Characteristics of primary care processes for the treatment of faecal incontinence in an urban area.

AIM: In this study, we investigated the adequacy of the healthcare response systems to detect and treat faecal incontinence in patients in the primary care areas (PCAs) in a core urban area of Barcelona. METHOD: Patients with a diagnosis of faecal incontinence in the study area were identified from the electronic register of diagnostic codes, and from a manual review of electronic medical records of a random sample of the study population. The remaining variables were obtained through a structured telephone interview. RESULTS: In the study population (n = 65,023) with a previously estimated prevalence of faecal incontinence of 13% [95% confidence interval (CI) 10-17%], 68 cases of faecal incontinence were detected by the health care system (prevalence: 0.10%; 95% CI, 0.08-0.13). Of these, 39 patients (68% women, 68 ± 18 years of age) were interviewed: 18 (46%) reported symptoms lasting for longer than 5-10 years and 20 (51%) had waited for more than 5 years before seeking medical advice. Only 8 (18%) had received any treatment for faecal incontinence, and 18 (46%) reported persistent faecal incontinence at the time of the interview (Vaizey severity score 13 ± 4/24). CONCLUSION: The detection and treatment of faecal incontinence is insufficient in primary care services. Strategies to correct this are needed.

[Upper digestive hemorrhage as a complication of postoperative reflux gastritis]. / Hemorragia digestiva alta como complicación de la gastritis postoperatoria por reflujo.

Seven cases of upper gastrointestinal hemorrhage after gastroduodenal surgery are presented; in all the cases the pyloric region had been resected or excluded. The gastritis was documented by endoscopy and/or surgery; it was located in the area proximal to the anastomosis. There were no other causes of bleeding. In five cases the hemorrhage was controlled with medical treatment. In one case it was necessary to operate on urgently. Another case was that of a recurrent hemorrhage after surgery for bleeding peptic ulcer located in the anastomosis. We emphasize the possibility of acute gross hemorrhage as a complication of reflux gastritis; the common clinical finding of previous treatment with antiinflammatory drugs; and the rarity of this lesion as the cause of gastrointestinal hemorrhage and as a complication of postoperative reflux gastritis.

[Bacteremia in patients with chronic hepatopathy: a study of 54 cases]. / Bacteriemia en pacientes con hepatopatía crónica: estudio de 54 casos.

The authors reviewed 54 cases of bacteremia in 48 patients with chronic liver disease over a period of two years. Thirty-three were outpatients and 21 were hospitalized. Fifty-eight microorganisms were detected, which represented 10.3% of the total number of germs isolated in all the cases of bacteremia in the hospital during that same period of time. Gram-negative bacilli were predominant, especially Escherichia coli (19 cases); among the gram-positive ones, the most frequent was Staphylococcus aureus (8 cases). There was ascites in 62.9% of the patients, but the predominant symptom was fever. The most frequent sources of infection were: unknown (29.6%), urinary (22.2%), catheter (16.6%) and lung (14.8%). All the in-hospital cases were preceded by an aggressive diagnostic or therapeutic technique. The rate of mortality was 29.6%, and it was highest among patients with gram-negative bacteremia, ascites, Child C (p less than 0.05), complications (hepatic encephalopathy, hemorrhage and/or septic shock) (p less than 0.03), unknown origin or originating from catheter and in-hospital episodes.

Digestive hemorrhage caused by a Meckel's diverticulum in a metformin-treated patient: is there any connection?

An obese patient, not diabetic, treated with metformin for some weeks, was referred to us with severe inferior digestive hemorrhage, diagnosed with Meckel's diverticulum. Metformin is described as a glucose-lowering agent for treatment of type 2 diabetes mellitus and as antiobesity drug, though results achieved with this last indication are not conclusive. But metformin has fibrinolytic features by means of diminished plasminogen activator inhibitor 1 activity. Although no coagulation study was done and the Meckel's diverticulum is normally associated with bleeding, the particular intensity of the following hemorrhage may have been favored by metformin.