ABSTRACT
ABSTRACT Background There are no data of reference values on 24-hour multichannel intraluminal impedance and pH (pH-MII) monitoring in Argentinian populations. Objective Our aim was to obtain the normal values of pH-MII variables among healthy asymptomatic volunteers in a metropolitan Health Care Center of Argentina, and to compare them with data already published from other regions around the world. Methods A cross-sectional study was undertaken in a tertiary referral center in Buenos Aires. We enrolled healthy subjects and asked them to undergo esophageal pH-MII 24hours monitoring. pH-MII variables were recorded and described. Results Median reflux events was 20.5 (25-75%, 95%) interquartile range: (14-46, 50) and proximal reflux episodes was 2.5 (0-10, 11). Sixty percent were acid reflux episodes: 12 (5-29, 38), representing a relatively low value when compared to those reported in European, American and Chinese populations. Conclusion Our study shows the first reference of normal values of gastroesophageal reflux in an Argentinian population. We found a total number of reflux events and a total number of proximal reflux events lower than what was reported until this date by other authors.
RESUMO Contexto Não há dados de valores de referência sobre o monitoramento de impedância intraluminal multicanal 24 horas e monitoramento de pH (pH-MII) em populações argentinas. Objetivo O objetivo foi obter os valores normais das variáveis pH-MII entre voluntários assintomáticos saudáveis em um centro metropolitano de saúde da Argentina, e compará-los com dados já publicados de outras regiões do mundo. Métodos Estudo transversal foi realizado em um centro de referência terciário em Buenos Aires. Foram recrutados indivíduos saudáveis para se submeterem ao monitoramento esofágico pH-MII 24 horas. As variáveis pH-MII foram registradas e descritas. Resultados A média de eventos de refluxo foi de 20,5 (25-75%, 95%) entre os episódios interquartis: (14-46, 50) e os episódios de refluxo proximal foram de 2,5 (0-10, 11). Sessenta por cento foram episódios de refluxo ácido: 12 (5-29, 38), representando um valor relativamente baixo quando comparado com os relatados em populações europeias, americanas e chinesas. Conclusão Nosso estudo mostra a primeira referência de valores normais de refluxo gastroesofágico em uma população argentina. Encontramos um número total de eventos de refluxo e um número total de eventos de refluxo proximal menor do que o relatado até esta data por outros autores.
ABSTRACT
Resumen: La embolia por cristales de colesterol es una enfermedad sistémica caracterizada por la oclusión de pequeñas arterias debido al desprendimiento de los mismos desde las placas de ateroma formadas en las paredes de arterias principales. Este caso clínico corresponde a un paciente masculino de 77 años de edad con factores de riesgo de enfermedad vascular que ingresó al servicio de urgencias por disnea y ortopnea. Se diagnosticó un cuadro clínico de insuficiencia cardiaca aguda y recibió tratamiento médico con buena respuesta. Se realizó una cinecoronariografía que evidenció severa ateroesclerosis coronaria con enfermedad de tres vasos, recibió tratamiento endovascular con colocación de endoprótesis vasculares. Luego de 20 días el paciente evolucionó con deposiciones melénicas, oligoanuria y claudicación intermitente progresiva en ambos miembros inferiores. Se observó obstrucción del flujo arterial en ambas arterias pedias por ecografía doppler; las biopsias de la piel de los pies revelaron signos vasculares correspondientes a depósitos de cristales de colesterol. Se interpretó enfermedad por embolia de cristales de colesterol secundario a las maniobras de cateterización previa, que provocaron alteraciones multiorgánicas isquémicas y persistentes. Resulta interesante este padecimiento porque es un proceso grave que demanda alto grado de sospecha clínica, el diagnóstico definitivo se establece mediante biopsia de las lesiones cutáneas, el pronóstico depende de la extensión de la enfermedad y en la actualidad no existe un tratamiento específico.
Abstract: The cholesterol crystal embolism is a systemic disease characterized by the occlusion of small arteries due these crystals, which come from the atheroma plaques of the walls of major arteries. This clinical case corresponds to a 77-year-old male patient with risk factors for cardiovascular disease who entered at the emergency service due dyspnea and orthopnea. In the Coronary Unit, a clinical status of acute heart failure was diagnosed, receiving medical treatment with good response. It was decided to perform a coronary angiography which showed a severe coronary atherosclerosis with 3-vessel compromised and endovascular treatment was performed with stent placement. After 20 days, the patient evolved with melenic depositions oligoanuria and progressive intermittent claudication in both lower limbs. Obstruction of arterial flow was observed in both pedia arteries by doppler ultrasound. Skin biopsies of lower limbs revealed vascular signs of deposits of cholesterol crystals. It was recognized as a cholesterol crystal disease secondary to previous medical catheterization procedures, causing ischemia and persistent alterations in the digestive and renal systems as well as in the skin of the lower limbs. This is an important affection because it is a serious process that demands a high level of clinical suspicion, the definitive diagnosis is established through the biopsy of the cutaneous lesions and the prognosis depends on the extension of the disease. Nowadays, there is no specific medical treatment of this disease.