Results of a survey about specific inflammatory bowel disease units in Andalusia.

BACKGROUND: Inflammatory bowel disease (IBD) has become one of the most prevalent pathologies in Gastroenterology Units, which added to its clinical outcome, treatment, the complexity of affected patients and the need to be continuously updated for the correct management of the disease, have made essential the presence of specific IBD units in each hospital. OBJECTIVES: The primary aims of this study were: a) to reveal the existence of these units in our area and how they work; and b) to draw conclusions regarding the necessary resources in these units and their aims. MATERIAL AND METHODS: In order to analyse the presence of these specialized units and the available resources in Andalusian hospitals, a 24-question survey was designed, being answered by 11 hospitals. The evaluated questions included the number of days patients are attended and the number of physicians attending the unit, the number of available healthcare assistants, if emergencies are attended or not, if there is an activated telephone number for patient consultation, if a day care unit is available and if new treatments are easily accessible. RESULTS: A specific IBD unit is present in all studied hospitals attending more than 11 patients each, although in the 63.4% of the cases patients are not attended more than 3 days per week. On the other hand, the 81.8% of the included hospitals attend emergencies although only the 54.5% of them had a specific telephone number for patient attendance. CONCLUSIONS: A specific IBD unit is present in many Andalusian hospitals, although some deficiencies can be observed. The general opinion of this Group is that these units are necessary in order to properly attend, monitorize and treat patients affected by IBD.

Resultados de la encuesta sobre consulta monográfica de enfermedad inflamatoria intestinal realizada en Andalucía / Results of a survey about specific inflammatory bowel disease units in Andalusia

Introducción: la enfermedad inflamatoria intestinal (EII) se está convirtiendo en una de las patologías más prevalentes en las consultas de digestivo. Esta mayor prevalencia de la enfermedad, su evolución, tratamiento y el tipo de pacientes cada vez más complejos, junto a la necesidad de conocer las últimas novedades para poder atenderlos correctamente, hace pensar en la necesidad de tener una consulta específica de esta entidad. Objetivos: a) conocer si existen este tipo de consultas en nuestro medio y cómo se desarrollan; y b) elaborar una serie de conclusiones sobre la infraestructura necesaria y los objetivos de la misma. Material y métodos: se ha realizado una encuesta de 24 preguntas en las que se analiza la existencia o no de este tipo de consulta en los hospitales andaluces, así como de los medios con los que cuentan. Han respondido a la misma 11 hospitales. Se analizan cuestiones como el número de días que se pasa la consulta y el número de médicos que las atiende, el personal auxiliar con el que se cuenta, si se atienden urgencias o existe línea telefónica de consultas, y si se dispone de Unidad de Día o acceso a las últimas líneas de tratamiento, entre otras. Resultados: en todos los hospitales encuestados existe consulta monográfica. En todos ellos se ven más de 11 enfermos en cada consulta, si bien, en el 63,6% de los casos esta consulta no se pasa más de 3 días a la semana. Por otro lado, el 81,8% de los hospitales atiende urgencias pero sólo el 54,5% de los encuestados tiene línea telefónica para atender a sus pacientes. Conclusiones: la consulta monográfica de EII está extendida en Andalucía, aunque existen algunas deficiencias en las mismas. Este grupo de trabajo cree que este tipo de consulta es necesaria para la atención, seguimiento y el tratamiento correcto de los pacientes con EII(AU)

Background: inflammatory bowel disease (IBD) has become one of the most prevalent pathologies in Gastroenterology Units, which added to its clinical outcome, treatment, the complexity of affected patients and the need to be continuously updated for the correct management of the disease, have made essential the presence of specific IBD units in each hospital. Objectives: the primary aims of this study were: a) to reveal the existence of these units in our area and how they work; and b) to draw conclusions regarding the necessary resources in these units and their aims. Material and methods: In order to analyse the presence of these specialized units and the available resources in Andalusian hospitals, a 24-question survey was designed, being answered by 11 hospitals. The evaluated questions included the number of days patients are attended and the number of physicians attending the unit, the number of available healthcare assistants, if emergencies are attended or not, if there is an activated telephone number for patient consultation, if a day care unit is available and if new treatments are easily accessible. Results: a specific IBD unit is present in all studied hospitals attending more than 11 patients each, although in the 63.4% of the cases patients are not attended more than 3 days per week. On the other hand, the 81.8% of the included hospitals attend emergencies although only the 54.5% of them had a specific telephone number for patient attendance. Conclusions: a specific IBD unit is present in many Andalusian hospitals, although some deficiencies can be observed. The general opinion of this Group is that these units are necessary in order to properly attend, monitorize and treat patients affected by IBD(AU)

[A high-resolution gastroenterology clinic in Andalusia: what is it, and how should it work]. / Consulta de alta resolución de digestivo en Andalucía: qué es y cómo debe funcionar?

INTRODUCTION: The present concept in our healthcare system is that medical care should be given on an outpatient basis with hospitalization occurring only when essential. We therefore put forth the development of the "all in one" outpatient office or "high resolution" outpatient clinic. For such purpose we administered a questionnaire to various Andalusian hospitals to define and determine those aspects necessary in the development of the aforementioned outpatient office. MATERIALS AND METHODS: The questionnaire was filled out by 10 Andalusian hospitals. This is a prospective-descriptive study of responses from all 10 participating hospitals. The 27 questions inquired on the existence of such an outpatient office and the infrastructure needed to develop this service: How many patients are seen, where is it physically located, where do patients come from, criteria for assigning patients to this medical office, condition of incoming patients, whether ultrasound scans are performed, whether an integrated hospital computer system exists, nursing staff, how many visits are required before coming to a diagnosis, and finally whether this type of outpatient office is needed, and if so, why. RESULTS: Of all 10 hospitals, 5 of them had this type of clinic. All of them considered this type of outpatient service essential. The number of patients treated should be "10", in the hospital itself. There are differences as to whether patients should come from the emergency room or a primary care physician. It seems logical to assume that only patients who can be diagnosed via ultrasounds or endoscopy should be chosen. To allow an ultrasonogram the patient should visit the outpatient office in a state of "fasting" and with standard blood counts from the primary care physician. The outpatient clinic should have a computer system and its own nurse. According to participating hospitals this type of outpatient visits is very useful in our present healthcare system, as it allows higher levels of collaboration between Primary Care and the specialist; it also provides a rapid orientation regarding patient pathology, and acts as a "filter" for the rest of the healthcare system. CONCLUSIONS: The outpatient office should be tended to by an attending specialist in the field (FEA) with knowledge and experience in ultrasounds and gastrointestinal endoscopy, as well as user competency with the required computer programs. In our present-day system this can be considered a modality of high-resolution outpatient services and a model of efficiency.

Consulta de alta resolución de digestivo en Andalucía: ¿qué es y cómo debe funcionar? / No disponible

Introducción: la idea actual de nuestro sistema sanitario esque la asistencia sea ambulatoria y que se utilice la hospitalizacióncuando sea precisa. En este sentido es de destacar el desarrollo dela consulta única o de alta resolución. Por ello, se ha realizado unaencuesta entre varios hospitales andaluces con la idea de definir ydeterminar qué aspectos son necesarios para poder desarrollaresta consulta.Material y métodos: la encuesta ha sido contestada por 10hospitales andaluces. Se trata de un estudio prospectivo descriptivode las respuestas contestadas por los distintos hospitales. Laspreguntas son 27 en las que se reflexiona sobre la existencia de laconsulta y la infraestructura para desarrollarla: cuántos pacientesse ven, dónde se pasa esta consulta, de dónde provienen los pacientes,los criterios para derivar los pacientes a esta consulta, lascondiciones en las que acude el enfermo, si se realiza ecografía deabdomen, si se dispone de sistema informático integrado hospitalario,enfermera, en cuántas visitas se emite un diagnóstico del pacientey, por último, se pregunta si se cree que es necesaria estaconsulta y por qué.Resultados: de los 10 hospitales 5 tienen consulta de alta resolución,aunque todos consideran que la deberían tener. El númerode pacientes atendidos debe ser 10 y en el propio hospital.Existen diferencias en considerar si los pacientes deben provenirdesde Urgencias o desde el médico de cabecera. Parece lógicopensar que sólo se deben derivar pacientes cuya patología puedaser diagnosticada mediante ecografía y/o endoscopia. El pacientedebería acudir a la consulta en ayunas y con analítica del médicode cabecera, para así poder realizarles la ecografía. La consultadebe constar de sistema informático y de una enfermera propia.Según los encuestados este tipo de consultas es muy útil en nuestroactual sistema, porque permite mayor colaboración entreAtención Primaria y el especialista, y consigue una orientación rápidade la patología del paciente actuando de filtro adecuado parael resto de las consultas

Introduction: the present concept in our healthcare system isthat medical care should be given on an outpatient basis with hospitalizationoccurring only when essential. We therefore put forththe development of the “all in one” outpatient office or “high resolution”outpatient clinic. For such purpose we administered aquestionnaire to various Andalusian hospitals to define and determinethose aspects necessary in the development of the aforementionedoutpatient office.Materials and methods: the questionnaire was filled out by10 Andalusian hospitals. This is a prospective-descriptive study ofresponses from all 10 participating hospitals. The 27 questionsinquired on the existence of such an outpatient office and the infrastructureneeded to develop this service: How many patientsare seen, where is it physically located, where do patients comefrom, criteria for assigning patients to this medical office, conditionof incoming patients, whether ultrasound scans are performed,whether an integrated hospital computer system exists,nursing staff, how many visits are required before coming to a diagnosis,and finally whether this type of outpatient office is needed,and if so, why.Results: of all 10 hospitals, 5 of them had this type of clinic.All of them considered this type of outpatient service essential.The number of patients treated should be “10”, in the hospital itself.There are differences as to whether patients should comefrom the emergency room or a primary care physician. It seemslogical to assume that only patients who can be diagnosed via ultrasoundsor endoscopy should be chosen. To allow an ultrasonogramthe patient should visit the outpatient office in a state of“fasting” and with standard blood counts from the primary carephysician.The outpatient clinic should have a computer system and itsown nurse. According to participating hospitals this type of outpatientvisits is very useful in our present healthcare system, as it allowshigher levels of collaboration between Primary Care and thespecialist; it also provides a rapid orientation regarding patientpathology, and acts as a “filter” for the rest of the healthcare system (AU)

Historia natural de la infecciónpor virus C de la hepatitis

No disponible

[Pseudotumorous hepatic tuberculosis: laparoscopic appearance]. / Tuberculosis hepática seudotumoral. Aspecto laparoscópico.

Local hepatic tuberculosis without active pulmonary or miliary tuberculosis is an uncommon diagnosis. Even less common is the finding of a nodular form of local hepatic tuberculosis. There is a growing incidence of the disease related to human immunodeficiency virus. The authors report a case of pseudotumoral hepatic tuberculosis in a patient without AIDS, manifesting as prolonged fever, diagnosed previously as metastatic liver. Imaging studies of the liver and laparoscopic findings suggested metastatic disease. The correct diagnosis was made by histology of biopsies obtained in laparoscopy, which is an easy and cheap method, with less morbidity and mortality than surgical intervention. The case report illustrates the difficulty in reaching the correct diagnosis, most often confused with carcinoma of the liver, primary or metastatic. A greater awareness of this rare clinical entity may prevent needless surgical intervention since the majority of patients respond well to antituberculous chemotherapy.

[Association of porphyria cutanea tarda and hepatitis C virus]. / Asociación entre porfiria cutánea tarda y virus de la hepatitis C.

UNLABELLED: Porphyria cutanea tarda (PCT) is caused by reduced activity of hepatic uroporphyrinogen decarboxylase. However extrinsic factors such as alcohol abuse and drug intake are required for the clinical manifestation of the disease. Hepatitis C virus antibodies have been detected in a high percentage of patients with PCT. Hepatitis C virus is probably the main pathogenetic factor of liver damage in patients with PCT. AIM: To study the association between hepatitis C virus and PCT in our patients with PCT. MATERIAL AND METHODS: We have investigated six patients diagnosed of PCT in order to detect the presence of hepatitis C virus and other possible causes of the disease. RESULTS: We have found that 66% of our patients had hepatitis C virus antibodies, 50% ethanol abuse, of which 2/3 presented hepatitis C virus antibodies, and one case of HIV.

[Wegener's granulomatosis with gastrointestinal involvement]. / Granulomatosis de Wegener con afectación gastrointestinal.

Wegener's granulomatosis is a necrotizing granulomatous vasculitis often characterized by involvement of the upper respiratory tract, lungs and kidney, although any organic system can be affected. We present the case of a female patient with Wegener's granulomatosis diagnosed by biopsy of the kidney, and severe gastrointestinal bleeding with fatal course. Endoscopic findings of the colon and the histopathology of the biopsy are discussed.

[Retrospective study of Crohn disease at a hospital in Andalucía (1978-1988)]. / Estudio retrospectivo de la enfermedad de Crohn en un hospital de Andalucía (1978-1988).

We reviewed 46 cases of Crohn's disease diagnosed during the period between 1978-1988, with the intention to analyse the age, sex, presentation, evolution, complications and diagnosis. The majority of patients were women, with a mean age of 39. In the last years we have seen an increment in our number of cases. The mean time to diagnosis was about 3.5 years. The main symptoms were abdominal pain, diarrhoea and loss of weight. The complications was of 40% in colonic disease and 75% when the affection was in ileum and colon. During the evolution 4 patients died, 2 of them from their Crohn's disease. One patient had a colonic carcinoma. In 15% of the cases there was a previous appendectomy. The most frequent radiological findings were in the small intestine: lack of haustration and cobblestone appearance. In the colon: lack of haustration and ulceration. The most frequent endoscopical findings were ulcers and a cobblestone appearance.

[Primary pulmonary hypertension associated with portal hypertension in a cirrhotic female patient]. / Hipertensión pulmonar primaria asociada a hipertensión portal en paciente cirrótica.

We present the case of a 28-year-old woman with hepatic cirrhosis, portal hypertension and hypersplenism associated with primary oligosymptomatic pulmonary hypertension, who had a survival somewhat longer than usual (10 years since she was diagnosed as pulmonary hypertension). The patient died in hepatic coma after upper gastrointestinal bleeding. The association between portal and pulmonary hypertension is rare, its true prevalence not being known and its pathogenesis being unclear. We remark the diagnostic tools and therapeutic possibilities.