RESUMEN
OBJECTIVES: Primary: to assess the necessity of a second endoscopy with a pathology study to confirm the healing of all gastric ulcers previously diagnosed through endoscopy in a population at intermediate risk for gastric cancer. Secondary: to assess correlation between endoscopic findings and pathology diagnosis. PATIENTS AND METHODS: a prospective analysis of patients diagnosed with gastric ulcer through endoscopy at Hospital General de Ciudad Real (Spain) over three years. We collected demographic, clinical, endoscopic, and pathological data for the first and subsequent endoscopies. We collected at least six biopsies obtained from ulcer margins, and assessed H. pylori infection. RESULTS: Three hundred and two patients were included in this study. H. pylori infection was diagnosed in 173 (57%), and 113 (37%) patients had used NSAIDs. The positive and negative predictive value for malignancy of endoscopic diagnosis regarding ulcer fold, base, and margins were 34 and 97%, respectively. Only one patient was diagnosed with a tumor during the second endoscopy. At the end of follow-up, the etiology of the ulcer was considered as peptic in 276 patients; Crohn s disease-related in one, and neoplastic in 25 patients (21 adenocarcinomas, 4 lymphomas). CONCLUSIONS: in an intermediate-risk population for gastric cancer a second endoscopy is not justified for gastric ulcer patients when endoscopy and biopsy results do not suggest malignancy.
Asunto(s)
Adenocarcinoma/epidemiología , Gastroscopía , Linfoma no Hodgkin/epidemiología , Neoplasias Gástricas/epidemiología , Úlcera Gástrica/epidemiología , Adenocarcinoma/complicaciones , Adenocarcinoma/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Antiinflamatorios no Esteroideos/efectos adversos , Biopsia , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/epidemiología , Femenino , Estudios de Seguimiento , Gastritis/inducido químicamente , Gastritis/epidemiología , Gastritis/microbiología , Gastritis/patología , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/epidemiología , Helicobacter pylori , Humanos , Linfoma no Hodgkin/complicaciones , Linfoma no Hodgkin/diagnóstico , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Riesgo , España/epidemiología , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/diagnóstico , Úlcera Gástrica/diagnóstico , Úlcera Gástrica/etiología , Úlcera Gástrica/microbiología , Úlcera Gástrica/patología , Procedimientos Innecesarios , Adulto JovenRESUMEN
BACKGROUND: Previous reports have shown that livers from controlled non-heart-beating-donors (NHBD) are associated with higher rates of primary failure and ischemic cholangiopathy of orthotopic liver transplantation (OLT) as a complication of the prolonged warm ischemia. METHODS: This retrospective review of activities from 1999 to 2006 examined donor characteristics of age, liver function tests, warm ischemic time before (1WITa) and after cardiac arrest (1WITb), cold ischemic time (CIT) and transplant results. RESULTS: Eleven NHBD retrieved livers were transplanted from "ideal" donors except for one elderly donor (73 years). Of the 11 recipients, 3 developed biliary cholangiopathy (27%). There were no episodes of primary graft nonfunction, but one recipient displayed primary graft dysfunction. Two recipients died: one due to biliary complications with sepsis (long CIT >10 hours, fatty liver), and the other due to aspiration pneumonia and hypoxic brain damage with normal liver function. One recipient required retransplantation owing to ischemic cholangiopathy (1WITb 45 min) at 6 months after OLT with a good result. The other eight recipients are alive (observation period 72 to 14 months) including six with normal liver function, one with biopsy-proven biliary ischemia and one with recurrent primary sclerosing cholangitis without biliary ischemic changes on biopsy. Among 164 heart-beating donors recipients transplanted in the same period, biliary complications occurred in 27 patients (16%), of whom 12 were leaks and 15 anastomotic strictures. CONCLUSION: NHBD were a good source for livers with reasonable early results. To avoid late complications especially ischemic cholangiopathy, caution is urged with the use of these organs as well as strict donor and ischemic time criteria.
Asunto(s)
Muerte Encefálica , Colangitis/etiología , Isquemia/etiología , Trasplante de Hígado/efectos adversos , Adolescente , Adulto , Anciano , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Donantes de Tejidos , Recolección de Tejidos y Órganos/métodos , Resultado del TratamientoRESUMEN
To determine the functional status in elderly patients after a hospitalisation in an Internal Medicine unit. We prospectively studied patients aged 80 or above hospitalised in the Hospital Provincial de Ciudad Real in an Internal Medicine unit, between February and July, 2003. The functional status was determined by Barthel Index. We examined 206 patients (77.4%). They showed a previous Barthel Index of 70.9; one of 48.9 in the hospitalisation stage and one of 58.6 when discharged (p<0.001). We noticed a Barthel Index when discharged which was lower than the previous Barthel one in 73.8% patients. Hospitalisation implies a great functional impairment in the functional status elderly patients. It would be convenient, therefore, to identify the risk factors to be able to set some guidelines for a preventive model.