Fecal Immunologic Test Results and Diagnostic Colonoscopy in a Mexican Population at Average Risk for Colorectal Cancer.

Colorectal cancer is preventable and treatable by screening and early detection. Fecal immunochemical tests (FIT) for average risk individuals is an effective strategy for screening. Incidence and mortality in Mexico is increasing and large-scale screening programs do not yet exist. The aim of this study was to evaluate the feasibility of FIT-based colorectal cancer screening program in Mexico City. For more than 15 months, average risk individuals in Mexico City were invited to participate at Mexico's Instituto Nacional de Cancerologia (INCan, Mexico City, Mexico). Participants received an FIT kit for stool collection, results ≥20 ng/mL were referred for high quality colonoscopy. Participants' results were classified according to the most advanced clinical finding as: adenocarcinoma, high-risk adenomas, low-risk adenomas, serrated lesions, hyperplastic polyps, and no polyps. Sequential analyses were performed to assess the positive predictive value (PPV) of FIT. A total of 810 participants were eligible, 737 (91.0%) returned the FIT and 112 (15.2%) had an abnormal result. Of these participants, 87 (77.7%) completed colonoscopy. Clinical findings of participants included: seven (8.1%) adenocarcinomas, 18 (20.7%) high-risk adenomas, 23 (26.4%) low-risk adenomas, one (1.2%) serrated lesions, 14 (16.1%) hyperplasic polyps, and 24 (27.6%) no polyps. The PPV of FIT using the ≥20 ng/mL was 8.1% for cancer and 20.7% for high-risk adenomas. In conclusion, colorectal cancer screening with FIT is feasible at INCan in Mexico City, where resources are available. Further studies are needed to determine feasibility of colorectal cancer screening in other settings, as well as optimal hemoglobin detection cut-off points to maximize the population benefits of colorectal cancer screening with FIT in Mexico.

[Prognostic factors of mortality in the malignant biliary obstruction unresectable after the insertion of an endoscopic stent]. / Factores pronósticos de mortalidad en la estenosis biliar distal maligna irresecable después de la colocación de una prótesis endoscópica.

OBJECTIVE: To determine the factors prognostics of early mortality in the malignant billary estenosis after the endoscopic derivation. BACKGROUND DATA: The surgical, percutaneous or endoscopic derivation is the alternative of palliative treatment in the biliary obstruction unresectable. The factors prognostic the early mortality after surgical derivation are: hemoglobin < 10 g/dL, serum bilirubin > 10 mg/dL and serum albumin < 2.5 g/dL; for the percutaneous derivation they are the sanguineous urea more of 4.3 mmol/L and hemoglobin < 10.9 g/dL; whereas in the single endoscopic derivation type 3 of Bismuth and the infectious complications after the endoscopic colangiography and the absence of the clinical success were factors prognoses of early mortality. METHODS: Descriptive and retrospective analysis of 97 cases with malignant biliary obstruction. The factors were evaluated prognoses of early mortality. Univariated and bivaried analysis and of survival by the method of Kaplan-Meier was made curved. RESULTS: 97 cases were included that presented/displayed unresectable disease and had a biochemical control subsequent to the drainage. They were 58 women and 39 men. More frequent symptoms: ictericia, pain and prurito. 61 cases of distal obstruction and 36 with proximal obstruction. Twenty deaths (25.9%) happened within the 30 later days to the treatment. The bilirubin > 14 mg/dL and the proximal location were like predicting of early mortality. CONCLUSIONS: The obstruction biliary more frequent is located in choledocho distal and is of pancreatic origin. The main factors associated to early mortality are: the bilirubin > of 14 mg/dL and the proximal location reason why is important the suitable selection of patient candidates to endoscopic derivation. The survival is better in the distal obstruction.

[Clinical manifestations and endoscopic characteristics of Kaposi's sarcoma in patients with acquired immunodeficiency syndrome]. / Manifestaciones clinicas y características endoscópicas del sarcoma de Kaposi en pacientes con síndrome de inmunodeficiencia adquirida.

BACKGROUND: Kaposi sarcoma may be the initial manifestation of immunodeficiency acquired syndrome (AIDS )in 30% of patients. The digestive tract is the thirth most affected site after the skin and lymph nodes. OBJECTIVE: To correlate the clinic and endoscopic manifestations of patients with AIDS. METHOD: 12 consecutive cases with AIDS and Kaposi sarcoma. We analyzed clinical data, positivity , immune state (leucocytes, lymphocytes, viral load, CD4 and CD8 counts, CD4/CD8 relation), opportunistic infections, tumors, endoscopic characteristics of the associated tumors, and histologic results. RESULTS: 12 patients. 11 men and 1 woman with an average age of 37.3 years old, a Karnofsky score X = 80%, weight X = 55.7 kg. All of them acquired the disease by sexual contact. The symptoms were weight loss in 6 cases, anemia in 6, abdominal pain 6, fever 6, melena 4, odynophagia 3, diarrhea 4, hematemesis 2, abdominal distention 2, dysphagia 2, bright red blood per rectum 1. The distribution of Kaposi sarcoma was as follows: hard palate 7, soft palate 2, larynx 3, esophagus 2, stomach 10, duodenum 2, colon 5 and anal conduct 1. The endoscopic appearance was in the majority a purple or blue elevated plaque that had various sizes. The biopsy was positive to Kaposi sarcoma in at least one lesion of each patient. The haemoglobin was x = 11.5, leukocytes X = 5463, total lymphocytes X = 2377 (35.7%), CD4 X = 247.8 (10.8%), CD8 X = 1008.7 (54.6%). CD4/CD8 relation = 0.20, T4/T8 = 0.25M, the viral load was X = 140,629 copies. CONCLUSIONS: The Kaposi sarcoma appears as a multiple lesion with diverse aspect and colors that go from purple to blue or red. There is correlation between a high number of Kaposi sarcoma lesions, affected organs, immunologic status and mortality.

[Comparative study of propranolol versus propranolol plus isosorbide 5-mononitrate in portal hypertension in cirrhotics. Evaluating splanchnic hemodynamics with color Doppler ultrasound]. / Estudio comparativo de propranolol contra propranolol más 5-mononitrato de isosorbide en hipertensión portal de cirróticos. Evaluando con eco Doppler color la hemodinamia esplácnica.

BACKGROUND: Hemorragic portal hypertension (HTP-H) has a mortality of 30-40%. Propranolol alone or in combination with isosorbide-5-mononitrate (5MNI) has been wed as hemorrhage preventive treatment. OBJECTIVE: Compare propranolol vs. propranolol and 5MNI as preventive treatment of HTP-H, evaluating splachnic hemodynamics by color Doppler ultrasound (EDC). METHODOLOGY: We included 20 patients with liver cirrhosis, mean age 53.3 years, 13 female, 10 for primary prevention and assigned them in to 2 groups treatment: l.- Propranolol alone (10 patients), ll.- Propranolol + 5-MNI (10 patients). We carried out EDC to each patient before iniciating and 2 months after treatment. RESULTS: A decrease in splachnic hemodynamics was found in both groups as measured by portal vein (PV), hepatic artery (HA) velocity and flux decreased in group I were: PV velocity from 15.4 to 12.5 cm/seg (p = 0.019089 ) and flux from 1639.8 to 1396.8 mL/min (p = 0.031082), HA velocity from 50.1 to 44.5 cm/seg (p = 0.120385), and flux 547.1 a 470 mL/min (p = 0.069642); in group 11: PV from 16.6 to 12.9 (p = 0.019699) and from 1,786.8 to 1,304.2 (p = 0.004072), in HA from 52.3 to 44.4 (p = 0.003498 ) and 612.5 to 448.8 (p = 0.000285). CONCLUSION: Propranolol and 5-MNI decreases splachnic flux and velocity more than propranolol alone, in consequence it should be better to prevent bleeding from portal hypertension.