[Sedation in upper gastrointestinal endoscopy. Analysis of tolerance, complications and cost-effectiveness]. / Sedación en la endoscopia gastrointestinal alta. Análisis de la tolerancia, las complicaciones y el coste-efectividad.

INTRODUCTION AND AIM: Sedation of patients is an important complement to endoscopic procedures. The aim of this study was to analyze tolerance, complications and cost-effectiveness in patients undergoing diagnostic upper gastrointestinal endoscopy. PATIENTS AND METHOD: A total of 357 patients were prospectively studied: 138 non-sedated, 116 sedated with midazolam and 103 sedated with midazolam and meperidine. Subjective tolerance, tolerance perceived by the endoscopist, complications, and cost-effectiveness were evaluated. The Chi-square test was used for the statistical analysis. P-values of less than 0.05 were considered statistically significant. RESULTS: Subjective tolerance was greater in patients sedated with midazolam and meperidine than in the other groups (p < 0.05). Tolerance perceived by the endoscopist was greater in the group sedated with both drugs than in the group sedated with midazolam (p < 0.05). Subjective tolerance was better in sedated men and women but there was no association between sedation and perceived tolerance according to sex. Subjective tolerance was better in sedated patients older than 70 years than in those younger than 40 years (p < 0.05). Complications were more frequent in sedated patients and the most frequent complication in all the groups studied was mild desaturation; there was a significant difference between the group sedated with midazolam and meperidine and the non-sedated group (p < 0.05). Non-sedation had the best cost-effectiveness ratio but sedation with midazolam and meperidine was the most effective alternative. CONCLUSION: From the point of view of the endoscopist, endoscopy can be performed without sedation, although subjective tolerance is greater in patients sedated with midazolam and meperidine. Non-sedation is more cost-effectiveness than sedation but if sedation is required midazolam and meperidine achieve better results in terms of effectiveness than midazolam alone.

[Lamivudine for the treatment of patients with chronic hepatitis with negative hepatitis B AgHbe]. / Lamivudina en el tratamiento de la hepatopatía crónica por virus hepatitis B AgHbe minus.

INTRODUCTION: It is estimated that chronic hepatitis B affects to than 350 million people around the world. Patients with AgHB- minus account, in some areas, for between 50-80% of the total of the population with chronic hepatitis B. Spontaneous clearance is rare within these patients, the response to interferon is low and the probability of developing cirrhosis and hepatocarcinoma is higher than in the wild type. AIM: To analyze the response to lamivudine treatment in patients with chronic hepatitis B which are AgHB negative. RESULTS: Seven of the 9 patients which were treated in our department for more than 3 months were AgHB negative. Six of them responded to the treatment in an average time of 3.5 months (range 1-6 months). There were two patients that relapsed at 18 and 24 months and they were treated with adefovir. Four patients remained DNA negative and had normal aminotransferases values after an average treatment time of 25 months. CONCLUSION: In our series, the majority of the patients (77.7%) were AgHB negative at the beginning of treatment. The efficacy of the treatment with lamivudine in these cases is high (85.7%) and with an early response (average 3.5 months). One third of patients treated relapsed after one and a half years of treatment.

[Survey of informed consent in a gastrointestinal endoscopy unit]. / Encuesta de opinión sobre el consentimiento informado en una unidad de endoscopia digestiva.

OBJECTIVES: Gastrointestinal endoscopy, like all diagnostic and therapeutic techniques, must be preceded by written informed consent. The aim of this study was to evaluate the patients' acceptance and understanding of the aim of informed consent as well as to determine their perception of the investigation. METHODS: For 2 months, informed consent forms were given together with a questionnaire to 221 consecutive patients who underwent diagnostic gastrointestinal endoscopy. RESULTS: Distribution of the patients according to level of education was: university graduated (6.5%), high-school graduate (21.1%) those who had completed primary school (48.6%) and those with no schooling (23.9%). The document was read by 144 patients (65.1%) and the attending physician had previously explained it to 69.6%. Informed consent was understood by 90.7% of the patients who read the document. Understanding was related to education (university and high-school graduates (83.3%) vs. those who had completed primary school or who had no schooling (60%); p < 0.005) and was not related to the information given by the attending physician. Patients' opinion on the aim of informed consent was: absolve the doctor of responsibility (42%), provide information in the patients' interests (51.1%) and senseless document (42%). Signing the document provoked fear in 20% of those surveyed. This fear was greater in patients who had not been informed by the attending physician (31.2% vs. 14.5%; p > 0.01). CONCLUSIONS: Informed consent is understood by most patients who read the form but a significant proportion perceive it as designed to defend the physician. When the technique is explained by the attending physician and the doctor performing the procedure, acceptance is increased and fear is reduced.

Dolor abdominal y síndrome de secreción inadecuada de hormona antidiurética (SIADH) en un paciente diagnosticado de porfiria aguda intermitente / No disponible

No disponible

Lamivudina en el tratamiento de la hepatopatía crónica por virus hepatitis B AgHbe minus / Lamivudine for the treatment of patients with hepatitis B AGHBE Minus

Introducción: Se estima que la hepatopatía crónica por virus de la hepatitis B afecta a más de 350 millones de personas en todo el mundo. Los pacientes AgHbe minus representan en algunas áreas entre el 50-80% del total. En estos pacientes la remisión espontánea es rara, la respuesta a interferón menor y la probabilidad de evolución a cirrosis y hepatocarcinoma mayor que en la cepa salvaje. Objetivo: Analizar la respuesta al tratamiento con Lamivudina en pacientes con hepatopatía crónica VHB AgHBe negativos. Resultados: De los nueve pacientes tratados en nuestro servicio durante más de 3meses, 7 eran AgHbe negativos. De ellos 6 pacientes respondieron al tratamiento, en un tiempo medio de 3,5 meses (rango 1-6). Se han producido dos recidivas a los 18 y 24 meses que han sido tratadas con Adefovir. Cuatro pacientes persisten con ADN negativo y transaminasas normales tras un tiempo medio de tratamiento de 25 meses.Conclusiones: En nuestra serie, la mayoría de los pacientes (77,7%) eran AgHbe negativos al inicio del tratamiento. La eficacia del tratamiento con Lamivudina en ellos es alta (85,7%) y precoz (media de 3,5 meses). En un tercio de los pacientes tratados se produce recidiva viral, al menos tras 1 año y medio de tratamiento

Introduction: It is estimated that chronic hepatitis B affects to than 350 million people around the world. Patients with eAgHB- minus account, in some areas, for between 50-80% of the total of the population with chronic hepatitis B. Spontaneous clearance is rare within these patients, the response to interferon is low and the probability of developing cirrhosis and hepatocarcinoma is higher than in the wild type. Aim: To analyze the response to lamivudine treatment in patients with chronic hepatitis B which are eAgHB negative. Results: Seven of the 9 patients which were treated in our departmentfor more than 3 months were eAgHB negative. Six of them responded to the treatment in an average time of 3.5 months (range 1-6 months). There were two patients that relapsed at 18 and 24 months and they were treated withadefovir. Four patients remained DNA negative and had normal aminotransferases values after an average treatment time of 25 months. Conclusion: In our series, the majority of the patients (77.7%) were eAgHB negative at the beginning of treatment. The efficacy of the treatment with lamivudine in these cases is high (85.7%) and with an early response (average 3,5 months). One third of patients treated relapsed after one and a half years of treatment

Enfermedad celiaca en paciente con criterios Roma II de síndrome de intestino irritable / Celiac disease in a patient with Rome II criteria of irritable bowell syndrome

No disponible

Disnea y anemia en relación con herniación de estómago y ángulo esplénico de colon a través del hiato esofágico / Disnea and anemia in relation to esophageal herniation and splenic colon angle throught esophageal hiatus

No disponible

Sedación en la endoscopia gastrointestinal alta. Análisis de la tolerancia, las complicaciones y el coste-efectividad / Sedation in upper gastrointestinal endoscopy. Analysis of tolerance, complications and cost-effectiveness

Introducción y objetivo: La sedación del paciente es un importante complemento de los procedimientos endoscópicos. El objetivo de nuestro trabajo ha sido el análisis de la tolerancia, las complicaciones y el coste-efectividad de la sedación en pacientes sometidos a endoscopia gastrointestinal diagnóstica alta. Pacientes y método: Se estudió a 357 pacientes prospectivamente: 138 no sedados, 116 sedados con midazolam y 103 sedados con midazolam y meperidina. Se analizaron la tolerancia subjetiva, la tolerancia percibida por el endoscopista, las complicaciones y el coste-efectividad. Para el análisis estadístico se utilizó la prueba de la c2, y valores de p < 0,05 se consideraron estadísticamente significativos. Resultados: La tolerancia subjetiva fue mejor en pacientes sedados con midazolam y meperidina que en los otros grupos (p < 0,05). Respecto a la tolerancia percibida, se encontró diferencia entre el grupo sedado con ambas drogas y el grupo sedado con midazolam (p < 0,05). La tolerancia subjetiva fue mejor tanto en mujeres como en varones sedados, pero no hubo una asociación entre la sedación y la tolerancia percibida en ninguno de los sexos. La tolerancia subjetiva fue mejor en pacientes sedados mayores de 70 años que en los pacientes menores de 40 (p < 0,05). Las complicaciones fueron más frecuentes en pacientes sedados; la más frecuente en todos los grupos fue la desaturación leve; se observó una diferencia significativa entre el grupo sedado con los 2 fármacos y el no sedado (p < 0,05). La alternativa de no sedación es la que consigue una mejor relación coste-efectividad, pero la sedación con midazolam y meperidina es la más efectiva. Conclusión: La endoscopia puede realizarse sin sedación desde el punto de vista del endoscopista, pero la tolerancia subjetiva es mejor en pacientes sedados con midazolam y meperidina. Respecto al coste-efectividad, la mejor alternativa es la no sedación pero, en caso de precisarse sedación, la opción midazolam más meperidina ofrece una mejor efectividad que el midazolam aislado

Introduction and aim: Sedation of patients is an important complement to endoscopic procedures. The aim of this study was to analyze tolerance, complications and cost-effectiveness in patients undergoing diagnostic upper gastrointestinal endoscopy. Patients and method: A total of 357 patients were prospectively studied: 138 non-sedated, 116 sedated with midazolam and 103 sedated with midazolam and meperidine. Subjective tolerance, tolerance perceived by the endoscopist, complications, and cost-effectiveness were evaluated. The Chi-square test was used for the statistical analysis. P-values of less than 0.05 were considered statistically significant. Results: Subjective tolerance was greater in patients sedated with midazolam and meperidine than in the other groups (p < 0.05). Tolerance perceived by the endoscopist was greater in the group sedated with both drugs than in the group sedated with midazolam (p < 0.05). Subjective tolerance was better in sedated men and women but there was no association between sedation and perceived tolerance according to sex. Subjective tolerance was better in sedated patients older than 70 years than in those younger than 40 years (p < 0.05). Complications were more frequent in sedated patients and the most frequent complication in all the groups studied was mild desaturation; there was a significant difference between the group sedated with midazolam and meperidine and the non-sedated group (p < 0.05). Non-sedation had the best cost-effectiveness ratio but sedation with midazolam and meperidine was the most effective alternative. Conclusion: From the point of view of the endoscopist, endoscopy can be performed without sedation, although subjective tolerance is greater in patients sedated with midazolam and meperidine. Non-sedation is more cost-effectiveness than sedation but if sedation is required midazolam and meperidine achieve better results in terms of effectiveness than midazolam alone