Subject(s)
Cross Infection/epidemiology , Delayed Diagnosis , Hospital Departments/statistics & numerical data , Hospitals, University/statistics & numerical data , Iatrogenic Disease/epidemiology , Internal Medicine , Medical Errors , Risk Management , Adult , Aged , Female , Hospital Records , Humans , Incidence , Male , Medication Errors , Middle Aged , Prospective Studies , Spain/epidemiologySubject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Drug Resistance, Microbial/physiology , Urinary Tract Infections/drug therapy , Risk Factors , Imipenem/therapeutic use , Retrospective Studies , Ofloxacin , Ofloxacin/therapeutic use , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Ceftriaxone/therapeutic use , Ampicillin/therapeutic use , Quinolones/therapeutic use , Nitrofurantoin/therapeutic useABSTRACT
OBJECTIVES: Primary: to assess the necessity of a second endoscopy with a pathology study to confirm the healing of all gastric ulcers previously diagnosed through endoscopy in a population at intermediate risk for gastric cancer. Secondary: to assess correlation between endoscopic findings and pathology diagnosis. PATIENTS AND METHODS: a prospective analysis of patients diagnosed with gastric ulcer through endoscopy at Hospital General de Ciudad Real (Spain) over three years. We collected demographic, clinical, endoscopic, and pathological data for the first and subsequent endoscopies. We collected at least six biopsies obtained from ulcer margins, and assessed H. pylori infection. RESULTS: Three hundred and two patients were included in this study. H. pylori infection was diagnosed in 173 (57%), and 113 (37%) patients had used NSAIDs. The positive and negative predictive value for malignancy of endoscopic diagnosis regarding ulcer fold, base, and margins were 34 and 97%, respectively. Only one patient was diagnosed with a tumor during the second endoscopy. At the end of follow-up, the etiology of the ulcer was considered as peptic in 276 patients; Crohn s disease-related in one, and neoplastic in 25 patients (21 adenocarcinomas, 4 lymphomas). CONCLUSIONS: in an intermediate-risk population for gastric cancer a second endoscopy is not justified for gastric ulcer patients when endoscopy and biopsy results do not suggest malignancy.
Subject(s)
Adenocarcinoma/epidemiology , Gastroscopy , Lymphoma, Non-Hodgkin/epidemiology , Stomach Neoplasms/epidemiology , Stomach Ulcer/epidemiology , Adenocarcinoma/complications , Adenocarcinoma/diagnosis , Adult , Aged , Aged, 80 and over , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Biopsy , Crohn Disease/complications , Crohn Disease/epidemiology , Female , Follow-Up Studies , Gastritis/chemically induced , Gastritis/epidemiology , Gastritis/microbiology , Gastritis/pathology , Helicobacter Infections/diagnosis , Helicobacter Infections/epidemiology , Helicobacter pylori , Humans , Lymphoma, Non-Hodgkin/complications , Lymphoma, Non-Hodgkin/diagnosis , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Risk , Spain/epidemiology , Stomach Neoplasms/complications , Stomach Neoplasms/diagnosis , Stomach Ulcer/diagnosis , Stomach Ulcer/etiology , Stomach Ulcer/microbiology , Stomach Ulcer/pathology , Unnecessary Procedures , Young AdultABSTRACT
Objetivos: Primario: valorar la necesidad de una segunda endoscopia con estudio anatomopatológico para confirmar la curación de todas las úlceras gástricas diagnosticadas previamente mediante endoscopia, en una población de riesgo intermedio de cáncer gástrico. Secundario: correlacionar el juicio diagnóstico del endoscopista y el diagnóstico anatomopatológico. Pacientes y métodos: análisis prospectivo de todos los pacientes diagnosticados de úlcera gástrica mediante endoscopia en el Hospital General de Ciudad Real durante tres años. Se recogieron datos demográficos, clínicos, endoscópicos y anatomopatológicos de la primera y sucesivas endoscopias. Se tomaron al menos seis muestras de biopsia del nicho y se valoró la presencia de H. pylori. Resultados: se incluyeron 302 pacientes. Se diagnosticó infección por H. pylori en 173 (57%) y se documentó la toma de AINE en 113 (37%). El valor predictivo positivo y negativo para malignidad del diagnóstico endoscópico atendiendo a los pliegues, fondo y bordes del nicho fue de 34 y 97%, respectivamente. La segunda endoscopia sólo diagnosticó un paciente. Al final del seguimiento, el diagnóstico etiológico fue de 276 casos de úlcera péptica, 1 de úlcera por enfermedad de Crohn y 25 de úlcera neo-plásica (21 adenocarcinomas, 4 linfomas). Conclusiones: en una población de riesgo intermedio de cáncer gástrico, no está indicada la realización sistemática de una segunda endoscopia en pacientes con úlcera gástrica en los que la visión endoscópica y la biopsia del nicho no indican malignidad(AU)
Objectives: Primary: to assess the necessity of a second endoscopy with a pathology study to confirm the healing of all gastric ulcers previously diagnosed through endoscopy in a population at intermediate risk for gastric cancer. Secondary: to assess correlation between endoscopic findings and pathology diagnosis. Patients and methods: a prospective analysis of patients diagnosed with gastric ulcer through endoscopy at Hospital General de Ciudad Real (Spain) over three years. We collected demographic, clinical, endoscopic, and pathological data for the first and subsequent endoscopies. We collected at least six biopsies obtained from ulcer margins, and assessed H. pylori infection. Results: Three hundred and two patients were included in this study. H. pylori infection was diagnosed in 173 (57%), and 113 (37%) patients had used NSAIDs. The positive and negative predictive value for malignancy of endoscopic diagnosis regarding ulcer fold, base, and margins were 34 and 97%, respectively. Only one patient was diagnosed with a tumor during the second endoscopy. At the end of follow-up, the etiology of the ulcer was considered as peptic in 276 patients; Crohn's disease-related in one, and neoplastic in 25 patients (21 adenocarcinomas, 4 lymphomas). Conclusions: in an intermediate-risk population for gastric cancer a second endoscopy is not justified for gastric ulcer patients when endoscopy and biopsy results do not suggest malignancy(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Adenocarcinoma/epidemiology , Gastritis/pathology , Biopsy/methods , Gastritis/microbiology , Adenocarcinoma/diagnosis , Lymphoma, Non-Hodgkin/epidemiology , Stomach Neoplasms/epidemiology , Stomach Ulcer/epidemiology , Follow-Up Studies , Adenocarcinoma/complications , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Crohn Disease/epidemiology , Gastritis/chemically induced , Helicobacter pylori/isolation & purification , Lymphoma, Non-Hodgkin/complications , Predictive Value of Tests , Prospective Studies , Spain/epidemiology , Unnecessary ProceduresABSTRACT
BACKGROUND: Previous reports have shown that livers from controlled non-heart-beating-donors (NHBD) are associated with higher rates of primary failure and ischemic cholangiopathy of orthotopic liver transplantation (OLT) as a complication of the prolonged warm ischemia. METHODS: This retrospective review of activities from 1999 to 2006 examined donor characteristics of age, liver function tests, warm ischemic time before (1WITa) and after cardiac arrest (1WITb), cold ischemic time (CIT) and transplant results. RESULTS: Eleven NHBD retrieved livers were transplanted from "ideal" donors except for one elderly donor (73 years). Of the 11 recipients, 3 developed biliary cholangiopathy (27%). There were no episodes of primary graft nonfunction, but one recipient displayed primary graft dysfunction. Two recipients died: one due to biliary complications with sepsis (long CIT >10 hours, fatty liver), and the other due to aspiration pneumonia and hypoxic brain damage with normal liver function. One recipient required retransplantation owing to ischemic cholangiopathy (1WITb 45 min) at 6 months after OLT with a good result. The other eight recipients are alive (observation period 72 to 14 months) including six with normal liver function, one with biopsy-proven biliary ischemia and one with recurrent primary sclerosing cholangitis without biliary ischemic changes on biopsy. Among 164 heart-beating donors recipients transplanted in the same period, biliary complications occurred in 27 patients (16%), of whom 12 were leaks and 15 anastomotic strictures. CONCLUSION: NHBD were a good source for livers with reasonable early results. To avoid late complications especially ischemic cholangiopathy, caution is urged with the use of these organs as well as strict donor and ischemic time criteria.
Subject(s)
Brain Death , Cholangitis/etiology , Ischemia/etiology , Liver Transplantation/adverse effects , Adolescent , Adult , Aged , Humans , Middle Aged , Retrospective Studies , Tissue Donors , Tissue and Organ Harvesting/methods , Treatment OutcomeSubject(s)
Carcinoma, Squamous Cell/complications , Dermatomyositis/etiology , Esophageal Neoplasms/complications , Polymyositis/etiology , Aged , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/therapeutic use , Biopsy , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/pathology , Dermatomyositis/diagnosis , Dermatomyositis/drug therapy , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/diagnostic imaging , Esophageal Neoplasms/pathology , Esophagus/pathology , Humans , Male , Polymyositis/diagnosis , Polymyositis/drug therapy , Prednisone/administration & dosage , Prednisone/therapeutic use , Tomography, X-Ray ComputedABSTRACT
No disponible
Subject(s)
Male , Aged , Humans , Dermatomyositis/etiology , Carcinoma/complications , Esophageal Neoplasms/complications , Dermatomyositis/drug therapy , Carcinoma/surgery , Prednisone/pharmacology , Prostheses and Implants , Esophageal Neoplasms/surgeryABSTRACT
No disponible
Subject(s)
Female , Adult , Humans , Common Variable Immunodeficiency/complications , Focal Nodular Hyperplasia/complications , Adrenal Cortex Hormones/therapeutic useABSTRACT
No disponible
Subject(s)
Female , Adult , Humans , Antiphospholipid Syndrome/complications , Salmonella Infections/complications , Salmonella Infections/microbiology , Bacteremia/complications , Bacteremia/microbiology , Salmonella enterica/isolation & purificationABSTRACT
To determine the functional status in elderly patients after a hospitalisation in an Internal Medicine unit. We prospectively studied patients aged 80 or above hospitalised in the Hospital Provincial de Ciudad Real in an Internal Medicine unit, between February and July, 2003. The functional status was determined by Barthel Index. We examined 206 patients (77.4%). They showed a previous Barthel Index of 70.9; one of 48.9 in the hospitalisation stage and one of 58.6 when discharged (p<0.001). We noticed a Barthel Index when discharged which was lower than the previous Barthel one in 73.8% patients. Hospitalisation implies a great functional impairment in the functional status elderly patients. It would be convenient, therefore, to identify the risk factors to be able to set some guidelines for a preventive model.
Subject(s)
Activities of Daily Living , Health Status Indicators , Hospitalization/statistics & numerical data , Aged , Aged, 80 and over , Female , Humans , Internal Medicine , Male , SpainABSTRACT
Valoramos la repercusión en la capacidad funcional de los pacientes ancianos tras un ingreso hospitalario en un servicio de Medicina Interna. Se estudió de forma prospectiva los pacientes con 80 años o más ingresados en el Servicio de Medicina Interna del Hospital Provincial de Ciudad Real, entre los meses de febrero a julio de 2003. La valoración de la capacidad funcional se realizó mediante el índice de Barthel. Se incluyeron 206 (77,4%) con un índice de Barthel previo de 70,9, al ingreso de 48,9 y al alta de 58,6 (p<0,001). Se recogió un índice de Barthel al alta menor al previo en el 73,8% de los pacientes. La hospitalización conlleva un deterioro importante en la capacidad funcional de los pacientes ancianos. Es necesario identificar los factores de riesgo responsables de esta pérdida funcional y poder establecer pautas preventivas de actuación
To determine the functional status in elderly patients after a hospitalisation in an Internal Medicine unit. We prospectively studied patients aged 80 or above hospitalised in the Hospital Provincial de Ciudad Real in an Internal Medicine unit, between February and July, 2003. The functional status was determined by Barthel Index. We examined 206 patients (77,4%). They showed a previous Barthel Index of 70,9; one of 48,9 in the hospitalisation stage and one of 58,6 when discharged (p<0,001). We noticed a Barthel Index when discharged which was lower than the previous Barthel one in 73,8% patients. Hospitalisation implies a great functional impairment in the functional status elderly patients. It would be convenient, therefore, to identify the risk factors to be able to set some guidelines for a preventive model
Subject(s)
Male , Female , Aged , Aged, 80 and over , Humans , Activities of Daily Living , Health Status Indicators , Hospitalization/statistics & numerical data , Internal Medicine , SpainABSTRACT
No disponible
Subject(s)
Male , Aged , Humans , Neurofibromatosis 1/complications , Intestinal Obstruction/etiology , Intestine, Small/physiopathology , Colonoscopy , Intestinal Polyps/complicationsSubject(s)
Mercury Poisoning , Mercury/administration & dosage , Suicide, Attempted , Adult , Humans , Injections, Subcutaneous , MaleABSTRACT
No disponible
