ABSTRACT
Introduction: Video capsule endoscopy (VCE) is a useful test for the evaluation of the small bowel mucosa. The main complication of VCE is retention, so in patients with risk factors it is recommended to evaluate the permeability of the digestive tract with Patency Capsule (PC). We describe patients evaluated with PC before the study with VCE. Methods: Descriptive observational study of 96 patients referred for VCE. A clinical survey and images identified that 7 of these patients (7.3%) had retention risk factors, so they were previously requested PC. Results: 2 of the 7 patients evaluated with PC did not excrete the device, so the use of VCE was contraindicated; the subsequent study concluded Crohn's disease (CD) and jejunal stenosis due to retractable mesenteritis in these cases. Of the remaining 89 patients, not evaluated with PC, 1 (1.1%) developed retention of the VCE at an ulcerated stenosis, and was subsequently diagnosed as CD. Conclusion: In our study, we confirmed the usefulness of PC as a method to assess the risk of retention of VCE in patients with risk factors for ID stenosis.
Introducción: La video-cápsula endoscópica (VCE) es un examen útil para el estudio de patologías del intestino delgado (ID). La principal complicación de la VCE es la retención, por lo que en pacientes con factores de riesgo se recomienda evaluar la permeabilidad del tubo digestivo con Cápsula Patency (CP). Se presenta una serie de casos evaluados con CP previo al estudio con VCE. Métodos: Estudio observacional descriptivo de 96 pacientes derivados para realización de VCE. Mediante encuesta clínica e imágenes se identificó que 7 de estos pacientes (7,3%) tenían factores de riesgo de retención, por lo que se les solicitó previamente CP. Resultados: 2 de los 7 pacientes evaluados con CP no expulsaron el dispositivo por lo que se contraindicó el uso de VCE; el estudio posterior concluyó Enfermedad de Crohn (EC) y estenosis yeyunal por mesenteritis retráctil en estos dos casos. De los 89 pacientes restantes, no evaluados con CP, 1 (1,1%) presentó retención de la VCE a nivel de una estenosis ulcerada diagnosticada posteriormente como EC. Conclusión: En nuestra casuística se confirma la utilidad de la CP como un método para evaluar el riesgo de retención de VCE en pacientes con factores de riesgo de estenosis de ID.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Capsule Endoscopes/adverse effects , Intestinal Obstruction/etiology , Intestinal Obstruction/prevention & control , Intestine, Small/pathology , Retrospective Studies , Foreign BodiesABSTRACT
Crohn's disease is an inflammatory bowel disease that affects the intestinal bowel in a transmural way presenting with fistulizing phenotypes with abnormal communication between two epithelial surfaces. In perianal Crohn's disease, there are fistulizing tracts between the anal canal and perianal skin that can complicate with abscess formation. Symptoms include pain, perianal discharge and fluctuating lesions, requiring combined clinical and surgical management. The disease is difficult to treat and is associated with significant reduction in quality of life, requiring a multidisciplinary approach for the management of these patients. The following review describes clinical concepts of perianal Crohn's disease, with emphasis on diagnosis and treatment.
La enfermedad de Crohn es una enfermedad inflamatoria del tubo digestivo con compromiso transmural de la pared que puede manifestarse con fenotipos fistulizantes mediante el desarrollo de comunicaciones anormales entre dos superficies epiteliales. En el caso de la enfermedad de Crohn perianal se establecen trayectos fistulosos entre el epitelio del canal anal y la piel alrededor del ano, que pueden complicarse con la formación de abscesos. Clínicamente se presenta con descarga perianal, dolor y masa fluctuante requiriendo un manejo conjunto médico-quirúrgico para el tratamiento de las complicaciones, el control de las fístulas y el compromiso luminal asociado. Es necesario un enfoque multidisciplinario dado que es una enfermedad de difícil manejo que afecta la calidad de vida de los pacientes. En la siguiente revisión se exponen conceptos acerca de la enfermedad de Crohn fistulizante perianal y sus complicaciones, con énfasis en el diagnóstico y tratamiento.
Subject(s)
Humans , Crohn Disease/complications , Rectal Fistula/diagnosis , Rectal Fistula/etiology , Rectal Fistula/therapy , Magnetic Resonance Imaging , Inflammatory Bowel Diseases/complications , Rectal Fistula/classification , AbscessABSTRACT
Capsule endoscopy is a technique that allows the study of the small intestine, through a device that is swallowed by the patient, capturing images as it travels through the digestive tract. Capsule retention is the most serious complication. We report the case of a 69 year-old male presenting with iron deficiency anemia, with normal upper endoscopy and colonoscopy; but obscure gastrointestinal bleeding was diagnosed and therefore a study with capsule endoscopy was requested. The patient evolves with retained capsule in the small intestine with ulcerated stenosis as shown by imaging. This finding was confirmed by enteroscopy with biopsy, without being able to extract the capsule. Medical management with corticosteroids was indicated for intestinal obstruction secondary to inflammatory stenosis in the context of Crohn's disease: The capsule was expelled after 21 days of ingestion, with a positive outcome
La cápsula endoscópica es una técnica que permite el estudio del intestino delgado, mediante un dispositivo que es deglutido por el paciente y captura imágenes en su recorrido por el tubo digestivo. La complicación más grave es la retención de la cápsula. Se reporta el caso de un paciente de sexo masculino, de 69 años con anemia ferropénica, con endoscopia alta y colonoscopia normal; planteándose sangrado gastrointestinal de origen oscuro por lo que se solicita estudio con cápsula endoscópica. El paciente evoluciona con retención de la cápsula en intestino delgado, visualizándose en las imágenes la presencia de estenosis ulcerada, hallazgo que se confirma mediante enteroscopia con toma de biopsias, sin lograr extraer la cápsula. Se indica manejo médico con corticoides por obstrucción intestinal secundario a estenosis inflamatoria en contexto de enfermedad de Crohn, expulsando espontáneamente la cápsula al día 21 de su ingestión, sin complicaciones.
Subject(s)
Humans , Male , Aged , Crohn Disease/diagnosis , Capsule Endoscopes/adverse effects , Foreign Bodies/etiology , Foreign Bodies/diagnostic imaging , Radiography, Abdominal , Tomography, X-Ray Computed , Capsule Endoscopy/adverse effectsABSTRACT
Ulcerative colitis (UC) is an autoimmune inflammatory chronic disease, which compromises the colonic mucosa continuously, affecting the rectum with a variable proximal extension to the cecum, in a relapsing and remitting way. The higher incidences and prevalence are described in Europe and North America, with no precise epidemiologic data from Chile. It usually presents in young patients with bloody diarrhea, with the diagnostic confirmation made by colonoscopic and histologic studies. There is no definitive cure for this condition, but the aim of the treatment is symptom resolution and endoscopic mucosal healing, based in the early use of 5-aminosalicylic acid drugs, steroids for a crisis, immunosuppressants, with some patients requiring biologic agents to reach remission. In some cases, colectomy is the last source for refractory disease or for treating colonic neoplasia. This review focuses on practical management of UC. (AU)
Subject(s)
Adolescent , Adult , Middle Aged , Aged , Colitis, Ulcerative/drug therapy , Colitis, Ulcerative/therapy , Inflammatory Bowel Diseases , Colitis, Ulcerative/surgery , Colitis, Ulcerative/etiologyABSTRACT
Differentiation between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) can be complex as their symptoms are often similar and unspecific. Fecal biomarkers could be useful to select patients with suspected organic diseases for colonoscopy, with the aim to improve early diagnosis and to avoid unnecessary invasive studies. Fecal calprotectin (FC) is a protein found mainly in neutrophils that is released into the feces as a result of cell disruption and apoptosis. Currently, FC is a simple and non-invasive biomarker of intestinal inflammation. Inflammatory gastrointestinal disorders are associated with high levels of FC, as occurs in IBD. This review focuses on FC as a useful tool for differential diagnosis between IBS and IBD in adults. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Inflammatory Bowel Diseases/diagnosis , Leukocyte L1 Antigen Complex/analysis , Irritable Bowel Syndrome/diagnosis , Feces/chemistryABSTRACT
Inflammatory bowel disease includes Crohn´s disease, ulcerative colitis and unclassified colitis. Conventional therapies used for treating these diseases are often insufficient orcontraindicated and biological agents have proved to be effective and safe in these cases. Infliximab is a quimeric IgG1 monoclonal anti-tumor necrosis factor antibody that is capableof inducing and mantaining clinical remission in patients with inflammatory bowel disease. Despite its proven efficacy a considerable group of patients lose response requiring changesin therapy. Serum Infliximab trough levels are correlated with clinical response, endoscopic remission and mucosal healing in patients with inflammatory bowel disease. Monitoring and adjusting therapy guided by drug serum levels have proved to be more cost-effective and safer than empiric adjustments. Current international guidelines recommend the measurement of Infliximab trough levels in the global evaluation and management of these patients to improve treatment, avoid adverse events and unnecessary costs.
Subject(s)
Male , Female , Humans , Inflammatory Bowel Diseases/drug therapy , Infliximab/pharmacokinetics , Infliximab/therapeutic useABSTRACT
Acute esophageal necrosis is a rare entity characterized by the presence of necrosis in the distal esophagus that ends abruptly at the gastroesophageal junction. Its etiology is ischemic and occurs mainly in patients with comorbidities, with a mortality approaching 30 percent. We describe the case of a 78 year-old female with history of hypertension, diabetes, cholangiocarcinoma and recent venous thrombosis in both legs, in anticoagulant treatment, presenting with an episode of upper gastrointestinal bleeding. At endoscopy esophageal necrosis was observed from 25 cm until gastroesophageal junction, also hiatal hernia, erosive duodenitis and duodenal ulcer. Patient had a poor outcome and died 48 h after onset.
La necrosis esofágica aguda es una entidad poco frecuente, caracterizada por la presencia de necrosis en el tercio distal del esófago que termina abruptamente a nivel de la unión gastroesofágica. Su etiología es principalmente isquémica y se presenta en pacientes con comorbilidades, con una mortalidad cercana a 30 por ciento. Se describe el caso de una paciente de sexo femenino de 78 años, con antecedentes de hipertensión arterial, diabetes, colangiocarcinoma y trombosis venosa profunda reciente de extremidades inferiores, en tratamiento anticoagulante, que presenta episodio de hemorragia digestiva alta. En la endoscopia se observa necrosis esofágica desde los 25 cm de la arcada dentaria hasta la unión gastroesofágica, hernia hiatal, duodenitis erosiva y úlcera duodenal. La paciente evoluciona en malas condiciones generales, falleciendo a las 48 h de evolución.
Subject(s)
Humans , Female , Aged , Endoscopy, Digestive System , Esophagus/pathology , Gastrointestinal Hemorrhage/etiology , Acute Disease , Fatal Outcome , NecrosisABSTRACT
Intestinal ischemia occurs when mesenteric blood flow is insufficient for the requirements of the intestine. Acute presentation includes acute mesenteric ischemia, usually secondary to occlusion of the superior mesenteric artery, and ischemic colitis due to decreased vascular flow to vulnerable regions of the colon. It usually presents with abdominal pain and non-specific laboratory abnormalities, so it requires a high index of clinical suspicion for early diagnosis and management in order to reduce morbidity and mortality. The following review describes clinical concepts of acute intestinal ischemia, with emphasis on diagnosis and management of these patients.
La isquemia intestinal surge cuando el flujo sanguíneo del territorio mesentérico resulta insuficiente para satisfacer los requerimientos del intestino. El cuadro agudo incluye la isquemia mesentérica aguda, generalmente secundaria a oclusión de la arteria mesentérica superior, y la colitis isquémica debida a disminución del flujo vascular a regiones vulnerables del colon. Se presenta habitualmente con dolor abdominal y alteraciones de laboratorio inespecíficos, por lo que es necesario un alto índice de sospecha clínica para el diagnóstico y manejo precoz con el fin de disminuir su alta morbimortalidad. En la siguiente revisión se exponen principalmente conceptos clínicos acerca de isquemia intestinal aguda, con énfasis en el diagnóstico y manejo de estos pacientes.
Subject(s)
Humans , Colitis, Ischemic/diagnosis , Colitis, Ischemic/therapy , Mesenteric Ischemia/diagnosis , Mesenteric Ischemia/therapy , Colitis, Ischemic/etiology , Diagnosis, Differential , Mesenteric Ischemia/etiology , PrognosisABSTRACT
Introducción. En Chile, se desarrolla una vigilancia activa de portación intestinal de Enterococcus resistente a vancomicina (ERV) desde el año 2000. Sin embargo, no hay publicaciones sobre casos clínicos. Objetivo: Describir casos de infección por ERV en un hospital de nivel terciario. Pacientes y Método: Se obtuvieron de los registros del laboratorio las muestras clínicas o intestinales positivas para ERV (2001 al 2006) y se analizaron en los pacientes afectados los factores de riesgo potenciales, manifestaciones clínicas, tratamiento y evolución. Resultados: Se identificaron 23 casos (tasa de incidencia año 2005 de 0,07 y año 2006 de 0,09/1.000 días camas ocupadas). El promedio de edad fue 62,0 ± 17 años. Antecedentes: cáncer (39,l por cientoo), procedimientos quirúrgicos recientes (54,1 por ciento), hemodiálisis (26,1 por ciento), corticoterapia (26,1 por ciento). El 87 por cientoo había recibido dos o más antimicrobianos, casi un tercio fue transferido desde otros hospitales y 22 por ciento había reingresado antes de 30 días. Los pacientes habían estado principalmente en UCI (60,9 por ciento), el resto en salas nefrológicas u onco-hematológicas. Los cuadros clínicos incluyeron bacteriemias (30,4 por ciento), infecciones del sitio quirúrgico o abscesos (26,1 por ciento), infecciones urinarias (26,1 por ciento) u otros. Tres pacientes fueron asintomáticos (13 por ciento). Los aislados fueron identificados como E. faecium en 82,6 por cientoo del total, el resto como Enterococcus sp. El 66,7 por cientoo de las cepas mostró susceptibilidad intermedia a vancomicina. En 14 cepas con estudio completo para vancomicina y teicoplanina, predominó el fenotipo VanB (85,7 por ciento), seguido de los fenotipos VanA (7,1 por ciento) y VanB/VanD (7,1 por ciento). Quince pacientes fueron tratados en forma médica o médico-quirúrgica, hubo respuesta favorable en 80 por cientoo de ellos. Ocho pacientes no recibieron tratamiento (34,8 por ciento), en dos...
An active surveillance of vancomycin-resistant enterococci (VRE) intestinal colonization in selected group of patients has been developed in Chile since year 2000. Nevertheless, no reports of clinical cases have been published. Aim. To describe main clinical and microbiological features of patients infected by VRE in a tertiary-level teaching Hospital. Patients and methods. Intestinal and clinical samples positive to VRE were provided by laboratory, and a retrospective analysis of potential risk factors, clinical features, treatment and outcomes was performed. Study encompassed years 2001 to 2006. Main results. 23 cases of infections were identified, all cases occurring during 2005 and 2006. Incidence rate was 0.07 and 0.09 cases per 1000 occupied bed-days, respectively. The mean age was 62.0 ± 17 years. A significant proportion of patients had cancer (39.1 percent), recent surgical procedures (54.1 percent), were on dialysis (26.1 percent), or were using steroids (26.1 percent). Most patients had received 2 or more antimicrobial (87 percent), almost a third represented transfers from other hospitals and an additional 22 percent readmissions before 30 days of latest discharge. Patients were mainly hospitalized in the ICU (60.9 percent) but nearly 30 percent were associated exclusively to nephrological or onco-hematological wards. Clinical manifestations included bacteremia (30.4 percent), surgical site infections or abscesses (26.1 percent), urinary tract infections (26.1 percent) and others. . Three patients (13 percent) did not have symptoms. After identification was possible, all isolates were identified as E. faecium (82.6 percent of total), the rest as Enterococcus sp. Most strains showed intermediate susceptibility to vancomycin (66.7 percent). For 14 strains studied both with vancomycin and teicoplanin, , phenotype Van B was predominant (85.7 percent), followed by VanA (7.1 percent) and VanB/VanD type (7.1 percent). No molecular...
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Humans , Middle Aged , Enterococcus/drug effects , Gram-Positive Bacterial Infections/microbiology , Vancomycin Resistance , Chile/epidemiology , Enterococcus/genetics , Enterococcus/isolation & purification , Gram-Positive Bacterial Infections/epidemiology , Hospitals, Teaching/statistics & numerical data , Incidence , Risk Factors , Vancomycin Resistance/geneticsABSTRACT
La emergencia de bacilos gramnegativos pan-resistentes ha obligado a la reutilización progresiva de colistín. Objetivo: Describir la experiencia clínica con este compuesto. Metodología: Se efectuó un análisis retrospectivo de todos los tratamientos con colistín endovenoso administrados por más de 48 horas, analizando datos clínicos, microbiológicos, la respuesta terapéutica y evolución hasta el egreso. Resultados: Se aplicaron 24 tratamientos entre junio de 2005 y septiembre de 2006. Colistín endovenoso fue utilizado en eventos de neumonía asociada a VM (n = 10; 41,7 por ciento), colecciones o abscesos (12,5 por ciento), bacteriemias, neumonía no asociada a VM e infección urinaria (4,2 por ciento cada una, respectivamente). El tratamiento fue iniciado en promedio a 3,2 (± 2,85) días desde el diagnóstico de infección. Todos los pacientes tenían infecciones por Pseudomonas aeruginosa o Acinetobacter baumannii. Se evaluó la susceptibilidad por E-test en once aislados (CIM90 3,6 µg/mL, rango 0,38 a 4 µg/mL). Una cepa (9 por ciento) presentó resistencia. Se observó una respuesta favorable en 50 por cientoo de los casos (n = 12) con recaída en cinco de estos casos (41,7 por ciento). El único factor asociado a fracaso fue la presencia de neumonía (p = 0,04). Se observó erradicación en ocho casos (33,3 por ciento) y persistencia en once (45,8 por ciento). En cinco casos el resultado microbiológico no fue evaluable. Sobrevivió a la hospitalización 45,5 por ciento de los pacientes (n = 10). No se observó nefrotoxicidad. Conclusiones: Colistín endovenoso es un compuesto seguro para el tratamiento de infecciones por bacilos gramnegativos pan-resistentes. Sin embargo, su eficacia terapéutica es limitada, especialmente, entre aquellos pacientes tratados por neumonía.
Emergence of panresistant gram negative bacilli has lead to the progressive reintroduction of intravenous colistin. Aim: To describe the clinical experience observed with this compound. Methodology: A retrospective analysis was performed for all treatments lasting ≥ 48 hours. Medical records were analyzed to obtain clinical parameters and microbiological data, evaluate clinical response and evolution until discharge. Main results: 24 treatments lasting ≥ 48 hours were applied between June 2005 and September 2006. Intravenous colistin was indicated to treat cases of ventilator-associated (VA) pneumonia (n = 10; 41.7 percent), abscess or collections (12.5 percent), bloodstream infections, non-VA pneumonia or urinary tract infections (4.2 percent each one, respectively). Treatment was initiated on average at 3.2 days (± 2.85) from diagnosis of infection. All courses were microbiologically-guided, and involved P. aeruginosa or A. baumannii isolates. Susceptibility was evaluated by E-test in 11 isolates (MIC90 3.6 µg/mL, range 0.38 to 4 µg/mL). One isolate was resistant to colistin (9 percent). A favorable response was observed in 12 treatments (50 percent) with a relapse in 5 cases (41.7 percent). Being treated for pneumonia was the only factor associated to failure, (p = 0.04) Eradication was documented in 8 cases (33.3 percent) and persistence in 11 (45.8 percent). In 5 cases a microbiological follow-up was not available. Survival at time of discharge was 45.5 percent. (n = 10) None of the treatment courses was associated with nefrotoxicity. Conclusions: Intravenous colistin is a safe compound useful to treat various nosocomial infections due to pan-resistant gram negative bacilli. Nonetheless, its clinical efficacy is limited, especially among patients treated for nosocomial pneumonia.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Acinetobacter Infections/drug therapy , Acinetobacter baumannii/drug effects , Anti-Bacterial Agents/therapeutic use , Colistin/therapeutic use , Pseudomonas Infections/drug therapy , Pseudomonas aeruginosa/drug effects , APACHE , Acinetobacter Infections/microbiology , Anti-Bacterial Agents/administration & dosage , Colistin/administration & dosage , Cross Infection/drug therapy , Cross Infection/microbiology , Drug Resistance, Multiple, Bacterial , Pseudomonas Infections/microbiology , Retrospective Studies , Treatment OutcomeABSTRACT
Los constantes cambios socioculturales que pueden observarse actualmente en países de América Latina como Chile, catalogados cómo en vías de desarrollo, traen consigo un incremento de trastornos como la diabetes, hipertensión arterial, dislipidemias, stress, obesidad, etc., y por ende mayor prevalencia de enfermedades cardiovasculares, lo que las coloca hoy en día en el primer lugar como causa general de morbilidad y mortalidad en la población. Constituido así en un problema de salud pública es imprescindible tomar medidas enérgicas para su enfrentamiento. Se ha demostrado en países desarrollados que una mayor cantidad de gente capacitada en maniobras de resucitación básica, trae consigo una disminución importante de la morbimortalidad producto de paro cardiorrespiratorio (PCR). En este sentido, es preciso e imprescindible fomentar y difundir los diversos programas educativos que pueden ser aplicados en diversos grupos blanco de nuestra población, de manera de preparar a las personas que pudieran verse enfrentadas a una situación de este tipo en distintos escenarios.
The constant social and cultural changes currently observed in Latin American countries like Chile, are associated with increases in pathological conditions like diabetes, arterial hypertension, dyslipidemia, stress, obesity, etc. As a consequence, a higher prevalence of cardiovascular diseases is observed, positioning them as the first general cause of morbidity and mortality. As a major public health issue, it is essential to implement measures to confront them. It has been demonstrated in developed countries that the more people is trained in basic resuscitation maneuvers, the bigger is the decrease in morbidity and mortality due to cardiogenic cardiorespiratory failure. Then, it appears of great importance to stimulate and diffuse diverse educative programs that may be applied to many target groups of our population, in order to prepare people to confront this kind of situations in different scenarios.
Subject(s)
Humans , Life Support Care/methods , Health Education/methods , Cardiopulmonary Resuscitation/education , Cardiopulmonary Resuscitation/methods , Emergency Medicine/educationABSTRACT
La preeclampsia es un trastorno multisistémico caracterizado por hipertensión inducida por el embarazo, asociada a proteinuria, edema e incremento de la permeabilidad vascular. Aparece en la segunda mitad de la gestación y es característicamente reversible en el post parto. Además puede presentar múltiples complicaciones llegando incluso a la muerte del feto o de su progenitora.De su fisiopatología aún en estudio, se ha podido concluir que es una sucesión multifactorial de eventos que se centran principalmente en dos etapas: la primera es una invasión placentaria pobre que conlleva una isquemia secundaria y una segunda etapa caracterizada por una activación endotelial y una respuesta autoinmune exagerada. Para cada una de estas etapas se han descrito múltiples alteraciones moleculares, las que se ven influidas tanto por la carga genética, factores maternos, paternos, del feto y también del ambiente.
Preeclampsia is a multisystemic disorder characterized by hypertension induced by the pregnancy, associated to proteinuria, edema and increase of the vascular permeability. It appears during the second half of gestation and is characteristically reversible during postpartum. In addition, it can elicit many complications including the death of the fetus or the mother. Of its physiopathology still in study, it has been possible to conclude that it is a multifactorial succession of events divided mainly in two stages: first there is a poor placental invasion that leads to secondary ischemia and the second stage is characterized by an endothelial activation and an exaggerated autoimmune response. For each one of these stages, multiple molecular alterations have been described, which are influenced by genetic load, maternal and father factors, fetal factors and also by environmental factors.