Revisión sistemática de los ensayos clínicos sobre terapia antitrombótica con inhibidores del factor XI / Systematic review of clinical trials on the antithrombotic therapy with factor XI inhibitors

Antecedentes y objetivo La información proveniente de los ensayos clínicos fase 2 sugiere que los inhibidores del factor XI podrían mostrar un perfil de eficacia/seguridad más favorable que las terapias antitrombóticas actuales. El objetivo de esta revisión sistemática es analizar la evidencia disponible derivada de esos estudios. Métodos Se realizó una búsqueda bibliográfica en las bases de datos PubMed, Cochrane Library, Scopus y EMBASE, y en las plataformas de registro de ensayos clínicos Clinical Trials y Cochrane Central Register of Controlled Trials. Los resultados se publicaron según la declaración PRISMA. Resultados Se identificaron un total de 18 ensayos clínicos concluidos o en curso abordando múltiples escenarios, incluyendo fibrilación auricular, ictus, infarto de miocardio y tromboembolismo venoso. Se analizó la evidencia procedente de 8 estudios con resultados disponibles. En general, los estudios fase 2 con inhibidores del factor XI mostraron un perfil adecuado de eficacia y seguridad. El balance beneficio/riesgo fue más favorable en términos de reducción de tromboembolismo venoso en pacientes sometidos a artroplastia total de rodilla. Para esta indicación, los inhibidores del factor XI mostraron una reducción global del 50% en la tasa de complicaciones trombóticas y del 60% en la tasa de hemorragias comparado con enoxaparina. En los estudios de pacientes con fibrilación auricular, ictus e infarto de miocardio se observaron resultados más modestos. Conclusión Los inhibidores del Factor XI abren nuevas perspectivas en el tratamiento y la profilaxis antitrombótica. Los estudios fase 3 en curso permitirán definir los fármacos e indicaciones más idóneas. (AU)

Background and objective Data from phase 2 clinical trials suggest that factor XI inhibitors may exhibit a more favourable efficacy/safety profile than current antithrombotic therapies. This systematic review aims to analyze the available evidence derived from these studies. Methods A literature search in the PubMed, Cochrane Library, Scopus, EMBASE databases, and clinical trial registration platforms Clinical Trials and Cochrane Central Register of Controlled was conducted. The results were reported in accordance with the PRISMA statement. Results A total of 18 completed or ongoing clinical trials addressing multiple scenarios, including atrial fibrillation, stroke, myocardial infarction, and venous thromboembolism, were identified. Evidence from 8 studies with available results was analyzed. Overall, phase 2 studies with factor XI inhibitors demonstrated an acceptable efficacy and safety profile. The benefit-risk balance, in terms of reducing venous thromboembolism in patients undergoing total knee arthroplasty, was more favourable. For this scenario, factor XI inhibitors showed a 50% reduction in the overall rate of thrombotic complications and a 60% reduction in bleeding compared to enoxaparin. Modest results in studies involving patients with atrial fibrillation, stroke, and myocardial infarction were observed. Conclusions Factor XI inhibitors offer new prospects in antithrombotic treatment and prevention. Ongoing phase 3 studies will help define the most suitable drugs and indications. (AU)

Systematic review of clinical trials on antithrombotic therapy with factor XI inhibitors.

INTRODUCTION AND OBJECTIVE: Data from phase 2 clinical trials suggest that factor XI inhibitors may exhibit a more favorable efficacy/safety profile compared to current antithrombotic therapies. The aim of this systematic review is to analyze the available evidence derived from these studies. METHODS: A literature search in the PubMed, Cochrane Library, Scopus, EMBASE databases, and clinical trial registration platforms Clinical Trials and Cochrane Central Register of Controlled was conducted. In accordance with the PRISMA statement, results were reported. RESULTS: A total of 18 completed or ongoing clinical trials addressing multiple scenarios, including atrial fibrillation, stroke, myocardial infarction, and venous thromboembolism, were identified. Evidence from 8 studies with available results was analyzed. Phase 2 studies with factor XI inhibitors, overall, demonstrated an acceptable efficacy and safety profile. The benefit-risk balance, in terms of reducing venous thromboembolism in patients undergoing total knee arthroplasty, was more favorable. For this scenario, factor XI inhibitors showed a 50% reduction in the overall rate of thrombotic complications and a 60% reduction in the rate of bleeding compared to enoxaparin. Modest results in studies involving patients with atrial fibrillation, stroke, and myocardial infarction were observed. CONCLUSIONS: Factor XI inhibitors offer new prospects in antithrombotic treatment and prophylaxis. Ongoing phase 3 studies will help define the most suitable drugs and indications.

Three-item loneliness scale: psychometric properties and normative data of the Spanish version.

Loneliness is a common social phenomenon across countries with negative effects in health. Thus, the measurement of loneliness is of paramount importance. The Three-Item Loneliness Scale (TILS) was designed to be used in large-population surveys as a quick measure of loneliness. The aim of this study is to provide a Spanish validation of the TILS. A representative sample of the Spanish population (N = 1951) was used. We analysed the psychometric properties, factor structure, and distribution demographics characteristics of the Spanish TILS. Analyses showed differences regarding age, gender, educational level, employment status, household composition and annual gross income in line with previous literature. The confirmatory factor analysis revealed a unifactorial structure, with significant moderate correlations between the TILS and depression, anxiety, paranoia and well-being, and mild significant correlations with belongingness and mistrust. The internal consistency of the Spanish TILS was good (α = 0.82). Our study indicates that the TILS is a valid and reliable measure of loneliness in the Spanish population. Loneliness is a modern epidemic and a precursor of mental and health problems that reduced the quality of life. Therefore, it is important to have reliable measures of this phenomenon.

Introduction of Basic Dermatologic Ultrasound in Undergraduate Medical Education.

Purpose: Teaching ultrasound procedures to undergraduates has recently been proposed to improve the quality of medical education. We address the impact of applying standardized dermatologic ultrasound teaching to our undergraduates. Materials and Methods: Medical students were offered an additional theoretical and practical seminar involving hands-on ultrasound dermatologic ultrasound during their mandatory dermatology practical training. The students' theoretical knowledge and dermatologic ultrasoud skills were tested with a multiple choice questionnaire extracted from Level 1 Spanish Society of Ultrasound Dermatologic Ultrasound accreditation exam before and after the course. After the course, the students were asked to answer a course evaluation questionnaire Results: The multiple-choice question scores after the course showed statistically significant improvement (5.82 vs. 8.71%; P<0.001). The questionnaire revealed that students were satisfied with the course, felt that it increased both their dermatologic and ultrasound knowledge, and indicated that they wanted more sonographic hands-on training in both dermatologic ultrasound and other medical fields. Conclusion: Using both objective and subjective methods, we showed that the introduction of standardized ultrasound training programs in undergraduate medical education can improve both students' understanding of the technique and the quality of medical education in dermatology.

EFSUMB Statement on Medical Student Education in Ultrasound [long version].

The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends that ultrasound should be used systematically as an easy accessible and instructive educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and hands-on training should be implemented and adhere to evidence-based principles. In this paper we report EFSUMB policy statements on medical student education in ultrasound that in a short version is already published in Ultraschall in der Medizin 1.

EFSUMB statement on medical student education in ultrasound [short version].

The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends that ultrasound should be used systematically as an easy accessible and instructive educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and hands-on training should be implemented and adhere to evidence-based principles. In this paper we summarise EFSUMB policy statements on medical student education in ultrasound.

A risk score for prediction of recurrence in patients with unprovoked venous thromboembolism (DAMOVES).

BACKGROUND: In patients with unprovoked venous thromboembolism (VTE), the optimal duration of anticoagulation is anchored on estimating the risk of disease recurrence. We aimed to develop a simple risk assessment model that improves prediction of the recurrence risk. METHODS: In a prospective cohort study, 398 patients with a first unprovoked VTE were followed up for a median of 21.3months after discontinuation of anticoagulation. We excluded patients with a strong thrombophilic defect. Preselected clinical and laboratory variables were analyzed based on the independent confirmation of the impact on the recurrence risk, simplicity of assessment, and reproducibility. Multivariable Cox regression analysis was used to develop a recurrence score that was subsequently internally validated by bootstrap analysis. RESULTS: A total of 65 patients (16.3%) had recurrent VTE. In all patients, VTE recurred spontaneously. Male sex (HR=2.89 [95% CI 1.21-6.90] P=0.016), age (HR=1.0310 per additional decade [95% CI 1.01-1.07] P=0.011), obesity (HR=3.92 [95% CI 1.75-8.75] P=0.0001), varicose veins (HR=4.14 [95% CI 1.81-9.43] P=0.0001), abnormal D-dimer during anticoagulation (HR=13.66 [95% CI 4.74-39.37] P=0.0001), high factor VIII coagulant activity (HR=1.01 [95% CI 1.00-1.02] P=0.028) and heterozygous of factor V Leiden and/or Prothrombin G20210A mutation (HR=13.86 [95% CI 5.87-32.75] P=0.0001) were related to a higher recurrence risk. Using these variables, we developed a nomogram [hereafter referred to as DAMOVES score (D-dimer, Age, Mutation, Obesity, Varicose veins, Eight, Sex)] for prediction of recurrence in an individual patient. CONCLUSIONS: The DAMOVES score can be used to predict recurrence risk in patients with a first unprovoked VTE and may be useful to decide whether anticoagulant therapy should be continued indefinitely or stopped after an initial treatment period of at least 3months.

Bone mineral density and bone turnover in non-cirrhotic patients with chronic hepatitis C and sustained virological response to antiviral therapy with peginterferon-alfa and ribavirin.

UNLABELLED: Patients with chronic hepatitis C have low bone mineral density and increased bone resorption related to serum transaminase levels. Elevated serum soluble tumor necrosis factor (sTNFR-55) receptor levels may play a role in the bone mass loss in these patients. Bone mass is improved and bone turnover normalized in patients who respond to antiviral therapy with interferon and ribavirin. INTRODUCTION: Low bone mineral density (BMD) has been described in patients with chronic hepatitis C (HCV). The study objective was to evaluate the effect of antiviral therapy on BMD and bone metabolism in non-cirrhotic HCV patients with sustained virological response. METHODS: We conducted a prospective study in 36 consecutive outpatients from the general community with non-cirrhotic HCV and an early and sustained virological response to peginterferon-alfa and ribavirin therapy. Determinations of BMD (dual X-ray absorptiometry at lumbar spine and femoral neck) and biochemical measurements of bone metabolism and sTNFR-55 were made at baseline, after 24 and 48 weeks of antiviral therapy, and at 48 weeks after the end of treatment. RESULTS: Patients had a significantly reduced BMD, which significantly increased during the follow-up. Serum levels of sTNFR-55 and bone turnover markers were increased at baseline and significantly reduced at all subsequent time points. We found an inverse correlation between BMD and both serum aminotransferase levels and urine deoxypyridinoline (D-pyr) and a positive correlation between serum aminotransferases and both urine D-Pyr and serum sTNFR-55. CONCLUSIONS: Patients with chronic hepatitis C have low bone mass associated with increased bone resorption, and some relationship can be expected between serum aminotransferase levels and the degree of bone mass loss. Bone mass may be improved and bone turnover normalized in patients who respond to antiviral therapy. Elevated serum sTRFR-55 levels may play a role in the bone mass loss of these patients.

Biliary sphincterotomy dilation for the extraction of difficult common bile duct stones.

BACKGROUND AND AIM: Endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy (BS) is the usual method for extracting common bile duct stones. However, following BS and by means of extraction balloons and Dormia baskets a complete bile duct clearance cannot be achieved in all cases. We present a study on the impact that hydrostatic balloon dilation of a previous BS (BSD) may have in the extraction rate of choledocholithiasis. PATIENTS AND METHODS: A prospective study which included 91 consecutive patients diagnosed with choledocholithiasis who underwent ERCP. For stone removal, extraction balloons and Dormia baskets were used, and when necessary BSD was employed. RESULTS: Complete bile duct clearance was achieved in 86/91 (94.5%) patients. BSD was used in 30 (33%) cases. In these cases, extraction was complete in 29/30 (97%); 23 (76%) patients in the BSD group had anatomic difficulties or bleeding disorders. The most frequently used hydrostatic balloon diameter was 15 mm (60%). There were 7 (7.6%) complications: two self-limited hemorrhage episodes in the BSD group and one episode of cholangitis, one of pancreatitis, and three of bleeding in the group in which BSD was not used. CONCLUSIONS: BSD is a very valuable tool for extracting common bile duct stones. In our experience, there has been an increase in the extraction rate from 73% (Rev Esp Enferm Dig 2002; 94: 340-50) to 94.5% (p = 0.0001, OR 0.1, CI 0.05-0.45), with no increase in complications.

Biliary sphincterotomy dilation for the extraction of difficult common bile duct stones

Background and aim: endoscopic retrograde cholangiopancreatography(ERCP) with biliary sphincterotomy (BS) is the usualmethod for extracting common bile duct stones. However, followingBS and by means of extraction balloons and Dormia baskets acomplete bile duct clearance cannot be achieved in all cases. Wepresent a study on the impact that hydrostatic balloon dilation of aprevious BS (BSD) may have in the extraction rate of choledocholithiasis.Patients and methods: a prospective study which included 91consecutive patients diagnosed with choledocholithiasis who underwentERCP. For stone removal, extraction balloons and Dormia basketswere used, and when necessary BSD was employed.Results: complete bile duct clearance was achieved in 86/91(94.5%) patients. BSD was used in 30 (33%) cases. In these cases,extraction was complete in 29/30 (97%); 23 (76%) patients in theBSD group had anatomic difficulties or bleeding disorders. Themost frequently used hydrostatic balloon diameter was 15 mm(60%). There were 7 (7.6%) complications: two self-limited hemorrhageepisodes in the BSD group and one episode of cholangitis,one of pancreatitis, and three of bleeding in the group inwhich BSD was not used.Conclusions: BSD is a very valuable tool for extracting commonbile duct stones. In our experience, there has been an increasein the extraction rate from 73% (Rev Esp Enferm Dig2002; 94: 340-50) to 94.5% (p = 0.0001, OR 0.1, CI 0.05-0.45), with no increase in complications(AU)

Ketamina fue efectiva en el tratamiento del dolor en un paciente con neoplasia de pulmón pero no en el tratamiento de la disnea / No disponible

Objetivos: la disnea es uno de los síntomas prevalentes en el cáncer de pulmón avanzado y, sin duda, el de mayor impacto sobre el paciente, familia y equipo asistencial. El abordaje de la misma incluye medidas dirigidas a la enfermedad debase, medidas farmacológicas y no farmacológicas. Entre las medidas farmacológicas destacan el uso de antibióticos, broncodilatadores y corticoides, sin olvidar morfina y probablemente fentanilo. Caso clínico: la ketamina es un fármaco anestésico utilizado también como analgésico por su actividad antagonista del receptor NMDA. Dado que actúa también como relajante de la musculatura lisa del árbol bronquial, existe evidencia práctica de su utilidad en casos de asma severa y status asmáticus. Conclusión: presentamos el caso de un paciente afecto de una neoplasia de pulmón en fase terminal en el que la utilización de ketamina conjuntamente con morfina alivió el dolor pero no la disnea asociada (AU)

Objectives: dyspnea is one of the most prevalent symptoms in advanced lung cancer, and the most distressing one for patients, relatives, and healthcare staff alike. Its management includes addressing the original disease using both pharmacological and non-pharmacological approaches. Pharmacological approaches most commonly include the use of appropriate antibiotics, bronchodilatators, steroids, and opiates (morphine and fentanyl). Clinical case: we report the case of a patient diagnosed with advanced lung cancer in whom the use of morphine together with ketamine alleviated pain but not associated dyspnea. Conclusion: ketamine is an anaesthetic drug with analgesic properties due to its NMDA receptor antagonist activity. As ketamine induces a relaxing effect on smooth-muscle fibers in the lung, evidence exists regarding its utility in refractory asthma and status asthmaticus (AU)

[Palliative management of malignant gastric outlet obstruction with endoscopically inserted self-expanding metal stents].

AIM AND BACKGROUND: the insertion of self-expanding metal stents to palliate malignant gastric outlet obstruction is a minimally invasive procedure that is being increasingly used. We discuss experience with this technique in a level-II hospital in the Spanish National Health System. PATIENTS AND METHODS: a retrospective five-year study (2003-2007) was conducted in 23 patients who underwent 27 procedures aimed at resolving malignant gastric outlet obstruction (mean, 0.45 procedures per month) using endoscopically inserted noncovered stents (Wallstent and Wallflex). RESULTS: insertion was technically feasible in all 27 (100%) attempts, with satisfactory clinical results in 25 cases (92.5%). Endoscopy alone was used 10 times (37%), and both endoscopy and fluoroscopy on 17 (63%) occasions. After stent insertion, one patient was intervened for treatment, and a patient with an unsuccessful prosthesis received a palliative surgical bypass. Four stents became obstructed by tumoral ingrowth, and patency was reestablished by inserting a new stent. Obstructive jaundice caused by stents covering the papilla of Vater occurred in three cases. There were no other complications or mortality due to the procedure. Mean survival was 104 days (range 28-400, SD +/- 94). CONCLUSIONS: in our experience endoscopic insertion of self-expanding metal stents appears to be a safe and efficient palliative method for malignant gastric outlet obstruction, and can be performed successfully in a center with our characteristics.

Long-term follow-up of patients with small-bowel angiodysplasia on capsule endoscopy. Determinants of a higher clinical impact and rebleeding rate.

BACKGROUND: the clinical impact of small-bowel angiodysplasia has not been defined. We present a prospective study to determine the features of individuals with a higher risk of rebleeding or a worse clinical outcome. PATIENTS AND METHODS: thirty patients with angiodysplasia found on CE were included and followed for 12 months. Angiodysplasia were classified by their size as small ( 10 mm). We also studied angiodysplasia lesion numbers in each patient. Rebleeding was defined as a hemoglobin drop of more than 2 g/dl in the absence of melena or hematochezia in the case of occult GI bleeding, or with any or both manifestations. RESULTS: a therapeutic procedure was carried out in 13 patients (43.4%). Individuals with large angiodysplasia had higher transfusion requirements, a higher proportion of therapeutic procedure performed after CE, lower hemoglobin concentration, and a lower rebleeding rate. Patients with ten or more angiodysplasia lesions had also higher transfusion requirements and lower hemoglobin levels, but we found no differences in the number of therapeutic procedures or rebleeding rate between both groups. On follow up rebleeding was detected in 5 patients (16.7%), all of them with small angiodysplasias. Rebleeding was more frequent in patients who did not receive further interventions (23.53 vs. 7.69%; p = 0.037). CONCLUSIONS: angiodysplasia size >or= 10 mm determines a worse clinical impact and more possibilities of receiving a therapeutic procedure. Our findings support that patients with large lesions would benefit from therapeutic interventions with a reduction in rebleeding rate.

Tratamiento paliativo de la obstrucción tumoral del vaciamiento gástrico con prótesis metálicas autoexpandibles insertadas endoscópicamente / No disponible

Antecedentes y objetivo: la inserción de prótesis metálicas autoexpandiblespara paliar la obstrucción tumoral del vaciamiento gástricoes un procedimiento mínimamente invasivo, que cada vez seutiliza con más frecuencia. Presentamos la experiencia de esta técnicaen un hospital de nivel II del Sistema Nacional de Salud.Pacientes y métodos: estudio retrospectivo de un periodo decinco años (2003-2007), en los que se trató de resolver la obstruccióntumoral del vaciamiento gástrico en 27 ocasiones a 23 pacientes(media de 0,45 procedimientos por mes), mediante la inserciónendoscópica de prótesis no recubiertas (Wallstent® y Wallflex®).Resultados: la inserción fue técnicamente posible en el 100%de los 27 intentos. Se obtuvo un buen resultado clínico en 25 ocasiones(92,5%). Se utilizó sólo endoscopia 10 (37%) veces y en lasotras 17 (63%) también fluoroscopia. Tras la inserción de la prótesisse intervino a un paciente con intención curativa y a otro, enel que la prótesis no funcionó, para realizar una derivación paliativa.Cuatro prótesis se obstruyeron por crecimiento tumoral, recanalizándosemediante la inserción de nuevas prótesis. En tres ocasionesse produjo ictericia obstructiva en prótesis que cubrían lapapila de Vater. No hubo otras complicaciones. Tampoco mortalidadderivada del procedimiento. La media de supervivencia fuede 104 días (rango 28-400, DE ± 94).Conclusiones: en nuestra experiencia, la inserción endoscópicade prótesis metálicas autoexpandibles parece un método seguroy eficaz en el tratamiento paliativo de la obstrucción tumoraldel vaciamiento gástrico y puede llevarse a cabo con éxito en uncentro de nuestras características

Aim and background: the insertion of self-expanding metalstents to palliate malignant gastric outlet obstruction is a minimallyinvasive procedure that is being increasingly used. We discussexperience with this technique in a level-II hospital in the SpanishNational Health System.Patients and methods: a retrospective five-year study(2003-2007) was conducted in 23 patients who underwent 27procedures aimed at resolving malignant gastric outlet obstruction(mean, 0.45 procedures per month) using endoscopically insertednoncovered stents (Wallstent® and Wallflex®).Results: insertion was technically feasible in all 27 (100%) attempts,with satisfactory clinical results in 25 cases (92.5%). Endoscopyalone was used 10 times (37%), and both endoscopy andfluoroscopy on 17 (63%) occasions. After stent insertion, one patientwas intervened for treatment, and a patient with an unsuccessfulprosthesis received a palliative surgical bypass. Four stentsbecame obstructed by tumoral ingrowth, and patency was reestablishedby inserting a new stent. Obstructive jaundice caused bystents covering the papilla of Vater occurred in three cases. Therewere no other complications or mortality due to the procedure.Mean survival was 104 days (range 28-400, SD ± 94).Conclusions: In our experience endoscopic insertion of selfexpandingmetal stents appears to be a safe and efficient palliativemethod for malignant gastric outlet obstruction, and can be performedsuccessfully in a center with our characteristics

Long-term follow-up of patients with small bowel angiodysplasia on capsule endoscopy. Determinants of a higher clinical impact and rebleeding rate

Introducción: no se ha definido con exactitud el impacto clínicode las angiodisplasias del intestino delgado. Presentamos un estudioprospectivo para determinar las características de los individuos conmayor riesgo de recidiva hemorrágica o peor evolución clínica.Pacientes y métodos: en este estudio se incluyeron treintapacientes con angiodisplasias, halladas con la cápsula endoscópica,que fueron seguidos durante 12 meses. Las lesiones se clasificaronpor su tamaño en pequeñas (≤ 10 mm) o grandes (> 10mm). Estudiamos también el número de angiodisplasias en cadapaciente. La recidiva hemorrágica se definió como una caída enlas cifras de hemoglobina de 2 g/dl, en ausencia de melenas o hematoqueciapara la hemorragia de origen oscuro o en presenciade cualquiera de estas manifestaciones.Resultados: se realizaron procedimientos terapéuticos en 13pacientes (43,4%). Los pacientes con angiodisplasias grandes tuvieronmayores requerimientos transfusionales, un mayor númerode procedimientos diagnósticos realizados tras la cápsula endoscópica,cifras inferiores de hemoglobina y menor tasa de recidivahemorrágica. Los pacientes con diez o más angiodisplasias recibierontambién más transfusiones y presentaron cifras inferioresde hemoglobina, pero no hubo diferencias en los procedimientosterapéuticos o recidiva hemorrágica entre ambos grupos. En el seguimiento,la recidiva hemorrágica se detectó en 5 pacientes(16,7%), todos con angiodisplasias pequeñas. Esta fue más frecuenteen pacientes que no recibieron tratamiento (23,53 vs.7,69%; p = 0,037).Conclusiones: el tamaño >= 10 mm de las angiodisplasias determinaun mayor impacto clínico y más posibilidades de recibirtratamiento. Nuestros hallazgos indican que pacientes con lesionesde mayor tamaño se beneficiarían de procedimientos terapéuticoscon una reducción de la tasa de recidiva hemorrágica

Background: the clinical impact of small-bowel angiodysplasiahas not been defined. We present a prospective study to determinethe features of individuals with a higher risk of rebleeding ora worse clinical outcome.Patients and methods: thirty patients with angiodysplasiafound on CE were included and followed for 12 months. Angiodysplasiawere classified by their size as small (≤ 10 mm) orlarge (> 10 mm). We also studied angiodysplasia lesion numbersin each patient. Rebleeding was defined as a hemoglobin drop ofmore than 2 g/dl in the absence of melena or hematochezia inthe case of occult GI bleeding, or with any or both manifestations.Results: a therapeutic procedure was carried out in 13 patients(43.4%). Individuals with large angiodysplasia had highertransfusion requirements, a higher proportion of therapeutic procedureperformed after CE, lower hemoglobin concentration, anda lower rebleeding rate. Patients with ten or more angiodysplasialesions had also higher transfusion requirements and lower hemoglobinlevels, but we found no differences in the number of therapeuticprocedures or rebleeding rate between both groups. Onfollow up rebleeding was detected in 5 patients (16.7%), all ofthem with small angiodysplasias. Rebleeding was more frequent inpatients who did not receive further interventions (23.53 vs.7.69%; p = 0.037).Conclusions: angiodysplasia size >= 10 mm determines aworse clinical impact and more possibilities of receiving a therapeuticprocedure. Our findings support that patients with large lesionswould benefit from therapeutic interventions with a reductionin rebleeding rate

Outcomes of bile duct drainage by means of ERCP in geriatric patients / Resultados del drenaje de la vía biliar por CPRE en pacientes con edad geriátrica.

BACKGROUND AND OBJECTIVE: Endoscopic retrograde cholangiopancreatography (ERCP) is usually the procedure of choice for relieving bile duct obstruction. a large number of patients undergoing this intervention are geriatric population (aged 75 years of age and older). Our aim was to assess the efficacy of ERCP in this group of patients as compared to younger ones. PATIENTS AND METHODS: A retrospective study. All patients in whom a therapeutic biliary endoscopy had been performed over a four-year period of time (2002-2005) were included. RESULTS: 178 geriatric patients and 159 younger ones underwent ERCP. No differences were found in successful biliary drainage (97.7 vs. 98.7%), complication number (11.8 vs. 14.4%), or mortality rate (1.1 vs. 0.6%). On the other hand, more common bile duct stones were found in geriatric patients (57.3 vs. 39.6%, p = 0.004), and also more self-expanding metal stents were employed to drain malignant obstructive jaundice (47 vs. 8%, p = 0.0035). In the youngest group, more ERCPs were repeated in the same patients (4 vs. 10%, p = 0.001). CONCLUSIONS: The geriatric population showed similar success and morbidity and mortality rates when compared to younger patients in draining their bile duct by means of ERCP. Common bile duct stones were more frequently found in geriatric patients. No patients needing an ERCP should be excluded only because of their age.

Resultados del drenaje de la vía biliar por CPRE en pacientes con edad geriátrica / Outcomes of bile duct drainage by means of ERCP in geriatric patients

Antecedentes y objetivo: la colangiopancreatografía retrógradaendoscópica (CPRE) es habitualmente la técnica de elecciónpara desobstruir la vía biliar. Una gran parte de los pacientes a losque se realiza esta intervención están en edad geriátrica (mayoresde 75 años). Nuestro objetivo ha sido valorar la eficacia de laCPRE en este grupo de pacientes, comparado con los de menoredad.Pacientes y métodos: estudio retrospectivo en el que se hanincluido los pacientes a quienes se realizó terapéutica biliar endoscópicamediante CPRE en un periodo de cuatro años (2002-2005).Resultados: se realizó CPRE a 178 pacientes en edad geriátricay a 159 de menor edad. No hubo diferencias en el éxito deldrenaje biliar (97,7-98,7%), en el número de complicaciones(11,8-14,4%), ni en la mortalidad (1,1-0,6%). Por el contrario, enel grupo geriátrico hubo más coledocolitiasis (57,3-39,6%, p =0,004) y se utilizaron más prótesis metálicas autoexpandiblespara drenar la ictericia obstructiva tumoral (47-8%, p = 0,0035).En el grupo de menor edad se repitieron más CPRE a los mismospacientes (4-10%, p = 0,001).Conclusiones: el éxito y la morbimortalidad para drenar lavía biliar mediante CPRE son similares en los pacientes con edadgeriátrica y en los de edad inferior. La coledocolitiasis es más frecuenteen los pacientes mayores. No se debe excluir a ningún pacienteque precise de una CPRE sólo por la edad

Background and objective: endoscopic retrograde cholangiopancreatography(ERCP) is usually the procedure of choice forrelieving bile duct obstruction. A large number of patients undergoingthis intervention are geriatric population (aged 75 years ofage and older). Our aim was to assess the efficacy of ERCP in thisgroup of patients as compared to younger ones.Patients and methods: a retrospective study. All patients inwhom a therapeutic biliary endoscopy had been performed over afour-year period of time (2002-2005) were included.Results: 178 geriatric patients and 159 younger ones underwentERCP. No differences were found in successful biliarydrainage (97.7 vs. 98.7%), complication number (11.8 vs.14.4%), or mortality rate (1.1 vs. 0.6%). On the other hand,more common bile duct stones were found in geriatric patients(57.3 vs. 39.6%, p = 0.004), and also more self-expanding metalstents were employed to drain malignant obstructive jaundice (47vs. 8%, p = 0.0035). In the youngest group, more ERCPs wererepeated in the same patients (4 vs. 10%, p = 0.001).Conclusions: the geriatric population showed similar successand morbidity & mortality rates when compared to younger patientsin draining their bile duct by means of ERCP. Common bileduct stones were more frequently found in geriatric patients. Nopatients needing an ERCP should be excluded only because oftheir age

El aceite de oliva es un excelente lubricante para el dilatador tipo Witzel / Olive oil is a good lubricating agent for the Witzel dilator

No disponible