Evaluación gastrointestinal en los pacientes con fiebre mediterránea familiar con dolor abdominal crónico y tratados con colchicina: serie de casos / Gastrointestinal evaluation in colchicine-treated familial Mediterranean fever patients with chronic abdominal pain: Cases series

El objetivo de este estudio fue evaluar a los pacientes con fiebre mediterránea familiar (familial Mediterranean fever, FMF) y dolor abdominal crónico resistentes al tratamiento con colchicina. Se incluyó a 48 pacientes diagnosticados en nuestro consultorio de reumatología pediátrica que tenían dolor abdominal a pesar del tratamiento con colchicina. A todos los pacientes se los derivó a un gastroenterólogo pediátrico. Se registraron las características del dolor, tales como aparición, duración y frecuencia; se planificó una endoscopía digestiva para obtener un diagnóstico diferencial. Se determinó la presencia de una mutación del gen MEFV en 46 pacientes. La mediana de la duración del tratamiento fue de 2,8 años. Aproximadamente el 60% de los pacientes tenían dolor abdominal todos los días o de dos a tres veces a la semana; en el 73% de los casos, duró menos de tres horas. A 41 pacientes se les realizó una endoscopía digestiva alta. La gastroduodenitis es un hallazgo frecuente en los pacientes con FMF y dolor abdominal persistente a pesar del tratamiento. Los pacientes con los puntajes más altos de severidad de la enfermedad tenían inflamación digestiva grave.

The aim of the study to evaluate familial mediterranean fever (FMF) patients with chronic abdominal pain unresponsive to colchicine treatment. Forty-eight patients who diagnosed in our Pediatric Rheumatology clinics and suffering from abdominal pain despite colchicine treatment were include. All patients were referred to a pediatric gastroenterologist. The pain characteristics such as onset, duration and frequency were recorded; gastrointestinal (GI) endoscopy was planned for differential diagnosis. MEFV mutation was determined in 46 patients. The median duration of treatment was 2.8 years. Approximately 60% of the patients suffered from abdominal pain every day or 2-3 times a week, in 73% of the cases it lasted less than three hours. Forty-one patients underwent upper GI endoscopy. Gastroduodenitis is a common finding in persisting abdominal pain despite therapy of FMF patients. The patients with the highest disease severity scores had severe inflammation within the entire GI system.

The Effectiveness of Transvaginal Ultrasonography Performed by Emergency Physicians

PURPOSE: The aim of this study was to examine the diagnostic accuracy and effectiveness of transvaginal ultrasonography (TVUS) performed by emergency physicians (EPs') in the emergency department. METHODS: In this study, female patients with lower abdominal pain who had risks for obstetric and gynecologic diseases were assessed. The accuracy and effectiveness of TVUS performed by emergency physicians was determined by comparing EPs' interpretations of TVUS with the interpretations of TVUS by OGs CT findings, and surgical pathologic results. RESULTS: Forty-one patients were included in the study. The diagnosis was changed in 48.8% of the patients after the TVUS had been performed by an EPs'. When the accuracy of diagnosis was compared pre- and post-TVUS, the accuracy of post-TVUS (80.5%) was higher than the pre-TVUS (39.0%). The agreement between the sonographic findings of EPs' and OGs' was substantial (accuracy=81.3~93.8%; kappa=0.611~0.811; p<0.05). The accuracy of TVUS performed by EPs' in obstetric and gynecologic diseases was 90.6%. The sensitivity and specificity were 100% and 90.9%, respectively, and the positive and negative predictive values were 96.8% and 100%, respectively. CONCLUSION: TVUS performed by EPs' is of considerable help in establishing the correct diagnosis with a high degree of accuracy.