Recambio de sonda de gastrostomía endoscópica percutánea en atención domiciliaria / Replacement of the Percutaneous Endoscopic Gastrostomy Catheter in Home Care

La sonda PEG o Gastrostomía Endoscópica Per-cutánea es utilizada para suministrar líquidos y/o medicamentos directamente en el estóma-go. Está principalmente indicada en pacientes con disfagia prolongada y función gastrointes-tinal conservada. La técnica de recambio de PEG es sencilla. Algunas de las complicaciones frecuentes derivadas del procedimiento son: Arrancamiento de la sonda, problemas con el balón y granulación e infección del estoma. El recambio puede ser realizado en el domicilio y conlleva un incremento del bienestar del pa-ciente y familiares, así como una reducción del gasto sanitario.(AU)

The PEG tube or Percutaneous Endoscopic Gastrostomy is used to deliver fluids or medi-cation directly into the stomach. It is mainly in-dicated in patients with prolonged dysphagia and preserved gastrointestinal function. PEG replacement technique is straightforward. Some common complications from the procedure are: Tube pulling, balloon problems, and stomatal granulation and infection. The replacement can be carried out at home and entails an increase in the well-being of the patient and family, as well as a reduction in healthcare costs.(AU)

Management of acquired hemophilia A: results from the Spanish registry.

The Spanish Acquired Hemophilia A (AHA) Registry is intended to update the status of AHA in Spain. One hundred and fifty-four patients were included and retrospectively followed for a median of 12 months. Patients were predominantly male (56.3%), with median age at diagnosis of 74 years. AHA was more frequently idiopathic (44.1%) and autoimmune disorder-associated (31.7%). Thirty-four percent of patients were on antithrombotic therapy at diagnosis. Hemostatic treatment was used in 70% of patients. Recombinant activated factor VII was more frequently infused (60.3% vs 20.6% activated prothrombin complex concentrate). Only 1 patient did not achieve control of hemorrhage. Complete remission (CR) was achieved by 84.2% of cases after immunosuppressive therapy. Steroids alone were less efficient than the other strategies (68.2% vs 87.2%, P = .049), whereas no differences existed among these (steroids/cyclophosphamide, 88.5%, vs steroids/calcineurin inhibitors, 81.2%, vs rituximab-based regimens, 87.5%). Female sex and high inhibitor levels influenced CR negatively. Thirty-six deaths (23.8%) were reported. Main causes of death were infection (15 patients, 9.9%) and hemorrhage (5 patients, 3.3%). All hemorrhage-related and half the infection-related deaths occurred within 2 months of diagnosis. Prior antithrombotic therapy was inversely associated with survival, irrespective of age. Median age of nonsurvivors was significantly higher (79 vs 73 years in survivors). Patients dying of infection were older than the other nonsurvivors (85 vs 78 years). In summary, fatal infection in the first months is common in our series. Antithrombotic therapy is associated with mortality. Particular care should be taken to avoid misdiagnosis.