RESUMO
BACKGROUND AND STUDY AIMS: Data from Japanese series show that surface morphology of laterally spreading tumors (LST) in the colon identifies lesions with different incidence and pattern of submucosal invasion. Such data from western countries are scarce. We compared clinical and histological features of LST in a western country and an eastern country, with special interest on mucosal invasiveness of LST, and investigated the effect of clinical factors on invasiveness in both countries. PATIENTS AND METHODS: Patients with LST lesions ≥20mm were included from a multicenter prospective registry in Spain and from a retrospective registry from the National Cancer Center Hospital East, Japan. The primary outcome was the presence of submucosal invasion in LST. The secondary outcome was the presence of high-risk histology, defined as high-grade dysplasia or submucosal invasion. RESULTS: We evaluated 1102 patients in Spain and 663 in Japan. Morphological and histological characteristics differed. The prevalence of submucosal invasion in Japan was six-fold the prevalence in Spain (Prevalence Ratio PR=5.66; 95%CI: 3.96, 8.08), and the prevalence of high-risk histology was 1.5 higher (PR=1.44; 95%CI: 1.31, 1.58). Compared to the granular homogeneous type and adjusted by clinical features, granular mixed, flat elevated, and pseudo-depressed types were associated with higher odds of submucosal invasion in Japan, whereas only the pseudo-depressed type showed higher risk in Spain. Regarding high-risk histology, both granular mixed and pseudo-depressed were associated with higher odds in Japan, compared with only the granular mixed type in Spain. CONCLUSION: This study reveals differences in location, morphology and invasiveness of LST in an eastern and a western cohort.
Assuntos
Colonoscopia , Neoplasias Colorretais , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Humanos , Mucosa Intestinal/patologia , Invasividade Neoplásica/patologia , Estudos RetrospectivosRESUMO
BACKGROUND AND AIMS: The Endoscopic Resection Group of the Spanish Society of Endoscopy (GSEED-RE) model and the Australian Colonic Endoscopic Resection (ACER) model were proposed to predict delayed bleeding (DB) after EMR of large superficial colorectal lesions, but neither has been validated. We validated and updated these models. METHODS: A multicenter cohort study was performed in patients with nonpedunculated lesions ≥20 mm removed by EMR. We assessed the discrimination and calibration of the GSEED-RE and ACER models. Difficulty performing EMR was subjectively categorized as low, medium, or high. We created a new model, including factors associated with DB in 3 cohort studies. RESULTS: DB occurred in 45 of 1034 EMRs (4.5%); it was associated with proximal location (odds ratio [OR], 2.84; 95% confidence interval [CI], 1.31-6.16), antiplatelet agents (OR, 2.51; 95% CI, .99-6.34) or anticoagulants (OR, 4.54; 95% CI, 2.14-9.63), difficulty of EMR (OR, 3.23; 95% CI, 1.41-7.40), and comorbidity (OR, 2.11; 95% CI, .99-4.47). The GSEED-RE and ACER models did not accurately predict DB. Re-estimation and recalibration yielded acceptable results (GSEED-RE area under the curve [AUC], .64 [95% CI, .54-.74]; ACER AUC, .65 [95% CI, .57-.73]). We used lesion size, proximal location, comorbidity, and antiplatelet or anticoagulant therapy to generate a new model, the GSEED-RE2, which achieved higher AUC values (.69-.73; 95% CI, .59-.80) and exhibited lower susceptibility to changes among datasets. CONCLUSIONS: The updated GSEED-RE and ACER models achieved acceptable prediction levels of DB. The GSEED-RE2 model may achieve better prediction results and could be used to guide the management of patients after validation by other external groups. (Clinical trial registration number: NCT03050333.).
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Ressecção Endoscópica de Mucosa , Austrália , Estudos de Coortes , Colonoscopia , Neoplasias Colorretais/cirurgia , Humanos , Fatores de RiscoRESUMO
This document summarizes the contents of the Clinical Guidelines for the Endoscopic Mucosal Resection of Non-Pedunculated Colorectal Lesions that was developed by the working group of the Spanish Society of Digestive Endoscopy (GSEED of Endoscopic Resection). This document presents recommendations for the endoscopic management of superficial colorectal neoplastic lesions.
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Neoplasias Colorretais/cirurgia , Cirurgia Colorretal/métodos , Ressecção Endoscópica de Mucosa/métodos , Endoscopia Gastrointestinal/métodos , Mucosa Intestinal/cirurgia , Doenças do Colo/cirurgia , Cirurgia Colorretal/normas , Ressecção Endoscópica de Mucosa/normas , Endoscopia Gastrointestinal/normas , Humanos , Doenças Retais/cirurgiaRESUMO
This document summarizes the contents of the Clinical Guidelines for the Endoscopic Mucosal Resection of Non-Pedunculated Colorectal Lesions that was developed by the working group of the Spanish Society of Digestive Endoscopy (GSEED of Endoscopic Resection). This document presents recommendations for the endoscopic management of superficial colorectal neoplastic lesions.
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Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa/normas , HumanosRESUMO
BACKGROUND & AIMS: After endoscopic mucosal resection (EMR) of colorectal lesions, delayed bleeding is the most common serious complication, but there are no guidelines for its prevention. We aimed to identify risk factors associated with delayed bleeding that required medical attention after discharge until day 15 and develop a scoring system to identify patients at risk. METHODS: We performed a prospective study of 1214 consecutive patients with nonpedunculated colorectal lesions 20 mm or larger treated by EMR (n = 1255) at 23 hospitals in Spain, from February 2013 through February 2015. Patients were examined 15 days after the procedure, and medical data were collected. We used the data to create a delayed bleeding scoring system, and assigned a weight to each risk factor based on the ß parameter from multivariate logistic regression analysis. Patients were classified as being at low, average, or high risk for delayed bleeding. RESULTS: Delayed bleeding occurred in 46 cases (3.7%, 95% confidence interval, 2.7%-4.9%). In multivariate analysis, factors associated with delayed bleeding included age ≥75 years (odds ratio [OR], 2.36; P < .01), American Society of Anesthesiologist classification scores of III or IV (OR, 1.90; P ≤ .05), aspirin use during EMR (OR, 3.16; P < .05), right-sided lesions (OR, 4.86; P < .01), lesion size ≥40 mm (OR, 1.91; P ≤ .05), and a mucosal gap not closed by hemoclips (OR, 3.63; P ≤ .01). We developed a risk scoring system based on these 6 variables that assigned patients to the low-risk (score, 0-3), average-risk (score, 4-7), or high-risk (score, 8-10) categories with a receiver operating characteristic curve of 0.77 (95% confidence interval, 0.70-0.83). In these groups, the probabilities of delayed bleeding were 0.6%, 5.5%, and 40%, respectively. CONCLUSIONS: The risk of delayed bleeding after EMR of large colorectal lesions is 3.7%. We developed a risk scoring system based on 6 factors that determined the risk for delayed bleeding (receiver operating characteristic curve, 0.77). The factors most strongly associated with delayed bleeding were right-sided lesions, aspirin use, and mucosal defects not closed by hemoclips. Patients considered to be high risk (score, 8-10) had a 40% probability of delayed bleeding.
Assuntos
Técnicas de Apoio para a Decisão , Ressecção Endoscópica de Mucosa/efeitos adversos , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Espanha , Adulto JovemRESUMO
BACKGROUND: Colorectal cancer screening effect on right-sided colorectal neoplasia is limited. We compared fecal immunochemical test and simulated sigmoidoscopy diagnostic accuracy for advanced right-sided neoplasia detection. METHODS: We analyzed 1,292 individuals with complete screening colonoscopy with a fecal immunochemical test determination before colonoscopy. Sigmoidoscopy and "hybrid strategy" (sigmoidoscopy or fecal hemoglobin concentration ≥ 20 µg hemoglobin/g) diagnostic yield were simulated according to UK Flexible Sigmoidoscopy, Screening for COlon REctum (SCORE), and Norwegian Colorectal Cancer Prevention (NORCCAP) trials criteria to complete colonic examination. We compared sensitivity and specificity of both strategies and of "hybrid strategy" for advanced right-sided neoplasia with McNemar test. RESULTS: An advanced right-sided neoplasia was detected in 47 (3.6 %) subjects. A fecal hemoglobin concentration ≥ 20 µg hemoglobin/g was determined in 6.6 % of the subjects and 10.1, 12.7, and 23.5 % met UK, SCORE, and NORCCAP criteria, respectively. Fecal immunochemical test was statistically more specific than sigmoidoscopy strategies (93.8 %, UK 90.3 %, SCORE 87.7 %, NORCCAP 77.8 %; p < 0.001). In contrast, fecal immunochemical test sensitivity for advanced right-sided neoplasia (17 %) was not statistically different than UK (21.3 %; p = 0.7) or SCORE (23.4 %; p = 0.5), although it was inferior than NORCCAP strategy (42.5 %; p < 0.001). Adding fecal immunochemical test to sigmoidoscopy increased number of positives (8.5-25.7 %), sensitivity (10-30 %), and significantly reduced advanced right-sided neoplasia specificity (p < 0.001). CONCLUSIONS: Fecal immunochemical test and sigmoidoscopy diagnostic yield for advanced right-sided neoplasia are low. Fecal immunochemical test is more specific than sigmoidoscopy but less sensitive than sigmoidoscopy according to NORCCAP criteria.
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Neoplasias Colorretais/diagnóstico , Imuno-Histoquímica , Sangue Oculto , Sigmoidoscopia , Idoso , Neoplasias Colorretais/imunologia , Neoplasias Colorretais/patologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Encaminhamento e Consulta , EspanhaRESUMO
There is little information on fecal immunochemical test (FIT) in familial risk colorectal cancer (CRC) screening. Our study assesses FIT accuracy, number needed to scope (NNS) and cost to detect a CRC and an advanced neoplasia (AN) in this setting. We performed a multicentric, prospective, double-blind study of diagnostic tests on individuals with first-degree relatives (FDRs) with CRC submitted to screening colonoscopy. Two stool samples were collected and fecal hemoglobin in the first sample (FIT1) and the highest in both samples (FITmax) were determined. Areas under the curve (AUC) for CRC and AN as well as the best FIT1 and FITmax cutoff value for CRC were determined. At this threshold, NNS and the cost per lesion detected were calculated. A total of 595 individuals were included (one FDR > 60 years, 413; two FDR or one ≤ 60 years, 182). AN and CRC were found in 64 (10.8%) and six (1%) patients, respectively. For CRC diagnosis, FIT1 AUC was 0.96 [95% confidence interval (CI): 0.95-0.98] and FITmax AUC was 0.95 (95% CI: 0.93-0.97). For AN diagnosis, FIT1 and FITmax AUC were 0.74 (95% CI: 0.66-0.82). The best cutoff point for CRC was 115. At this threshold, the NNS to detect a CRC was 5.67 and 7.67, and the cost per CRC was 1,064 and 1591.33 on FIT1 and FITmax strategies, respectively. FIT shows high accuracy to detect CRC in familial CRC screening. Performing two tests does not improve diagnostic accuracy, but increases cost and NNS to detect a lesion.
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Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Fezes/química , Predisposição Genética para Doença , Colonoscopia , Neoplasias Colorretais/economia , Neoplasias Colorretais/genética , Análise Custo-Benefício , Estudos Transversais , Método Duplo-Cego , Feminino , Seguimentos , Hemoglobinas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Prospectivos , Curva ROCRESUMO
Resumen Introducción Cada año a nivel mundial se presentan millones de muertes y lesiones no mortales por inadecuadas prácticas en salud laboral, muertes por cardiopatías isquémicas y accidente cerebrovascular son causadas por largas jornadas y altas cargas laborales. Objetivo Identificar el grado de correlación del riesgo psicosocial con el riesgo de enfermedad cardiovascular e indicadores de adiposidad corporal: IMC (índice de masa corporal), PA (perímetro abdominal) y BFP (porcentaje de grasa corporal) en trabajadores del sector económico de comercio. Método Estudio de enfoque cuantitativo y alcance correlacional no causal, con una muestra de 118 sujetos (56.7% mujeres y 43.3% hombres). Se evaluó los indicadores de adiposidad mediante el protocolo internacional para la valoración antropométrica ISAK, el riesgo cardiovascular por medio de la escala de Framingham y para evaluar el riesgo psicosocial se aplicó la Batería de Instrumentos para la Evaluación de Factores de Riesgos Psicosociales validada para la población colombiana. Estos datos fueron procesados y analizados estadísticamente mediante SPSS versión 28. Resultados Se destaca una relación significativa (p < .05) entre las variables en diferentes grados, en el caso de la correlación entre enfermedad cardiovascular y el riesgo psicosocial su coeficiente de correlación es de (r = .62), para la correlación entre el IMC y el riesgo psicosocial un coeficiente de (r = .52), en el caso del BFP y el riesgo psicosocial en mujeres fue de (r = .45) y en hombres de (r = .67) y para el PA y el riesgo psicosocial, su coeficiente de correlación fue de (r = .42) y (r = .64) respectivamente. Conclusión Existe una correlación positiva y fuerte entre el riesgo psicosocial y el riesgo de enfermedad cardiovascular, del mismo modo, entre el IMC y el riesgo psicosocial. En el caso del BFP y el riesgo psicosocial, el grado de correlación fue moderado en mujeres y fuerte en hombres al igual que en la correlación entre el PA y el riesgo psicosocial.
Resumo Introdução Todos os anos, em todo o mundo, ocorrem milhões de mortes e lesões não fatais devido a práticas inadequadas de saúde ocupacional, as mortes por doença cardíaca isquêmica e acidente vascular cerebral são causadas por longas jornadas de trabalho e altas cargas de trabalho. Objetivo Identificar o grau de correlação do risco psicossocial com o risco de doenças cardiovasculares e com os indicadores de adiposidade corporal: IMC (índice de massa corporal), PA (circunferência abdominal) e PBC (percentagem de gordura corporal) em trabalhadores do sector econômico do comércio. Método Estudo quantitativo de âmbito correlacional não causal, com uma amostra de 118 indivíduos (56.7% mulheres e 43.3% homens). Os indicadores de adiposidade foram avaliados através do protocolo internacional de avaliação antropométrica ISAK, o risco cardiovascular foi avaliado através da escala de Framingham e o risco psicossocial foi avaliado através da Bateria de Instrumentos para a Avaliação de Factores de Risco Psicossocial validada para a população colombiana. Estes dados foram processados e analisados estatisticamente utilizando o SPSS versão 28. Resultados Existe uma relação significativa (p < .05) entre as variáveis em diferentes graus, no caso da correlação entre doença cardiovascular e risco psicossocial o seu coeficiente de correlação é (r = .62), para a correlação entre IMC e risco psicossocial um coeficiente de (r = .52), para a PAF e risco psicossocial nas mulheres um coeficiente de (r = .52). 62), para a correlação entre o IMC e o risco psicossocial um coeficiente de (r = .52), no caso da PA e do risco psicossocial nas mulheres foi (r = .45) e nos homens (r = .67) e para a PA e o risco psicossocial, o seu coeficiente de correlação foi (r = .42) e (r = .64) respetivamente. Conclusão Existe uma forte correlação positiva entre o risco psicossocial e o risco de doença cardiovascular, bem como entre o IMC e o risco psicossocial. No caso da PAF e do risco psicossocial, o grau de correlação foi moderado nas mulheres e forte nos homens, tal como a correlação entre a PA e o risco psicossocial.
Abstract Introduction Every year worldwide millions of deaths and non-fatal injuries occur due to inadequate occupational health practices, deaths from ischemic heart disease and stroke are caused by long working hours and high workloads. Objective To identify the degree of correlation of psychosocial risk with the risk of cardiovascular disease and body adiposity indicators: BMI (body mass index), AC (abdominal circumference) and BFP (body fat percentage) in workers of the commerce economic sector. Method A study with a quantitative approach and non-causal correlational scope, with a sample of 118 subjects (56.7% women and 43.3% men). Adiposity indicators were evaluated by means of the international protocol for anthropometric assessment ISAK, cardiovascular risk by means of the Framingham scale and to evaluate psychosocial risk, the Battery of Instruments for the Evaluation of Psychosocial Risk Factors validated for the Colombian population was applied. These data were processed and analyzed statistically using SPSS version 28. Results A significant relationship (p < .05) between the variables is highlighted in different degrees, in the case of the correlation between cardiovascular disease and psychosocial risk its correlation coefficient is (r =. 62), for the correlation between BMI and psychosocial risk a coefficient of (r = .52), in the case of BFP and psychosocial risk in women it was (r = .45) and in men (r = .67) and for AC and psychosocial risk, its correlation coefficient was (r = .42) and (r = .64) respectively. Conclusion There was a strong positive correlation between psychosocial risk and cardiovascular disease risk, as well as between BMI and psychosocial risk. In the case of BFP and psychosocial risk, the degree of correlation was moderate in women and strong in men, as was the correlation between AC and psychosocial risk.
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Gastropod communities associated with the calcareous green alga Halimeda opuntia are described and compared for two Puerto Rico coral reefs: one in the northeast with front tradewinds (windward zone) and one in the southwest (leeward zone). We analyzed the content of 21 lots (2432 g) of H. opuntia from leeward zone and 15 lots (2448 g) from the windward zone. In total we recovered 526 gastropods (prosobranchs) classified in 54 taxa. Thirteen species of gastropods represented 79.6% of the community. Differences between species richness and mean density values were not significant (p > 0.100). Forty species were identified from leeward and thirty one (31) species from windward. Gastropod mean density was 13.9/100 g of algae in leeward and 7.6/100 g in windward. Significant differences were found for the Simpson Diversity Index (0.91 in the leeward and 0.82 in the windward community; t = 3.44, alpha = 0.005). We found no correlation between the weight of the algae and the frequency of the gastropods (R2 = 0.0893 in leeward, 0.0249 windward and 0.0923 for both). The relationship between species composition in lots of windward and leeward study sites was explored via polar ordination and no segregation was found. When compared, the gastropod communities found in H. opuntia collected in coral reefs in Puerto Rico were more similar within them than any other communities found in other genera of seaweed and in other environments. Our results agree with the hypothesis that H. opuntia offers the interstitial community a protected microhabitat from water movement impact. H. opuntia creates more homogenous conditions than those of the habitat where we found the algae.
Assuntos
Clorófitas/classificação , Ecossistema , Gastrópodes/classificação , Animais , Biodiversidade , Gastrópodes/fisiologia , Densidade Demográfica , Porto RicoRESUMO
Background and study aims: Data from Japanese series show that surface morphology of laterally spreading tumors (LST) in the colon identifies lesions with different incidence and pattern of submucosal invasion. Such data from western countries are scarce. We compared clinical and histological features of LST in a western country and an eastern country, with special interest on mucosal invasiveness of LST, and investigated the effect of clinical factors on invasiveness in both countries. Patients and methods: Patients with LST lesions ≥20mm were included from a multicenter prospective registry in Spain and from a retrospective registry from the National Cancer Center Hospital East, Japan. The primary outcome was the presence of submucosal invasion in LST. The secondary outcome was the presence of high-risk histology, defined as high-grade dysplasia or submucosal invasion. Results: We evaluated 1102 patients in Spain and 663 in Japan. Morphological and histological characteristics differed. The prevalence of submucosal invasion in Japan was six-fold the prevalence in Spain (Prevalence Ratio PR=5.66; 95%CI: 3.96, 8.08), and the prevalence of high-risk histology was 1.5 higher (PR=1.44; 95%CI: 1.31, 1.58). Compared to the granular homogeneous type and adjusted by clinical features, granular mixed, flat elevated, and pseudo-depressed types were associated with higher odds of submucosal invasion in Japan, whereas only the pseudo-depressed type showed higher risk in Spain. Regarding high-risk histology, both granular mixed and pseudo-depressed were associated with higher odds in Japan, compared with only the granular mixed type in Spain. Conclusion: This study reveals differences in location, morphology and invasiveness of LST in an eastern and a western cohort.(AU)
Antecedentes y objetivos del estudio: Los datos de series japonesas muestran que la morfología de los tumores de extensión lateral (LST) en el colon identifica lesiones con diferente incidencia y patrón de invasión submucosa. Esta información es escasa en series de países occidentales. Comparamos las características clínicas e histológicas de LST en un país occidental y un país del este, con especial interés en la infiltración de la lesión, e investigamos el efecto de los factores clínicos sobre esta infiltración en ambos países. Pacientes y métodos: Se incluyeron pacientes con lesiones LST ≥20mm de un registro prospectivo multicéntrico en España y de un registro retrospectivo del National Cancer Center Hospital East, Japón. El objetivo primario fue la presencia de invasión submucosa en los LST. El objetivo secundario fue la presencia de histología de alto riesgo, definida como displasia de alto grado o invasión submucosa. Resultados: Evaluamos 1.102 pacientes en España y 663 en Japón. Las características morfológicas e histológicas difirieron. La prevalencia de invasión submucosa en Japón fue 6 veces mayor que la prevalencia en España (razón de prevalencia PR=5,66; IC 95%: 3,96, 8,08), y la prevalencia de histología de alto riesgo fue 1,5 mayor (PR=1,44; IC 95%: 1,31, 1,58). En comparación con el tipo granular homogéneo y ajustado por las características clínicas, los tipos granular mixto, plano elevado y pseudodeprimido se asociaron con mayores probabilidades de invasión submucosa en Japón, mientras que solo el tipo pseudodeprimido mostró mayor riesgo en España. Con respecto a la histología de alto riesgo, tanto el granular mixto como el pseudodeprimido se asociaron con mayores probabilidades en Japón, en comparación con solo el tipo granular mixto en España. Conclusión: Este estudio revela diferencias en la localización, morfología e invasividad de LST en una cohorte oriental y occidental.(AU)
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Humanos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Mucosa Intestinal/patologia , Estudos Retrospectivos , Gastroenterologia , Espanha , JapãoRESUMO
BACKGROUND: Studies directed at understanding the demography and population dynamics of corals are relatively scarce. This limits our understanding of both the dynamics of coral populations and our capacity to develop management and conservation initiatives directed at conserving such ecosystems. METHODS: From 2012 to 2014, we collected data on the growth, survival, and recruitment rates of two common Caribbean coral species, the stress-tolerant Orbicella annularis and the weedy Porites astreoides. A set of size-based population matrix model was developed for two localities in Northeastern Puerto Rico and used to estimate population growth rates (λ) and determine the life cycle transition(s) that contribute the most to spatiotemporal differences in λs. The model was parameterized by following the fate of 100 colonies of each species at the two sites for two years. RESULTS: Our data indicate that spatial variability in vital rates of both species was higher than temporal variability. During the first year, populations of O. annularis exhibited λs below equilibrium at Carlos Rosario (0.817) and Palomino (0.694), followed by a considerable decline at both sites during the second year (0.700 and 0.667). Populations of P. astreoides showed higher λs than O. annularis during the first census period at Carlos Rosario (0.898) and Palomino (0.894) with a decline at one of the sites (0.681 and 0.893) during the second census period. Colony fate in both species exhibited a significant interaction with respect to location but not to time (G2 = 20.96; df = 3 for O. annularis and G2 = 9.55; df = 3 for P. astreoides). DISCUSSION: The similar variability of λs as well as the similar survival rates for both species during the two-year census period (2012-2014) show similar variability on demographic patterns in space and time. Our results suggest that location rather than time is important for the resiliency in coral colonies. Also, P. astreoides will show higher resistance to disturbance in the future than O. annularis.
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BACKGROUND AND OBJECTIVES: Isolated vasculitis of the gastrointestinal (GI) tract is a rare entity. Endoscopic biopsies have low sensitivity to diagnose intestinal vasculitis, even though the endoscopic findings may be suggestive of this condition. Our aims were to describe a case of biopsy-proven colonic leukocytoclastic vasculitis and review the literature. METHODS: A patient with biopsy-proven colonic leukocytoclastic vasculitis is described. A Medline database search of cases with localized GI vasculitis between January 1985 and September 2005 was conducted. RESULTS: A 32-year-old man was admitted to the hospital because of abdominal pain and diarrhea. A colonic biopsy showed leukocytoclastic vasculitis. There are very few articles on leukocytoclastic GI vasculitis as a separate disease, and most of them emphasize the difficulty in classification. Unlike our case, in former cases of localized vasculitis a diagnosis was made after surgery. Although our patient had steroid-refractory biopsy-proven isolated intestinal vasculitis, treatment with intravenous cyclophosphamide resulted in rapid resolution of symptoms and surgery was not required. CONCLUSIONS: In patients with abdominal pain a diagnosis of intestinal vasculitis should be considered. Immunosuppressive therapy allowed our patient to avoid surgery and may be similarly beneficial in other similar cases.
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Doenças do Colo Sigmoide/diagnóstico , Vasculite Leucocitoclástica Cutânea/diagnóstico , Adulto , Anti-Inflamatórios/administração & dosagem , Azatioprina/administração & dosagem , Biópsia , Colonoscopia , Ciclofosfamida/administração & dosagem , Quimioterapia Combinada , Humanos , Imunossupressores/administração & dosagem , Masculino , Metilprednisolona/administração & dosagem , Prednisona/administração & dosagem , Doenças do Colo Sigmoide/tratamento farmacológico , Doenças do Colo Sigmoide/patologia , Vasculite Leucocitoclástica Cutânea/tratamento farmacológico , Vasculite Leucocitoclástica Cutânea/patologiaRESUMO
BACKGROUND: Fecal immunochemical test (FIT) diagnostic accuracy for colorectal adenoma detection in colorectal cancer screening is limited. METHODS: We analyzed 474 asymptomatic subjects with adenomas detected on colonoscopy in two blinded diagnostic tests studies designed to assess FIT diagnostic accuracy. We determined the characteristics of adenomas (number, size, histology, morphology, and location) and the risk of metachronous lesions (according to European guidelines). Finally, we performed a logistic regression to identify those variables independently associated with a positive result. RESULTS: Advanced adenomas were found in 145 patients (75.6% distal and 24.3% only proximal to splenic flexure). Patients were classified as low (59.5%), intermediate (30.2%), and high risk (10.3%) according to European guidelines. At a 100-ng/mL threshold, FIT was positive in 61 patients (12.8%). Patients with advanced adenomas [odds ratio (OR), 8.8; 95% confidence interval (CI), 4.76-16.25], distal advanced adenomas (OR, 6.7; 95% CI, 1.9-8.8), high risk (OR, 20.1; 95% CI, 8.8-45.8), or intermediate risk lesions (OR, 6; 95% CI, 2.9-12.4) had more probabilities to have a positive test. The characteristics of adenomas independently associated were number of adenomas (OR, 1.22; 95% CI, 1.04-1.42), distal flat adenomas (OR, 0.44; 95% CI, 0.21-0.96), pedunculated adenomas (OR, 2.28; 95% CI, 1.48-3.5), and maximum size of distal adenomas (mm; OR, 1.24; 95% CI, 1.16-1.32). CONCLUSIONS: European guidelines classification and adenoma location correlates with the likelihood of a positive FIT result. IMPACT: This information allows us to understand the FIT impact in colorectal cancer prevention. Likewise, it should be taken into account in the development of new colorectal adenomas biomarkers.
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Adenoma/sangue , Neoplasias Colorretais/sangue , Sangue Oculto , Adenoma/patologia , Colonoscopia/métodos , Neoplasias Colorretais/patologia , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Humanos , Imuno-Histoquímica/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
BACKGROUND: There is little information about the fecal immunochemical test (FIT) in familial-risk colorectal cancer (CRC) screening. OBJECTIVES: The objective of this article is to investigate whether FIT diagnostic accuracy for advanced neoplasia (AN) differs between average and familial-risk (first-degree relative) patients. METHODS: A total of 1317 consecutive participants (595 familial) who collected one stool sample before performing a colonoscopy as a CRC screening test were included. FIT diagnostic accuracy for AN was evaluated with Chi-square test at a 20 µg hemoglobin/g of feces cut-off value. Finally, we determined which variables were independently related to AN. RESULTS: An AN was found in 151 (11.5%) patients. The overall accuracy was not statistically different between both cohorts for AN (88.4%, 91.7%; p = 0.051). At the cut-off stablished, differences in FIT sensitivity (31.1%, 40.6%; p = 0.2) or specificity (96.5%, 97.3%; p = 0.1) were not statistically significant. Finally, independent variables such as sex (male) (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.4-3.1), age (50-65, >65 years) (OR 2.1, 95% CI 1.1-4.3; OR 2.7, 95% CI 1.2-6.1), previous colonoscopy (OR 0.4, 95% CI 0.2-0.9) and FIT ≥20 µg/g feces (OR 17.7, 95% CI 10.8-29.1) were associated with AN diagnosis. CONCLUSIONS: FIT accuracy for AN detection is equivalent in average and familial-risk CRC screening cohorts.
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Este documento resume el contenido de la Guía de resección mucosa endoscópica elaborada por el grupo de trabajo de la Sociedad Española de Endoscopia Digestiva (GSEED de Resección Endoscópica) y expone las recomendaciones sobre el manejo endoscópico de las lesiones neoplásicas colorrectales superficiales (AU)
This document summarizes the contents of the Clinical Guidelines for the Endoscopic Mucosal Resection of Non-Pedunculated Colorectal Lesions that was developed by the working group of the Spanish Society of Digestive Endoscopy (GSEED of Endoscopic Resection). This document presents recommendations for the endoscopic management of superficial colorectal neoplastic lesions (AU)
Assuntos
Humanos , Masculino , Feminino , Ressecção Endoscópica de Mucosa/métodos , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa/instrumentação , Ressecção Endoscópica de Mucosa/normas , Neoplasias Colorretais/economiaRESUMO
Este documento resume el contenido de la Guía de resección mucosa endoscópica elaborada por el grupo de trabajo de la Sociedad Española de Endoscopia Digestiva (GSEED de Resección Endoscópica) y expone las recomendaciones sobre el manejo endoscópico de las lesiones neoplásicas colorrectales superficiales (AU)
This document summarizes the contents of the Clinical Guidelines for the Endoscopic Mucosal Resection of Non-Pedunculated Colorectal Lesions that was developed by the working group of the Spanish Society of Digestive Endoscopy (GSEED of Endoscopic Resection). This document presents recommendations for the endoscopic management of superficial colorectal neoplastic lesions (AU)
Assuntos
Humanos , Neoplasias Colorretais/cirurgia , Endoscopia Gastrointestinal/métodos , Ressecção Endoscópica de Mucosa/métodos , Mucosa Intestinal/patologia , Revisão por Pares , Seleção de Pacientes , Cuidados Pré-Operatórios/métodos , Colonoscopia/métodosRESUMO
A 76-year-old woman presented with a 1-year history of back pain and sudden onset of plantar keratoderma. Her serum carbohydrate antigen (CA 19.9) levels were elevated. Endoscopic radial sonographic examination led to the diagnosis of pancreatic adenocarcinoma, in a stage not detectable with helical CT yet amenable to surgical therapy. Cutaneous lesions disappeared after distal pancreatectomy.
Assuntos
Adenocarcinoma/complicações , Endossonografia/métodos , Ceratodermia Palmar e Plantar/etiologia , Neoplasias Pancreáticas/complicações , Síndromes Paraneoplásicas , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Idoso , Diagnóstico Diferencial , Progressão da Doença , Feminino , Humanos , Ceratodermia Palmar e Plantar/diagnóstico , Pancreatectomia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgiaRESUMO
A minor proportion of patients with achalasia eventually have a neoplasm and, as a consequence, pseudoachalasia is diagnosed. A neoplasm may either involve gastrointestinal junction or present a paraneoplastic effect. Over the global diagnoses of achalasia issued in 5 years of experience in our motility unit, we have found 13% (3/23 cases) of pseudoachalasia (2-4% in previous series, probably due to the fact that the population assisted was mainly composed of elderly patients). The origin of the neoplasm was bladder, prostate and metastases from epidermoid carcinoma of vocal chord. Treatment of primary neoplasm, besides classical approach (with dilatation of botulinum injection) may help in the resolution of this clinical disorder.
Assuntos
Adenocarcinoma/complicações , Toxinas Botulínicas Tipo A/uso terapêutico , Neoplasias do Colo/complicações , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Acalasia Esofágica , Fármacos Neuromusculares/uso terapêutico , Neoplasias Urológicas/complicações , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Acalasia Esofágica/tratamento farmacológico , Acalasia Esofágica/etiologia , Acalasia Esofágica/fisiopatologia , Humanos , Masculino , Síndromes ParaneoplásicasRESUMO
Gastropods associated with the calcareous alga Halimeda opuntia (Udoteaceae) in Puerto Rico. Gastropod communities associated with the calcareous green alga Halimeda opuntia are described and compared for two Puerto Rico coral reefs: one in the northeast with front tradewinds (windward zone) and one in the southwest (leeward zone). We analyzed the content of 21 lots (2432 g) of H. opuntia from leeward zone and 15 lots (2448 g) from the windward zone. In total we recovered 526 gastropods (prosobranchs) classified in 54 taxa. Thirteen species of gastropods represented 79.6% of the community. Differences between species richness and mean density values were not significant (p>0.100). Forty species were identified from leeward and thirty one (31) species from windward. Gastropod mean density was 13.9 /100g of algae in leeward and 7.6/100g in windward. Significant differences were found for the Simpson Diversity Index (0.91 in the leeward and 0.82 in the windward community; t=3.44, α=0.005). We found no correlation between the weight of the algae and the frequency of the gastropods (R²=0.0893 in leeward, 0.0249 windward and 0.0923 for both). The relationship between species composition in lots of windward and leeward study sites was explored via polar ordination and no segregation was found. When compared, the gastropod communities found in H. opuntia collected in coral reefs in Puerto Rico were more similar within them than any other communities found in other genera of seaweed and in other environments. Our results agree with the hypothesis that H. opuntia offers the interstitial community a protected microhabitat from water movement impact. H. opuntia creates more homogenous conditions than those of the habitat where we found the algae. Rev. Biol. Trop. 56 (4): 1665-1675. Epub 2008 December 12.
Se describen y comparan las comunidades de gasterópodos asociados al alga verde calcárea H. opuntia. Se compararon estas comunidades en arrecifes coralinos de lugares geográfica y ambientalmente diferentes, uno en el noreste de Puerto Rico, frente a los vientos alisios (barlovento), el otro en el suroeste (sotavento). Se analizó el contenido de 15 lotes (2432 g) de H. opuntia recolectadas en la estación de sotavento y 21 lotes (2448 g) en la de barlovento. En los 36 lotes se recuperaron 526 gasterópodos (prosobranquios) que se clasificaron en 54 taxones. Trece especies de gasterópodos representaron el 79.6% de la muestra de la comunidad. No encontramos diferencias significativas en las densidades de gasterópodos ni en la riqueza de especies (p>0.100). La densidad promedio fue de 13.9/100 g alga en la estación de sotavento y 7.6/100 g en la de barlovento. Se identificaron 40 especies diferentes en las muestras de sotavento y 31 en las de barlovento. Solamente se encontraron diferencias significativas en los valores de diversidad (Simpson), de 0.91 para la comunidad de sotavento y de 0.82 en la de barlovento (t = 3.44, α = 0.05). No encontramos correlaciσn entre el peso de la muestra del alga y la frecuencia de gasterσpodos en ésta, R² = 0.0893 para sotavento, 0.0249 para barlovento y 0.0923 para datos combinados. Utilizando los métodos de ordenación polar se comprueba la similitud de las dos comunidades estudiadas. Estos resultados sostienen la hipótesis de que H. opuntia le ofrece a los organismos que viven en sus intersticios un microhábitat protegido del impacto del movimiento del agua, creando condiciones más homogéneas que las del hábitat donde encontramos creciendo el alga.