[Gastrostomy tubes in patients with amyotrophic lateral sclerosis: indications, safety and experience in a tertiary care centre]. / Sondas de gastrostomía en pacientes con esclerosis lateral amiotrófica: indicaciones, seguridad y experiencia en un centro de tercer nivel.

AIM: The aim of this study is the clinical characterisation of patients diagnosed with amyotrophic lateral sclerosis (ALS), who were indicated for the placement of a gastrostomy tube (G-Tube) in the period 2007-2017 in the Complejo Asistencial Universitario de Salamanca, and to find possible associated prognostic factors. MATERIAL AND METHODS: It is a descriptive study of clinical cases. RESULTS: Between 2007 and 2017, 139 cases of ALS were assessed and a G-Tube was indicated in 29 of them. Of these 29, on two occasions it was not performed, one due to the patient refusing and the other because of clinical deterioration. Of the total number of G-Tubes, 21 were placed by endoscopy, four by interventional radiology and two by surgery. The main indications were: in 10 cases, for severe dysphagia; in eight cases, for weight loss >10%; and in nine cases, for reduced forced vital capacity <50%. Immediate complications (first 24 hours) included: two intraprocedural desaturations, one ostomy infection, one abdominal pain, one paralytic ileus and one respiratory failure resulting in death. Late complications (first month) include pneumonia, intestinal ischaemia, cellulitis and poor control of secretions. The main cause of death was respiratory failure. The median time elapsed between G-Tube placement and death was 7.89 months. An improvement in analytical nutritional parameters was observed, without showing statistical significance, as a prognostic factor. CONCLUSION: G-Tube placement is an effective and safe procedure to ensure enteral nutrition in ALS patients.

TITLE: Sondas de gastrostomía en pacientes con esclerosis lateral amiotrófica: indicaciones, seguridad y experiencia en un centro de tercer nivel.Objetivo. El objetivo es la caracterización clínica de los pacientes diagnosticados de esclerosis lateral amiotrófica (ELA) a los que se les indicó la colocación de una sonda de gastrostomía (SG) en el período 2007-2017 en el Complejo Asistencial Universitario de Salamanca, y encontrar posibles factores pronósticos asociados. Material y métodos. Es un estudio descriptivo de casos clínicos. Resultados. Entre 2007 y 2017 se evaluaron 139 ELA y se indicó SG en 29 casos. De esos 29, en dos ocasiones no se llevó a cabo, en una ocasión por negativa del paciente y en otra por deterioro clínico. Del total de SG, 21 se colocaron por endoscopia; cuatro, por radiología intervencionista; y dos, por cirugía. Las principales indicaciones fueron: en 10 casos, por disfagia grave; en ocho, por pérdida ponderal > 10%; y en nueve, por disminución de la capacidad vital forzada menor de 50%. Entre las complicaciones inmediatas (primeras 24 horas) se observaron: dos desaturaciones intraprocedimiento, una infección de la ostomía, un dolor abdominal, un íleo paralítico y una insuficiencia respiratoria con fallecimiento. Entre las complicaciones tardías (primer mes): una neumonía, una isquemia intestinal, una celulitis y un mal control de las secreciones. La principal causa de fallecimiento fue la insuficiencia respiratoria. La mediana de tiempo desde la colocación de la SG hasta el fallecimiento fue de 7,89 meses. Se constató mejoría de los parámetros analíticos nutricionales, sin demostrarse significación estadística, como factor pronóstico. Conclusión. La colocación de una SG es un procedimiento eficaz y seguro para asegurar la nutrición enteral en los pacientes con ELA.

Cytomegalovirus ileitis in an immunocompetent patient.

Cytomegalovirus (CMV) is a virus that belongs to the family of Herpesviridae. Infection can cause a serious disease in immunocompromised patients, but it can also affect immunocompetent patients, creating generally self limiting symptoms. However, in some cases it can be fatal. We present a case of CMV ileitis with serious clinical symptoms that led to an operation in an immunocompetent patient.

EUS-guided tissue acquisition in the study of the adrenal glands: Results of a nationwide multicenter study.

BACKGROUND: There are limited data about the role of endoscopic ultrasound-guided tissue acquisition (EUS-TA), by fine needle aspiration (EUS-FNA) or biopsy (EUS-FNB), in the evaluation of the adrenal glands (AG). The primary aim was to assess the diagnostic yield and safety. The secondary aims were the malignancy predictors, and to create a predictive model of malignancy. METHODS: This was a retrospective nationwide study involving all Spanish hospitals experienced in EUS-TA of AGs. Inclusion period was from April-2003 to April-2016. Inclusion criteria: all consecutive cases that underwent EUS-TA of AGs. EUS and cytopathology findings were evaluated. Statistical analyses: diagnostic accuracy of echoendoscopist's suspicion using cytology by EUS-TA, as gold standard; multivariate logistic regression model to predict tumor malignancy. RESULTS: A total of 204 EUS-TA of AGs were evaluated. Primary tumor locations were lung70%, others19%, and unknown11%. AG samples were adequate for cytological diagnosis in 91%, and confirmed malignancy in 60%. Diagnostic accuracy of the endosonographer's suspicion was 68%. The most common technique was: a 22-G (65%) and cytological needle (75%) with suction-syringe (66%). No serious adverse events were described. The variables most associated with malignancy were size>30mm (OR2.27; 95%CI, 1.16-4.05), heterogeneous echo-pattern (OR2.11; 95%CI, 1.1-3.9), variegated AG shape (OR2.46; 95%CI, 1-6.24), and endosonographer suspicion (OR17.46; 95%CI, 6.2-58.5). The best variables for a predictive multivariate logistic model of malignancy were age, sex, echo-pattern, and AG-shape. CONCLUSIONS: EUS-TA of the AGs is a safe, minimally invasive procedure, allowing an excellent diagnostic yield. These results suggest the possibility of developing a pre-EUS procedure predictive malignancy model.

Sondas de gastrostomía en pacientes con esclerosis lateral amiotrófica: indicaciones, seguridad y experiencia en un centro de tercer nivel / Gastrostomy tubes in patients with amyotrophic lateral sclerosis: indications, safety and experience in a tertiary care centre

Objetivo: El objetivo es la caracterización clínica de los pacientes diagnosticados de esclerosis lateral amiotrófica (ELA) a los que se les indicó la colocación de una sonda de gastrostomía (SG) en el período 2007-2017 en el Complejo Asistencial Universitario de Salamanca, y encontrar posibles factores pronósticos asociados. Material y métodos. Es un estudio descriptivo de casos clínicos. Resultados: Entre 2007 y 2017 se evaluaron 139 ELA y se indicó SG en 29 casos. De esos 29, en dos ocasiones no se llevó a cabo, en una ocasión por negativa del paciente y en otra por deterioro clínico. Del total de SG, 21 se colocaron por endoscopia; cuatro, por radiología intervencionista; y dos, por cirugía. Las principales indicaciones fueron: en 10 casos, por disfagia grave; en ocho, por pérdida ponderal > 10%; y en nueve, por disminución de la capacidad vital forzada < 50%. Entre las complicaciones inmediatas (primeras 24 horas) se observaron: dos desaturaciones intraprocedimiento, una infección de la ostomía, un dolor abdominal, un íleo paralítico y una insuficiencia respiratoria con fallecimiento. Entre las complicaciones tardías (primer mes): una neumonía, una isquemia intestinal, una celulitis y un mal control de las secreciones. La principal causa de fallecimiento fue la insuficiencia respiratoria. La mediana de tiempo desde la colocación de la SG hasta el fallecimiento fue de 7,89 meses. Se constató mejoría de los parámetros analíticos nutricionales, sin demostrarse significación estadística, como factor pronóstico. Conclusión: La colocación de una SG es un procedimiento eficaz y seguro para asegurar la nutrición enteral en los pacientes con ELA.(AU)

Aim: The aim of this study is the clinical characterisation of patients diagnosed with amyotrophic lateral sclerosis (ALS), who were indicated for the placement of a gastrostomy tube (G-Tube) in the period 2007-2017 in the Complejo Asistencial Universitario de Salamanca, and to find possible associated prognostic factors. Material and methods: It is a descriptive study of clinical cases. Results: Between 2007 and 2017, 139 cases of ALS were assessed and a G-Tube was indicated in 29 of them. Of these 29, on two occasions it was not performed, one due to the patient refusing and the other because of clinical deterioration. Of the total number of G-Tubes, 21 were placed by endoscopy, four by interventional radiology and two by surgery. The main indications were: in 10 cases, for severe dysphagia; in eight cases, for weight loss >10%; and in nine cases, for reduced forced vital capacity <50%. Immediate complications (first 24 hours) included: two intraprocedural desaturations, one ostomy infection, one abdominal pain, one paralytic ileus and one respiratory failure resulting in death. Late complications (first month) include pneumonia, intestinal ischaemia, cellulitis and poor control of secretions. The main cause of death was respiratory failure. The median time elapsed between G-Tube placement and death was 7.89 months. An improvement in analytical nutritional parameters was observed, without showing statistical significance, as a prognostic factor. Conclusion: G-Tube placement is an effective and safe procedure to ensure enteral nutrition in ALS patients.(AU)

Potential protective effect of Helicobacter pylori on the development of gastrointestinal GvHD.

Previous reports ascribe a modulating capacity of the immune response to Helicobacter pylori (HP). Our hypothesis was to demonstrate in a prospective study that HP infection could have a protective effect against development of gastrointestinal GvHD in patients receiving allogeneic hematopoietic cell transplantation (HCT). Presence of HP before transplant was determined using C(13) urea breath test. Seventy-nine patients receiving an allogeneic HCT were included and 93.7% of them received PBSC; in 51.9%, the donor was unrelated. Acute gastrointestinal GvHD was diagnosed in 51.9% (n=41). In the multivariable analysis, HP infection was associated with a lower frequency of gastrointestinal GvHD (odds ratio (OR)=0.19 (95% confidence interval (CI): 0.05-0.67); in contrast, an unrelated donor was associated with a higher frequency of gastrointestinal GvHD (odds ratio=5.4 (95% confidence interval: 1.6-18.2). One year overall survival (OS) was 74%. In the multivariate Cox proportional-hazards regression analysis, stages 0-II gastrointestinal GvHD (hazards ratio (HR)=0.19), reduced intensity conditioning (HR=0.04) and tacrolimus-sirolimus GvHD prophylaxis (HR=0.06) were all associated with a better OS. In summary, HP infection could have a role in decreasing gastrointestinal GvHD in patients receiving allogeneic HCT from peripheral blood including related and unrelated donors.

Tuberculosis intestinal: un reto diagnóstico / No disponible

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Cetoacidosis diabética asociada a trombosis arterial de pequeño vaso en mujer de 54 años / Diabetic ketoacidosis associated to venous thrombosis in a 54 years old woman

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