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1.
Gastroenterol. hepatol. (Ed. impr.) ; 43(1): 45-56, ene. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-188294

RESUMO

El cáncer colorrectal constituye un problema de salud importante. Se ha demostrado una mejoría de la supervivencia mediante la realización de colonoscopias de cribado y la extirpación de sus lesiones precursoras, los pólipos. Sin embargo, la colonoscopia no es infalible y se han propuesto múltiples estrategias dirigidas a mejorar la calidad de la misma. En esta revisión se describen los sistemas endoscópicos de que disponemos para mejorar la detección y caracterización de los pólipos, las diferentes clasificaciones utilizadas para la predicción histológica y las indicaciones actuales de las técnicas de diagnóstico endoscópico avanzado


Colorectal cancer is a major health problem. An improvement to its survival has been demonstrated by performing colonoscopy screenings and removing its precursor lesions: polyps. However, colonoscopy is not infallible and multiple strategies have been proposed aimed at improving the quality thereof. This report describes the endoscopic systems available to improve the detection and characterization of polyps, the different classifications for histological prediction and the current indications of advanced endoscopic diagnostic techniques


Assuntos
Humanos , Pólipos do Colo/diagnóstico , Colonoscópios , Colonoscopia/instrumentação , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/instrumentação , Adenoma/diagnóstico , Desenho de Equipamento
2.
Cir. Esp. (Ed. impr.) ; 98: 0-0, 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192544

RESUMO

INTRODUCCIÓN: Durante el estado de alarma sanitaria establecido a causa de la pandemia de la COVID-19 se anularon la mayor parte de las consultas externas presenciales y se estableció una consulta telefónica para el seguimiento de pacientes coloproctológicos. El objetivo de este estudio fue analizar la eficacia de la consulta telefónica (teleconsulta) en el seguimiento de los pacientes de una unidad de coloproctología, en el contexto de la pandemia de COVID-19. MÉTODO: Estudio descriptivo prospectivo de pacientes consecutivos en un solo centro. Se clasificó el resultado de la teleconsulta como alta, visita resuelta o reprogramación y se analizó por diferentes grupos diagnósticos. RESULTADOS: Del 19 de marzo al 17 de abril de 2020 se realizó la teleconsulta de 190 pacientes. La tasa de respuesta fue del 94,2% (179). Las categorías diagnósticas de los pacientes atendidos fueron: 51 (26,9%) neoplasia colorrectal, 48 (25,3%) enfermedad proctológica, 72 (37,9%) disfunciones del suelo pélvico y 19 (10%) otras enfermedades benignas. Se pudo volver a citar a 105 (55,26%) como si hubieran venido de forma presencial. Se dio el alta a 11 (5,8%) pacientes. No se encontraron diferencias significativas entre las distintas categorías diagnósticas y la resolución de la teleconsulta. Los motivos de reprogramación se analizan en el estudio. CONCLUSIÓN: En el contexto de pandemia, la teleconsulta ha permitido resolver de forma definitiva el 61% de las visitas de seguimiento y ha evitado la reprogramación de 116 pacientes. El nuevo paradigma social y sanitario tras la pandemia requerirá un replanteamiento de nuestro modelo de atención sanitaria y, en muchos aspectos, la telemedicina puede ofrecer herramientas para ello


INTRODUCTION: During the state of alarm established in Spain due to the COVID-19 pandemic, most of the face-to-face outpatient consultations were cancelled and a telephone consultation was established to follow up coloproctological patients. The objective of this study was to analyse the efficacy of telemedicine (by telephone) in monitoring patients in a coloproctology unit, in the context of the COVID-19 pandemic. METHOD: Prospective descriptive study of consecutive patients in a single centre. The result of the teleconsultation was classified as discharge, resolved visit or reprogramming and was analysed by different diagnostic groups. RESULTS: From March 19th to April 17th, 2020, the teleconsultation of 190 patients was carried out. The response rate was 94.2% (179). The diagnostic categories of the patients attended were: 51 (26.9%) colorectal neoplasia, 48 (25.3%) proctological pathology, 72 (37.9%) pelvic floor dysfunctions and 19 (10%) other benign pathologies. 105 (55.26%) could be recited as if they had come in person. Eleven (5.8%) patients were discharged. No significant differences were found between the different diagnostic categories and the resolution of the teleconsultation. The reasons for reprogramming are analyzed in the study. CONCLUSION: In the context of a pandemic, teleconsultation has allowed 61% of follow-up visits to be definitively solved, avoiding the reprogramming of 116 patients. The new social and health paradigm after the pandemic will require a rethinking of our healthcare model, and in many aspects, telemedicine can offer tools for this


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Telemedicina , Pandemias , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Neoplasias Colorretais/terapia , Doenças do Colo/terapia , Doenças Retais/terapia , Estudos Prospectivos
3.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 38(6): 355-361, nov.-dic. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-191699

RESUMO

OBJETIVO: El factor inducible para hipoxia (HIF-1) tiene un papel crítico en la homeostasis del oxígeno y es un activador transcripcional de angiogénesis, eritropoyesis, hierro y metabolismo de glucosa. La tasa de metabolismo de glucosa aumenta en algunos tumores a través de HIF-1alfa. Nuestro objetivo es evaluar la relación entre hipoxia en el cáncer colorrectal, los parámetros de PET, el tamaño del tejido necrótico y los factores pronósticos patológicos mediante el uso de HIF-1alfa. MATERIALES/MÉTODOS: 70 pacientes (28 mujeres/42 hombres; promedio de edad: 63 años) diagnosticados con cáncer colorrectal mediante biopsia, se estadificaron con PET/TC preoperatoria y se operaron posteriormente. La puntuación de evaluación inmunohistoquímica se realizó de acuerdo con la expresión de HIF-1alfa nuclear, la intensidad y la densidad de tinción. El volumen metabólico tumoral (MTV), la glucólisis de lesión total (TLG) y el volumen tumoral (TV) se calculó utilizando el volumen de una fórmula elipsoide mediante las imágenes de TC y el porcentaje de necrosis tumoral (%TmNcr) se calculó por diferencia entre TV y MTV. RESULTADOS: Hubo una correlación positiva moderadamente significativa entre el SUVmáx del tumor y TV y el %TmNcr (r=0,403, p = 0,001 y r=0,5, p = 0,0001, respectivamente). No hubo una relación estadísticamente significativa entre niveles de expresión de HIF-1alfa y SUVmáx tumoral, TLG, MTV, TV, %TmNcr, estadio tumoral, invasión linfovascular, invasión perineural y afectación ganglionar extracapsular/capsular. Por otro lado, se observó una fuerte tinción inmunohistoquímica nuclear en las células tumorales adyacentes al borde invasivo, las células inflamatorias. Aunque no fue estadísticamente significativa, se observó una tinción nuclear moderada o fuerte en el 64,9% de los pacientes metastásicos. CONCLUSIÓN: Aunque la presencia de una correlación positiva entre SUVmáx tumoral y el % de TmNcr muestra que hay células hipóxicas en tejido canceroso con una alta captación de FDG, no se demostró ninguna relación entre la presencia de HIF-1alfa y el incremento metabólico de glucosa y los factores patológicos del tumor. La fuerte tinción inmunohistoquímica nuclear en células tumorales adyacentes a las células inflamatorias y de borde invasivas nos hace pensar que HIF-1alfa desempeña un papel en el área de invasión del microambiente tumoral


AIM: The hypoxia-inducible factor 1 (HIF-1) has a critical role in oxygen homeostasis and it is a transcriptional activator of angiogenesis, erythropoiesis, iron and glucose metabolism. Glucose metabolism rate is increased in some tumours via HIF-1alfa. Our aim is to evaluate the relationship between hypoxia in colorectal cancer, PET parameters, necrotic tissue size and pathologic prognostic factors via using HIF-1alfa. MATERIALS/METHODS: 70 patients (28 female/42 male; median age: 63 years) who were diagnosed with colorectal cancer via biopsy were staged with preoperative PET/CT and operated subsequently. Immunohistochemical evaluation scoring was done according to nuclear HIF-1alfa expression, staining density and intensity. Metabolic tumour volume (MTV), total lesion glycolysis (TLG) and tumour volume (TV) were calculated by using volume of an ellipsoid formula via CT images, and percentage of tumour necrosis (%TmNcr) that was calculated by the difference between TV and recorded MTV. RESULTS: There was a moderately meaningful positive correlation between tumour SUVmax and TV and %TmNcr (r=0.403, p = 0.001 and r=0.500, p = 0.0001, respectively). There were no statistically significant relationships between HIF-1alfa expression levels and tumour SUVmax, TLG, MTV, TV, %TmNcr, tumour stage, lymphovascular invasion, perineural invasion and extracapsular/capsular lymph node involvement. On the other hand, strong nuclear immunohistochemical staining was seen in tumour cells adjacent to invasive border, inflammatory cells. Although not statistically significant, moderate or strong nuclear staining were seen in 64.9% of metastatic patients. CONCLUSION: Although the presence of a positive correlation between tumour SUVmax and %TmNcr shows that there are hypoxic cells in cancer tissue with high FDG uptake, the relationship between the presence of HIF-1alfa and enhanced glucose metabolism and pathological prognostic factors of tumour was not shown. Strong nuclear immunohistochemical staining in tumour cells adjacent to invasive border and inflammatory cells leads us to believe that HIF-1alfa plays a role in the invasion area of tumour microenvironment


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/química , Neoplasias Colorretais/diagnóstico por imagem , Fluordesoxiglucose F18 , Subunidade alfa do Fator 1 Induzível por Hipóxia/análise , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos
5.
Rev. esp. enferm. dig ; 111(12): 903-908, dic. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-190531

RESUMO

Background: satisfaction with healthcare is focused on the patient and is known as "patient-centered care". However, user satisfaction is not always synonymous with good care. Healthcare practitioners should determine and understand what patients need and expect in order to improve the quality of care. Aims: the main objective of this study was to determine the perceived quality of care of patients diagnosed with colorectal cancer in our unit. Methods: a cross-sectional study was performed in all patients diagnosed with colorectal cancer (CRC) that underwent staging studies and were hospitalized in the Gastroenterology Department from May 2013 to October 2013. Furthermore, outpatients with rapid consultations for CRC staging from November 2013 to November 2014 were also included. Two questionnaires were administered: a) a survey of 20 questions with closed responses regarding the competence of treating physicians and nurses, the information received and the waiting time; b) the European Organization for Research and Treatment of Cancer (EORTC) QLQ-INFO25: information on the disease, medical tests, treatment and other services, with eight single items. Results: there were no differences in the perceived healthcare quality, delays in starting treatment, the tumor stage, symptoms (performance status) or the time spent studying the disease. In-patients and those with advanced disease started treatment earlier than outpatients and those with disease stage I or II. Likewise, outpatients perceived a better psychological support. Conclusions: outpatient study did not reduce the quality of care and did not delay treatment


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/epidemiologia , Satisfação do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/tendências , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Unidades Hospitalares/organização & administração , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Estudos Transversais , Assistência Ambulatorial/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos
7.
Cir. Esp. (Ed. impr.) ; 97(10): 590-593, dic. 2019.
Artigo em Espanhol | IBECS | ID: ibc-187935

RESUMO

El tratamiento de la dehiscencia de sutura después de cirugía oncológica del cáncer de recto supone un reto quirúrgico. El objetivo de este trabajo es mostrar como la cirugía transanal combinada con el abordaje abdominal es una herramienta muy útil para decidir el tratamiento individualizado en función del grado de dehiscencia y ayudarnos al manejo local de la misma. Presentamos tres casos de pacientes con dehiscencia de sutura colorrectal. En dos de ellos se muestra el tratamiento de una dehiscencia colorrectal aguda y como la cirugía transanal nos permite comprobar la viabilidad y descartar isquemia subyacente. Por otro lado, nos facilita un buen drenaje de la colección adyacente, así como si es necesaria la colocación de un sistema vacuum y de sus recambios siguientes. El último caso se trata de una dehiscencia tardía con sinus presacro crónico y su tratamiento mediante acceso transanal para destechamiento del mismo


The treatment of anastomotic leakage after oncological surgery for rectal cancer is a surgical challenge. The goal of this study is to show how transanal surgery combined with the abdominal approach is a very useful tool to decide on individualized treatment depending on the degree of dehiscence and to assist us in its local management. We present three cases of patients with colorectal anastomotic dehiscence. In two, we demonstrate the treatment of acute colorectal leakage and how transanal surgery allows us to confirm its viability and rule out any underlying ischemia. Furthermore, it facilitates good drainage of the adjacent collection as well as the placement of a vacuum system, if necessary, and its subsequent replacements. The last case is a delayed dehiscence with chronic presacral sinus, and its treatment by transanal access for fenestration


Assuntos
Humanos , Idoso , Pessoa de Meia-Idade , Cirurgia Endoscópica Transanal/métodos , Anastomose Cirúrgica/métodos , Deiscência da Ferida Operatória/terapia , Neoplasias Colorretais/cirurgia , Fístula Anastomótica/prevenção & controle , Neoplasias Colorretais/patologia , Fístula Anastomótica/epidemiologia , Terapia Neoadjuvante , Colo Sigmoide/patologia , Colo Sigmoide/cirurgia , Equipamentos de Proteção , Drenagem/instrumentação
9.
Gastroenterol. hepatol. (Ed. impr.) ; 42(9): 527-533, nov. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-187913

RESUMO

Objetivo: Analizar el efecto de la demora atribuible al sistema sanitario en una cohorte consecutiva de pacientes diagnosticados de forma ambulatoria de cáncer colorrectal (CCR) en el área sanitaria de Ourense. Pacientes y métodos: Estudio observacional de cohortes retrospectivo en el que se incluyeron los pacientes diagnosticados entre 2009 y 2017. Se definió la demora atribuible al sistema sanitario como el tiempo entre la primera consulta por síntomas y la confirmación diagnóstica. Se determinó si existía una relación independiente entre la demora diagnóstica y el CCR estadio IV mediante una regresión logística. Finalmente, realizamos una regresión de riesgos proporcionales para determinar qué variables se asociaban con la mortalidad global y por CCR. Resultados: Se incluyeron 575 pacientes (hombres 64,5%, edad 71,9±11,5 años) con una demora atribuible al sistema sanitario de 115±153 días. Ninguna de las variables analizadas se asoció con el estadio tumoral al diagnóstico. Durante un seguimiento de 30,6±21 meses fallecieron 121 pacientes (79,3% en relación al CCR). Las variables asociadas de forma independiente con la mortalidad atribuible al CCR fueron el estadio IV al diagnóstico (HR 50,65; IC 95% 12,28-209), la edad (HR 1,04; IC 95% 1,02-1,05) y la solicitud de la colonoscopia desde Atención Primaria (HR 0,55; IC 95% 0,37-0,88). Conclusiones: La demora diagnóstica atribuible al sistema sanitario no se relacionó ni con el estadio ni con el pronóstico del CCR. Sin embargo, la solicitud de la colonoscopia desde Atención Primaria se asoció a una reducción en el riesgo de mortalidad


Objectives: To analyse the effect of a delay attributable to the healthcare system on a consecutive cohort of outpatients diagnosed with colorectal cancer in the healthcare area of Ourense (Spain). Patients and methods: We performed a retrospective cohort study that included patients diagnosed between 2009 and 2017. Delay attributable to the healthcare system was defined as the time between the first consultation with symptoms and the diagnostic confirmation. A logistic regression model was performed to evaluate the relationship between stage IV CRC and diagnostic delay. To analyse which variables were associated independently with overall mortality and mortality due to CRC we used a Cox regression model. Results: 575 patients were included (men 64.5%, age 71.9 ± 11.5 years), with a delay attributable to the healthcare system of 115 ± 153 days. None of the variables analysed were associated with tumour stage at diagnosis. With a mean follow-up of 30.6 ± 21 months, 121 patients died (79.3% due to CRC). The variables independently associated with CRC-related mortality were metastatic CRC (HR 50.65, 95% CI 12.28-209), age (HR 1.04, 95% CI 1.02-1.05) and colonoscopy requested from the Primary Healthcare level (HR 0.55, 95% CI 0.36-0.88). Conclusions: Diagnostic delay attributable to the healthcare system is not related to the prognosis or stage of CRC. However, a direct referral to colonoscopy from the Primary Healthcare level reduces the risk of mortality in our patients


Assuntos
Humanos , Masculino , Feminino , Idoso , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/mortalidade , Diagnóstico Tardio/efeitos adversos , Setor de Assistência à Saúde , Fatores Etários , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/patologia , Seguimentos , Modelos Logísticos , Prognóstico , Estudos Retrospectivos , Fatores de Tempo
10.
Rev. esp. enferm. dig ; 111(10): 750-756, oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-190447

RESUMO

Objeto: el objetivo del presente estudio es examinar la asociación entre el tipo de admisión hospitalaria, la supervivencia y las características patológicas de una amplia población de pacientes con cáncer colorrectal. Métodos: realizamos un estudio en 1.079 pacientes diagnosticados en el Hospital Costa del Sol de Marbella con cáncer colorrectal y evaluamos la relación entre su tasa de supervivencia y la vía por la que realizaron el primer contacto con el hospital (admisión programada o de urgencias). Las variables incluidas en nuestro estudio fueron las siguientes: edad, género, localización del tumor, estadio patológico, grado de diferenciación, quimioterapia previa a la cirugía y supervivencia. Resultados: los pacientes admitidos por primera vez al hospital a través del Servicio de Urgencias fueron diagnosticados con mayor frecuencia de cáncer de colon (63,7%) y con tumores pobremente diferenciados (64,2%) y metastásicos (70%). En el análisis de regresión de Cox la supervivencia libre de enfermedad produjo una razón de riesgo (RR) de 1,36 (intervalo de confianza [IC] 95%: 1,11-1,66) para los pacientes del Servicio de Urgencias y para la supervivencia global de 1,41 (IC 95%: 1,14-1-76). Conclusiones: La admisión hospitalaria a través del Servicio de Urgencias es un indicador de agresividad y de peor pronóstico frente a los pacientes que ingresan por vía programada


Aims: the aim of this study was to examine the possible association between the type of hospital admission and subsequent survival of the patient, as well as the pathological features recorded in a large population of patients with colorectal cancer. Methods: the study included 1,079 patients diagnosed with colon or rectal cancer in the Hospital Costa del Sol (Marbella, Spain). The relationship between patient survival rate and type of first admission to the hospital (elective or emergency admission) was assessed. The following variables were studied: age, gender, tumor location, pathological stage, differentiation grade, chemotherapy before surgery and survival. Results: colon tumors are more common in patients admitted to hospital for the first time via the emergency service (63.7%) and the tumors tend to be poorly differentiated (64.2%) and metastatic (70%). These patients also present a more aggressive disease and a poorer prognosis than patients with an elective admission. With regard to patients from the Emergency Department, a Cox regression analysis showed a risk-ratio (RR) of 1.36 (confidence interval [CI] 95%: 1.11-1.66) for disease-free survival and of 1.41 (95% CI: 1.14-1.76) for overall survival. Conclusions: hospital admission via the Emergency Department is an indicator of aggressiveness and poorer prognosis compared to patients who enter via programmed routes


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Tratamento de Emergência/estatística & dados numéricos , Prognóstico , Programas de Rastreamento/tendências , Intervalo Livre de Progressão , Sobreviventes de Câncer/estatística & dados numéricos
11.
Farm. hosp ; 43(5): 158-162, sept.-oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183928

RESUMO

Objetivo: Analizar las reacciones adversas en pacientes con cáncer colorrectal no metastásico debidas al tratamiento con capecitabina innovadora o genérica, y/o al régimen quimioterápico empleado, capecitabina en monoterapia o en combinación con oxaliplatino (XELOX). Método: Estudio descriptivo retrospectivo llevado a cabo en un hospital de segundo nivel en dos periodos de estudio (noviembre de 2013-abril de 2014 y agosto de 2016-mayo de 2017). Las variables recogidas fueron variables de exposición (esquema quimioterápico y/o medicamento recibido), variables de control (datos demográficos, de enfermedad y de tratamiento) y variables de respuesta (reacciones adversas). El análisis estadístico de los datos se efectuó con el programa SPSS(R) 15.0. Resultados: Se incluyeron 50 pacientes. Según el esquema quimioterápico administrado, se encontraron diferencias estadísticamente significativas en la aparición de eritrodisestesia palmo-plantar, más frecuente con monoterapia (p < 0,05), y neurotoxicidad, trombopenia y neutropenia, más frecuentes con XELOX (p < 0,05). Según el medicamento de capecitabina administrado, no se observaron diferencias estadísticamente significativas en las reacciones adversas estudiadas. Conclusiones: El perfil de seguridad de dos formulaciones de capecitabina, innovadora y genérica, parece estar asociado al esquema quimioterápico empleado, y no al medicamento en cuestión. La mayor eritrodisestesia palmo-plantar para monoterapia se debe probablemente a la mayor dosis de capecitabina empleada en dicho esquema, y la mayor neurotoxicidad, trombopenia y neutropenia para XELOX se debe probablemente a la toxicidad acumulada de dos fármacos antineoplásicos


Objective: To analyze adverse reactions in patients with nonmetastatic colorectal cancer due to treatment with either innovative or generic capecitabine and/or to the chemotherapeutic regimen employed, to the capecitabine alone, or in combination with oxaliplatin (XELOX). Method: Descriptive retrospective study carried out in a secondary level hospital in two study periods (November 2013-April 2014 and August 2016-May 2017). The collected variables were: exposure (chemotherapy scheme and/or received medication), control (demographics, disease and treatment data), and response (adverse reactions). The statistical analysis of data was performed with the SPSS(R) 15.0 program. Results: Fifty patients were included. According to the administered chemotherapeutic scheme, statistically significant differences were found in the appearance of palmar-plantar erythrodysesthesia, which is more frequent with monotherapy (p < 0.05), and neurotoxicity, thrombocytopenia and neutropenia, which is more frequent with XELOX (p < 0.05). Concerning the capecitabine drug administered, no statistically significant differences were found in the studied adverse reactions. Conclusions: The safety profile of two capecitabine formulations -innovative and generic- appears to be associated with the chemotherapy scheme employed, and not the drug itself. Most palmar-plantar erythrodysesthesia for monotherapy is likely due to the higher dose of capecitabine used in said scheme. The increase in neurotoxicity, thrombocytopenia and neutropenia for XELOX is probably due to cumulative toxicity of two antineoplastic drugs


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Capecitabina/administração & dosagem , Neoplasias Colorretais/tratamento farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Oxaliplatina/administração & dosagem , Estudos Retrospectivos , Análise Estatística , Síndromes Neurotóxicas/complicações , Trombocitopenia/complicações , Neutropenia/induzido quimicamente
12.
Nutr. hosp ; 36(5): 1150-1156, sept.-oct. 2019. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-184639

RESUMO

Objetivo: evaluar el impacto de la inmunonutrición oral preoperatoria y postoperatoria en la prevención de la desnutrición y las complicaciones posquirúrgicas en cáncer colorrectal. Pacientes y método: estudio retrospectivo descriptivo observacional con una única cohorte. Se incluyeron todos los pacientes sometidos a cirugía por cáncer colorrectal desde junio de 2014 a diciembre de 2015, sin ningún criterio de exclusión. En un pequeño número de casos (28 pacientes) no se suministró suplementación nutricional oral y se consideran pérdidas del estudio. Se realizó una evaluación del estado nutricional preoperatorio (NSR-2002). Se pautó inmunonutrición durante los cinco o diez días previos a la intervención en función del resultado. En el postoperatorio, se añadió inmunonutrición al tercer día postoperatorio hasta el séptimo o hasta el alta hospitalaria. Los pacientes con albúmina < 2,5 g/dl o íleo prolongado recibieron nutrición parenteral. El análisis de los datos se realizó con el paquete estadístico SPSS 21.0. Resultados: se incluyeron 220 pacientes con cáncer colorrectal, de los cuales 28 fueron pérdidas del estudio. La suplementación preoperatoria mejoró significativamente las cifras de prealbúmina y transferrina al ingreso. En el postoperatorio recibieron nutrición enteral 121 pacientes y 41 nutrición parenteral. Los pacientes que no tomaron suplementos nutricionales preoperatorios tuvieron más complicaciones (50% vs. 28,1%; p = 0,019) y la estancia media fue superior (14,64 ± 11,86 vs. 9,36 ± 5,5; p < 0,005). Los pacientes que no tomaron suplementos en el postoperatorio tuvieron más complicaciones (24% vs. 18,2%; p < 0,005), destacando más infección de herida (1,9% vs. 0,8%) y más dehiscencia anastomótica (1,9% vs. 0,8%). Tuvieron también una estancia media superior (9,15 ± 4,6 vs. 7,57 ± 2,5 días; p = 0,021). Conclusión: la administración de suplementos nutricionales orales previo a la intervención y en el postoperatorio en la cirugía del cáncer colorrectal se ha asociado a menos complicaciones y estancia media


Introduction: the aim of the study is to evaluate the effect of preoperative and postoperative oral nutritional therapy in the prevention of malnutrition and postsurgical complications in colorectal cancer Patients and methods: patients who underwent oncological colorectal surgery between June 2014 and December 2015 are included. An evaluation of preoperative nutritional status is performed. Patients received IMPACT(R) (2/day) for 5-10 days previous surgery. In the postoperative period, patients received IMPACT(R)/24h from 3rd to 7th postoperative day. Patients with low rates of albumin (< 2.5) or postoperative ileus received parenteral nutrition. Data were analyzed with the statistical package SPSS 21.0. Results: two hundred and twenty colorectal cancer patients were included. Twenty-eight patients did not take the preoperative oral supplements. Following the intake of nutritional supplements, an improvement of prealbumin and transferrin was noticed. One hundred and twenty-one patients received oral nutrition and 41 received parenteral nutrition in the postoperative period. There were more postoperative complications among patients without preoperative nutritional supplements (50% vs 28.1%; p = 0.019), and hospital stay was higher 14.64 ± 11.86 vs 9.36 ± 5.5; p < 0.005). There were more complications among patients without postoperative oral nutritional supplements (24% vs 18.2%; p < 0.005), with more wound infection (1.9% vs 0.8%) and leaks (1.9% vs 0.8%). They also had a higher average stay (9.15 4.6 vs 7.57 2.5 days; p = 0.021). Conclusion: in our study, patients that received oral nutritional supplements prior and following colorectal surgery had a lower rate of complications and a shorter hospital stay


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estado Nutricional/imunologia , Cirurgia Colorretal , Desnutrição/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Suplementos Nutricionais , Apoio Nutricional , Neoplasias Colorretais/cirurgia , Estudos Retrospectivos , Nutrição Parenteral/métodos , Soluções de Nutrição Parenteral , Desnutrição/imunologia
14.
Index enferm ; 28(3): 115-119, jul.-sept. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-192665

RESUMO

OBJETIVO PRINCIPAL: comparar los pacientes intervenidos de CCR (Cáncer colorrectal) en el contexto de un programa de cribado poblacional versus aquellos diagnosticados por presentar síntomas. METODOLOGÍA: estudio longitudinal retrospectivo. Se estudiaron dos cohortes de pacientes intervenidos de CCR en el Hospital Clínico de Barcelona (2010-2012) procedentes del Programa de detección precoz de CCR de Barcelona (n = 59), y de Urgencias o de Consultas Externas por presentar sintomatología (n = 118). RESULTADOS PRINCIPALES: Los del grupo cribado presentaron con mayor frecuencia tumores en estadio precoz (estadios I-II) que el grupo síntomas (57,6% vs 23,7%; p < 0,001). La necesidad de uso de ostomía, y la estancia hospitalaria fue superior en el grupo síntomas (36,4% vs 10,2%; p = 0,001; 10,1 días vs 7,1 días; p < 0,001. CONCLUSIÓN PRINCIPAL: los pacientes con CCR diagnosticados en el contexto de programas de cribado presentan un estadio más precoz, menor estancia hospitalaria y menor necesidad de ostomías. El programa de cribado poblacional presenta beneficios para los pacientes y el sistema sanitario


OBJECTIVE: the comparison of patients diagnosed in a screening program versus those diagnosed by symptoms has not been studied in depth. The aim of this study is to compare patients diagnosed with CRC in the context of a population-based screening program and those diagnosed only by symptoms. METHODS: longitudinal retrospective study in which two cohorts of patients with CRC are compared between 2010 and 2012 at Hospital Clinic de Barcelona depending on the method of diagnosis. Fifty-nine patients diagnosed by the cancer screening programme of Barcelona were compared with 118 patients diagnosed only by symptoms at the emergency room or outpatient clinic. RESULTS: Patients in the screened group presented more frequently tumors in the early stage (stages I-II) compared with the symptom group (57.6% vs. 23.7%, p < 0.001). The need for ostomy was higher in the symptom group, (36, 4% vs 10,2%, p = 0.001). Hospital stay was higher in the group diagnosed only by symptoms (10.1 days vs 7.1 days, p < 0.001). CONCLUSIONS: Patients with CRC diagnosed in the context of screening programmes have an earlier stage, shorter hospital stay and less need for ostomy. In conclusion, the population screening program, beyond the reduction of delayed diagnosed and mortality, directly benefits CRC patients and decreases Hospital costs


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Programas de Triagem Diagnóstica , Cirurgia Colorretal/enfermagem , Sangue Oculto , Neoplasias Colorretais/prevenção & controle , Estudos Retrospectivos , Estudos Longitudinais , Estadiamento de Neoplasias , Tempo de Internação , Fatores de Risco , Neoplasias Colorretais/enfermagem
15.
Radiología (Madr., Ed. impr.) ; 61(4): 286-296, jul.-ago. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185306

RESUMO

Las complicaciones posquirúrgicas del cáncer colorrectal son frecuentes en los servicios de urgencias. La tomografía computarizada multidetector tiene un papel fundamental en el seguimiento de los pacientes operados, ya que hace posible el reconocimiento de complicaciones y recidiva. Es importante que el radiólogo esté familiarizado con las diferentes técnicas quirúrgicas y los cambios postoperatorios normales, con objeto de diferenciarlas de potenciales complicaciones y recidivas. El objetivo de este trabajo es revisar los hallazgos en tomografía computarizada multidetector que pueden considerarse normales tras la intervención quirúrgica, y hacer una revisión de las complicaciones tempranas que con mayor frecuencia encontramos en los servicios de urgencias


Complications after surgery for colorectal cancer are common in emergency departments. Multidetector computed tomography plays a fundamental role in the follow-up of patients after surgery, because it enables the detection of relapse and complications. Radiologists need to be familiar with different surgical techniques and the normal postsurgical changes so that we can differentiate them from potential complications and relapse. This article reviews the multidetector computed tomography findings that can be considered normal after surgical intervention for colorectal cancer as well as the most common early complications seen in postsurgical colorectal cancer patients presenting at emergency departments


Assuntos
Humanos , Tomografia Computadorizada Multidetectores/métodos , Neoplasias Colorretais/cirurgia , Colectomia/métodos , Anastomose Cirúrgica/métodos , Colostomia/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Tratamento de Emergência/métodos , Recidiva Local de Neoplasia/diagnóstico por imagem
16.
Rev. esp. enferm. dig ; 111(8): 598-602, ago. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-190330

RESUMO

Aim: the adenoma detection rate is the quality indicator of colonoscopy that is most closely related to the development of interval colorectal cancer or post-colonoscopy colorectal cancer. However, the recording of this indicator in different units of gastrointestinal endoscopy is obstructed due to the large consumption of resources required for its calculation. Several alternatives have been proposed, such as the polyp detection rate. The objective of this study was to evaluate the relationship between the polyp detection rate and its influence on post-colonoscopy colorectal cancer rate. Patients and methods: in this study, 12,482 colonoscopies conducted by 14 endoscopists were analyzed. The polyp detection rate was calculated for each endoscopist. Endoscopists were grouped into quartiles (Q1, Q2, Q3, and Q4), from lowest to highest polyp detection rate, in order to evaluate whether there were any differences in the development of post-colonoscopy colorectal cancer. Results: the lowest polyp detection rate was 20.66% and the highest was 52.16%, with a median of 32.78 and a standard deviation of +/- 8.54. A strong and positive association between polyp endoscopy diagnosis and adenoma histopathology result was observed and a linear regression was performed. A significantly higher post-colonoscopy colorectal cancer rate was observed in the group of endoscopists with a lower polyp detection rate (p < 0.02). Conclusion: polyp detection rate is a valuable quality indicator of colonoscopy and its calculation is much simpler than that of the adenoma detection rate. In our study, the prevalence of post-colonoscopy colorectal cancer was inversely and significantly related to the endoscopists' polyp detection rate


No disponible


Assuntos
Humanos , Pólipos do Colo/diagnóstico por imagem , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico por imagem , Detecção Precoce de Câncer/métodos , Pólipos do Colo/patologia , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/patologia , Sensibilidade e Especificidade , Lesões Pré-Cancerosas/diagnóstico por imagem , Estudos Retrospectivos
17.
Rev. esp. enferm. dig ; 111(7): 543-549, jul. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-190101

RESUMO

Background and aims: underwater endoscopic mucosal resection (U-EMR) has been recently described as an alternative to endoscopic mucosal resection (EMR) for flat colorectal polyps. However, the real applications remain unclear due to the lack of comparative studies. Methods: a multi-centric prospective study was performed from November 2016 to December 2017. All lesions larger than 15 mm that were resected with both techniques were included in the study. The samples were matched using the size, morphology, site and access (SMSA) score as a reference. The efficacy, efficiency and adverse events rates were compared. Results: a total of 162 resections were collected (112 EMR and 50 U-EMR) with an average size of 25 mm. U-EMR achieved better results for the en bloc resection rate (49 vs 62%; p = 0.08) and there were no cases of an incomplete resection (10.7 vs 0%; p = 0.01). U-EMR was faster than EMR and there were no differences in the adverse events rate. Furthermore, U-EMR tended to achieve better results in terms of recurrence. Performing the resection in emersion appeared to prevent the cautery artefact, especially in sessile serrated adenomas. Conclusion: in the real clinical practice, U-EMR and EMR are equivalent in terms of efficacy and safety. Furthermore, U-EMR may be a feasible approach to prevent cautery artefact, allowing an accurate pathologic assessment


No disponible


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Colorretais/cirurgia , Colonoscopia/métodos , Ressecção Endoscópica de Mucosa/métodos , Estudos Prospectivos , Mucosa Intestinal/cirurgia , Adenoma/cirurgia
18.
Gastroenterol. hepatol. (Ed. impr.) ; 42(6): 351-361, jun.-jul. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183786

RESUMO

Objetivo: Evaluar la efectividad de una entrevista telefónica realizada por profesionales de Atención Primaria en personas no participantes en la primera ronda del Programa de detección precoz de cáncer colorrectal (PDPCCR), en el área básica de salud (ABS) urbana Guineueta de Barcelona (España). Pacientes y métodos: Un grupo de profesionales de Atención Primaria del ABS Guineueta contactó, mediante un protocolo de llamadas telefónicas estandarizadas, con personas que no atendieron la invitación a participar en la primera ronda del PDPCCR. Se analiza el impacto de esta intervención en la tasa de participación y las enfermedades detectadas. Resultados: Se realizaron 3.327 llamadas telefónicas a 2.343 personas. Tras la intervención, la tasa de participación fue del 54,9%, lo que supone un incremento del 5,7% con respecto a la participación del protocolo habitual del programa (49,2%). Se han diagnosticado 5 cánceres, 2 neoplasias de riesgo alto y 8 lesiones de riesgo bajo e intermedio. En promedio, han sido necesarias 9 llamadas para conseguir la aceptación de una persona adicional. Discusión: La intervención telefónica de los profesionales de Atención Primaria ha aumentado de forma significativa la tasa de participación de la población y la detección de neoplasias con respecto al protocolo habitual del PDPCCR


Aim: To assess the effectiveness of a telephonic interview performed by primary care professionals among non-participants in the first round of the colorectal cancer early detection programme in the basic urban health area Guineueta in Barcelona, Spain. Patients and methods: The Primary Healthcare Team of La Guineueta contacted people who did not respond to the invitation to the first round of the colorectal cancer early detection programme using a standardised telephone call protocol. We analysed the impact of the intervention based on participation and diagnosed disease. Results: We made 3,327 phone calls to 2,343 people. After the intervention the participation rate was 54.9%, which meant an increase of 5.7% with respect to the participation in the usual protocol for the programme (49.2%). The intervention allowed 5cancers, 2high-risk neoplasms and 8low- and intermediate-risk lesions to be diagnosed. An average of 9phone calls was necessary to achieve the participation of one additional person. Discussion: The telephonic intervention performed by primary care professionals has significantly increased the population participation rate and the detection of neoplasms with respect to the usual colorectal cancer early detection programme protocol


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Colorretais/diagnóstico , Atenção Primária à Saúde , Diagnóstico Precoce , Prevenção Secundária , Pessoal de Saúde , Telefone/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Participação da Comunidade/estatística & dados numéricos , Modelos Logísticos
19.
Sanid. mil ; 75(2): 80-86, abr.-jun. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183709

RESUMO

Antecedentes: El carcinoma colorrectal es la afectación maligna más común del tubo digestivo. Las metástasis hepáticas más frecuentes son las del cáncer colorrectal, siendo un importante condicionante de la supervivencia de estos pacientes. Alrededor del 25% de los pacientes con cáncer colorrectal presentan metástasis al diagnóstico (metástasis sincrónicas). Más del 30% las desarrollará durante la evolución de su enfermedad (metástasis metacrónicas). Es decir, entre el 55-60% desarrollarán metástasis en algún momento de su vida, generalmente en un periodo de tres años. Objetivo: Revisar la frecuencia de metástasis hepáticas en pacientes diagnosticados de cáncer colorrectal en el Hospital Central de la Defensa "Gómez Ulla" durante los años 2012, 2013 y 2014, realizando su seguimiento hasta 2017. Material y Métodos: Se realizó un estudio observacional transversal longitudinal retrospectivo. Se tomaron datos de pacientes del Servicio de Cirugía General y del Aparato Digestivo diagnosticados de neoplasia colorrectal durante los años 2012, 2013 y 2014, realizando su seguimiento hasta 2017, teniendo en cuenta las revisiones realizadas posteriormente. Resultados: Se recogieron datos de 210 pacientes. De ellos, 27 pacientes presentaron metástasis hepáticas sincrónicas (13%) y 25 presentaron metástasis hepáticas metacrónicas (12%). Conclusiones: En nuestro hospital el porcentaje de pacientes que presenta metástasis hepática sincrónica (12%) es menor que el indicado en la literatura (25%), aun siendo el tamaño muestral inicial pequeño. La evidencia científica indica que más del 30% de los pacientes las desarrollarán metástasis metacrónicas, siendo en nuestro centro únicamente descritas el 12%. Estudios posteriores determinarán la reducción de estas cifras en nuestro centro


Introduction: Colorectal cancer is the most common malignant affection of the intestine. Liver metastases due to colorrectal cancer are the most frequent, being decisive for the survival of these patients. Nearly 25% of the patients have metastases at the time of the diagnosis (synchronous metastases). More than 30% will develop them during their follow-up (metachronous metastases). Ergo, between 55-60% will manifest metastases during the progression of their disease, usually in three years. Purpose: Review the frequency of liver metastases in patients with colorectal cancer who had been diagnosed at the "Gómez Ulla" military hospital during 2012, 2013 and 2014, tracking them until 2017. Methods: A retrospective longitudinal transversal observational study has been conducted. Patients from General and Digestive Surgery Department diagnosed of colorectal cancer during 2012, 2013 and 2014 have been analyzed, tracking them until 2017 considering the follows-up realized after their surgery. Results: 210 patients have been analyzed. 27 had synchronous liver metastases (13%) and 25 had metachronous liver metastases (12%). Conclusions: Despite the non-significant sample size, results show that the percentage of synchronous liver metastases at our hospital (12%) is smaller than the percentage reflected by the scientific knowledge (25%). The bibliography shows that more than 30% of the patients develop metachronous liver metastases. At our hospital, results showed than only 12% develop metachronous liver metastases. That means we have a smaller amount of liver metastasis


Assuntos
Humanos , Masculino , Feminino , Idoso , Neoplasias Colorretais/complicações , Neoplasias Colorretais/epidemiologia , Recidiva Local de Neoplasia/epidemiologia , Hospitais Militares , Estudos Transversais , Estudos Longitudinais , Estudos Retrospectivos
20.
Rev. esp. anestesiol. reanim ; 66(5): 259-266, mayo 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187470

RESUMO

Introducción: Los protocolos ERAS de cirugía colorrectal son programas multimodales cuyo objetivo es minimizar la respuesta al estrés quirúrgico y acelerar así la recuperación del paciente. Un aspecto fundamental es el manejo intraoperatorio de fluidos, ya que tanto la hipovolemia como la hipervolemia se han relacionado con complicaciones. Los protocolos de fluidoterapia guiada por objetivos se basan en la monitorización de parámetros hemodinámicos para guiar la administración de fluidos y optimizar la perfusión tisular. Objetivo: Comparar la aplicación de 2regímenes de fluidoterapia (balance cero vs. optimización hemodinámica) en pacientes intervenidos mediante cirugía colorrectal laparoscópica ERAS, en cuanto a la aparición de infección del sitio quirúrgico, dehiscencia anastomótica, íleo, náuseas y vómitos postoperatorios y cambios en la función renal. Materiales y métodos: Estudio observacional retrospectivo, para comparar la aplicación de 2regímenes de fluidoterapia en pacientes intervenidos mediante cirugía colorrectal laparoscópica ERAS y estudiar la tasa de complicaciones postoperatorias?. Resultados: Recogimos datos de 128 pacientes, en 43 (33,6%) se empleó la fluidoterapia intraoperatoria habitual o balance cero, y en 85 (66,4%) la fluidoterapia guiada por objetivos. El total de fluidos administrados fue menor en el grupo de optimización. La tasa de complicaciones sépticas postoperatorias (infección del sitio quirúrgico o dehiscencia anastomótica) e íleo fue mayor en el grupo balance cero, y la aparición de náuseas y vómitos postoperatorios fue menor en el grupo de optimización; todos estos resultados fueron estadísticamente significativos. No observamos diferencias en la estancia hospitalaria, diuresis intraoperatoria ni en el filtrado glomerular estimado. Conclusión: La aplicación de un algoritmo de fluidoterapia guiada por objetivos puede conseguir una reducción en la cantidad de fluidos administrada, con una menor incidencia en las complicaciones analizadas, sin afectar a la función renal


Introduction: Enhanced recovery after surgery protocols (ERAS) are used in peri-operative care to reduce the stress response to surgical aggression. As fluid overload has been associated with increased morbidity and delayed hospital discharge, a major aspect of this is fluid management. Intra-operative goal-directed fluid protocols have been shown to reduce post-operative complications, particularly in high risk patients.?. Objective: To compare 2fluid therapy models (zero-balance versus goal-directed fluid therapy) in patients who were scheduled for laparoscopic colorectal surgery within an ERAS program, recording the rate of complications such as surgical site infection, ileus, post-operative náusea and vomiting, and variability of the estimated glomerular filtration rate (eGFR). Materials and methods: An observational, retrospective study was conducted including adults who were scheduled for elective laparoscopic colorectal surgery within an ERAS program, and to investigate the postoperative complication rate. Results: A total of 128 patients were included in this study; 43 (33.6%) in the zero-balance group and 85 (66.4%) in the goal-directed fluid therapy group. The total fluids administered was lower in the goal-directed fluid therapy group, as well as the incidence of post-operative complications (surgical site infection, anastomotic leak, ileus, and postoperative náusea and vomiting). No significant differences were found for length of stay, intra-operative urine output, and variability of the eGFR?. Conclusion: The results of this study show that by using a goal-directed fluid therapy algorithm, the total amount of fluids administered can be reduced, as well as obtaining a lower incidence of post-operative complications


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Hidratação/métodos , Soluções para Reidratação/administração & dosagem , Neoplasias Colorretais/cirurgia , Laparoscopia/métodos , Terapia Combinada/métodos , Complicações Pós-Operatórias/epidemiologia , Hipovolemia/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento
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