EZH2 mutations at diagnosis in follicular lymphoma: a promising biomarker to guide frontline treatment.

EZH2 is mutated in nearly 25% of follicular lymphoma (FL) cases. Little is known about how EZH2 affects patients' response to therapy. In this context, the aim of this study was to retrospectively analyze the frequency of mutations in EZH2 at diagnosis in tissue and ctDNA in patients with FL and to assess the patients' outcomes after receiving immunochemotherapy, depending on the EZH2 mutation status. Among the 154 patients included in the study, 27% had mutated EZH2 (46% with high-grade and 26% with low-grade FL). Of the mutated tissue samples, the mutation in ctDNA was identified in 44% of cases. EZH2 mutation in ctDNA was not identified in any patient unmutated in the tissue.Unmutated patients who received R-CHOP had significantly more relapses than patients who received R-Bendamustine (16/49 vs. 2/23, p = 0.040). Furthermore, our results show that patients with mutated EZH2 treated with R-CHOP vs. those treated with R-Bendamustine present a lower incidence of relapse (10% vs. 42% p = 0.09 at 4 years), a higher PFS (92% vs. 40% p = 0.039 at 4 years), and higher OS (100% vs. 78% p = 0.039 at 4 years). Based on these data, RCHOP could be a more suitable regimen for mutated patients, and R-bendamustine for unmutated patients. These findings could mean the first-time identification of a useful biomarker to guide upfront therapy in FL.

Bienestar de la mujer durante el proceso de parto: comparación de dos herramientas de evaluación / Women's welfare during the process of childbirth: a comparison of two evaluation tolos

OBJETIVO: Describir la experiencia y el bienestar de las mujeres durante el proceso de parto atendido en el Área de Salud 2-Cartagena, del Servicio Murciano de Salud, y relacionarlos con las características ociodemográficas y obstétricas de la muestra y discutir la adecuación de las escalas utilizadas CEQ-E y BMSP2 en el entorno donde se emplean. MÉTODO: Estudio descriptivo de corte transversal realizado sobre 120 mujeres con parto eutócico. Los datos fueron recogidos mediante las encuestas CEQ-E y BMSP2. RESULTADOS: El bienestar y la experiencia durante el parto fueron valorados entre adecuados y óptimos por un 83,8% de las participantes (120 mujeres) con la escala BMSP2, y con una puntuación media de 3,19 sobre 4 puntos con la herramienta CEQ-E. Los resultados de las subescalas indican que el apoyo profesional y el contacto madre-hijo fueron las dimensiones mejor valoradas. El bienestar y la satisfacción no se relacionaron con la edad, la fórmula obstétrica, el tipo de inicio de parto, la duración del parto y el desgarro durante el expulsivo. Únicamente la nacionalidad y el tipo de anestesia se relacionaron de forma estadísticamente significativa con algunas de las subescalas de las herramientas utilizadas. Entre las dos escalas de nuestro estudio existe una correlación positiva moderada (R = 0,557) que contribuye a la validez de criterio de la escala BMSP2. CONCLUSIONES: La correlación positiva entre las dos herramientas nos indica que ambas pueden ser útiles en contextos culturales como el mediterráneo, en el que son valoradas tanto la autoeficacia (dimensión que enfatiza la herramienta CEQ-E elaborada en Suecia) como la participación de la familia (dimensión incluida en la herramienta chilena BMSP2)

OBJECTIVE: Describe the experience and well-being of women in Area II of the Murcian Health Service during the birth process, and relate them to the sociodemographic and obstetric characteristics of the sam-ple, and discuss the adequacy of the scales used CEQ-E and BMSP2 in the environment where they are used. METHOD: Descriptive crosssectional study performed on 120 women with eutocic delivery. The data was collected through the CEQ-E and BMSP2 surveys. RESULTS: The level of well-being was assessed as adequate and optimal in 83.8% of the participants (120 women), with the BMSP2 scale, and with an average score of 3.19 over 4 points with the CEQ-E tool. The results of the subscales indicate that the professional support and the contact mother-newborn were the most valued dimensions. Well-being was not related to age, the obstetric formula, type of onset of labor, the duration of delivery and the tear during the expulsive period. Only the nationality and the type of anesthesia were related in a statistically significant way with some of the subscales of the tools used. Between the two scales of our study, there is moderate positive correlation (R = 0.557) that contributes to the criterion validity of the BMSP2 scale. CONCLUSIONS: The positive correlation between the two surveys indicates that both can be useful in cultural contexts such as the Mediterranean, in which both self-efficacy (dimension that emphasizes the CEQ-E scale developed in Sweden) and family participation are valued (dimension included in the Chilean questionary BMSP2)

Use of fully covered self-expanding metal stents for the management of benign biliary conditions.

BACKGROUND AND AIM: biliary self-expanding metal stents (SEMS) have the advantage of being inserted undeployed with very small sizes and provide, when fully opened, large diameters for biliary drainage. However, their use in benign conditions has been very limited, mainly because of difficulty in their extraction. We present our initial experience with a fully covered SEMS (Wallflex) for the management of benign problems of the bile duct. PATIENTS AND METHODS: in a prospective study, stents of 8 mm in diameter and 4, 6 or 8 cm long were inserted by means of ERCP. These SEMS were chosen when according to medical judgement it was thought that diameters greater than 10 French (3.3 mm) were needed for proper biliary drainage. Stents were extracted also endoscopically, several months later when deemed clinically appropriate. RESULTS: twenty biliary SEMS were inserted. Reasons for insertion were: large intrahepatic biliary fistula after hydatid cyst surgery (1), perforation of the papillary area following endoscopic sphincterotomy (2), coaxial insertion to achieve patency in obstructed uncovered stents inserted in benign conditions (3), benign strictures (7), multiple and large common bile duct stones that could not be extracted because of tapering and stricturing of the distal common bile duct (7). In all cases, successful biliary drainage was achieved and there were no complications from insertion. Stents were easily extracted after a mean time of 132 days (36-270) in place. Complete resolution of biliary problems was obtained in 14 patients (70%). CONCLUSIONS: in our initial experience, the fully covered Wallflex biliary stent was removed without any complication after being in place in the common bile duct for a mean time of over four months. Therefore, it could be used in the management of benign biliary conditions.

Utilización de prótesis metálicas autoexpandibles totalmente recubiertas en procesos biliares benignos / No disponible

Introducción y objetivo: las prótesis metálicas autoexpandibles biliares (PMAB) tienen la ventaja de introducirse plegadas con calibres muy pequeños y proporcionar, al abrirse completamente, diámetros grandes para el drenaje biliar. Su utilización en procesos benignos ha estado muy limitada, fundamentalmente por la dificultad en su extracción. Presentamos nuestra experiencia inicial con una PMAB totalmente recubierta (Wallflex) para tratar patología benigna de la vía biliar. Pacientes y métodos: en un estudio descriptivo prospectivo se insertaron por CPRE prótesis de 8 mm de diámetro y 4, 6 u 8 cm de longitud, cuando se consideró que para el drenaje biliar eran precisos diámetros superiores a 10 french (3,3 mm). Las prótesis se retiraron también por endoscopia varios meses después según se consideró oportuno clínicamente. Resultados: se insertaron 20 PMAB. Los motivos fueron: gran fístula biliar intrahepática tras cirugía de quiste hidatídico (1), perforación del área papilar por esfinterotomía endoscópica (2), recanalización de prótesis no recubiertas insertadas en procesos benignos (3), estenosis benignas (7), coledocolitiasis múltiples y de gran tamaño con afilamiento-estenosis del colédoco distal que no pudieron extraerse (7). En todos los casos se logró un drenaje biliar satisfactorio y no se produjeron complicaciones por la inserción. Las prótesis se extrajeron con facilidad a los 132 días de media (36-270). La resolución completa de los procesos se obtuvo en 14 pacientes (70%). Conclusiones: en nuestra experiencia inicial, la prótesis Wallflex biliar totalmente recubierta pudo extraerse sin complicaciones tras permanecer en el colédoco hasta una media de más de cuatro meses, por lo que podría utilizarse en el tratamiento de procesos biliares benignos(AU)

Background and aim: biliary self-expanding metal stents (SEMS) have the advantage of being inserted undeployed with very small sizes and provide, when fully opened, large diameters for biliary drainage. However, their use in benign conditions has been very limited, mainly because of difficulty in their extraction. We present our initial experience with a fully covered SEMS (Wallflex) for the management of benign problems of the bile duct. Patients and methods: in a prospective study, stents of 8 mm in diameter and 4, 6 or 8 cm long were inserted by means of ERCP. These SEMS were chosen when according to medical judgement it was thought that diameters greater than 10 French (3.3 mm) were needed for proper biliary drainage. Stents were extracted also endoscopically, several months later when deemed clinically appropriate. Results: twenty biliary SEMS were inserted. Reasons for insertion were: large intrahepatic biliary fistula after hydatid cyst surgery (1), perforation of the papillary area following endoscopic sphincterotomy (2), coaxial insertion to achieve patency in obstructed uncovered stents inserted in benign conditions (3), benign strictures (7), multiple and large common bile duct stones that could not be extracted because of tapering and stricturing of the distal common bile duct (7). In all cases, successful biliary drainage was achieved and there were no complications from insertion. Stents were easily extracted after a mean time of 132 days (36- 270) in place. Complete resolution of biliary problems was obtained in 14 patients (70%). Conclusions: in our initial experience, the fully covered Wallflex biliary stent was removed without any complication after being in place in the common bile duct for a mean time of over four months. Therefore, it could be used in the management of benign biliary conditions(AU)

Biliary sphincterotomy dilation for the extraction of difficult common bile duct stones.

BACKGROUND AND AIM: Endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy (BS) is the usual method for extracting common bile duct stones. However, following BS and by means of extraction balloons and Dormia baskets a complete bile duct clearance cannot be achieved in all cases. We present a study on the impact that hydrostatic balloon dilation of a previous BS (BSD) may have in the extraction rate of choledocholithiasis. PATIENTS AND METHODS: A prospective study which included 91 consecutive patients diagnosed with choledocholithiasis who underwent ERCP. For stone removal, extraction balloons and Dormia baskets were used, and when necessary BSD was employed. RESULTS: Complete bile duct clearance was achieved in 86/91 (94.5%) patients. BSD was used in 30 (33%) cases. In these cases, extraction was complete in 29/30 (97%); 23 (76%) patients in the BSD group had anatomic difficulties or bleeding disorders. The most frequently used hydrostatic balloon diameter was 15 mm (60%). There were 7 (7.6%) complications: two self-limited hemorrhage episodes in the BSD group and one episode of cholangitis, one of pancreatitis, and three of bleeding in the group in which BSD was not used. CONCLUSIONS: BSD is a very valuable tool for extracting common bile duct stones. In our experience, there has been an increase in the extraction rate from 73% (Rev Esp Enferm Dig 2002; 94: 340-50) to 94.5% (p = 0.0001, OR 0.1, CI 0.05-0.45), with no increase in complications.

Evaluation of the environmental contamination at an abandoned mining site using multivariate statistical techniques--the Rodalquilar (Southern Spain) mining district.

Unsupervised and supervised pattern recognition techniques such as hierarchical cluster analysis, principal component analysis, factor analysis and linear discriminant analysis have been applied to water samples recollected in Rodalquilar mining district (Southern Spain) in order to identify different sources of environmental pollution caused by the abandoned mining industry. The effect of the mining activity on waters was monitored determining the concentration of eleven elements (Mn, Ba, Co, Cu, Zn, As, Cd, Sb, Hg, Au and Pb) by inductively coupled plasma mass spectrometry (ICP-MS). The Box-Cox transformation has been used to transform the data set in normal form in order to minimize the non-normal distribution of the geochemical data. The environmental impact is affected mainly by the mining activity developed in the zone, the acid drainage and finally by the chemical treatment used for the benefit of gold.

Biliary sphincterotomy dilation for the extraction of difficult common bile duct stones

Background and aim: endoscopic retrograde cholangiopancreatography(ERCP) with biliary sphincterotomy (BS) is the usualmethod for extracting common bile duct stones. However, followingBS and by means of extraction balloons and Dormia baskets acomplete bile duct clearance cannot be achieved in all cases. Wepresent a study on the impact that hydrostatic balloon dilation of aprevious BS (BSD) may have in the extraction rate of choledocholithiasis.Patients and methods: a prospective study which included 91consecutive patients diagnosed with choledocholithiasis who underwentERCP. For stone removal, extraction balloons and Dormia basketswere used, and when necessary BSD was employed.Results: complete bile duct clearance was achieved in 86/91(94.5%) patients. BSD was used in 30 (33%) cases. In these cases,extraction was complete in 29/30 (97%); 23 (76%) patients in theBSD group had anatomic difficulties or bleeding disorders. Themost frequently used hydrostatic balloon diameter was 15 mm(60%). There were 7 (7.6%) complications: two self-limited hemorrhageepisodes in the BSD group and one episode of cholangitis,one of pancreatitis, and three of bleeding in the group inwhich BSD was not used.Conclusions: BSD is a very valuable tool for extracting commonbile duct stones. In our experience, there has been an increasein the extraction rate from 73% (Rev Esp Enferm Dig2002; 94: 340-50) to 94.5% (p = 0.0001, OR 0.1, CI 0.05-0.45), with no increase in complications(AU)

Prevalencia de factores de riesgo modificables en el diagnóstico de enfermería: riesgo del síndrome de la muerte súbita del lactante / Prevalence of modifiable risk factors in the nursing diagnosis of risk for sudden infant death syndrome

Objetivo. Medir la prevalencia de los factores de riesgo modificables del diagnóstico de enfermería riesgo del síndrome de la muerte súbita del lactante (RSMSL), y relacionarla con las características sociodemográficas de la muestra. Material y métodos. Muestra compuesta por 384 madres (españolas, marroquíes y ecuatorianas). Los datos se recogieron en la planta de maternidad del Hospital Sta. María del Rosell de Cartagena (Murcia) entre junio y noviembre de 2007, a través de un cuestionario que incluía preguntas sobre los hábitos y prácticas de crianza, definidos como factores de riesgo modificables por la taxonomía NANDA-I. Para el análisis estadístico se utilizó el test de la χ2 para variables cualitativas, y la t de Student y análisis de la varianza para variables cuantitativas. Resultados. Un 77,1% (297) de los neonatos fue diagnosticado de RSMSL relacionado con factores modificables. Destaca la elevada prevalencia de algunos factores de riesgo modificables como la elección de la posición de decúbito lateral para acostar al recién nacido 39,8% (153), o el haber fumado durante el embarazo 25,7% (99). Se encontraron relaciones estadísticamente significativas (p<0,001) entre la presencia del diagnóstico y la nacionalidad de las madres, su nivel de instrucción y el nivel de ingresos en el hogar. Conclusión. La elevada prevalencia entre los neonatos de algunos factores de riesgo modificables, hace necesario reforzar la información acerca de determinados hábitos y prácticas de crianza relacionados con la prevención del SMSL, no sólo en las consultas de enfermería Infantil sino también durante el embarazo y primeros días de vida del recién nacido(AU)

Objective. To measure the prevalence of modifiable risk factors for the nursing diagnosis of risk of sudden infant death syndrome (RSIDS), and to establish the association between the prevalence found and the sociodemographic characteristics of the sample. Material and methods. The sample was composed of 384 mothers (Spaniards, Moroccans and Ecuadorians). Data were collected in the maternity ward of Sta. Ma del Rosell Hospital in Cartagena (Murcia) from June to November 2007 through a questionnaire containing items on sociodemographic variables and questions about up bringing habits and practices, which are defined as modifiable risk factors by the NANDA-I taxonomy. In the statistical analysis, the Chi-square test was used for qualitative variables and Student's t-test and analysis of variance were used for quantitative variables. Results. A total of 77.1% of newborns were diagnosed with RSIDS related to modifiable risk factors. Notable was the high prevalence of risk factors such as the choice of side-lying position to put the newborn to bed in 39.8% (153) and smoking during pregnancy in 25.7% (99). Statistically significant associations were found (p<0.001) between the diagnosis of RSIDS and the mother's nationality, educational level and household income. Conclusion. The high prevalence of some modifiable risk factors among newborns raises the need to provide more information about up bringing habits and practices for SIDS prevention, not only in Infant Nursing Consulting Rooms but also throughout pregnancy and in the first days of life of the newborn(AU)

[Prevalence of modifiable risk factors in the nursing diagnosis of risk for sudden infant death syndrome]. / Prevalencia de factores de riesgo modificables en el diagnóstico de enfermería: riesgo del síndrome de la muerte súbita del lactante.

OBJECTIVE: To measure the prevalence of modifiable risk factors for the nursing diagnosis of risk of sudden infant death syndrome (RSIDS), and to establish the association between the prevalence found and the sociodemographic characteristics of the sample. MATERIAL AND METHODS: The sample was composed of 384 mothers (Spaniards, Moroccans and Ecuadorians). Data were collected in the maternity ward of Sta. M del Rosell Hospital in Cartagena (Murcia) from June to November 2007 through a questionnaire containing items on sociodemographic variables and questions about upbringing habits and practices, which are defined as modifiable risk factors by the NANDA-I taxonomy. In the statistical analysis, the Chi-square test was used for qualitative variables and Student's t-test and analysis of variance were used for quantitative variables. RESULTS: A total of 77.1% of newborns were diagnosed with RSIDS related to modifiable risk factors. Notable was the high prevalence of risk factors such as the choice of side-lying position to put the newborn to bed in 39.8% (153) and smoking during pregnancy in 25.7% (99). Statistically significant associations were found (p<0.001) between the diagnosis of RSIDS and the mother's nationality, educational level and household income. CONCLUSION: The high prevalence of some modifiable risk factors among newborns raises the need to provide more information about upbringing habits and practices for SIDS prevention, not only in Infant Nursing Consulting Rooms but also throughout pregnancy and in the first days of life of the newborn.

Intención de colecho en el puerperio según características sociodemográficas de las madres. ¿Qué podemos recomendar los profesionales de enfermería? / Intention of bed sharing during the postpartum period according to sociodemographic characteristics of the mother. What should professional nurses recommend?

ustificación: El colecho es una práctica muy extendida en algunos entornos culturales, sin embargo diferentes investigaciones presentan resultados muy contradictorios respecto a los beneficios y riesgos de compartir el lecho con el lactante.Objetivo: determinar la prevalencia en la intención de practicar colecho entre madres que están en la planta de maternidad (puerperio inmediato e intermedio), y relacionarla con sus características sociodemográficas.Diseño-metodología: Estudio transversal de prevalencia realizado en una muestra de 384 madres: españolas, marroquíes y ecuatorianas. Para determinar el grado de asociación entre variables categóricas se utilizó el test de la Chi-cuadrado. El tratamiento de los datos se realizó con el programa SPSS v.13.Resultados y conclusiones: Un 12% de las madres encuestadas tienen intención de practicar colecho esporádico o permanente. Las madres inmigrantes y las que tienen más hijos fueron las que más optaron por compartir el lecho con el lactante en el ámbito doméstico. Comparando nuestros resultados con los de otras investigaciones, podemos afirmar que algunas madres, aunque no tengan intención de practicar colecho, finalmente lo llevan a la práctica sin haber recibido por parte del profesional sanitario ningún consejo para que se lleve a cabo con unas condiciones de seguridad aceptables (AU)

Justification: Bed sharing is widely practised within different cultural environments, however different researches show contradicting results on the benefits and risks of parent-infant bed sharing.Objective: To determine the prevalence of the intention of bed sharing practice among mothers admitted to the maternity ward (immediate and intermediate postpartum period), and to relate this prevalence to their sociodemographic characteristics.Design-Methodology: Cross-sectional prevalence study conducted with a sample of 384 mothers: Spaniards, Moroccans and Ecuadorians. Chi-square test was used to examine the association among categorical variables. The statistical package employed to conduct the analysis was the SPSS v.13.Results and conclusions: 12% of questionnaired mothers, either sporadically or permanently, intended to bed share. Immigrant mothers and those having more children were whom mostly referred their intention of practising bed sharing within the domestic ambit. Comparing the results found with other studies it was pointed out the fact that some mothers eventually practise bed sharing even though they did not intend to, and without having received any advice from health professionals to implement it under acceptable safety conditions (AU)

[Palliative management of malignant gastric outlet obstruction with endoscopically inserted self-expanding metal stents].

AIM AND BACKGROUND: the insertion of self-expanding metal stents to palliate malignant gastric outlet obstruction is a minimally invasive procedure that is being increasingly used. We discuss experience with this technique in a level-II hospital in the Spanish National Health System. PATIENTS AND METHODS: a retrospective five-year study (2003-2007) was conducted in 23 patients who underwent 27 procedures aimed at resolving malignant gastric outlet obstruction (mean, 0.45 procedures per month) using endoscopically inserted noncovered stents (Wallstent and Wallflex). RESULTS: insertion was technically feasible in all 27 (100%) attempts, with satisfactory clinical results in 25 cases (92.5%). Endoscopy alone was used 10 times (37%), and both endoscopy and fluoroscopy on 17 (63%) occasions. After stent insertion, one patient was intervened for treatment, and a patient with an unsuccessful prosthesis received a palliative surgical bypass. Four stents became obstructed by tumoral ingrowth, and patency was reestablished by inserting a new stent. Obstructive jaundice caused by stents covering the papilla of Vater occurred in three cases. There were no other complications or mortality due to the procedure. Mean survival was 104 days (range 28-400, SD +/- 94). CONCLUSIONS: in our experience endoscopic insertion of self-expanding metal stents appears to be a safe and efficient palliative method for malignant gastric outlet obstruction, and can be performed successfully in a center with our characteristics.

Tratamiento paliativo de la obstrucción tumoral del vaciamiento gástrico con prótesis metálicas autoexpandibles insertadas endoscópicamente / No disponible

Antecedentes y objetivo: la inserción de prótesis metálicas autoexpandiblespara paliar la obstrucción tumoral del vaciamiento gástricoes un procedimiento mínimamente invasivo, que cada vez seutiliza con más frecuencia. Presentamos la experiencia de esta técnicaen un hospital de nivel II del Sistema Nacional de Salud.Pacientes y métodos: estudio retrospectivo de un periodo decinco años (2003-2007), en los que se trató de resolver la obstruccióntumoral del vaciamiento gástrico en 27 ocasiones a 23 pacientes(media de 0,45 procedimientos por mes), mediante la inserciónendoscópica de prótesis no recubiertas (Wallstent® y Wallflex®).Resultados: la inserción fue técnicamente posible en el 100%de los 27 intentos. Se obtuvo un buen resultado clínico en 25 ocasiones(92,5%). Se utilizó sólo endoscopia 10 (37%) veces y en lasotras 17 (63%) también fluoroscopia. Tras la inserción de la prótesisse intervino a un paciente con intención curativa y a otro, enel que la prótesis no funcionó, para realizar una derivación paliativa.Cuatro prótesis se obstruyeron por crecimiento tumoral, recanalizándosemediante la inserción de nuevas prótesis. En tres ocasionesse produjo ictericia obstructiva en prótesis que cubrían lapapila de Vater. No hubo otras complicaciones. Tampoco mortalidadderivada del procedimiento. La media de supervivencia fuede 104 días (rango 28-400, DE ± 94).Conclusiones: en nuestra experiencia, la inserción endoscópicade prótesis metálicas autoexpandibles parece un método seguroy eficaz en el tratamiento paliativo de la obstrucción tumoraldel vaciamiento gástrico y puede llevarse a cabo con éxito en uncentro de nuestras características

Aim and background: the insertion of self-expanding metalstents to palliate malignant gastric outlet obstruction is a minimallyinvasive procedure that is being increasingly used. We discussexperience with this technique in a level-II hospital in the SpanishNational Health System.Patients and methods: a retrospective five-year study(2003-2007) was conducted in 23 patients who underwent 27procedures aimed at resolving malignant gastric outlet obstruction(mean, 0.45 procedures per month) using endoscopically insertednoncovered stents (Wallstent® and Wallflex®).Results: insertion was technically feasible in all 27 (100%) attempts,with satisfactory clinical results in 25 cases (92.5%). Endoscopyalone was used 10 times (37%), and both endoscopy andfluoroscopy on 17 (63%) occasions. After stent insertion, one patientwas intervened for treatment, and a patient with an unsuccessfulprosthesis received a palliative surgical bypass. Four stentsbecame obstructed by tumoral ingrowth, and patency was reestablishedby inserting a new stent. Obstructive jaundice caused bystents covering the papilla of Vater occurred in three cases. Therewere no other complications or mortality due to the procedure.Mean survival was 104 days (range 28-400, SD ± 94).Conclusions: In our experience endoscopic insertion of selfexpandingmetal stents appears to be a safe and efficient palliativemethod for malignant gastric outlet obstruction, and can be performedsuccessfully in a center with our characteristics

Extracción de cálculo coledociano de gran tamaño con esfinterotomía biliar seguida de dilatación de la papila con balón hidrostático / No disponible

No disponible

Outcomes of bile duct drainage by means of ERCP in geriatric patients / Resultados del drenaje de la vía biliar por CPRE en pacientes con edad geriátrica.

BACKGROUND AND OBJECTIVE: Endoscopic retrograde cholangiopancreatography (ERCP) is usually the procedure of choice for relieving bile duct obstruction. a large number of patients undergoing this intervention are geriatric population (aged 75 years of age and older). Our aim was to assess the efficacy of ERCP in this group of patients as compared to younger ones. PATIENTS AND METHODS: A retrospective study. All patients in whom a therapeutic biliary endoscopy had been performed over a four-year period of time (2002-2005) were included. RESULTS: 178 geriatric patients and 159 younger ones underwent ERCP. No differences were found in successful biliary drainage (97.7 vs. 98.7%), complication number (11.8 vs. 14.4%), or mortality rate (1.1 vs. 0.6%). On the other hand, more common bile duct stones were found in geriatric patients (57.3 vs. 39.6%, p = 0.004), and also more self-expanding metal stents were employed to drain malignant obstructive jaundice (47 vs. 8%, p = 0.0035). In the youngest group, more ERCPs were repeated in the same patients (4 vs. 10%, p = 0.001). CONCLUSIONS: The geriatric population showed similar success and morbidity and mortality rates when compared to younger patients in draining their bile duct by means of ERCP. Common bile duct stones were more frequently found in geriatric patients. No patients needing an ERCP should be excluded only because of their age.

Resultados del drenaje de la vía biliar por CPRE en pacientes con edad geriátrica / Outcomes of bile duct drainage by means of ERCP in geriatric patients

Antecedentes y objetivo: la colangiopancreatografía retrógradaendoscópica (CPRE) es habitualmente la técnica de elecciónpara desobstruir la vía biliar. Una gran parte de los pacientes a losque se realiza esta intervención están en edad geriátrica (mayoresde 75 años). Nuestro objetivo ha sido valorar la eficacia de laCPRE en este grupo de pacientes, comparado con los de menoredad.Pacientes y métodos: estudio retrospectivo en el que se hanincluido los pacientes a quienes se realizó terapéutica biliar endoscópicamediante CPRE en un periodo de cuatro años (2002-2005).Resultados: se realizó CPRE a 178 pacientes en edad geriátricay a 159 de menor edad. No hubo diferencias en el éxito deldrenaje biliar (97,7-98,7%), en el número de complicaciones(11,8-14,4%), ni en la mortalidad (1,1-0,6%). Por el contrario, enel grupo geriátrico hubo más coledocolitiasis (57,3-39,6%, p =0,004) y se utilizaron más prótesis metálicas autoexpandiblespara drenar la ictericia obstructiva tumoral (47-8%, p = 0,0035).En el grupo de menor edad se repitieron más CPRE a los mismospacientes (4-10%, p = 0,001).Conclusiones: el éxito y la morbimortalidad para drenar lavía biliar mediante CPRE son similares en los pacientes con edadgeriátrica y en los de edad inferior. La coledocolitiasis es más frecuenteen los pacientes mayores. No se debe excluir a ningún pacienteque precise de una CPRE sólo por la edad

Background and objective: endoscopic retrograde cholangiopancreatography(ERCP) is usually the procedure of choice forrelieving bile duct obstruction. A large number of patients undergoingthis intervention are geriatric population (aged 75 years ofage and older). Our aim was to assess the efficacy of ERCP in thisgroup of patients as compared to younger ones.Patients and methods: a retrospective study. All patients inwhom a therapeutic biliary endoscopy had been performed over afour-year period of time (2002-2005) were included.Results: 178 geriatric patients and 159 younger ones underwentERCP. No differences were found in successful biliarydrainage (97.7 vs. 98.7%), complication number (11.8 vs.14.4%), or mortality rate (1.1 vs. 0.6%). On the other hand,more common bile duct stones were found in geriatric patients(57.3 vs. 39.6%, p = 0.004), and also more self-expanding metalstents were employed to drain malignant obstructive jaundice (47vs. 8%, p = 0.0035). In the youngest group, more ERCPs wererepeated in the same patients (4 vs. 10%, p = 0.001).Conclusions: the geriatric population showed similar successand morbidity & mortality rates when compared to younger patientsin draining their bile duct by means of ERCP. Common bileduct stones were more frequently found in geriatric patients. Nopatients needing an ERCP should be excluded only because oftheir age

Afectación gastrointestinal por citomegalovirus en un paciente inmunocompetente / Gastrointestinal affectation with cytomegalovirus in an immunocompetent patient

No disponible

No disponible