COVID-19 y cirugía. Impacto en los volúmenes de atención, complicaciones posoperatorias y mortalidad. Resultados después de un año de pandemia / COVID-19 and surgery. Impact on volumes of care, postoperative complications and mortality. Results after one year of the pandemic

RESUMEN Antecedentes: la pandemia por COVID-19 generó importantes cambios en la atención y tratamiento de los pacientes quirúrgicos. Objetivo: los objetivos de este estudio fueron comparar los volúmenes de prestaciones realizadas durante un año de pandemia con un período igual sin pandemia, proyectar su impacto asistencial e institucional, y comparar pacientes COVID+ versus COVID- para determinar complicaciones posoperatorias, mortalidad y los factores de riesgo asociados a estos eventos. Material y métodos: estudio observacional y retrospectivo. Comparamos el volumen de prestaciones realizadas entre el 19/3/20 y el 18/3/21 con idéntico período de 2019/20. Efectuamos un estudio de cohorte emparejada (2:1) entre los pacientes con COVID-19 y sin él y se analizaron las complicaciones posoperatorias, la mortalidad, y doce variables objetivas como factores de riesgo asociados. Resultados: todas las variables prestacionales analizadas disminuyeron, pero solo las internaciones programadas y las cirugías y endoscopias no urgentes cayeron significativamente. De los 979 ingresos, 41 casos fueron COVID+ (4,1%). La mortalidad fue del 29,2% en COVID+ (12/41) vs. 7,3% en COVID- (6/82) P = 0,021. Los factores de riesgo significativos asociados a mortalidad fueron: edad ≥ 75 años, hombres, COVID+, urgencias, neumonía, requerimiento de UTI y ARM. Los pacientes operados presentaron una tasa significativamente mayor de neumonías. El análisis de regresión logística (COVID+ vs. -) mostró que por ser COVID+ y registrar la necesidad de ARM, como variables determinantes, en los COVID+ solo la ARM fue determinante en la mortalidad. Conclusión: la pandemia por COVID-19 disminuyó la actividad prestacional y aumentó la mortalidad de los afectados por la virosis.

ABSTRACT Background: The COVID-19 pandemic produced significant changes in the care and treatment of surgical patients. Objectives: The aims of this study were to compare the volume of services provided during a year of pandemic with an equal period without pandemic, estimate its impact on health care and institutional care, and compare COVID-positive versus COVID-negative patients to determine postoperative complications, mortality and risk factors associated with these events. Material and methods: We conducted an observational and retrospective study, comparing the volume of services performed between March 19, 2020, and March 18, 2021, with the same period in 2019/2020. We performed a matched cohort study (in a 2:1 ratio) between patients with and without COVID-19 and analyzed the postoperative complications, mortality, and twelve objective variables as associated risk factors. Results: There was a significant decrease in planned hospitalizations and non-urgent surgeries and endoscopies, while all the other variables showed a non-significant reduction. Of the 979 admissions, 41 corresponded to COVID-positive patients (4.1%). Mortality was 29.2% in COVID-positive patients (12/41) vs. 7.3%% in those COVID negative (p = 0.021). The significant risk factors associated with mortality were age ≥75 years, male sex, COVID+, emergencies, pneumonia, requirement of ICU and MV. Patients operated on had a significantly higher rate of pneumonia. Logistic regression analysis between COVID+ patients and COVID- patients showed that COVID+ and need for MV were predictors of mortality. In COVID+ patients, only MV was a determinant of mortality. Conclusion: The COVID-19 pandemic reduced healthcare services and increased mortality in patients infected with the virus.

La derivación protocolizada a endoscopía asociada a la detección de Helicobacter pylori mediante antígeno en deposiciones disminuye lista de espera para endoscopía y optimiza la detección de lesiones pre-malignas y cáncer gástrico incipiente / Protocolized referral to endoscopy and Helicobacter pylori detected in stools aimed to decrease endoscopy waiting lists

Background Chile has one of the highest mortality rates by gastric cancer (GC) worldwide. Primary prevention of GC and detection of pre-neoplastic and early neoplastic lesions should be a national priority. Aim To assess the impact of the protocolization of endoscopy referral and the use of H. pylori stool antigen test (HPSA) in the management of dyspepsia to decrease the waiting list for endoscopy and increase the detection of gastric pre-neoplastic and early neoplastic lesions. Material and Methods We included all patients referred to the Endoscopy Unit of a regional hospital, from January 2015 to December 2017. We also included patients with known pre-neoplastic lesions and all those with first degree relatives with GC. We implemented protocols for referral of patients with dyspepsia considering the use of HPSA test, prioritizing to endoscopy those with a higher risk of GC. Results A total of 4,641 endoscopies and 2,631 HPSA tests were carried out. After the adoption of these protocols, we observed a 52% decrease in the waiting time for endoscopy. The GC detection rate in this period was 1.8 to 3.1 cases per 100 endoscopies. After the adoption of the protocols, we observed a significant increase in early GC detection rate (from none in 2015 to 13% in 2017, p = 0.03). Conclusions The protocolization of the referral for endoscopy associated with widespread use of HPSA test in the management of patients with dyspepsia, are successful strategies to decrease waiting lists for endoscopy and optimize the detection rate of pre-neoplastic lesions and early GC.

Tratamiento endoscópico del sangrado digestivo alto por úlcera péptica / Endoscopic treatment of the high digestive bleeding by peptic ulcer

RESUMEN Introducción: la hemorragia digestiva alta ocurre por una lesión sangrante localizada entre el esfínter esofágico superior y el ángulo de Treitz. Objetivo: determinar el comportamiento del tratamiento endoscópico del sangrado digestivo alto por úlcera péptica, en el departamento de Gastroenterología del Hospital Universitario Comandante "Faustino Pérez". Materiales y métodos: se realizó un estudio descriptivo, prospectivo para evaluar el resultado del tratamiento endoscópico en el sangrado digestivo alto por úlcera péptica en el Hospital Universitario Comandante "Faustino Pérez" de Matanzas, de enero del 2016 a febrero del 2018. El tratamiento endoscópico fue la inyectoterapia con epinefrina al 1:10000. Se analizaron las variables: grupo de edades, sexo, resultado del tratamiento endoscópico, estigmas endoscópicos de sangrado, recidiva hemorrágica, mortalidad directa, necesidad de cirugía, estadía hospitalaria y cantidad de unidades transfusionales. Resultados: se constató un predominio de pacientes masculinos (87.5 %), menores de 60 años (70%). Prevalecieron los pacientes con estigmas endoscópicos de sangrado activo venoso (45%). La terapia endoscópica tuvo un resultado satisfactorio (92.5%) en su mayoría. La ocurrencia de resangrado (45%), mortalidad directa por hemorragia digestiva, promedio de estadía hospitalaria, cantidad de unidades transfusionales y necesidad de intervención quirúrgica de urgencia (17.5%), resultó similar a los estudios reportados, demostrando que la inyectoterapia endoscópica aún constituye una opción eficaz si no se cuenta con otras terapias endoscópicas. Conclusiones: la mayoría de los casos tratados con inyectoterapia endoscópica tuvieron un sangrado activo venoso o Forrest IB que fue satisfactoria. La inyectoterapia no satisfactoria fue en pacientes con sangrado activo. La mortalidad directa relacionada con el sangrado fue infrecuente y en relación con el sangrado arterial. Se demostró que la inyectoterapia endoscópica aún constituye una opción eficaz si no se cuenta con otras terapias endoscópicas (AU).

SUMMARY Introduction: high digestive bleeding happens due to a bleeding lesion located between the upper anatomical sphincter of the esophagus and the angle of Treitz. Objective: to determine the endoscopic treatment behavior of high digestive bleeding caused by peptic ulcer, in the department of Gastroenterology of the University Hospital "Comandante Faustino Perez". Materials and methods: a prospective descriptive study was carried out to evaluate the result of the endoscopic treatment in high digestive bleeding caused by peptic ulcer in the University Hospital "Comandante Faustino Perez", of Matanzas, from January 2016 to February 2018. The endoscopic treatment was injecto-therapy with epinephrine at 1:10000. The analyzed variables were: age group, sex, result of the endoscopic treatment, bleeding endoscopic stigma, hemorrhagic relapse, direct mortality, surgery necessity, hospital staying, and quantity of transfusion units. Results: male patients (87.5 %), aged less than 60 years predominated. Patients with endoscopic stigma of venous active bleeding (45 %) prevailed. In most of cases, endoscopic therapy achieved satisfactory results (92.5 %). The authors found that bleeding relapse (45 %), direct mortality by digestive hemorrhage, average hospital staying, quantity of transfusion units and necessity of urgent surgeries (17.5 %) were similar to those reported in other studies. Conclusions: most cases treated with endoscopic injectotherapy had active venous or Forrest IB bleeding and treatment was satisfactory. Therapy was unsatisfactory in patients with active bleeding. The direct mortality related to bleeding was infrequent, and related to arterial bleeding. It was showed that endoscopic injectotherapy is still an efficacious option if other endoscopic therapies are not available (AU).

Cirugía endoscópica nasosinusal: ¿un procedimiento ambulatorio? / Endoscopic sinus surgery: a day surgery?

RESUMEN Introducción: La cirugía endoscópica nasosinusal (CEN) ha aumentado progresivamente debido a que brinda un gran acceso quirúrgico mediante un abordaje mínimamente invasivo. Debido a que tiene un posoperatorio reducido y con pocas complicaciones se puede realizar como cirugía ambulatoria (CA). Esta modalidad es ampliamente aceptada a nivel internacional, sin embargo, no se ha masificado en nuestra realidad nacional. Objetivo: Describir la incidencia y causas de estadía no programada pos CEN ambulatoria en el Servicio de Otorrinolaringología del Hospital del Salvador. Material y método: Revisión retrospectiva de fichas de pacientes operados de CEN por el mismo equipo quirúrgico (Dra. Constanza J. Valdés y Dra. Paula Ruz) entre agosto 2013 y diciembre 2015. Se registraron datos demográficos, cirugías y complicaciones perioperatorias. Resultados: De un total de 75 CEN programadas para realizarse en forma ambulatoria, la incidencia de estadía no programada fue de 15%. Las principales causas fueron problemas administrativos (6 casos) seguido de complicaciones perioperatorias (5 casos). Conclusión: Excluyendo causas administrativas de estadía no programada, el 93% de los procedimientos lograron realizarse como CA. Esta modalidad es plausible y recomendable en el sistema de salud donde los recursos son escasos.

ABSTRACT Introduction: Endoscopic sinus surgery (ESS) has an increase trend because it provides wide surgical access through a minimally invasive approach. It can be performed on a day surgery basis because it has a fast postoperative recovery and a low complication rate. This method has worldwide acceptance, however it has not been established in our national practice. Aim: Describe incidence and unplanned admission causes of ESS in the Otolaryngology service of the Hospital del Salvador. Material and method: Retrospective review of patient medical records undergoing ESS by the same surgical team (Dra. Constanza J. Valdés y Dra. Paula Ruz) between August 2013 and December 2015. Patient demographic information, surgery and perioperative complications were recorded. Results: 75 ESS procedures were scheduled to be performed on an outpatient basis. The incidence of unplanned stay was 15%. Fifteen patients had an unplanned admission, due to administrative problems (6) and perioperative complications (5). Conclusions: Fifteen percent of the patients who underwent ESS on a day surgery basis had an unplanned stay; its main cause is due to administrative problems. Excluding administrative causes of unplanned admission, 93% of the procedures performed were ambulatory procedures. This mode is plausible and desirable in the health system where resources are scarce.

Predictores de hemorragia digestiva grave: correlación entre la presentación clínica y el hallazgo de lesión endoscópica / Predictors of severe gastrointestinal bleeding: Correlation between the clinical presentation and the finding of endoscopic injury

Introducción: La hemorragia digestiva es un motivo importante de ingreso a unidades hospitalarias y constituye una verdadera emergencia médica por lo que se hace prioritario reconocer los signos clínicos que hagan sospechar hemorragia grave a fin de realizar precozmente una endoscopia diagnostica-terapéutica. Objetivos: Analizar los diversos parámetros objetivos predictores de hemorragia digestiva grave. Evaluar la correlación existente entre la presentación clínica y la constatación de lesión endoscópica. Demostrar la utilidad del estudio endoscópico tanto para el diagnóstico como para el tratamiento Diseño: Observacional. Descriptivo. Retrospectivo Material y Método: Se tuvieron en cuenta todos los pacientes internados en los que se les ha realizado una endoscopia de urgencia con diagnostico probable de hemorragia digestiva entre Enero a junio de 2017. En base a los datos obtenidos de orden médica, historia clínica, estado del paciente e informe endoscópico. Resultados: El 21,65% se encontraba en unidad cerrada o shock room de la guardia; inestables Hemodinamicamente. La indicación médica que con mayor frecuencia se observo fue la denominada Hemorragia digestiva alta (Melena, vomito porraceo y / o Hematemesis combinada) con el 50,51%. Las UGD y la patología erosiva fue La lesión endoscópica que con mayor frecuencia se hayo con el 25,77%. El 21,65% ha requerido la realización de alguna técnica terapéutica Conclusión: La hemorragia digestiva se asociada a una elevada morbimortalidad. Existe una marcada relación entre la presencia de parámetros de inestabilidad hemodinámica, hallazgo de lesión endoscópica y necesidad de terapéutica

Introduction: Digestive haemorrhage is an important cause of income in hospitals and constitutes a true medical emergency, so it becomes a priority to recognise clinical signs that make us suspect a sever haemorrhage in order to perform an early diagnostic and therapeutic endoscopy. Objectives: To analyse the different severe digestive haemorrhage predictors. To evaluate the correlation between clinical presentation and endoscopic injury. To demonstrate the usefulness of endoscopic study as much as for the diagnosis as the treatment Material and method: Observational, descriptive and retrospective study. They were taken into account all hospitalized patients in whom it has been performed an emergency endoscopy with a probable diagnosis of digestive haemorrhage between January and June 2017. Based on the data obtained from medical order, clinical history, patient ́s status and endoscpic report. Results: 21,65% were in closed unit or shock room, hemodynamically unstable. The medical indication that was most often observed was upper gastrointestinal bleeding with 50,51%. Gastrointestinal ulcers and erosive pathology was the most frequently found lesion with 25,77%. 21,65% has required a therapeutic technique. Conclusions: Digestive haemorrhage is associated with a high morbidity and mortality. There is a strong relationship between the presence of hemodynamic unstable parameters, endoscopic lesion finding and therapeutic need

Open Surgery versus Endoscopic Intervention in the Management of Bile Duct Stones

Background: Choledocholithiasis or the presence of common bile duct stones [CBDS] is one of the medical conditions that requires surgical intervention

The management of Choledocholithiasis has evolved from open common bile duct exploration [OCBDE] to therapeutic endoscopic retrograde cholangiopancreatography [ERCP] to laparoscopic common bile duct exploration [LCBDE]. Each entails a degree of difficulty. In this review we aim to assess and compare the benefits and pitfalls of open surgery [OCBDE] versus endoscopic retrograde cholangiopancreatography [ERCP] in management of common bile duct stones

Methods: A systematic review of the electronically searched publications of the scientific literature. We searched the Cochrane HepatoBiliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE [1946 to 2016], EMBASE [1974 to 2016], and Science Citation Index Expanded [1900 to 2016]. Initially all randomized clinical trials which compared the results from open surgery versus endoscopic clearance for common bile duct stones were included, articles were selectively screened according to the eligibility criteria

Results: eight publications were selectively included with 761 participants compared to open surgical clearance with ERCP. All trials had a high risk of bias. There was no significant difference in the mortality between open surgery versus ERCP clearance [eight trials; 733 participants; 5/371 [1%] versus 10/358 [3%] OR 0.51;95% CI 0.18 to 1.44]. Neither was there a significant difference in the morbidity between open surgery versus ERCP clearance [eight trials; 733 participants; 76/371 [20%] versus 67/358 [19%] OR 1.12; 95% CI 0.77 to 1.62]

Participants in the open surgery group had significantly fewer retained stones compared with the ERCP group [seven trials; 609 participants; 20/313 [6%] versus 47/296 [16%] OR 0.36; 95% CI 0.21 to 0.62], P = 0.0002. Meta-analysis of the outcomes duration of hospital stay, quality of life, and cost of the procedures could not be performed due to lack of data

Conclusion: open surgery intervention in order to remove the gallbladder and trapped gallstones appears to be as safe as endoscopy and further suggested to be more successful than the endoscopic technique in clearing the duct stones

Inyección endoscópica para la corrección del reflujo vesicoureteral / Endoscopic Injection for the Correction of Vesicoureteral Reflux

Resumen:Introducción:la inyección endoscópica subureteral es el método menos invasivo con resultados favorables para el tratamiento del reflujo vesicoureteral.Objetivo:investigar los resultados de la inyección endoscópica y comparar la eficacia de dos agentes de carga diferentes tanto como el Macroplastique y Vantris.Métodos:los datos de los pacientes que se sometieron a inyección endoscópica para el tratamiento del reflujo vesicoureteral en el Hospital Nacional de Niños entre diciembre 2011 y Febrero 2015 fueron retrospectivamente revisados. Se excluyeron pacientes con disfunción miccional persistente, que no tuvieran cistouretrografía miccional posterior al tratamiento endoscópico y expedientes incompletos. La técnica quirúrgica utilizada fue la de STING clásica. El control postoperatorio fue a los 3 meses y se realizó ecografía de vías urinarias; la profilaxis antibiótica se continuó hasta la cistouretrografía miccional control. El éxito del tratamiento se define como la desaparición de reflujo en el cistouretrografía miccional de control.Resultados:en total se revisaron 38 casos, de los cuales 33 cumplían con los criterios de inclusión, el 66,6% correspondía a niñas y el 33,3% a niños; se documentó un 42,4% con reflujo vesicoureteral bilateral (14 casos), luego sigue el lado izquierdo con un 36,36% (12 casos) y el lado derecho con un 21,21% (7 casos). En total se evaluaron 47 unidades ureterales. El Vantris se utilizó en el 63,6% de los casos y el Macroplastique en el 27,4%. La mayoría de los pacientes presentó resolución de su reflujo vesicoureteral posterior al tratamiento (29 casos: 88%); una menor cantidad, persistencia del reflujo (4 casos: 12%), y de estos, 4 pacientes persistieron con reflujo vesicoureteral de menor grado que al momento del diagnóstico. Todos se volvieron a someter a inyección endoscópica antirreflujo, de ellos 3 se curaron y uno persistió con reflujo vesicoureteral, pero de bajo grado y asintomático, por lo que se está manejando de manera conservadora.Conclusiones:la corrección del reflujo vesicoureteral por inyección endoscópica con Macroplastique y Vantris es segura, efectiva y mínimamente invasiva.

Abstract:Introduction:Endoscopic suburetal injection, is the less invasive method with promising results for the treatment vesicoureteral reflux.Objective:To investigate the results of endoscopic injection and compare the efficacy of two agents of different load such as Macroplastique and Vantris.Methods:Data of patients that underwent endoscopic injection for vesicoureteral reflux treatment at Hospital Nacional de Niños between December 2011 and February 2015 were revised retrospectively. Patients with persistent voiding dysfunction, that had no micturatingcystourethrogram after the endoscopic treatment and incomplete records were excluded. The surgical technique used was STING Classic. The postopertative control was after 3 months and an urinary tract ultrasonography was done, a continuous antibiotic prophylaxis was performed until the control voiding cystourethrogram. Treatment success is defined as the disappearance of reflux in the control voiding cystourethrogram control.Results:A total of 38 cases were reviewed, of which 33 met the inclusion criteria, 66.6% were girls and 33.3% were boys, 42.4% were documented with bilateral vesicoureteral reflux (14 Cases), following 36.36% (12 cases) on the left side and on the right side 21.21% (7 cases). In total 47 ureteral units were evaluated. The Vantris was used in 63.6% of cases and Macroplastique in 27.4%. The majority of patients showed resolution of their subsequent vesicoureteral reflux after the treatment (29 cases: 88%), a smaller amount with persistent reflux (4 cases: 12%) of these, 4 patients persisted with vesicoureteral reflux in a lesser degree than at the moment of the diagnosis, all were submited the endoscopic antireflux injection again, of which 3 were cured and one persisted with vesicoureteral reflux, but of low grade and asymptomatic, being managed conservatively.Conclusions:Correction of vesicoureteral reflux by endoscopic injection with Macroplastique and Vantris is safe, effective and minimally invasive.

Sewing Needle Obturation of Root Canal: A Rare Case Report.

Discovery of a foreign object in the root canal is unusual and rare. Forceful lodgement or impaction of the foreign object in the pulp chamber or root canal is usually accidental. It is seen more often among children with habits of chewing and placing various objects in the oral cavity. Despite new advances and a large understanding about the root canal morphology, retrieval of foreign objects from the root canal is still a challenging procedure to the endodontists. Exposed pulp chamber due to trauma or tooth left open for drainage after root canal access opening are predisposing factors to foreign body lodgement. The impacted foreign objects in root canals may act as a source in causation of discomfort, pain, infection, and swelling. An attempt to retrieve any foreign body from the root canal may increase the chances of its further apical displacement and firm lodgement in the apical third of the root invariably risking the prognosis of the tooth involved. The present case report describes an inadvertently broken sewing needle in the root canal of the permanent maxillary left central incisor with periapical abscess and its successful retrieval by non-surgical orthograde endodontic treatment.

Microscopic versus endoscopic approach to the sellar and supprasellar space, a cadaveric study

Skull base endoscopic endorasal approaches are used more and more liberally to expose the skull base transnasally. However the surgical microscope is still used by some surgeons for sellar exposure transnasally. To provide a qualitative and quantitative anatomical evaluation of the surgical exposure and maneuverability afforded by the endoscope versus that of the surgical microscope in exploring the sellar / suprasellar areas. We used seven embalmed cadaver heads whose vascular system had been injected with colored silicon material. Sublabial trans-septal exploration of the sellar/suprasellar areas was conducted using the endoscope and then microscope. The exposure and maneuverability associated with each mode were evaluated. The endoscope exposed the sellar/superasellar compartment better than the microscope in terms of maneuverability and surgical field exposure. In our model, use of the endoscope provided a better maneuverability advantage over microscope mode in the exploration of the suprasellar compartment

Preliminary study of the role of the nasal endoscopy in the management for posterior epistaxis

To evaluate the role and efficacy of the nasal endoscopy for posterior epistaxis. Prospective study. It was conducted during the period from January 2009 to May 2013. Al-Madinah Poly-Clinic in Al-Mukalla city of Yemen. Fifteen [15] patients with posterior epistaxis were subjected to management by nasal endoscopy. Eleven [11] patients were managed successfully be nasal endoscopic cauterization, while 3 patients were failed and managed by anterio-posterior nasal packing and one patient was managed by ligation of sphenopalatinal artery. All cauterizations were done under general anaesthesia by o and 30 4mm nasal endoscopy, suction cautery and 22 gauge spinal needle. Data collected and analyzed. The most affected age groups were 51-60 and >60 years and female more affected. The most causes for posterior epitaxis were arteriosclerosis and hypertension [40%]. The most applied treatment was cauterization [73.33%]. The nasal endoscopic cauterization is recommended as the first line of the management for posterior epistaxis in order to avoid the possible, dangerous complications of nasal packing and to find the underlying pathology

A desinfecção de endoscópios com ácido peracético por dez minutos é efetiva? / Is endoscope disinfection with peracetic acid during ten minutes effective?

Artigos médico-hospitalares permanentes necessitam ser processados de maneira segura. Os objetivos foram avaliar a efetividade do ácido peracético na desinfecção de eendoscópios; identificar a oxidação dos equipamentos e verificar o tempo de atividade da solução. Métodos: Coletamos 40 amostras antes e 40 após a desinfecção dos gastroscópios. os lavados foram envaidos para identificação de bactérias, fungos e micobactérias. A avaliação da integridade foi feita antes e após seis meses. A monitoração da atividade da solução foi diária. Resultados: Pré-desinfecção, 12,5% dos videogastroscópicos foram positivas e pós, todas negativas. Na pré-desinfecção dos videocolonoscópios, 34,1% positivas e na pós-desinfecção, negativas. Pesquisa para micobactérias foi negativa. Conclusões: a desinfecção por dez minutos de endoscópios com ácido peracético foi efetiva, os equipamentos não oxidaram, e a solução apresentou boa estabilidade.

Causes and outcome of upper gastrointestinal bleeding in emergency endoscopy unit of Ain Shams University Hospital

This prospective follow-up study was designed to analyze the causes and outcome of upper gastrointestinal bleeding among patients presenting by hematemesis and/or melena to Emergency Endoscopy Unit, Ain Shams University Hospitals. One thousand patients presented by upper GIT bleeding were subjected to complete clinical evaluation, emergency upper gastrointestinal endoscopy and therapeutic interventions as indicated. Follow up was done for occurrence of re-bleeding or mortality. Variceal causes of bleeding were the most common, representing 70.1% followed by non-variceal causes [26.1%] and obscure causes [3.8%]. Esophageal varices [EV] alone represented 17.8% of causes of variceal bleeding, while combined esophageal and gastric varices represented 39.5% and isolated gastric varices 12.8%. Gastric lesions were the most common causes of non variceal bleeding. Recurrence of bleeding occurred in 19.4% of variceal group in comparison to 6.1% of non variceal group, while mortality was found in 4.3% of variceal group in comparison to 1.5% of non variceal group with very highly significant difference [P <0.001]. Hypertension, ascites, EV columns, EV grade IV, presence of gastric varices and associated respiratory disorder were independent factors as-sociated with recurrence of bleeding in variceai group. In non variceal group, recurrence of bleeding was significantly related only to the presence of gastric ulcers [P=0.035]. Independent factors associated with mortality in studied patients were age, associated diabetes, presence of esophageal varices and associated duodenal ulcer

Balloon catheter sinuplasty for chronic rhinosinusitis: feasibility and impact on quality of life

To evaluate the outcome of balloon sinuplasty for patients with chronic rhinosinusitis [CRS] and its impact on patients' symptom and quality of life scoring The study included 35 patients with mean age of 34.1 +/- 4.4 years. All patients underwent complete otorhinolaryngological examination and endoscopic staging according to Lund and Kennedy endoscopic score. CT scans of paranasal sinuses were assessed according to Lund-Mackay scale. All patients underwent symptoms and quality of life assessment using Sino Nasal Outcome Test-20 [SNOT-20]. All patients underwent balloon catheter sinuplasty under guide of fiberoptic nasal endoscope. Patients were assessed at three and six months after dilatation for SNOT-20 score. Intraoperative catheter insertion and advancement was accomplished successfully in 26 patients with a procedural success rate of 92.9% and the other two patients were shifted to FESS and were excluded of follow-up. No intraoperative or postoperative complications were encountered. Intraoperative bleeding was minimal and controllable without the need for nasal packing and all patients were discharged once they were ready for. All patients showed progressive improvement of SNOT-20 scoring that showed significant improvement at 3-months and 6-months follow-up evaluation compared to baseline score with significantly lower scores determined at 6-months compared versus 3-months. Balloon catheter sinuplasty is a feasible, safe and effective therapeutic modality for CRS associated with significant improvement of patients' quality of life and could be managed as one-day surgical procedure

Endoscope-assisted inlay butterfly cartilage myringoplasty

Myringoplasty is one of the most common forms of surgery in otology. It yields very satisfying results for both to the patient and the surgeon. Popular myringoplasty techniques include either an underlay or an onlay approach using tissues such as temporalis fascia or perichondrium as grafts. In 1998, Eavey described an inlay tympanoplasty technique in children using a cartilage graft which resembled butterfly wings. This technique was effective for closure of tympanic membrane perforations, while being more rapid for the surgeon and more comfortable for the patient. The aim of this study was to evaluate the results of using middle ear endoscopy for doing inlay butterfly cartilage myringoplasty. Between December 2008 and December 2010, Twenty one consecutive patients between age group of 16-50 years with persistent tympanic membrane perforation were included in this study. All patients underwent Endoscope-assisted Inlay Butterfly Cartilage [Eavey Technique] myringoplasty [EAIBCM]. The overall success rate of the graft uptake and improvement in conductive deafness as air-bone gap closure was achieved in above 80 percent of cases. tympanoscopy, with its visualisation of hidden corners, justifies Butterfly inlay myringoplasty via a tympanic membrane perforation. Furthermore, the cost of the endoscope is much less than the operating microscope and the endoscope is portable tool thus it is more cost-effective, especially in developing countries. Combining butterfly inlay tympanoplasty technique with the middle ear endoscopy as a tool carries definitive advantages of less operative time, day care surgery, minimal scarring and hence can be accepted as a routine procedure in day-to-day practice.

Assessment of different diagnostic tests of helicobacter pylori in children

H.pylori was first identified and .recognized by marshal and warren in 1983 [1],recently, H.pylori antigen detection test in stool [HPS A] was reported to be a sensitive and reliable screening test for H.pylori infection as compared to urea breath test. This study was carried out on 3 groups of children aged 6 months-14 years selected from pediatric patients of Damnhour hospital. In group I [hematemesis] upper upper gastrointestinal endoscopy revealed mucosal erythema in 60% associated with antral nodularity in 4 patients. All patients who had a positive urease test [40%], had a histopathological diagnosis of chronic active full thickness gastritris. The results of endoscopic, histopathologic examination and rapid urease test in group II [RAP] showed mucosal erythema in 90% [18 patients], antral nodularity in 60% urease test was positive in 12 children [60%]. The results of HPS A showed that 30% of patients in group II had positive test. When these results were compared to the histopathologic and urease test and results of HpSA was 70%, specificity 100% +ve and -ve predictive values of 100, 75.2% respectively

prevalence of gastro esophageal reflux disease [GERD] in copd patients and its effect on the number of exacerbations in dnmi

This study included 25 COPD inpatients in chest, ICU and internal medicine departments in Damanhur National medical Institute., 10 of them with moderate COPD and 15 of them with severe COPD [by gold 2007][1]. 21 were males and 4 were females [active or passive smokers]. The aim of the work was to study the prevalence of GERD in COPD patients and its effect on the number of exacerbations of COPD. Both groups were subjected to history taking, full clinical examination, full laboratory investigations, Chest radiography, spirometry, arterial blood gases and upper GIT endoscopy and biopsy. Results revealed that the prevalence of GERD in COPD patients by endoscopy was 36% in the moderate group, 64% in the severe group. By biopsy being more prevalent in the severe group of COPD 86.6% compared to70% in moderate COPD. GERD severity increases as the degree of COPD increases. GERD increases with increase in the smoking [pack/year] both in moderate, in the severe group. Moreover, there was increase in the frequency of exacerbations of COPD in GERD patients both in moderate and severe groups. This study revealed that the frequency of exacerbation was higher among GERD cases with statistically significant difference in between both group From this study we conclude that GERD is common in COPD patients being more among severe COPD. Also GERD increase the number of exacerbations of COPD

Describen la utilidad de la endoscopia virtual para diagnosticar enfermedades del tracto urinario superior / Virtual endoscopy in the diagnosis of upper urinary tract pathologies

Introducción: La patología del tracto urinario superior supone un reto diagnóstico para el urólogo. La aparición de nuevo hardware y software de adquisición y procesamiento de imágenes de tomografía computarizada (TC) ha hecho posible el desarrollo de técnicas como la que presentamos en este estudio. Material y métodos: Entre enero de 2005 y agosto de 2007 hemos incluido 57 urografías por tomografía computarizada (Uro-TC) realizadas en nuestro centro a pacientes con enfermedades del tracto urinario superior. Recogemos las indicaciones, los diagnósticos y comparamos los valores de validez interna y externa de la prueba con los de otras exploraciones radiológicas. Resultados: Realizamos un total de 57 exploraciones a 56 pacientes con edades entre los 38 y los 84 años en las que diagnosticamos 21 litiasis, 8 neoformaciones uroteliales, 2 pélvicas, 3 ureterales y 3 vesicales. En 6 pacientes con ureterohidronefrosis de etiología incierta en otras exploraciones conseguimos dilucidar la causa de la obstrucción. Diagnosticamos 2 litiasis durante el seguimiento de pacientes portadores de derivaciones urinarias, así como 5 casos de estenosis benigna. En 11 pacientes se diagnosticaron diferentes malformaciones congénitas. Los valores de validez interna de la prueba fueron superiores a los de las pruebas de imagen usadas convencionalmente para el diagnóstico de trastornos del tracto urinario superior. Conclusiones: La Uro-TC es una prueba eficiente, que está al alcance de la mayoría de centros en los que se disponga de la tecnología necesaria. Permite en casos seleccionados optimizar recursos sanitarios y agilizar el diagnóstico de la enfermedad urológica.

Mucoceles of the paranasal sinuses: surgical treatment and long term results

To present our long term results managing paranasal sinus mucoceles highlighting the pros and cons of the endoscopic approach. Retrospective analysis of the clinical characteristics and treatment outcome of 40 patients with paranasal sinus mucoceles managed by the author over a 9-year period. All patients were subjected to thorough history taking, general otolaryngologic examination, nasal endoscopy and preoperative computed tomography scan of the paranasal sinuses. Magnetic resonance imaging was done whenever indicated to evaluate intracranial and br intraorbital extension. An ophthalmological examination was carried out in patients with ocular or visual disturbances. The patients were 24 males and 16fengles, their age ranged from 6 to 53 years. The clinical presentation consisted mainly of ophthalmological signs and ymptoms that reflects the preferential localization of mucoceles in the frontoethmoid complex [52.5%]. Thirty six case were managed solely and successfully via endoscopic means. The remaining 4 cases were managed by external approach alone [2 cases] or through combined external and endoscopic approaches [2 cases]. Follow-up ranged between 10-70 months. At the last follow up visit, the presenting symptoms resolved completely in 33 patients, improved in 5 patients. Two patients reported persistence of headache which was later diagnosed as migraine. Our study pointed out the usefulness of the endoscopic approach for both the treatment and follow up of mucoceles. This mini-invasive technique permits accurate drainage and marsipulization of the mucocele with low morbidity, excellent visualization, lack of external incision, and a short hospital stay. Throughout our experience, the endonasal endoscopic approach has proved to be a reliable intervention modality with a favorable long term outcome

Diagnóstico y tratamiento de las várices esófago gástricas en Chile: realidad nacional / Management of bleeding esophageal varices in public and private institutions in Chile

Background: The better treatment modalities for bleeding esophageal varices have improved the prognosis of cirrhosis. Aim: To inquire about diagnostic and treatment modalities for esophageal bleeding in Chile. Material and methods: An enquiry about diagnosis and treatment of esophageal bleeding was designed and electronically sent to public and private health institutions that could admit patients and were located in cides with more than 100,000 inhabitants. Results: The enquiry was answered by 31 of 35 public and 17 of 19 private health institutionis that were consulted. Emergency endoscopy was available in 6 of 27 public and in the 16 private institutionis that had an emergency room. Rubber band ligation was available in 16 public (52 percent) and in all private institutions. Cyanoacrylate injections were done in 10 public (32 percent) and 11 (65 percent) private institutions. No public institution installed transjugular intrahepatic portosystemic shunts, but 8 had occasional access to this technique. This procedure was done in 7 (41 percent) private institutions and all had access to it. Surgical treatment was feasible in 20 public (65 percent) and all private institutions. Primary prophylaxis was done in 18 public (58 percent) and 14 private (82 percent) institutions. Secondary prophylaxis was carried out in 26 public (84 percent) and 16 private (94 percent) institutions. Conclusions: Public health institutions have poor access to adequate diagnostic and treatment methods for esophageal bleeding. The primary and secondary prophylaxis of esophageal varices must be improved in both types of institutions.

Endoscopic assessment of effacement of balloon waist during pneumatic dilatation of primary achalasia cardia under topical anesthesia

Balloon dilatation of Primary Achalasia Cardia [PAC] is usually performed under antegrade endoscopic guidance, with conscious sedation. The main goats of this prospective study were to assess the safety and efficacy of pneumatic dilatation without conscious sedation and to determine the endoscopic signs of effacement of the balloon "waist". Pneumatic dilatation was successfully performed as outdoor procedure without conscious sedation in patients [n= 25; mean age 42.56 years] with endoscopic and radiologic diagnosis of PAC. Immediate relief of symptoms was observed in 23 [92%] cases. Effacement of the balloon "waist" under endoscopic vision was appreciated in all cases in the present study. Common complications of pneumatic dilatation were chest pain in all [100%] subjects and mild local bleeding in 17 [68%] patients. There was no cancellation of procedure. Re-dilatation was required in 2 [8%] cases. The duration of follow-up was from 6 weeks to 23 months. Pneumatic dilatation of PAC can be safely performed as same day procedure, without conscious sedation. Obliteration of the balloon "waist" can be readily determined by antegrade "endoscopic assessment of stretch on the lower oesophageal sphincter [EASL]"