[Complications in diagnostic and therapeutic endoscopic cholangiopancreatography. Prospective study]. / Complicaciones en colangiopancreatografía endoscópica diagnóstica y terapéutica. Estudio prospectivo.

BACKGROUND: Studies of ERCP-related morbidity seldom include a sufficient patient follow-up. The complication rate is variable. AIM: To characterize and to evaluate the frequency of complications in patients after Diagnostic and Therapeutic ERCP. PATIENTS AND METHODS: All patients undergoing ERCP during a 2-year period were included in this prospective study. Complications were assessed at time of ERCP and by personal or telephone contact at 1st, 7, 14 and 30-days after the procedure. RESULTS: A total of 897 ERCPs were included in the analysis, of which 93.9% were therapeutic procedures. 640 were female with age of 49.68 (+/-18.59) and 257 male with age 58.80 (+/-16.67). The 30-day complications rate was 3.19%; the procedure-related mortality rate was 0.11%. Mild hemorrhage occurred in 1.48% and moderate hemorrhage in 0.11%. Post-ERCP pancreatitis occurred in 0.79% and duodenal perforation in 0.45%. The 30-day procedure-no related mortality was 1.14%. CONCLUSION: This prospective study confirms the complications rate of ERCP including therapeutic procedures is low in our experience.

[Treatment with high doses of intravenous immunoglobulin in a case of complicated pemphigus vulgaris]. / Tratamiento con dosis altas de inmunoglobulina intravenosa en un caso de pénfigo vulgar complicado.

A case of a young woman with recalcitrant pemphigus vulgaris involving skin and mucosae, with multiple side effects due to the chronic use of corticosteroids and azathioprine related myelosuppression is presented. She received high doses of intravenous immunoglobulin for five consecutive days and showed a rapid disease control, with healing in three weeks. Remission observed in this patient supports the idea that intravenous immunoglobulin is a good alternative of treatment for patients with pemphigus vulgaris, when there is no response to it or when significant adverse effects appear as a result of its prolonged use.

Eustachian tube dysfunction in allergic rhinitis.

OBJECTIVE: To assess eustachian tube function in patients with allergic rhinitis and compare them with a control group. STUDY DESIGN AND SETTING: Tympanometry was performed in 130 patients (260 ears), divided into 2 groups: 80 cases with allergic rhinitis and 50 healthy controls. Cases underwent skin hypersensitivity tests. RESULTS: Cases, age 21.1 +/- 14.9; Controls, age 23.9 +/- 15.6. Most frequent skin hypersensitivity: Dermatophagoides pt (62%), Zea Maiz (44%), and Cockroach (37%). Tympanometry of cases showed negative values of peak tympanometric pressure in both children and adults (P < or = 0.05). Among children under 11 years of age, 15.5% tympanograms showed abnormal curves (13% C curves and 3% B curves); among the control group only normal curves were found (type A). CONCLUSION: Allergic rhinitis patients have a higher risk of eustachian tube dysfunction, particularly during childhood. Tympanometry is a noninvasive, readily available procedure that may be useful in these patients to prevent chronic middle-ear disease.

Clinical factors predicting a rapid response to short-acting beta2 agonists in mild and moderate asthma exacerbations.

BACKGROUND: The need for establishing criteria that facilitate decision-making has lead to search for factors that could predict prognosis and response to treatment for asthma exacerbations. OBJECTIVE: To assess which clinical factors are associated with a rapid response to short-acting beta2 agonists during asthma exacerbations. PATIENTS AND METHODS: Two hundred and twenty consecutive adults with mild to moderate asthma crisis were included. Their medical history and physical examinations were completed and closely monitored: heart rate, respiratory rate, SO2, and FEV-1. They were initially treated with O2 and micronebulized albuterol (2.5 mg every 20' x 4). A FEV-1 > or = 80% of predicted and an improvement at 90' were considered as good response. RESULTS: One hundred and forty-four (65.5%) patients had a good response to micronebulized albuterol, while 76 (34.5%) required steroids and hospitalization. Early relapse rate (72 hours) in this study was low (3.4%) and it was associated to other factors, such as: upper airway infection (40%) and history of oral steroids usage in the previous year (80%). The variables associated to a good response were: < 6 hours since crisis started, no hospitalization or steroid use during a crisis in the last year, initial SO2 > or = 90% and initial FEV-1 > or = 60%. CONCLUSIONS: These variables are easily measured and predict a therapeutic response in asthma patients when first seen in the emergency room.

Effect of polymeric diets in patients on continuous ambulatory peritoneal dialysis.

OBJECTIVE: To determine if a diet complemented with calcium caseinate is better than a natural high protein diet for increasing serum albumin levels in patients on continuous ambulatory peritoneal dialysis (CAPD). PATIENTS AND METHODS: A 4-month clinical trial involving 100 patients older than 18 years was performed. Patients were randomized into two groups: group A, high protein diet (1.4 g natural protein/kg target weight/day and 35 kcal/kg target weight/day); and group B, calcium caseinate (0.7 g calcium caseinate plus 0.7 g natural protein diet/kg target weight/day and 35 kcal/kg target weight/day). Serum levels of albumin, total proteins (TP), BUN, creatinine, glucose, urea, sodium, and potassium, and hematocrit, leukocytes, erythrocytes, and hemoglobin were analyzed at baseline and every 30 days. RESULTS: The final mean albumin value was, for group A, 3.04 +/- 0.39 g/dL, and for group B, 3.12 +/- 0.41 g/dL (p < 0.05); TP for group A, 6.29 +/- 0.47 g/dL, and for group B, 6.49 +/- 0.51 g/dL (p < 0.05); leukocytes for group A, 6888 +/- 1282/mm3, for group B, 7288 +/- 1878/mm3 (p = 0.05); BUN for group A, 47 +/- 11 mg/dL, for group B, 50 +/- 16 mg/dL (p = 0.05). Regression analysis showed a treatment effect in serum albumin and TP levels from the third month in both groups. In group B, a constant elevation of serum albumin of 0.19 mg/dL and TP of 0.27 mg/dL was observed in every month of treatment with calcium caseinate. In the regression analysis of group A we observed a smaller increase in serum albumin, 0.06 mg/dL, and in TP, 0.11 mg/dL, in each month of treatment with the high protein diet. Both differences are significant (p < 0.05). CONCLUSION: Calcium caseinate used in CAPD patients suffering from malnutrition increases serum albumin levels.