ABSTRACT
Choloproctolgical pathologies work-up comprises an aspect pertaining to general clinical and laboratory evaluation, and other aspect specifical or the subspeciality. The diagnostic tools available for colorectoanal assessment may be classified according its invasiveness on the patient and its functional features. This report is aimed to describe the features of these evaluations, their indications and contraindications, sensitivity, specificity and accuracy, their complications and the comparative advantages and disadvantages of each one related to the others.
El estudio diagnóstico de las patologías en coloproctología consta de una parte clínica apoyada por exámenes básicos y otros propios de las especialidad. Los exámenes diagnósticos disponibles para el estudio colorectoanal se pueden clasificar de acuerdo a su invasividad en el paciente o según la funcionalidad de estos. Este artículo tiene como objetivo central conocer las características principales de estos exámenes, como las indicaciones y contradicciones, sensibilidad, especificidad y eficacia, sus complicaciones, y las ventajas y desventajas con respecto a los otros exámenes.
Subject(s)
Humans , Colonoscopy , Anus Diseases/diagnosis , Colonic Diseases/diagnosis , Rectal Diseases/diagnosis , Diagnosis, DifferentialABSTRACT
The use in intravenous antibiotics in prophylaxis of acute necrotizing pancreatitis is still an issue under active debate, and consensus have not been accomplished yet. The main goal of this prophylaxis is the impregnation of pancreatic tissue with antibiotics, in order to prevent the bacterial colonization, ensuing the microbial translocation from the gut. Different experts have developed different approaches to this issue, each one with argumentation for the defense or the rejection of prophylactic use of antibiotics. Our review reveled strong evidence that nobody has demonstrated yet a real benefit, in terms of lower mortality or decreased rate of infections, with the prophylactic use of antibiotics in pancreatic necrosis. Many groups have reported a decrease in numbers of infections or mortality, but without statistical significance. In some series the use of prophylactic antibiotics decreased the length of stay, but no correlation with changes in mortality or infection rate in pancreatic necrosis was established. The indication of antibiotic prophylaxis in a sterile necrotic pancreatic tissue is a decision that involves several factors as: the individual clinical assessment of every case, the knowledge about the pathogenic flora and of the bacterial spectrum and tissue penetration of the antimicrobial agent, and, also, its cost-effectiveness and toxicity. The criteria used by some hospitals in the country is the antibioprophylaxis is a cases whose pancreatic necrosis exceeds 30 percent in abdominal CT scan with contrast medium, as in these cases severity increases twofold, but there has not been shown significant reduction of morbility in these cases corresponding to an evidence type II. Consequently and according to the available reports we dont't recommend the prophylactic use of antibiotics in pancreatic necrosis. A promising field, shown in a dutch study by Luiten & cols is the selective decontamination of the gut with non absorbable antibiotics...
El uso de antibióticos endovenosos en la profilaxis de la pancreatitis aguda necrótica, es un tema vigente en plena discusión. No existe un consenso con respecto a su utilidad. La profilaxis antibiótica tiene como objetivo primordial impregnar el tejido pancreático con antibióticos que prevengan luego la colonización a partir de la translocación bacteriana del tubo digestivo. Distintos grupos de expertos han tomado diferentes posturas al respecto, utilizando diversos argumentos para defenderse, o rechazar el uso de antibióticos profilácticos. Nuestra revisión muestra de manera bastante contundente que ningún grupo ha logrado demostrar que el uso de antibióticos entregue beneficios en cuanto a prevenir la mortalidad o disminuir la infección de la necrosis pancreática o de su mortalidad. En algunas series el uso de antibióticos disminuyó la permanencia hospitalaria, pero esto no se relacionó con cambios en la mortalidad ni en la infección de la necrosis. La indicación de antibioprofilaxis en tejido pancreático necrótico estériles es una decisión que implica considerar varios factores tales como: evaluación clínica individual de cada caso; conocimiento de la flora patógena así como del espectro y penetración del antimicrobiano, pero también su costo-efectividad y su toxicidad. Una conducta utilizada en algunos centros hospitalarios del país consiste en la indicación de antibióticos profilácticos en necrosis pancreática mayores del 30 por ciento estimadas al TAC abdominal con contraste, valor sobre el cual la gravedad se duplica, pero la experiencia no avala una reducción significativa de la mortalidad en estos casos que corresponden a un nivel de evidencia tipo II. En consecuencia y en base a los estudios disponibles no recomendamos el uso de antibióticos profilácticos en la necrosis pancreática. Un aspecto promisorio, demostrado por el estudio holandés de Luiten y cols es el uso de la descontaminación selectiva del tracto digestivo con antibióticos...
Subject(s)
Humans , Antibiotic Prophylaxis , Anti-Bacterial Agents/therapeutic use , Pancreatitis, Acute Necrotizing/drug therapy , Injections, IntravenousABSTRACT
Background: Congenital malformations are defined as those structural, metabolic or functional defects found at birth. Aim: To study the mortality due to congenital malformations in Chile between 1969 and 1997, their type, individual, temporal and geographic variations. Material and Methods: A descriptive analisis of deaths registered by the National Statistics Institute and the Ministry of Health. Means, frequencies, raw and adjusted rates were calculated and inferences for some variables were carried out. Results: Between 1969 and 1997 ther was tendency towards a reduction in rates of mortality due to congenital malformations and an increment in their relative importance. During the period, the risk for chromosome (98 percent) and osteomuscular (67 percent) malformations increased. Men and children of less than one year had the higher risk. In 1995, 1167 deaths due to congenital malformations were registered, 90 percent in children of less than 5 years. Higher risks occurred in urban zones (with a rate of 8.25 per 100.000) in the third region (rate 11.59) and second region (rate 11.2). Most deaths occurred in hospitals (85 percent). Main causes of death were circulatory system, central nervous system and chromosome malformations. Conclusions: The differences in regional deaths due to congenital malformations suggests specific risks that deserve further study