Experience in the treatment of obstructive colorectal cancer with self-expandable colon prosthesis in a tertiary hospital.

Colorectal cancer is one of the most frequent neoplasms, with an increasing incidence in recent years. Intestinal obstruction is present at the time of diagnosis in 10-30% of patients. The aim of our study is to describe our experience in the use of colonic SEMS in the treatment of colonic stenosing neoplasia. For this purpose, we retrospectively evaluated the 92 patients treated with self-expandable metallic prostheses in our hospital between 2016 and 2021. In 66.3% of patients the prosthesis placement was bridge to curative surgery and in 33.7% with palliative attitude. The stenosis location was differentiated: rectum (2.1%), rectosigmoid junction (20.7%), sigma (58.7%), left colon (8.7%), splenic angle (8.7%) and transverse colon (1.1%); being the size of the self-expandable metallic prostheses used 60x25 mm, 90x25 mm and 120x25 mm. The procedure was technically effective in 92.4% of the cases and clinically effective in 89.1%, with post-procedural perforations being detected in 9 patients (9.8%). Survival 30 days after prosthesis placement was 91.3%. No mortality directly related to the procedure was detected. In our experience, placement of self-expandable metallic prostheses is a safe and effective option in the initial management of neoplastic colon stenosis.

Experience in the treatment of esophageal anastomosis dehiscence using self-expanding metallic prosthesis.

INTRODUCTION: esophageal anastomosis dehiscence is a serious complication after esophageal cancer surgery with high mortality risk. One of the treatment options is self-expanding esophageal prostheses. Our aim was to evaluate the outcome of esophageal prostheses in the management of suture dehiscences after oncologic surgery. MATERIAL AND METHODS: we performed a descriptive and retrospective study with patients diagnosed with esophageal anastomosis fistula or dehiscence treated by esophageal prosthesis between the years 2015 and 2021. We considered technical success as the correct positioning of the prosthesis with visualization of anastomotic leak closure after release of the prosthesis during endoscopy, and clinical success the resolution of dehiscence after removal of the prosthesis 8 weeks after positioning. RESULTS: technical success was 95% and clinical success 89%. CONCLUSION: in our center, esophageal prostheses are a treatment option for fistulas and anastomotic dehiscence after surgery with a high success rate and few complications.

Legal regulation of ventilation rates in homes in Europe 2010-2022: Evolution and comparison study regarding Covid-19 recommendations.

The airborne transmission of SARS-CoV-2, the virus that causes Covid-19 disease, has been recognized as an essential route of contagion, so adequate ventilation is vital indoors. For this reason, the research goal focuses on carrying out the study and evolutionary and comparison analysis of the regulation of ventilation rates in dwellings in Europe (2010-2022) and on determining whether modifications are necessary for the said regulation based on the recommendations of competent international organizations. To do this, the methodology followed initially starts from the study carried out in 2010 by Christine Dimitroulopoulou, in which the existing regulation in various European countries regarding ventilation in dwellings was studied. Once this study has been analysed, it continues to update and compare the regulation of the different European countries cited in the said work, detecting during the process if a modification is necessary based on the recommendations indicated by international organizations such as the WHO or ECDC. The results and conclusions indicate that few countries have significantly changed their ventilation rates. Although the existing ones may be admissible, requiring controlled ventilation in the different regulations would be convenient.

Distances of transmission risk of COVID-19 inside dwellings and evaluation of the effectiveness of reciprocal proximity warning sounds.

One of the main modes of transmission and propagation of COVID-19 (SARS-CoV-2) is the direct contact with respiratory droplets transmitted among individuals at a certain distance. There are indoor spaces, such as dwellings, in which the transmission risk is high. This research aims to record and analyze risk close contacts in this scope, experimentally assessing the effectiveness of using electronic proximity warning sound devices or systems. For this purpose, the methodology is based on monitoring the location of the occupants of a dwelling. Then, the days in which a proximity warning sound system is installed and activated are compared to the days in which the system is not activated. The results stressed the significant reduction of time and number of close contacts among individuals when the warning was activated. Regarding the relation between the number and the duration of close contacts, together with the reductions mentioned, the possibility of making certain predictions based on the distributions obtained is proved. All this contributes to the progress in the prevention of COVID-19 transmission because of close contacts in dwellings.

Detection of activities in bathrooms through deep learning and environmental data graphics images.

Automatic detection activities in indoor spaces has been and is a matter of great interest. Thus, in the field of health surveillance, one of the spaces frequently studied is the bathroom of homes and specifically the behaviour of users in the said space, since certain pathologies can sometimes be deduced from it. That is why, the objective of this study is to know if it is possible to automatically classify the main activities that occur within the bathroom, using an innovative methodology with respect to the methods used to date, based on environmental parameters and the application of machine learning algorithms, thus allowing privacy to be preserved, which is a notable improvement in relation to other methods. For this, the methodology followed is based on the novel application of a pre-trained convolutional network for classifying graphs resulting from the monitoring of the environmental parameters of a bathroom. The results obtained allow us to conclude that, in addition to being able to check whether environmental data are adequate for health, it is possible to detect a high rate of true positives (around 80%) in some of the most frequent and important activities, thus facilitating its automation in a very simple and economical way.

In-situ disinfection of wastes generated in dwellings by utilizing ozone for their safe incorporation into the recycling chain.

The Covid-19 pandemic has certainly changed behaviour patterns in many aspects of life, such as the management of solid wastes inside residential spaces. The goal of this research work is to study an ozone generator device as a disinfection and sterilization tool for these wastes in dwellings themselves, thus re-establishing the selective collection to take them back to the recycling chain. In addition, an approach to the risk verification is made. The methodology is based on an experimentation with a device designed to be as cheap as possible. A room like a bedroom is used as a test bed to apply the device, but with no people inside the room to avoid risks. The results show that the device is feasible, concluding that risks are acceptable if its use is correct and appropriate equipment is available to be applied and controlled, all without prejudice of the rigorous control by the competent authorities that approve its use.

[Acute pancreatitis associated with hereditary angioedema]. / Pancreatitis aguda asociada a angioedema hereditario.

Hereditary angioedema (HAE) is an infrequent, recurrent, and potentially lethal disorder caused by a deficiency of C(1) inhibitor or its activity. Abdominal pain secondary to bowel edema is common in these patients. However, a thorough literature search yielded only six previously reported cases of pancreatitis associated with this entity.

[Primary diffuse large B-cell lymphoma of the rectum simulating a rectal adenocarcinoma]. / Linfoma de tipo B difuso de células grandes primario rectal que simula un adenocarcinoma de recto.

Colorectal lymphoma is an extremely infrequent entity, representing less than 0.5% of all primary colorectal neoplasms. Colorectal localization accounts for 15-20% of all gastrointestinal lymphomas, after the stomach and small intestine. Because the symptoms are non-specific, this disease is usually diagnosed in the advanced stages. Dawson's criteria are highly useful in the differential diagnosis between primary colorectal involvement and gastrointestinal tract involvement secondary to systemic lymphoma, which is important due to the distinct prognosis and treatment of these entities. We report the case of a B-cell non-Hodgkin's lymphoma that was difficult to diagnose and was treated with R-CHOP polychemotherapy. Outcome was poor.

Experience in the treatment of esophageal anastomosis dehiscence using self-expanding metallic prosthesis

Introduction: esophageal anastomosis dehiscence is a serious complication after esophageal cancer surgery with high mortality risk. One of the treatment options is self-expanding esophageal prostheses. Our aim was to evaluate the outcome of esophageal prostheses in the management of suture dehiscences after oncologic surgery.Material and methods: we performed a descriptive and retrospective study with patients diagnosed with esophageal anastomosis fistula or dehiscence treated by esophageal prosthesis between the years 2015 and 2021. We considered technical success as the correct positioning of the prosthesis with visualization of anastomotic leak closure after release of the prosthesis during endoscopy, and clinical success the resolution of dehiscence after removal of the prosthesis 8 weeks after positioning.Results: technical success was 95% and clinical success 89%.Conclusion: in our center, esophageal prostheses are a treatment option for fistulas and anastomotic dehiscence after surgery with a high success rate and few complications. (AU)

[Tacrolimus in the treatment of refractory moderate-to-severe inflammatory bowel disease]. / Tacrolimus en el tratamiento de la enfermedad inflamatoria intestinal refractaria moderada-grave.

INTRODUCTION: The primary endpoint of this study was to evaluate the efficacy of oral tacrolimus in patients with active moderate-to-severe luminal IBD, mainly those refractory to steroids. Secondary endpoints were surgery requirements during follow-up, the percentage of patients achieving steroid withdrawal, and treatment safety. PATIENTS AND METHOD: Nineteen patients were included. The main indication for tacrolimus therapy was steroid resistance. The mean duration of treatment was 11 (range 3- 13) and 15 (range 4-44) months in patients with UC and CD, respectively. Remission was evaluated at weeks 4, 8 and 24 from the start of treatment, using the Harvey-Bradshaw index and the Truelove-Witts criteria for CD and UC patients, respectively, and acute- phase reactants (Serum erythrocyte sedimentation rate and C-reactive protein). Steroid withdrawal, need for surgery, and previous and concomitant medication were also evaluated. RESULTS: Overall, 47%, 66% and 41% of the patients were in complete remission at weeks 4, 8 and 24, respectively. Steroid withdrawal was achieved in 50% of the patients. Among patients who could not undergo complete steroid withdrawal, steroid therapy was reduced to a mean prednisone dose of 12.5 mg /day (range 10-15 mg). Surgery was required in 16% (mean follow-up of 38 months). Adverse effects occurred in 63% patients, who improved with dose reduction; none of the patients required tacrolimus withdrawal. CONCLUSIONS: Oral tacrolimus could be a safe, effective and useful option in patients with refractory IBD.

[Pulmonary toxicity associated with sirolimus therapy in liver transplantation]. / Toxicidad pulmonar asociada a sirolimus en el trasplante hepático.

Sirolimus is a potent immunosuppressive drug that began to be used in the last few years. This drug was initially used in renal transplantation but its use in other solid organ transplantations such as liver, heart, lung and pancreas, has been increasing. Sirolimus is indicated in rescue therapies and to reduce the secondary toxic effects of calcineurin inhibitors. However, this drug has been associated with infrequent but severe pulmonary toxicity and cases of interstitial pneumonitis, bronchiolitis obliterans with organizing pneumonia, and alveolar proteinosis have been described. We present the case of a male liver transplant recipient who developed interstitial pneumonitis associated with sirolimus use.

Hemobilia de causa poco frecuente: seudoaneurisma de la arteria hepática tras colangiopancreatografía retrógrada endoscópica / An unusual cause of hemobilia: Hepatic artery pseudoaneurysm after endoscopic retrograde cholangiopancreatography

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Pancreatitis aguda asociada a angioedema hereditario / Acute pancreatitis associated with hereditary angioedema

El angioedema hereditario (AH) es un proceso infrecuente, de carácter recurrente, potencialmente mortal, originado por el déficit o disfunción de factor C1 inhibidor. El dolor abdominal secundario a edema intestinal es relativamente frecuente en pacientes con AH pero tras una revisión de la literatura solo se han informado seis casos de pancreatitis aguda asociado a angioedema hereditario (AU)

Hereditary angioedema (HAE) is an infrequent, recurrent, and potentially lethal disorder caused by a deficiency of C1 inhibitor or its activity. Abdominal pain secondary to bowel edema is common in these patients. However, a thorough literature search yielded only six previously reported cases of pancreatitis associated with this entity (AU)

Linfoma de tipo B difuso de células grandes primario rectal que simula un adenocarcinoma de recto / Primary diffuse large B-cell lymphoma of the rectum simulating a rectal adenocarcinoma

El linfoma colorrectal es una entidad extremadamente infrecuente, representando menos del 0,5% del total de las neoplasias colorrectales primarias. La localización colorrectal supone el 15–20% del total de los linfomas gastrointestinales, tras el estómago y el intestino delgado. Debido a la inespecificidad de los síntomas, la enfermedad suele estar avanzada en el momento del diagnóstico. Primordial interés tienen los criterios de Dawson para diferenciar la afectación colorrectal primaria de la afectación del tracto gastrointestinal secundaria a un linfoma sistémico, dadas sus diferentes connotaciones pronósticas y terapéuticas. Presentamos el caso de un linfoma no hodgkiniano tipo B de localización rectal, de difícil diagnóstico, tratado con esquema poliquimioterapéutico con ciclofosfamida, adriamicina, vincristina, prednisona y rituximab, cuya evolución fue desfavorable (AU)

Colorectal lymphoma is an extremely infrequent entity, representing less than 0.5% of all primary colorectal neoplasms. Colorectal localization accounts for 15–20% of all gastrointestinal lymphomas, after the stomach and small intestine. Because the symptoms are non-specific, this disease is usually diagnosed in the advanced stages. Dawson's criteria are highly useful in the differential diagnosis between primary colorectal involvement and gastrointestinal tract involvement secondary to systemic lymphoma, which is important due to the distinct prognosis and treatment of these entities. We report the case of a B-cell non-Hodgkin's lymphoma that was difficult to diagnose and was treated with R-CHOP polychemotherapy. Outcome was poor (AU)

Hepatotoxicidad inducida por cocaína / Cocaine-induced hepatotoxicity

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Tacrolimus en el tratamiento de la enfermedad inflamatoria intestinal refractaria moderada-grave / Tacrolimus in the treatment of refractory moderate-to-severe inflammatory bowel disease

Introducción: El objetivo principal de este estudio ha sido evaluar la eficacia de tacrolimus oral en la enfermedad inflamatoria intestinal (EII) moderada-grave luminal, principalmente corticorrefractaria. Los objetivos secundarios fueron evaluar los requerimientos de cirugía en el período de seguimiento, el porcentaje de pacientes en que se consiguió la suspensión de la terapia corticoidea y analizar la seguridad del tratamiento. Pacientes y método: Se incluyó a 19 pacientes. La indicación mayoritaria fue la corticorrefractariedad. La duración media del tratamiento con tacrolimus fue de 11 meses (rango, 3-13) y 15 meses (rango, 4-44) en pacientes con colitis ulcerosa y enfermedad de Crohn, respectivamente. Para evaluar los resultados se consideró el porcentaje de pacientes que se encontraban en remisión a las 4, 8 y 24 semanas desde el inicio del tratamiento, utilizando para ello índices de actividad clínicos (Truelove modificado y Harvey-Bradshaw) apoyados por reactantes de fase aguda (PCR Y VSG). También se analizó la posibilidad de suspensión de corticoides y la necesidad de cirugía. A su vez, se consideraron las medicaciones previas y concomitantes que habían sido utilizadas. Resultados: De forma global, un 47, un 66 y un 41% de los pacientes presentan remisión a las semanas 4, 8 y 24, respectivamente. Se consiguió retirar los esteroides en un 50% de los pacientes. Entre los pacientes a los que no se pudo retirar por completo el tratamiento esteroideo, se pudo reducir la dosificación con una media de 12,5 mg de prednisona/día (rango, 10-15). Precisó cirugía el 16% de los pacientes en un seguimiento medio de 38 meses. Presentó efectos adversos el 63% de los pacientes, que no obligaron a la suspensión del tratamiento en ningún caso, y mejoraron con la reducción de la dosis. Conclusiones: Tacrolimus oral puede ser una opción útil, de fácil manejo, efectiva y segura en los pacientes con EII refractaria

Introduction: The primary endpoint of this study was to evaluate the efficacy of oral tacrolimus in patients with active moderate-to-severe luminal IBD, mainly those refractory to steroids. Secondary endpoints were surgery requirements during follow-up, the percentage of patients achieving steroid withdrawal, and treatment safety. Patients and Method: Nineteen patients were included. The main indication for tacrolimus therapy was steroid resistance. The mean duration of treatment was 11 (range 3- 13) and 15 (range 4-44) months in patients with UC and CD, respectively. Remission was evaluated at weeks 4, 8 and 24 from the start of treatment, using the Harvey-Bradshaw index and the Truelove-Witts criteria for CD and UC patients, respectively, and acute- phase reactants (Serum erythrocyte sedimentation rate and C-reactive protein). Steroid withdrawal, need for surgery, and previous and concomitant medication were also evaluated. Results: Overall, 47%, 66% and 41% of the patients were in complete remission at weeks 4, 8 and 24, respectively. Steroid withdrawal was achieved in 50% of the patients. Among patients who could not undergo complete steroid withdrawal, steroid therapy was reduced to a mean prednisone dose of 12.5 mg /day (range 10-15 mg). Surgery was required in 16% (mean follow-up of 38 months). Adverse effects occurred in 63% patients, who improved with dose reduction; none of the patients required tacrolimus withdrawal. Conclusions: Oral tacrolimus could be a safe, effective and useful option in patients with refractory IBD