ABSTRACT
BACKGROUND: Esophageal stricture due to caustic ingestion is one of the most difficult problems to manage. Esophageal dilations are the usual treatment and they require a great number of sessions in the majority of cases. This implies time, risks for the patient, anguish for the relatives, and very often, frustration for the physician. OBJECTIVES: To evaluate the efficacy of the application of topical mitomycin C and intralesional triamcinolone in the prevention of post-dilation esophageal stricture recurrence. MATERIAL AND METHODS: A prospective, comparative, nonrandomized, and longitudinal study was conducted that compared a cohort of 16 patients treated with mitomycin C (2009-2012) with a retrospective cohort of 34 patients treated with triamcinolone (2002-2009). RESULTS: The patients treated with intralesional triamcinolone had a median of 11 dilations (minimum 4 and maximum 24), whereas the median in the patients treated with topical mitomycin C was 4.5 (minimum 3 and maximum 8). The groups were compared using the Mann-Whitney U test, finding a statistically significant difference of a two-tailed P<.001. In the multiple linear regression model, the dependent variable was the number of dilations and the independent variables were the type of lesion and treatment. The result was an R(2) .676 with a significance level of P<.001, in which the regression coefficient for treatment was B -.682 (95% CI -8.286 to -5.025) and the lesion grade was B .435 (95% CI 2.043- 4.573). The ANOVA result was an F 49.08 and a P<.001 and showed that the independent variables of type of lesion and treatment had a linear relation with the number of dilations, reinforcing the fact that our results were not due to chance. CONCLUSIONS: Topical mitomycin C considerably reduced the number of esophageal dilations compared with the use of intralesional triamcinolone to alleviate dysphagia, and therefore we suggest it as a treatment option in strictures due to caustic ingestion.
Subject(s)
Anti-Inflammatory Agents/administration & dosage , Antibiotics, Antineoplastic/administration & dosage , Burns, Chemical/complications , Esophageal Stenosis/drug therapy , Mitomycin/administration & dosage , Triamcinolone/administration & dosage , Administration, Topical , Anti-Inflammatory Agents/therapeutic use , Antibiotics, Antineoplastic/therapeutic use , Caustics/toxicity , Child , Child, Preschool , Combined Modality Therapy , Dilatation , Esophageal Stenosis/chemically induced , Esophageal Stenosis/therapy , Esophagoscopy , Female , Humans , Infant , Injections, Intralesional , Longitudinal Studies , Male , Mitomycin/therapeutic use , Prospective Studies , Recurrence , Retrospective Studies , Treatment Outcome , Triamcinolone/therapeutic useABSTRACT
Objetivo. Conocer el grado de concordancia existente entre el grado de control glucémico obtenido mediante el autoanálisis de glucemia capilar y mediante la determinación de hemoglobina glucosilada en pacientes con diabetes tipo 2. Diseño. Estudio observacional, transversal. Emplazamiento. Población de pacientes con diabetes tipo 2, adscrita a tres consultas de medicina general de un área básica de salud semiurbana. Intervenciones. Se compararon los valores medios de glucemia capilar basal y posprandial obtenidos durante 8 semanas con el valor correspondiente al mismo período de hemoglobina glucosilada y se midió el grado de concordancia mediante la kappa ponderada. Resultados. De los 21 sujetos de la muestra, el 52 por ciento eran varones. La edad media fue de 64,7 años (DE, 7,69). El grado de concordancia entre los valores de control según las cifras de hemoglobina glucosilada y las de automonitorización de glucemia capilar fue de 0,33 con las glucemias basales y de 0,37 con las glucemias posprandiales. El grado de correlación entre la hemoglobina glucosilada y la media de glucemias basales fue de 0,8, mientras que con la media de las glucemias posprandiales fue de 0,66 y con la media de todas las determinaciones fue de 0,77. Conclusiones. Existe una baja concordancia entre los valores de hemoglobina glucosilada y los de la glucemia capilar, por lo que ambos métodos son igualmente necesarios en el control de la diabetes mellitus y han de considerarse complementarios (AU)
