Phenotype and natural history of elderly onset inflammatory bowel disease: a multicentre, case-control study.

BACKGROUND: Onset during old age has been reported in upto 10% of total cases of inflammatory bowel disease (IBD). AIM: To evaluate phenotypic characteristics and the use of therapeutic resources in patients with elderly onset IBD. METHODS: Case-control study including all those patients diagnosed with IBD over the age of 60 years since 2000 who were followed-up for >12 months, identified from the IBD databases. Elderly onset cases were compared with IBD patients aged 18 to 40 years at diagnosis, matched by year of diagnosis, gender and type of IBD (adult-onset). RESULTS: One thousand three hundred and seventy-four elderly onset and 1374 adult-onset cases were included (62% ulcerative colitis (UC), 38% Crohn's disease (CD)). Among UC patients, elderly onset cases had a lower proportion of extensive disease (33% vs 39%; P < 0.0001). In CD, elderly onset cases showed an increased rate of stenosing pattern (24% vs 13%; P < 0.0001) and exclusive colonic location (28% vs 16%; P < 0.0001), whereas penetrating pattern (12% vs 19%; P < 0.0001) was significantly less frequent. Regarding the use of therapeutic resources, there was a significantly lower use of corticosteroids (P < 0.0001), immunosuppressants (P < 0.0001) and anti-TNFs agents (P < 0.0001) in elderly onset cases. Regarding surgery, we found a significantly higher surgery rate among elderly onset UC cases (8.3% vs 5.1%; P < 0.009). Finally, elderly onset cases were characterised by a higher rate of hospitalisations (66% vs 49%; P < 0.0001) and neoplasms (14% vs 0.5%; P < 0.0001). CONCLUSIONS: Elderly onset IBD shows specific characteristics and they are managed differently, with a lower use of immunosuppressants and a higher rate of surgery in UC.

A retrospective study of pediatric endoscopy as performed in an adult endoscopy unit.

Gastrointestinal endoscopy is a safe, efficient technique with minimal complications, and a useful diagnostic tool for the pediatric population. Under ideal conditions endoscopies for children should be performed by experienced pediatric endoscopists. In this study we report our experience with pediatric endoscopy at the general adult endoscopy unit in our hospital. Our goal is to quantify the number of endoscopies performed in children, as well as their indications and findings, the type of sedation or anesthesia used, and the time waiting for the test to occur. Our experience demonstrates that endoscopists in a general adult gastroenterology department, working together with pediatricians, may perform a relevant number of endoscopies in children in a fast, safe, effective manner.

Estudio retrospectivo sobre la endoscopia pediátrica desarrollada en un servicio de endoscopias de adultos / A retrospective study of pediatric endoscopy as performed in an adult endoscopy unit

La endoscopia gastrointestinal es una técnica segura y eficientecon mínimas complicaciones, así como una útil herramienta diagnósticaen la población pediátrica. En condiciones ideales, las endoscopiasen niños deberían ser realizadas por endoscopistas pediátricosexperimentados. En este estudio reportamos nuestraexperiencia en la realización de endoscopias pediátricas en la Unidadde Endoscopias general de adultos de nuestro hospital.El objetivo es cuantificar la cantidad de endoscopias realizadasen niños, así como las indicaciones y hallazgos de las mismas, eltipo de sedación o anestesia empleado y el tiempo de espera parala realización de la prueba. Nuestra experiencia demuestra que losendoscopistas de un servicio de gastroenterología general de adultos,en colaboración con pediatras, pueden realizar un númeroimportante de endoscopias a niños, de forma rápida, segura y eficaz(AU)

Gastrointestinal endoscopy is a safe, efficient technique withminimal complications, and a useful diagnostic tool for the pediatricpopulation. Under ideal conditions endoscopies for childrenshould be performed by experienced pediatric endoscopists. Inthis study we report our experience with pediatric endoscopy atthe general adult endoscopy unit in our hospital. Our goal is toquantify the number of endoscopies performed in children, as wellas their indications and findings, the type of sedation or anesthesiaused, and the time waiting for the test to occur. Our experiencedemonstrates that endoscopists in a general adult gastroenterologydepartment, working together with pediatricians, mayperform a relevant number of endoscopies in children in a fast,safe, effective manner(AU)

Colitis ulcerosa, tacrolimus y curación mucosa / No disponible

No disponible

Esofagitis necrotizante aguda. Una patología poco conocida / No disponible

La esofagitis necrotizante aguda (ENA) es una rara entidadcuya etiología es desconocida, siendo el mecanismo patogénicomultifactorial, participando fundamentalmente el compromiso isquémico,la malnutrición y la obstrucción del tracto digestivo alto.Los hallazgos endoscópicos muestran una coloración negruzca dela mucosa esofágica con transición brusca a nivel de la unión esofagogástrica.El pronóstico depende de las enfermedades de base.Se revisan los casos de ENA, excluyendo los secundarios a caústicos,recogidos de forma retrospectiva durante los últimos 2 años.Se analizan los factores de riesgo, la presentación clínica, los hallazgosendoscópicos, la histología, el tratamiento y la evolución.En nuestro departamento, se han diagnosticado 7 casos de ENAen 6.003 gastroscopias realizadas en el periodo de estudio, representandoasí la ENA el 0,11% de la exploraciones

Acute esophageal necrosis is a rare disorder, and its etiology isunknown, the mechanism of damage being usually multifactorialand secondary to ischemic compromise, acute gastric outlet obstruction,and malnutrition. Endoscopic findings show circumferentialblack discoloration of the distal esophagus with proximal extensionending sharply at the gastroesophageal junction, which isthe most common presentation. Prognosis depends on comorbidillnesses. In this study we analyze all cases reported in a retrospectiveanalysis over a 2-year period to define risk factors, clinicalpresentation, endoscopic features, histological appearance, treatmentand outcome. Our department has recorded 7 cases from6,003 endoscopies performed in the last 2 years. The finding of a"black esophagus" represented 0.11% of cases

[Acute esophageal necrosis. An underdiagnosed disease]. / Esofagitis necrotizante aguda. Una patología poco conocida.

Acute esophageal necrosis is a rare disorder, and its etiology is unknown, the mechanism of damage being usually multifactorial and secondary to ischemic compromise, acute gastric outlet obstruction, and malnutrition. Endoscopic findings show circumferential black discoloration of the distal esophagus with proximal extension ending sharply at the gastroesophageal junction, which is the most common presentation. Prognosis depends on comorbid illnesses. In this study we analyze all cases reported in a retrospective analysis over a 2-year period to define risk factors, clinical presentation, endoscopic features, histological appearance, treatment and outcome. Our department has recorded 7 cases from 6,003 endoscopies performed in the last 2 years. The finding of a "black esophagus" represented 0.11% of cases.

ERCP's role in the management of acute biliary-pancreatic pathology in the laparoscopic era.

OBJECTIVES: Laparoscopic cholecystectomy (LC) combined with endoscopic retrograde cholangiopancreatography (ERCP) has been widely used in the management of the acute biliopancreatic pathology. Nevertheless, controversy remains about the appropriate timing for retrograde cholangiopancreatography. METHODS: A retrospective study was undertaken on a consecutive series of 117 patients with acute biliary-pancreatic pathology, who underwent laparoscopic cholecystectomy between April 1995 and April 1999. Criteria for preoperative endoscopic retrograde cholangiopancreatography were defined, and the patients were divided into 3 groups based on the presence or absence of a preoperative retrograde cholangiopancreatography indication: (1) ERCP+LC group: patients with retrograde cholangiopancreatography indicated and performed (n = 30); (2) LC group: patients without retrograde cholangiopancreatography criteria treated only by LC (n = 47); (3) LC-ERCP group: patients with retrograde cholangiopancreatography criteria but not performed (n = 40). RESULTS: The groups were similar in age, sex, ASA, and clinical diagnosis. No statistical differences occurred in operative times (73.8 min, 68 min, 67 min), major complications (3.3%, 4.25%, 12.5%), and mean postoperative stay (3.7 +/- 4; 4.7 +/- 2; 5.7 +/- 2). Postoperative retrograde cholangiopancreatography had to be used, respectively, in 0%, 10.6%, and 7.5%. The best predictive criteria for common bile duct pathology were choledocholithiasis on an ultrasound scan and the presence of cholangitis. The other criteria tested had a low predictive value. CONCLUSIONS: Preoperative endoscopic retrograde cholangiopancreatography followed by early laparoscopic cholecystectomy can be performed safely in acute biliary-pancreatic pathology, avoiding 2-stage treatment of these patients and minimizing hospital stay and inconvenience to the patients. Nevertheless, this therapeutic/diagnostic tool must be used selectively.

Hipertensión arterial y capacidad intelectual

Datos epidemiológicos señalan que la prevalencia de demencia en España en la población mayor de 65 años puede alcanzar la tasa del 10 por ciento. La enfermedad de Alzheimer da cuenta de un mayor número, pero no es despreciable la que se asocia a hipertensión crónica. Las alteraciones cerebrales secundarias a lesiones vasculares generales en los hipertensos, además de condicionar un deterioro intelectual, suponen un hándicap para la calidad de vida de los pacientes. En los últimos años se ha progresado en el control de los pacientes hipertensos y del resto de factores de riesgo y ello ha determinado un descenso en cuanto a las complicaciones cardiovasculares. Se presta más atención a los niveles de presión arterial sistólica y se conoce mejor la fisiopatología del envejecimiento vascular, lo cual contribuye a mejorar aún más el pronóstico cerebral de los hipertensos mayores (AU)

Normal bromsulfalein excretion in familial non-hemolytic jaundice

A patient with familial non-hemolytic jaundice with normal Bromsulfalein retention test is presented. Discussion on this unusual observation is done. It is suggested that preservation of BSP excretion by the liver cells occur inspite of defective excretion of bilirubin. It is postulated that this is due to the presence of binding site for the dye and not for bilirubin on the protein molecule carrier within the liver cytoplasm. The protein is necessary for excretion of substances by the liver. (Summary)

Congenital malformations of the gallbladder and cystic duct diagnosed by laparoscopy: high surgical risk.

Congenital anomalies of the gallbladder are rare and can be accompanied by other malformations of the biliary or vascular tree. Being difficult to diagnose during routine preoperative studies, these anomalies can provide surgeons with an unusual surprise during laparoscopic surgery. The presence of any congenital anomaly or the mere suspicion of its existence demands that we exercise surgical prudence, limit the use of electrocoagulation, and ensure that no structure be divided until a clear picture of the bile ducts and blood vessels is obtained. If necessary, perform intraoperative cholangiography to further define the biliary system. However, if the case remains unclear, or if laparoscopy does not provide enough information, open surgery should be considered before undesirable complications occur.

The laparoscopic approach in the treatment of diverticular colon disease.

BACKGROUND AND OBJECTIVES: The experience with treatment of diverticular colon disease (DCD) by the laparoscopic method is analyzed. METHODS: Between January 1994 and July 1997, a group of 22 patients with criteria for symptomatic diverticular disease in the descending and sigmoid colon underwent laparoscopy with average resections of 40 cm. Intra-abdominal mechanical anastomosis completed the procedure. RESULTS: The operative morbidity was 28%. Two cases, in acute diverticulitis phase, were reconverted to open surgery, and three cases presented postoperative rectorrhagia which ceased spontaneously. No long-term complications have been found. Postoperative hospitalization was 4-8 days (mean 5.5) and mean operative time was 165 minutes (range 120-240). CONCLUSIONS: Nevertheless, the learning curve precise to practice this type of surgery, the acceptable morbity-mortality rates which the laparoscopic method presents, especially with these high-risk groups of patients (age > 65, high blood pressure, etc), encouraged us to modified the criteria indicating surgery for the disease, offering first choice operative treatment with efficiency and safety. However, we feel that those patients with acute complications of diverticular colon disease must be excluded initially for laparoscopic approach.

[A study of neoadjuvant chemotherapy in the treatment of cancer of pyriform sinuses]. / Papel de la quimioterapia neoadjuvante en el tratamiento del carcinoma de seno piriforme.

We present a retrospective study of 49 cases of squamous cell carcinoma of the pyriform sinus treated with induction chemotherapy (group I) and compared with 103 cases that did not received this treatment (group II). Thirty four patients were treated with combined cis-platinum and 5-fluoracil. Local and regional control and distant metastasis were analyzed, and no differences between the two groups were found. Five-year global actuarial survival rates were 23% in group I, and 35% in group II (p = no significant). In group I, those cases that responded to chemotherapy had a better 4-year survival rate (33%) than those who did not (7%) (p < 0.1). When patients who underwent radical radiotherapy were analyzed, a better 5-year survival rate was found in group I (41%) versus group II (13%) (p < 0.05).

[Results of radiotherapy in 117 cases of carcinoma of pyriform sinuses]. / Resultados del tratamiento radioterápico en 117 casos de carcinoma de seno piriforme.

A retrospective study was made of 117 cases of squamous cell carcinoma of the pyriform sinus treated with radiation therapy (RTX). Sixty-three patients underwent radical RTX (group I) and 54 patients received combined treatment (group II). Adjuvant chemotherapy (QTX) was applied in 36 patients (27 of group I, 9 of group II). Residual disease after treatment was observed in 35% (group I) and 4% (group II) (p < 0.001). The rates of local and/or regional recurrence were 46% and 38% respectively. Distant metastases were found in 6% (group I) and 20% (group II) (p < 0.05). The 5-year actuarial survival rates were 23% (group I) and 35% (group II). The group I patients who received QTX had better survival rates (41%) than those who did not (13%) (p < 0.05). The group II survival was not improved by QTX.