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1.
Gastroenterol. latinoam ; 31(1): 9-20, mayo 2020. tab, ilus
Artigo em Espanhol | LILACS, Inca | ID: biblio-1103076

RESUMO

The outbreak of COVID-19 disease has recently spread from its original place in Wuhan, Hubei province, China, to the entire world, and has been declared to be a pandemic by the World Health Organization in March 2020. All countries in America, in particular Chile, show an important increase in COVID-19 cases and deaths. The clinical manifestations of COVID-19 are a broad spectrum, from asymptomatic mild disease, to severe respiratory failure, shock, multiorgan dysfunction and death. Thus, high clinical suspicion and appropriate structure risk stratification are needed. Health care teams in endoscopy units, are at an increased risk of infection by COVID-19 from inhalation of droplets, mucosae contact, probably contamination due to contact with stools. Endoscopic aerosolized associated infections have also been reported. Different societies' recommendations, have recently placed digestive endoscopy (especially upper) among the high risk aerosol generating procedures (AGPs). In addition, live virus has been found in patient stools. On top of this, the infected health professionals may transmit the infection to their patients. Health care infection prevention and control (HCIPC), has been shown to be effective in assuring the safety of both health care personnel and patients. This is not limited to the correct use of personal protective equipment (PPE), but is based on a clear, detailed and well communicated HCIPC strategy, risk stratification, use of PPE, and careful interventions in patients with moderate and high risk of COVID-19. A conscientious approach regarding limited resources is important, as the simultaneous outbreak in all countries heavily affects the availability of health supplies. The Chilean Gastroenterology Society (SChGE) and Digestive Endoscopy Association of Chile (ACHED) are joining to provide continued updated guidance in order to assure the highest level of protection against COVID-19, for both patients and health care workers. This guideline will be updated online as needed.


El brote de la enfermedad denominada COVID-19, se ha extendido desde su origen en Wuhan, provincia de Hubei, China, a todo el mundo. La Organización Mundial de la Salud lo declaró pandemia en marzo de 2020. Todos los países de América, en especial Chile, presentan incremento de casos y fallecidos. Las manifestaciones clínicas de COVID-19 van desde una enfermedad leve, hasta insuficiencia respiratoria severa, shock, disfunción orgánica y muerte. Se necesita una alta sospecha clínica y una adecuada estratificación del riesgo. El equipo de salud en las unidades de endoscopia, tiene un mayor riesgo de COVID-19 que otras unidades clínicas y de apoyo diagnóstico, dada la mayor exposición a inhalación de gotas, contacto posible con mucosas y contaminación por contacto con deposiciones. Recomendaciones de diferentes sociedades colocan la endoscopia digestiva (especialmente la esofagogastroscopia o endoscopia digestiva alta, EDA) entre los procedimientos generadores de aerosoles (PGA) de alto riesgo. Además, se han encontrado virus viables en las deposiciones de los pacientes. Potencialmente, los profesionales de la salud infectados podrían contagiar a los pacientes. Se ha demostrado que la prevención y control de infecciones asociadas a la atención de salud (IAAS), son efectivos para garantizar la seguridad tanto del personal de salud, como de los pacientes. Esto no es solamente el correcto uso del equipo de protección personal (EPP), sino que se basa en una clara estrategia de IAAS, bien comunicada, con estratificación de riesgo, uso de EPP e intervenciones correctas en pacientes con riesgo moderado y alto. Es relevante un enfoque sobre los limitados recursos, dado la simultaneidad del brote en todos los países, que afecta la disponibilidad de insumos. La Sociedad Chilena de Gastroenterología (SChGE) y la Asociación Chilena de Endoscopia Digestiva (ACHED) publican esta guía actualizada para apoyar las buenas prácticas contra COVID-19, tanto para pacientes como para el equipo de salud. Esta guía podrá tener actualizaciones según avance la información disponible.


Assuntos
Humanos , Pneumonia Viral/prevenção & controle , Endoscopia do Sistema Digestório/normas , Infecções por Coronavirus/prevenção & controle , Betacoronavirus , Pneumonia Viral/epidemiologia , Fatores de Risco , Controle de Infecções/métodos , Guias de Prática Clínica como Assunto , Infecções por Coronavirus/epidemiologia , Pandemias , Unidades Hospitalares/normas
2.
Gastroenterol. latinoam ; 28(2): 63-69, 2017. ilus, tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1118079

RESUMO

BACKGROUND: The use of endoscopic ultrasound with fine needle aspiration (EUS-FNA) has improved the characterization and staging of pancreatic solid masses. The primary strategy for improving the ability to diagnose malignant masses is the use of rapid on site evaluation (ROSE) by a cytopathologist. OBJECTIVE: To evaluate the diagnostic yield of EUS-FNA after the implementation of ROSE in an academic center. MATERIAL AND METHODS: Prospective enrollment and follow-up of EUS-FNA with ROSE during 2015 and 2016, was compared to EUS-FNA without ROSE in previous years (2011-2014) in Hospital Clínico UCChristus. Clinical and endosonographic features, cytopathological and histological diagnosis and number of passes per procedure were evaluated. All EUS-FNA included cytology and cellular block for definitive diagnosis. RESULTS: 59 pancreatic solid masses were included in the analysis. 44 EUS-FNA were performed with ROSE, compared with 15 EUS-FNA without ROSE. The mean age of patients included was 62.8 years, 54.2% male gender, and most masses studied were in the head of pancreas (77.6%). In EUS 86.5% were hypoechoic and 56.9% had poor defined margins. No differences in baseline characteristics were observed between groups. EUS-FNA led to diagnosis in 86.2% of the overall sample. The diagnostic rate was superior in the group of EUS-FNA with ROSE, compared to EUS-FNA without ROSE (97.7% vs 50%, p < 0.0001). The mean number of passes was inferior in EUS-FNA ROSE (+) (2.71 vs 5.78, p < 0.0001). No differences in rate of complications were observed between groups. CONCLUSION: The use of ROSE associated to EUS-FNA improves the diagnostic yield in the evaluation of pancreatic solid masses. Our findings are consistent with those described in the literature, recommending the use of ROSE in EUS-FNA in centers where the diagnostic yield is less than 90% without the use of ROSE


INTRODUCCIÓN: La adquisición de tejido mediante el uso de endosonografía, con punción con aguja fina, (EUS-FNA) ha mejorado el diagnóstico de lesiones pancreáticas sólidas. La principal medida para aumentar el rendimiento diagnóstico de la EUS-FNA es la evaluación por citopatólogo próximo al lugar de punción (in situ) (técnica conocida en inglés como ROSE "rapid on-site evaluation"). OBJETIVO: Evaluar el rendimiento diagnóstico de EUS-FNA en lesiones pancreáticas sólidas posterior a la implementación de ROSE en un centro universitario. MATERIAL Y MÉTODOS: Registro prospectivo de EUS-FNA realizadas con ROSE durante el período 2015-2016, comparado con EUS-FNA con evaluación histopatológica diferida realizada entre los años 2011-2014, en Hospital Clínico UC-Christus. Se evaluaron características clínicas, endosonográficas, diagnóstico histopatológico y número de pases por procedimiento. Todas las EUS-FNA incluyeron citología y block celular para diagnóstico definitivo. RESULTADOS: Se incluyeron en el análisis 59 lesiones pancreáticas sólidas evaluadas con EUS-FNA. Seguimiento prospectivo de 44 EUS-FNA con ROSE, que fueron comparadas con 15 EUS-FNA sin evaluación in situ (retrospectivo). La muestra total incluyó individuos con un promedio de 62,8 años de edad, 54,2% hombres, donde 77,6% de las lesiones se ubicaba en la cabeza pancreática. Endosonográficamente 86,5% de las lesiones eran hipoecoicas y 56,9% tenían márgenes poco definidos. La EUS-FNA fue diagnóstica en 86,2% del total de la muestra. Las EUS-FNA realizadas con ROSE presentaron un mayor rendimiento diagnóstico respecto a las efectuadas sin evaluación in situ (97,7% vs 50%, p < 0,0001). El número de pases por procedimiento fue menor (2,7% vs 5,8%, p < 0,0001) en el grupo con ROSE. No hubo diferencias en complicaciones en ambos grupos. CONCLUSIÓN: La evaluación por citopatólogo in situ de la muestra obtenida por EUS-FNA mejora el rendimiento diagnóstico de las lesiones pancreáticas sólidas. Nuestros hallazgos apoyan el uso de ROSE asociado a EUS-FNA, siendo concordantes con las recomendaciones actuales de utilizar evaluación histopatológica in situ en EUS-FNA, especialmente en centros donde el rendimiento diagnóstico sin uso de ROSE es menor a 90%.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Pancreatopatias/patologia , Pancreatopatias/diagnóstico por imagem , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/diagnóstico por imagem , Estudos Prospectivos , Seguimentos , Biópsia por Agulha Fina , Avaliação Rápida da Integridade Ambiental
3.
Gastroenterol. latinoam ; 27(4): 207-214, 2016. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-907638

RESUMO

Introduction: Gastric cancer (GC) is the leading cause of cancer mortality in Chile. The development ofgastric adenocarcinoma its preceded by a histopathologic cascade composed of gastric atrophy, intestinal metaplasia and gastric dysplasia. Sydney protocol has been proposed as the standard method for diagnosingthese conditions. The aim of this research study was to establish whether Sydney protocol increase thedetection of premalignant gastric lesions, as gastric atrophy and intestinal metaplasia, compared to non protocolizedendoscopies/biopsies. Methods: Upper gastroduodenal endoscopies (GDE) from Hospital Clí-nico Universidad Católica de Chile between April-May 2015 and April-May 2016 was analyzed. Patientswith histological study with 18 years-old or older were included. Patients with history of GC or malignantlesions at GDE where excluded. Detection of gastric atrophy, intestinal metaplasia and suggestive findingsof autoimmune gastritis where compared between Sydney protocol and non-protocolized endoscopies/biopsies...


Introducción: El cáncer gástrico (CG) es la principal causa de muertes por cáncer en Chile. El desarrollo del adenocarcinoma gástrico es precedido por una cascada histopatológica (gastritis; atrofia gástrica/AG; metaplasia intestinal/MI). Se ha propuesto la biopsia del cuerpo, ángulo y antro a través del protocolo de Sydney para la búsqueda de estas condiciones. Objetivo: Determinar la diferencia en la detección delesiones premalignas gástricas a través del protocolo de Sydney comparado con el estudio endoscópico habitual. Métodos: Se analizaron las endoscopias digestivas altas (EDA) realizadas en el Centro de Endoscopia Digestiva del Hospital Clínico de la Universidad Católica en los períodos entre abril y mayo del 2015 y 2016. Se incluyeron las EDA de pacientes mayores de 18 años con estudio histológico. Fueron excluidos los pacientes con antecedente personal de CG o lesiones de aspecto maligno macroscópicas. Se comparó la detección de AG, MI y gastritis autoinmune (GA) en el estudio histológico entre los pacientes con protocolo Sydney y el estudio endoscópico no protocolizado...


Assuntos
Masculino , Feminino , Humanos , Adulto , Adulto Jovem , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Biópsia/métodos , Lesões Pré-Cancerosas/patologia , Neoplasias Gástricas/patologia , Atrofia/patologia , Chile , Protocolos Clínicos , Endoscopia do Sistema Digestório , Infecções por Helicobacter/patologia , Metaplasia/patologia , Estudos Retrospectivos
4.
Gastroenterol. latinoam ; 26(4): 191-197, 2015. tab
Artigo em Espanhol | LILACS | ID: biblio-982675

RESUMO

Colon preparation is more effective if it is partially or totally administered the same day of the colonoscopy. Objective: To know acceptance of a preparation guideline for the same day of the procedure and adherence to this guideline once it is implemented in a digestive endoscopy center. Methods: First, the importance of a preparation guideline for the same day was explained and adult patients and accompanying persons with preparation in the previous day were asked if they would be willing to prepare for the colonoscopy 4-5 h before the procedure. In the second stage, adult patients were surveyed who received instructions to prepare using polyethylene glycol solution (3 litres) the same day of the procedure. Results: 160 people were surveyed in phase one. 86 percent was willing to get up at 4 am to drink the solution, without statistical correlation with the other variables studied. 42.7 percent would prefer to split the doses and 39 percent would drink all the same day. 102 people were surveyed in phase two. 92 percent drank the preparation totally or partially the same day of the procedure (69 percent and 25 percent, respectively). 82 percent drank at least 80 percent of the dose. 51.5 percent described the preparation process as quite or very unpleasant. 45 percent would prefer colonoscopy preparation in the previous day. Conclusions: In our experience, most patients would accept preparation in the same day of the procedure and adhere to this, however, almost 50 percent would prefer to take it the previous day, in a future procedure.


La preparación de colon es más efectiva si es administrada parcial o totalmente el mismo día de la colonoscopia. Objetivo: Conocer la aceptación a una pauta de preparación al menos en parte el mismo día de la colonoscopia y adherencia a esta una vez implementada en un Centro de Endoscopia Digestiva. Métodos: Primero se explicó la importancia de una pauta de preparación el mismo día y se encuestó a pacientes adultos y acompañantes a estudio endoscópico con preparación exclusiva el día anterior si estarían dispuestos a realizar preparación para colonoscopia 4-5 h antes de la prueba. En la segunda fase se encuestó a pacientes adultos a los que se había indicado preparación con solución de polietilenglicol (3 litros) el mismo día del procedimiento. Resultados: En la fase 1 se encuestó a 160 personas. El 86 por ciento aceptaría levantarse a las 4 AM para tomar la preparación, sin relación estadística con las demás variables estudiadas. El 42,7 porciento preferirían tomar la dosis en forma repartida y 39 por ciento preferían beber todo el mismo día. En la fase 2 se encuestó a 102 personas. El 92 porciento tomó la preparación total o parcialmente el mismo día del examen (69 por ciento y 25 por ciento respectivamente). El 82 porciento tomó al menos 80 por ciento de la cantidad indicada. El 51,5 porciento calificó el proceso de la preparación como bastante o muy desagradable. El 45porciento preferiría en colonoscopias futuras la preparación el día anterior. Conclusiones: En nuestro medio, la mayoría de los pacientes aceptarían la pauta de preparación el mismo día de la prueba y adhieren a esta, aunque casi la mitad preferiría tomarla el día anterior en el futuro.


Assuntos
Masculino , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Colonoscopia/métodos , Cooperação do Paciente , Cuidados Pré-Operatórios/métodos , Polietilenoglicóis/administração & dosagem , Inquéritos e Questionários
5.
Gastroenterol. latinoam ; 25(4): 243-256, 2014.
Artigo em Espanhol | LILACS | ID: lil-766591

RESUMO

Digestive endoscopy is a complex tool for diagnosis and treatment, with continuous development both in technical aspects and in their application for the different pathologies where this technique is required. Therefore, a continuous education program is necessary for the practitioner using this technique. With the purpose of reaching an agreement between different aspects of the performance of these procedures and also generating proposals for its application that are useful for the physicians of this area of expertise, during 2013 the Chilean Association of Digestive Endoscopy (ACHED) developed a workshop called ‘Relevant aspects of digestive endoscopy. Evidence-based suggestions’. This workshop was attended by gastroenterologists and trainee practitioners, who worked in groups during a period of two months where they reviewed available evidence to answer several questions relating to milestones and lesions that need to be described in upper gastrointestinal endoscopy, the preparation of the GI endoscopy report, technical aspects and quality measures in colonoscopy. This review resulted in proposals that were analyzed and agreed on in the form of recommendations presented for further analysis and discussion amongst endoscopic teams in our country.


La endoscopia digestiva es una herramienta de diagnóstico y tratamiento médico compleja, en continuo desarrollo tanto en lo técnico como en los conceptos de manejo de las patologías en las que se utiliza.Por lo tanto, es deseable una estrategia de formación continua del profesional que la realiza. Con el objetivode consensuar diferentes aspectos en la realización de estos procedimientos y generar propuestas de manejoque sean de utilidad para todos los médicos involucrados en esta especialidad, la Asociación Chilenade Endoscopia Digestiva (ACHED) realizó durante el año 2013 un curso taller denominado “Aspectosrelevantes en la realización de la endoscopia digestiva. Propuestas basadas en la evidencia”. Este cursoconvocó a gastroenterólogos y médicos en formación de la especialidad que conformaron grupos de trabajoque durante 2 meses revisaron la evidencia disponible para responder diversas preguntas en relación a los hitos y lesiones a describir en endoscopia digestiva alta (EDA), la realización del informe en EDA, aspectos técnicos y medidores de calidad en colonoscopia. La revisión les permitió generar propuestas que fuerondiscutidas y consensuadas en recomendaciones que se proponen para su discusión por los equipos endoscópicos de nuestro país.


Assuntos
Humanos , Medicina Baseada em Evidências , Endoscopia Gastrointestinal/normas , Gastroenteropatias/cirurgia , Gastroenteropatias/diagnóstico , Controle de Qualidade
6.
Rev Med Chil ; 136(3): 376-84, 2008 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-18575666

RESUMO

The liver is a common site of hematogenous metastasis, especially from gastrointestinal malignancies. Liver metastasis are generally classified as stage IV disease. Previously treatment in such patients was met with great skeptiscism. However, advances in surgical and medical therapies during the last two decades have provided effective therapeutic options for selected patients. Since major hepatic resections are now performed with acceptable morbidity and a mortality rate <3%, colorectal cancer metastasis to the liver are associated with 5-year survival rates of 30% or more. Meanwhile, a variety of new therapies have been developed, including hepatic artery infusion of chemotherapy; alcoholic, crio and radiofrequency ablation and novel strategies of systemic chemotherapy with the development of molecular targeted new products. These new therapeutic armamentarium have been used mostly in liver metastasis from colorectal cancer patients. However, liver metastasis of neuroendocrine tumors and selected cases of non colorectal cancer liver metastasis are benefited from the same strategies. This report summarizes the different therapeutic tools, their advantages and results mainly on colorectal cancer liver metastasis. These results are expected to improve even further with multimodality approaches.


Assuntos
Carcinoma/terapia , Neoplasias Colorretais/terapia , Neoplasias Hepáticas/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Camptotecina/administração & dosagem , Camptotecina/análogos & derivados , Carcinoma/secundário , Ablação por Cateter , Neoplasias Colorretais/patologia , Terapia Combinada , Criocirurgia , Floxuridina/administração & dosagem , Fluoruracila/administração & dosagem , Hepatectomia , Humanos , Irinotecano , Neoplasias Hepáticas/secundário , Estadiamento de Neoplasias , Prognóstico , Taxa de Sobrevida , Fatores de Tempo
7.
Rev Med Chil ; 134(3): 320-5, 2006 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-16676104

RESUMO

BACKGROUND: Tumor necrosis factor alpha, interleukin 6 and 1 have a pathogenic role in Crohn's disease. Infliximab, a monoclonal antibody against tumor necrosis factor, is useful in the treatment of Crohn's disease, specially when the disease is active and associated to fistula formation. AIM: To assess the effectiveness of Infliximab in patients with Crohn's disease. MATERIAL AND METHODS: Twelve patients with Crohn's disease (aged 16 to 63 years, 10 women) refractory to treatment with steroid, 5-aminosalicylic acid, antimicrobials and immunomodulatory drugs, were studied. A single intravenous 5 mg/kg dose Infliximab was administered. The Crohn's disease activity index (CDAI) was measured before and one week after the administration of the drug. RESULTS: CDAI before and after Infliximab administration was 357+/-62 and 138+/-122 score points, respectively (p <0.005). According to this score, five patients had a severe and seven a moderate disease flare. The disease remitted in 7 (58%) and a clinical response was observed in 75%. CONCLUSIONS: A single dose of Infliximab was effective to induce remission of the disease in 75% of this selected group of patients with Crohn's disease.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Doença de Crohn/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Adolescente , Adulto , Feminino , Humanos , Infliximab , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
8.
Gastroenterol. latinoam ; 21(4): 468-475, oct.-dic. 2010. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-679628

RESUMO

Subepithelial lesions are a frequent finding in the upper gatrointestinal tract. Endoscopic ultrasound (EUS) is the preferred procedure to characterize these lesions, but in case of a hypoechogenic image, this technique does not differentiate between leiomyoma and a potentially malignant gastrointestinal stromal tumor (GIST). The diagnosis is determined by histological study and immunohistochemistry (IHC), but endoscopic sampling and EUS-guided techniques have efficiency below 60 percent. Objective: To assess the performance of submucous resection and Jumbo biopsy forceps technique, to access esophageal subepithelial lesions and sampling for histology and IHC. Methods: Endosonographic assessment of the subepithelial lesion. Biopsy samples of tissue were obtained with Jumbo biopsy forceps for histology and IHC. Results: Seven patients were evaluated. Age: 54.8 years (range 32-69), 5 esophageal lesions and 2 gastric lesions, maximum diameter of 15.6 mm (range 10-20). The procedure was successful in all patients, no complications were seen. Histology showed that all esophageal lesions were leiomyomas, CD 117 and CD 34 were negative in the selected patients (4 of 4). Gastric lesions corresponded to a heterotopic pancreas and one GIST with positive reaction to CD 117 and CD 34. Discussion: The described technique is useful to obtain histology and IHC diagnosis of esophageal subepithelial lesions. Prospective studies are necessary to compare these techniques with EUS-guided techniques.


Las lesiones subepiteliales son un hallazgo frecuente en el tubo digestivo alto. La ultrasonografía endoscópica (USE) es el examen de elección para caracterizarlas, pero frente a una imagen hipoecogénica no diferencia entre un leiomioma y un tumor estromal gastrointestinal (GIST) potencialmente maligno. El diagnóstico se establece con estudio histológico e inmunohistoquímica (IHQ) pero la obtención de muestra por vía endoscópica y las técnicas guiadas por USE tienen un rendimiento que no supera el 60 por ciento. Objetivo: Evaluar el rendimiento de la técnica de incisión submucosa y biopsia con pinza jumbo, para acceso a lesiones subepiteliales esofágicas o gástrricas y obtención de muestras para estudio histológico e IHQ. Métodos: Se realiza evaluación endosonográfica de la lesión subepitelial seguido de incisión de mucosa y submucosa con papilótomo de punta para acceso a la lesión. Se toman muestras de tejido con pinza Jumbo, para estudio histológico e IHQ. Resultados: Se evaluaron 7 pacientes, edad 54,8 años (32-69), 5 lesiones esofágicas y 2 gástricas, diámetro máximo de 15,6 mm (rango 10-20). El procedimiento fue exitoso en todos los pacientes, sin complicaciones. En el estudio histológico todas las lesiones esofágicas correspondieron a leiomiomas, CD 117 y Cd 34 negativo en los pacientes en que fue solicitado (4 de 4). Las lesiones gástricas correspondieron a un páncreas heterotópico y un GIST con reacción positiva para CD 117 y CD 34. Discusión: La técnica descrita es útil para obtener diagnóstico histológico e IHQ de lesiones esofagogástricas subepiteliales. Estudios prospectivos son necesarios para compararlas con técnicas guiadas por USE.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Leiomioma/patologia , Leiomioma , Tumores do Estroma Gastrointestinal/patologia , Tumores do Estroma Gastrointestinal , Biópsia , Endoscopia Gastrointestinal , Endossonografia , Imuno-Histoquímica , Mucosa Gástrica/patologia , Mucosa Gástrica , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais
9.
Rev. méd. Chile ; 136(3): 376-384, mar. 2008. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-484910

RESUMO

The liver is a common site of hematogenous metastasis, especially from gastrointestinal malignancies. Liver metastasis are generally classified as stage IV disease. Previously treatment in such patients was met with great skeptiscism. However, advances in surgical and medical therapies during the last two decades have provided effective therapeutic options for selected patients. Since major hepatic resections are now performed with acceptable morbidity and a mortality rate <3 percent, colorectal cancer metastasis to the liver are associated with 5-year survival rates of 30 percent or more. Meanwhile, a variety of new therapies have been developed, including hepatic artery infusion of chemotherapy; alcoholic, crio and radiofrequency ablation and novel strategies of systemic chemotherapy with the development of molecular targeted new products. These new therapeutic armamentarium have been used mostly in liver metastasis from colorectal cancer patients. However, liver metastasis of neuroendocrine tumors and selected cases of non colorectal cancer liver metastasis are benefited from the same strategies. This report summarizes the different therapeutic tools, their advantages and results mainly on colorectal cancer liver metastasis. These results are expected to improve even further with multimodality approaches.


Assuntos
Humanos , Carcinoma/terapia , Neoplasias Colorretais/terapia , Neoplasias Hepáticas/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Camptotecina/administração & dosagem , Camptotecina/análogos & derivados , Carcinoma/secundário , Ablação por Cateter , Neoplasias Colorretais/patologia , Terapia Combinada , Criocirurgia , Floxuridina/administração & dosagem , Fluoruracila/administração & dosagem , Hepatectomia , Neoplasias Hepáticas/secundário , Estadiamento de Neoplasias , Prognóstico , Taxa de Sobrevida , Fatores de Tempo
10.
Gastroenterol. latinoam ; 23(4): 191-196, oct.-dic. 2012. tab, graf
Artigo em Espanhol | LILACS | ID: lil-680413

RESUMO

Introduction: Upper endoscopy (UE) is one the most common diagnostic medical procederes. While UE is safe, it is not free of complications. Structured training programs could help to ensure technical quality and adequate safety standars. Objective: To describe a standardized training program in diagnostic UE in a simulated and a clinical environment. Methods: Gastroenterology residents of the following areas: pediatrics, adults, digestive surgery, and family medicine, without previous experience in UE, were trained in a simulated environment followed by a stage of supervised clinical practice. The achievement of 4 pre-established key-goals in UE were assessed (esophageal intubation, pylorus trespassing, second portion of the duodenum trespassing, and gastric retroversion), and learning curves were constructed. Results: Eight residents completed the simulated training sessions, followed by 130 UE performed during their clinical training. Initially, the most difficult goal to be achieved was the esophageal intubation with only 12.5 percent during the first 10 sessions, and it was statistically significant compared to the other endoscopic goals (gastric retroversion: 63.8 percent second portion of the duodenum trespassing: 46.3 percent; and pylorus trespassing: 62.5 percent p < 0.001). The learning curves were flat between 80 to 90 UE for the 4 endoscopic goals, and no complications were observed in 1,040 procedures. Conclusion: The endoscopic program reduces the training time in a manner that is efficient and safe for the patient. Simulation models could be useful to improve the trainees’ performance in more difficult stages in their training process.


Introducción: La endoscopía digestiva alta (EDA) diagnóstica es uno de los procedimientos médicos más solicitados en la práctica clínica habitual y si bien es una técnica segura no está exenta de complicaciones. Programas de entrenamiento estructurados podrían ayudar a garantizar un procedimiento de calidad y con adecuados estándares de seguridad. Objetivo: Describir un programa estandarizado de entrenamiento en EDA diagnóstica en un ambiente simulado y clínico. Métodos: residentes de los programas de gastroenterología adultos, pediátrica, cirugía digestiva y medicina familiar, sin experiencia en EDA, fueron sometidos a un programa de entrenamiento simulado, seguido de una etapa de práctica clínica supervisada. Se evaluó el cumplimiento de 4 hitos preestablecidos (intubación esofágica, paso del píloro, paso a la segunda porción duodenal y retrovisión) y se confeccionaron curvas de aprendizaje. Resultados: Ocho residentes completaron la etapa de simulación y realizaron 130 EDA durante la etapa clínica. Inicialmente el hito más difícil de cumplir fue la intubación esofágica, logrado sólo en el 12,5 por ciento en las primera 10 sesiones, existiendo una diferencia estadísticamente significativa con los otros hitos (retrovisión: 63,8 por ciento paso a la segunda porción duodenal: 46,3 por ciento y paso del píloro: 62,5 por ciento; p < 0,001). El aplanamiento de la curva de aprendizaje fue alcanzado entre la endoscopía 80 y 90 de forma comparable para los 4 hitos, sin complicaciones en 1.040 procedimientos. Conclusión: El programa de entrenamiento reduce el tiempo de entrenamiento de manera eficiente y segura para los pacientes. Modelos de simulación podrían servir para mejorar el rendimiento en etapas de mayor dificultad.


Assuntos
Humanos , Criança , Adulto , Educação Médica/métodos , Endoscopia do Sistema Digestório/educação , Curva de Aprendizado
11.
Rev. méd. Chile ; 134(3): 320-325, mar. 2006. tab, graf
Artigo em Espanhol | LILACS | ID: lil-426098

RESUMO

Background: Tumor necrosis factor alpha, interleukin 6 and 1 have a pathogenic role in Crohn's disease. Infliximab, a monoclonal antibody against tumor necrosis factor, is useful in the treatment of Crohn's disease, specially when the disease is active and associated to fistula formation. Aim: To assess the effectiveness of Infliximab in patients with Crohn's disease. Material and methods: Twelve patients with Crohn's disease (aged 16 to 63 years, 10 women) refractory to treatment with steroid, 5-aminosalicylic acid, antimicrobials and immunomodulatory drugs, were studied. A single intravenous 5 mg/kg dose Infliximab was administered. The Crohn's disease activity index (CDAI) was measured before and one week after the administration of the drug. Results: CDAI before and after Infliximab administration was 357±62 and 138±122 score points, respectively (p <0.005). According to this score, five patients had a severe and seven a moderate disease flare. The disease remitted in 7 (58%) and a clinical response was observed in 75%. Conclusions: A single dose of Infliximab was effective to induce remission of the disease in 75% of this selected group of patients with Crohn's disease.


Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anticorpos Monoclonais/uso terapêutico , Doença de Crohn/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
12.
Rev. méd. Chile ; 129(6): 620-5, jun. 2001. tab
Artigo em Espanhol | LILACS | ID: lil-295390

RESUMO

Background: The clinical parameters for the suspicion of Clostridium difficile infections, namely the use of antimicrobials and diarrhea, have a low predictive value for the diagnosis. Aim: To search other clinical variables and determine a clinical prediction model for (Clostridium difficile diarrhea. Patients and methods: All patients to whom a Clostridium difficile study was requested, were prospectively studied during 5 months. Clinical variables of these patients were registered. The diagnosis of Clostridium difficile was done using the cytotoxicity test in fibroblast cultures. Results: Ninety two patients were analyzed and in 26, the diagnosis of Clostridium difficile was confirmed. A logistic regression model disclosed an age over 60 years old, the presence of mucus in the stools and a temperature over 37.8 ­C in the previous 24 h, as significant predictors of the infection. The correlation of the model, between the predicted probability and the observed condition, was 81.5 per cent. Conclusions: The presence of the clinical variables identified in this study are associated with a high probability of an infection by Clostridium difficile in patients with diarrhea and the recent use of antimicrobials


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Enterocolite Pseudomembranosa/diagnóstico , Clostridioides difficile/patogenicidade , Diarreia/etiologia , Enterocolite Pseudomembranosa/etiologia , Enterocolite Pseudomembranosa/tratamento farmacológico , Estudos Prospectivos , Clostridioides difficile/isolamento & purificação , Clostridioides difficile/efeitos dos fármacos , Diarreia/diagnóstico , Diarreia/tratamento farmacológico , Fezes/microbiologia , Fibroblastos/microbiologia , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Diagnóstico Clínico , Testes Imunológicos de Citotoxicidade
13.
Rev. méd. Chile ; 130(7): 723-730, jul. 2002. tab
Artigo em Espanhol | LILACS | ID: lil-323245

RESUMO

Background: Cholelithiasis is the second cause of hospital admissions in Chile. Aim: To study the prevalence of symptomatic gallstone disease and opportunity of cholecystectomy in La Florida, Santiago and among Mapuche Indians in Huapi Island. Patients and methods: In the period 2000-2001, we contacted to 71 percent (1127 subjects) and to 61 percent (145 subjects) patients of La Florida and Huapi Island, respectively, that had previously participated in an epidemiological study on cholelithiasis in 1993. We defined symptomatic gallstone patients as those with a history of biliary colic. Each patient was subjected to gallbladder ultrasound. Results: In 1993, 30-35 percent of gallstone patients were symptomatic (&70 percent women). During the lapse 1993-2001, only 50 percent of subjects from La Florida and 25 percent of patients from Huapi Island were cholecystectomized (p <0.05). Fifty percent of cholecystectomies were emergency operations. In 38 symptomatic Mapuche Indians from Huapi, cholecystectomy was indicated in 2001. After five months of the indication, only one of these subjects had been operated. Laparoscopic cholecystectomy represented 40 percent of all cholecystectomies performed in the National Health Service Hospitals. Conclusions: This study demonstrates an unacceptable high prevalence of symptomatic gallstone patients remaining non-operated in both the urban and rural communities. This reciprocally correlates with the high frequency of emergency cholecystectomies and the high incidence of gallbladder cancer among Chileans. This study contrasts negatively with the situation of Scotland, where 73.5 percent of cholecystectomies were laparoscopic in 1998-1999. To reach Scotland standards, the Chilean Public Health System should increase the number of cholecystectomies from 27,000 in 2001 to 57,510


Assuntos
Humanos , Masculino , Adulto , Feminino , Colecistectomia , Colelitíase , Indígenas Sul-Americanos , Colelitíase , História Natural das Doenças , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos
14.
Gastroenterol. latinoam ; 16(3): 243-249, jul.-sept. 2005. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-433865

RESUMO

El sistema MARS (“molecular adsorbent recirculating system”) es un sistema de soporte hepático extracorpóreo, con capacidad de eliminar substancias liposolubles ligadas a la albúmina y compuestos hidrosolubles involucrados en la patogenia de la encefalopatía, alteraciones hemodinámicas y metabólicas de la falla hepática aguda. Se presenta un paciente de 53 años con una cirrosis hepática secundaria a infección por virus C de la hepatitis, que desarrolló un carcinoma hepatocelular y un deterioro importante de las funciones hepática y renal, después de dos procedimientos de quimioembolización arterial del tumor. El paciente fue considerado para un trasplante hepático urgente y fue sometido a MARS en espera de la cirugía. Se realizaron 4 sesiones de 24, 12, 8 y 12 horas, respectivamente. Inmediatamente después del primer tratamiento se produjo un descenso significativo de los niveles séricos de bilirrubina, remisión de la encefalopatía hepática, mejoría de la función renal y parámetros hemodinámicos. Cuatro días después de la última sesión se realizó el trasplante hepático sin complicaciones y 20 meses después el paciente está en buenas condiciones. MARS representa una nueva técnica de soporte hepático que puede ser de utilidad en pacientes con cirrosis descompensada en espera de un trasplante de hígado.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Fígado Artificial , Insuficiência Hepática/terapia , Desintoxicação por Sorção , Adsorção , Albuminas/uso terapêutico , Diálise Renal/instrumentação , Diálise Renal/métodos , Doença Crônica , Falência Hepática Aguda/etiologia , Quimioembolização Terapêutica/métodos , Resultado do Tratamento , Transplante de Fígado
15.
Rev. chil. neuro-psiquiatr ; Rev. chil. neuro-psiquiatr;26(2): 133-41, abr.-jun. 1988. tab, ilus
Artigo em Espanhol | LILACS | ID: lil-56358

RESUMO

Se analizaron 1288 fichas de pacientes con diferentes diagnósticos psiquiátricos, a los que se les instauró un tratamiento con fármacos neurolépticos, de los cuales un 57,2% fueron hombres y un 75% de ellos, con diagnóstico de esquizofrenia (EQZ). Las población femenina alcanzó un 42,8% y de ellas, un 52% presentaba un diagnóstico de EQZ. Los neurolépticos más usados fueron la tioridazina (TDZ), el haloperidol (HAL), la cloropromazina (CPZ) y la sulpirida (SUL). Se corrobora que los fármacos neurolépticos de mayor potencia (butirofenonas) producen mas reacciones adversas (RAM) en la esfera extrapiramidal, en cambio los neurolépticos de baja potencia (tioridazina y cloropromazina) producen mas RAM a nivel del SNC y de la esfera vegetativa. En este estudio obtuvimos una incidencia de un 0,5% de discinesias tardías, asociadas al uso prolongado de HAL y fluspirileno. El reconocimiento precoz de la DT y la pronta supresión del neuroléptico cuando en indicado, puede reducir la incidencia de esta alteración


Assuntos
Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Antipsicóticos/efeitos adversos , Discinesia Induzida por Medicamentos , Haloperidol/efeitos adversos , Tioridazina/efeitos adversos
16.
Rev. chil. neuro-psiquiatr ; Rev. chil. neuro-psiquiatr;25(4): 233-46, oct.-dic. 1987. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-56753

RESUMO

La discinesia tardía (DT) consiste en movimientos involuntarios persistentes asociados al uso prolongado de fármacos neurolépticos. La frecuencia estimativa de esta alteración es de 10 - 15%. Los ancianos tienen mayor riesgo que aquellos de menos de 50 años. Aunque es de causa desconocida, el aumento de la sensibilidad de los receptores dopaminérgicos en los ganglios basales, explica en parte la fisiopatología de esta alteración. No se dispone de un tratamiento corrientemente satisfactorio, pero el reconocimiento precoz de la DT y la pronta supresión del neuroléptico cuando es indicado puede reducir la incidencia de esta alteración. La prevención es esencial y depende de un diagnóstico psiquiátrico preciso y del uso de neurolépticos solo en indicaciones específicas.


Assuntos
Antipsicóticos/efeitos adversos , Discinesia Induzida por Medicamentos/fisiopatologia , Discinesia Induzida por Medicamentos/prevenção & controle , Antipsicóticos/farmacologia , Dopamina/efeitos adversos , Risco
17.
Rev. méd. Chile ; 125(8): 899-904, ago. 1997. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-207127

RESUMO

Eight patients received 80 units of BoTx. Assessment of response was based on changes in the symptom scores (0-9) and esophageal manometric studies. Results: Six out of 8 patients (75 percent) had sustained clinical improvement after therapy. This effect was maintained for a mean time of 17.8 months. The symptom score decreased from a mean of 6.7 to 0.5 (p < 0.01) and after treatment, LES pressure decreased from 63 to 25.5 mm Hg (p = 0.07).l There were no serious adverse effects. Five of the six responders have relapsed. Two of these patients received a second BoTx infection with satisfactory results, two went to surgery and one refused other type of therapy and died of pneumonia. Conclusions: Intrasphincteric BoTx injection is a simple, safe and effective method of treatment in patients with achalasia, with a duration of response averaging 1.5 years. Its use may be suggested in some patients with high surgical risk and those who refuse a more invastive therapy. It is also useful in malnourished patients to attain an adequate nutritional status before surgery


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Acalasia Esofágica/tratamento farmacológico , Toxinas Botulínicas/administração & dosagem , Junção Esofagogástrica
18.
Rev. chil. cir ; 52(4): 382-8, ago. 2000. ilus, tab, graf
Artigo em Espanhol | LILACS | ID: lil-274688

RESUMO

El tratamiento de la acalasia con dilatación neumática o inyección de toxina botulínica tiene una importante frecuencia de recidiva a largo plazo, superior al tratamiento quirúrgico convencional (clásico). Los progresos en la cirugía de menor invasión han permitido ofrecer la cardiomiotomía laparoscópica como una alternativa terapéutica. Entre mayo 1995 y enero 1999 se operaron por vía laparoscópica 9 enfermos de acalasia. En el estudio diagnóstico, la presión del esfínter esofágico inferior era de x: 50,8 mmHg (18-78 mmHg), con relajación incompleta o ausente. En todo se descartó una enfermedad de Chagas y en 4 se comprobó un megaesófago. La baja de peso en promedio era de 10 kg (0-15 kg) en un período de síntoma de x: 66,3 meses (24-204). Cinco enfermos tenían tratamientos previos a la cirugía: 4 con toxina botulínica y uno con dilatación neumática. En todos los enfermos se realizó una cardiomiotomía anterior con control endoscópico durante la operación. No hubo mortalidad operatoria y la mediana de estadía hospitalaria fue de 3 días (2-18). Complicaciones: un paciente tuvo una perforación esofágica tardía, al tercer día, que requirió de una reintervención. Otro enfermo tuvo una perforación cubierta que cerró con tratamiento médico


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Acalasia Esofágica/cirurgia , Esofagoscopia , Esofagostomia , Acalasia Esofágica/diagnóstico , Esôfago/cirurgia , Esôfago/patologia , Esofagoscopia/efeitos adversos , Esofagostomia/efeitos adversos , Tempo de Internação , Perfuração Esofágica/cirurgia , Perfuração Esofágica/etiologia , Complicações Pós-Operatórias/cirurgia
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