RESUMO
BACKGROUND: Stenosis is one of the most common complications in patients with Crohn's disease (CD). Endoscopic balloon dilation (EBD) is the treatment of choice for a short stenosis adjacent to the anastomosis from previous surgery. Self-expandable metal stents (SEMS) may be a suitable treatment option for longer stenoses. To date, however, there is no scientific evidence as to whether endoscopic (EBD/SEMS) or surgical treatment is the best approach for de novo or primary stenoses that are less than 10 cm in length. METHODS/DESIGN: Exploratory study as "proof-of-concept", multicentre, open-label, randomized trial of the treatment of de novo stenosis in the CD; endoscopic treatment (EBD/SEMS) vs surgical resection (SR). The type of endoscopic treatment will initially be with EDB; if a therapeutic failure occurs, then a SEMS will be placed. We estimate 2 years of recruitment and 1 year of follow-up for the assessment of quality of life, costs, complications, and clinical recurrence. After the end of the study, patients will be followed up for 3 years to re-evaluate the variables over the long term. Forty patients with de novo stenosis in CD will be recruited from 15 hospitals in Spain and will be randomly assigned to the endoscopic or surgical treatment groups. The primary aim will be the evaluation of the patient quality of life at 1 year follow-up (% of patients with an increase of 30 points in the 32-item Inflammatory Bowel Disease Questionnaire (IBDQ-32). The secondary aim will be evaluation of the clinical recurrence rate, complications, and costs of both treatments at 1-year follow-up. DISCUSSION: The ENDOCIR trial has been designed to determine whether an endoscopic or surgical approach is therapeutically superior in the treatment of de novo stenosis in CD. TRIAL REGISTRATION: ClinicalTrials.gov NCT04330846. Registered on 1 April 1 2020. https://clinicaltrials.gov/ct2/home.
Assuntos
Doença de Crohn , Humanos , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/cirurgia , Constrição Patológica , Dilatação , Qualidade de Vida , Resultado do Tratamento , Stents/efeitos adversosRESUMO
El carcinoma de mama se manifiesta frecuentemente como microcalcificaciones distribuidas siguiendo patrones cálcicos característicos.La presencia de microcalcificaciones en los ganglios axilares es un hallazgo infrecuente, y excepcionalmente secundaria a la afectación metastásica de los mismos por un carcinoma mamario. Presentamos el caso de una paciente con antecedentes de artritis reumatoide con microcalcificaciones en ganglios axilares observadas en una mamografía de control, describiendo los hallazgos radiológicos, el diagnóstico diferencial, y realizando una revisión de la bibliografía (AU)
Assuntos
Idoso , Feminino , Humanos , Calcinose/complicações , Calcinose/diagnóstico , Calcinose , Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico , Artrite Reumatoide , Doenças Mamárias/complicações , Doenças Mamárias/diagnóstico , Doenças Mamárias , Mamografia/métodos , Antirreumáticos/administração & dosagem , Antirreumáticos/uso terapêutico , Diagnóstico Diferencial , Mamografia/classificação , Mamografia/instrumentação , Axila , Axila/patologia , Necrose Gordurosa/diagnóstico , Necrose Gordurosa/etiologia , Doenças da Túnica Conjuntiva/complicações , Doenças da Túnica Conjuntiva/diagnósticoRESUMO
En el estudio de las causas de infertilidad, los factores tubáricos y peritoneales representan el 25-40 por ciento de los casos. La histerosalpingografía (HSG) es el método diagnóstico principal en el estudio de la morfología y permeabilidad tubárica, aunque presenta una menor sensibilidad en la valoración de las adherencias pélvicas. El propósito de este trabajo es describir las manifestaciones radiológicas más frecuentes de las principales patologías tubáricas y peritoneales observadas mediante histerosalpingografía. Hemos revisado las histerosalpingografías practicadas en nuestro centro desde enero de 1998 hasta diciembre de 1999 en pacientes en estudio de infertilidad, seleccionando las imágenes más representativas de las distintas entidades patológicas (AU)