Valoración de la respuesta endoscópica al tratamiento con argón plasma en la rectitis actínica crónica / No disponible

Objetivo: valorar la mejoría endoscópica tras el tratamientocon argón plasma utilizado para el control sintomático de las rectitisactínicas crónicas.Diseño y pacientes: estudio prospectivo de 48 meses de duración,con 38 pacientes (26 hombres y 12 mujeres, con edadmedia de 70,9 ± 7,38 años). Todos presentaban algún grado derectorragia y/o anemia. Se realizaron entrevistas clínicas, analíticasy sesiones endoscópicas con argón, de forma periódica mensual,hasta la normalización analítica y cese del sangrado, con unseguimiento posterior de 24 meses. Para valorar la mejoría se utilizaronparámetros analíticos, gradación de sangrado (Chutckan)y un índice endoscópico.Resultados: el tiempo medio trascurrido entre el inicio y la finalizacióndel seguimiento fue de 28,5 ± 3,9 meses. La media desesiones administradas por paciente ha sido de 3,6 ± 2,7. Sicomparamos los síntomas antes, después del tratamiento existeuna disminución significativa en el grado de rectorragia según laclasificación de Chutkan (2,29 ± 1,08 vs. 0,59 ± 1,12, p <0,05). Cuando comparamos los valores medios de la hemoglobina,antes y después del tratamiento apreciamos una aumento estadísticamentesignificativo (11,33 ± 3,05 mg/dl vs. 14,014 ±1,29 mg/dl, p < 0,001) así como los valores medios de ferritina(31,15 ± 66, 45 μg/dl vs. 80,60 ± 55,60 μg/dl, p < 0,05). En elíndice endoscópico, también existe una mejoría evidente de laafectación endoscópica tras el tratamiento con respecto a la friabilidad(p < 0,0001) y porcentaje de mucosa afecta (p < 0,0001).Conclusión: el argón plasma es eficaz y la realización del índiceendoscópico es una herramienta útil para valorar la mejoría endoscópicade las lesiones tras el tratamiento

Objectives: to evaluate endoscopic improvement after argonplasma coagulation (APC) in symptomatic patients with chronicradiation proctopathy.Methods and patients: a prospective study of 38 patientswith radiation proctitis (26 males and 12 females, mean age 70.9± 7.38 yrs), and with rectal bleeding and or anemia. We performedmonthly interviews, blood tests, and APC sessions untilrectal bleeding had ceased and hemoglobin and ferritin levels wereimproved, with a follow-up of 24 months. We used blood testing,bleeding scores (Chutckhan’s index), and endoscopic scores toevaluate improvement.Results: mean time between inclusion and follow-up completionwas 28.5 ± 3.9 months. Mean number of sessions per patientwas 3.6 ± 2.7. There was a significant decrease (2.29 ± 1.8vs. 0.59 ± 1.12, p < 0.05) in rectal bleeding (Chutckan score)from baseline after APC. There was a significant increase in hemoglobinlevels (11.3 ± 3.05 vs. 14.014 ± 1.29, p < 0.001) andferritin levels (31.15 ± 66.45 vs. 80.60 ± 55.6, p < 0.05) frombaseline after APC. Also, there was improvement in the endoscopicindex at the end of treatment, as well as in friability (p <0.0001) and involved surface area (p < 0.0001).Conclusion: argon plasma coagulation is an effective technique,and the endoscopic index is a useful tool to evaluate endoscopicimprovement

[Evaluation of the endoscopic response to argon plasma coagulation in patients with chronic radiation proctopathy]. / Valoración de la respuesta endoscópica al tratamiento con argón plasma en la rectitis actínica crónica.

OBJECTIVES: To evaluate endoscopic improvement after argon plasma coagulation (APC) in symptomatic patients with chronic radiation proctopathy. METHODS AND PATIENTS: A prospective study of 38 patients with radiation proctitis (26 males and 12 females, mean age 70.9 +/- 7.38 yrs), and with rectal bleeding and or anemia. We performed monthly interviews, blood tests, and APC sessions until rectal bleeding had ceased and hemoglobin and ferritin levels were improved, with a follow-up of 24 months. We used blood testing, bleeding scores (Chutckhan's index), and endoscopic scores to evaluate improvement. RESULTS: Mean time between inclusion and follow-up completion was 28.5 +/- 3.9 months. Mean number of sessions per patient was 3.6 +/- 2.7. There was a significant decrease (2.29 +/- 1.8 vs. 0.59 +/- 1.12, p < 0.05) in rectal bleeding (Chutckan score) from baseline after APC. There was a significant increase in hemoglobin levels (11.3 +/- 3.05 vs. 14.014 +/- 1.29, p < 0.001) and ferritin levels (31.15 +/- 66.45 vs. 80.60 +/- 55.6, p < 0.05) from baseline after APC. Also, there was improvement in the endoscopic index at the end of treatment, as well as in friability (p < 0.0001) and involved surface area (p < 0.0001). CONCLUSION: Argon plasma coagulation is an effective technique, and the endoscopic index is a useful tool to evaluate endoscopic improvement.

[Cholecystectomy: a choice technique in biliary microlithiasis]. / La colecistectomía: técnica de elección en la microlitiasis biliar.

The purpose of our study is to show results obtained after a cholecystectomy on 25 patients in order to present a suggestive clinic of bile origin and a positive result for determination of microcrystals in the bile probe even in the case of negative radiologic diagnoses (echography, cholecystography). Out of 25 patients operated on the following results were obtained: microscopic cholelithiasis in 12, granular cholelithiasis in 3, acute cholecystitis in 2, cholesterolosis in 2 and without pathologic findings in 6 patients after an observation period of 24 months following the operation it was demonstrated that almost all the patients (96%) had no symptoms. On the other hand, the above mentioned results are compared to the findings obtained during an observation period of a group of 34 patients with positive probe results with the same clinic characteristics and not having been operated on refusing the operation suggested.

[Diagnostic value of duodenal drainage in patients with biliary symptoms and negative imaging test]. / Valor diagnóstico del sondaje duodenal en pacientes con clínica biliar y test de imagen negativo.

A group of patients with clinical manifestations suggesting biliary origin in whom diagnostic imaging techniques were negative were studied by duodenal biliary drainage with the aim of identifying whether microcalculi were present in the bilis being responsible for the symptomatology. The problem group was made up of 96 patients with the results being compared with those of a control group (without biliary disease) including 45 subjects. Duodenal biliary drainage was analyzed for the detection of microlithiasis in the biliary sediment in all the subjects. The analysis was positive in 46 (47.9%) of the patients with biliary clinical manifestations while analysis was positive in only 5 (11.2%) of the control group with the differences being statistically significant. Seventeen of the 46 positive patients underwent surgery demonstrating biliary disease in all (chronic cholecystitis). All these patients remained asymptomatic except one on follow up with 94.1% cure by cholecystectomy being achieved. The authors conclude that duodenal biliary drainage is a highly profitable, complication-free and easily performed diagnostic technique for the detection of microlithiasis which should be regularly used in patients with symptoms suggestive of biliary origin and complementary negative explorations.

[Biliary drainage in the diagnosis of acute idiopathic pancreatitis]. / El sondaje biliar en el diagnóstico de las pancreatitis agudas idiopáticas.

The identification of a casual agent in the so-called "idiopatic acute pancreatitis" is of great interest in relationship with the prognosis and the election of correct therapy. We have performed a duodenal drainage for the microscopic study of the bile, looking for cholesterol crystals and bilirrubinate's in a group of 19 patients with idiopatic acute pancreatitis. The results have been compared with a control group composed by 45 assymptomatic individuals. In the patients group drainage results were abnormal in 11 cases (57.9%) vs. 11.2% in the control group (difference statistically significant). In 4 of the 11 cases, a cholecystectomy was performed showing biliary pathology. Patients at follow-up were assymptomatic. Duodenal drainage is an easy method without risks that must be used always in idiopatic acute pancreatitis. It allows the diagnosis of microlithiasis and may help in the therapeutic indication of cholecystectomy.