Dysphagia and stenosis secondary to intramural esophageal pseudodiverticulosis.

We present the case of a patient with smoking, alcoholism, cirrhosis and HIV who was endoscopically diagnosed with esophageal candidiasis due to an episode of dysphagia. After treatment with antifungals and PPIs, the patient remained asymptomatic for almost 3 years. He presented an event of food impaction that was resolved by an upper endoscopy in which an esophageal stenosis and multiple esophageal pseudodiverticulosis were visualized. The biopsies only showed chronic nonspecific esophagitis. The stenosis was dilated with a balloon and PPIs were continued, with good response. Esophageal intramural pseudodiverticulosis is rare and can lead to motor disorders and strictures. It has a doubtful association with HIV and a clearer relationship with alcoholism, smoking, diabetes, reflux and candidiasis. The endoscopic diagnosis can be difficult so in order to make an accurate diagnosis is necessary an esophagram or CT. Treatment is based on controlling risk factors and dilating stenosis. The prognosis is usually favorable.

Intestinal spirochetosis - Four cases with different clinical presentations.

We present 4 clinical cases of intestinal spirochetosis. The first one presents with chronic diarrhea, and spirochetes are detected in random biopsies. The second is homosexual, HIV+, presents rectal bleeding, colonoscopy shows a straight ulcer and spirochete biopsies show negative treponema PCR. The third was also homosexual, HIV+, asymptomatic, with a chance finding of spirochetosis. The last case is also a chance histological diagnosis in a patient with inactive ulcerative colitis without lesions. Intestinal spirochetosis appears to be transmitted sexually and by consumption of contaminated water. The majority are asymptomatic cases but could cause lesions including ulcerations and symptoms. Treatment is only recommended in symptomatic or immunosuppressed patients. It must be distinguished from lesions caused by Treponema pallidum.

A rare endoscopic finding: primary esophageal melanoma.

We report a case of a patient accidentally diagnosed with an esophageal lesion compatible (histologically and immunohistochemically) with epithelioid melanoma. The skin examination did not reveal any evidence of melanoma and the patient was diagnosed with primary malignant melanoma of the esophagus. It's a very rare tumour. The majority of melanocytic lesions of the gastrointestinal tract are presumably secondary to a cutaneous melanoma and in order to discard this, a thorough skin examination is needed. Diagnosis is based on endoscopic image, histological data and especially on immunohistochemical evaluation. Primary malignant melanoma has a very poor prognosis as it usually presents distant metastasis when diagnosed. Surgery (with or without associated immunotherapy) remains the base of treatment in absence of advanced disease.

Esophageal stent placement for endoscopic treatment failure.

Up until approximately 10 years ago, the treatment for acute refractory esophageal variceal bleeding was balloon tamponading. Esophageal fully covered self-expanding stents are considered as effective as balloons and also much safer. They are kept in situ for longer periods, what eases the access to more definitive treatments with a low complication rate. We present 6 cases of patients with cirrhosis and massive bleeding due to esophageal varices refractory to conventional treatment, successfully treated with an esophageal fully covered self-expanding stent. There were no major complications, achieving an effective bleeding control in all cases.

Diagnostic yield of the capsule endoscopy and enteroscopy combination for early small bowel carcinoid tumors.

Small bowel carcinoid tumor is a difficult to diagnose entity that can present an aggressive clinical course even if they are small in size. The diagnosis based on tumor markers and imaging tests is limited, but the combination of capsule endoscopy followed by enteroscopy when the carcinoid tumor is suspected, has been shown to be useful for its early diagnosis, as well as for reaching a thorough study of the small bowel. We present a clinical case of two small synchronous carcinoid tumors of the ilium that were diagnosed by using this strategy.

Comparative study of visits to Hospital Emergency Department for opioid overdose in two periods.

OBJECTIVE: The last few years have seen an increase in the use of opioid analgesics and in the incidence of opioid overdoses. The objective of this study was to evaluate the number of overdose-related visits to a  university hospital emergency department at two different periods of time  to analyze potential differences in terms of patient characteristics,  prescription profile, and treatment. METHOD: This is a retrospective observational study of opioid  verdoserelated visits in two periods of time: 2009-2014 and 2018-2020. RESULTS: The study included 47 cases of opioid overdoses: 20 during the first period (3.3 cases/year) and 27 during the second (9 cases/year).  A comparison between the two period showed a decrease in the patients' age (81.1 vs 74.0; p = 0.044) and an increase in the number of  acute trauma-derived pain treatments at the expense of chronic pain  treatments (p = 0.002). No differences were observed in the opioids  involved. As regards symptoms, there was a decrease in the incidence of  confusional syndromes (p = 0.026) and an increase in deaths. CONCLUSIONS: Emergency room visits for opioid overdoses have increased in recent years, as has the mortality associated to them. A  change has also been observed in the profile of affected patients, with a  higher number of cases where pain is derived from acute trauma.

Objetivo: El uso de fármacos opioides ha aumentado en las últimas  écadas, así como las intoxicaciones relacionadas con su uso. El objetivo de este estudio es evaluar el número de visitas a urgencias en un hospital  universitario por intoxicaciones por opiáceos entre dos periodos y analizar  las posibles diferencias de las características de los pacientes, perfil de  prescripción y el tratamiento de dicha intoxicación.Método: Estudio observacional, retrospectivo de las visitas debidas a intoxicaciones por fármacos opiáceos en dos periodos: 2009-2014 y 2018-2020.Resultados: Se incluyeron 47 casos de intoxicaciones, 20 en el primer periodo (3,3 casos/año) y 27 en el segundo (9 casos/año). Se observó una disminución en la edad de los pacientes (81,1 versus 74,0; p = 0,044) y un incremento de tratamientos debidos a dolor  raumatológico agudo a expensas de menos tratamientos de dolor crónico (p = 0,002). No hubo diferencias en el opiáceo implicado. Con  respecto a la clínica, se observó una disminución en los síndromes  confusionales (p = 0,026) y un incremento de fallecimientos.Conclusiones: Las visitas a urgencias por intoxicaciones a fármacos opiáceos han aumentado en los últimos años, así como la  mortalidad asociada. El perfil de los pacientes implicados ha variado,  incrementándose el tratamiento de dolor traumatológico agudo.

Poisoning cases in Catalonia: characteristics according to age groups in the Intox.28 study. / Características de las intoxicaciones agudas atendidas en Cataluña y diferencias según grupos de edad: Estudio Intox-28.

OBJECTIVES: The Toxicology Working Group of the Catalan Society of Emergency Medicine (SoCMUETox) began the Intox-28 study in 2013. The aim was to identify differences in poisoning cases between 3 age groups. MATERIAL AND METHODS: Descriptive observational study of poisoning cases managed in 8 hospital emergency departments on the 28th day of each month from 2013 to 2019. We gathered information on patient particulars, type of poison, clinical data, and discharge destination. The patient sample was distributed into 3 groups for comparison: minors under the age of 17 years, adults aged 17 to 65 years, and adults over the age of 65 years. RESULTS: The hospitals registered 1088 cases: 132, 859, and 97 in each age group. In comparisons between the minors and the adults aged 65 years or younger, the minors had more females (58.3% vs 46.1%), fewer recreational poisonings (22% vs 46.1%) more poisonings inside the home (67.4% vs 51.1%), more medication poisonings (49.2% vs 31.1%), and less often received treatment (43.2% vs 73%) (P .001, all comparisons). The proportion of older adults receiving treatment (73.2%) was similar to that of the younger adults. CONCLUSION: The characteristics of poisonings vary according to age. Differences lie in gender, intentionality, and type of poison.

OBJETIVO: El Grupo de Trabajo de Toxicología de la Societat Catalana de Medicina d'Urgències i Emergències (SoCMUETox) inició en 2013 el estudio Intox-28. El objetivo de este trabajo es evaluar las diferencias existentes en las características de las intoxicaciones según la edad de los pacientes. METODO: Estudio descriptivo observacional de las intoxicaciones atendidas en 8 servicios de urgencias hospitalarios (SUH) el día 28 de cada mes durante el periodo 2013-19. Se recogieron datos demográficos, tipo de tóxico, datos clínicos y destino al alta. Los pacientes se dividieron en 3 grupos: menores de 17 años, adultos (entre 17 y 65 años) y mayores de 65 años. RESULTADOS: Se registraron 1.088 intoxicaciones: 132 (12,1%), 859 (78,9%) y 97 (8,9%) en cada grupo de edad respectivamente. En comparación a los pacientes adultos, en los menores de 17 años hubo más mujeres (58,3% vs 46,1%; p 0,001), menos intoxicaciones de tipo recreativo (22% vs 46,1%; p 0,001) y acontecieron más frecuentemente en el domicilio (67,4% vs 51,1%; p 0,001). El tipo de tóxico más implicado fueron los fármacos (49,2% vs 31,1%; p 0,001) y precisaron tratamiento con menor frecuencia (43,2% vs 73%; p 0,001). Los mayores de 65 años precisaron tratamiento en porcentaje similar a los pacientes de 17 a 65 años (73,2%). CONCLUSIONES: Existen diferencias entre los grupos de edad, entre las que destacan el sexo predominante, la intencionalidad de la intoxicación y el tipo de tóxico implicado.

Current role of capsule endoscopy in Crohn's disease.

Capsule endoscopy (CE) currently plays an important role in Crohn's disease (CD). It is a noninvasive technique that has led to a breakthrough in the endoscopic diagnosis of diseases of the small intestine. Its superior diagnostic performance and excellent safety profile lead to its considerable acceptance on the part of the patient. This paper reviews current indications of CE in three stages of clinical practice: Suspected CD, unclassified colitis and its extensive role in diagnosed CD. The diagnostic and therapeutic impact of the results of CE on the monitoring of this disease is also reviewed. Knowledge of its applications, the interpretation of its results in an appropriate context and the existence of a validated endoscopic activity index could change the way in which these patients are managed. The definition of mucosal healing and postoperative recurrence by means of endoscopic scoring systems will endow CE with new applications in the management of CD in the near future.

Multicenter assessment of the revisit risk for a further drug-related problem in the emergency department in cocaine users (MARRIED-cocaine study).

INTRODUCTION AND OBJECTIVES: Emergency departments (EDs) in Spanish hospitals daily attend a large number of patients for adverse reactions or clinical complications resulting from cocaine use. After discharge, some of these patients revisit the ED for the same reason within a year. The objective of the present study was to quantify the rate of such revisits and identify the factors associated with them. METHOD: We performed a retrospective, multicenter study with cohort follow-up and without a control group, conducted in the EDs of six Spanish hospitals during 12 months (January-December 2009). We included all ED patients attended for cocaine-related symptoms who reported recent cocaine use and those with cocaine-positive urine analysis by immunoassay without declared consumption. Twelve independent variables assessed for each hospital ED were collected: sex, age, place of consumption, month, day, and time of consumption, mode of arrival at the ED, discharge diagnosis, psychiatric assessment on the ED episode, concomitant drugs, destination on discharge, and history of previous ED visits related with drug use and alcohol use. The dependent variable was a subsequent visit to the ED associated with drug use, identified using the computerized hospital admissions system. RESULTS: The study included 807 patients, of whom 6.7% revisited the ED within 30 days, 11.9% within 3 months and 18.9% within 1 year. The variables significantly associated with ED revisits were: presence of clinical manifestations directly related to cocaine (p < 0.05), ED attendance on a working day (p < 0.05), history of ED visits related with the consumption of alcohol (p < 0.001) or drugs (p < 0.001), and the need for urgent consultation with a psychiatrist (p < 0.001), although only the last four were independent predictors in multivariate analysis. We derived a score based on these variables to predict risk of revisits (MARRIED-score, ranging from 0 to 400 points), which had a reasonably good predictive value for revisit (area under ROC of 0.75; 95% CI 0.71-0.79).

Compresibilidad del pliegue cutáneo y su relación con algunas variables biológicas: evidencias en cadáveres humanos / Compressibility of the skinfold and its relationship with some biological variables. Evidences in corpses

Se estudió la compresibilidad de los pliegues cutáneos subescapular, tricipital, bicipital, pectoral, suprailíaco, abdominal, muslo frontal y pierna medial en 37 cadáveres humanos frescos (17 del sexo masculino y 20 del femenino). Con el grosor del plieque graso (GPC, mm) y la profundidad de una incisión (PI, mm) hasta la fascia muscular subyacente, se determinó la compresibilidad [C)=(PI-0,5GPC/PI)100], cuyos valores promedio fueron similares en uno y otro sexos, excepto a nivel pectoral (61,6 ñ 11,3 y 74,1ñ 5,7 [p < 0,05], para varones y hembras, respectivamente) y de la pierna (50,8 ñ 18,6 comparado con 37,0 ñ 11,0 [p < 0,05]). Los valores más bajos pertenecieron al muslo (hombres: 51,5 ñ 19,6; mujeres: 43,9ñ11,4) y la pierna, con una marcada variabilidad interregiones (ANOVA: varones: F = 2,561 p = 0,0168; hembras: F = 28,75 p = 0,0000) e interindividuos. La compresibilidad se relacionó pobremente con el grosor del panículo adiposo. La PI y el GPC se correlacionaron significativamente (p < 0,05), especialmente en los varones (r = 0,848 frente a r = 0,791) y en las regiones contempladas por las ecuaciones de Jackson y Pollock para la estimación de la densidad corporal mediante plieques cutáneos