Estudio español multicéntrico de estimacion de incidencia de la pancreatitis crónica / Spanish multicenter study to estimate the incidence of chronic pancreatitis

Objetivo: estimar la incidencia de pancreatitis crónica en España diagnosticada mediante ecoendoscopia y evaluar los factores de riesgo y las complicaciones locales detectadas. Material y métodos: estudio observacional, descriptivo, de los casos diagnosticados de pancreatitis crónica en los centros sanitarios españoles con unidad de ecoendoscopia. Mediante un cuestionario estructurado se valoró la incidencia de la enfermedad (casos detectados en 18 meses: de enero 2011 a junio 2012), los factores de riesgo, el número de criterios ecoendoscópicos y la clasificación de Rosemont, así como la frecuencia de complicaciones locales. Resultados: se seleccionaron 23 centros sanitarios con un área de referencia total de 14.752.704 habitantes. En el periodo de estudio se diagnosticaron 1.031 casos de pancreatitis crónica, con una incidencia de 4,66 casos por 105 habitantes-año (IC 95% 4,65-4,67). El consumo de tabaco y el de alcohol aparecen como factores de riesgo en el 63,8% y 66,7% de los casos, respectivamente. El 53,3% de los pacientes tenía > 5 criterios endoscópicos de pancreatitis crónica y el 69% presentó hallazgos sugestivos o consistentes para pancreatitis crónica según la clasificación de Rosemont. Las calcificaciones (34,7%), los pseudoquistes (16%) y la presencia de un tumor pancreático inflamatorio (10,4%) fueron las complicaciones más prevalentes. Conclusiones: la incidencia de pancreatitis crónica en España es similar a otros países europeos. Dada la amplia difusión de la técnica, las unidades de ecoendoscopia son esenciales en la detección de la enfermedad, y su actividad y resultados permiten la estimación de la incidencia de pancreatitis crónica sobre áreas poblacionales amplias y representativas (AU)

Objective: To estimate the incidence of chronic pancreatitis in Spain as diagnosed with endoscopic ultrasound (EUS), and to assess the risk factors and complications detected. Material and method: A descriptive, observational study of chronic pancreatitis cases diagnosed in Spanish health care centers with an EUS unit. A structured questionnaire was used to evaluate the incidence of the disease (cases identified over 18 months: from January 2011 to June 2012), risk factors, EUS criteria, Rosemont classification, and frequency of local complications. Results: Twenty-three centers were selected serving a total reference area of 14,752,704 population. During the study period 1,031 chronic pancreatitis cases were diagnosed, with an incidence of 4.66 cases per 105 inhabitants/year (95% CI: 4.65-4.67). Tobacco and alcohol use appear as risk factors in 63.8% and 66.7% of cases, respectively. Of these, 53.3% met > 5 EUS criteria for chronic pancreatitis, and 69% had findings suggestive of or consistent with chronic pancreatitis according to the Rosemont classification. Most prevalent complications included calcifications (34.7%), pseudocysts (16%), and presence of an inflammatory pancreatic tumor (10.4%). Conclusions: The incidence of chronic pancreatitis in Spain is similar to that of other European countries. Given the widespread use of the technique, EUS units are key in detecting the disease, and their activity and results allow to estimate the incidence of chronic pancreatitis over wide, representative population areas (AU)

A Spanish multicenter study to estimate the prevalence and incidence of chronic pancreatitis and its complications.

BACKGROUND AND OBJECTIVE: No nation-wide epidemiological study on the incidence and prevalence of chronic pancreatitis (CP) had been thus far carried out in Spain. Our goal is to estimate the prevalence and incidence of CP, as well as to determine the diagnostic and therapeutic criteria used in Spanish pancreas units. METHODS: An observational, descriptive study of hospital pancreas units in Spain. CP-related epidemiology, etiology, manifestations, diagnostic tests, functional complications, and treatments were all assessed using a structured questionnaire. Overall results were estimated by weighting cases in each site. RESULTS: Information was collected from six pancreas units with a sample frame of 1,900,751 inhabitants. Overall prevalence was 49.3 cases per 105 population (95 % CI, 46 to 52) and incidence was 5.5 cases per 105 inhabitant-years (95 % CI, 5.4 to 5.6). Most common etiologies included tobacco and alcoholism, which were associated with three in every four cases. The most prevalent symptoms were recurring pain (48.8 %) and chronic abdominal pain (30.6 %). The most widely used diagnostic method was echoendoscopy (79.8 %), CT (computerized tomography) (58.7 %), and MRI (magnetic resonance imaging)/MRCP (magnetic resonance cholangiopancreatography) (55.9 %). Most prevalent morphologic findings included calcifications (35 %) and pseudocysts (27 %). Exocrine (38.8 %) and endocrine (35.2 %) pancreatic insufficiency had both a similar frequency. Treatments used were rather heterogeneous among sites, with enzyme replacement therapy (40.7 %) and insulin (30.9 %) being most commonly used. CONCLUSIONS: Pancreas units amass a significant number of both prevalent and incident CP cases. Patients seen in these units share a similar typology, and differences between units are greater regarding diagnostic and therapeutic strategies.

Estudio español multicéntrico de estimación de la prevalencia e incidencia de la pancreatitis crónica y sus complicaciones / A Spanish multicenter study to estimate the prevalence and incidence of chronic pancreatitis and its complications

Antecedentes y propósito: en España no se ha llevado a cabo hasta ahora ningún estudio epidemiológico nacional sobre la incidencia y prevalencia de la pancreatitis crónica (PC). El objetivo es estimar la prevalencia e incidencia de casos de PC, así como los criterios diagnósticos y terapéuticos utilizados en las unidades de páncreas españolas. Métodos: estudio observacional, descriptivo de las unidades de páncreas de ámbito hospitalario en España. Mediante un cuestionario estructurado se valoró la epidemiología de la PC, la etiología, sintomatología, pruebas diagnósticas, complicaciones funcionales y los tratamientos utilizados. Los resultados globales se estimaron mediante la ponderación por la casuística de cada centro. Resultados: se recopiló información de seis unidades de páncreas, con un marco muestral de 1.900.751 habitantes. La prevalencia global fue de 49,3 casos por 105 habitantes (IC95 % 46 a 52) y la incidencia de 5,5 casos por 105 habitantes-año (IC95 % 5,4 a 5,6). Las etiologías más frecuentes fueron el tabaco y el alcoholismo que se asociaron a tres de cada cuatro casos. La sintomatología más prevalente fue el dolor recidivante (48,8 %), seguido del dolor abdominal crónico (30,6 %). El método diagnóstico más utilizado fue la ecoendoscopia (79,8 %), la TC (tomografía computerizada) (58,7 %) y la RNM (resonancia magnética)/CPRM (colangiopancreatografía por resonancia magnética) (55,9 %). Los hallazgos morfológicos más prevalentes fueron las calcificaciones (35 %) y pseudoquistes (27 %). Se presentaron con una frecuencia similar la insuficiencia pancreática exocrina (38,8 %) y la endocrina (35,2 %). Los tratamientos utilizados fueron bastante heterogéneos entre centros, siendo los más frecuentemente usados el tratamiento enzimático sustitutivo (40,7 %) y la insulina (30,9 %). Conclusiones: las unidades especializadas del páncreas acumulan un importante número de casos prevalentes e incidentes de PC. La tipología del paciente atendido en estas unidades es similar con mayores diferencias entre unidades en los métodos diagnósticos y terapéuticos utilizados (AU)

Background and objective: No nation-wide epidemiological study on the incidence and prevalence of chronic pancreatitis (CP) had been thus far carried out in Spain. Our goal is to estimate the prevalence and incidence of CP, as well as to determine the diagnostic and therapeutic criteria used in Spanish pancreas units. Methods: An observarional, descriptive study of hospital pancreas units in Spain. CP-related epidemiology, etiology, manifestations, diagnostic tests, functional complications, and treatments were all assessed using a structured questionnaire. Overall results were estimated by weighting cases in each site. Results: Information was collected from six pancreas units with a sample frame of 1,900,751 inhabitants. Overall prevalence was 49.3 cases per 105 population (95 % CI, 46 to 52) and incidence was 5.5 cases per 105 inhabitant-years (95 % CI, 5.4 to 5.6). Most common etiologies included tobacco and alcoholism, which were associated with three in every four cases. The most prevalent symptoms were recurring pain (48.8 %) and chronic abdominal pain (30.6 %). The most widely used diagnostic method was echoendoscopy (79.8 %), CT (computerized tomography) (58.7 %), and MRI (magnetic resonance imaging)/MRCP (magnetic resonance cholangiopancreatography) (55.9 %). Most prevalent morphologic findings included calcifications (35 %) and pseudocysts (27 %). Exocrine (38.8 %) and endocrine (35.2 %) pancreatic insufficiency had both a similar frequency. Treatments used were rather heterogeneous among sites, with enzyme replacement therapy (40.7 %) and insulin (30.9 %) being most commonly used. Conclusions: Pancreas units amass a significant number of both prevalent and incident CP cases. Patients seen in these units share a similar typology, and differences between units are greater regarding diagnostic and therapeutic strategies (AU)

Síndrome de rubéola congénita y manifestaciones bucales: reporte de un caso / The congenital rubella syndrome: case report

El Síndrome de la Rubéola Congénita (SRC), se caracteriza por presentar secuelas tempranas y tardías que afectan el sistema ocular, cardíaco y auditivo de manera simultánea acompañada de diferentes manifestaciones bucales. El objetivo de este reporte es dar a conocer las características bucales asociadas al Síndrome, como puede afectar al paciente desde temprana edad y guiar al odontólogo a identificar dicha entidad. Se presenta el caso de escolar de género femenino que acude al servicio de ortodoncia interceptiva del Postgrado de Odontología Infantil de la U.C.V., con el diagnóstico de S.R.C. se realizó el consentimiento informado y se cumplieron los protocolos de profilaxis antibiótica. Al examen clínico intraoral y extraoral y al análisis cefalométrico se diagnosticó Maloclusión dentaria Clase I tipo 3, Maloclusión esquelética Clase III, oligodoncias, microdoncias, además de ciertas características no reportadas asociadas al SRC como la queilitis descamativa y lesiones fibrosas. El SRC posee diferentes manifestaciones bucales que incluyen alteraciones en el desarrollo dental, maloclusiones. El tratamiento odontológico adecuado para estos pacientes debe realizarse en conjunto con un equipo multidisciplinario tomando en cuenta el estado sistémico del paciente

The Congenital Rubella Syndrome (CRS) is characterized by early and late sequelae that affect the eye, heart and ear simultaneously accompanied by various oral manifestations. The purpose of this report is to present oral characteristics associated with Syndrome, how it can affect the patient from an early age and guide the dentist to identify the syndrome. We report the case of a female pacient who attended school at the time in which she was treated at the Graduate interceptive orthodontic Pediatric Dentistry UCV, with the diagnosis of CRS. Informed consent was performed and antibiotic prophylaxis protocols were fulfilled. When intraoral and extraoral clinical examination and cephalometric analysis were diagnosed dental malocclusion Class I Type 3, Class III skeletal, oligodontics , microdontics, plus some unreported characteristics associated with the SRC as desquamative cheilitis and fibrous lesions. SRC has various oral manifestations that include disturbances in dental development, malocclusion. Appropriate dental treatment for these patients should be performed in conjunction with a multidisciplinary team taking into account the patient's clinical state

Granuloma piogénico en la edad pediátrica: reporte de un caso / Pyogenic granuloma in children: a case report

Granuloma Piogénico (GP) es una lesión reactiva producida por un crecimiento excesivo del tejido conectivo, es frecuente en la mucosa bucal muy especialmente en el tejido gingival. Se trata de una patología de crecimiento rápido, sangrante y se asocia a la presencia de irritantes locales, microtraumatismos, entre otros factores. Tiene importante predilección por el género femenino entre la segunda y quinta década de la vida. Lesiones como malformaciones vasculares, lesión periférica de células gigantes y sarcoma de Kaposi son sus principales diagnósticos diferenciales y el tratamiento de elección es la escisión quirúrgica. A continuación se presenta un caso clínico poco común debido a las características clínicas de la lesión y la edad del paciente, pues se trata de un infante del género masculino de 5 años de edad, que acudió a la Facultad de Odontología de la UCV, referido por su odontólogo general, debido a la presencia de una lesión tumoral en el sector posterior derecho maxilar, adyacente a la cara distal del 55 de 2.5cm de tamaño. Se realizó la escisión quirúrgica de la lesión posterior a la evaluación de los exámenes preoperatorios y fue analizada histopatológicamente, donde se confirmó el diagnóstico inicial de GP

Pyogenic Granuloma (PG), is a reactive lesion caused by an excessive connective tissue growth and it frequently appears on oral mucosa, especially the gingiva. The PG present fast growth, bleeding propensity and it is associated, among other factors, to local irritation and minor trauma. It has predilection for female patients between second and fifth decade of life. The main differential diagnosis can be made with lesions such as: vascular malformations, peripheral giant-cell lesion and Kaposi's sarcoma. Surgical excision is the treatment of choice. This article presents a case report of an uncommon lesion regarding its rare clinical features and age of the patient. A 5 year old male patient who attended the Facultad de Odontología of Universidad Central de Venezuela, referred by his dental practitioner, presented a tumor-like lesion. The lesion was 2.5 cm in size and located on posterior right maxilla next to distal surface of 55. Surgical excision was performed after full laboratory test evaluation. The histopathology findings confirmed initial diagnose of PG

Validity of insertion depth measurement in double-balloon endoscopy.

BACKGROUND AND STUDY AIMS: In double-balloon enteroscopy (DBE) the use of a reliable and practical method to calculate the insertion depth of the endoscope could help to improve diagnosis accuracy and optimize the effort and cost of the technique. The objectives of this work were to compare and evaluate two methods of estimating the insertion depth and to obtain a descriptive model capable of representing the exploration dynamics and efficiency in terms of advanced distance and time. METHODS: Oral DBE was performed in 25 pigs. Insertion depth was calculated during the procedure by: 1) estimation of time and distance for each push and pull cycle during progression; and 2) estimation of distance during withdrawal. At the maximum insertion depth a tattoo was placed, and the observed measures for the two methods were compared with the distance between the pylorus and the mark after euthanasia and necropsy of the animals 1 week after DBE. RESULTS: The average insertion depth during progression, withdrawal, and after necropsy was 324.92 cm, 317.23 cm, and 342.05 cm, respectively (P Anova = 0.72). The Pearson correlation coefficient (r > 0.85; P < 0.001) and paired Brand - Altman plots demonstrated high agreement between progression and necropsy (0.03 % difference) and between withdrawal and necropsy (6.9 % difference). The exploration dynamics and efficiency in terms of advanced distance per cycle and time fitted to potential and logarithmic regression models, respectively. CONCLUSIONS: Measurement of insertion depth in vivo was validated in the porcine model during progression and withdrawal. Estimation during progression was more accurate and allowed exploration dynamics and efficiency to be plotted, which might be used as approximate reference values for humans.

Efficacy of a multimodal therapeutic exercise program in shellfish gatherers for the prevention of musculoskeletal disorders: a quasi-experimental study.

AIM: Aim of the present study was to determine the efficacy of a therapeutic exercise program to modify the muscular endurance of the trunk, the localization and intensity of musculoskeletal pain, fear-avoidance beliefs, perceived change after the treatment and satisfaction. METHODS: The present study has a quasi-experimental design (N.=19) with measurements taken before and after 16 sessions. The measures included: trunk extensors and flexors endurance, localization and intensity of pain and fear avoidance behavior. At the end of the program the perception of changes at musculoskeletal level and satisfaction were also obtained. Statistical analysis was carried out using Student's T-test for paired data, Wilcoxon's test and McNemar's test. The study was approved by the Ethics Committee and the patients gave their informed consent. RESULTS: The 94% were women with a mean age of 58 years. The 42.1% had musculoskeletal pain, with the most frequent locations being the lower back, neck and shoulder regions. A significant increase in the muscular endurance of the trunk extensors and flexors (in seconds) was detected; (67.1±42 vs. 96.1±55.2) (P=0.005) and (28.2±18.3 vs. 67.8±41.1) (P=0.000), respectively. A decrease that was close to statistical significance (P=0.19) was observed in the score on the FABQ (53.9±18.8 vs. 48±19.7). The prevalence of lower back pain (84.2% vs. 47.4%; P=0.016) and upper back pain (42.1% vs. 10.5%; P=0.031) decreased significantly after the treatment. The 78.4% had improved and 89.5% were very satisfied with the treatment. CONCLUSION: The treatment increased the muscular endurance of both the trunk extensors and flexors. A decrease in the prevalence of lower back, upper back and neck pain was observed. The perceived change and satisfaction were high.

Hidrops fetal como manifestación ecográfica de una enfermedad familiar: incontinentia pigmenti (síndrome de bloch-sulzberger) / Hydrops fetalis as a echographic manifestations of a familial disease: incontinentia pigmenti (bloch-sulzberger syndrome)

Diagnóstico de un caso de enfermedad familiar a partir de un hidrops fetal. Gestante con 2 abortos previos ocurridos al inicio del segundo trimestre, ambos fetos masculinos. Se detecta en la semana 12 un higroma quístico en el contexto de un hidrops fetal. Estudio serológico (TORCH y parvovirus B12), con resultado negativo y biopsia corial con cariotipo 46 XY. La anamnesis y exploración detallada hacen sospechar una enfermedad ligada al cromosoma X, dado que la paciente y una hermana están afectas de una genodermatosis desde la infancia: Incontinentia Pigmenti.

We revealed a family disease by a fetal anomaly. The patient had a history of two early miscarriages of male fetuses. In the present pregnancy hydrops fetalis was demonstrated by routine ultrasound sean at 12 weeks. Serological tests were negative and chorionic villous sampling revealed normal karyotype, 46XY. We suspected a X-linked disease. Detailed family history leaded to the demonstration that the patient and a sister were affected of a rare genodermatosis: Incontinentia Pigmenti.

Presion capilar en medios porosos y su aplicacion a los Yacimientos de Petroleo y Gas Monteagudo

La existencia simultaneas de dos o mas fases fluidas en una roca exige un detallado estudio teorico-practico de conceptos tales como la presion capilar, permeabilidad relativa y mojabilidad. No obstante la importancia tecnologica de las leyes que rigen el flujo de fluidos a traves de medio porosos, muchas de ellas no han sido formuladas claramente. Las caracteristicas capilares, por ejemplo, no ha sido posible interpretarlas correctamente en terminos de distribucion del tamano de los poros y otras propiedades del medio poroso. Asi, han sido propuestas algunas descripciones empiricas matematicas y se han desarrollando rigurosamente ecuaciones en base a pruebas de laboratorio hechas sobre modelos geometricos simples de sistemas porosos. Estas ecuaciones asi obtenidas, han llevado a conclusiones, o erroneas, o cuya valides esta sujeta a ciertas limitaciones, o erroneas, o cuya valides esta sujeta a ciertas limitaciones particulares, y solo se ha podido alcanzar una conformidad entre la teoria y la practica, mediante una conformidad entre la teoria y la practica, mediante la introduccion de algunos parametros cuya significacion fisica no esta estrictamente comprobada. Se ha hecho posible sin embargo, establecer claramente relaciones entre la presion capilar y las saturaciones de los fluidos presentes, asi como la influencia de los fenomenos capilares en el recobro y en los procesos de recuperacion secundaria. Ha sido posible tambien la consideracion de los datos de presion capilar como punto de partida en el calculo de permeabilidades relativas y de distribucion de fluidos en rocas de acumulacion. Dada la intima relacion existente entre presiones capilar y los conceptos de tension interfasial, tension superficial, mojabilidad, etc.; se precisa un estudio previo mas o menos completo de estos fenomenos naturales que son los que van a determinar las caracteristicas y la magnitud de la presion capilar en un medio poroso saturado de una o mas fases fluidas.