Assuntos
Gastrite Atrófica , Neoplasias Gástricas , Humanos , Endoscopia , Endoscópios , Mucosa GástricaAssuntos
Lesões Pré-Cancerosas , Gastropatias , Neoplasias Gástricas , Endoscopia , Mucosa Gástrica , Humanos , MetaplasiaAssuntos
Lesões Pré-Cancerosas , Corantes , Endoscópios , Endoscopia , Humanos , Lesões Pré-Cancerosas/diagnósticoAssuntos
Degeneração Hepatolenticular/complicações , Falência Hepática Aguda/cirurgia , Transplante de Fígado , Adolescente , Biomarcadores , Ceruloplasmina/análise , Cobre/análise , ATPases Transportadoras de Cobre/genética , Diagnóstico Tardio , Emergências , Feminino , Transtornos Hemorrágicos/etiologia , Degeneração Hepatolenticular/diagnóstico , Degeneração Hepatolenticular/genética , Homozigoto , Humanos , Achados Incidentais , Falência Hepática Aguda/etiologia , Mutação de Sentido Incorreto , Índice de Gravidade de DoençaRESUMO
BACKGROUND: non-anesthesiologist administration of propofol (NAAP) using continuous infusion systems may achieve a more sustained sedative action. AIM: to compare intermittent boluses (IB) with pump continuous infusion (PCI) for NAAP, targeted to moderate sedation, for colonoscopy. METHODS: 192 consecutive outpatients were randomized to receive IB (20 mg propofol boluses on demand) or PCI (3 mg/kg/h plus 20 mg boluses on demand). Sedation could be stopped at cecal intubation at the discretion of the endoscopist. Satisfaction rates of the patient, nurses and endoscopist, propofol doses, depth of sedation (at the beginning, at cecal intubation and at the end), recovery times, complications and were collected. RESULTS: there were no differences between groups regarding patient, nurse or endoscopist satisfaction rates with procedural sedation. Propofol doses (mg) were significantly higher during the induction phase -86 (30-172) vs. 78 [30-160], p 0.03- and overall -185 (72-400) vs. 157 (60-460), p = 0.003- for PCI group. 81 % of assessments of the depth of sedation were moderate. The level of sedation (O/AAS scale) was borderline significantly deeper at cecal intubation (2.38 vs. 2.72; p = 0.056) and at the end of the procedure (4.13 vs. 4.45; p = 0.05) for PCI group, prolonging thus early recovery time (6.3 vs. 5.1 minutes, p = 0.008), but not discharge time. Complications, all of them in minors, were non-significantly more frequent in the PCI group (9 vs. 7 %, p = 0.07). CONCLUSIONS: NAAP for colonoscopy was safely administered with comparable satisfaction and complication rates with either IB or PCI.
Assuntos
Anestésicos Intravenosos/administração & dosagem , Colonoscopia , Propofol/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Humanos , Bombas de Infusão , Infusões Intravenosas/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
BACKGROUND: Split dosage of bowel preparations has been shown to substantially improve bowel cleansing. AIM: To compare the split dose (SD) sodium picosulphate/magnesium oxide/anhydrous citric acid (Citrafleet(®)) regimen for morning colonoscopies with standard cleansing the day before. METHODS: Consecutive outpatients were randomized to receive Citrafleet(®) the day before colonoscopy or SD, in whom the second half was administered on an individual basis from 2 to 6 hours before the procedure. No bisacodyl was administered. All procedures were performed with non-anesthesiologist administered propofol sedation. The Boston scale was used to assess the quality of bowel preparation (adequate cleansing if score ≥ 6, with no score of 0/1 in any segment). RESULTS: A total of 193 patients were included. Overall bowel cleansing was significantly better in the SD group (7 vs. 5.2, p<0.001), as well as in the cecum (2.4 vs. 1.4, p < 0.001), ascending colon (2.5 vs. 1.6, p<0.001) and transverse colon (2.4 vs. 2, p=0.004). A significant proportion of SD patients had adequate bowel cleansing (71% vs. 30%, p<0.001). Patients in the SD group drank a greater amount of liquid (4.9 vs. 4 liters, p=0.006) and more frequently perceived the cleansing process to be easy or very easy to complete (89 vs. 68%, p=0.04), although they slept significantly fewer hours (6.5 vs. 7.9, p<0.001). No bronchoaspiration pneumonia was reported. CONCLUSIONS: SD Citrafleet(®) 2 to 6 hours before colonoscopy increased the rate of procedures with adequate bowel cleansing by 40%, especially in the proximal colon, allowed more liquids to be drunk and increased the perception of ease in completing the preparation, with no sedation-related complications.
Assuntos
Catárticos/administração & dosagem , Citratos/administração & dosagem , Ácido Cítrico/administração & dosagem , Colonoscopia , Compostos Organometálicos/administração & dosagem , Picolinas/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Catárticos/efeitos adversos , Citratos/efeitos adversos , Ácido Cítrico/efeitos adversos , Diarreia/induzido quimicamente , Comportamento de Ingestão de Líquido , Esquema de Medicação , Medo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos/efeitos adversos , Aceitação pelo Paciente de Cuidados de Saúde , Picolinas/efeitos adversos , Privação do Sono , Adulto JovemRESUMO
BACKGROUND: Nonanesthesiologist-administered propofol (NAAP) is controversial due to deep sedation concerns. AIM: The purpose of this study was to evaluate the feasibility of moderate sedation with two different NAAP regimens for colonoscopy. METHODS: This was a double-blinded, randomised, placebo-controlled trial allocating 135 consecutive outpatients to placebo (group P) or midazolam 2 mg (group M+P) before NAAP targeted to moderate sedation. Depth of sedation every 2 min throughout the procedure, propofol doses, recovery times, complications and patient and endoscopist satisfaction were measured. RESULTS: A total of 84 % of assessments of the depth of sedation were moderate. Mean induction (76 [40-150] vs. 53 [30-90]) and total propofol doses (mg) (136 [60-270] vs. 104 [50-190]) were significantly higher for group P (p < 0.001). However, deep sedation was significantly more prevalent in group M+P in minutes 4 (16 vs. 1 %, p = 0.05), 6 (20 vs. 3.5 %, p = 0.046) and 8 (17 vs. 1.8 %, p = 0.06) of the procedure, coinciding with midazolam peak action. From minute 8 on, moderate sedation was significantly deeper for M+P (p = 0.002). Early recovery time (6.8 min vs. 5.2, p = 0.007), but not discharge time (10.4 min vs. 9.8, p = 0.5), was longer for M+P. Pain perception (P 1.03 vs. M+P 0.3, p = 0.009) and patient satisfaction scores (P 9.4 vs. M+P 9.8, p = 0.047) were better for M+P. No major complications occurred. CONCLUSIONS: Moderate sedation was feasible with both NAAP regimens. Drug synergy in the midazolam plus propofol sedation regimen promotes a deeper and longer moderate sedation, improving patient satisfaction rates but prolonging early recovery time (Clinical Trials gov NCT01428882).
Assuntos
Sedação Consciente/métodos , Hipnóticos e Sedativos/farmacologia , Midazolam/farmacologia , Propofol/farmacologia , Período de Recuperação da Anestesia , Colonoscopia , Relação Dose-Resposta a Droga , Sinergismo Farmacológico , Quimioterapia Combinada , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Midazolam/administração & dosagem , Satisfação do Paciente , Propofol/administração & dosagem , Fatores de TempoRESUMO
Percutaneous endoscopic colostomy (PEC), using the classic pull-through technique in the ascending or the descending colon, has been proven useful to treat chronic intestinal pseudo-obstruction. We report the case of a high-surgical risk 70-year-old male with refractory chronic intestinal pseudo-obstruction, in whom the ascending colon could not be reached due to tortuous left dolichocolon. Endoscopic-assisted colopexy and push colostomy in the proximal transverse colon was decided accordingly. Colopexy was performed under direct endoscopic vision in the proximal transverse colon using 3 preloaded T-fasteners surrounding the intended stoma site. The stoma tract was created with an introducer needle, allowing the advance of the 24 Fr 4-sleeve dilator over a guidewire. Afterwards, the dilator was removed and the peel-away sheath was left in place. Over the guidewire, a 20-Fr gastrostomy tube was advanced into the colon lumen through the covering, which was finally removed. The patient recovered uneventfully, despite postprocedure pneumoperitoneum, which was related to the technique. He died a month later due to unrelated comorbidities, without further abdominal complaints after discharge. This is the first report of PEC both using a push technique, and the first report in a different location than the ascending or the descending colon. We believe this novel push technique may be feasible for PEC, avoiding the need of reinsertion in patients with difficult colonoscopy.
Assuntos
Colo Transverso/cirurgia , Pseudo-Obstrução do Colo/cirurgia , Colonoscopia/métodos , Colostomia/métodos , Idoso , Doença Crônica , Evolução Fatal , Humanos , MasculinoAssuntos
Branquioma/diagnóstico , Transtornos de Deglutição/etiologia , Fístula Esofágica/etiologia , Neoplasias de Cabeça e Pescoço/diagnóstico , Sulfato de Bário , Branquioma/complicações , Meios de Contraste , Endoscopia Gastrointestinal , Feminino , Neoplasias de Cabeça e Pescoço/complicações , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XAssuntos
Canal Anal/irrigação sanguínea , Hemorragia Gastrointestinal/etiologia , Reto/irrigação sanguínea , Malformações Vasculares/complicações , Idoso de 80 Anos ou mais , Coagulação com Plasma de Argônio , Endoscopia por Cápsula , Colonoscopia , Comorbidade , Epinefrina/uso terapêutico , Hemorragia Gastrointestinal/tratamento farmacológico , Humanos , Ligadura , Masculino , Polidocanol , Polietilenoglicóis/uso terapêutico , Recidiva , Escleroterapia , Técnicas de Sutura , Malformações Vasculares/diagnóstico , Malformações Vasculares/cirurgiaRESUMO
Primary pancreatic tuberculosis (PPTB) is an extremely rare entity defined by an isolated pancreatic lesion with microbiological confirmation, in the absence of previously identified tuberculosis (TB) and involvement of any other organ. We report the case of a 47-year-old man referred for abdominal pain and weight loss, in whom several imaging techniques revealed a solid mass in the head of the pancreas. CT-guided fine-needle aspiration cytology was consistent with necrotic granuloma. Intradermic tuberculin reaction was positive, but acid fast bacilli staining was negative in repeat cytology. No additional evidence of TB was found after exhaustive diagnostic work-up. Exploratory laparotomy was proposed for a definitive diagnosis, but cultures grew Mycobacterium tuberculosis at 50 days. The pancreatic lesion disappeared after 4 months of antitubercular therapy. This is the first case report of PPTB in an immunocompetent person in Spain. A high index of suspicion and accurate samples for microbiology are mandatory to avoid unnecessary surgical procedures.