Adenoma paratiroideo ectópico resecado mediante videomediastinoscopia. A propósito de un caso / Parathyroid ectopic adenoma resected through videomediastinoscopy. A case report

Presentamos a una mujer de 44 años, con cólicos renoureterales de repetición. Durante su estudio, se detectan niveles de hormona paratiroidea (PTH) y calcio elevados, y litiasis renal, siendo el principal diagnóstico hiperparatiroidismo primario. La gammagrafía con Tecnecio Sestamibi (99m Tc MIBI) sugiere la existencia de glándula paratiroides patológica en el mediastino. En la tomografía computarizada (TC) se objetiva un nódulo compatible con adenoma paratiroideo. Se procedió a su resección mediante videomediastinoscopia. Las glándulas paratiroideas ectópicas se atribuyen a la migración anormal durante la embriógenesis; ocurren en un 15-20% de pacientes con hiperparatiroidismo. El hiperparatiroidismo debido a la actividad de estas glándulas ectópicas es infrecuente (entre el 1-8% de pacientes sometidos a cirugía de glándulas paratiroides). Su resección está indicada si existe hiperfunción glandular o complicaciones por hipercalcemia. Dada la escasa incidencia de esta patología, consideramos de interés su divulgación en la literatura médica

We present a 44-year-old woman with no history of interest, who presented recurrent renourelate colic. Elevated parathyroid hormone (PTH) and calcium levels were detected, as well as renal lithiasis. The main diagnosis was primary hyperparathyroidism. The scintigraphy with Technetium (99m Tc MIBI) Sestamibi suggested the existence of a pathological parathyroid gland in the mediastinum. A computed tomography (CT) scan revealed a nodule compatible with a parathyroid adenoma. We proceeded with its resection by videomediastinoscopy. The ectopic parathyroid glands are attributed to abnormal migration during embryogenesis; they occur in 15-20% of patients with hyperparathyroidism. Hyperparathyroidism caused by ectopic glands is infrequent (between 1-8% of patients undergoing surgery for parathyroid glands). Its resection is indicated if there is glandular hyperfunction or complications due to hypercalcemia. Given the low incidence of this pathology, we consider its report in the medical literature to be of interest

Eficacia y seguridad de tres esquemas para la preparación del colon para colonoscopia (polietilenglicol (PEG) 4 litros (4 L) (dosis única) vs. PEG 4 L dividido (2 L + 2 L) vs. PEG 2 L dividido de volumen bajo (1 L + 1 L): ensayo clínico controlado aleatorizado / A randomized controlled clinical trial of the efficacy and safety of colonoscopy preparation using a single four liter dose of polyethylene glycol (PEG) vs. two 2 liter doses of PEG vs. two low volume (1L + 1L) doses of PEG

Resumen Introducción: la colonoscopia es el examen estándar de oro para evaluar la mucosa del colon. De la limpieza del colon en la preparación intestinal para colonoscopia depende el hallazgo de pólipos, que pueden ser adenomatosos con potencial maligno y con la posibilidad de degenerarse en cáncer de colon. Objetivo: comparar la eficacia y la seguridad de tres tipos de preparaciones para la limpieza del colon: dosis única de polietilenglicol (PEG) 4 litros (4 L) y dosis divididas: PEG 4 L dividido (2 L + 2 L) y PEG 2 L dividido (1 L + 1 L) de volumen bajo. Métodos: en pacientes con una colonoscopia electiva de una clínica universitaria, se realizó un ensayo clínico controlado aleatorizado y ciego (para el médico que evaluó la limpieza del colon). Se asignaron 74 pacientes para cada grupo. El parámetro principal de eficacia fue la preparación integral de calidad adecuada medida con la escala de Boston, y los parámetros secundarios fueron el porcentaje de eventos adversos, la tolerabilidad y la tasa de detección de pólipos. Resultados: la preparación completa de todo el colon fue significativamente de mayor la calidad en la alternativa de 4 L divididos (2 L + 2 L), seguida de la otra alternativa dividida (1 L + 1 L) y menor en la dosis única (79,7 %, 75,7 % y 63,5 %, respectivamente, p = 0,019); también se encontraron diferencias en la detección de pólipos (13,5 %, 24,3 % y 9,5 %, p = 0,037) y sin diferencias en la presentación de al menos un evento adverso (p = 0,254) ni en la tolerabilidad (p = 0,640). Conclusiones: las dos preparaciones de dosis dividida tienen una mayor eficacia en la limpieza del colon en comparación con la dosis única de 4 L y en la detección de pólipos, mientras que no se evidencian diferencias en las preparaciones para la ocurrencia de eventos adversos y la tolerabilidad. La dosis de PEG 2 L dividido puede ser una muy buena opción para las preparaciones de colonoscopia electiva.

Abstract Introduction: Colonoscopy is the gold standard for evaluation of the colonic mucosa. Colon cleansing in preparation for colonoscopy depends on finding of polyps which can be adenomatous with malignant potential and the possibility of degenerating into colon cancer. Objective: This study's objective was to compare the efficacy and safety of three types of preparations for colon cleansing: a single four liter dose of polyethylene glycol (PEG) vs. two 2 liter doses of PEG vs. two low volume (1L + 1L) doses of PEG. Methods: This is a randomized controlled clinical trial of patients who underwent elective colonoscopy at a University clinic. It was blinded for the doctor who evaluated colon cleansing. Seventy four patients 74 patients were randomized into each group. The main parameter of effectiveness was integral preparation of adequate quality measured on the Boston scale. Secondary parameters were the percentage of adverse events, tolerability and detection rate of polyps. Results: Complete preparation of the entire colon was achieved significantly more often with 4 liters divided into two 2 liter doses followed by the other divided alternative (1 L + 1 L). It was achieved least frequently with in the single dose: 79.7%, 75.7% and 63.5%, respectively, p = 0.019. Differences were also found in the detection of polyps (13.5%, 24.3% and 9.5%, respectively, p = 0.037). ) There were no differences in presentation of at least one adverse event (p = 0.254) or in tolerability (p = 0.640). Conclusions: The two divided dose preparations had higher colon cleansing and polyp detection efficacies than did the single 4L dose while there were no differences in occurrence of adverse events and tolerability. The divided PEG 2L dose could be a very good option for elective colonoscopy preparation.

Características endoscópicas e histopatológicas de los pólipos colorrectales resecados endoscópicamente en una institución universitaria de Bogotá D. C / Endoscopic and Histopathological Characteristics of Colorectal Polyps Resected Endoscopically at a University Institution in Bogotá D. C

Resumen El cáncer colorrectal es una de las causas de mortalidad más importantes en los países occidentales. Desde cuando se estableció la progresión de adenoma a carcinoma, se ha considerado que los pólipos del colon son un factor de riesgo importante para desarrollar el cáncer colorrectal, por esta razón es importante el conocimiento, detección y resección, e investigación del tema. En Colombia no se han realizado estudios prospectivos que evalúen las características de los pólipos colorrectales, razón por la cual se considera de gran importancia la realización de este estudio con el objetivo de determinar las características endoscópicas e histopatológicas de los pólipos colónicos encontrados y resecados mediante colonoscopia. Se realizó un estudio observacional descriptivo, mediante el análisis de los pólipos resecados en pacientes del servicio de gastroenterología y endoscopia digestiva de la Clínica Universitaria Colombia. Se calculó un tamaño de muestra de forma probabilística (n = 306 pólipos resecados). En cuanto a la histología, y contrario a lo informado en la literatura, la mayoría de los pólipos detectados en nuestro estudio (170) fue de tipo adenomatoso (55,6 %). El mayor porcentaje de ellos (86 %) correspondió al tipo tubular, hallazgo acorde con lo mencionado en la literatura, la mayoría de ellos con displasia de bajo grado. Solo en 2 de nuestros pacientes se realizó el hallazgo de pólipos cuya histología diagnosticó la presencia de adenocarcinoma.

Abstract Colorectal cancer is one of the most important causes of death in Western countries. Since the progression from adenoma to carcinoma was established, it has been considered that colon polyps are an important risk factor for development of colorectal cancer, hence the importance of knowledge and research about them as well as their detection and resection. In our country there had been no prospective evaluations of the characteristics of colorectal polyps, so we considered this study to determine the endoscopic and histopathological characteristics of colonic polyps found and resected through colonoscopy to be of great importance. This descriptive and observational study includes analysis of polyps resected from patients inthe Gastroenterology and Digestive Endoscopy service of the Clínica Universitaria Colombia. Sample size was calculated probabilistically (n = 306 resected polyps). Contrary to reports in the literature, most of the polyps detected in our study (170) were adenomatous (55.6%). The highest percentage (86%) were tubular which is consistent with the literature. Most of them had low grade dysplasia. Only two of our patients had polyps found whose histology indicated adenocarcinoma.

Enfermedad inflamatoria intestinal: características de fenotipo y tratamiento en un hospital universitario de Bogotá, Colombia / Phenotypic characteristics and treatment of inflammatory bowel disease at a university hospital in Bogotá, Colombia

Resumen Introducción: la enfermedad inflamatoria intestinal (EII) (colitis ulcerativa [CU], enfermedad de Crohn [EC]) es una patología inflamatoria crónica y recurrente del tracto digestivo, de causa aún incierta. La incidencia y prevalencia de esta enfermedad están en aumento a nivel mundial, especialmente en los países en vías de desarrollo. Objetivo: describir las características del fenotipo y el tipo de tratamiento administrado a 165 pacientes con diagnóstico de EII que consultaron durante el período comprendido entre el 5 de julio del 2013 y el 31 de diciembre del 2016 en un hospital universitario de la ciudad de Bogotá, Colombia. Materiales y métodos: se realizó un estudio descriptivo basado en frecuencias y proporciones de los pacientes con diagnóstico de EII atendidos en la Clínica Universitaria Colombia (Bogotá) entre el 5 de julio del 2013 y el 31 de diciembre del 2016. Resultados: el 75,8% de los casos correspondió a CU y el 24,2% a EC, con un leve predominio del sexo femenino en ambas (56% y 55%, respectivamente); la forma de presentación más frecuente de la CU fue la pancolitis en el 46,4%. Los pacientes con EC tuvieron un compromiso más frecuentemente ileocolónico (52,5%) e inflamatorio no estenosante ni fistulizante (60%), un mayor porcentaje de manifestaciones extraintestinales (35%), de uso de medicamentos biológicos (35%) y requirieron un mayor número de cirugías (27,5%) en comparación con los pacientes con CU.

Abstract Inflammatory bowel disease (IBD) includes ulcerative colitis and Crohn's disease which are chronic and recurrent inflammatory pathologies of the digestive tract whose causes are still uncertain. IBD's incidence and prevalence are increasing worldwide, especially in developing countries. Objectives: The objective of this study was to describe phenotypic characteristics and types of treatment of 165 patients diagnosed with IBD treated between July 5, 2013 and December 31, 2016 at a university hospital in Bogotá, Colombia. Methods: This is a descriptive study based on frequencies and proportions of patients diagnosed with IBD at the University Clinic Colombia in Bogotá between July 5, 2013 and December 31, 2016. Results: UC accounted for 75.8% of the cases while CD accounted for 24.2% of these cases. Women accounted for a slightly larger proportion of patients than did men: 56% of UC cases and 55% of CD cases. UC's most frequent form of presentation was pancolitis which was found 46.4% of the patients. Frequent forms of CD presentation were ileocolonic (52.5%) and inflammatory non-stenosing or fistulizing (60%). CD patients had a greater percentage of extraintestinal manifestations (35%), greater use of biological medications (35%) and required a greater number of surgeries (27.5%) than did UC patients.

Th1/Th17/Th22 immune response and their association with joint pain, imagenological bone loss, RANKL expression and osteoclast activity in temporomandibular joint osteoarthritis: A preliminary report.

It is well accepted that the presence of cytokines belonging to the Th1/Th17/Th22 axis of immuno-inflammatory response in the joint environment, such as IL-1ß, IL-17 and IL-22, respectively, are associated with pathogenesis of several synovial joint degenerative disorders. During temporomandibular joint osteoarthritis (TMJ-OA), IL-1ß and IL-17 have been implicated in the inflammation and resorption of sub-chondral bone; however, the role of Th22 response in the TMJ-OA pathophysiology has not been established. This study aimed to compare the expression of Th1/Th17/Th22-type cytokines, chemokines and chemokine receptors in synovial fluid samples obtained from TMJ-OA or disk displacement with reduction (DDWR) patients. In addition, it aimed to associate these levels with joint pain, imagenological signs of bone degeneration, RANKL production, osteoclastogenesis and osteoclast-induced bone resorption. Higher levels of IL-1ß, IL-17 and IL-22 were expressed in TMJ-OA compared with DDWR subjects, and these increased levels significantly correlated with RANKL expression, joint pain and articular bone degeneration. Higher levels of CCR5, CCR6 and CCR7, as well as their respective ligands CCL5 and CCL20, responsible for recruitment of IL-1ß, IL-17 and IL-22-producing cells, were over-expressed in TMJ-OA compared with DDWR subjects. Osteoclastogenesis and osteoclast-induced bone resorption were significantly greater in presence of synovial fluid from TMJ-OA compared with DDWR subjects. These data demonstrate that cytokines, CCLs and CCRs associated with the Th1/Th17/Th22 axis of immuno-inflammatory response are involved in TMJ-OA pathogenesis. These findings suggest that IL-22 is involved in the RANKL expression in TMJ-OA, which in turn induces differentiation of osteoclasts and subsequent resorption of sub-chondral bone.

Sospecha de sinusitis, alteraciones en el electrocardiograma y nódulos pulmonares en paciente joven y asiático / No disponible

Presentamos el caso de un varón de 38 años, de origen asiático, sin antecedentes de interés, que acude a Urgencias por fiebre de origen desconocido de dos meses de evolución, asociada en los últimos días a cefalea frontal y mucosidad verdosa (compatible con sinusitis), sin mejoría con tratamiento antibiótico. En el electrocardiograma presentó alteraciones. En la tomografía computarizada (TC) se objetivaron múltiples opacidades nodulares bilaterales de predominio en lóbulos superiores y masa interauricular de aspecto infiltrativo. Se realizó una biopsia pulmonar por videotoracoscopia, siendo el diagnóstico histopatológico definitivo de linfoma no Hodgkin de células T/NK extraganglionar. Este tipo de tumores representa el 1% de todos los linfomas no Hodgkin, con mayor prevalencia en Asia y América del Sur, y sólo el 20% de los casos afecta a localizaciones extranasales. Dada la escasa incidencia de estos pacientes, consideramos de interés que sean reportados estos casos en la literatura médica (AU)

We report the case of a 38-years-old Asian man, with no history of interest, who comes to the Emergency Department for a fever of unknown origin of two months of evolution, associated in the last days with headache and greenish mucus (compatible with sinusitis), without improvement with antibiotic treatment. The electrocardiogram shows alterations. In CT, multiple bilateral nodular opacities of predominance in upper lobes and infiltrative aspect interatrial mass were observed. A pulmonary biopsy was performed by videothoracoscopy, being the definitive histopathological diagnosis non-Hodgkin’s lymphoma of extraganglion T/NK cells. This type of tumors represents 1% of all non-Hodgkin’s lymphomas, with a higher prevalence in Asia and South America, and only 20% of the cases affect extranodal sites. Given the low incidence of these patients, reports of the cases reported these cases in the medical literature (AU)

Systematic review of the literature on reproducibility of the interpretation of renal biopsy in lupus nephritis.

Objective Before using a test, it should be determined whether the results are reliable. The reliability of the interpretation of renal biopsy in patients with lupus nephritis has not been clearly elucidated. Our objective was to estimate inter and intra-observer reliability of the histological classification, as well as activity and chronicity indices in renal biopsy of patients with lupus nephritis. Methods We conducted a systematic search of the literature, which included articles in any language, using PubMed, Embase, Cochrane and Lilacs databases. Search terms included were: reproducibility, reliability, agreement, systemic lupus erythematosus and lupus nephritis. Comparative studies with any design were included, regardless of the year or the language of publication. Two investigators, independently, screened the literature published in accordance with pre-established inclusion and exclusion criteria. Results We found 13 relevant studies. Inter-observer reproducibility of most measurements was moderate or low, despite the fact that, in most cases, the readings were made by expert nephropathologists. There was great diversity among designs, participants, including samples and outcomes evaluated in different studies. Although there are too many reports on the clinical use, studies evaluating the reliability of classifications on renal biopsy in lupus nephritis are rare. The quality of the methodological design and reporting was fair. Conclusion The interpretation of renal biopsy in lupus nephritis is poorly reproducible, causing serious doubts about its validity and its clinical application. As it can lead to serious diagnosis, treatment and prognosis errors, it is necessary to intensify research in this field.

Increased levels of the T-helper 22-associated cytokine (interleukin-22) and transcription factor (aryl hydrocarbon receptor) in patients with periodontitis are associated with osteoclast resorptive activity and severity of the disease.

BACKGROUND AND OBJECTIVE: Two new T-helper (Th) phenotypes have been recently described and named Th9 and Th22 lymphocytes; however, their role in the pathogenesis of periodontitis remains unclear. This study was aimed to assess whether Th9 and Th22 lymphocytes, through interleukin (IL)-9 and IL-22 production, respectively, are associated with the severity of periodontitis and bone resorption. MATERIAL AND METHODS: Gingival crevicular fluid samples and biopsies were obtained from patients with moderate-to-advanced chronic periodontitis and gingivitis, and healthy controls. The levels for the Th9 and Th22-associated cytokines and master-switch transcription factors Spi-B and aryl hydrocarbon receptor (AhR) were quantified by enzyme-linked immunosorbent assay, real-time reverse-transcription quantitative polymerase chain reaction and flow cytometry. In addition, the osteoclast activity in response to tissue homogenates from periodontitis and healthy samples was analyzed quantifying the number of TRAP-positive cells and areas of bone resorption pits produced, in the presence or absence of recombinant human IL-22 and anti-IL-22 neutralization antibody. RESULTS: Higher levels of IL-22 and AhR were detected in patients with periodontitis compared with gingivitis and healthy individuals. In addition, higher levels of IL-9 and Spi-B were detected in gingivitis patients compared with periodontitis and healthy individuals. In patients with periodontitis, a significant positive correlation was detected between secreted levels of IL-22 and clinical attachment level of the sampled periodontal pockets. When osteoclasts were exposed to tissue homogenates obtained from patients with periodontitis, higher levels of resorptive activity were observed as compared with the same cells exposed to tissue homogenates obtained from healthy individuals, and this increment was dependent on the presence and neutralization of IL-22. CONCLUSION: Increased levels of IL-22 produced by Th22 lymphocytes are associated with the pathogenesis of periodontitis, in particular, with osteoclast resorptive activity and severity of disease.

Removal of sulfur-containing organic molecules adsorbed on inorganic supports by Rhodococcus Rhodochrous spp.

OBJECTIVE: To remove dibenzothiophene (DBT) and 4,6-dimethyl-dibenzothiophene (4,6-DMDBT) adsorbed on alumina, silica and sepiolite through biodesulfurization (BDS) using Rhodococcus Rhodochrous spp., that selectively reduce sulfur molecules without generating of gaseous pollutants. RESULTS: The adsorption of DBT and 4,6-DMDBT was affected by the properties of the supports, including particle size and the presence of surface acidic groups. The highest adsorption of both sulfur-containing organic molecules used particle sizes of 0.43-0.063 mm. The highest percentage removal was with sepiolite (80 % for DBT and 56 % for 4,6-DMDBT) and silica (71 % for DBT and 37 % for 4,6-DMDBT). This is attributed to the close interaction between these supports and the bacteria. CONCLUSIONS: Biodesulfurization is effective for removing the sulfur-containing organic molecules adsorbed on inorganic materials and avoids the generation of gaseous pollutants.

Perforación duodenal post-CPRE de manejo no quirúrgico: reporte de un caso / A Case Report of Non-Surgical Duodenal Perforation Following ERCP

Resumen La perforación duodenal posterior a la colangiopancreatografía retrógrada endoscópica (CPRE) es una complicación infrecuente que sucede en un 0,1%-0,6% de los casos. El manejo (quirúrgico o no quirúrgico) depende de varios factores. Presentamos el caso de una mujer que sufrió una perforación duodenal post-CPRE manejada conservadoramente con un stent biliar metálico autoexpandible (SMAE) totalmente recubierto y antibióticos, quien no requirió manejo quirúrgico.

Abstract Post-ERCP duodenal perforations occur in only 0.1 to 0.6% of ERCP cases. Whether these occurrences are managed with or without surgery depends on several factors. We report the case of a woman who had a post-ERCP duodenal perforation that was conservatively managed with a fully covered self-expanding metal stent (FCSEMS) and antibiotics who did not require surgical management.

Divertículo gástrico: hallazgo inusual en la endoscopia digestiva alta / Gastric diverticulum: an unusual finding in upper gastrointestinal endoscopy

Diverticula may occur throughout the gastrointestinal tract, gastric localization is the most infrequent and these can be: false diverticula, which are less common and typically located in the antrum; and true diverticula, which are more frequent and are located in the posterior wall of the gastric fundus. This is a very rare condition and its prevalence in radiographic studies can be of 0.04 percent, in endoscopy, of 0.01 percent to 0.11 percent, and of 0.1 percent to 2.6 percent in autopsy series. Diagnosis is typically in the fifth and sixth decades. Normally this is an incidental finding in asymptomatic patients, by means of an upper gastrointestinal endoscopy, upper digestive tract ultrasound or computed tomography. Due to low incidence, there is no consensus regarding treatment, however the general practice is that only those patients with symptomatic diverticula must receive medical treatment; and those with diverticula > 4 cm must undergo surgery, due to the risk of inflammation, bleeding, perforation, or malignant transformation, caused by food retention and subsequent release of gastric juices within the mucosal sac. We present the case of two asymptomatic patients who were diagnosed incidentally.

Los divertículos pueden ocurrir a lo largo de todo el tracto gastrointestinal, la localización gástrica es la menos frecuente, pueden ser falsos, que son menos frecuentes y se localizan en el antro gástrico, y verdaderos que son los más frecuentes y se localizan en la pared posterior del fondo gástrico. Se trata de una condición muy rara y su prevalencia en estudios radiográficos puede ser del 0,04 por ciento, en endoscopias del 0,01 por ciento al 0,11 por ciento, y con una prevalencia en series de autopsias del 0,1 al 2,6 por ciento. El diagnóstico se realiza más frecuentemente en la quinta década de la vida. Generalmente, es un hallazgo casual en pacientes asintomáticos, y se realiza mediante endoscopia de vías digestivas altas, radiografía de vías digestivas altas o tomografía computarizada. Debido a la baja incidencia, no existe consenso en cuanto al tratamiento, pero el concepto general es que solo deben ser tratados medicamente los pacientes con divertículos sintomáticos, o mediante cirugía, aquellos con diámetro mayor a 4 cm, dado el riesgo de inflamación, sangrado, perforación, o transformación maligna, debido a la retención de los alimentos con la subsiguiente liberación y retención de los jugos gástricos dentro del saco diverticular. Presentamos el caso de dos pacientes asintomáticos, en quienes se realizó el diagnóstico de forma fortuita.

Hepatotoxicidad por isoniazida en un paciente con enfermedad de Crohn: Reporte de caso y revisión de la literatura / Hepatotoxicity due to Isoniazide in a Patient with Crohn’s Disease: Case Report and Literature Review

La isoniazida se utiliza para el tratamiento o profilaxis de la tuberculosis; sin embargo, su uso puede asociarse con reacciones hepáticas adversas. La hepatitis clínicamente manifiesta sucede en 0,5%-1% de los pacientes que reciben isoniazida como monoterapia. En este artículo se describe el caso de un paciente con enfermedad de Crohn que cursó con hepatotoxicidad grave por isoniazida, y se hace una revisión de la literatura al respecto

Isoniazid is used for treatment or prophylaxis of tuberculosis but may be associated with adverse hepatic reactions. Clinically manifest hepatitis occurs in 0.5%-1% of patients who receive isoniazid as monotherapy. This article describes the case of a patient with Crohn’s disease who experienced severe hepatotoxicity due to isoniazid. It also reviews the literature.

Tratamiento de las várices gástricas con cianoacrilato, experiencia institucional / Institutional Experience with Cyanoacrylate Treatment of Gastric Varices

La principal causa de hemorragia de vías digestivas altas es la enfermedad ulcerosa del estómago y/o duodeno (Enfermedad ulceropéptica). Cada vez y con mayor frecuencia se presentan pacientes con sangrado originado en várices gástricas, quizás debido al número creciente de pacientes que las presentan como una secuela de la hipertensión portal causada a su vez por problemas hepáticos, especialmente por la cirrosis. Las opciones actuales de tratamiento de las várices gástricas incluyen desde métodos preventivos o profilácticos, hasta los propiamente terapéuticos mediante el uso de medicamentos (vasopresina, somatostatina y sus análogos), las derivaciones portosistémicas transyugulares (TIPS, por sus siglas en inglés) los métodos endoscópicos y la cirugía. Los métodos endoscópicos incluyen el uso de bandas y de inyección de sustancias esclerosantes, o de sustancias obturativas como el N-Butyl-2-cianoacrilato (Histoacryl®). Desde hace poco tiempo, y basados en la literatura cada vez con mejores niveles de evidencia y grados de recomendación, hemos empezado a usar el cianoacrilato en la Clínica Universitaria Colombia. Presentamos nuestra casuística y realizamos una revisión del tema

The main causes of upper digestive tract bleeding are ulcers in the stomach and/or duodenum (peptic ulcer disease). With increasing frequency, patients are being seen who have bleeding gastric varices. This may be due to the increasing number of patients who have portal hypertension caused in turn by liver problems, especially cirrhosis. Current options for treatment of gastric varices range include preventive and prophylactic methods. These include therapy using drugs including vasopressin, somatostatin and their analogs, transjugular intrahepatic portosystemic shunts (TIPS) endoscopic methods and surgery. Endoscopic methods include the use of bands and injection sclerotherapy and sealants such as N-Butyl-2-cyanoacrylate (Histoacryl ®). Recently, on the basis of literature with increasingly higher levels of evidence and recommendations, we have started using cyanoacrylate at the Clínica Universitaria Colombia. We present our cases and we review the issue.

Lesión de Dieulafoy de duodeno: hallazgo inusual / An Unusual Finding of a Dieulafoy’s Lesion in the Duodenum

La lesión de Dieulafoy es una causa poco frecuente de sangrado gastrointestinal alto, pero es una de las causas más frecuentes relacionadas con sangrado oculto y recurrente. La ubicación extragástrica de la lesión de Dieulafoy es rara. Por su localización la lesión de Dieulafoy duodenal es de difícil diagnóstico y manejo. La terapia endoscópica, combinada con inyección de adrenalina más terapia mecánica, reduce el riesgo de resangrado. En este artículo se presenta el caso de un paciente tratado en la Clínica Universitaria Colombia, así como la revisión del tema

Dieulafoy’s lesions do not usually cause upper gastrointestinal bleeding, but they are one of the most common causes of hidden and recurrent bleeding. An extra-gastric Dieulafoy lesion is rare, and, because of their location, Dieulafoy’s lesions in the duodenum are difficult to diagnosis and treat. Endoscopic injection therapy combined with adrenaline injections and mechanical therapy reduce the risk of rebleeding. This article describes the case of a patient treated at the Clínica Universitaria Colombia and reviews the topic of Dieulafoy’s lesions

Serotype b of Aggregatibacter actinomycetemcomitans increases osteoclast and memory T-lymphocyte activation.

During periodontitis, alveolar bone resorption is associated with activation of T helper type 17 (Th17) lymphocytes and receptor activator of nuclear factor-κB ligand (RANKL) -induced osteoclasts. We previously reported that serotype b of Aggregatibacter actinomycetemcomitans has a higher capacity to trigger Th17-type differentiation and function in activated T lymphocytes and its lipopolysaccharide is a more potent immunogen compared with the other serotypes. This study aimed to investigate whether serotype b of A. actinomycetemcomitans induces higher Th17-associated RANKL production, RANKL-induced osteoclast activation, and antigen-specific memory T lymphocyte proliferation. On naive CD4(+) T lymphocytes stimulated with autologous dendritic cells primed with different A. actinomycetemcomitans serotypes, RANKL production, T-bet, GATA-3, RORC2 and Foxp3 expression, RORC2/RANKL intracellular double-expression, TRAP(+) osteoclast activation, and bone resorption were quantified. The frequency of proliferating memory T lymphocytes in response to A. actinomycetemcomitans serotypes was determined in periodontitis and healthy subjects. Naive CD4(+) T lymphocytes stimulated by serotype b-primed dendritic cells elicited higher levels of RANKL, RORC2, TRAP(+) osteoclasts, and bone resorption than the same cells stimulated with the other serotypes. RANKL positively correlated and co-expressed with RORC2. Memory T lymphocytes responding to serotype b were more frequently detected in periodontitis patients than healthy subjects. These results indicate that serotype b of A. actinomycetemcomitans is associated with higher production of RANKL and these increased levels are associated with Th17 lymphocyte induction, osteoclast activation, and bone resorption.

Hyoid and laryngeal excursion kinematics - magnitude, duration and velocity - changes following successful exercise-based dysphagia rehabilitation: MDTP.

Variability in magnitude of deglutitional hyolaryngeal excursion in patients with dysphagia suggests that it does not adequately represent the kinematics of swallowing difficulties or recovery following rehabilitation. On the other hand, reduced hyolaryngeal excursion velocity has been reported in patients with dysphagia. While increased movement velocity often accompanies clinical and functional recovery in many diseases, velocity changes in swallowing-related movement following dysphagia therapy have not been well studied. This study evaluated changes in hyoid and laryngeal excursion (magnitude, duration and velocity) before and following successful dysphagia therapy to provide a more comprehensive representation of improvement to swallowing kinematics in patients who have experienced successful rehabilitation. A secondary analysis of case series data was completed. Eight patients with severe, chronic dysphagia completed a standard course of an exercise-based dysphagia treatment programme (McNeill dysphagia therapy program, MDTP). Pre- and post-treatment, kinematic aspects of swallowing were evaluated for thin liquid, thick liquid and pudding swallows. Maximum hyoid and laryngeal excursion magnitude and excursion duration were measured. Excursion velocities were calculated from excursion magnitude and duration measures. Successful treatment for dysphagia facilitated increased hyolaryngeal excursion magnitude, duration and velocity. These changes were most prominent for the hyoid and most often observed with thin liquids. By examining hyoid and laryngeal excursion velocity in patients who have experienced successful dysphagia rehabilitation, this study demonstrated the value of evaluating spatial and temporal aspects of swallowing kinematics in a single measure for a more comprehensive representation of positive changes underlying functional recovery.

Dental caries prevalence and tooth loss in chilean adult population: first national dental examination survey.

The purpose of this study was to assess the prevalence of dental caries, tooth loss, and risk factors among adult population of Chile. Furthermore, age, gender, and behavioural specific differences in caries prevalence and tooth loss were examined. A national stratified multistage probabilistic sample design in two-age cohorts was applied to the Chilean population. A sample of 1553 adults, comprising 1088 individuals aged 35-44 and 465 senior individuals aged 65-74, were examined. The DMFT was evaluated following WHO recommendations using diagnostic criteria of caries lesions into dentin. The data were analyzed by univariate and multivariate models using logistic regression analyses. Results showed a mean DMFT of 15.06 in the 35-44-year-old group and of 21.57 in the 65-74 group. Factors related to tooth loss in the 35-44 group through univariate logistic regression were depression (OR 1.9 CI 95% 1.26-2.85), education level <12 years (OR 2.24 CI 95% 1.31-3.73), personal income (OR 1.51 CI 95% 1.04-2.19), and familiar income (OR 2.05 CI 95% 1.34-3.13), and through multivariate logistic regression in the same age group were depression (OR 1.93 CI 95% 1.24-3.0), education level <12 years (OR 1.94 CI 95% 1.2-3.14), and familiar income (OR 1.71 CI 95% 1.09-2.68). Factors related to tooth loss in the 65-74-year-old group through univariate logistic regression were education level <12 years (OR 2.54 CI 95% 1.3-4.96) and personal income (OR 1.66 CI 95% 1.05-2.63), and for multivariate logistic regression in the same age group, it was education level <12 years (OR 2.51 CI 95% 1.21-5.18). In conclusion, adult population in Chile showed a high prevalence of dental caries and tooth loss, as age, education level, personal and familiar incomes, and depression are being the main risk factors.

Agentes etiológicos de infecciones del tracto urinario y su resistencia a antibióticos en población pediátrica; Medellín, Colombia / Etiologic agents of urinary tract infections and their resistance to antibiotics in the pediatric population; Medellín, Colombia

Antecedentes: La infección urinaria es una de las causas más frecuentes de consulta en la población pediátrica. En la mayoría de los casos manejada empíricamente,siendo el Trimetoprim/sulfametoxazol el antibiótico más utilizado. El propósito de esta investigación es establecer la frecuencia de los diferentes agentes etiológicos causantes de infecciones del tracto urinario (ITU), su resistencia y sensibilidad a los antibióticos en población pediátrica. Materiales y métodos: Se realizó un análisis retrospectivo de 180 historias clínicas de niños menores de 14 años que ingresaron a una unidad de segundo nivel de atenciónen salud, del Valle de Aburrá. Resultados: Escherichia coli causó el 52.0% de las ITU, seguida del Enterococcus sp(26%). La resistencia al Trimetoprim/Sulfametoxazol fue del 80%, seguida por Ampicilina(71.4%) y Ciprofloxacina (61.5%). Los antibióticos con mejor respuesta fueron laAmikacina (94.4%) y la nitrofurantoína (93.3%). Se estableció que existe una relaciónsignificativa (p=0.003; OR= 2.53) entre urocultivo positivo para E. coli y pacientes confiebre; el 6.11% de la población presentó malformación del tracto genitourinario. Conclusiones: Escherichia coli fue el agente más frecuente en infección del tractourinario, presentando alta resistencia al Trimetoprim/Sulfametoxazol. La malformación más frecuente fue el reflujo vesicoureteral principalmente en menores de dos años; además se mostró la importancia de conocer los datos epidemiológicos locales y el comportamiento de estas bacterias, para un adecuado manejo y seguimiento de niños con infección del tracto urinario...

Human recombinant activated factor VII for upper gastrointestinal bleeding in patients with liver diseases.

BACKGROUND: Mortality from upper gastrointestinal bleeding in patients with liver disease is high. The human recombinant activated factor VII is one of the suggested treatments for upper gastrointestinal bleeding in these patients. OBJECTIVES: To assess the beneficial and harmful effects of human recombinant factor VIIa in patients with liver disease and upper gastrointestinal bleeding. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, ISI Web of Knowledge, and LILACS. The search strategies used are given in Table 01. We sought additional randomised trials from the reference lists of the trials and reviews identified through the electronic searches. SELECTION CRITERIA: All randomised clinical trials irrespective of design, publication status, and language comparing human recombinant activated factor VII versus placebo, or any other control intervention for patients with liver disease and upper gastrointestinal bleeding, irrespectively of aetiology. DATA COLLECTION AND ANALYSIS: We estimated relative risks (RR) for dichotomous outcomes and mean differences for continuous data. Since only one trial was identified, meta-analysis was not possible. MAIN RESULTS: We included one trial with 242 adult patients. In this study, human recombinant activated factor VII administration did not reduce the risk of death (mortality within five days (RR 1.75, 95% confidence interval (CI) 0.53 to 5.82), and mortality within 42 days (RR 1.45, 95% CI 0.70 to 3.00)). AUTHORS' CONCLUSIONS: We found no evidence that human recombinant activated factor VII reduces the risk of death in patients with liver disease and upper gastrointestinal bleeding. However, we made our conclusion on a single randomised clinical trial. More randomised clinical trials having low risk of bias are necessary in order to determine the role of human recombinant factor VIIa in clinical practice.

[Evolution study in children with suspected obstructive sleep apnea]. / Datos evolutivos en niños estudiados por sospecha de síndrome de apnea del sueño.

INTRODUCTION: Obstructive sleep apnea syndrome is a common disorder in childhood with an uncertain evolution. OBJECTIVES: Study of children's clinical evolution with suspected diagnosis of OSAS, which was carried out after two years of an overnight polisomnogram. PATIENTS AND METHODS: 73 children were studied. We evaluated if they had been operated and what type of surgery was performed, Brouillete Scale and subjective impressions. We have correlated: age, clinical evolution and surgery. RESULTS: Age was inversely correlated with changes in Brouillete (r=-0.39, p=0.002), standing out that children that underwent surgery were younger (4.1 vs. 7.0 years, Student t: -4.22, p=0.00009). Without the influence of age, the difference between evolution in operated and not operated ones was not significative, statistically speaking, but it was if we analysed the different types of surgery by themselves (Snedecor F: 3.9, p=0.007), tonsillectomy was the larger. CONCLUSION: The middle-term evolution in children with OSAS is good if we use the correct treatment.