The value of sentinel lymph-node biopsy after neoadjuvant therapy: an overview

PurposeWe conducted a systematic review to analyse the performance of the sentinel lymph-node biopsy (SLNB) after the neoadjuvant chemotherapy, compared to axillary lymph-node dissection, in terms of false-negative rate (FNR) and sentinel lymph-node identification rate (SLNIR), sensitivity, negative predictive value (NPV), need for axillary lymph-node dissection (ALND), morbidity, preferences, and costs.MethodsMEDLINE, Embase, Scopus, and The Cochrane Library were searched. We assessed the quality of the included systematic reviews using AMSTAR2 tool, and estimated the degree of overlapping of the individual studies on the included reviews.ResultsSix systematic reviews with variable quality were selected. We observed a very high overlapping degree across the included reviews. The FNR and the SLNIR were quite consistent (FNR 13–14%; SLNIR ~ 90% or higher). In women with initially clinically node-negative breast cancer, the FNR was better (6%), with similar SLNIR (96%). The included reviews did not consider the other prespecified outcomes.ConclusionsIt would be reasonable to suggest performing an SLNB in patients treated with NACT, adjusting the procedure to the previous marking of the affected lymph node, using double tracer, and biopsy of at least three sentinel lymph nodes. More well-designed research is needed. (AU)

The value of sentinel lymph-node biopsy after neoadjuvant therapy: an overview.

PURPOSE: We conducted a systematic review to analyse the performance of the sentinel lymph-node biopsy (SLNB) after the neoadjuvant chemotherapy, compared to axillary lymph-node dissection, in terms of false-negative rate (FNR) and sentinel lymph-node identification rate (SLNIR), sensitivity, negative predictive value (NPV), need for axillary lymph-node dissection (ALND), morbidity, preferences, and costs. METHODS: MEDLINE, Embase, Scopus, and The Cochrane Library were searched. We assessed the quality of the included systematic reviews using AMSTAR2 tool, and estimated the degree of overlapping of the individual studies on the included reviews. RESULTS: Six systematic reviews with variable quality were selected. We observed a very high overlapping degree across the included reviews. The FNR and the SLNIR were quite consistent (FNR 13-14%; SLNIR ~ 90% or higher). In women with initially clinically node-negative breast cancer, the FNR was better (6%), with similar SLNIR (96%). The included reviews did not consider the other prespecified outcomes. CONCLUSIONS: It would be reasonable to suggest performing an SLNB in patients treated with NACT, adjusting the procedure to the previous marking of the affected lymph node, using double tracer, and biopsy of at least three sentinel lymph nodes. More well-designed research is needed. PROSPERO registration number: CRD42020114403.

Las múltiples dimensiones de la salud y enfermedad del ser ecobiopsicosocial en Un monstruo viene a verme (2016) / The multiple dimensions of health and disease of the ecobiopsychosocial being in A monster calls (2016)

Connor O'Malley es un chico de 12 años que padece del síndrome del cuidador debido a la enfermedad terminal de su madre; sus temores se materializan y cobran vida constituyendo de manera fantástica un temible monstruo que tiene como propósito sacar a la luz sus más profundos temores y sentimientos. Todo paciente con enfermedad terminal al dejar de ser independiente requiere atención de cuidadores que aseguren su bienestar y en muchas ocasiones los cuidadores son miembros de la familia. El síndrome del cuidador es una condición provocada por el cuidado extenuante de un familiar dependiente. Este síndrome se manifiesta en respuesta a un estrés emocional y se caracteriza por el agotamiento tanto físico como psicológico. Al constituirse como una entidad ecobiopsicosocial, la salud humana es resultado del bienestar en cada esfera, de modo que, cuando existe afectación de tan solo una de ellas, la salud de un individuo puede afectarse, como sucede en el síndrome del cuidador. El síndrome del cuidador en Connor es el tema del presente artículo, así como lo son los potenciales medios para su abordaje. (AU)

Connor O'Malley is a 12-year-old boy suffering from caregiver syndrome due to his mother's terminal illness; his fears materialize and come to life in a fantastic way constituting a fearsome monster whose purpose is to bring to light his deepest fears and feelings. Every terminally ill patient, when becoming no longer independent, requires care from caregivers who may ensure their well-being, and in many cases the caregivers are family members. Caregiver Syndrome is a condition caused by the strenuous care of a dependent family member. This syndrome manifests in response to emotional stress and is characterized by both physical and psychological exhaustion. By establishing itself as an ecobiopsychosocial entity, human health is the result of well-being in each sphere, so that, when only one of them is affected, the health of an individual can be affected, as occurs in caregiver syndrome. The caregiver syndrome in Connor is the subject of this article, as are the potential means for its approach. (AU)

Effect of the Dynamic Response of a Side-Wall Pressure Measurement System on Determining the Pressure Step Signal in a Shock Tube Using a Time-of-Flight Method.

Technological progress demands accurate measurements of rapidly changing pressures. This, in turn, requires the use of dynamically calibrated pressure meters. The shock tube enables the dynamic characterization by applying an almost ideal pressure step change to the pressure sensor under calibration. This paper evaluates the effect of the dynamic response of a side-wall pressure measurement system on the detection of shock wave passage times over the side-wall pressure sensors installed along the shock tube. Furthermore, it evaluates this effect on the reference pressure step signal determined at the end-wall of the driven section using a time-of-flight method. To determine the errors in the detection of the shock front passage times over the centers of the side-wall sensors, a physical model for simulating the dynamic response of the complete measurement chain to the passage of the shock wave was developed. Due to the fact that the use of the physical model requires information about the effective diameter of the pressure sensor, special attention was paid to determining the effective diameter of the side-wall pressure sensors installed along the shock tube. The results show that the relative systematic errors in the pressure step amplitude at the end-wall of the shock tube due to the errors in the detection of the shock front passage times over the side-wall pressure sensors are less than 0.0003%. On the other hand, the systematic errors in the phase lag of the end-wall pressure signal in the calibration frequency range appropriate for high-frequency dynamic pressure applications are up to a few tens of degrees. Since the target phase measurement uncertainty of the pressure sensors used in high-frequency dynamic pressure applications is only a few degrees, the corrections for the systematic errors in the detection of the shock front passage times over the side-wall pressure sensors with the use of the developed physical dynamic model are, therefore, necessary when performing dynamic calibrations of pressure sensors with a shock tube.

Predictors of health professionals' satisfaction with continuing education: A cross-sectional study.

OBJECTIVES: to verify which organizational, methodological, and resource-related characteristics of Continuing Health Education (CHE) help to best predict the professionals´ satisfaction. METHOD: a cross-sectional study with multivariate logistic regressions to predict a high mean satisfaction with different dimensions of educational actions used: Overall satisfaction, Utility, Methodology, Organization and resources, and Teaching Capacity. 25,281 satisfaction questionnaires have been analysed completed by health professionals attending 1,228 training activities in Andalusia (Spain), during the period from March 2012 to April 2015. RESULTS: the characteristics that best predict a high overall satisfaction are the following: clinical session type as opposed to the workshop (Odds Ratio [OR]=2.07, p<0.001); face-to-face attendance modality (OR=3.88, p<0.001) or semi-personal-attendance (OR=2.83, p<0.001), as opposed to e-learning; and 1-2 days in duration (OR=2.38, p<0.001) as opposed to those of between 3 and 14 days. A lower number of hours (OR=0.99, p<0.001) and a lower number of professionals (OR=0.98, p<0.05) also increase the probability. Having the educational actions accredited increases the probabilities in the following dimensions: Utility (OR=1.33, p<0.05), Methodology (OR=1.5, p<0.01) and Teaching capacity (OR=1.5, p<0.01). CONCLUSION: the study provides relevant information on aspects that improve professional satisfaction, such as that e-learning activities should improve their content, teaching methods, and styles, or that face-to-face clinical sessions are the type of CHE with the greatest satisfaction.

Programa de atención a pacientes diabéticos y prediabéticos en farmacia comunitaria: 'DayBTS' / Treatment program for diabetic and prediabetic patients in community pharmacy: 'DayBTS'

JUSTIFICACIÓN: en España hay 6 millones de personas con diabetes. Canarias está 1,86 puntos porcentuales por encima de la media nacional. Aunque haya mejor conocimiento de la diabetes, el número de pacientes sigue aumentando. El farmacéutico comunitario puede jugar un papel importante a través de su formación académica como sanitario experto en el medicamento y por su cercanía al paciente. Por ello, son importantes proyectos de diseño y estandarización de servicios de seguimiento farmacoterapéutico en diabetes más un abordaje multidisciplinar. OBJETIVO: diseño de un servicio para atención a pacientes diabéticos y prediabéticos en farmacia comunitaria denominado DayBTS. Población diana: mayores de edad que acuden a la farmacia y cumplen al menos uno de estos requisitos: tratamiento con medicación antidiabética, presenten sobrepeso u obesidad, hipertensión arterial o hipercolesterolemia, presenten antecedentes familiares de diabetes o directamente soliciten el servicio. Estructura: serie de visitas divididas en dos fases. Fase inicio, comprende 5 visitas. Fase continuación, 2 visitas para seguimiento y nuevas dudas o problemas. Las actividades a realizar de forma general son: educación diabetológica, medición de variables clínicas (glucemia capilar, índice de masa corporal, hemoglobina glicosilada, patrones en glucemia), variables económicas (visitas a atención primaria, urgencias, número de medicamentos utilizados) y variables humanísticas (adherencia al tratamiento, calidad de vida, conocimientos sobre diabetes). Coste previsto: el coste por visita se estima en función de: tipo de visita, recursos materiales y tiempo del personal farmacéutico. Entre 5,95 € (paciente prediabético) a 20,90€ (paciente diabético) con precio propuesto de 7,44 € y 26,13 € para margen 20 %. El coste del servicio completo sería de 88,31-111 € (Prediabetes-Diabetes)

REASON: in Spain there are 6 million people with diabetes. The Canary Islands are 1.86 percentage points above the national average. Although information on diabetes has improved, the number of patients continues to increase. Community pharmacists can play a significant role thanks to their academic training as healthcare providers specialized in medications and their proximity to patients. For this reason, it is important to have projects for the design and standardization of pharmacotherapeutic monitoring services in diabetes, besides a multidisciplinary approach. OBJECTIVE: design of a treatment service for diabetic and prediabetic patients in community pharmacy called DayBTS. Target population: older people who visit the pharmacy and meet at least one of the following requirements: treatment with antidiabetic medication, are overweight or obese, arterial hypertension or hypercholesterolemia, with family history of diabetes or who ask for the service directly. Structure: series of visits in four phases. Initial phase, includes 5 visits. Continuation phase, 2 visits for monitoring and new doubts or issues. The activities to perform in general are as follows: diabetes education, measurement of clinical variables (blood glucose, body mass index, glycosylated hemoglobin, glycemic patterns), economic variables (visits at primary care, acute care, number of medications used) and human variables (treatment compliance, quality of life, knowledge of diabetes). Expected cost: the cost per visit is estimated according to: type of visit, material supplies and pharmaceutical staff time. Between 5.95 € (prediabetic patient) and 20.90 € (diabetic patient) with cost proposed 7.44 € and 26.13 € for a 20 % margin. The cost of the complete service would be 88.31-111 € (Prediabetes-Diabetes)

Pancreatitis aguda en carcinoma de célula pequeña de pulmón (CPCP) resuelta con quimioterapia / Acute pancreatitis in small-cell lung carcinoma (SCLC) resolved with chemotherapy

Resumen El carcinoma de célula pequeña (CPCP) o microcítico de pulmón es un subtipo de cáncer de pulmón que típicamente se ha asociado al tabaquismo y que se caracteriza por su agresividad y mal pronóstico a corto plazo. Como entidad, puede metastatizar en cualquier órgano, siendo las metástasis pancreáticas raras y la mayoría de las veces asintomáticas. Por ello, la presencia de una pancreatitis neoplásica, como en el caso presentado, es excepcional, y aún más cuando presenta refractariedad al tratamiento médico convencional y responde al tratamiento citotóxico sistémico. Por todo ello, se expone esta experiencia clínica y se debate la presencia de esta rara entidad y su manejo.

Abstract Small-cell lung carcinoma is a subtype of neoplasm that has been typically associated with smoking; it is characterized by its aggressiveness and poor prognosis in the short term. As an entity, it can metastasize in any organ, but pancreatic metastases are rare and most of the time asymptomatic. Therefore, the presence of neoplastic pancreatitis as in our case is exceptional; even more when it presents refractoriness to conventional medical treatment, responding instead to systemic cytotoxic treatment. Therefore, we expose our clinical experience and discuss the presence of this rare entity and its management.

Predictors of health professionals' satisfaction with continuing education: A cross-sectional study / Preditores de satisfação dos profissionais de saúde com a educação continuada: um estudo transversal / Variables predictoras de la satisfacción de los profesionales de la salud con la educación continua: un estudio transversal

Objectives: to verify which organizational, methodological, and resource-related characteristics of Continuing Health Education (CHE) help to best predict the professionals´ satisfaction. Method: a cross-sectional study with multivariate logistic regressions to predict a high mean satisfaction with different dimensions of educational actions used: Overall satisfaction, Utility, Methodology, Organization and resources, and Teaching Capacity. 25,281 satisfaction questionnaires have been analysed completed by health professionals attending 1,228 training activities in Andalusia (Spain), during the period from March 2012 to April 2015. Results: the characteristics that best predict a high overall satisfaction are the following: clinical session type as opposed to the workshop (Odds Ratio [OR]=2.07, p<0.001); face-to-face attendance modality (OR=3.88, p<0.001) or semi-personal-attendance (OR=2.83, p<0.001), as opposed to e-learning; and 1-2 days in duration (OR=2.38, p<0.001) as opposed to those of between 3 and 14 days. A lower number of hours (OR=0.99, p<0.001) and a lower number of professionals (OR=0.98, p<0.05) also increase the probability. Having the educational actions accredited increases the probabilities in the following dimensions: Utility (OR=1.33, p<0.05), Methodology (OR=1.5, p<0.01) and Teaching capacity (OR=1.5, p<0.01). Conclusion: the study provides relevant information on aspects that improve professional satisfaction, such as that e-learning activities should improve their content, teaching methods, and styles, or that face-to-face clinical sessions are the type of CHE with the greatest satisfaction.

Objetivo: verificar quais características organizacionais, metodológicas e relacionadas a recursos da educação continuada em saúde (ECS) ajudam a predizer melhor a satisfação dos profissionais. Método: estudo transversal com regressões logísticas multivariadas para predizer uma alta satisfação média com diferentes dimensões das ações educativas utilizadas: Satisfação Geral, Utilidade, Metodologia, Organização e Recursos, e Capacidade de Ensino. Foram analisados 25.281 questionários de satisfação preenchidos por profissionais de saúde que participaram de 1.228 atividades de treinamento na Andaluzia (Espanha), no período de março de 2012 a abril de 2015. Resultados: características que melhor predizem uma alta Satisfação Geral são as seguintes: Método de sessão clínica em oposição a workshops (Odds Ratio[OR]=2,07;p<0,001); modalidade presencial (OR=3,88;p<0,001) ou semipresencial (OR=2,83;p<0,001) em oposição a e-learning; e 1-2 dias de duração (OR=2,38;p<0,001) em oposição a 3-14 dias. Um menor número de horas (OR=0,99;p<0,001) e de profissionais (OR=0,98;p<0,05) também aumenta a probabilidade. A acreditação das ações educativas aumenta as probabilidades nas dimensões: Utilidade (OR=1,33;p<0,05), Metodologia (OR=1,5;p<0,01) e Capacidade de Ensino (OR=1,5;p<0,01). Conclusão: o estudo fornece informações relevantes sobre aspectos que melhoram a satisfação profissional, como a opinião de que atividades e-learning precisam melhorar seu conteúdo, métodos e estilos de ensino, ou de que sessões clínicas presenciais são o tipo de ECS com maior satisfação.

Objetivo: verificar qué características organizativas, metodológicas y de recursos de la Educación Continua en Salud (ECS) ayudan a predecir mejor la satisfacción de los profesionales. Método: se utiliza un estudio transversal con regresiones logísticas multivariadas para predecir un alto promedio de satisfacción con los diferentes tipos de acciones educativas: Satisfacción general, Utilidad, Metodología, Organización y recursos y Capacidad docente. Se han analizado 25.281 cuestionarios de satisfacción respondidos por los profesionales de la salud que asistieron a 1228 actividades formativas, en Andalucía (España), durante el período de marzo a abril de 2012. Resultados: características que mejor predicen una alta Satisfacción general: Tipo de sesión clínica frente al taller (OddsRatio [OR]=2,07, p<0,001); modalidad de asistencia presencial (OR=3,88, p<0,001) o semipersonal (OR=2,83, p<0,001), frente al aprendizaje electrónico (e-learning); y 1-2 días de duración (OR=2,38, p<0,001) frente a 3-14 días. Una menor cantidad de horas (OR=0,99, p<0,001) y una menor cantidad de profesionales (OR=0,98, p<0,05) también aumentan la probabilidad. Acreditar las acciones educativas aumenta las probabilidades en las siguientes dimensiones: Utilidad (OR=1,33, p<0,05), Metodología (OR=1,5, p<0,01) y Capacidad docente (OR=1,5, p<0,01). Conclusión: el estudio aporta información relevante sobre aspectos que mejoran la satisfacción profesional, como que las actividades de aprendizaje electrónico deben mejorar sus contenidos, métodos y estilos de enseñanza o que las sesiones clínicas personales son el tipo de ECS con mayor satisfacción.

Asthma exacerbations: factors related to longer hospital stay.

BACKGROUND: Hospital admissions account for a significant part of asthma cost, but with significant differences between geographic areas. AIMS: The aim of our study is to analyse hospital admissions due to asthma, as well as the factors associated with longer hospital stays. METHODS: A review was retrospectively carried out on all admissions of patients over 18 years old due to exacerbation of asthma occurring in our hospital between the years 2000 and 2010. The personal characteristics of each patient, the asthma personal history, characteristics of every exacerbation, as well as the treatment before admission and after hospital discharge were recorded. RESULTS: During the study period, there were 2163 hospital admissions in 1316 patients (mean age 62.6 years; mean hospital stay 11.6 days). The admissions mainly occur in winter, in the 56-75-year age group, and in patients with severe asthma. Female sex, higher comorbidity, a greater number of emergencies due to asthma in the previous year, and baseline treatment with theophylline were independently associated to longer hospital stay. CONCLUSIONS: The management of asthma in our population seems improvable. There appears to be a need to optimise both the diagnosis and treatment of the disease, and to identify risk factors as important as tobacco habits. As regards exacerbations, the hospital stay and mortality must be significantly reduced.

Comparing methods of determining Legionella spp. in complex water matrices.

BACKGROUND: Legionella testing conducted at environmental laboratories plays an essential role in assessing the risk of disease transmission associated with water systems. However, drawbacks of culture-based methodology used for Legionella enumeration can have great impact on the results and interpretation which together can lead to underestimation of the actual risk. Up to 20% of the samples analysed by these laboratories produced inconclusive results, making effective risk management impossible. Overgrowth of competing microbiota was reported as an important factor for culture failure. For quantitative polymerase chain reaction (qPCR), the interpretation of the results from the environmental samples still remains a challenge. Inhibitors may cause up to 10% of inconclusive results. This study compared a quantitative method based on immunomagnetic separation (IMS method) with culture and qPCR, as a new approach to routine monitoring of Legionella. RESULTS: First, pilot studies evaluated the recovery and detectability of Legionella spp using an IMS method, in the presence of microbiota and biocides. The IMS method results were not affected by microbiota while culture counts were significantly reduced (1.4 log) or negative in the same samples. Damage by biocides of viable Legionella was detected by the IMS method. Secondly, a total of 65 water samples were assayed by all three techniques (culture, qPCR and the IMS method). Of these, 27 (41.5%) were recorded as positive by at least one test. Legionella spp was detected by culture in 7 (25.9%) of the 27 samples. Eighteen (66.7%) of the 27 samples were positive by the IMS method, thirteen of them reporting counts below 10(3) colony forming units per liter (CFU l(-1)), six presented interfering microbiota and three presented PCR inhibition. Of the 65 water samples, 24 presented interfering microbiota by culture and 8 presented partial or complete inhibition of the PCR reaction. So the rate of inconclusive results of culture and PCR was 36.9 and 12.3%, respectively, without any inconclusive results reported for the IMS method. CONCLUSION: The IMS method generally improved the recovery and detectability of Legionella in environmental matrices, suggesting the possibility to use IMS method as valuable indicator of risk. Thus, this method may significantly improve our knowledge about the exposure risk to these bacteria, allowing us to implement evidence-based monitoring and disinfection strategies.

Tolerability to nabumetone and meloxicam in patients with nonsteroidal anti-inflammatory drug intolerance.

BACKGROUND: Because nonsteroidal anti-inflammatory drug (NSAID) intolerance depends on COX-1 inhibition, preferential or selective COX-2 inhibitors have been thought to be well tolerated by these patients. OBJECTIVE: The aim of this study is to evaluate tolerability to nabumetone and meloxicam in patients with NSAID intolerance. METHODS: Seventy patients intolerant to NSAIDs were selected. Thirty subjects were patients with asthma with respiratory (rhinitis-asthma) intolerance to NSAIDs (group A); 40 patients (group B) had cutaneous-mucous (urticaria-angioedema) NSAID intolerance. Diagnosis was based on clinical histories in all patients, and it was confirmed by positive single-blind placebo-controlled oral challenge test in 36 patients. After written informed consent, a single-blind placebo-controlled oral challenge test with nabumetone in all patients (2 g except for 11 patients who reached 1 g) and meloxicam (15 mg) in 51 patients was performed. RESULTS: Of the total selected, 94.3% tolerated 1 g nabumetone. In those who reached the 2-g dose, the tolerability was 83.6%. With respect to meloxicam, 96.1% of patients, tolerated 15 mg. No significant difference in nabumetone and meloxicam tolerability was observed between groups A and B. CONCLUSION: The results of this study confirm a high percentage of tolerability to the maximum therapeutic dosage of nabumetone and meloxicam in patients with NSAID intolerance, both in those with cutaneous/mucous manifestations and in those with respiratory disease. CLINICAL IMPLICATIONS: Nabumetone and meloxicam are safe alternatives in NSAID-intolerant patients.

Hematoma espinal subdural espontáneo / Spontaneous spinal subdural hematoma

El hematoma espinal subdural es una patología extremadamente rara. Aparece normalmente asociado a punciones lumbares y/o a discrasias sanguíneas. Presentamos el caso de un varón de 78 años, con antecedente de toma de anticoagulantes orales que presentó de forma brusca un déficit neurológico motor de ambos miembros inferiores. Describimos los hallazgos en RM, que fueron confirmados posteriormente de forma quirúrgica. Destacamos la importancia que esta técnica tiene tanto en la identificación precoz de la colección hemática, para diferenciarla de otras patología espinales, ya que puede ser necesario un tratamiento quirúrgico inmediato, como en el seguimiento de estos pacientes, ya que es indispensable para la valoración de atrofia medular o signos de aracnoiditis

Spinal subdural hematoma is extremely rare. It is normally associated to lumbar puncture and/or blood disorders. We present the case of 78-year-old man with a history of oral anticoagulant treatment that presented with a sudden neurologic motor deficit in the lower limbs. We describe the MRI findings, which were confirmed at surgery. We emphasize the importance of MRI both in the early identification of the hematic collection, as immediate surgical treatment may be necessary, and in the follow-up of these patients, as it is essential in the evaluation of atrophy of the spinal cord and signs of arachnoiditis

La colonoscopia: análisis de 2000 procedimientos / Colonoscopy: analysis of 2000 procedures

Antecedentes: desde hace tres décadas, la colonoscopia constituye el estudio diagnóstico con mayo sensibilidad y especificidad de la patología colónica. objetivos: ratificar las indicaciones, conocer los diagnósticos colonoscópicos estableciendo el Análisis de los mismos y corroborar la seguridad del procedimiento colonoscópico. Método: se realizó un estudio descriptivo transversal, retrospectivo y observacional de 2,000 colonoscopias efectuadas entre 1987 y 1997 y se registraron los hallazgos endoscópicos y sus características. Resultados: de las 2,000 colonoscopias, 947 se realizaron en el sexo masculino (47.3 por ciento) y 1053 en el femenino (52.6 por ciento) con edad promedio de 55.8 años(margen de 10 a 93 años) Se consideró completa la colonoscopia cuando se alcanzo el ciego, lo que ocurrió en 1740 casos (87 por ciento). Las indicaciones más frecuentes para efectuar el procedimiento fueron: hemorragia del tubo digestivo bajo en 525 pacientes (26.2 por ciento), sospecha de cáncer en 402 (20.1 por ciento), de enfermedad inflamatoria intestinal en 292 (14.6 por ciento) y de pólipos rectocolónicos en 199 (10 por ciento). Se detectó patología en 1,150 pacientes (57.5 por ciento) y los diagnósticos endoscópicos más frecuentes fueron: pólipos rectocolónicos en 405 pacientes (35.7 por ciento), enfermedad diverticular en 404 (35.1 por ciento), enfermedad inflamatoria intestinal en 185 (16 por ciento), cáncer colorrectal en 85 (7.4 por ciento) y ectasias vasculares en 52 (4.5 por ciento) Hubo cuatro complicaciones (0.2 por ciento), 3 por colonoscopias terapéuticas, una con fines diagnósticos. Conclusiones. las indicaciones más frecuentes para llevar a cabo la colonoscopia fueron la hemorragia del tubo digestivo bajo y la sospecha de cáncer. Los diagnósticos más comunes que se establecieron fueron los pólipos colorrectales y la enfermedad diverticular. Se confirma que la colonoscopia es un procedimiento diagnóstico y terapéutico seguro.

Tumor estromal maligno de colon transverso. Informe de un caso / Malignant stromal tumor of transverse colon

Antecedentes. Los sarcomas de colon son poco comunes, de ellos, el más frecuente es el leiomiosarcoma. A la fecha se han informado 45 casos de tumor estromal maligno en la literatura mundial. La histogénesis de estas neoplasias mesenquimatosas se determinan con análisis ultraestructural y tinciones de inmunohistoquímica, sin embargo, cuando estas técnicas especiales son negativas y existe duda en cuanto a la línea de diferenciación celular (músculo liso, neural o indiferenciado), es preferible llamarlos tumores estromales del tracto gastrointestinal (TEGI). Objetivo. Presentar un caso de tumor estromal maligno del colon transverso. Método. Se revisó el caso de un paciente de 46 años de edad con diagnóstico de tumor estromal maligno de colon transverso y el tratamiento efectuado. Resultados. Se informa el caso de un paciente con diagnóstico de tumor estromal maligno en el colon transverso, cuyas principales manifestaciones clínicas fueron dolor abdominal, hemorragia transanal, y finalmente oclusión intestinal. Se sometió a laparotomía exploradora, encontrando intusucepción del colon transverso, por lo que se hizo hemicolectomía derecha ampliada. La evolución postquirúrgica fue satisfactoria y la vigilancia a tres años no ha demostrado datos de activación tumoral. Conclusiones. Los tumores estromales de colon son raros y su tratamiento es la resección quirúrgica con fines curativos o paliativos