ABSTRACT
Existe una gran variedad de marcadores útiles tanto en el diagnóstico como en el seguimiento de la enfermedad inflamatoria intestinal. Clásicamente se han utilizado los serológicos, ampliamente distribuidos y accesibles, pero en los últimos años han cobrado importancia los fecales, en especial la calprotectina fecal, por haber demostrado mayor precisión a la hora tanto de establecer la sospecha de la enfermedad como de predecir la curación mucosa o la persistencia de actividad inflamatoria. La calprotectina fecal muestra buena capacidad para predecir estudios endoscópicos patológicos, pero tiene una especificidad limitada ya que puede alterarse en otros cuadros digestivos con síntomas similares. La calprotectina fecal presenta mayor precisión cuando se asocia a otros parámetros, en especial a la proteína C reactiva, y a escalas clínicas de actividad inflamatoria. Finalmente, hay múltiples marcadores de nueva generación, serológicos y fecales, de los que hay escasa evidencia, aunque algunos han mostrado resultados prometedores en diferentes estudios
There are many useful biomarkers for initial diagnosis and the management of inflammatory bowel disease. Serologic biomarkers have been traditionally used because they are widely disposable, but recently faecal biomarkers, especially faecal calprotectin, have acquired great importance as they have shown to be more precise when establishing suspicion of the disease and also as predictors of mucosal healing or persistence of inflammatory activity. Faecal calprotectin is a good tool for predicting abnormal endoscopic studies, but has limited specificity because its levels can be altered in many digestive diseases presenting with similar symptoms. The precision of faecal calprotectin is higher when associated with other altered parameters, especially with C-reactive protein, or with clinical scores of inflammatory activity. Finally, there are many new generation serologic and faecal biomarkers. Despite there not being much evidence about these yet, some of them have shown promising results in different studies
Subject(s)
Humans , Crohn Disease/diagnosis , Colitis, Ulcerative/diagnosis , Feces/chemistry , C-Reactive Protein/analysis , Pyruvate Kinase/blood , Antibodies, Antineutrophil Cytoplasmic/blood , S100A12 Protein/analysis , Lactoferrin/analysis , Occult Blood , Gene Expression , Biomarkers/analysisABSTRACT
There are many useful biomarkers for initial diagnosis and the management of inflammatory bowel disease. Serologic biomarkers have been traditionally used because they are widely disposable, but recently faecal biomarkers, especially faecal calprotectin, have acquired great importance as they have shown to be more precise when establishing suspicion of the disease and also as predictors of mucosal healing or persistence of inflammatory activity. Faecal calprotectin is a good tool for predicting abnormal endoscopic studies, but has limited specificity because its levels can be altered in many digestive diseases presenting with similar symptoms. The precision of faecal calprotectin is higher when associated with other altered parameters, especially with C-reactive protein, or with clinical scores of inflammatory activity. Finally, there are many new generation serologic and faecal biomarkers. Despite there not being much evidence about these yet, some of them have shown promising results in different studies.
Subject(s)
Biomarkers/metabolism , Colitis, Ulcerative/diagnosis , Crohn Disease/diagnosis , Feces/chemistry , Leukocyte L1 Antigen Complex/analysis , Antibodies, Antineutrophil Cytoplasmic/metabolism , Biomarkers/analysis , Blood Sedimentation , C-Reactive Protein/analysis , C-Reactive Protein/metabolism , Colitis, Ulcerative/metabolism , Crohn Disease/metabolism , Gastrointestinal Microbiome/immunology , Humans , Inflammatory Bowel Diseases/diagnosis , Inflammatory Bowel Diseases/metabolism , Metabolome , MicroRNAs/metabolism , Occult Blood , Procalcitonin/metabolism , Proteomics , Pyruvate Kinase/metabolism , S100A12 Protein/metabolism , Sensitivity and SpecificityABSTRACT
We present the case of a young man with a hepatic mass in which ultrasound gives great and immediate support for diferential diagnosis.
Subject(s)
Carcinoma, Hepatocellular/diagnostic imaging , Liver Neoplasms/diagnostic imaging , Abdomen/diagnostic imaging , Adolescent , Carcinoma, Hepatocellular/drug therapy , Humans , Liver Neoplasms/drug therapy , Male , Tomography, X-Ray Computed , UltrasonographyABSTRACT
No disponible
Subject(s)
Humans , Male , Adolescent , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/drug therapy , Carcinoma, Hepatocellular , Platinum Compounds/therapeutic use , Diagnosis, Differential , Liver , Liver/pathology , Liver , Tomography, Emission-Computed/methods , Tomography, Emission-ComputedABSTRACT
Direct percutaneous endoscopic jejunostomy (DPEJ) is an infrequent procedure as it is not always easy to obtain transillumination, being this the main reason for failure of this technique. In patients with previous surgery, this procedure is more complex and there are only 6 reported cases in pediatric population. In our case, we provide the use of an endoscopic triangulation system with "T" pexies not used before in these cases. With this technique, we guarantee not to replace the introduction system afterwards, obtaining the placement of a balloon fixation system initially. We also provide several improvements that helped us developing the procedure: Placement of the jejunostomy through a gastrostomy; use of water column to avoid penetration in hollow viscus; use of a guide wire, and a triangulation pexy system.
Subject(s)
Endoscopy, Gastrointestinal/methods , Jejunostomy/methods , Child, Preschool , Endoscopy, Gastrointestinal/instrumentation , Female , Humans , Jejunostomy/instrumentationABSTRACT
La yeyunostomía endoscópica directa es una técnica infrecuente pues no siempre es fácil conseguir la transiluminación, motivo por el que se fracasa en su colocación con mayor frecuencia. En pacientes con cirugía previa aún es más compleja, y en la edad pediátrica sólo hay 6 casos publicados en la literatura. Además se aporta la utilización de un sistema de triangulación con pexias en T que no se ha utilizado hasta ahora en esta indicación. De esta forma nos aseguramos el no tener que retirar posteriormente el sistema de introducción, dejando desde el principio un sistema de fijación con balón. Aportamos varias mejoras que nos ayudaron en la técnica: realización a través de la gastrostomía, uso de columna de agua para evitar paso por vísceras huecas, uso de hilo guía y sistema de pexia-triangulación (AU)
Direct percutaneous endoscopic jejunostomy (DPEJ) is an infrequent procedure as it is not always easy to obtain transillumination, being this the main reason for failure of this technique. In patients with previous surgery, this procedure is more complex and there are only 6 reported cases in pediatric population. In our case, we provide the use of an endoscopic triangulation system with "T" pexies not used before in these cases. With this technique, we guarantee not to replace the introduction system afterwards, obtaining the placement of a balloon fixation system initially. We also provide several improvements that helped us developing the procedure: Placement of the jejunostomy through a gastrostomy; use of water column to avoid penetration in hollow viscus; use of a guide wire, and a triangulation pexy system
Subject(s)
Humans , Female , Child, Preschool , Jejunostomy/methods , Gastroesophageal Reflux/surgery , Endoscopy, Digestive System/methods , Respiratory Aspiration/complications , Jejunoileal Bypass/methods , Treatment Failure , Iatrogenic DiseaseABSTRACT
No disponible
