Clinical impact of confocal laser endomicroscopy in the management of gastrointestinal lesions with an uncertain diagnosis.

AIM: To evaluate the clinical impact of confocal laser endomicroscopy (CLE) in the diagnosis and management of patients with an uncertain diagnosis. METHODS: A retrospective chart review was performed. Patients who underwent CLE between November 2013 and October 2015 and exhibited a poor correlation between endoscopic and histological findings were included. Baseline characteristics, indications, previous diagnostic studies, findings at the time of CLE, clinical management and histological results were analyzed. Interventions based on CLE findings were also analyzed. We compared the diagnostic accuracy of CLE and target biopsies of surgical specimens. RESULTS: A total of 144 patients were included. Of these, 51% (74/144) were female. The mean age was 51 years old. In all, 41/144 (28.4%) lesions were neoplastic (13 bile duct, 10 gastric, 8 esophageal, 6 colonic, 1 duodenal, 1 rectal, 1 ampulloma and 1 pancreatic). The sensitivity, specificity, positive predictive value, negative predictive value, and observed agreement when CLE was used to detect N-lesions were 85.37%, 87.38%, 72.92%, 93.75% and 86.81%, respectively. Cohen's Kappa was 69.20%, thus indicating good agreement. Changes in management were observed in 54% of the cases. CONCLUSION: CLE is a new diagnostic tool that has a significant clinical impact on the diagnosis and treatment of patients with uncertain diagnosis.

Intoxicaciones agudas en pediatría: Hospital Central Universitario "Dr. Antonio María Pineda" Enero 1991-Enero 1992 / Acute poisoning in pediatry that had been attended at \"Dr Antonio María Pineda\" University Central Hospital. January 1991-January 1992

Se estudiaron 2.200 casos de intoxicación agudas que consultaron a la Emergencia Pediátrica del Hospital Central Universitario "Dr. Antonio María Pineda". La intoxicación más frecuente fue la medicamentosa, seguida de los agentes de uso doméstico. La circunstancia predominante fue la accidental. Los lactantes representaron el grupo etario más afectado; en general prodedían del medio urbano. Los escolares estuvieron más afectados por emponzoñamiento ofídico y escorpiónico y procedían generalmente del medio rural. El sexo más afectado fue el masculino. Ciento cuarenta y cuatro (144) pacientes presentaron manifestaciones clínicas severas. El 68,8 por ciento de los casos fueron tratados ambulatoriamente. Se registró una mortalidad del 0,3 por ciento