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PURPOSE: Evidence-based guidelines for the management of polycystic ovary syndrome (PCOS) recommend clinical laboratories use liquid chromatography-tandem mass spectrometry (LC-MS/MS) for diagnosing biochemical hyperandrogenism. However, automated immunoassays are still mostly used in routine laboratories worldwide. Another hurdle for PCOS phenotyping in the clinical setting is ultrasound assessment of polycystic ovarian morphology. We address the impact of using state-of-the-art (LC-MS/MS) and of an anti-müllerian hormone (AMH) assay on the diagnosis of PCOS in routine practice. METHODS: In a cross-sectional study, we included 359 premenopausal women consecutively evaluated because of symptoms of functional androgen excess or hyperandrogenemia, and finally diagnosed with PCOS. Patients were submitted to routine phenotyping based on serum androgen measurements by immunoassays and an ovarian ultrasound when necessary. Samples of all patients were also assayed by LC-MS/MS for hyperandrogenemia and for circulating AMH. RESULTS: The observed agreement between immunoassays and LC-MS/MS in identifying hyperandrogenemia was poor [78.0%; k(95%CI): 0.366 (0.283;0.449)]. The observed agreement between ultrasound and increased AMH was 27.3% [(95%CI): 0.060 (0.005; 0.115)]. Using LC-MS/MS changed PCOS phenotypes in 60(15.8%) patients. Fifty-two (18.3%) individuals with hyperandrogenemia by routine immunoassays no longer presented with androgen excess by LC-MS/MS. Overall diagnostic agreement between routine assessment using immunoassays and ultrasound and that derived from LC-MS/MS and the addition of AMH to US was moderate [weighted κ (linear weights): 0.512 (0.416;0.608)]. CONCLUSIONS: Immunoassays used in routine practice are unacceptably inaccurate for phenotyping women with PCOS. Our data cast some doubts upon the interchangeability of serum AMH and ultrasound examination for the diagnosis of PCOS.
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OBJECTIVE: The aim of the study was to determine the optimal position for femoral nerve block (FNB) under ultrasound guidance. PATIENTS AND METHODS: We included fifty volunteers between 18-65 years of age in this study. The distances from the skin to the landmarks, which were taken as a reference for the ultrasound-guided FNB (apex point of the femoral artery = F12, lateral point = F9, and lower point = F6), were measured and compared in 3 different positions given to the lower extremity (neutral position: P1, 45° abduction: P2, and flexed knee: P3). The ease of application and the quality of the ultrasound images were evaluated at each measurement by assigning a subjective observer score and comparing them in three positions. RESULTS: All three measurement points were found to be closest to the skin at position P3. However, the distances from F9 (p = 0.023) and F6 (p = 0.006) to the skin were significant. A significant difference was found between P1 and P3 in terms of the distance from F9 (p = 0.027) and F6 to the skin (p = 0.007). P3 was determined to be the position with the highest score for clarity of the ultrasonography images and ease of detection of the measurement points (p < 0.001). As the scores of ease of access to the femoral nerve (FN) and image clarity increased, the distance from the measurement point to the skin surface decreased, which was statistically significant. CONCLUSIONS: The ideal position for ultrasound-guided FNB is the P3 position. As an alternative for patients with limited mobility, the P2 position can be used.
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Nervo Femoral , Extremidade Inferior , Bloqueio Nervoso , Humanos , Nervo Femoral/diagnóstico por imagem , Bloqueio Nervoso/métodos , Adulto , Estudos Prospectivos , Pessoa de Meia-Idade , Extremidade Inferior/diagnóstico por imagem , Adulto Jovem , Masculino , Feminino , Idoso , Adolescente , Ultrassonografia de Intervenção/métodos , UltrassonografiaRESUMO
Las dermatosis neutrofílicas (DN) constituyen un grupo heterogéneo de enfermedades. Excepcionalmente, las DN pueden acompañarse de acúmulos de neutrófilos estériles en otros tejidos distintos a la piel. Una paciente de 34 años consultó por una cefalea que no respondía al tratamiento analgésico. Una TAC demostró una lesión osteolítica a nivel parietal derecho, cuyo estudio histopatológico sugería una osteomielitis. Un año después del inicio de la cefalea desarrolló un pioderma gangrenoso en cara anterior de ambas piernas. Tras tratamiento con corticoterapia sistémica se resolvieron las lesiones cutáneas y la cefalea. La afectación ósea en las dermatosis neutrofílicas es excepcional. Habitualmente afecta a la población infantil en el contexto de una osteomielitis crónica recurrente multifocal (OCRM). Solo se han descrito dos casos en adultos, una paciente de 26 años, con una OCRM desde la infancia, y un varón de 67 años que desarrolló una osteomielitis aséptica en continuidad de un pioderma gangrenoso (AU)
Neutrophilic dermatoses include a heterogeneous group of entities. Uncommonly, they can accumulate aseptic neutrophilic abscesses in other tissues in addition to the skin. A 34-year-old female complained of a headache which was unresponsive to usual drugs. A TAC revealed an osteolytic lesion in the right parietal bone. The biopsy showed osteomyelitis. One year later, pyoderma gangrenosum appeared in the anterior aspect of both legs. The headache and the cutaneous lesions disappeared after treatment with oral prednisone. The bone involvement in the background of neutrophilic dermatoses is exceptional. Usually, it involves children in the context of chronic recurrent multiple osteomyelitis (CRMO). Only two cases have been described in adults. One of them was a 26-year-old woman who had had CRMO since childhood, and the other one in contiguity with the cutaneous lesions of pyoderma gangrenosum (AU)
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Humanos , Feminino , Adulto , Osteomielite , Pioderma Gangrenoso , Biópsia , Osteomielite/complicações , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Pioderma Gangrenoso/complicações , Pioderma Gangrenoso/diagnóstico por imagem , Pioderma Gangrenoso/tratamento farmacológico , Tomografia Computadorizada por Raios X , Imageamento por Ressonância MagnéticaRESUMO
Objetivo: Evaluar la atención en Urgencias por torsión testicular en reclamaciones por responsabilidad profesional médica.MétodoSe extrajeron las reclamaciones relacionadas con torsión testicular del 2000 al 2018, analizando la asistencia dispensada y la asociación con responsabilidad profesional médica.ResultadosSe identificaron 80 reclamaciones, registrándose como síntoma principal el dolor testicular en el 83,75% de las primeras asistencias, con 15,5h de evolución media. El tiempo hasta el diagnóstico fue de 7,98 días de media. La primera consulta fue hospitalaria en el 75,1% de los casos, pero solo en el 7,5% se realizó ecografía. Cuando se diagnosticó la torsión testicular, se hizo uso de pruebas complementarias en el 97,3% de los casos. La responsabilidad profesional médica se asoció significativamente con la vía de reclamación no penal y con cuadros de menos de 6h de evolución, y dentro de este subgrupo, con la no realización de ecografía.ConclusionesSe reclaman consultas tardías, el error y el retraso en el diagnóstico. Cuando la reclamación es por vía no penal, es frecuente que se considere la existencia de responsabilidad, y más en los casos en que la consulta fue antes de las 6h y sin haber realizado prueba complementaria alguna. (AU)
Objective: To evaluate emergency care for testicular torsion in medical professional liability claims.MethodClaims related to testicular torsion from 2000 to 2018 were located. The assistance provided and the association with medical professional liability were analyzed.ResultsEighty complaints were identified, testicular pain was reported in 83.75% of first consultations, with a mean evolution time of 15.5h. The mean time to diagnosis was 7.98 days. The first consultation was at the hospital in 75.1% of cases, but an ultrasound was performed only in 7.5%. When testicular torsion diagnosis was performed, 97.3% had undergone ancillary tests. The medical professional liability was significantly associated with non-criminal proceedings and with less than 6h of symptoms evolution, and, within this subgroup, without undergoing an ultrasound scan.ConclusionsLate consultations, wrong diagnosis and late diagnosis are claimed. When medical professional liability are claimed by means of non-criminal law, the existence of responsibility is frequently considered, even more in those cases when the consultation took place before 6h of evolution with no ancillary tests having been performed. (AU)
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Humanos , Medicina de Emergência , Responsabilidade Legal , Imperícia , Torção do Cordão Espermático/diagnósticoRESUMO
Resumen: Introducción: Las luxaciones posteriores de hombro son raras (2%) y se asocian a convulsiones, electrocuciones y traumatismos de alta energía. Pueden presentarse asociadas a una lesión de Hill Sachs reversa. Uno de los principios del tratamiento consiste en la transferencia del tendón subescapular hacia el área de lesión o procedimiento de McLaughlin. Caso clínico: Se expone el caso de un masculino con un defecto de Hill-Sachs reverso tratado con una modificación de la técnica original de McLaughlin. Se reportan los resultados funcionales tras 13 meses de la cirugía. Resultados: Actualmente con un Constant Score de 98 puntos. Discusión: La modificación técnica empleada para el tratamiento quirúrgico de la lesión de Hill Sachs reversa presentada en este paciente demostró bueos resultados funcionales con material de bajo costo.
Abstract: Introduction: Posterior shoulder dislocations are rare (2%) and are associated with seizures, electrocutions and high-energy trauma. They may be associated with a reverse Hill-Sachs lesion. One of the treatment principles consists of the subscapular tendon transfer to the injury area or McLaughlin procedure. Clinical case: A case of a man with a reverse Hill-Sachs defect treated with a modification of McLaughlin's original technique is presented. The functional results after 13 months of surgery are reported. Results: Currently with a Constant Score of 98 points. Conclusion: The technical modification used for the surgical treatment of the reverse Hill-Sachs lesion presented in this patient demonstrated good functional results with low cost material.
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Humanos , Masculino , Ombro , Luxação do Ombro/cirurgia , Transferência TendinosaRESUMO
No disponible
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Humanos , Feminino , Adolescente , Erros Inatos do Metabolismo dos Aminoácidos/genética , Erros Inatos do Metabolismo dos Aminoácidos/mortalidade , Peptídeos e Proteínas de Sinalização Intracelular/genética , Mutação/genética , Marcha Atáxica/etiologia , Imageamento por Ressonância MagnéticaRESUMO
La muerte súbita en personas jóvenes mientras realizan una actividad física intensa es un proceso patológico muy poco prevalente, pero con una importante carga de pérdida de años de vida en la sociedad y con un fuerte impacto social. Presentamos el caso de un varón de 19 años que sufre una parada cardiaca mientras juega un partido de fútbol, con reanimación prolongada, y que sufre múltiples complicaciones posteriores (fracaso renal agudo, coagulopatía, hemorragia digestiva, colitis isquémica y precisa colocación de DAI y realización de hemicolectomía). El inicio de la rehabilitación precoz de manera intensiva en un centro especializado consiguió minimizar las secuelas, permitiendo mejorar en la Escala Rankin desde 4 a 2, y en el Índice de Barthel de 0 a 95 puntos, permitiendo realizar una vida casi autónoma del paciente
Sudden death in young people while performing intense physical activity has a very low prevalence but a significant burden in terms of loss of years of life in society and a strong social impact. We present the case of a 19-year-old man who had a cardiac arrest while playing a football match, with prolonged resuscitation, and multiple subsequent complications (acute renal failure, coagulopathy, digestive bleeding, ischaemic colitis, and need for implantable cardioverter-defibrillator placement and hemicolectomy). The onset of intensive early rehabilitation in a specialised centre minimised the sequels, improving the Rankin score from 4 to 2 and Barthel index from 0 to 95 points, allowing the patient to lead an almost autonomous life
Assuntos
Humanos , Masculino , Adulto Jovem , Hipóxia Encefálica/complicações , Morte Súbita Cardíaca , Dano Encefálico Crônico/reabilitação , Hipertrofia Ventricular Esquerda/complicações , Miocardite/complicações , Displasia Arritmogênica Ventricular Direita/complicaçõesRESUMO
No disponible
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Humanos , Masculino , Adulto Jovem , Mielite Transversa/diagnóstico , Infecção por Zika virus/diagnóstico , Mielite Transversa/complicações , Zika virus/patogenicidade , Infecção por Zika virus/complicações , Colômbia , Hipestesia/etiologia , Parestesia/etiologiaRESUMO
Objetivo. Evaluar el porcentaje de complicaciones asociadas con la artroscopia de tobillo y retropié en nuestro centro y comparar nuestros resultados con aquellos publicados en la literatura. Material y método. Realizamos un estudio descriptivo retrospectivo de las complicaciones asociadas con las artroscopias de tobillo y retropié realizadas entre mayo del 2008 y abril del 2013. Se revisaron 257 artroscopias, un 23% de subastragalina y un 77% de tobillo. El acceso empleado fue anterior en el 69%, posterior en el 26% y combinado en el 5% restante. Resultados. Se recogieron 31 complicaciones (12,06%), siendo la complicación más frecuente la lesión neurológica (14 casos) y el nervio más afectado el nervio peroneo superficial (8 casos). Observamos 10 casos de drenaje persistente a través de los portales, 4 casos de infección y 3 casos de síndrome de dolor regional complejo tipo 1. Discusión. Los avances en la artroscopia de tobillo y retropié, y el aumento de sus indicaciones, conllevan un aumento del riesgo potencial de complicaciones. La tasa de complicaciones reflejada en nuestro análisis (12,06%) es comparable con lo descrito en la literatura (0-17%), siendo la complicación más frecuente la lesión neurológica. Conclusiones. La artroscopia de tobillo y retropié es un procedimiento seguro. Es importante realizar una cuidadosa planificación preoperatoria, utilizar una técnica meticulosa y realizar un cuidado postoperatorio apropiado para disminuir la tasa de complicaciones (AU)
Objective. To evaluate the percentage of complications associated with ankle and hindfoot arthroscopy in our hospital and to compare the results with those reported in the literature. Material and method. A retrospective descriptive review was conducted on the complications associated with ankle and hindfoot arthroscopy performed between May 2008 and April 2013. A total of 257 arthroscopy were performed, 23% on subtalar joint, and 77% of ankle joint. An anterior approach was used in 69%, with 26% by a posterior approach, and the remaining 5% by combined access. Results. A total of 31 complications (12.06%) were found. The most common complication was neurological damage (14 cases), with the most affected nerve being the superficial peroneal nerve (8 cases). Persistent drainage through the portals was found in 10 cases, with 4 cases of infection, and 3 cases of complex regional pain syndrome type 1. Discussion. There have been substantial advances in arthroscopy of ankle and hindfoot in recent years, expanding its indications, and also the potential risk of complications. The complication rate (12.06%) found in this study is consistent with that described in the literature (0-17%), with neurological injury being the most common complication. Conclusions. Ankle and hindfoot arthroscopy is a safe procedure. It is important to make a careful preoperative planning, to use a meticulous technique, and to perform an appropriate post-operative care, in order to decrease the complication rates (AU)
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Humanos , Masculino , Feminino , Artroscopia/efeitos adversos , Artroscopia/métodos , Traumatismos do Tornozelo/complicações , Traumatismos do Tornozelo/cirurgia , Articulação Talocalcânea/lesões , Articulação Talocalcânea/cirurgia , Procedimentos Ortopédicos/métodos , Estudos Retrospectivos , Cuidados Pós-Operatórios/métodos , Artrodese/instrumentação , ArtrodeseRESUMO
The primary cause of tumor-related death in breast cancer is still represented by distant metastasization. The dissemination of tumor cells from the primary tumor to distant sites through bloodstream cannot be early detected by standard imaging methods. Circulating tumor cells (CTCs) play a major role in the metastatic spread of breast cancer. Different analytical systems for CTCs isolation and detection have been developed and novel areas of research are directed towards developing assays for CTCs molecular characterization. This review describes the current state of art on CTCs detection techniques and the present and future clinical implications of CTCs enumeration and characterization (AU)
No disponible
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Humanos , Feminino , Neoplasias da Mama/diagnóstico , Células Neoplásicas Circulantes , Células Neoplásicas Circulantes/patologia , Biomarcadores Tumorais/análise , Micropeneiramento/métodos , Eletroforese/instrumentação , Eletroforese , Imuno-Histoquímica/instrumentação , Imuno-Histoquímica/métodos , Imuno-Histoquímica , Citometria de Fluxo/métodos , Técnicas de Amplificação de Ácido NucleicoRESUMO
Purposes. There is scarce information on the time to return to work after general surgery. The aim of this study was to analyze time off work after elective cholecystectomy and to compare the results with those in patients undergoing other surgical interventions. Methods. Observational and comparative study. Inclusion criteria were: being of working age and undergoing elective laparoscopic cholecystectomy (group 1) or unilateral inguinal hernia or haemorrhoidectomy (group 2). Results. 36 patients were included: 18 patients in each group. Overall, return to work occurred at a mean of 35.7 days, with no significant differences (p = 0.656) between groups (group 1: 36.6 days vs. group 2: 35.44 days). The reasons for not returning to work earlier were fear of complications (37.5%), pain control (37.5%), surgeon recommendation (12.5%), and general practitioner recommendation (12.5%). Conclusions. Time to recovery after laparoscopic cholecystectomy is prolonged. No statistically significant differences with less complex surgical procedures were detected (AU)
Objetivos. Existe escasa información acerca de la vuelta al trabajo tras una cirugía general. El objetivo de este estudio fue el de analizar el tiempo de ausencia del trabajo tras una colecistectomía electiva, comparando los resultados con los de aquellos pacientes sometidos a otras intervenciones quirúrgicas. Métodos. Estudio observacional y comparativo. Los criterios de inclusión fueron: estar en edad laboral y someterse a una colecistectomía electiva laparoscópica opcional (grupo 1), cirugía por hernia inguinal unilateral o una hemorroidectomía (grupo 2). Resultados. Se incluyó a un total de 36 pacientes, 18 de ellos en cada grupo. La vuelta al trabajo se produjo a una media de 35,7 días, sin diferencias significativas (p = 0,656) entre los grupos (grupo 1: 36,6 días frente al grupo 2: 35,44 días). Los motivos de no retornar al trabajo con anterioridad fueron el miedo a las complicaciones (37,5%), el control del dolor (37,5%), la recomendación del cirujano (12,5%), y la recomendación del médico de familia (12,5%). Conclusiones. El tiempo de recuperación tras una colecistectomía laparoscópica es largo. No se detectaron diferencias estadísticamente significativas en comparación a las intervenciones quirúrgicas menos complejas (AU)
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Feminino , Humanos , Masculino , Retorno ao Trabalho/legislação & jurisprudência , Retorno ao Trabalho/estatística & dados numéricos , Retorno ao Trabalho/tendências , Cirurgia Geral/legislação & jurisprudência , Cirurgia Geral/métodos , Colecistectomia/métodos , Colecistectomia/reabilitação , Colecistectomia/tendências , /reabilitação , /normas , Hérnia Inguinal/reabilitação , Hérnia Inguinal/cirurgia , Hemorroidectomia/métodos , Manejo da Dor/instrumentação , Manejo da Dor/métodosRESUMO
No disponible
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Humanos , Masculino , Idoso de 80 Anos ou mais , Sulco Nasogeniano/patologia , Transtornos de Fotossensibilidade/diagnóstico , Ceratose Actínica/diagnóstico , Fatores de RiscoAssuntos
Humanos , Masculino , Feminino , Consentimento Livre e Esclarecido/legislação & jurisprudência , Revelação/ética , Revelação/legislação & jurisprudência , Confidencialidade/ética , Confidencialidade/legislação & jurisprudência , Confidencialidade/normas , Consentimento Livre e Esclarecido/normasRESUMO
No disponible
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Humanos , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Estadiamento de Neoplasias , Terminologia como AssuntoRESUMO
Introducción. Los recursos estructurales del Sistema Nacional de Salud son limitados y no podemos intervenir quirúrgicamente a todos los pacientes precozmente. El objetivo fue analizar la satisfacción percibida por el paciente respecto a la demora de tratamiento por la lista de espera quirúrgica en 3 tipos de cirugía. También se analizó la influencia de la expectativa del paciente y de la alteración de la calidad de vida por síntomas durante la demora sobre la satisfacción del mismo con la espera. Material y métodos. Estudio prospectivo mediante una encuesta a pacientes intervenidos quirúrgicamente. Se compararon las expectativas de espera (escala del 1 al 5), la afectación de la calidad de vida por síntomas (escala del 1 al 5) y el grado de satisfacción de los pacientes (escala del 1 al 5) respecto al tiempo en lista de espera de colelitiasis, hernia inguinal y hemorroides. Se analizaron los factores predictores de insatisfacción de los pacientes. Resultados. Se incluyó una muestra 57 pacientes. Cuando se compararon las características de los pacientes con y sin satisfacción respecto al tiempo en lista de espera, el tiempo en la lista en días (p = 0,044), la alteración en la calidad de vida por síntomas (p = 0,028) y las expectativas de un tiempo inferior (p < 0,001) fueron significativamente diferentes entre ambos grupos. En el estudio multivariado la expectativa se asoció a la insatisfacción de los pacientes respecto al tiempo esperado (OR: 3,14, IC 95%: 5,91-220,73, p < 0,001). Conclusiones. El grado de insatisfacción de los pacientes está asociado, sobre todo, a las expectativas más que al propio tiempo de demora (AU)
Introduction: The structural resources of the National Health system are limited, and therefore early surgery cannot be performed on all patients. The objective was to analyse the satisfaction perceived by the patient as regards the delay of treatment by waiting list of three types of surgery. The influence of expectations on waiting times, and impaired quality of life due to the clinical symptoms during the delay, were studied. Material and methods: A prospective study was conducted using a postal questionnaire. We compared the expectations (scale of 1 to 5), the impact on quality of life for symptoms (scale of 1 to 5) and the level of patient satisfaction (scale of 1 to 5) with respect to time on the waitng list for cholelithiasis, inguinal hernia and haemorrhoids. The predictors of patient dissatisfaction were analysed. Results: A total of 57 patients were included. When comparing the characteristics of patients with and without satisfaction over time on the waiting list, days on the waiting list (P = .044), the change in the quality of life due to the symptoms (P = .028), and expectations (P <. 001) were significantly different between the two groups. In the multivariate analysis, the expectation was associated with patient dissatisfaction as regards the time on waiting list (OR: 3.14 95% CI: 5.91 to 220.73, P < .001). Conclusions: The level of patient dissatisfaction is associated with expectations about time in waiting list (AU)
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Cirurgia Geral/educação , Cirurgia Geral/métodos , Listas de Espera , Satisfação do Paciente/economia , Satisfação do Paciente/legislação & jurisprudência , Colelitíase/epidemiologia , Hérnia Inguinal/epidemiologia , Hemorroidas/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Qualidade de Vida/legislação & jurisprudência , Sistemas Nacionais de Saúde , Análise Multivariada , Estudos Transversais/métodos , Estudos TransversaisRESUMO
Objetivo: Describir los resultados de la implantación del programa piloto, en la comunidad de Castilla y León, del cribado de cáncer colorrectal (CCR) mediante la detección de sangre oculta en heces utilizando una prueba inmunológica cuantitativa de aglutinación en látex (TSOHi). Métodos: Población diana de 4.930 personas entre 50-69 anos de la zona básica de salud de Medina del Campo. A los que presentaron TSOHi positivo se les realizó colonoscopia. Se calcularon tasas de participación, positividad, aceptación de colonoscopia, detección de lesiones, porcentajes y valor predictivo positivo (VPP) de la prueba. Resultados: La tasa de participación fue de 2.241 personas (46.33%). Los TSOHi positivos fueron 138 (6,15%). La tasa de aceptación de la colonoscopia fue del 99,27%. Se detectaron 12 pacientes con CCR (el 91,66% en estadios precoces), 42 con adenoma de alto riesgo (AAR) y 34 con adenoma de bajo riesgo (ABR). Las tasas de detección fueron para el CCR de 5,35, para el AAR de 18,74, para el ABR de 15,17 y del 39,26 para todo tipo de adenoma. El VPP fue del 8,69% para el CCR, del 30,43% para el AAR y del 24,63% para el ABR. Conclusiones: El programa de detección de CCR es factible en nuestro contexto. Los indicadores del TSOHi son superiores a los de otros estudios realizados con pruebas clásicas. Las altas tasas de detección de CCR y de todo tipo de adenoma justificarían por sí solas el estudio. Estas, junto con la precocidad del diagnóstico de CCR, harían posible anticipar una reducción de la mortalidad (AU)
Objective: To describe the results of implementing a pilot screening program, in the Castilla y León, for colorectal cancer (CRC) with the faecal occult blood test (iFOBT) using a quantitative immunological latex agglutination assay. Methods: The study population included 4930 persons between 50-69 years from the Basic Health Area of Medina del Campo. Colonoscopy was performed on those who had a positive iFOBT. The rates of participation were calculated, positivity, acceptance of colonoscopy, detection of lesions, percentages and predictive positive value (PPV) of the test. Results: A total of 2241 (46.33%) people took part. There were 138 (6.15%) positive iFOBT. The rate acceptance of the colonoscopy was 99.27%. CRC was detected in 12 patients (91.66% in early stages), a high risk adenoma (HRA) in 42, and a low risk adenoma (LRA) in 34. The rates of detection were for CRCwas 5.35, 18.74 for HRA, 15.17 for LRA, and 39.26 for all kinds of adenoma. The PPV was 8.69% for CCR, 30.43% for HRA and 24.63% for LRA. Conclusions: The CRC screening program is feasible in our context. The iFOBT indicators are superior to those of other studies performed using the classic test. The high rates of detection of CRC, and all kinds of adenoma would be enough to justify the study. These together with the diagnosis of CRC in the early stages could lead to a reduction of the mortality (AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/imunologia , Diagnóstico Precoce , Testes Imunológicos/instrumentação , Testes Imunológicos/métodos , Testes Imunológicos , Valor Preditivo dos Testes , Sangue Oculto , Colonoscopia/métodos , Programas de Rastreamento/métodos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/prevenção & controle , População Urbana/tendências , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde , Testes Imunológicos/tendênciasRESUMO
No disponible
Assuntos
Humanos , Masculino , Idoso , Angioceratoma/patologia , Neoplasias Testiculares/patologia , Escroto/lesões , Neoplasias Vasculares/patologia , Varicocele/complicaçõesRESUMO
Introducción y objetivos: En el mundo desarrollado la pelagra es una entidad rara confinada a unos pocos grupos de riesgo. Afecta especialmente a personas alcohólicas, con transgresiones dietéticas, malabsorción intestinal o en tratamiento con determinados medicamentos. El objetivo del presente trabajo es realizar un estudio de las características clínicas, histopatológicas y epidemiológicas de los pacientes diagnosticados de pelagra en nuestro centro, y compararlo con los hallazgos «clásicos» de esta entidad. Pacientes y métodos: Se realiza un estudio retrospectivo de los pacientes con hallazgos clínicos y/o patológicos de pelagra en nuestro centro en el periodo comprendido entre 1998 y 2009. Resultados: Siete pacientes cumplían los criterios de inclusión. Todos eran varones y los factores predisponentes más importantes fueron el alcoholismo y la transgresión dietética. Todos mostraban un cuadro de fotosensibilidad, donde el dorso de los antebrazos fue el área más afectada y el dorso del pie la zona donde las lesiones eran más graves. Los hallazgos histopatológicos más constantes fueron la presencia de vasos dilatados asociados a una extravasación hemática, con escaso o nulo infiltrado inflamatorio. Los cambios epidérmicos fueron variados e incluyeron cambios sugestivos de pelagra en grado leve, como una palidez de la epidermis y cierto grado de balonización de los queratinocitos, pero también otras alteraciones como ampollas con necrosis epidérmica e hiperqueratosis. En la mayoría de los pacientes la sospecha clínica inicial no fue de pelagra. Casi todos asociaban una discreta clínica extracutánea. Conclusiones: Ante pacientes con lesiones en áreas fotoexpuestas se debe descartar pelagra. Para ello se deben investigar los factores predisponentes de pelagra, la situación social del paciente y la presencia de alteraciones digestivas y/o neurológicas (AU)
Background and objectives: In the developed world, pellagra is a rare condition that is restricted to a small number of at-risk groups. It mainly affects alcoholic patients and those with dietary deficiencies, with intestinal malabsorption, or in treatment with certain drugs. The aim of this study was to analyze the clinical, histopathological, and epidemiological characteristics of patients diagnosed with pellagra in our hospital and to compare the results with the findings traditionally described for this disease. Patients and methods: We undertook a retrospective study of patients with clinical or pathological evidence of pellagra who were seen in our hospital between 1998 and 2009. Results: Seven patients met the inclusion criteria. All were men and the most common predisposing factors were alcoholism and dietary deficiency. All exhibited photosensitivity mainly affecting the forearms and the upper surface of the feet, where the lesions were more severe. The most consistent histopathological findings were the presence of dilated blood vessels with extravasation and little or no inflammatory infiltrate. Various changes were observed in the epidermis, including those suggestive of mild pellagra, such as epidermal pallor and some degree of ballooning of the keratinocytes. Other abnormalities such as epidermal necrosis and hyperkeratosis were also observed. In most patients, pellagra was not initially suspected. Additional noncutaneous findings were observed in almost all cases. Conclusions: Pellagra should be ruled out in patients with lesions on sun-exposed areas. Predisposing factors for pellagra should be assessed along with the social situation of patients and the presence of digestive or neurological abnormalities (AU)