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No disponible
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Humanos , Masculino , Anciano de 80 o más Años , Hemorragia Gastrointestinal/etiología , Divertículo/complicaciones , Conducto Arterioso Permeable/complicaciones , Enfermedades Duodenales/complicaciones , Endoscopía GastrointestinalRESUMEN
In relation to the article published in this journal by Valdivielso Cortázar et al., we have recently diagnosed a massive digestive hemorrhage secondary to a Dieulafoy's lesion inside a duodenal diverticulum. This was successfully treated with endoscopy.
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Divertículo/complicaciones , Enfermedades Duodenales/complicaciones , Hemorragia Gastrointestinal/etiología , Anciano de 80 o más Años , Divertículo/diagnóstico por imagen , Enfermedades Duodenales/diagnóstico por imagen , Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas , Humanos , MasculinoRESUMEN
INTRODUCTION: The prevalence of portal vein thrombosis (PVT) in patients that have undergone liver transplantation (LT) is 9.7% (SD 4.5). The aim of our study was to determine the prevalence, assess the factors that are associated with PVT and clarify their association with prognosis in patients with liver cirrhosis (LC) and LT. AIMS AND METHODS: From 2005 to 2014, laboratory, radiological and surgical data were collected from patients with LC in our center who had undergone LT for the first time. RESULTS: One hundred and ninety-one patients were included. The mean age was 55 (SD 9), 75.4% of patients were male and 48.7% had HCV. The Child-Pugh scores were A/B/C 41.9%/35.9%/25.5% and the MELD score was 15 (SD 6). Previous decompensations were: ascites (61.4%), hepatic encephalopathy (34.4%), variceal bleeding (25.4%), hepatocellular carcinoma (48.9%) and spontaneous bacterial peritonitis (SPB) (14.3%). The mean post-transplant follow-up was 42 months (0-113). PVT was diagnosed at LT in 18 patients (9.4%). Six patients were previously diagnosed using imaging tests (33.3%): 2 patients (11.1%) by DU and 4 patients (22.2%) by CT scan. All patients with PVT had DU in a mean time of 6 months before LT (0-44) and 90 patients (47.1%) had a CT scan in a median time of 6 months before LT (0-45). PVT was significantly related to the presence of SBP (33.3% vs 12.6%; p = 0.02) and lower levels of albumin (3.1g/dl vs 3.4g/dl; p = 0.05). MELD was higher in patients with PVT (16.6 vs 14.9; p = 0.3). There were no significant differences with regard to the need for transfusion of blood components. Moreover, the surgery time was similar in both groups. PVT correlated with a higher mortality in the first 30 days (8.8% vs 16.7%; p = 0.2). CONCLUSION: Prior history of SBP and lower levels of albumin were identified as factors associated with PVT. The pre-transplant diagnosis rate is very low and the presence of PVT may have implications for short-term mortality.
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Cirrosis Hepática/complicaciones , Cirrosis Hepática/cirugía , Trasplante de Hígado/efectos adversos , Trombosis de la Vena/epidemiología , Trombosis de la Vena/terapia , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vena Porta , Prevalencia , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Campylobacter infection usually starts in the jejunum and ileum and progresses distally. The case fatality rate is low and most occur in elderly or patients with comorbidity as in this case. Antibiotics should be used in severe cases or patients at risk. The choices are macrolides and fluoroquinolones. However, in some countries quinolone resistance is increasing, as in Spain. We shouldn´t forget this fact for the proper treatment approach and specifically in refractory cases.
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Infecciones por Campylobacter/microbiología , Campylobacter jejuni , Colitis/microbiología , Ileítis/microbiología , Anciano , Infecciones por Campylobacter/complicaciones , Infecciones por Campylobacter/terapia , Campylobacter jejuni/efectos de los fármacos , Colitis/complicaciones , Colitis/terapia , Enfermedad de Crohn/complicaciones , Farmacorresistencia Bacteriana , Resultado Fatal , Humanos , Ileítis/complicaciones , Ileítis/terapia , MasculinoRESUMEN
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Humanos , Masculino , Anciano , Enfermedad de Crohn/microbiología , Infecciones por Campylobacter/complicaciones , Campylobacter jejuni/aislamiento & purificación , Antibacterianos/uso terapéuticoRESUMEN
BACKGROUND: Transarterial chemoembolisation (TACE), having demonstrated survival benefits, is the treatmentof choice in intermediate-stage hepatocellular carcinoma, although there is great heterogeneity in its clinical application. MATERIAL AND METHODS: A survey was sent to the Madrid Regional hospitals to assess applicability, indications and treatment protocols. The assessment was made overall and according to the type of hospital (groups A vs. B and C). RESULTS: Seventeen out of 22 hospitals responded (8/8 group A, 9/ 14 group B-C). All do/indicate transarterial chemoembolisation, 13/17 at their own facilities. Eight of the 17 hospitals have multidisciplinary groups (5/8 A, 3/9 B-C). Nine hospitals perform > 20 procedures/year (7 group A), and 6 from group B-C request/perform < 10/year. It is performed on an "on-demand" basis in 12/17. In 5 hospitals, all the procedures use drug-eluting beads loaded with doxorubicin. The average number of procedures per patient is 2. The mean time from diagnosis of hepatocellular carcinoma to transarterial chemoembolisation is ≤ 2 months in 16 hospitals. In 11/17 hospitals, response is assessed by computed tomography. Radiological response is measured without specific criteria in 12/17 and the other five hospitals (4 group A) assessed using standardised criteria. CONCLUSION: Uniformity among the Madrid Regional hospitals was found in the indication and treatment regimen. The use of DEB-TACE has become the preferred form of TACE in clinical practice. The differentiating factors for the more specialised hospitals are a larger volume of procedures, decision-making by multidisciplinary committees and assessment of radiological response more likely to be standardised.
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Carcinoma Hepatocelular/tratamiento farmacológico , Quimioembolización Terapéutica/tendencias , Hospitales/tendencias , Neoplasias Hepáticas/tratamiento farmacológico , Pautas de la Práctica en Medicina/tendencias , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/patología , Adhesión a Directriz/tendencias , Encuestas de Atención de la Salud , Humanos , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Estadificación de Neoplasias , Guías de Práctica Clínica como Asunto , España , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del TratamientoRESUMEN
INTRODUCTION AND OBJECTIVES: prevalence of viral hepatitis (B and C) changes geographically. Our aim was to determinate the prevalence of hepatitis B (HBV) and hepatitis C virus (HCV) serological markers in healthy working population and to describe the epidemiological characteristics associated to its presence. METHODS: blood samples and epidemiological data of 5,017 healthy workers from Murcia and Madrid were recorded prospectively. RESULTS: a total of 5,017 healthy volunteers participated. Mean age 39 ± 11 years, men predominance (73 %). Prevalence of serological markers of HCV and HBV was 0.6 % and 0.7 %. Age of patients with HCV antibody was significantly higher (43 + or - 9 years vs. 39 + or - 11 years; p = 0.03). We observed significant differences in liver test values (alanine aminotransferase [ALT] 64 ± 56 IU/L vs. 28 ± 20 IU/L; p < 0.001; aspartate aminotransferase [AST] (51 + or - 45 IU/L vs. 23 + or - 12 IU/L; p < 0.001) and in gamma-glutamyltransferase(GGT) value (104 + or - 122 IU/L vs. 37 + or - 46 IU/L; p < 0.001. The presence of HCV antibody was related significantly to previous transfusion (13 % vs. 5 %; p = 0.03), tattoos (29 % vs. 13 %; p < 0.01), intravenous drug addiction (13 % vs. 0.2 %; p < 0.001) and coexistence with people with positive HCV antibody (16 % vs. 4 %; p < 0.001). In HBV no differences in basal characteristics were observed with exception in AST values (29 + or - 15 IU/L vs. 23 + or - 12 IU/L; p < 0.01). Hepatitis B surface antigen (HBsAg) was related significantly to previous transfusion (15 % vs. 5 %; p < 0.01), tattoos (26 % vs. 14 %; p = 0.04) and coexistence with people with positive HBsAg (17 % vs. 4 %; p < 0.001). CONCLUSIONS: Prevalence of serological markers in healthy working population is low. Risk factors for infection were previous transfusion and tattoos. Intravenous drug addiction was only a risk factor in HCV.
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Antígenos de Superficie de la Hepatitis B/sangre , Hepatitis B/sangre , Hepatitis B/epidemiología , Anticuerpos contra la Hepatitis C/sangre , Hepatitis C/sangre , Hepatitis C/epidemiología , Adulto , Biomarcadores/sangre , Estudios Transversales , Femenino , Humanos , Masculino , Prevalencia , Estudios Prospectivos , Estudios SeroepidemiológicosRESUMEN
Introducción y objetivos: la prevalencia de las hepatitis víricas (B y C) varía geográficamente. Nuestro objetivo fue determinar la prevalencia de los marcadores serológicos de los virus de la hepatitis B (VHB) y de la hepatitis C (VHC) en población trabajadora sana describiendo las características epidemiológicas asociadas. Métodos: se recogieron prospectivamente muestras de sangre y datos epidemiológicos de 5.017 trabajadores sanos de Murcia y Madrid. Resultados: se incluyeron en el estudio 5.017 voluntarios sanos. Edad media 39 ± 11, 73 % varones. La prevalencia de los marcadores serológicos del VHC y el VHB fue de 0,6 % y 0,7 %, respectivamente. La edad de los pacientes con presencia de anti-VHC fue significativamente mayor (43 ± 9 años frente a 39 ± 11 años; p = 0,03). Se objetivaron diferencias significativas en los valores de transaminasas (alanina-aminotransferasa [ALT] 64 ± 56 UI/l frente a 28 ± 20 UI/l; p < 0,001; aspartato-aminotransferasa [AST] 51 ± 45 UI/l frente a 23 ± 12 UI/l; p < 0,001) y en los valores de gamma-glutamiltransferasa (GGT) (104 ± 122 UI/l frente a 37 ± 46 UI/l; p < 0,001). La presencia de anti-VHC se relacionó significativamente con transfusión previa (13 % frente a 5 %; p = 0,03), tatuajes (29 % frente a 13 %; p < 0,01), adicción a drogas por vía parenteral (ADPV) (13 % frente a 0,2 %; p < 0,001) y convivencia con personas con anti-VHC positivo (16 % frente a 4 %; p < 0,001). Respecto al VHB, no se evidenciaron diferencias en las características basales, a excepción de los valores de AST (29 ± 15 UI/l frente a 23 ± 12 UI/l; p < 0,01) El antígeno de superficie del VHB (AgHBs) se relacionó significativamente con transfusión previa (15 % frente a 5 %; p < 0,01), tatuajes (26 % frente a 14 %; p = 0,04) y convivencia con personas con AgHBs + (17 % frente a 4 %; p < 0,001). Conclusiones: la prevalencia de los marcadores serológicos del VHC y del VHB en población trabajadora sana es baja. Los factores de riesgo asociados a su presencia fueron la transfusión previa y la presencia de tatuajes. La ADVP se demostró como factor de riesgo solo en el caso del VHC (AU)
Introduction and objectives: prevalence of viral hepatitis (B and C) changes geographically. Our aim was to determinate the prevalence of hepatitis B (HBV) and hepatitis C virus (HCV) serological markers in healthy working population and to describe the epidemiological characteristics associated to its presence. Methods: blood samples and epidemiological data of 5,017 healthy workers from Murcia and Madrid were recorded prospectively. Results: a total of 5,017 healthy volunteers participated. Mean age 39 ± 11 years, men predominance (73 %). Prevalence of serological markers of HCV and HBV was 0.6 % and 0.7 %. Age of patients with HCV antibody was significantly higher (43 ± 9 years vs. 39 ± 11 years; p = 0.03). We observed significant differences in liver test values (alanine aminotransferase [ALT] 64 ± 56 IU/L vs. 28 ± 20 IU/L; p < 0.001; aspartate aminotransferase [AST] (51 ± 45 IU/L vs. 23 ± 12 IU/L; p < 0.001) and in gamma-glutamyltransferase (GGT) value (104 ± 122 IU/L vs. 37 ± 46 IU/L; p < 0.001. The presence of HCV antibody was related significantly to previous transfusion (13 % vs. 5 %; p = 0.03), tattoos (29 % vs. 13 %; p < 0.01), intravenous drug addiction (13 % vs. 0.2 %; p < 0.001) and coexistence with people with positive HCV antibody (16 % vs. 4 %; p < 0.001). In HBV no differences in basal characteristics were observed with exception in AST values (29 ± 15 IU/L vs. 23 ± 12 IU/L; p < 0.01). Hepatitis B surface antigen (HBsAg) was related significantly to previous transfusion (15 % vs. 5 %; p < 0.01), tattoos (26 % vs. 14 %; p = 0.04) and coexistence with people with positive HBsAg (17 % vs. 4 %; p < 0.001). Conclusions: prevalence of serological markers in healthy working population is low. Risk factors for infection were previous transfusion and tattoos. Intravenous drug addiction was only a risk factor in HCV (AU)
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Humanos , Masculino , Femenino , Pruebas Serológicas/métodos , Pruebas Serológicas , Hepatitis/epidemiología , Hepatitis/prevención & control , Hepatitis B/epidemiología , Hepatitis B/prevención & control , Hepatitis C/complicaciones , Hepatitis C/epidemiología , Hepatitis C/prevención & control , Transaminasas , Estudios Prospectivos , Encuestas y Cuestionarios , Análisis Multivariante , Hepatitis B/inmunología , Hepatitis C/inmunologíaAsunto(s)
Presión Atmosférica , Divertículo/patología , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
AIMS: The aim of this work is to investigate the accuracy of the urea breath test (UBT) performed immediately after emergency endoscopy in peptic ulcer bleeding (PUB). METHODS: Urea breath test was carried out right after emergency endoscopy in patients with PUB. The accuracy of this early UBT was compared to a delayed one after hospital discharge that was considered the gold standard. Clinical and epidemiological factors were analyzed in order to study their influence on the accuracy of the early UBT. RESULTS: Early UBT was collected without any complication and good acceptance from all the 74 patients included. In 53 of the patients (71.6%), a delayed UBT was obtained. Comparing concordance between the two tests we have calculated an accuracy of 83% for the early UBT. Sensibility and specificity were 86.36 and 66%, respectively, with a positive predictive value of 92.68% and negative predictive value of 50% (Kappa index = 0.468; p = 0.0005; CI: 95%). We found no influence of epidemiological factors, clinical presentation, drugs, times to gastroscopy, Forrest classification, endoscopic therapy, hemoglobin, and urea levels over the accuracy of early UBT. CONCLUSIONS: Urea breath test carried out right after emergency endoscopy in PUB is an effective, safe, and easy-to-perform procedure. The accuracy of the test is not modified by clinical or epidemiological factors, ulcer stage, or by the type of therapy applied. However, we have found a low negative predictive value for early UBT, so a delayed test is mandatory for all negative cases.
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Pruebas Respiratorias/métodos , Servicio de Urgencia en Hospital , Endoscopía Gastrointestinal , Hemorragia Gastrointestinal/cirugía , Infecciones por Helicobacter/diagnóstico , Úlcera Péptica/cirugía , Urea/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hemorragia Gastrointestinal/etiología , Tracto Gastrointestinal/microbiología , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/metabolismo , Helicobacter pylori/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Úlcera Péptica/etiología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los ResultadosAsunto(s)
Humanos , Masculino , Anciano de 80 o más Años , Esofagitis/complicaciones , Esofagitis/diagnóstico , Fracturas del Fémur/complicaciones , Fracturas del Fémur/diagnóstico , Dolor en el Pecho/complicaciones , Dolor en el Pecho/etiología , Endoscopía/métodos , Isquemia/complicaciones , Esofagitis/patología , EsofagitisAsunto(s)
Angiodisplasia/cirugía , Enfermedades del Colon/cirugía , Colonoscopía , Electrocoagulación , Anciano de 80 o más Años , Angiodisplasia/complicaciones , Angiodisplasia/diagnóstico , Angiodisplasia/tratamiento farmacológico , Argón , Transfusión Sanguínea , Enfermedades del Colon/complicaciones , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/tratamiento farmacológico , Terapia Combinada , Electrocoagulación/instrumentación , Electrocoagulación/métodos , Epinefrina/administración & dosificación , Epinefrina/uso terapéutico , Hemorragia Gastrointestinal/tratamiento farmacológico , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas , Humanos , Inyecciones Intralesiones , MasculinoRESUMEN
No disponible
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Masculino , Anciano , Humanos , Angiodisplasia/terapia , Enfermedades del Colon/terapia , Argón/uso terapéutico , Hemorragia Gastrointestinal/etiología , Epinefrina/uso terapéuticoAsunto(s)
Antituberculosos/efectos adversos , Isoniazida/efectos adversos , Pancreatitis/inducido químicamente , Enfermedad Aguda , Anciano de 80 o más Años , Antituberculosos/uso terapéutico , Quimioterapia Combinada , Femenino , Fracturas del Cuello Femoral/tratamiento farmacológico , Fracturas del Cuello Femoral/etiología , Fracturas Espontáneas/tratamiento farmacológico , Fracturas Espontáneas/etiología , Humanos , Isoniazida/uso terapéutico , Pirazinamida/uso terapéutico , Rifampin/uso terapéutico , Tuberculosis Osteoarticular/tratamiento farmacológico , Tuberculosis Osteoarticular/etiologíaRESUMEN
No disponible