Estudio prospectivo de los factores asociados a una mala tolerancia. A la colonoscopia ambulatoria bajo sedación consciente / Prospective study of the factors associated with poor tolerance to ambulatory colonoscopy under conscious sedation

Antecedentes: la sedación consciente con benzodiacepinas y opiáceos para la colonoscopia es una práctica clínica muy extendida. Objetivo: determinar la tolerancia del paciente a la colonoscopia y los factores asociados con una peor tolerancia. Métodos: estudio prospectivo unicéntrico descriptivo de los pacientes sometidos a colonoscopia ambulatoria bajo sedación consciente. Se valoró el dolor mediante una escala visual analógica de 0 a 100 y cualitativamente. Resultados: completaron el estudio 300 pacientes, 138 (46%) de ellos eran hombres con una edad mediana de 54 años (p25-75: 45-64). La tolerancia fue buena en 273 casos (91%). El valor mediano de la tolerancia fue 13 (p25-p75: 4-33). Se consideró el dolor como leve en 215 (71,7%), moderado en 57 (19%) e intenso en 28 (9,3%). En el estudio univariante se asoció mayor dolor al género femenino, a la ansiedad, a la indicación, al tiempo y la dificultad de la exploración y a las dosis de sedantes. En el estudio multivariante la indicación (OR 2,92, IC 95% = 1,03-8,2; p < 0,05) y la dificultad de la exploración (OR 4,68; IC 95% = 1,6-13,6; p< 0,01) fueron significativas. Se registraron complicaciones en 16 pacientes (5,3%), todas ellas menores. Conclusiones: la tolerancia de los pacientes sometidos a una colonoscopia ambulatoria bajo sedación consciente es buena en la mayoría de los casos y con complicaciones infrecuentes y menores. Se asocia una peor tolerancia al sexo femenino, a la ansiedad previa, a la indicación, a una exploración difícil y de mayor duración y a menores dosis de sedantes

Background: conscious sedation with benzodiazepines and opiates for colonoscopy is a widespread clinical practice. Objective: to determine the patient’s tolerance to colonoscopy and identify the factors associated with lower tolerance. Methods: a prospective, single-center, descriptive study of patients undergoing ambulatory colonoscopy under conscious sedation. The pain was assessed using a visual analogue scale with a score of 0 to 100 and also qualitatively. Results: three hundred patients with a median age of 54 years completed the study (p25-75: 45-64); 138 were men (46%). Tolerance was good in 273 cases (91%). The median value of tolerance was 13 (p25-p75: 4-33). Pain was considered as mild in 215 (71.7%), moderate in 57 (19%) and intense in 28 (9.3%). In the univariate study, greater pain was associated with females, anxiety, the indication for the procedure, the length of time and difficulty of the examination, and the doses of sedatives. In the multivariate study, both the indication (OR 2.92, 95% CI = 1.03-8.2, p < 0.05) and the difficulty of the examination (OR 4.68, 95% CI = 1.6-13.6, p < 0.01) were significant. Complications were found in 16 patients (5.3%), although all of them were insignificant. Conclusions: tolerance of patients undergoing ambulatory colonoscopy under conscious sedation is good in most cases and complications are infrequent and minor. A worse tolerance to the test is associated with women patients, individuals with anxiety prior to colonoscopy, indication, difficult and longer exploration and lower doses of sedatives

Prospective study of the factors associated with poor tolerance to ambulatory colonoscopy under conscious sedation.

BACKGROUND: conscious sedation with benzodiazepines and opiates for colonoscopy is a widespread clinical practice. OBJECTIVE: to determine the patient's tolerance to colonoscopy and identify the factors associated with lower tolerance. METHODS: a prospective, single-center, descriptive study of patients undergoing ambulatory colonoscopy under conscious sedation. The pain was assessed using a visual analogue scale with a score of 0 to 100 and also qualitatively. RESULTS: three hundred patients with a median age of 54 years completed the study (p25-75: 45-64); 138 were men (46%). Tolerance was good in 273 cases (91%). The median value of tolerance was 13 (p25-p75: 4-33). Pain was considered as mild in 215 (71.7%), moderate in 57 (19%) and intense in 28 (9.3%). In the univariate study, greater pain was associated with females, anxiety, the indication for the procedure, the length of time and difficulty of the examination, and the doses of sedatives. In the multivariate study, both the indication (OR 2.92, 95% CI = 1.03-8.2, p < 0.05) and the difficulty of the examination (OR 4.68, 95% CI = 1.6-13.6, p < 0.01) were significant. Complications were found in 16 patients (5.3%), although all of them were insignificant. CONCLUSIONS: tolerance of patients undergoing ambulatory colonoscopy under conscious sedation is good in most cases and complications are infrequent and minor. A worse tolerance to the test is associated with women patients, individuals with anxiety prior to colonoscopy, indication, difficult and longer exploration and lower doses of sedatives.

Estudio prospectivo de la ansiedad del paciente previa a la realización de una colonoscopia ambulatoria / Prospective study of anxiety in patients undergoing an outpatient colonoscopy

Antecedentes: la realización de una colonoscopia puede originar ansiedad en los pacientes. Esta situación ha sido poco estudiada en nuestro medio. Objetivos: determinar la frecuencia, el grado y los factores relacionados con la ansiedad previa a la realización de una colonoscopia. Métodos: estudio prospectivo descriptivo de los pacientes sometidos a colonoscopia ambulatoria en nuestro hospital. Se valoró la ansiedad mediante una escala visual analógica de 0 a 100. Se ponderó la gravedad de la ansiedad en leve, moderada e intensa según los valores de la escala entre 1-29, 30-79 y 80-100, respectivamente. Resultados: completaron el estudio 327 pacientes, 154 (47,1%) hombres con una edad mediana de 54 años (p25-75: 45-65). En 309 (94,5%) pacientes existía algún grado de ansiedad. La mediana del valor de la escala visual analógica fue de 31 (p25-75: 10-53). La ansiedad fue leve en 136 (44%), moderada en 141 (45,6%) e intensa en 32 (10,4%) pacientes. Se asoció una mayor ansiedad con el sexo femenino (media 40,38 vs. 31,99, p = 0,01) a una colonoscopia previa mal tolerada (media 50,67 vs. 28,44, p = 0,01) y se correlacionó de manera inversa con la edad (r = -0,170, p = 0,02). Conclusiones: la realización de una colonoscopia provoca algún grado de ansiedad en la mayoría de los pacientes. El sexo femenino, una edad menor y una tolerancia mala en una exploración previa se asocian con un mayor grado de ansiedad. Esta circunstancia debe ser tenida en cuenta para implementar medidas para mejorar la calidad y la tolerancia de la colonoscopia (AU)

Background: Undergoing a colonoscopy can cause anxiety in patients and this is something which has not been closely studied. Objective: To determine the frequency and intensity of anxiety prior to a colonoscopy and the factors which are related to the procedure. Methods: This is a prospective study of patients undergoing outpatient colonoscopy in our hospital. Anxiety was assessed using a visual analogue scale of 0 to 100. The severity of anxiety was rated as mild (1-29), moderate (30-79) or severe (80-100). Results: Three hundred and twenty-seven patients completed the study, of whom 154 (47.1%) were men with a median age of 54 years (p25-75: 45-65). Three hundred and nine (94.5%) patients were found to suffer a certain degree of anxiety. The median value on the visual analogue scale was 31 (p25-75: 10-53). Anxiety levels were mild in 136 patients (44%), moderate in 141 (45.6%) and severe in 32 (10.4%). Greater anxiety was associated with female patients (mean 40.38 vs 31.99, p = 0.01) and a poorly tolerated previous colonoscopy (mean 50.67 vs 28.44, p = 0.01) and correlated inversely with age (r = -0.170, p = 0.02). Conclusions: Colonoscopy causes some degree of anxiety in most patients. Being female, younger and having experienced poor tolerance to a previous scan are associated with greater degrees of anxiety. These findings should be taken into account in the implementation of measures to improve the quality and tolerance of colonoscopy (AU)

Prospective study of anxiety in patients undergoing an outpatient colonoscopy.

BACKGROUND: Undergoing a colonoscopy can cause anxiety in patients and this is something which has not been closely studied. OBJECTIVE: To determine the frequency and intensity of anxiety prior to a colonoscopy and the factors which are related to the procedure. METHODS: This is a prospective study of patients undergoing outpatient colonoscopy in our hospital. Anxiety was assessed using a visual analogue scale of 0 to 100. The severity of anxiety was rated as mild (1-29), moderate (30-79) or severe (80-100). RESULTS: Three hundred and twenty-seven patients completed the study, of whom 154 (47.1%) were men with a median age of 54 years (p25-75: 45-65). Three hundred and nine (94.5%) patients were found to suffer a certain degree of anxiety. The median value on the visual analogue scale was 31 (p25-75: 10-53). Anxiety levels were mild in 136 patients (44%), moderate in 141 (45.6%) and severe in 32 (10.4%). Greater anxiety was associated with female patients (mean 40.38 vs 31.99, p = 0.01) and a poorly tolerated previous colonoscopy (mean 50.67 vs 28.44, p = 0.01) and correlated inversely with age (r = -0.170, p = 0.02). CONCLUSIONS: Colonoscopy causes some degree of anxiety in most patients. Being female, younger and having experienced poor tolerance to a previous scan are associated with greater degrees of anxiety. These findings should be taken into account in the implementation of measures to improve the quality and tolerance of colonoscopy.

Hepatopulmonary syndrome: What we know and what we would like to know.

Hepatopulmonary syndrome (HPS) is characterized by abnormalities in blood oxygenation caused by the presence of intrapulmonary vascular dilations (IPVD) in the context of liver disease, generally at a cirrhotic stage. Knowledge about the subject is still only partial. The majority of the information about the etiopathogenesis of HPS has been obtained through experiments on animals. Reported prevalence in patients who are candidates for a liver transplantation (LT) varies between 4% and 32%, with a predominance of mild or moderate cases. Although it is generally asymptomatic it does have an impact on their quality of life and survival. The diagnosis requires taking an arterial blood gas sample of a seated patient with alveolar-arterial oxygen gradient (AaO2) ≥ 15 mm Hg, or ≥ 20 mm Hg in those over 64 years of age. The IPVD are identified through a transthoracic contrast echocardiography or a macroaggregated albumin lung perfusion scan ((99m)Tc-MAA). There is currently no effective medical treatment. LT has been shown to reverse the syndrome and improve survival rates, even in severe cases. Therefore the policy of prioritizing LT would appear to increase survival rates. This paper takes a critical and clinical look at the current understanding of HPS, as well as the controversies surrounding it and possible future research.

Diarrea por infección parasitaria múltiple / Diarrhea caused by multiparasitic infection

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Diarrhea caused by multiparasitic infection.

Diarrhoea caused by multiple nematode infection is uncommon in Spain, therefore we are not very familiar with the diagnosis and treatment of these patients.

Melatonina como probable causa de diarrea / Melatonin as a probable cause of diarrhoea

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[Hepatopulmonary syndrome in patients with advanced hepatic disease: study of a series of 24 cases]. / Síndrome hepatopulmonar en pacientes con hepatopatía avanzada: estudio de 24 casos.

BACKGROUND AND OBJECTIVE: To describe the characteristics observed in patients diagnosed of hepatopulmonary syndrome (HPS) waiting for orthotopic liver transplantation and those who underwent liver trasplantation. PATIENTS AND METHOD: An observational prospective descriptive study was carried out of patients waiting for liver transplantation in whom data of liver illness and lung function tests were analyzed. RESULTS: 107 patients of 53.69 years average age were studied (7.7 standard deviation). 24 of them (22.4%) had criteria of HPS. Ortodeoxia was present in the 34% of cases. The lung function tests were normal. In the comparative study between patients with HPS and no HPS, differences in diffusion were found (7.1 vs. 8.6 mmol/min/kPa; p = 0.04), as well as in the shunt (8% vs. 5.3%; p = 0.05) and the forced expiratory volume in one second (2,390 vs. 2,743 ml; p = 0.03). Seven patients were transplanted with correction of oxygenation and vascular dilatations in all of them. CONCLUSIONS: HPS is a frequent illness in patients waiting for orthotopic liver transplantation. The main alteration in the blood oxygenation seems owe to shunt, and the diffusion tests is the analysis that could best differentiate patients with HPS. Orthotopic liver transplantation corrects the syndrome in all cases.

Síndrome hepatopulmonar en pacientes con hepatopatía avanzada: estudio de 24 casos / Hepatopulmonary syndrome in patients with advanced hepatic disease: study of a series of 24 cases

Fundamento y objetivo: Describir las características clínicas y funcionales de pacientes con síndrome hepatopulmonar (SHP) en lista de espera para trasplante ortotópico hepático y los cambios producidos en ellas en un grupo de pacientes que recibió el trasplante. Pacientes y método: Se ha realizado un estudio observacional, transversal y descriptivo con carácter prospectivo de pacientes en lista de espera para trasplante hepático, en quienes se analizaron datos de enfermedad hepática y de pruebas de función respiratoria. Resultados: Se ha estudiado a 107 pacientes, con una edad media (desviación estándar) de 53,69 (7,7) años, de los que 24 (22,4%) cumplían criterios de SHP. La ortodesoxia estaba presente en el 34% de los pacientes. Las pruebas de función respiratoria estaban dentro de la normalidad. En el estudio comparativo entre los pacientes afectados de SHP y el resto se encontraron diferencias en la difusión de monóxido de carbono (7,1 frente a 8,6 mmol/min/kPa; p = 0,04), la cuantía del cortocircuito pulmonar (un 8 frente al 5,3%; p = 0,05) y el volumen espiratorio forzado en el primer segundo (2.390 frente a 2.743 ml; p = 0,03). En 7 pacientes con SHP que recibieron el trasplante se corrigieron la oxigenación y las dilataciones vasculares. Conclusiones: El SHP es una entidad frecuente en pacientes en espera de trasplante ortotópico hepático. La principal alteración en la oxigenación sanguínea parece ser debida al efecto cortocircuito. Las pruebas de difusión de monóxido de carbono son las que parecen tener mayor carácter discriminativo entre los pacientes con y sin SHP. Tras el trasplante desaparece el síndrome en todos los pacientes

Background and objective: To describe the characteristics observed in patients diagnosed of hepatopulmonary syndrome (HPS) waiting for orthotopic liver transplantation and those who underwent liver trasplantation. Patients and method: An observational prospective descriptive study was carried out of patients waiting for liver transplantation in whom data of liver illness and lung function tests were analyzed. Results: 107 patients of 53.69 years average age were studied (7.7 standard deviation). 24 of them (22.4%) had criteria of HPS. Ortodeoxia was present in the 34% of cases. The lung function tests were normal. In the comparative study between patients with HPS and no HPS, differences in diffusion were found (7.1 vs. 8.6 mmol/min/kPa; p = 0.04), as well as in the shunt (8% vs. 5.3%; p = 0.05) and the forced expiratory volume in one second (2,390 vs. 2,743 ml; p = 0.03). Seven patients were transplanted with correction of oxygenation and vascular dilatations in all of them. Conclusions: HPS is a frequent illness in patients waiting for orthotopic liver transplantation. The main alteration in the blood oxygenation seems owe to shunt, and the diffusion tests is the analysis that could best differentiate patients with HPS. Orthotopic liver transplantation corrects the syndrome in all cases

Enteropatía proteinorreica asociada a cirugía de Fontan. Presentación de un caso / Protein losing enteropathy in association with Fontan operation. Report of a case

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