cervantes-Bustamante J.A. Ramírez-Mayans 《Revista de gastroenterologia de Mexico》2021,86(3):253-258
Introduction and aimsPost-fundoplication dysphagia is resolved with no therapeutic intervention in the majority of cases but it can persist in 5.3% of children that undergo the procedure. Among the differential diagnoses, esophagogastric junction outflow obstruction (EGJOO) is a disorder that should be suspected if there is a persistence of dysphagia. The aim of our study was to describe the clinical characteristics, treatment, and follow-up in a case series of patients diagnosed with post-fundoplication EGJOO.Materials and methodsThe clinical records of patients diagnosed with EGJOO at a tertiary care hospital within the time frame of September 2015 to September 2019 were reviewed, with respect to manometry, etiology, treatment, and clinical course of the disease.ResultsOf the 213 high-resolution esophageal manometries performed, 4 patients met the criteria for post-fundoplication EGJOO. The primary symptom was dysphagia, presenting 15 days after the procedure. Esophageal dilations were carried out on all the patients but with no improvement. Symptoms related to the condition resolved spontaneously in three of the four patients.ConclusionThe management of children with post-fundoplication EGJOO continues to be a challenge. Even though more than half of the cases resolve with no intervention, optimum management of the motility disorder is still limited, given the scant experience with the condition in the pediatric population. 相似文献
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C. Fortea-Sanchis P. Priego-Jiménez D. Martínez-Ramos V. Ángel-Yepes C. Villegas-Cánovas J. Escrig-Sos J.L. Salvador-Sanchis 《Revista de gastroenterologia de Mexico》2013,78(4):219-224
BackgroundThe laparoscopic approach to bowel obstruction is still controversial.ObjectiveTo evaluate our initial results in the laparoscopic treatment of bowel obstruction.Material and methodsA retrospective study on patients diagnosed with bowel obstruction that underwent laparoscopic surgery within the time frame of January 2008 to June 30, 2012. The variables employed were: age, sex, occlusion etiology, previous surgeries, clinical progression, pneumoperitoneum creation, use of an auxiliary incision, anesthesia duration, conversion rate, postoperative hospital stay, time needed to tolerate liquids, and complications.ResultsTwenty-six patients, 18 women (69.2%) and 8 men (30.8%), with a mean age of 64.35 years (range: 21-92 years) were analyzed. The most frequent obstruction etiology was secondary to adhesions and presented in 12 cases. Nine patients (34.6%) underwent a completely laparoscopic approach and laparoscopy was complemented by an auxiliary incision in another 9 patients (34.6%), resulting in 18 cases (69.2%) of successful laparoscopic approach. Eight patients (30.8%) required conversion to open surgery. The mean anesthesia duration was 95 min (range: 55-165 min), mean postoperative hospital stay was 6 days (range: 3-72 days), and the mean amount of time needed to tolerate liquids was 3 days (range: 1-10 days). The patients that underwent complete laparoscopic approach presented with shorter hospital stay, they were able to ingest liquids earlier, and they presented with a lower number of postoperative complications; this latter variable was the only one that was statistically significant.ConclusionsThe initial results of our experience were good, although more patients are needed in order to standardize and extend the use of this technique. 相似文献
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G.A. Morales-Fuentes A. Zarate-Osorno E.E. Quiñónez-Urrego M. Antonio-Manrique C.L. Martínez-García P. Figueroa-Barojas Y. Zamorano-Orozco S.E. Leal-Osuna C. Martínez-Camacho L.A. Mejía-Cuán C.A. Rivera-Nava X. Sánchez-Chávez M.A. Ramírez-Ramírez 《Revista de gastroenterologia de Mexico》2013,78(1):12-20
BackgroundHelicobacter pylori (Hp) is recognized as a type 1 carcinogen for gastric cancer associated with pre-neoplastic lesions (atrophy and intestinal metaplasia [IM]). Its relation with p53, which intervenes in the cell cycle, has had contradictory results.AimsTo analyze p53 expression in gastric mucosa and its relation with Hp infection.MethodsA 3-month prospective, observational, cross-sectional study was conducted. Patients that had no evidence of acute or clinically significant gastric pathology had biopsies taken according to the Sydney system at the Hospital Juárez de México and the histopathologic studies were done at the Hospital Español de México.ResultsHp prevalence was 32.7% in 104 patients. There were no cases of atrophy or dysplasia. A total of 91% of the infected patients were positive for p53. Of the non-infected patients, 14% were positive for p53 and 60% of them had IM. Of the IM patients, 75% presented with positive p53. Of the patients without IM, 31 presented with positive p53, and Hp was positive in 85% of them. There was association between Hp and p53 and between p53 and IM (P<.0001 and P<.0006, respectively).ConclusionsSignificant association was shown between Hp and p53 expression, even in patients with pre-neoplastic lesions that no longer presented with Hp. Given that the identification of pre-neoplastic lesions is important for the prevention of cancer, immunohistochemistry could benefit routine biopsy carried out during endoscopy for the detection of Hp, by identifying patients with expression of the important oncogene regulator, p53. 相似文献
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C.L. Fernández-Garrido I. Bernárdez-Zapata J. Iglesias-Leboreiro M.E. Rendón-Macías 《Revista de gastroenterologia de Mexico》2021,86(2):145-152
IntroductionInfectious gastroenteritis can result in unnecessary emergency room consultations. Instruments are needed to detect the risks for unfavorable progression.AimTo develop and validate a comprehensive severity scale for acute gastroenteritis in children.Materials and methodsData associated with complications (probable items) were determined through a MeSH search. The EsVida scale was developed with 4 theoretic domains: personal history (3 items), social problems (2 items), risks for severe gastroenteritis (4 items), and signs of fluid and electrolyte imbalance (4 items). The items were evaluated as present (one point) or absent (zero points) on a 0 to 13-point scale. To validate the instrument, an observational study was conducted at the emergency service on children from one to 13 years of age with acute gastroenteritis. The scale was re-developed utilizing the risks calculated by logistic regression analysis.ResultsNinety-seven pediatric patients were evaluated using the EsVida scale (theoretic development). Its initial version showed an area under the ROC curve of 0.69 (95% CI of 0.6 to 0.79). After risk adjustment, it was simplified to a total of 5 items, with a score of 0 to 42.5. The new scale produced an area under the ROC curve of 0.85 (95% CI of 0.75 to 0.90). At a cutoff value of 12 points, the scale had 69.8% sensitivity and 70.5% specificity. A score below 6 indicated that patients could be managed at home at no risk.ConclusionsThe modified EsVida scale could be used as an aid in deciding on at-home management in cases of acute infectious gastroenteritis. 相似文献
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Francisco Maduell Raquel Ojeda Lara Belmar Paula Munguía Cristina Sango Ana Isabel Martinez-Díaz Marta Arias-Guillén Manel Vera Néstor Fontseré Miquel Gómez Lida Rodas Nayra Rico 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2018,38(1):34-40
Introduction
Online haemodiafiltration (OL-HDF) has been associated with increased survival. To date, the influence of the inner diameter of the hollow fibres of the dialyser on convective volume has not been well established. The objective of the study was to evaluate the effect of increasing the inner diameter of the dialyser on the convective volume and removal capacity.Material and methods
We included 16 patients in posdilutional OL-HDF with autosubstitution. Each patient was analysed in 4 sessions in which the inner diameter varied; 185 μm (FX60 Cordiax and FX80 Cordiax) versus 210 μm (FX600 Cordiax and FX800 Cordiax). Different solutes were measured at the beginning and end of each dialysis session.Results
No differences in the convective volume were found with an increased inner diameter: 32.3 ± 3.1 vs. 31.8 ± 3.6 l/session (FX60 vs. FX600) and 33.7 ± 4.3 vs. 33.5 ± 3.8 l/session (FX80 vs. FX800). The reduction percentages also did not differ: urea 83.7 ± 4.5 vs. 84.1 ± 3.4 for FX60 and FX600, and 82.7 ± 4.1 vs. 83.6 ± 3.8 for FX80 vs. FX800; creatinine similar 78.2 ± 5.6 vs. 77.8 ± 4.6 y 77.1 ± 5.4 vs. 78.1 ± 4.9; β2-microglobulin 82.2 ± 4.3 vs. 82.9 ± 4.2, and 82.9 ± 4.7 vs. 84.0 ± 3.8; myoglobin 71.0 ± 10 vs. 70.2 ± 9 and 72.8 ± 11 vs. 75.0 ± 10; prolactin 70.4 ± 9 vs. 68.1 ± 9, and 72.2 ± 10 vs. 73.4 ± 8.2; and α1-microglobulin 22.9 ± 10 vs. 21.6 ± 10, and 26.5 ± 12 vs. 28.8 ± 11, respectively.Conclusion
The increase in the inner diameter of the hollow fibres did not result in improved convective volume and removal capacity. 相似文献13.
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《Archivos de bronconeumología》2015,51(5):219-222
ObjectiveEvaluate the restrictiveness of selection criteria for lung resection in lung cancer patients over 80 years of age compared to those applied in younger patients. Compare and analyze 30-day mortality and postoperative complications in both groups of patients.MethodsCase-controlled retrospective analysis. Study population: Consecutive patients undergoing elective anatomical lung resection. Population was divided into octogenarians (cases) and younger patients (controls). Variables determining surgical risk (BMI, FEV1%, postoperative FEV1%, FEV1/FVC, DLCO and pneumonectomy rate) were compared using either Wilcoxon or Chi-squared tests. Thirty-day mortality and morbidity odds ratio were calculated. A logistic regression model with bootstrap resampling was constructed, including postoperative complications as dependent variable and age and post-operative FEV1% as independent variables. Data were retrieved from a prospective database.ResultsNo statistically significant differences were found in BMI (P=.40), FEV1% (P=.41), postoperative FEV1% (P=.23), FEV1/FVC (P=.23), DLCO (P=.76) and pneumonectomy rate (P=.90). Case mortality was 1.85% and control mortality was 1.26% (OR: 1.48). Cardiorespiratory complications occurred in 12.80% of younger subjects and in 13.21% of patients aged 80 years or older. (OR: 1.03). In the logistic regression, only FEV1% was related to postoperative complications (P<.005).ConclusionSelection criteria for octogenarians are similar to those applied in the rest of the population. Advanced age is not a factor for increased 30-day mortality or postoperative morbidity. 相似文献
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《Reumatología clinica》2022,18(10):580-586
ObjectiveTo analyse the role of nursing in the approach to axial spondyloarthritis (axSpA) and to make proposals to include the role of rheumatology nursing consultations (RECs) in the quality certification of these specialized units.MethodsA systematic review of the nursing role in quality certification systems in the management of axSpA was conducted. Subsequently a consensus conference was held with the participation of 3 rheumatology nurses to determine elements that should be considered in future revisions of certification standards.ResultsThe systematic review yielded 5 papers as relevant. None of the publications reviewed explicitly proposed standards applicable to nursing care in the management of patients with axSpA, although they contemplated the activities of this professional group. The proposals agreed upon to incorporate the role of RECs in the certification standards for axSpA monographic units included the following: basic equipment and resources, organization, administration of pharmacological treatments and promotion of adherence, standardized programmes for axSpA, telematic consultation (e-consultation) for monitoring the stable patient and promoting continuity of care and registry of patient-reported outcome measures.ConclusionsThe literature on quality standards and certification standards for axSpA monographic units is scarce and hardly reflects the role of RECs in providing quality care. The consensus proposals in this study would incorporate RECs into quality certification standards. In the future, the increased presence of RECs in Spain should be accompanied by a review of the indicators regarding their role. 相似文献
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A. Pérez-Mendoza Á.M. Zárate-Guzmán E.S. Galvis García S. Sobrino Cossío J. Djamus Birch 《Revista de gastroenterologia de Mexico》2018,83(2):117-124
Introduction and aims
Gastric cancer is one of the main causes of cancer worldwide, but there is currently no global screening strategy for the disease. Endoscopy is the screening method of choice in some Asian countries, but no standardized technique has been recognized. Systematic alphanumeric-coded endoscopy can increase gastric lesion detection. The aim of the present article was to compare the usefulness of systematic alphanumeric-coded endoscopy with conventional endoscopy for the detection of premalignant lesions and early gastric cancer in subjects at average risk for gastric cancer.Materials and methods
A cross-sectional, comparative, prospective, randomized study was conducted on patients at average risk for gastric cancer (40-50 years of age, no history of H. pylori infection, intestinal metaplasia, gastric atrophy, or gastrointestinal surgery). Before undergoing endoscopy, the patients had gastric preparation (200 mg of oral acetylcysteine or 50 mg of oral dimethicone). Conventional chromoendoscopy was performed with indigo carmine dye for contrast enhancement.Results
Fifty consecutive cases (mean age 44.4 ± 3.34 years, 60% women, BMI 27.6 ± 5.82 kg/m2) were evaluated. Endoscopic imaging quality was satisfactory in all the cases, with no differences between methods (p = 0.817). The detection rate of premalignant lesions and early gastric cancer was 14% (6 cases of intestinal metaplasia and one case of gastric adenocarcinoma). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 100, 95, 80, 100 and 96%, respectively, for systematic alphanumeric-coded endoscopy, and 100, 45, 20, 100, and 52%, respectively, for conventional endoscopy. Lesion detection through systematic alphanumeric-coded endoscopy was superior to that of conventional endoscopy (p = 0.003; OR = 12).Conclusion
Both techniques were effective, but systematic alphanumeric-coded endoscopy significantly reduced the false positive rate. 相似文献17.
Lissette Batista Josefa Pérez Jove Mercè Rosinach Victoria Gonzalo Empar Sainz Carme Loras Montserrat Forné Maria Esteve Fernando Fernández-Bañares 《Gastroenterologia y hepatologia》2017,40(6):381-387
Introduction
Blastocystis hominis (B. hominis) is a protozoan commonly found in the gastrointestinal tract. There are doubts about its clinical significance. Metronidazole (MTZ) is the recommended first-line treatment.Materials and methods
A retrospective review was carried out between 2011 and 2012. A total of 151 samples were randomly selected from 383 samples positive for B. hominis. Inclusion criteria were: suggestive symptoms, treatment indication and microbiological follow-up. A systematic review was performed of all studies that evaluated the effect of MTZ on B. hominis infection.Results
Forty-six patients met the inclusion criteria (64% women; age, 44.2 ± 2 years). MTZ was used in 39 patients, 31 of whom obtained a clinical response (79.5%) but only 15 a microbiological response (48.4%). No dose-effect relationship was observed. Twenty patients with no initial microbiological response received a second round of treatment (MTZ, cotrimoxazole, paramomycin, others), with a microbiological response in 70%. Overall, B. hominis was cured in 72% (95% CI: 57%-83%). Of 54 treatments associated with a clinical response, a microbiological response occurred in 31 (57%), while in the remaining 12 with no clinical response, microbiological cure was observed in only 2 (17%) (P = .022). The eradication rate in the systematic review varied between 0% and 100%.Conclusions
There seems to be a relationship between the clinical and microbiological response to B. hominis treatment. The microbiological response to MTZ treatment is insufficient in our geographical setting. The systematic review shows that the response to MTZ is very variable. 相似文献18.
Ana Isabel Morales García Margarita Martínez Atienza María García Valverde Juan Fontes Jimenez Antonio Martínez Morcillo M. Angustias Esteban de la Rosa Pablo de Diego Fernández Miguel García González Rafael Fernández Castillo Irene Argüelles Toledo Juan Antonio Bravo Soto Rafael Esteban de la Rosa 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2018,38(2):190-196
Introduction
Although autosomal dominant polycystic kidney disease is the most common hereditary kidney disease, available data tend to be limited to after initiation of renal replacement therapy.Objective
To ascertain an overview of autosomal dominant polycystic kidney disease within the health area of Granada in southern Spain.Material and methods
From January 2007 to December 2016, we collected clinical, family and demographic information about all patients with autosomal dominant polycystic kidney disease, irrespective of whether or not they were treated with RRT, in the Granada health area. The computer software SPSS 15.0 and GenoPro were used.Results
50.6% of the 1,107 diagnosed patients were men. 99.1% were Caucasian and 4–6 generations/family were studied. The geographical distribution was heterogeneous. There was no family history in 2.43%. The mean age of diagnosis was 34.0 ± 17.80 years and the diagnosis was made after having offspring in 57.7% of cases. The main reason for diagnosis was family history (46.4%). The mean age of initiation of renal replacement therapy was 54.2 ± 11.05 years. 96.3% of the deceased had some degree of renal failure at the time of death. The mean age of death was 60.9 ± 14.10 years, the main cause of death being unknown in 33.5% of cases, followed by cardiovascular (27.8%).Conclusions
Cases and families were concentrated in certain geographical areas and a significant number of individuals were undiagnosed prior to cardiovascular death or diagnosed late after reproduction. Given that there is currently no curative treatment, the primary prevention strategy of preimplantation genetic diagnosis should play a leading role. 相似文献19.
《Revista de gastroenterologia de Mexico》2019,84(2):136-142
Introduction and aimsSurgical resection with negative margins is part of the curative treatment of gastric adenocarcinoma. Positive surgical margins are associated with worse outcome. The aim of the present study was to determine the clinical usefulness of extending the proximal surgical margin in patients undergoing total gastrectomy for gastric adenocarcinoma.Materials and methodsA retrospective analysis of patients that underwent total gastrectomy within the time frame of 2002 and 2017 was conducted. Patients diagnosed with adenocarcinoma that underwent curative surgery were included. Patients were divided into three groups, depending on proximal surgical margin status: negative margin (R0), positive margin with additional resection to achieve negative margin (R1-R0), and positive margin (R1). Demographic and clinical variables were analyzed. The outcome measures to evaluate were recurrence, disease-free survival, and overall survival.ResultsForty-eight patients were included in the study. Thirty-seven were classified as R0, 9 as R1-R0, and 2 as R1. Fifty-two percent of the patients had clinical stage III disease. The overall surgical mortality rate was 2% and the morbidity rate was higher than 29%. The local recurrence rate was 0% in the R1-R0 group vs. 50% in the R1 group (p = 0.02). Disease-free survival was 49 months in the R1-R0 group vs. 32 months in the R1 group (p = 0.6). Overall survival was 51 months for the R1-R0 group vs. 35 months for the R1 group (p = 0.5).ConclusionsIntraoperative extension of the positive surgical margin improved the local recurrence rate but was not associated with improvement in overall survival or disease-free survival and could possibly increase postoperative morbidity. 相似文献
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Andrea Burón Margarita Posso Judit Sivilla Jaume Grau Rafael Guayta Xavier Castells Antoni Castells Francesc Macià 《Gastroenterologia y hepatologia》2017,40(4):265-275