Changing trends in polypoid colorectal cancer diagnosed by colonoscopy.

AIM: This study analysed trends in polypoid colorectal cancer (PCRC) diagnosed by colonoscopy during the period 1995-2008 and compared the patterns observed in the years 2005-2008 with 1995-1998. METHOD: In the period 1995-2008, 24,245 colonoscopies were performed and 1041 patients with PCRC were diagnosed: pediculated (n = 220) or sessile (n = 821). RESULTS: The mean age at diagnosis was 68.3 ± 11.6 years. Males were more likely to have PCRC (males 62.6%vs females 37.4%; P < 0.0001). Significantly more pediculated PCRCs were located in the distal colon (P < 0.001). In the 2005-2008 period the prevalence of PCRC among patients undergoing colonoscopy decreased, the number of polypectomies increased significantly (P < 0.0001) and the pediculated PCRC location changed, with a significant increase in right-sided lesions. CONCLUSION: The prevalence of PCRC in patients undergoing colonoscopy decreased, with a significant increase in the number of polypectomies in the last decade. Pediculated PCRCs were more often located in the left colon and sessile PCRCs in the right colon. From the period 1995-1998 to 2005-2008 the location of pediculated PCRCs changed, with an increase in right-sided lesions.

Endoscopist experience as a risk factor for colonoscopic complications.

AIM: We aimed to determine the incidence of colonic perforation (CP) following colonoscopy and postpolypectomy bleeding (PPB) in a teaching hospital, assessing the influence of endoscopist experience as a risk factor. METHOD: All colonoscopies performed between 1995 and 2008 were reviewed. Demographic data, endoscopic procedure information, incidence of CP and PPB, and endoscopist experience were recorded. RESULTS: In the 14-year period, 25,214 endoscopic colonic procedures were performed, and 3991 patients underwent polypectomy. The overall CP risk was 0.51/1000 procedures; and PPB 14.7/1000. The relative risk (RR) ratio of complications was 2.8/1000 procedures. The RR rate was highest for endoscopists performing less than 591 procedures per year (4.0/1000 [95% CI, 3.7-4.3] vs 2.9/1000 [95% CI, 2.6-3.2]), P < 0.001). CONCLUSION: The complication rate after colonoscopy was comparable to that previously reported. Colonoscopy carried out by a low-volume endoscopist was independently associated with bleeding and perforation.

Appropriateness of colonoscopy in Europe (EPAGE II). Functional bowel disorders: pain, constipation and bloating.

BACKGROUND AND STUDY AIMS: To summarize the published literature on assessment of appropriateness of colonoscopy for the investigation of functional bowel symptoms, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS: A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of functional bowel symptoms was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. RESULTS: Much of the evidence for use of colonoscopy in evaluation of chronic abdominal pain, and/or constipation and/or abdominal bloating is modest. Major limitations include small numbers of patients and lack of adequate characterization of these patients. Large community-based follow-up studies are needed to enable better definition of the natural history of patients with functional bowel disorders. Guidelines stress that alarm features ("red flags"), such as rectal bleeding, anemia, weight loss, nocturnal symptoms, family history of colon cancer, age of onset > 50 years, and recent onset of symptoms should all lead to careful evaluation before a diagnosis of functional bowel disorder is made. EPAGE II assessed these symptoms by means of 12 clinical scenarios, rating colonoscopy as appropriate, uncertain and inappropriate in 42 % (5/12), 25 % (3/12), and 33 % (4/12) of these, respectively. CONCLUSIONS: Evidence to support the use of colonoscopy in the evaluation of patients with functional bowel disorders and no alarm features is lacking. These patients have no increased risk of colon cancer and thus advice on screening for this is not different from that for the general population. EPAGE II criteria, available online (http://www.epage.ch), consider colonoscopy appropriate in patients of > 50 years with chronic or new-onset bowel disturbances, but not in patients with isolated chronic abdominal pain.

[Epidemiologic analyses of elderly patients in an Internal Medicine department]. / Análisis epidemiológico de los pacientes ingresados en un servicio de medicina interna.

OBJECTIVES: To study the characteristics of the entered patients in an Internal Medicine department. PATIENTS AND METHODS: Descriptive and observational study with admissions elder than 65 years old in an Internal Medicine Department during the year 2002. The variables analyzed were: age, sex, intake date, discharge date, days of hospital stay, chronic disease previous, reason for admission (guide symptom), deceased and diagnosis at discharge. The statistical analysis was performed with measures of central tendency and of standard deviation, Chi-squared Mann-Whitney-Wilcoxon. RESULTS: 770 patients were accepted for the study. The distribution in sex is similar, although the women show greater median age. The most frequent chronic disease was ischemic hypertensive heart disease (25.7%) and the 64.9% of the patients have some cardiovascular risk factor. The men show more cardiovascular risk factor and more chronic disease (p < 0.01). The most frequent was dyspnea (42.7%). The most frequent diagnosis was cardiac failure (20.6%). 16.6% of the patients died in the hospital, and the most frequent diagnosis was respiratory tract infection (49.5%). CONCLUSIONS: The most frequent pathologies are the cardiopulmonary chronic disease of developed countries. The primary and secondary prevention and an improvement of chronic cardiopulmonary disease would be an effective way of cost control in these disease.

[Epidermiology of alcohol withdrawal syndrome. Mortality and factors of poor prognostic]. / Epidemiología del síndrome de abstinencia alcohólica. Mortalidad y factores de mal pronóstico.

INTRODUCTION: Patients with alcoholism and alcohol withdrawal syndrome (AWS) have a worse prognostic. METHODS: We have performed a retrospective analysis of the hospital discharges in with diagnosis include AWS from 1 of January of 1997 to the 31 of December of 2002. RESULTS: We identified 924 hospital stays with 2.4% of mortality (1.6% in Internal Medicine). Mortality is associated with greater age (57 years +/-15 vs. 49+/- 13, p < 0.005), with the diagnostic of hepatic cirrhosis (6.2 vs. 1.8%, p < 0.005), bacteraemia (10 vs. 1.8%, p < 0.001) and respiratory infection (9.6 vs. 1.8%, p < 0,001), with a lower mortality when AWS was secondary diagnosis (1.2 vs. 4.2%, p < 0.005). In multivariant analysis were associated with more mortality age (OR 1.03), hepatic cirrhosis (OR 3.4), bacteriemia (OR 4.5) and respiratory infection (OR 3.6). CONCLUSION: Alcohol withdrawal syndrome mortality could to benefit from treatment in an Internal Medicine Service.

[Control of hypertension in elderly patients admitted in internal medicine]. / Grado de control de hipertensión arterial en población mayor de 65 años ingresada en un servicio de Medicina Interna.

OBJECTIVES: To investigate hypertension control in elderly patients. To identify the cardiovascular risk factors and cardiovascular diseases associated with poor control of hypertension. To evaluate the pharmacologic treatment needed for the good control of hypertension. To analyse the existence of date in the medical history to evaluate the cardiovascular risk. METHODS: A cross-sectional study of elderly hypertensive patients intaked between 1 to January 2002 to 31 December 2002 in a Internal Medicine Service. Blood pressure was measured in the standard manner. Blood pressure control was regarded as optimum if pressure averaged less than 140/90 mmHg or, in diabetics, less than 130/80 mmHg. RESULTS: The study included 484 hypertensive patients. In the hypertensive patients, both systolic and diastolic blood pressures were well controlled in 53.9% of patients, systolic blood pressure alone in 2,1% and diastolic blood pressure alone in 30.8%. The isolated systolic arterial hypertension prevalence is bigger in the group with poor control, p < 0.001. The 77% of hypertensive patients associated other cardiovascular risk factor, and the 69% associated any cardiovascular disease. The 64% of hypertensive patients needed pharmacologic treatment. CONCLUSIONS: Arterial blood pressure control was optimum in only one out of two hypertensive patients. Diabetes is the most influential variable in poor control. The diuretics are the active ingredients more used in the hypertension therapeutic.

Análisis epidemiológico de los pacientes ingresados en un servicio de medicina interna / Epidemiologic analises of elderly patients in an Internal Medicine departament

Objetivos: Estudiar las características clínico epidemiológicas de los pacientes ingresados en un servicio de Medicina Interna. Material y métodos: Estudio descriptivo trasversal, en el que se incluyeron los pacientes mayores de 65 años que fueron ingresados a lo largo del año 2002 en un Servicio de Medicina Interna. Las variables recogidas para cada paciente fueron: edad, sexo, tiempo de ingreso, patologías crónicas anteriormente diagnosticadas, factores de riesgo cardiovascular, motivo de ingreso hospitalario (síntoma guía por el que el paciente decide acudir al centro hospitalario), exitus intrahospitalario, diagnósticos clínicos al alta y tratamientos prescritos. Se emplearon índices estadísticos descriptivos de variables cualitativas y cuantitativas, Chi-cuadrado para variables cualitativas y Mann-Withney-Wilcoxon para variables cuantitativas. Resultados: Se incluyeron un total de 770 pacientes. La proporción entre sexos es similar, aunque las mujeres presentan mayor mediana de edad (p < 0,001). La patología más prevalente entre los antecedentes personales fue la Cardiopatía isquémico-hipertensiva (25,7%) y el 64,9% de los pacientes presentaron algún factor de riesgo cardiovascular. Los varones presentaban mayor número de factores de riesgo cardiovascular asociados y mayor número de patologías (p < 0,01 en ambos casos). La disnea fue el motivo de ingreso más frecuente (42,7%). El diagnóstico más frecuente fue la insuficiencia cardiaca (20,6%). Se produjo el fallecimiento en el 16,6% de los pacientes, como principal diagnóstico presentaron la infección respiratoria (49,5%). Conclusiones: La patología más prevalente y que causa más ingresos son las enfermedades crónicas de los países desarrollados. La prevención primaria y secundaria es la forma más eficaz de control de estas patologías

Objetives: To study the characteristics of the entered patients in an Internal Medicine department. Patients and Methods: Descriptive and observational study with the admissions elder than 65 years old in an Internal Medicine Department during the year 2002. The variables analized were: age, sex, intake date, discharge date, days of hospital stay, chronic disease previous, reason for admission (guide symptom), deceased and diagnosis at discharge. The statistical analysis was performed with measures of central tendency and of standard deviation, Chi-cuadrado, Mann-Whitney-Wilcoxon. Results: 770 patients were accepted for the study. The distribution in sex is similar, although the women show bigger median age. The most frequent chronic disease was isquemic hipertensive heart disease (25.7%) and the 64.9% of the patients have someone cardiovascular risk factor. The men show more cardiovascular risk factor and more chronic disease (p < 0.01). The most frequent was the dyspnea (42.7%). The most frequent diagnosis was the cardiac failure (20.6%). The 16.6% of the patients died in the hospital, and the most frequent diagnosis was respiratory tract infection (49.5%). Conclusions: The most frequents pathologies are the cardiopulmonary chronic disease of developed countries. The primary and secondary prevention and an improvement of chronic cardiopulmonary disease would be an effective way of cost control in these disease

Grado de control de hipertensión arterial en población mayor de 65 años ingresada en un servicio de Medicina Interna / Control of hypertension in elderly patients intaked of internal medicine

Objetivos: Conocer el grado de control de la presión arterial (PA) en los pacientes hipertensos mayores de 65 años que ingresaron en un servicio de Medicina Interna a lo largo del año 2002. Identificar los factores de riesgo cardiovascular y las patologías cardiovasculares asociadas al mal control de la presión arterial. Valorar el tratamiento farmacológico necesario para un adecuado control de la hipertensión arterial. Analizar la existencia de datos suficientes en la historia clínica que permitan una adecuada valoración del riesgo cardiovascular. Material y métodos: Estudio descriptivo transversal, en el que se incluyeron los pacientes mayores de 65 años que fueron ingresados, a lo largo del año 2002, en el Servicio de Medicina Interna del Hospital Clínico Universitario de Santiago de Compostela. La PA se midió siguiendo normas estandarizadas y se consideró que había un buen control si eran los valores <140/90 mmHg (en pacientes diabéticos < 130/80). Resultados: Se incluyeron 484 pacientes hipertensos, de los que el 53,9% presentaban buen control de presión arterial sistólica (PAS) y diastólica (PAD), el 2,1% sólo de PAS y el 30,8% sólo de PAD. El 77% de los hipertensos presentan asociado otro factor de riesgo cardiovascular, y el 69% asocian alguna patología cardiovascular. La probabilidad de presentar mal control de HTA en pacientes diabéticos es 1,45 veces mayor que en los no diabéticos. En el momento del alta, el 64% de los pacientes hipertensos precisaron tratamiento farmacológico para el control de la HTA. Conclusiones: Sólo la mitad de los pacientes hipertensos mayores de 65 años están correctamente controlados. La diabetes es la variable que más influye en el mal control de la PA. Los diuréticos son los fármacos más empleados para el control farmacológico de la HTA

Objectives: To investigate hypertension control in elderly patients. To identify the cardiovascular risk factors and cardiovascular diseases associated with poor control of hypertension. To evaluate the pharmacologic treatment needed for the good control of hypertension. To analyse the existence of date in the medical history to evaluate the cardiovascular risk. Methods: A coss-sectional study of elderly hypertensive patients intaked between 1 to January 2002 to 31 December 2002 in a Internal Medicine Service. Blood pressure was measured in the standard manner. Blood pressure control was regarded as optimum if pressure averaged less than 140/90 mmHg or, in diabetics, less than 130/80 mmHg. Results: The study included 484 hipertensive patients. In the hypertensive patients, both systolic and diastolic blood pressures were well controlled in 53.9% of patients, systolic blood pressure alone in 2,1% and diastolic blood pressure alone in 30.8%. The isolated systolic arterial hypertension prevalence is bigger in the group with poor control, p < 0.001. The 77% of hypertensive patients associated other cardiovascular risk factor, and the 69% associated any cardiovascular disease. The 64% of hypertensive patients needed pharmacologic treatment. Conclusions: Arterial blood pressure control was optimum in only one out of two hypertensive patients. Diabetes is the most influential variable in poor control. The diuretics are the active ingredients more used in the hypertension therapeutic

Epidemiología del síndrome de abstinencia alcohólica. Mortalidad y factores de mal pronóstico / Epidemiology of alcohol withdrawal syndrome. Mortality factors of poor prognostic

Introducción: El alcoholismo y la aparición del síndrome de abstinencia alcohólica (SAA) condicionan un peor pronóstico en los pacientes que lo presentan. Métodos: Se recogieron las características epidemiológicas, evolución y mortalidad de todos los casos diagnosticados de SAA en el Complexo Hospitalario de Santiago durante los años 1997 al 2002. Resultados: Se identificaron 924 casos con una mortalidad del 2,4% (1,6% en Medicina Interna). La mortalidad se asoció con mayor edad (57 años ± 15 vs. 49± 13, p < 0,005), y con los diagnósticos de cirrosis hepática (6,2 vs. 1,8%, p < 0,005), bacteriemia (10 vs. 1,8%, p < 0,001) e infección respiratoria (9,6 vs. 1,8%, p < 0,001), con una mortalidad menor cuando el SAA fue diagnóstico secundario (1,2 vs. 4,2%, p < 0,005). En el análisis multivariante se asociaron a mayor mortalidad la edad (OR 1,03), la cirrosis hepática (OR 3,4), la bacteriemia (OR 4,5) y la infección respiratoria (OR 3,6). Conclusión: La mortalidad asociada al síndrome de abstinencia podría beneficiarse de la centralización del tratamiento en el Servicio de Medicina Interna

Introduction: Patients with alcoholism and alcohol withdrawal syndrome (AWS) have a worse prognostic. Methods: We have performed a retrospective analysis of the hospital discharges in with diagnosis include AWS from 1 of January of 1997 to the 31 of December of 2002. Results: We identified 924 hospital stays with 2.4% of mortality (1.6% in Internal Medicine). Mortality is associated with greater age (57 years ±15 vs. 49± 13, p < 0.005), with the diagnostic of hepatic cirrhosis (6.2 vs. 1.8%, p < 0.005), bacteraemia (10 vs. 1.8%, p < 0.001) and respiratory infection (9.6 vs. 1.8%, p < 0,001), with a lower mortality when AWS was secondary diagnosis (1.2 vs. 4.2%, p < 0.005). In multivariant analysis were associated with more mortality age (OR 1.03), hepatic cirrhosis (OR 3.4), bacteriemia (OR 4.5) and respiratory infection (OR 3.6). Conclusion: Alcohol withdrawal syndrome mortality could to benefit from treatment in an Internal Medicine Service

Intoxicación alimentaria por consumo de calabacín / Food intoxication due to consumption of zucchini

No disponible

[Bacteraemia due to Leuconostoc spp. in a patient without immunological disorders]. / Bacteriemia por Leuconostoc spp. en paciente sin factores de riesgo.

Leuconostoc spp are gram-positive coccobacilli, catalase and oxidase negative, vancomycin resistant. Causes of infection have been reported previously but it has not been described confirmed bacteremia due to Leuconostoc spp in patient without other immunological disorders. We describe a case of bacteremia in a 64-years-old man with a prosthetic valve 7 months before to begin fever of unknown origin. We confirmed bacteremia due Leuconostoc spp and the treatment with respective antibiotics permits the cure. Leuconostoc spp should be considered as a potential cause of bacteraemia, but we would be observant to the bacteremias due vancomycin resistant germs, because in most cases the laboratory do not find the sensitivity to this antibiotic.

[Diagnosis by cranial computer tomography of sphenoidal sinusitis]. / Diagnóstico por tomografía axial computarizada de sinusitis esfenoidal.

Sphenoidal sinusitis is an uncommon pathology potentially dangerous condition, that we can find in young population. Clinically it is very difficult to diagnose because of its nonspecific symptoms, but cranial computer tomography confirms the diagnosis. The most cases were treated with antibiotics and recovered completely. We present a young man with isolated sphenoidal sinusitis who was managed in our medical centre, and a review of the literature.

Bacteriemia por Leuconostoc spp. en paciente sin factores de riesgo / Bacteriemia due to Leuconostoc spp. in a patient without inmunological disorders

Los microorganismos del género Leuconostoc son coco-bacilos gram-positivos, catalasa-negativos y oxidasa-negativos, que se caracterizan por ser intrínsecamente resistentes a Vancomicina. Se han descrito procesos infecciosos causados por estos microorganismos, pero no se han descrito casos de bacteriemia confirmada por Leuconostoc spp. en pacientes sin alteraciones inmunológicas. Describimos un caso de bacteriemia en un hombre de 64 años con bioprótesis 7 meses antes de iniciar cuadro de fiebre de origen desconocido. Confirmamos bacteriemia por Leuconostoc spp. y el tratamiento antibiótico correspondiente permitió la curación del cuadro. Aunque Leuconostoc spp. deba ser considerado una causa excepcional de bacteriemia, debemos estar atentos a las infecciones por gérmenes vancomicín-resistentes ya que muchos laboratorios no determinan de forma rutinaria la sensibilidad a esta antimicrobiano

Leuconostoc spp are gram-positive coccobacilli, catalasa and oxidase negative, vancomycin resistant. Causes of infection have been reported previously but it has not been described confirmed bacteremia due to Leuconostoc spp in patient without other immunological disorders. We describe a case of bacteremia in a 64-years-old man with a prosthetic valve 7 months before to begin fever of unknown origin. We confirmed bacteremia due Leuconostoc spp and the treatment with respectives antibiotics permits the cure. Leuconostoc spp should be considered as a potencial cause of bacteriemia, but we would be observant to the bacteremias due vancomicin resitant germs, because in most cases the laboratory do not find the sensitivity to this antibiotic

Insulin-like growth factor I improves intestinal barrier function in cirrhotic rats.

BACKGROUND AND AIMS: In liver cirrhosis, disruption of the intestinal barrier facilitates bacterial translocation and spontaneous bacterial peritonitis. Insulin-like growth factor I (IGF-I) is an anabolic hormone synthesised by hepatocytes that displays hepatoprotective activities and trophic effects on the intestine. The aim of this study was to investigate the effect of IGF-I on intestinal barrier function in cirrhotic rats. METHODS: In rats with carbon tetrachloride induced cirrhosis, we investigated the effect of IGF-I therapy on: (a) portal pressure; (b) intestinal histology and permeability to endotoxin and bacteria; (c) intestinal expression of cyclooxygenase 2 (COX-2) and tumour necrosis factor alpha (TNF-alpha), two factors that influence in a positive and negative manner, respectively, the integrity of the intestinal barrier; (d) intestinal permeability to 3H-mannitol in rats with bile duct ligation (BDL); and (e) transepithelial electrical resistance (TER) of polarised monolayers of rat small intestine epithelial cells. RESULTS: IGF-I therapy reduced liver collagen expression and portal pressure in cirrhotic rats, induced improvement in intestinal histology, and caused a reduction in bacterial translocation and endotoxaemia. These changes were associated with diminished TNF-alpha expression and elevated COX-2 levels in the intestine. IGF-I reduced intestinal permeability in BDL rats and enhanced barrier function of the monolayers of epithelial intestinal cells where lipopolysaccharide (LPS) caused a decrease in TER that was reversed by IGF-I. This effect of IGF-I was associated with upregulation of COX-2 in LPS treated enterocytes. CONCLUSIONS: IGF-I enhances intestinal barrier function and reduces endotoxaemia and bacterial translocation in cirrhotic rats. IGF-I therapy might be useful in the prevention of spontaneous bacterial peritonitis in liver cirrhosis.

Diagnóstico por tomografía axial computarizada de sinusitis esfenoidal / Diagnosis by cranial computer tomography of sphenoidal sinusitis

La sinusitis esfenoidal es una patología muy poco frecuente y potencialmente muy peligrosa, que podemos encontrar en la población más joven. Clínicamente es muy difícil el diagnóstico porque los datos clínicos son inespecíficos, pero el estudio por tomografía axial computarizada (TAC) craneal confirma el diagnóstico. La mayoría de los casos son tratados con antibióticos y se recuperan completamente. Presentamos un caso de sinusitis esfenoidal aislada en paciente joven, que nosotros tratamos en nuestro centro, y una revisión de la literatura

Sphenoidal sinusitis is an uncommon pathology potencially dange condition, what we can find in young population. Clinically it is very difficult the diagnosis because of its nonspecific symptoms, but cranial computer tomography proves the diagnosis. The most cases were trated with antbiotics and recovered completely. We present a young-man with isolated sphenoidal sinusitis who were managed in our medical centre, and a review the literature