Tumor carcinoide gástrico solitario y anemia perniciosa: tratamiento mediante polipectomía endoscópica / No disponible

No disponible

Fallo hepático fulminante secundario a infiltración maligna hepática / Fulminant hepatic failure caused by metastatic liver disease

No disponible

Endoscopist controlled administration of propofol: an effective and safe method of sedation in endoscopic procedures.

OBJECTIVES: Propofol is a short-acting, hypnotic agent that is increasingly being used for gastrointestinal endoscopic sedation. There are concerns about the use of propofol by non anesthesiologists due to its potential for respiratory and cardiovascular depression. This report describes our experience concerning effectiveness and safety of propofol administered in endoscopic procedures by the endoscopist and the assistant nurse. METHODS: In this prospective study, a total of 102 consecutive endoscopies (60 colonoscopies and 42 upper endoscopies) performed under sedation with propofol were included. In 27 (26.47%) endoscopies propofol was administered alone and in 75 endoscopies (73.53%) it was combined with benzodiazepines and/or opioids. Seventy-six (74.51%) endoscopies were performed in patients under 65 years of age and 26 (25.49%) in patients over 65 years of age. Ninety-one (89.22%) endoscopies were performed in patients with low surgical risk (ASA I-II) and 11 (10.78%) in patients with high surgical risk. The medication was administered by the endoscopist that performed the procedure and the assistant nurse. RESULTS: The mean dose of propofol used was 72.14 mg for gastroscopies and 71.33 for colonoscopies (p = 0.92). The mean dose of propofol when infused alone was 84.81 mg whereas in combination with benzodiazepines/opioids was 66.93 mg (p = 0.06). The doses of propofol required were lower for those colonoscopies in which midazolam and/or meperidine was combined and in patients over 65 years of age (p = 0.006 y p = 0.001, respectively). Eleven (10.8%) minor complications were reported, and managed by the own endoscopist. Patients had no memories of the procedure. The tolerance rated by the endoscopist was excellent-good, fair, bad-very bad in 83, 5 and 12% of the gastroscopies and in 79, 8 and 13% of the colonoscopies respectively. Nevertheless bad tolerance did not hinder the completion of the procedure in any case. CONCLUSIONS: The administration of propofol by the endoscopist and the assistant nurse, is an effective and safe method of sedation in patients of low and high-risk as well as in elderly patients. The doses of propofol required for an adequate sedation were lower in patients over 65 years of age and for colonoscopies in which medication was combined.

Administración controlada de propofol por el endoscopista: un método efectivo y seguro de sedación en endoscopia / Endoscopist controlled administration of propofol: an effective and safe method of sedation in endoscopic procedures

Objetivos: el propofol es un agente hipnótico de acción rápidautilizado de forma cada vez más frecuente en la endoscopia digestiva.Existen controversias sobre su utilización por no anestesistas,dado su potencial efecto cardiodepresor. Este estudiodescribe nuestra experiencia en cuanto a efectividad y seguridaddel propofol, administrado por el endoscopista y su enfermera, enla endoscopia digestiva.Métodos: en este estudio prospectivo, se incluyeron un totalde 102 endoscopias (60 colonoscopias y 42 gastroscopias) realizadasbajo sedación con propofol. En 27 (26,47%) endoscopiasse empleó sólo propofol y en 75 endoscopias (73,53%) se asociómidazolam y/o meperidina. Se realizaron 76 (74,51%) endoscopiasen menores de 65 años y 26 (25,49%) en pacientes mayoresde 65 años. Fueron realizadas 91 (89,22%) endoscopias en pacientescon bajo riesgo quirúrgico (ASA I-II) y 11 (10,78%) en pacientescon alto riesgo quirúrgico. La sedación fue administradapor el endoscopista que realizaba la exploración y su enfermeraasistente.Resultados: las dosis media de propofol fue de 72,14 mgen las gastroscopias y de 71,33 en las colonoscopias (p = 0,92).La dosis media de propofol cuando no se asoció comedicaciónfue de 84,81 mg y en presencia de comedicación de 66,93 (p =0,06). Las dosis de propofol requeridas fueron significativamentemenores en las colonoscopias en las que se asoció midazolamy/o meperidina y en pacientes mayores de 65 años (p =0,006 y p = 0,001, respectivamente). Se observaron 11(10,8%) incidencias de carácter leve y resueltas por el propio endoscopista.Ningún paciente guardaba recuerdo de la exploración.La tolerancia registrada por el endoscopista fue muy buena-buena, regular y mala-muy mala en 83, 5 y 12% de lasgastroscopias y en el 79, 8 y 13% de las colonoscopias respectivamente.Sin embargo la mala tolerancia no impidió completarla endoscopia en ningún caso.Conclusiones: el empleo de propofol, administrado por elendoscopista y su enfermera, es una técnica efectiva y segurade sedación en pacientes de bajo y alto riesgo anestésico asícomo en pacientes mayores de 65 años. Las dosis de propofolprecisas para una adecuada sedación son menores en pacientesmayores de 65 años y en las colonoscopias en las que se asocia

comedicaciónObjectives: propofol is a short-acting, hypnotic agent thatis increasingly being used for gastrointestinal endoscopic sedation.There are concerns about the use of propofol by nonanesthesiologists due to its potential for respiratory and cardiovasculardepression. This report describes our experience concerningeffectiveness and safety of propofol administered in endoscopicprocedures by the endoscopist and the assistantnurse.Methods: in this prospective study, a total of 102 consecutiveendoscopies (60 colonoscopies and 42 upper endoscopies) performedunder sedation with propofol were included. In 27(26.47%) endoscopies propofol was administered alone and in 75endoscopies (73.53%) it was combined with benzodiazepinesand/or opioids. Seventy-six (74.51%) endoscopies were performedin patients under 65 years of age and 26 (25.49%) in patientsover 65 years of age. Ninety-one (89.22%) endoscopieswere performed in patients with low surgical risk (ASA I-II) and 11(10.78%) in patients with high surgical risk. The medication wasadministered by the endoscopist that performed the procedureand the assistant nurse.Results: the mean dose of propofol used was 72.14 mg forgastroscopies and 71.33 for colonoscopies (p = 0.92). The meandose of propofol when infused alone was 84.81 mg whereas incombination with benzodiazepines/opioids was 66.93 mg (p =0.06). The doses of propofol required were lower for thosecolonoscopies in which midazolam and/or meperidine was combinedand in patients over 65 years of age (p = 0.006 y p =0.001, respectively). Eleven (10.8%) minor complications werereported, and managed by the own endoscopist. Patients had nomemories of the procedure. The tolerance rated by the endoscopistwas excellent-good, fair, bad-very bad in 83, 5 and 12% ofthe gastroscopies and in 79, 8 and 13% of the colonoscopies respectively.Nevertheless bad tolerance did not hinder the completionof the procedure in any case.Conclusions: the administration of propofol by the endoscopistand the assistant nurse, is an effective and safe method ofsedation in patients of low and high-risk as well as in elderly patients.The doses of propofol required for an adequate sedationwere lower in patients over 65 years of age and for colonoscopiesin which medication was combined

Hidrotórax hepático refractario: tratamiento eficaz con octreótido / Refractory hepatic hydrothorax: successful treatment with octreotide

Describimos el caso de una paciente que presentó un hidrotórax como primera manifestación de una cirrosis hepática. Ante la ausencia de respuesta al tratamiento diurético, a la realización de una pleurodesis y a la colocación de una derivación portosistémica percutánea intrahepática, se inició tratamiento con octreótido conlo que se obtuvo la resolución del mismo. Se trata del tercer caso publicado en la literatura de hidrotórax hepático refractario con respuesta completa y mantenida al tratamiento con octreótido

We report the case of a patient that developed hepatic hydrothorax as the first complication of liver cirrhosis. Due to the lack of response to diuretics, pleurodesis and TIPS, treatment with octreotide was started with resolution of hydrothorax. To the best of our knowledge, this is the third reported case of refractory hepatic ;;hydrothorax with complete and sustained response to octreotide

Metástasis hepáticas de melanoma uveal / Liver metastases from uveal melanoma

No disponible

Refractory hepatic hydrothorax: successful treatment with octreotide.

We report the case of a patient that developed hepatic hydrothorax as the first complication of liver cirrhosis. Due to the lack of response to diuretics, pleurodesis and TIPS, treatment with octreotide was started with resolution of hydrothorax. To the best of our knowledge, this is the third reported case of refractory hepatic hydrothorax with complete and sustained response to octreotide.

Amebic liver abscess with bacterial superinfection in a patient with no epidemiologic risk factors.

The amebic liver abscess is uncommon in developed countries like Spain, but the incidence is increasing probably due to the migratory movements of the population. We report a case of an amebic abscess, initially unsuspected due to the absence of epidemiologic risk factors and the negative serology for amebiasis, in the early stages of the disease.

Safe endoscopic resection of gangliocytic paraganglioma of the major duodenal papilla.

A case of gangliocytic paraganglioma of the papilla of Vater in a 76-year-old man with a history of recurrent obstructive jaundice is presented. This is the first case of gangliocytic paraganglioma of the major papilla successfully resected by endoscopic ampullectomy.