Prevalence and clinical characteristics of patients with rheumatoid arthritis with interstitial lung disease using unstructured healthcare data and machine learning.

OBJECTIVES: Real-world data regarding rheumatoid arthritis (RA) and its association with interstitial lung disease (ILD) is still scarce. This study aimed to estimate the prevalence of RA and ILD in patients with RA (RAILD) in Spain, and to compare clinical characteristics of patients with RA with and without ILD using natural language processing (NLP) on electronic health records (EHR). METHODS: Observational case-control, retrospective and multicentre study based on the secondary use of unstructured clinical data from patients with adult RA and RAILD from nine hospitals between 2014 and 2019. NLP was used to extract unstructured clinical information from EHR and standardise it into a SNOMED-CT terminology. Prevalence of RA and RAILD were calculated, and a descriptive analysis was performed. Characteristics between patients with RAILD and RA patients without ILD (RAnonILD) were compared. RESULTS: From a source population of 3 176 165 patients and 64 241 683 EHRs, 13 958 patients with RA were identified. Of those, 5.1% patients additionally had ILD (RAILD). The overall age-adjusted prevalence of RA and RAILD were 0.53% and 0.02%, respectively. The most common ILD subtype was usual interstitial pneumonia (29.3%). When comparing RAILD versus RAnonILD patients, RAILD patients were older and had more comorbidities, notably concerning infections (33.6% vs 16.5%, p<0.001), malignancies (15.9% vs 8.5%, p<0.001) and cardiovascular disease (25.8% vs 13.9%, p<0.001) than RAnonILD. RAILD patients also had higher inflammatory burden reflected in more pharmacological prescriptions and higher inflammatory parameters and presented a higher in-hospital mortality with a higher risk of death (HR 2.32; 95% CI 1.59 to 2.81, p<0.001). CONCLUSIONS: We found an estimated age-adjusted prevalence of RA and RAILD by analysing real-world data through NLP. RAILD patients were more vulnerable at the time of inclusion with higher comorbidity and inflammatory burden than RAnonILD, which correlated with higher mortality.

Analysis of Renal Cell Carcinoma Cell Response to the Enhancement of 5-aminolevulinic Acid-mediated Protoporphyrin IX Fluorescence by Iron Chelator Deferoxamine†.

As a tumor photodiagnostic agent, 5-aminolevulinic acid (ALA) is metabolized in the heme biosynthesis pathway to produce protoporphyrin IX (PpIX) with fluorescence. ALA-PpIX fluorescence was evaluated in human renal cell carcinoma (RCC) cell lines and non-tumor HK-2 cell lines. We found that extracellular PpIX level was correlated with ABCG2 activity, illustrating its importance as a PpIX efflux transporter. Extracellular PpIX was also related to the Km of ferrochelatase (FECH) that chelates PpIX with ferrous iron to form heme. The Vmax of FECH was higher in all RCC cell lines tested than in the HK-2 cell line. TCGA dataset analysis indicates a positive correlation between FECH expression and RCC patient survival. These findings suggest FECH as an important biomarker in RCC. Effects of iron chelator deferoxamine (DFO) on the enhancement of PpIX fluorescence were assessed. DFO increased intracellular PpIX in both tumor and non-tumor cells, resulting in no gain in tumor/non-tumor fluorescence ratios. DFO appeared to increase ALA-PpIX more at 1-h than at 4-h treatment. There was an inverse correlation between ALA-PpIX fluorescence and the enhancement effect of DFO. These results suggest that enhancement of ALA-PpIX by DFO may be limited by the availability of ferrous iron in mitochondria following ALA administration.

Pleural and pulmonary dissemination patterns from gastric adenocarcinoma among patients with treated primary disease in Latin America.

Purpose: Latin America is one of the regions with the highest incidence of gastric cancer. Even though, there are not reports about the patterns of pleuro-pulmonary metastases in patients with gastric adenocarcinoma treated with curative intent and the prognosis according to each dissemination pattern. Material and methods: We conducted a retrospective analysis of patients with gastric adenocarcinoma treated with curative intent at the National Cancer Institute (INC) between 2010 and 2017. Demographic variables, variables associated with the primary disease and variables associated with the presence of pleuro-pulmonary opacities and metastases were collected. A univariate and multivariate logistic regression analysis was performed and survival curves were presented using the Kaplan Meier method and compared using the log-rank test. A Cox regression model was performed for multivariate analysis for overall survival. Results: The study included 450 patients, 51.3% were male and the median age was 63 years. Intestinal adenocarcinoma was the most frequent histological subtype, in 261 cases (58.0%). Gastric cancer initial pathological stage was stage I in 23.3% of the patients, stage II in 19.3% and stage III in 53.6%. During a median follow-up of 31.9 months, 37 (8.2%) patients developed pleuro-pulmonary opacities; among those, 14 (3.1%) met the criteria for pleuro-pulmonary metastases: 6 (1.3%) had lymphangitic metastasis, 4 (0.9%) had a mixed pattern of pleural and lung nodules, 3 (0.7%) had pleural metastasis, and only one (0.2%) had hematogenous metastasis. The median OS was 114.5 months for the entire cohort and 38.2 (95%CI, 19.2-57.2) months for patients with pleuro-pulmonary metastases. Patients with pleural metastasis and lymphangitic carcinomatosis had median survival of 24.3 (95%CI, 0.01-51.0) and 26.4 (95%CI, 18.2-34.7) months, respectively. Conclusions: incidence of pleuro-pulmonary metastases in patients with gastric adenocarcinoma treated with curative intention was low. In our series, lymphangitic carcinomatosis was the main pattern of dissemination; meanwhile, hematogenous metastasis was rare and patients with pleural carcinomatosis had the lowest median survival.

Perfusión aislada de extremidad: una opción terapéutica para metástasis en tránsito de melanoma nodular y lentiginoso acral.

OBJETIVO: describir la experiencia inicial en Colombia en el manejo del melanoma de extremidad con perfusión aislada y comparar la respuesta de los subtipos histológicos más frecuentes en Colombia con la literatura. MATERIALES Y MÉTODOS: estudio descriptivo, retrospectivo de una serie de pacientes con diagnóstico de melanoma con metástasis en tránsito tratados con perfusión aislada de extremidad, seleccionados entre 2007 y 2016. Las variables cualitativas se analizaron con frecuencias absolutas y relativas. Las cuantitativas con medidas de tendencia central y dispersión. RESULTADOS: 11 pacientes fueron tratados con perfusión aislada de extremidad. Hubo respuesta parcial en siete pacientes (63,6%), enfermedad estable en dos pacientes (18,2%) y progresión en dos pacientes (18,2%). Después del tratamiento, cinco pacientes (45,5%) presentaron complicaciones menores. CONCLUSIONES: la perfusión aislada sigue siendo importante para el tratamiento del melanoma localmente avanzado con el fin de mejorar la calidad de vida de los pacientes. La respuesta puede cambiar según el tipo clínico de melanoma, siendo menor, según este estudio, en pacientes con melanoma lentiginoso acral y nodular, aunque por el bajo poder, esto no se puede concluir. OBJECTIVE: to describe the initial experience in Colombia of locally advanced melanoma treated by isolated limb perfusion and compare the response rate of our melanoma subtypes with the literature. METHODS: descriptive, retrospective study of a series of patients selected between 2007 and 2016. Qualitative variables were analyzed with proportions and frequencies, and quantitative variable with central tendency measures and measures of dispersion. RESULTS: 11 patients were treated by isolated limb perfusion. After the treatment, seven patients (63.6%) had partial response, two patients (18.2%) had stable disease and two patients (18.2%) had disease progression. Five patients (45.5%) had mild complications. CONCLUSIONS: Isolated limb perfusion is still an important treatment strategy for locally advanced melanoma, with the goal of improving the patient quality of life. The response can change according to the type of melanoma, and could be smaller in patients with acral lentiginous and nodular melanoma, although we cannot make this conclusion with this type of study because it has low power and lack of a comparison group.

Primary BRAF Mutant Melanoma of the Lung Treated with Immunotherapy and Pulmonary Bilobectomy: A Case Report.

BACKGROUND Primary melanoma of the lung is a rare tumor that represents 0.01% of primary lung tumors, with only 40 cases reported in the literature. Mucosal melanomas are tumors with a biological and clinical presentation that differs from that of cutaneous melanomas; therefore, the therapeutic approach differs as well. Survival rates of patients with primary melanoma of the lung are much lower than those of patients with cutaneous melanoma, and there are no diagnostic or treatment guidelines for this entity. Radical surgery is the treatment of choice when disease is resectable. The effectiveness of current established treatments for cutaneous melanoma (eg, immunotherapy and targeted therapy) is unknown in this particular subgroup. CASE REPORT We present the case of a patient who presented with cough and hemoptysis. The fiberoptic bronchoscopy revealed an endobronchial mass and the computed tomography images suggested an unresectable mass. The patient was initially diagnosed with an unresectable primary lung melanoma with a clinical stage IIIB (T4N2M0). This lesion achieved partial response after treatment with Pembrolizumab, which allowed radical surgery to be performed, achieving complete resection with negative margins and adequate postoperative evolution. Despite the delays in our health care system, she is currently alive and disease-free more than 24 months after diagnosis. CONCLUSIONS Immunotherapy can reduce the size of mucosal melanoma to the point that it can be resectable and this therapeutic approach increases the survival opportunities of these patients.

Factores asociados al miedo y ansiedad en pacientes que asisten a consulta odontológica: Estudio Transversal / Factors associated with fear and anxiety in patients attending a dental care: A cross-sectional study

Antecedentes: Las personas que sienten miedo y ansiedad muestran peores condiciones de salud bucal, postergando las citas odontológicas hasta tal punto de evitarlas. Objetivo: Determinar los factores asociados al miedo y la ansiedad en pacientes atendidos en las clínicas de la Facultad de Odontología de la Universidad Cooperativa de Colombia. Materiales y métodos: Se realizó un estudio cuantitativo tipo descriptivo transversal con 198 pacientes atendidos en las clínicas de la facultad de Odontología. Se aplicaron las encuestas: Dental Fear Survey (DFS), Escala de Ansiedad Dental de Corah Modificada (MDAS) y una tercera encuesta para identificar: características sociodemográficas y elementos, situaciones y sensaciones asociados a miedo a la ansiedad durante la consulta. Resultados: El 92,4% de los participantes presentaron algún grado de miedo en la consulta odontológica. El 48,7% presento ansiedad en algún grado. La presencia del miedo y ansiedad se encontró asociada con la evaluación de las experiencias previas en la consulta odontológica (Vp <0,001), evidenciado en la mayor proporción de individuos con miedo alto y ansiedad severa cuya experiencia fue negativa en comparación con las frecuencias observadas para aquellos con clasificación de ansiedad leve o moderada y miedo nulo o bajo. Conclusiones: Las experiencias traumáticas previas están relacionadas con el miedo y la ansiedad dental y pueden influir en el adecuado desarrollo de la consulta odontológica, por lo que se recomienda indagar al paciente acerca de estas antes de iniciar atención odontológica.

Background: People who feel fear and anxiety show worse oral health conditions than those who not, thus delaying dentist appointments to the point of cancelling all together. Aim: Determine the degree of fear, anxiety and associated factors in patients seen in the clinics of the Faculty of Dentistry of the Universidad Cooperativa de Colombia. Materials and methods: A quantitative cross-sectional descriptive study was conducted with patients treated in clinics of the Faculty of Dentistry, for a universe of 941, a sample of 198 participants were calculated, not randomly selected. Three surveys were applied by the DFS (Dental Fear Survey), the MDAS (Anxiety Scale Modified Corah Dental) and a third survey to identify sociodemographic variables and factors associated with fear and anxiety. Results: The 92.4% of the participants presented some degree of fear in the dental practice. 48.7% have anxiety to some degree. The presence of fear and anxiety was found associated with the evaluation of previous experiences in dental practice (Vp <0.001), evidenced in the highest proportion of individuals with high fear and anxiety whose experience was negative compared to the frequencies observed for those with mild or moderate anxiety and zero or low fear. Conclusion: Previous traumatic experiences are related to fear and dental anxiety and can influence the proper development of the dental appointments, so it is recommended to inquire about these before starting with a dental treatment.

Filtración de anastomosis colorrectal tratada con E-VAC con espuma de polivinilo podría reducir el tiempo de tratamiento / Colorectal anastomotic leak treated with E-VAC with polyvinyl sponge could reduce treatment time

RESUMEN Las filtraciones de anastomosis colorrectales tienen una incidencia de 5 a 15% y su manejo depende de las manifestaciones clínicas, la distancia desde el margen anal y su ubicación intra o extra peritoneal. En algunos casos seleccionados el manejo endoscópico ha demostrado ser un tratamiento efectivo. En el presente reporte de caso se utilizó el sistema de drenaje rectal transanal asistido por vacío descrito por Weidenhagen et al., para el tratamiento de una fuga anastomótica pero se utilizó una espuma de polivinilo en vez la espuma tradicionalmente usada de poliuretano con el fin de disminuir el número de cambios de la espuma y el tiempo de tratamiento.

ABSTRACT Colorectal anastomosis leaks have an incidence of 5 to 15% and their management depends on the clinical manifestations, the distance to the anal verge and the intra or extra peritoneal location. In some selected cases, endoscopic management has proven to be an effective treatment. In this case report, the vacuum-assisted transanal rectal drainage system described by Weidenhagen et al. was used for the treatment of an anastomotic leak. We used a polyvinyl sponge instead of the polyurethane sponge traditionally used with the intention to reduce sponge changes and treatment time.

Evaluation of aminolevulinic acid-mediated protoporphyrin IX fluorescence and enhancement by ABCG2 inhibitors in renal cell carcinoma cells.

Aminolevulinic acid (ALA) has been approved as an intraoperative molecular imaging probe for protoporphyrin IX (PpIX) fluorescence-guided resection of glioma. Here we explored its potential application for renal cell carcinoma (RCC) that is showing increased incidence in recent years. ALA-mediated PpIX in cell lysates (intracellular) and culture medium was measured in five human RCC cell lines (786-O, 769-P, A-704, Caki-1, Caki-2) and a non-tumor human kidney epithelial cell line HK-2 by spectrofluorometry and flow cytometry. The activity of PpIX bioconversion enzyme ferrochelatase (FECH) and PpIX efflux transporter ABCG2 was determined to correlate with the PpIX level. We found that ALA-PpIX fluorescence was highly variable among RCC cell lines and A-704 was the only RCC cell line exhibiting significantly higher intracellular PpIX than HK-2 cells. Neither the intracellular PpIX level nor the total amount of PpIX (including PpIX in cell lysates and the medium) had significant correlation with the activity of FECH or ABCG2. To enhance the intracellular PpIX, cells were treated with Ko143, a pharmacological inhibitor of ABCG2. Ko143 significantly increased the intracellular PpIX in cell lines with ABCG2 activity, but not in cell lines with little ABCG2 activity. In fact, there was a positive correlation between the ABCG2 activity and Ko143-induced PpIX enhancement across kidney cell lines. To identify clinically relevant ABCG2 inhibitors, small molecule inhibitors targeting various cell signaling pathways, some of which are known to inhibit ABCG2, were evaluated for the enhancement of ALA-PpIX in Caki-2 cells that had the highest ABCG2 activity in the RCC cell panel. Our screening led to the identification of several clinically available inhibitors that significantly increased the intracellular PpIX. Particularly, kinase inhibitor lapatinib exhibited the strongest enhancement effect. These clinical inhibitors can be used for the enhancement of ALA-PpIX fluorescence in tumors with elevated ABCG2 activity.

Treatment Alternatives for Recurrent Esophagogastric Junction Adenocarcinoma: Case Report of an Ileocolonic Reconstruction and Literature Review.

Esophagogastric junction tumors are a challenging pathology for surgeons and the best treatment depends on an adequate initial localization and stadification. Approximately half of patients relapse after curative surgery during the first two years. Surgical resection could increase the survival of these patients, but the esophageal reconstruction is a surgical challenge for which there are multiple reconstruction techniques described with different organs. In this report, we present the case of a patient with an esophagogastric junction tumor treated initially with total gastrectomy and esophageal margin. The patient presented an anastomotic recurrence that was taken to surgical resection, but a second recurrence required a residual esophagectomy with ileocolonic reconstruction, to achieve adequate oncologic treatment.

Peritoneal Metastasis of Cholangiocarcinoma Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy at the Instituto Nacional de Cancerología, Colombia.

Cholangiocarcinoma is a low-frequency neoplasm of onset with a poor prognosis. Peritoneal carcinomatosis is the most frequent site of metastasis with a standard palliative chemotherapy treatment. In the present article, we describe the case of a 35-year-old woman with peritoneal carcinomatosis secondary to an intrahepatic cholangiocarcinoma who was treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) as a non-standard therapeutic method. The patient has disease-free survival of 12 months with very good quality of life. The treatment of peritoneal metastasis from cholangiocarcinoma by CRS and HIPEC is feasible and could proportion better survival to these patients compared to systemic palliative chemotherapy. These therapeutic modalities can complement each other.

[Colorectal anastomotic leak treated with E-VAC with polyvinyl sponge could reduce treatment time]. / Filtración de anastomosis colorrectal tratada con E-VAC con espuma de polivinilo podría reducir el tiempo de tratamiento.

Colorectal anastomosis leaks have an incidence of 5 to 15% and their management depends on the clinical manifestations, the distance to the anal verge and the intra or extra peritoneal location. In some selected cases, endoscopic management has proven to be an effective treatment. In this case report, the vacuum-assisted transanal rectal drainage system described by Weidenhagen et al. was used for the treatment of an anastomotic leak. We used a polyvinyl sponge instead of the polyurethane sponge traditionally used with the intention to reduce sponge changes and treatment time.

Diagnóstico endoscópico de uncinariasis: presentación de un caso con anemia ferropénica grave / Endoscopic diagnosis of Uncinariasis, presentation of a case with severe iron deficiency anemia

Resumen Presentamos el caso clínico de un joven, proveniente del área rural, con anemia ferropénica severa, sin sangrado evidente, quien requirió transfusión de hemoderivados y múltiples exámenes, donde se descartaron causas hemolíticas, autoinmunes y anemia de enfermedad crónica. En estudios endoscópicos se le documentó uncinariasis masiva como causa de su cuadro clínico. La uncinariasis es una causa sub-diagnosticada y potencialmente curable de anemia en nuestro medio. En este artículo hacemos la descripción de un caso clínico, la discusión sobre diagnósticos diferenciales de anemia ferropénica y revisión de la literatura.

Abstract We present the clinical case of a young man from a rural area who required transfusion of blood products due to severe iron deficiency anemia although there was no obvious bleeding. Multiple tests ruled out hemolytic, autoimmune causes and chronic disease as the cause of his anemia. Endoscopy found massive ancylostomiasis, a potentially curable cause of anemia in our environment. In this article we describe the clinical case, discuss differential diagnoses of iron deficiency anemia, and review the literature.

Robot-assisted thoracic surgery in Colombia: a multi-institutional initial experience.

BACKGROUND: Robotic assisted videothoracoscopic surgery (RVATS) adoption has increased worldwide from 3.4% in 2010 to 17.5% in 2015. However, in Latin America, the literature is limited to a report of a series of 10 patients who underwent RVATS lobectomy and one case report of an RVATS thymectomy from Brazil. METHODS: This is a retrospective review of all RVATS performed in Bogotá Colombia since 2012. A single thoracic surgeon (RB) performed all the operations at three institutions: Clínica de Marly, Fundación Clínica Shaio and Instituto Nacional de Cancerología. Preoperative, intraoperative, postoperative and pathology report variables were included. Patients were analyzed in three groups: robotic RVATS pulmonary resections, RVATS mediastinal surgeries and other RVATS procedures. Descriptive statistics were used to report the median and interquartile range (IQR) of the continuous variables, and number and percentage were used to describe categorical variables. The association between total operative time and the year the surgery was analyzed using a linear regression model. RESULTS: Forty-seven patients underwent RVATS pulmonary resections; 72.3% (n=34) of these patients underwent a RVATS lobectomy. The median total operative time was 220 (IQR: 200 to 250) minutes, 6.4% (n=3) had intraoperative complications, and the most frequent histologic diagnosis was adenocarcinoma (n=24, 51.1%). Of 18 patients who underwent RVATS mediastinal surgeries, 50.0% (n=9) had RVATS thymectomy, the median total operative time was 195.5 (IQR: 131 to 221) minutes and two patients (11.1%) had intraoperative complications. The linear regression model of the association between total operative time and the year the surgery showed a 10.3 minute reduction per year (P=0.006). CONCLUSIONS: This is the second series of RVATS published in Latin America and the first published in Colombia, with comparable perioperative results to other reports.

Manejo del mesotelioma peritoneal maligno con citorreducción quirúrgica más quimioterapia hipertérmica intraperitoneal en el Instituto Nacional de Cancerología, Colombia: reporte de un caso y revisión bibliográfica / Peritoneal malignant mesothelioma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at the National Cancer Institute, Colombia: case report and literature review

El mesotelioma peritoneal es una neoplasia que se origina en las células mesoteliales del peritoneo. Histórica-mente, la supervivencia de los pacientes con mesotelioma peritoneal maligno sin tratamiento, es menor de 12 meses y se considera una neoplasia resistente a la quimioterapia. La citorreducción quirúrgica y la quimioterapia regional administrada como quimioterapia hipertérmica intraperitoneal (Hyperthermic Intraperitoneal Chemothe-rapy, HIPEC) se asocia con mejor supervivencia a largo plazo.Se presenta el caso de un paciente con antecedentes de exposición al asbesto y con diagnóstico de mesotelioma peritoneal maligno de tipo epitelioide, que fue tratado con cirugía citorreductora más quimioterapia hipertérmica intraperitoneal en el Instituto Nacional de Cancerología con una supervivencia de un año libre de enfermedad

Peritoneal mesothelioma is originated at the mesothelial cells of the peritoneum. Historically the survival of patients with this disease is less than 12 months without treatment and it is considered a neoplasm resistant to chemotherapy. Citorreductive surgery with hiperthermic intraperitoneal chemotherapy (HIPEC) is associated with an increased long-term survival. Here we present the case of a patient who had a past history of asbestos exposure and who was diagnosed with peritoneal mesothelioma of the epithelioid subtype. The patient was treated with cytoreductive surgery and HIPEC at the Instituto Nacional de Cancerología (Bogotá, Colombia) and has had a 12 month disease free survival

Endometriosis de la pared abdominal: estudio descriptivo de una serie de 21 casos / Abdominal wall endometriosis: A descriptive study of a series of 21 cases

Introducción. La endometriosis de la pared abdominal se define como la presencia de tejido endometrial en cualquiera de las capas que componen la pared abdominal. Su incidencia es baja y se caracteriza por un diagnóstico tardío. Materiales y métodos. Se trata de un estudio descriptivo y retrospectivo entre 2010 y 2014 en pacientes con endometriosis de la pared abdominal, cuyo análisis patológico fue realizado en un centro de ayudas diagnósticas de Medellín. Se identificaron las variables histopatológicas del reporte, y la información clínica mediante una entrevista telefónica suministrada por la paciente. Se analizaron los datos con medidas descriptivas de resumen. Resultados. Participaron 21 de 65 pacientes con diagnóstico de endometriosis de la pared abdominal. La media de edad al momento del diagnóstico fue de 35,3 años (desviación estándar, DE=8), el 71,4 % tenía el antecedente de cesárea y, el 38,1 %, el de endometriosis pélvica. El 95,2 % de las pacientes manifestaron dolor, de las cuales el 50 % lo percibió como constante con agudización cíclica y, el 40 %, como cíclico; además, el 90,5 % manifestó sensación de masa. La mediana del tiempo desde la aparición de la lesión hasta el diagnóstico, fue de 24 meses (RIQ=6-60). Solo en cuatro pacientes se hizo el diagnóstico prequirúrgico. El tratamiento fue quirúrgico en todas las pacientes y ocho (38,1 %) presentaron recidiva.Conclusiones. La endometriosis de la pared abdominal usualmente se manifiesta como masas dolorosas aso-ciadas con cicatrices quirúrgicas previas, generalmente de origen ginecológico y los síntomas empeoran con la menstruación. Es usual que su diagnóstico sea tardío y pocas veces se hace antes del estudio histopatológico. El tratamiento de elección es la resección quirúrgica, aunque no es despreciable el porcentaje de recidivas (AU)

Introduction: Abdominal wall endometriosis is defined by the presence of endometrial tissue in any of the layers that compose the abdominal wall. It has a low incidence and is characterized by a late diagnosis. Materials and Methods: A descriptive, ambispective study that included patients with abdominal wall endometriosis whose pathological analysis was performed in a diagnostic center in Medellín between 2010 and 2014. Histopathological variables of the report were identified, and clinical information was provided by the patient by a phone interview. They were analyzed with descriptive summary measures.Results: 21 patients with abdominal wall endometriosis of 65 identified participated. The mean age at diagnosis was 35.3 years ± 8, 71.4% had a prior caesarean section and 38.1% had pelvic endometriosis. 95.2% manifested pain, among them, 50% was perceived as constant with cyclical exacerbation, 40% cyclical; 90.5% manifested mass sensation. The median from the onset of the lesion to the diagnosis was 24 months (IQR 6-60). Only four patients had pre-surgical. The treatment was surgical in all patients and eight (38.1%) had recurrence.Conclusions: Abdominal wall endometriosis usually manifests through painful masses associated with previous surgical scars usually of gynecological origin and whose symptoms worsen with menstruation. Its diagnosis is usually late and it is rarely reached before the histopathological study. Management of choice is surgical resection, however, its percentage of recurrence is not negligible (AU)

Robotic simultaneous resection of rectal cancer and liver metastases.

Surgical resection is the only potential cure for colorectal cancer with synchronous liver metastases (SLM). Simultaneous resection of colorectal cancer and SLM using robotic-assistance has been rarely reported. We demonstrate that robotic-assisted simultaneous resection of colorectal cancer and SLMs is feasible, safe, and has potential to demonstrate good oncologic outcomes.

Estudio comparativo del stent colónico versus laparotomía en el tratamiento de la obstrucción intestinal aguda por cáncer colorrectal / Comparative Study of Colonic Stenting against Laparotomy for Treating Acute Intestinal Obstruction Due to Colorectal Cancer

Objetivo: la obstrucción por cáncer colorrectal (CCR) es una entidad frecuente y con importante morbilidad y mortalidad. El uso de stent colónicos aparece como una buena alternativa y pueden utilizarse con carácter paliativo o como una terapia puente para facilitar una única y definitiva cirugía. El objetivo del presente estudio es comparar el uso de los stents con la cirugía en los pacientes con obstrucción maligna colorrectal en términos de necesidad de ostomías, morbimortalidad y sobrevida. Métodos: se realizó un estudio descriptivo donde se analizaron retrospectivamente los datos recogidos de una cohorte de 103 pacientes, desde 2004 al 2012, registrada en una base de datos para tal fin y dividida en 4 grupos: un grupo al que se le colocó stent colónico y luego se llevó a cirugía electiva (SCX, n = 26), otro grupo llevado a cirugía convencional (CXC, n = 30), y los otros dos grupos con pacientes en fase avanzada de la enfermedad, unos en quienes solo se les colocó stent paliativo (SP, n = 24) y otros llevados a cirugía con intención paliativa (CP, n = 23). Se establecieron comparaciones entre los grupos y se realizó una descripción de los hallazgos más relevantes. Resultados: se registró un éxito técnico en 90,0% y éxito clínico en 82,0% en los grupos con stents. Se presentaron dos perforaciones asociadas con el stent (8,3%) en el grupo SP y ninguna en el grupo SCX. Hubo migración del stent en 3 pacientes (11,5%) del grupo SCX y en 3 (12,5%) del grupo SP. Se encontró una sobrevida global del 42,7%, siendo más baja en los grupos SP y CP con 4,2% y 34,8%, respectivamente. Se presentó una menor necesidad de ostomías en el grupo SCX con 5 pacientes (19,2%) versus 8 (26,7%) del grupo CXC, sin relevancia estadística, la cual sí se observó al comparar la necesidad de ostomías entre los grupos de CXC y CP con 8 (26,7%) y 15 (65,2%) pacientes respectivamente (P<0,05). Hubo alivio en el grupo SCX en 22 pacientes (84,6%) y solo en 18 del grupo CXC (60%), con una diferencia estadísticamente significativa (p = 0,042). La estancia hospitalaria fue menor en los grupos manejados con stent (SCX y SP), con promedio de 4 días (0-9 días) para cada uno. En el grupo CXC, 30 pacientes requirieron al menos una reintervención, 9 (39,1%) del grupo CP y 8 en el grupo de los stents. Conclusión: el uso de los stents colorrectales con intención paliativa o como terapia puente preoperatoria tiene baja morbilidad y evita en ocasiones una colostomía temporal o definitiva; también previene cirugías en pacientes con enfermedad avanzada y minimiza las ostomías en comparación con los pacientes operados paliativamente; además de que tienen menor estancia hospitalaria. Sin embargo, se necesitan estudios prospectivos que aclaren cuál es el verdadero papel de los stents en la patología obstructiva colorrectal maligna.

Objective: Obstructions due to colorectal cancer (CRC) are common and carry significant risks of morbidity and mortality. The use of colonic stents appears to be a good alternative and can be used with palliative therapy or as a bridge to facilitate definitive one-time-only surgery. The aim of this study is to compare the use of stents with surgery in patients with malignant colorectal obstructions in terms of morbidity, survival and the need for ostomies. Methods: This is a descriptive study based on data collected from a cohort of 103 patients from 2004 to 2012. Data were recorded in a database designed for this purpose. Patients were retrospectively divided into four groups for purposes of analysis. One group, which was labelled SCX, had had colonic stents placed and later underwent elective surgery (n = 26). A second group labelled CXC had undergone conventional surgery (n = 30). The other two groups consisted of patients in advanced stages of the disease. One of these groups, labelled SP received palliative stents (n = 24). The final group, labelled CP, underwent palliative surgery (n = 23). Comparisons among groups were made and then descriptions of the most important findings were developed. Results: The technical success rate was 90.0% and the clinical success rate was 82.0% in the groups of patients who received stents. There were two perforations in the SP group (8.3%) and none in the other group (SP) which received stents. Stent migration occurred in three patients (11.5%) in the SCX group and three (12.5%) in the SP group. The overall survival rate was 42.7%, but was only 4.2% in the SP group and 34.8% in the CP group. Fewer ostomies were required in the SCX group (five patients, 19.2%) than in the CXC group (eight patients, 26.7%) although the difference was not statistically significant. Similarly eight patients (26.7%) in the CXC group and 15 patients (65.2%) in the CP group required ostomies (P <0.05). Obstructions were ...

Guía de práctica clínica para la detección temprana de las anomalías durante el trabajo de parto, atención del parto normal y distócico / Clinical practice guidelines for early detection of abnormalities during labor, care for normal and dystocic delivery

Objetivo: realizar recomendaciones para detección temprana de las anomalías durante el trabajo de parto, atención del parto normal y distócico. Materiales y métodos: el grupo desarrollador de la Guía (GDG) elaboró esta GPC durante 2011-2012 acorde con la Guía Metodológica para la elaboración de Guías de Atención Integral en el Sistema General de Seguridad Social en Salud colombiano, basándose en la evidencia científica disponible y sumando la participación activa de grupos de pacientes, sociedades científicas y grupos de interés. En particular, la evidencia de esta Guía fue adaptada de la “Guía de práctica clínica sobre la atención del parto normal” (País Vasco - 2010) y actualizada por procedimientos sistemáticos, tanto para la búsqueda y valoración de la evidencia como para la generación de recomendaciones. El nivel de evidencia y la fuerza de las recomendaciones fueron expresados por medio del sistema del Scottish Intercollegiate Guidelines Network (SIGN). Esta guía y sus secciones hacen parte de un grupo de 25 GAI basadas en la evidencia que incorporan consideraciones económicas y de implementabilidad en el contexto del Sistema General de Seguridad Social en Salud colombiano, y que se desarrollaron por iniciativa del Ministerio de Salud y Protección Social y el Departamento de Ciencia, Tecnología e Innovación (Colciencias) en temas prioritarios y de alta prevalencia en el país mediante contrato otorgado a la Universidad Nacional de Colombia en el año 2010. Resultados: se presentan las recomendaciones para la asistencia del trabajo de parto y el parto asociadas con mayor probabilidad de obtener un resultado materno fetal exitoso durante la atención del parto. Conclusiones: se espera que las recomendaciones de esta GPC sean utilizadas por los profesionales de la salud de los programas de atención de la gestación con el fin de disminuir la morbilidad y mortalidad atribuibles a complicaciones del trabajo de parto y el parto.

Objective: To make recommendations for early detection of abnormalities during labor, and care of normal and dystocic delivery. Materials and methods: The Guideline Developer Group (GDG) prepared this CPG during 2011-2012 in accordance with the Methodology Guideline for the development of Comprehensive Care Guidelines of the Colombian General System of Social Security, on the basis of the available scientific evidence, and with the active participation of patient groups, scientific societies and stakeholders. In particular, the evidence for this section was adapted from the “Clinical practice guideline for normal delivery care” (País Vasco – 2010) and adapted through systematic procedures for the search and assessment of the evidence as well as for the generation of recommendations. The level of evidence and the power of the recommendations were expressed using the Scottish Intercollegiate Guidelines Network (SIGN) system. Results: We present the recommendations for labor and delivery care associated with the highest probability of a successful outcome for the mother and the baby. Conclusions: It is expected that the recommendations contained in this CPG will be used by practitioners in pregnancy care programs in order to reduce morbidity and mortality attributable to labor and delivery complications.

La experiencia de "tocar fondo" en alcohólicos recuperados: Una aproximación fenomenológica / The Experience of "Hitting Rock Bottom" Among Recovering Alcoholics: A Phenomenological Approach

El objetivo del presente estudio es describir la experiencia de "tocar fondo" en alcohólicos recuperados, para lo cual se utilizó el método fenomenología) y se practicó una entrevista en profundidad a cinco hombres y tres mujeres seleccionados entre la comunidad de Alcohólicos Anónimos, por medio del procedimiento de máxima variación en los casos. Los hallazgos mostraron que en la experiencia de "tocar fondo", generada por una acumulación de sucesos críticos, el alcohólico toma conciencia de su ruina existencial, se pregunta por su propia vida, siente deseos de cambiar, detiene su camino hacia la autodestrucción, busca ayuda, experimenta sentimientos de esperanza y liberación, y comienza un proceso de transformación y renacimiento, por así decirlo, que lo conduce a una vida más plena y saludable. Dicho renacer culmina con el abandono de la bebida. Esta experiencia entraña un enorme sufrimiento, precede el proceso de recuperación del alcohólico y parece ser un eslabón ineluctable de dicho proceso, cuya gravedad podría reducirse al conocer las experiencias de tocar fondo de otros alcohólicos.

Availing of the phenomenological method, this study aims to describe the experience of "hitting bottom" among recovering alcoholics. In-depth interviews were conducted with five men and three women who belong to the Alcoholic Anonymous community. These individuals were selected through a maximum variation sampling procedure. The results demonstrate that, due to the accumulation of critical events, in "hitting bottom" an alcoholic becomes aware of his/her existential ruin, is questioned for his/her life, feels a desire to change course, desists from the road toward self-destruction, seeks help, experiences feelings of hope and liberation, and begins a process of rebirth and transformation that leads him/her to stop drinking and therefore to a healthier life. Such an experience involves enormous suffering, precedes the process of recovery from alcoholism whereto it seems to be necessary.

Infección oculta por el virus de la hepatitis B Aspectos clínicos epidemiológicos y moleculares / Occult hepatitis B virus infection Clinical epidemiological and molecular aspects

Resumen Propósito: La infección oculta por el virus de la hepatitis B se caracteriza por la presencia del genoma viral en muestras de suero y/o tejido hepático pero sin detección de antígeno de superficie. Los mecanismos de patogénesis no se conocen completamente. El propósito del presente artículo es discutir y describir los aspectos clínicos, epidemiológicos y moleculares más importantes de este tipo de infección. Metodología: Se realizó una búsqueda de literatura en la base de datos PUBMED, de trabajos originales y revisiones de tema publicados entre 1979 y 2012. La búsqueda se realizó utilizando las palabras claves "Occult HBV infection, Epidemiology, clinical implications, mechamisms y outcome". Artículos relevantes citados en las publicaciones seleccionadas también fueron consultados. Conclusiones: La identificación de casos de infección oculta por el virus de la hepatitis B y la descripción de la prevalencia es de importancia para la prevención de la transmisión de la infección y del desarrollo de hepatopatías terminales. La disponibilidad de métodos sensibles y específicos para la detección del genoma viral ha permitido explorar la epidemiologia. No obstante, aún son materia de estudio los mecanismos de patogénesis. (Acta Médica Colombiana 2013; 38: 143-153).

Abstract Objective: occult hepatitis B virus infection is characterized by the presence of the viral genome in serum and / or liver tissue samples but without surface antigen detection. The mechanisms of pathogenesis are not fully known. The purpose of this article is to discuss and describe the most important clinical, epidemiological and molecular aspects of this type of infection. Methods: we performed a literature search in PUBMED database of original works and reviews of the subject published between 1979 and 2012. The search was performed using the keywords "occult HBV infection, epidemiology, clinical implications, mechanisms and outcome". Relevant articles cited in the selected publications were also consulted. Conclusions: the identification of cases of occult hepatitis B virus infection and the description of its prevalence is important in preventing transmission of the infection and the development of terminal hepatic diseases. The availability of sensitive and specific methods for the detection of viral genome has allowed us to explore the epidemiology. However, the mechanisms of pathogenesis are still under examination. (Acta Médica Colombiana 2013; 38: 143-153).