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1.
Iatreia ; 34(4): 375-382, oct.-dic. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1350838

ABSTRACT

RESUMEN Introducción: el SARS-CoV-2 es un nuevo coronavirus descrito por primera vez en China y con alta capacidad de propagación. Su presentación clínica más frecuente son los síntomas respiratorios, aunque se han descrito otros como los gastrointestinales. La transmisión ocurre por gotas, aerosoles, vía fecal oral, conjuntiva, fómites y por contacto directo con fluidos corporales del paciente. En este sentido, los procedimientos realizados en las salas de endoscopia deben considerarse de alto riesgo. Objetivo: describir y analizar las medidas de prevención frente al SARS-CoV-2 para la práctica endoscópica-anestésica u otros procedimientos que requieran sedación, con el fin de disminuir la exposición y así minimizar el contagio del personal de salud. Resultados: la respuesta global se ha enfocado en la utilización de elementos de protección personal para tratar de disminuir el riesgo al que se encuentra expuesto el personal de salud. Sin embargo, debido a la prontitud de la emergencia, no se han podido generar evidencias de alta calidad que permitan dar recomendaciones definitivas. Reflexión: el personal de salud debe tomar todas las medidas de protección que puedan ser consideradas como efectivas, además deconstruir protocolos y fomentar la adherencia a los mismos.


SUMMARY Introduction: SARS-CoV-2 is a new coronavirus described for the first time in China, with high capacity of propagation. Its most frequent clinical presentation is respiratory symptoms; however, others have been described as gastrointestinal. Transmission occurs by droplets, aerosols, oral fecal route, conjunctiva, fomites and by direct contact with body fluids of the patient. In this sense, the procedures performed in endoscopy rooms should be considered high risk. Objective: To describe and analyze preventive measures against SARS-CoV-2 for endoscopic-anesthesia practice or other procedures that require sedation, in order to reduce exposure and thus minimize contagion of health personnel. Results: The global response has focused on the use of personal protective equipment to try to reduce the risk to which health care personnel are exposed, but due to the urgency of the emergency, it has not been possible to generate high quality evidence to give definitive recommendations. Reflection: Health personnel should take all protective measures that can be considered effective, and also deconstruct protocols and encourage adherence to them.


Subject(s)
Humans , Coronavirus , Personal Protection , Endoscopy , Conscious Sedation , Anesthesia
2.
Rev. inf. cient ; 100(4): e3490, 2021. graf
Article in Spanish | LILACS | ID: biblio-1289660

ABSTRACT

RESUMEN Se realizó un reporte de un caso de paciente femenina de 48 años de edad, con antecedentes patológicos personales de hipertensión arterial, cardiopatía isquémica, arritmias cardíacas y neurosis depresiva e ingestión diaria de cuerpos extraños desde hace algunos años, la cual tenía el hábito de masticar fragmentos de espuma de poliestireno (poliespuma), los que diluía en gasolina para poderlos moldear, ablandar e ingerirlos posteriormente. La paciente acudió a la consulta de Gastroenterología por presentar epigastralgia, acidez, sensación de repletes gástrica posprandial, aun cuando solo podía digerir escasas cantidades de alimento. Se realizó endoscopia, donde se apreció a la entrada de la luz gástrica un bezoar gigante de consistencia dura, superficie lisa, no movible, que midió aproximadamente 6-7 cm de diámetro, que ocupó prácticamente el 50 % de la luz gástrica, correspondiente al fundus y cuerpo gástrico, con extensión hacia el antro. Los intentos de extraerlo por vía endoscópica fueron fallidos, por lo que se intervino quirúrgicamente y se extrajo el mismo. La paciente tuvo una evolución posoperatoria favorable y egresó a los siete días, con seguimiento por consulta externa y tratamiento médico ambulatorio.


ABSTRACT A 48-year-old female presented to gastroenterologist consultation with epigastralgia, heartburn, and sensation of postprandial gastric fullness even when she only could intake meal in small proportion. She had a history of hypertension, ischemic heart disease, and cardiac arrhythmias, depressive neurosis associated to the ingestion, daily and since several years, of foreign bodies. She was used to chewing fragments of polyfoam, which she diluted them in gasoline in order to mold them, soften them and ingests them afterwards. An endoscopy procedure was used, which revealed, at the entrance of the gastric lumen, a giant bezoar of hard mass, smooth surface, non-movable, with approximately 6-7 cm size and occupying almost 50% of the gastric lumen region corresponding to the gastric body and fundus, and extending to the antrum. Attemps for removal the mass, endoscopically, were unsuccessful, so surgery was performed and it was removed successfully. The patient had a favorable postoperative evolution and was discharged 7 days after surgery, with outpatient follow-up and ambulatory medical treatment.


RESUMO Relatou-se o caso de uma paciente do sexo feminino, 48 anos, com história patológica pessoal de hipertensão arterial, cardiopatia isquêmica, arritmias cardíacas e neurose depressiva e ingestão diária de corpos estranhos há alguns anos, que tinha hábito de mastigar fragmentos de espuma de poliestireno (polyfoam), que ele diluiu em gasolina para poder moldar, amolecer e ingerir depois. A paciente compareceu à consulta de Gastroenterologia por apresentar epigastralgia, azia, sensação de plenitude gástrica pós-prandial, embora só conseguisse digerir pequenas quantidades de alimentos. Foi realizada endoscopia, onde um bezoar gigante de consistência dura, superfície lisa, imóvel, medindo aproximadamente 6-7 cm de diâmetro, ocupando praticamente 50% da luz gástrica, correspondente à luz gástrica, foi observado na entrada do lúmen gástrico, fundo e corpo gástrico, com extensão em direção ao antro. As tentativas de removê-lo endoscopicamente não tiveram sucesso, então ele foi submetido a uma cirurgia e foi removido. O paciente teve evolução pós-operatória favorável, com alta hospitalar sete dias após, com acompanhamento ambulatorial e acompanhamento médico ambulatorial.


Subject(s)
Humans , Female , Middle Aged , Bezoars/surgery , Bezoars/diagnosis , Endoscopy/methods
3.
Rev. inf. cient ; 100(4): e3524, 2021. tab
Article in Spanish | LILACS | ID: biblio-1289651

ABSTRACT

RESUMEN Introducción: El cáncer de esófago avanzado es una de las neoplasias más agresivas con una elevada morbilidad y mortalidad. Botsuana ocupa el duodécimo cuarto puesto mundial con respecto a las muertes ocasionadas por esta enfermedad. Objetivo: Determinar las características clínico-patológicas de los pacientes con cáncer esofágico avanzado en el Hospital Princess Marina de Gaborone, Botsuana. Método: Se realizó un estudio prospectivo-descriptivo donde se caracterizó clínica y patológicamente a 45 pacientes con el diagnóstico endoscópico e histológico de cáncer de esófago avanzado en el periodo de enero a septiembre de 2019. Resultados: Predominó el sexo masculino (86,7 %) y los pacientes mayores de 60 años (60,0 %). La disfagia, la anorexia y la pérdida de peso fueron los síntomas más frecuentes y prevalecieron los pacientes con un tiempo entre la aparición de los síntomas y el diagnóstico-endoscópico entre tres y seis meses; la dieta inadecuada, el etilismo crónico y el hábito de fumar fueron los factores de riesgo predominantes. La localización anatómica más frecuente fue el tercio medio (51,1 %), el tipo endoscópico predominante fue el vegetante (46,7 %) y la mayoría de los pacientes presentó el tipo histológico carcinoma epidermoide (95,6 %) bien diferenciado (84,4 %). Conclusiones: El estudio de las características clínico-patológicas de los pacientes con cáncer esofágico avanzado permite su correcta estadificación, siendo una herramienta útil en la valoración multidisciplinaria del tratamiento debido a su complejo manejo clínico e institucional.


ABSTRACT Introduction: Advanced esophageal cancer is one of the most aggressive neoplasms with high morbidity and mortality. Botswana ranks 14th in the world for deaths from this disease. Objective: To determine the clinicopathological characteristics of patients with advanced esophageal cancer at the Princess Marina Hospital in Gaborone, Botswana. Method: A prospective-descriptive study was carried out, where 45 patients with endoscopic and histological diagnosis of advanced esophageal cancer were characterized clinically and pathologically, from January to September 2019. Results: Males predominated (86.7%), and also patients older than 60 years (60.0%). Dysphagia, anorexia and weight loss were the most frequent symptoms, and prevailed patients with three to six months between the appearance of symptoms and endoscopic diagnosis; inadequate diet, chronic alcoholism, and smoking were the predominant risk factors. The most frequent anatomical location was the middle third (51.1%), the predominant endoscopic type was the vegetative (46.7%) and most of the patients presented the histological type squamous cell carcinoma (95.6%) well differentiated (84.4%). Conclusions: The study of the clinical-pathological characteristics of patients with advanced esophageal cancer allows its correct staging, being a useful tool in the multidisciplinary assessment of treatment due to its complex clinical and institutional management.


RESUMO Introdução: O câncer de esôfago avançado é uma das neoplasias mais agressivas com alta morbimortalidade. Botswana ocupa o 14º lugar no mundo em mortes por esta doença. Objetivo: determinar as características clínico-patológicas de pacientes com câncer de esôfago avançado no Hospital Princesa Marina em Gaborone, Botsuana. Método: Foi realizado estudo prospectivo-descritivo em que 45 pacientes com diagnóstico endoscópico e histológico de câncer de esôfago avançado foram caracterizados clínica e patologicamente de janeiro a setembro de 2019. Resultados: Predominou o sexo masculino (86,7%) e pacientes com mais de 60 anos ( 60,0%). Disfagia, anorexia e perda de peso foram os sintomas mais frequentes e prevaleceram os pacientes com tempo entre o aparecimento dos sintomas e o diagnóstico endoscópico entre três e seis meses; dieta inadequada, alcoolismo crônico e tabagismo foram os fatores de risco predominantes. A localização anatômica mais frequente foi o terço médio (51,1%), o tipo endoscópico predominante foi o vegetativo (46,7%) e a maioria dos pacientes apresentou o tipo histológico carcinoma espinocelular (95,6%) bem diferenciado (84,4%). Conclusões: O estudo das características clínico-patológicas dos pacientes com câncer de esôfago avançado permite seu correto estadiamento, sendo uma ferramenta útil na avaliação multidisciplinar do tratamento devido ao seu complexo manejo clínico e institucional.


Subject(s)
Humans , Male , Adult , Middle Aged , Aged , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/pathology , Endoscopy/methods , Botswana , Epidemiology, Descriptive , Prospective Studies , Observational Study
4.
Rev. Rede cuid. saúde ; 15(1): [1-11], 15/07/2021.
Article in Portuguese | LILACS | ID: biblio-1282324

ABSTRACT

Objetivou-se caracterizar as EDA realizadas na Comunidade de Saúde de Mossoró, RN, no período de 2008 a 2013, definindo a taxa de exames normais e a prevalência dos principais achados sugestivos de patologias digestivas. Trata-se de um estudo transversal e retrospectivo, no qual se analisou 10311 laudos de EDA. As análises estatísticas foram realizadas pelo SPSS (Statistical Package for the Social Sciences, versão 20.0), com nível de confiança95% e um p < 0,05, utilizando-se testes Qui-quadrado. Pelos dados levantados, constatamos que a EDA é um exame prático e seguro, com raríssimas complicações, sendo a agitação e a presença de alimento no estômago as limitações mais comuns. Na análise descritiva geral observou-se que a maioria dos exames foi realizada no gênero feminino, formando mais de 70% da amostra total. A faixa etária predominante, independente do gênero, foi 41 a 60 anos. As patologias frequentes no segmento esofágico foram as Esofagites. No segmento gástrico, a maior frequência de achados foram as Gastrites, que são mais frequentes com o avançar da idade. Na Transição Gastroduodenal, as úlceras de Canal Pilórico são os achados mais descritos, mas observamos também modestos achados de duodenites. No duodeno, os principais achados foram úlceras duodenais, seguidas pelas duodenites e sinais de atrofia. Portanto, as EDA são mais realizadas no gênero feminino, mas apresentam maior percentual de exames normais, sendo a maior frequência de achados encontrada no gênero masculino. Assim, após analisar as 10.311 EDA, é possível prever os achados mais comuns encontrados a EDA.


This study aimed to characterize the EDA held in Mossoro Health Community, RN, from 2008 to 2013, setting the rate of normal examinations and the prevalence of the main findings suggestive of digestive pathologies. It is a cross-sectional retrospective study, which analyzed 10,311 reports of EDA. Statistical analyzes were performed using SPSS (Statistical Package for Social Sciences, version 20.0), with a confidence level 95% and p <0.05, using chi-square tests. Raised by the data, we found that EDA is a practical and safe exam, with very few complications, agitation and presence of food in the stomach the most common limitations. In general descriptive analysis it was observed that most of the exams was held in females, forming more than 70% of the total sample. The predominant age group, regardless of gender, was 41-60 years. The frequent pathologies in esophageal segment were Esophagitis. Gastric segment, the highest frequency of findings were Gastritis, which are more common with advancing age. Gastroduodenal in Transition, the Channel Pyloric ulcers are the most described findings, but also observed modest findings of duodenitis. In the duodenum, the main findings were duodenal ulcers, followed by duodenitis and signs of atrophy. Therefore, the EDA are more performed in females, but have a higher percentage of normal results, with the highest frequency of findings found in males. So after analyzing 10,311 EDA, it is possible to predict the most common findings EDA.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Diagnosis , Duodenitis , Endoscopy , Esophagitis , Gastritis
5.
Rev. bras. ortop ; 56(3): 346-350, May-June 2021. tab
Article in English | LILACS | ID: biblio-1288666

ABSTRACT

Abstract Objective The present study aimed to determine the frequency of trigger finger (TF) onset after surgery for carpal tunnel syndrome (CTS) using an open (OT) or an endoscopic technique (ET). As a secondary endpoint, the present study also compared paresthesia remission and residual pain rates in patients submitted to both techniques. Methods Trigger finger onset and remission rates of paresthesia and pain at the median nerve territory was verified prospectively in a series of adult patients submitted to an OT procedure (n = 34). These findings were compared with a retrospective cohort submitted to ET (n = 33) by the same surgical team. Patients were evaluated with a structured questionnaire in a return visit at least 6 months after surgery. Results Sixty-seven patients were evaluated. There was no difference regarding trigger finger onset (OT, 26.5% versus ET, 27.3%; p = 0.94) and pain (OT, 76.5% versus ET, 84.8%; p = 0.38). Patients submitted to OT had fewer paresthesia complaints compared with those operated using ET (OT, 5.9% versus ET, 24.2%; p = 0.03). Conclusions In our series, the surgical technique did not influence trigger finger onset and residual pain rates. Patients submitted to OT had less complaints of residual postoperative paresthesia.


Resumo Objetivo Determinar a frequência do aparecimento de dedo em gatilho (DG) no pós-operatório da síndrome do túnel do carpo (STC) em duas técnicas: aberta (TA) e endoscópica (TE). Como desfecho secundário, comparar as taxas de remissão da parestesia e dor residual entre as duas técnicas. Métodos De forma prospectiva, verificamos o aparecimento de dedo em gatilho e taxa de remissão da parestesia e dor no território do nervo mediano em série de pacientes adultos operados pela TA (n = 34). Comparamos com coorte retrospectiva operada pela TE (n = 33), pela mesma equipe de cirurgiões. A avaliação dos pacientes ocorreu por meio de questionário estruturado em consulta de retorno, com mínimo de 6 meses de pós-operatório. Resultados Sessenta e sete pacientes foram avaliados. Não houve diferença quanto ao aparecimento de dedo em gatilho (TA, 26,5% versus TE, 27,3%; p = 0,94) e dor (TA, 76,5% versus TE, 84.8%; p = 0,38). Os pacientes operados pela TA apresentaram menos queixas de parestesia do que os operados pela TE (TA 5,9% versus TE 24,2%; p = 0,03). Conclusões Em nossa série, a técnica cirúrgica não influenciou o aparecimento de dedos em gatilho e dor residual. Os pacientes operados pela técnica aberta apresentaram menos queixa de parestesia residual pós-operatória.


Subject(s)
Humans , Male , Female , Adult , Paresthesia , Comparative Study , Carpal Tunnel Syndrome , Surveys and Questionnaires , Endoscopy , Trigger Finger Disorder , Median Nerve
6.
Rev. colomb. gastroenterol ; 36(supl.1): 37-41, abr. 2021. graf
Article in Spanish | LILACS | ID: biblio-1251544

ABSTRACT

Resumen Introducción: Los schwannomas esofágicos son tumores de elementos perineurales de la vaina nerviosa de la célula de Schwann en los nervios periféricos y representan el 2 % de los tumores primarios de esófago. Su difícil diagnóstico está dado por la baja incidencia que este presenta; sin embargo, es una etiología que debe considerarse debido a que su comportamiento clínico e imagenológico es rápidamente progresivo e inusual, comparado con otros tumores benignos de esófago. Caso clínico: Paciente femenina de 38 años con cuadro clínico de disfagia de 1 año de evolución, con endoscopia de vías digestivas altas y tomografía axial computarizada (TAC) de tórax contrastada que evidencian una masa a nivel del esófago cervical y torácico transmural, que obstruye la luz y ejerce el efecto de masa sobre la tráquea. Se realizó una biopsia que reportó un tumor fusocelular con inmunohistoquímica positiva para el marcador S100, por lo que se diagnosticó un schwannoma esofágico. En la actualidad, la paciente se encuentra en controles periódicos y en espera del concepto por oncología clínica para proponer tratamiento no quirúrgico dado el compromiso adyacente. Conclusión: Ante la sospecha de tumor primario de esófago, la primera impresión diagnóstica según la incidencia será un leiomioma, pero con nuestro reporte de caso de schwannoma esofágico, se resalta que, en un cuadro clínico no usual, este es un diagnóstico diferencial que requiere atención precoz para evitar complicaciones y secuelas en los pacientes.


Abstract Introduction: Esophageal schwannomas are tumors of the perineural components of the Schwann cell nerve sheath in peripheral nerves and account for 2% of primary esophageal tumors. Its low incidence makes diagnosis challenging; however, this etiology should be considered because its clinical and imaging behavior is rapidly progressive and unusual compared to other benign esophageal tumors. Case study: A 38-year-old female patient with a 1-year history of dysphagia underwent upper digestive tract endoscopy and contrast chest CT showing a mass at the cervical and transmural thoracic esophagus level, obstructing the lumen and exerting a mass effect on the trachea. A biopsy revealed a spindle cell tumor with positive immunohistochemistry for the S100 marker, leading to the diagnosis of esophageal Schwannoma. The patient is currently undergoing regular check-ups and is awaiting the advice of a clinical oncologist to recommend non-surgical treatment options due to the involvement of adjacent structures. Conclusion: The first diagnostic impression in the case of a suspected primary esophageal tumor would be a leiomyoma based on its incidence. The present case report of an esophageal schwannoma emphasizes that this is a differential diagnosis that requires timely treatment to avoid complications and sequelae in patients.


Subject(s)
Humans , Female , Adult , Esophageal Neoplasms , Neurilemmoma , Therapeutics , Endoscopy
7.
Rev. argent. cir ; 113(1): 62-72, abr. 2021. graf
Article in Spanish | LILACS | ID: biblio-1288175

ABSTRACT

RESUMEN Antecedentes: la prevalencia conjunta de litiasis vesicular y coledociana aumenta con la edad y llega al 15% en la octava década de la vida. Su manejo continúa siendo controvertido: algunos profesionales prefieren el abordaje en un tiempo por videolaparoscopia, y otros, el abordaje en dos tiempos con endoscopia (CPRE preoperatoria) seguida de colecistectomía laparoscópica. Objetivo: evaluar la eficacia y seguridad del manejo en un tiempo por videolaparoscopia en pacientes consecutivos con diagnóstico de litiasis vesicular y coledociana. Material y métodos: estudio retrospectivo con datos de una base de datos prospectiva, entre julio de 2008 y julio de 2018. Resultados: sobre un total de 2447 colecistectomías laparoscópicas realizadas en el citado período, 416 (17%) presentaron litiasis coledociana. El éxito global de la vía transcística en la extracción de litiasis coledociana fue del 81,2%: del 70,4% en los casos con diagnóstico prequirúrgico de colestasis extrahepática litiásica y del 92,9% en los otros diagnósticos. La morbilidad fue del 4%, sin mortalidad ni lesiones quirúrgicas de la vía biliar. Conclusión : el manejo en un tiempo por videolaparoscopia es eficaz y seguro debido al elevado éxito global de la instrumentación transcística (ITC). El diagnóstico preoperatorio de coledocolitiasis condi ciona una disminución de esa eficacia, por mayor indicación de coledocotomía, con un aumento de la morbilidad y del tiempo de internación.


ABSTRACT Background: The prevalence of common bile duct stones associated with cholelithiasis increases with age and is about 15 % in the 8th decade of life but its management is still controversial. Some surgeons prefer the single-stage approach with laparoscopy while others suggest the two-stage management with preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Objective: The aim of the present study was to evaluate the efficacy of feasibility of single-stage laparoscopic surgery in patients with cholelithiasis and choledocholithiasis. Material and methods: We conducted a retrospective study with prospectively collected data between July 2008 and July 2018. Results: Of 2447 laparoscopic cholecystectomies performed during the study period, 416 presented common bile duct stones. The global success of the transcystic approach to clear common bile duct stones was 81.2%, 70.4% in the cases with preoperative diagnosis of choledocholithiasis and 92.9% for other diagnoses. The rate of complications was 4% without deaths or bile duct injuries. Conclusion: Single-stage laparoscopic surgery is an efficient and safe approach based on the high global success of transcystic exploration. The preoperative diagnosis of choledocholithiasis reduces the efficacy of the procedure due to greater indication of choledocotomy, with complications and longer length of hospital stay.


Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy, Laparoscopic , Laparoscopy , Cholelithiasis , Efficacy , Retrospective Studies , Choledocholithiasis , Endoscopy
8.
Rev. cuba. anestesiol. reanim ; 20(1): e701, ene.-abr. 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1156367

ABSTRACT

Introducción: La convivencia con la infección por COVID-19 en Cuba supone un reto actual de adaptación a todos los entornos hospitalarios y de salud, creación de protocolos y nuevos modelos de asistencia. La intervención sobre la vía aérea en sus diferentes formas, conlleva un riesgo de contaminación al personal de la salud. Objetivo: Describir las consideraciones anestésicas en los procedimientos laparoscópicos y endoscópicos durante la pandemia COVID-19. Métodos: Se realizó un estudio cualitativo, de investigación-acción, apoyado en el análisis de documentos y la observación participante de las acciones tomadas en el Centro Nacional de Cirugía de Mínimo Acceso en el curso de los cuatro meses transcurridos a partir de que se identificara el primer caso de COVID-19 en Cuba. Resultados: Se establecieron las recomendaciones anestésicas para el procedimiento de actuación durante la COVID-19 en el Centro Nacional de Cirugía de Mínimo Acceso, que dictan las acciones para el tratamiento de los pacientes y la protección de los trabajadores. Esto posibilita mantener la calidad de los servicios médico quirúrgicos en estos escenarios de riesgo. Conclusiones: La evaluación y tratamiento anestésico estandarizado de los pacientes ante el brote de COVID-19 y en la fase poscovid permite optimizar la seguridad del paciente y el personal sanitario. Es importante el cumplimiento de los protocolos dirigidos hacia el control estricto de la parada quirúrgica, uso adecuado de los equipos de protección personal, disminución de los aerosoles con métodos de barrera y la desinfección del salón y equipos al concluir la intervención(AU)


Introduction: Coexistence with COVID-19 infection in Cuba is a current challenge of adaptation to all hospital and health settings, creation of protocols and new models of care. The airway approach in its different forms represents a risk of contamination of the health personnel. Objective: To describe the anesthetic considerations in laparoscopic and endoscopic procedures during the COVID-19 pandemic. Methods: A qualitative, action-research study was carried out, supported by the analysis of documents and participant observation of the actions taken in the National Center for Minimally-Invasive Surgery in the course of four months after the first case of COVID-19 was identified in Cuba. Results: Anesthetic recommendations were established for the action procedure during COVID-19 in the National Center for Minimally-Invasive Surgery, which dictate the actions for the treatment of patients and the protection of workers. This makes it possible to maintain the quality of surgical medical services in these risk settings. Conclusions: Assessment and standardized anesthetic treatment of patients in the face of the COVID-19 outbreak and in the post-COVID phase allows optimizing the safety of the patient and the healthcare personnel. It is important to comply with the protocols aimed at controlling strictly the surgical setting, proper use of personal protective equipment, reduction of aerosols with barrier methods, and disinfection of the room and equipment at the conclusion of the intervention(AU)


Subject(s)
Humans , Coronavirus Infections/prevention & control , Protocols , Patient Safety , Laparoscopy/methods , Endoscopy/methods , Evaluation Studies as Topic , Anesthesia/standards
9.
Rev. medica electron ; 43(2): 3231-3238, mar.-abr. 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1251940

ABSTRACT

RESUMEN El páncreas ectópico es una entidad poco común. Como tumor submucoso de origen congénito, frecuentemente presenta un curso asintomático, aunque con posibles complicaciones. Su diagnóstico de certeza se basa en la endoscopia, el ultrasonido endoscópico y la histología, que permiten adoptar una conducta expectante o quirúrgica. El paciente estudiado presentó un páncreas ectópico localizado en antro gástrico asociado a síntomas de reflujo gastroesofágico rebeldes a tratamiento, los cuales motivaron el estudio endoscópico, con el consecuente hallazgo de dicha entidad (AU).


ABSTRACT Ectopic pancreas is a little common entity. As congenital-originated sub mucous tumor, it frequently presents an asymptomatic course, though with possible complications. Its definitive diagnosis is based in the endoscopy, endoscopic ultrasound and histology, allowing to adopt an expectant or surgical behavior. The current patient presented an unresponsive-to-treatment ectopic pancreas located in the gastric antrum associated to gastro-esophageal reflux symptoms. This motivated the endoscopic study consequently leading to finding this entity (AU).


Subject(s)
Humans , Male , Adult , Pancreatic Neoplasms/diagnosis , Pyloric Antrum/pathology , Gastroesophageal Reflux/complications , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/drug therapy , Signs and Symptoms , Therapeutics/methods , Endoscopy/methods
10.
An. Fac. Cienc. Méd. (Asunción) ; 54(1): 101-108, 20210000.
Article in Spanish | LILACS | ID: biblio-1178954

ABSTRACT

La litiasis vesicular sintomática puede presentarse asociada a litiasis de la vía biliar principal, siendo necesaria la utilización de medios diagnósticos adecuados para su posterior tratamiento. En este trabajo, se sugiere la evaluación mediante las guías de la Sociedad Americana para Endoscopia Gastrointestinal (American Society for Gastrointestinal Endoscopy ASGE), usando factores como la edad, pruebas hepáticas y hallazgos ecográficos, categorizando a los pacientes en baja, intermedia y alta probabilidad de coledocolitiasis. Estudio de diseño retrospectivo, observacional, descriptivo, de corte transversal, con un muestreo no probabilístico de casos consecutivos, sobre pacientes con diagnóstico de litiasis vesicular sintomática y sospecha de litiasis de la via biliar principal internados en la II Cátedra de Clínica Quirúrgica, del Hospital de Clínicas de San Lorenzo, entre los años 2017 a 2019. Con los siguientes resultados, de un total de 339 pacientes con diagnóstico de litiasis vesicular sintomática, el 6,64% tuvo el diagnóstico de coledocolitiasis asociada. En cuanto a los predictores muy fuertes de coledocolitiasis el más frecuentemente (68,6%,) encontrado fue el nivel de la bilirrubina total ≥ 4mg/dl; de los predictores fuertes el 70,6% presentaba la vía biliar principal dilatada; de los predictores moderados, el 84,3% presentó las enzimas hepáticas alteradas. En conclusión, se pudo identificar que la mayoría de los pacientes presentó alta probabilidad de coledocolitiasis y la conducta tomada fue realizar en primer lugar una colangiografía retrógrada endoscópica, con fines terapéuticos y luego colecistectomía, correspondiente al manejo correcto establecido por las guías actuales internacionales.


Symptomatic gallstones can occur associated with lithiasis of the main bile duct, requiring the use of adequate diagnostic tools for subsequent treatment. In this paper, we suggest using the guidelines of the American Society for Gastrointestinal Endoscopy (ASGE), that uses factors such as age, liver tests, and ultrasound findings, categorizing patients as those with low, intermediate, and high probability. of choledocholithiasis. A Retrospective, observational, descriptive, cross-sectional design study, with a non-probabilistic sampling of consecutive cases, on patients with a diagnosis of symptomatic gallstones and suspected stones of the main bile duct admitted to the the 2nd Surgical Department and Service of Clinica´s Hospital of San Lorenzo, between the years 2017 to 2019. With the following results; of a total of 339 patients with the diagnosis of symptomatic gallstones, 6.64% had associated choledocholithiasis. Regarding the very strong predictors of choledocholithiasis, the most frequent (68.6%) was the total bilirubin level ≥ 4mg / dl; 70.6% had a dilated main bile duct as a strong predictor; as a moderate predictor, 84.3% had altered liver enzymes. In conclusion, it was possible to identify that most of the patients presented a high probability of choledocholithiasis and the action taken was to first perform an endoscopic retrograde cholangiography, for therapeutic purposes, and then cholecystectomy, corresponding to the correct management established by current international guidelines.


Subject(s)
Bile Ducts , Bilirubin , Cholangiography , Cholecystectomy , Gallstones , Lithiasis , Liver , Sampling Studies , Endoscopy, Gastrointestinal , Endoscopy
11.
Rev. argent. cir ; 113(1): 117-120, abr. 2021. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1288181

ABSTRACT

RESUMEN La resección gástrica atípica ha demostrado ser beneficiosa para tumores submucosos. La técnica pre senta mayor riesgo cuando estos se desarrollan próximos a la unión esófago-gástrica (UEG). Para esta limitación se propuso la resección intragástrica mediante una técnica mixta combinando laparoscopia y endoscopia. En nuestro medio no existen publicaciones al respecto. Se trata de una mujer de 42 años, con lesión subepitelial-subcardial de 2 cm, evaluada mediante videoendoscopia alta (VEDA), compa tible con tumor del estroma gastrointestinal (GIST) evaluado mediante ecoendoscopia. La lesión fue resecada mediante abordaje combinado laparoendoscópico. Bajo visión laparoscópica se introdujeron en cavidad abdominal trocares con balón, y bajo visión endoscópica intragástrica se introdujeron estos en el estómago y se fijó la pared gástrica a la pared abdominal insuflando dichos balones. Posterior mente se realizó la resección de la lesión con sutura mecánica. El abordaje combinado es seguro y eficaz, simple en manos entrenadas, pero constituye una opción reproducible en casos seleccionados.


ABSTRACT Atypical gastric resection has proved to be beneficial to treat submucosal tumors. The technique is more difficult when these tumors develop next to the gastroesophageal junction (GEJ). Intragastric resection combining endoscopic and laparoscopic approach was proposed to solve this limitation. There are no publications about this technique in our environment. A 42-year-old female patients with a 2-mm subepithelial tumor below the cardia evaluated by upper gastrointestinal (UGI) videoendoscopy and endoscopic ultrasound suggestive of a gastrointestinal stroma tumor (GIST) underwent resection using the combined laparo-endoscopic approach. Under laparoscopic guidance, balloon-tipped trocars were introduced in the abdominal cavity and then into the stomach using endoscopic view. The balloons were inflated to fix the gastirc wall to the abdominal wall. The lesion was resected using mechanical stapler. The combined approach is safe and efficient, and simple to perform for trained professionals, constituting a reproducible option in selected cases.


Subject(s)
Laparoscopy , Esophagogastric Junction , Neoplasms , Patients , Stomach , Surgical Instruments , Vision, Ocular , Women , Wounds and Injuries , Cardia , Endosonography , Mechanics , Abdominal Cavity , Endoscopy , Environment , Hand , Methods
12.
Rev. colomb. gastroenterol ; 36(1): 130-137, ene.-mar. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1251534

ABSTRACT

Resumen Introducción: en el estudio de la baja talla de origen digestivo en niños no hay un patrón de paraclínicos preestablecido; sin embargo, la endoscopia de vías digestivas puede ser una herramienta útil para tal fin. Objetivo: reportar una serie de casos de niños con diagnóstico de baja talla a quienes se les indicó una endoscopia de vías digestivas altas como parte de su estudio. Reporte de casos: se incluyeron 15 niños entre los 2 y 16 años de edad, 53,3% niñas, 26,7% desnutridos según el índice de masa corporal y la talla para la edad, 66,7% con baja talla grave y 33,3% con baja talla moderada. El 53,3% presentó dolor abdominal, el 46,7% no tuvo ganancia de peso, el 26,7% tuvo inapetencia y el 13,3% tuvo vómito, entre otros. Entre el 40,0% y el 93,4% presentaron macro- o microscópicamente esofagitis, gastritis y duodenitis. Los hallazgos microscópicos más importantes fueron duodenitis crónica con giardiasis, úlceras duodenales, hiperplasia nodular linfoide duodenal, Helicobacter pylori y duodenitis crónica eosinofílica. Conclusiones: a pesar de que la endoscopia de vías digestivas es un método poco utilizado y no bien descrito en el estudio de niños con baja talla, este reporte de casos describe organicidad en un 80,0% de los niños analizados.


Abstract Introduction: The study of short stature of digestive origin in children shows no pre-established laboratory patterns. However, endoscopy of the digestive tract may be a useful tool for this purpose. Objective: To report a series of cases of children with a diagnosis of short stature who underwent upper digestive tract endoscopy as part of their study. Case report: 15 children between the ages of 2 and 16 years were included; 53.3% were girls. 26.7% presented with malnutrition according to their body mass index and height-for-age, 66.7% had short stature, and 33.3% moderate short stature. Abdominal pain was reported in 53.3% of the cases, and no weight gain in 46.7%. Other symptoms were lack of appetite in 26.7%, vomiting in 13.3%, among others. Between 40% and 93.4% of the children presented macro and/or microscopic esophagitis, gastritis, and duodenitis. The most important microscopic findings were chronic duodenitis with giardiasis, duodenal ulcers, duodenal nodular lymphoid hyperplasia, Helicobacter pylori, and chronic eosinophilic duodenitis. Conclusions: Although endoscopy of the digestive tract is a method barely used and not well described in the study of children with short stature, this case report describes organicity in 80% of the children analyzed.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Baja , Endoscopy, Gastrointestinal , Endoscopy , Body Mass Index , Duodenitis , Esophagitis , Gastritis
13.
Int. braz. j. urol ; 47(2): 308-321, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154449

ABSTRACT

ABSTRACT Introduction and objective: To evaluate changes in verumontanum anatomy in patients with benign prostatic hyperplasia (BPH) who used 5-alpha reductase inhibitors (5-ARIs) and to propose an anatomical classification of the verumontanum. Materials and Methods: We studied 86 patients with BPH and 7 patients without the disease (age under 40 years-old who underwent kidney or ureteral lithotripsy). Of the patients with BPH, 34 (mean age=67.26) had 5-ARIs use and 52 (mean age=62.69) did not use the drug. During surgeries, photographs of the seminal colliculus were taken and later, with the aid of software (Image J), the length (longitudinal diameter) and width (transverse diameter) of the verumontanum were measured in all patients. During the procedure, we evaluated the different types of verumontanum. For statistical analysis, the R-Project software was used. Results: In the group of patients with BPH who were taking medication (group 1), the mean measures of length and width of the verumontanum were 4.69mm and 2.94mm respectively. In the group of patients with BPH who did not use the drug (group 2), the mean diameters were 4.54mm and 3.20mm respectively. In the control group (group 3), the average length and width were 5.63mm and 4.11mm respectively. There was an increase in longitudinal and transverse measurements of the control group with an increase in body mass index (BMI) (p=0.0001 and p=0.035 respectively). In addition, there was a reduction in transverse diameter in the group of BPH using 5-ARI with increased prostate volume (p=0.010). We found five different verumontanum types: "volcano" (51.61%), "lighthouse" (24.73%), "whale tail" (12.90%), "hood" (5.38%) and "castle door" (5.38%), which we propose as an anatomical classification. Conclusion: Veromontanum has smaller measurements in patients with BPH regardless of treatment. In the control group, there was an increase in verumontanum diameters with an increase in BMI. The volcano type of verumontanum was the most frequent regardless of groups and BMI.


Subject(s)
Humans , Male , Prostatic Hyperplasia/surgery , Prostatic Hyperplasia/drug therapy , Urethra , Endoscopy , 5-alpha Reductase Inhibitors
14.
Coluna/Columna ; 20(1): 47-49, Jan.-Mar. 2021. tab
Article in English | LILACS | ID: biblio-1154022

ABSTRACT

ABSTRACT Objective: In Brazil, there are no studies comparing endoscopic treatment of lumbar disc herniation with the conventional open technique in SUS (Unified Health System) with regard to hospitalization time and complications occurring within one year, which is the objective of this study. Methods: A survey of 32 surgeries performed in 2019 (11 open and 21 endoscopic) to evaluate pain parameters before and after surgery (VAS), days of hospitalization, and complications. The data were submitted to statistical analysis (ANOVA) using the Kruskal-Wallis test. Results: Fourteen patients were female and eighteen were male, with a mean age of 41.35 years (p> 0.05 between sexes). The pre- and postoperative VAS for pain radiating to the lower limb were similar between the groups: 8.5 ± 0.82 with the open technique and 8.19 ± 1.15 with endoscopic technique. In both groups there was an improvement in the pain pattern with a significant reduction in the VAS (p < 0.05) and there was no statistical relevance between the groups in terms of pain improvement. There was statistical relevance between the groups in the comparison of days of hospitalization required, with the group submitted to endoscopic surgery having a lower number of days. The complications reported were compatible with those found in the literature (postoperative dysesthesia, new herniation). Conclusions: The endoscopic technique resulted in an important reduction in the number of days of hospitalization, a factor with a high impact on the costs of any surgical procedure, which can be a determining factor in the feasibility of minimally invasive techniques. Level of evidence IV; Therapeutic Study.


RESUMO Objetivos: No Brasil, não há estudos que comparem o tratamento endoscópico de hérnia de disco lombar no SUS (Sistema Único de Saúde) com a técnica aberta convencional, no que diz respeito aos resultados com relação ao tempo de internação e complicações ocorridas em um ano, o que vem a ser o objetivo deste estudo. Métodos: Levantamento de 32 cirurgias realizadas em 2019 (11 por via aberta e 21 por via endoscópica) para avaliar os parâmetros de dor antes e depois da cirurgia (EVA), dias de internação e complicações. Os dados foram submetidos à análise estatística (ANOVA) com o teste de Kruskal-Wallis. Resultados: Catorze pacientes eram do sexo feminino e 18 do sexo masculino, com média de idade de 41,35 anos (p > 0,05 para os dois sexos). A EVA de dor irradiada para o membro inferior no pré e pós-operatório foi semelhante entre os grupos: 8,5 ± 0,82 com a técnica aberta e 8,19 ± 1,15 com a técnica endoscópica. Em ambos os grupos houve melhora do padrão de dor com redução significativa da EVA (p < 0,05) e não houve relevância estatística entre os grupos quanto à melhora do dor. Na comparação das diárias de internação necessárias houve relevância estatística entre os grupos, sendo que o grupo submetido à endoscopia teve número menor de diárias. As complicações relatadas são compatíveis com as encontradas na literatura (disestesia pós-operatória, nova herniação). Conclusões: A técnica endoscópica resultou em redução importante do número de dias de internação, fator com alto impacto nos custos de qualquer procedimento cirúrgico, que pode ser determinante para viabilizar técnicas minimamente invasivas. Nível de evidência IV; Estudo Terapêutico.


RESUMEN Objetivos: En Brasil, no hay estudios que comparen el tratamiento endoscópico de hernia de disco lumbar en el SUS (Sistema Único de Salud) con la técnica abierta convencional, en lo que refiere a los resultados con relación al tiempo de internación y complicaciones ocurridas en un año, lo que viene a ser el objetivo de este estudio. Métodos: Levantamiento de 32 cirugías realizadas en 2019 (once por vía abierta y veintiuna por vía endoscópica) para evaluar los parámetros de dolor antes y después de la cirugía (EVA), días de internación y complicaciones. Los datos fueron sometidos a análisis estadístico (ANOVA) con el test de Kruskal-Wallis. Resultados: Catorce pacientes eran del sexo femenino y dieciocho del sexo masculino con promedio de edad de 41,35 años (p>0,05 para los dos sexos). La EVA de dolor irradiado para el miembro inferior en el pre y postoperatorio fue semejante entre los grupos: 8,5±0,82 con la técnica abierta y 8,19±1,15 con la técnica endoscópica. En ambos grupos hubo mejoras del patrón de dolor con reducción significativa de la EVA (p<0,05) y no hubo relevancia estadística entre los grupos cuanto a la mejora del dolor. En la comparación de los días de internación necesarios hubo relevancia estadística entre los grupos, siendo que el grupo sometido a la endoscopia tuvo número menor de días de internación. Las complicaciones relatadas son compatibles con las encontradas en la literatura (disestesia postoperatoria, nueva herniación). Conclusiones: La técnica endoscópica resultó en reducción importante del número de días de internación, factor con alto impacto en los costos de cualquier procedimiento quirúrgico, que puede ser determinante para viabilizar técnicas mínimamente invasivas. Nivel de evidencia IV; Estudio Terapéutico.


Subject(s)
Humans , Minimally Invasive Surgical Procedures , Endoscopy , Conversion to Open Surgery
15.
Rev. Col. Bras. Cir ; 48: e20202672, 2021. graf
Article in English | LILACS | ID: biblio-1155361

ABSTRACT

ABSTRACT Incisional hernia is a late complication of the most frequent after abdominal surgeries, with resulting morbidity that can worsen the condition. The treatment has been done both by open techniques, using screens or not, and by laparoscopic and robotic methods, which use them systematically. However, introducing a permanent foreign body into the tissues requires more surgical time, despite not closing the parietal defect in most cases and a higher risk of infections. New technologies have been trying to improve these results, with absorbable prostheses (biological or synthetic), but their high cost and recurrences remain a severe problem. Even so, standard repair establishes reinforcement with screens, routine, and whether the approach is traditional or mini-invasive. The authors report their first case of endoscopic repair of incisional hernia, which occurred two years ago, with a Brazilian technique already fifty years old: the transposition with the hernia sac proposed by Prof. Alcino Lázaro da Silva in 1971.


RESUMO A hérnia incisional é uma das complicações tardias mais frequentes, após operações abdominais, resultando em alta morbidade. O tratamento tem sido feito tanto por técnicas abertas, com telas ou sem, quanto por métodos laparoscópicos e robóticos, que utilizam próteses de forma sistemática. No entanto, a introdução de um corpo estranho permanente entre os tecidos requer mais tempo cirúrgico, não fecha o defeito parietal na maioria dos casos e está associado a maior risco de infecções. Novas tecnologias têm sido utilizadas para melhorar esses resultados, empregando próteses absorvíveis (biológicas ou sintéticas), mas o alto custo e as recidivas continuam sendo um grave problema. No entanto, a reparação padrão rotineiramente estabelece reforço com telas, seja na abordagem tradicional ou minimamente invasiva. Os autores relatam o primeiro caso do reparo endoscópico de hérnia incisional, usando técnica brasileira com 50 anos de idade: a transposição com o saco herniário, conforme proposta pelo Prof. Alcino Lázaro da Silva, em 1971.


Subject(s)
Humans , Male , Surgical Mesh , Endoscopy , Herniorrhaphy/methods , Incisional Hernia/surgery , Hernia, Ventral/surgery , Brazil , Treatment Outcome , Length of Stay , Middle Aged
16.
Gastroenterol. latinoam ; 32(1): 11-13, 2021. ilus
Article in Spanish | LILACS | ID: biblio-1352356

ABSTRACT

Pseudomelanosis duodeni is a very rare appearance of the duodenal mucosa, characterized by the presence of a dark pigment (iron oxide) seen in the surface of the villi, evident by endoscopy. It can be associated with pathologies such as arterial hypertension, chronic heart failure, chronic kidney failure, gastrointestinal bleeding, and consumption of different drugs. We describe the case of a 68-year-old male patient, with chronic renal insufficiency, hemodialysis and intravenous iron treatment.


La Pseudomelanosis duodeni es una entidad muy poco frecuente de la mucosa duodenal que se caracteriza por la presencia de un pigmento oscuro de las vellosidades (oxido de hierro) que es evidente mediante endoscopía y puede estar asociado a patologías como hipertensión arterial, insuficiencia cardíaca crónica, insuficiencia renal crónica, hemorragia gastrointestinal y consumo de diferentes fármacos. Describimos el caso de un paciente masculino de 68 años, con antecedentes de insuficiencia renal crónica, en hemodiálisis y uso de hierro intravenoso.


Subject(s)
Humans , Male , Aged , Duodenal Diseases/pathology , Duodenum/pathology , Melanosis/pathology , Duodenal Diseases/diagnostic imaging , Duodenum/diagnostic imaging , Endoscopy/methods , Melanosis/diagnostic imaging
17.
Artrosc. (B. Aires) ; 28(3): 243-245, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1348327

ABSTRACT

La lesión de Morel-Lavallée es una patología cerrada de partes blandas, ocasionada por la separación traumática de la piel y tejido celular subcutáneo de la fascia muscular. Debido a su asociación con traumatismos de alta energía puede pasar desapercibida y llevar a un diagnóstico tardío. Su localización es variable, y la región lumbar es poco frecuente. Generalmente con el diagnóstico precoz y el tratamiento conservador se obtienen buenos resultados.Presentamos un reporte de caso de una paciente de sexo femenino, de veinte años, que sufrió un accidente automovilístico, con una colección localizada en región dorsolumbar diagnosticada tardíamente. Fue tratada de forma endoscópica y con la aplicación de agentes esclerosantes. Se obtuvieron buenos resultados con remisión de la colección. Nivel de Evidencia: V


The Morel-Lavallée lesion is closed soft tissue pathology, caused by the traumatic separation of the skin and subcutaneous cellular tissue of the muscular fascia. Due to its association with high-energy trauma, it can go unnoticed, generating a late diagnosis. Its location is variable, the lumbar region being rare. Generally, with early diagnosis and conservative treatment, good results are obtained.We present a case report of a twenty-year-old female patient suffering a car accident with a late-diagnosed collection located in the thoracolumbar region. She was treated endoscopically and with the application of sclerosing agents. Good results were obtained with remission of the collection. Level of Evidence: V


Subject(s)
Young Adult , Spinal Diseases , Endoscopy/methods , Degloving Injuries/surgery
18.
Clinics ; 76: e2280, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153951

ABSTRACT

OBJECTIVES: Strategic planning for coronavirus disease (COVID-19) care has dominated the agenda of medical services, which have been further restricted by the need for minimizing viral transmission. Risk is particularly relevant in relation to endoscopy procedures. This study aimed to describe a contingency plan for a tertiary academic cancer center, define a strategy to prioritize and postpone examinations, and evaluate the infection rate among healthcare workers (HCWs) in the endoscopy unit of the Cancer Institute of the State of São Paulo (ICESP). METHODS: We created a strategy to balance the risk of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to mitigate the effects of postponing endoscopic procedures in oncological patients. A retrospective analysis of prospectively collected data on all endoscopies between March and June 2020 compared with those during the same period in 2019 was carried out. All HCWs were interviewed to obtain clinical data and SARS-CoV-2 test results. RESULTS: During the COVID-19 outbreak, there was a reduction of 55% in endoscopy cases in total. Colonoscopy was the most affected modality. The total infection rate among all HCWs was 38%. None of the senior digestive endoscopists had COVID-19. However, all bronchoscopists had been infected. One of three fellows had a serological diagnosis of COVID-19. Two-thirds of all nurses were infected, whereas half of all technicians were infected. CONCLUSIONS: In this pandemic scenario, all endoscopy services must prioritize the procedures that will be performed. It was possible to maintain some endoscopic procedures, including those meant to provide nutritional access, tissue diagnosis, and endoscopic resection. Personal protective equipment (PPE) seems effective in preventing transmission of COVID-19 from patients to digestive endoscopists. These measures can be useful in planning, even for pandemics in the future.


Subject(s)
Humans , Coronavirus Infections , Coronavirus , Neoplasms/epidemiology , Brazil/epidemiology , Retrospective Studies , Infection Control , Health Personnel , Endoscopy , Pandemics , Betacoronavirus
19.
Article in English | WPRIM | ID: wpr-880656

ABSTRACT

OBJECTIVES@#To study the risk factors for complications after endoscopic therapy for upper gastrointestinal subepithelial lesions (SELs).@*METHODS@#Retrospective analysis was performed on 184 patients in the Department of Gastroenterology in the Third Xiangya Hospital, Central South University after therapeutic endoscopy [endoscopic submucosal dissection (ESD), endoscopic full-thickness resection (EFR), endoscopic submucosal excavation (ESE), and submucosal tunneling endoscopic resection (STER)] for the upper gastrointestinal SELs from 2014-09-01 to 2019-09-30. The clinic data were collected and risk factors for postoperative complications were analyzed.@*RESULTS@#Among the 184 patients, 22 patients were in the complication group (including 3 cases of delayed bleeding, 2 cases of delayed perforation, and 17 cases of electrocoagulation syndrome) and 162 patients were in the non-complication group. There was no significant difference between the complication group and the non-complication group in gender, age over 70 year, basic diseases, lesion location, lesion invasion layers, pathological results, endoscopic therapy, and preventive closure of wounds (all @*CONCLUSIONS@#For the patients with upper gastrointestinal SELs after endoscopic minimally invasive therapy with the lesion diameter over 40 mm and the operative time over 120 minutes, it needs to highly alert to the occurrence of postoperative complications.


Subject(s)
Endoscopic Mucosal Resection/adverse effects , Endoscopy , Endoscopy, Gastrointestinal , Gastric Mucosa , Humans , Retrospective Studies , Risk Factors , Stomach Neoplasms , Treatment Outcome
20.
Pesqui. vet. bras ; 41: e06741, 2021. tab, ilus
Article in English | ID: biblio-1250489

ABSTRACT

Colonoscopy is a minimally invasive technique used to assess the large intestine through direct inspection of the intestinal mucosa. When associated with histopathological examination of fragments collected from the intestine, the definitive diagnosis can be obtained. This retrospective study evaluated colonoscopy and histopathological exams of the large intestine and ileum of dogs with gastrointestinal disorders admitted at the Veterinary Hospital of the Federal University of Minas Gerais (UFMG) and the Veterinary Hospital São Francisco de Assis to determine the frequency of injuries, their distribution in the intestinal segments, and the relationship of the findings observed in these two analyzes. The colonoscopy and histopathological findings of the case series were described using absolute and relative frequencies, as well as nature and intensity classification of the findings. Cohen's Kappa coefficient was obtained to assess the concordance of nature and intensity classifications between colonoscopy and histopathology, and its 95% confidence interval constructed. The analyses were performed using the Software SAS University Edition. It was observed a moderate agreement between the classification of the nature of the findings by endoscopy and histopathology (Kappa coefficient = 0.39, CI = 0.20-0.59). This can also be observed when assessing the frequency of similar diagnoses between the methods, since only 39 (72.22%) were consistent, i.e., 15 (22.78%) diagnoses differed depending on the nature of the finding, which could have a great influence on the final diagnosis if histopathology was disregarded. For the intensity of the injuries, little agreement was observed between the methods (Kappa coefficient = 0.1243, C = -0.05-0.30). This was even more evident in the frequency of similar diagnoses in terms of intensity, of which 20 (37.04%) were similar and 34 (62.96%) were different. Inflammatory affections are the most frequently observed alterations in the large intestine and ileum of dogs. The most common finding that reveals inflammatory changes is the lymphoplasmacytic infiltrate. As for the proliferative and neoplastic lesions, adenomatous polyps and lymphoma were common. The most affected sites of the large intestine were the descending colon and the rectum. Findings such as edema and reddening of the mucosa were frequent by macroscopy. Although the changes observed by colonoscopy and histopathology may not be similar, these techniques are complementary, which makes biopsies mandatory for a diagnostic conclusion.(AU)


A colonoscopia é uma técnica pouco invasiva utilizada para avaliação do intestino grosso por meio de inspeção direta da mucosa intestinal. Quando associada ao exame histopatológico, com a coleta de fragmentos do intestino, o diagnóstico definitivo pode ser obtido. O objetivo desse estudo retrospectivo foi associar os achados de exames de colonoscopia e histopatologia do intestino grosso e íleo em 54 cães com distúrbios gastrointestinais dos Hospitais Veterinários da Universidade Federal de Minas Gerais (UFMG) e São Francisco de Assis. Na colonoscopia, as alterações mais frequentemente observadas foram edema, friabilidade e avermelhamento de mucosa. Quanto à distribuição de lesões por segmento intestinal, houve maior incidência de alterações inflamatórias, das quais foram as mais frequentes, com o infiltrado linfoplasmocitário sendo o mais comum em todos segmentos analisados (i.e. reto, cólon, ceco e íleo). O cólon ascendente e o reto foram os locais de alterações mais frequentes na colonoscopia e na histopatologia. Os pólipos hiperplásicos e o linfoma foram as lesões proliferativas de ocorrência mais comum. Houve baixa concordância entre as classificações por natureza e intensidade dos achados na colonoscopia e histopatologia. Assim, não foi possível associar alterações descritas nos exames histopatológicos quanto à natureza e intensidade das lesões utilizando a colonoscopia, o que leva à conclusão de que é essencial a realização de biópsias em todos os exames para conclusão diagnóstica.(AU)


Subject(s)
Animals , Dogs , Colonoscopy , Dogs/anatomy & histology , Endoscopy , Intestine, Large , Hospitals, Animal , Intestinal Mucosa
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