Enfermedad de Crohn: utilidad de la RM-enterografía en la detección de recurrencias posquirúrgicas / Crohn's disease: the usefulness of MR enterography in the detection of recurrence after surgery

Objetivos. Demostrar la utilidad de la RM-enterografía (RM-E) en la detección de recurrencias en la anastomosis ileocolónica en pacientes con enfermedad de Crohn (EC) que han sufrido una resección intestinal previa. Material y métodos. Se estudió a 30 pacientes con EC e historia de resección intestinal mediante RM-E e ileocolonoscopia. Para determinar el grado de la recurrencia, los hallazgos se cuantificaron mediante un índice propio de actividad de la EC en RM y mediante el índice endoscópico de recurrencia de Rutgeerts, respectivamente. Se consideró a la ileocolonoscopia como el patrón de referencia. Resultados. La RM-E mostró para la detección de recurrencia sensibilidad del 100%, especificidad del 60%, valor predictivo positivo (VPP) del 92,6%, valor predictivo negativo (VPN) del 100% y exactitud diagnóstica del 93,3%. La concordancia entre el grado de la recurrencia determinado por RM-E y por ileocolonoscopia fue moderada (k=0,41). Sin embargo, después de establecer solo dos grupos (alto o bajo grado) que indican el comportamiento evolutivo y la posibilidad de nueva cirugía, la concordancia pasó a ser excelente (k=0,87). Para este supuesto se obtuvo sensibilidad del 85%, especificidad del 100%, VPP del 100% y VPN del 76,9%. Conclusiones. La RM-E es un método de imagen útil para detectar la recurrencia posquirúrgica en la EC y diferenciar entre grupos de mayor o menor riesgo evolutivo. Su concordancia con la ileocolonoscopia es alta, por lo que puede ser una alternativa en determinadas ocasiones (AU)

Objectives. To determine the usefulness of MR enterography in the detection of recurrence in the ileocolonic anastomosis in patients with Crohn's disease that have undergone intestinal resection. Material and methods. We used MR enterography and ileocolonoscopy to study 30 patients with Crohn's disease who had undergone intestinal resection. To determine the degree of relapse, the findings at MR enterography were quantified using our own index of Crohn's disease activity and the findings at ileocolonoscopy were quantified using the Rutgeerts scale. Ileocolonoscopy was considered the gold standard. Results. Compared to the gold standard, MR enterography yielded 100% sensitivity, 60% specificity, 92.6% positive predictive value (PPV), 100% negative predictive value (NPV), and 93.3% diagnostic accuracy. The concordance between the degree of recurrence determined with MR enterography and with ileocolonoscopy was moderate (k=0.41). However, when patients were classified into two groups (high or low grade) according to outcome and the possibility of repeat surgery, the concordance was excellent (k=0.87). Using this classification, MR enterography had 85% sensitivity, 100% specificity, 100% PPV, and 76.9% NPV. Conclusions. MR enterography is a useful imaging method for detecting recurrence of Crohn's disease after surgery and for differentiating between patients with higher or lower risk of poor outcome. MR enterography has good concordance with ileocolonoscopy and is an alternative to ileocolonoscopy in determinate occasions (AU)

[Crohn's disease: the usefulness of MR enterography in the detection of recurrence after surgery]. / Enfermedad de Crohn: utilidad de la RM-enterografía en la detección de recurrencias posquirúrgicas.

OBJECTIVES: To determine the usefulness of MR enterography in the detection of recurrence in the ileocolonic anastomosis in patients with Crohn's disease that have undergone intestinal resection. MATERIAL AND METHODS: We used MR enterography and ileocolonoscopy to study 30 patients with Crohn's disease who had undergone intestinal resection. To determine the degree of relapse, the findings at MR enterography were quantified using our own index of Crohn's disease activity and the findings at ileocolonoscopy were quantified using the Rutgeerts scale. Ileocolonoscopy was considered the gold standard. RESULTS: Compared to the gold standard, MR enterography yielded 100% sensitivity, 60% specificity, 92.6% positive predictive value (PPV), 100% negative predictive value (NPV), and 93.3% diagnostic accuracy. The concordance between the degree of recurrence determined with MR enterography and with ileocolonoscopy was moderate (κ=0.41). However, when patients were classified into two groups (high or low grade) according to outcome and the possibility of repeat surgery, the concordance was excellent (κ=0.87). Using this classification, MR enterography had 85% sensitivity, 100% specificity, 100% PPV, and 76.9% NPV. CONCLUSIONS: MR enterography is a useful imaging method for detecting recurrence of Crohn's disease after surgery and for differentiating between patients with higher or lower risk of poor outcome. MR enterography has good concordance with ileocolonoscopy and is an alternative to ileocolonoscopy in determinate occasions.

Experiencia con la infusión continua de levodopa intraduodenal (Duodopa®) en pacientes con enfermedad de Parkinson avanzada en un hospital de segundo nivel asistencial / Experience with continuous levodopa enteral infusion (Duodopa®) in patients with advanced Parkinson's disease in a secondary level hospital

Introducción: La infusión continua de levodopa intraduodenal (Duodopa®) constituye una alternativa a la infusión subcutánea de apomorfina y a la cirugía en pacientes con enfermedad de Parkinson (EP) avanzada. Describimos nuestra experiencia con Duodopa® en pacientes con EP avanzada.Métodos: Realizamos un estudio epidemiológico, observacional, no intervencionista, poblacional, descriptivo, y retrospectivo, en el que se incluyen todos aquellos pacientes con EP avanzada tratados con Duodopa® por parte de la Sección de Neurología del Hospital A. Marcide de Ferrol hasta abril de 2010. Resultados: Once de un total de 12 pacientes seleccionados fueron tratados con Duodopa® [63,6% varones; edad media 62,7±10,6 (44-74) años]. En el momento de ser seleccionados para recibir Duodopa® presentaban: tiempo medio de evolución de enfermedad de 14,5±8,9 (3-34) años, dosis media de levodopa oral de 918,2±277,7 (450-1300) mg/día, y un estadio de Hoehn y Yahr de 3,7±0,5 (3-4). Nueve pacientes mantienen el tratamiento con Duodopa®. Hubo mejoría en las fluctuaciones motoras (72,7% gran mejoría) y discinesias (55,5% gran mejoría) con reducción del tiempo off/día (90,9%) y tiempo con discinesias/día (66,6%) después de un tiempo total de seguimiento con Duodopa® de 170,5 (3-31) meses. La mejoría en las escalas PDQ-39 y Schwab&England fue de 38,5±19,8 y 24±12,5 puntos respectivamente (p<0,05). La dosis media equivalente oral de levodopa (abril 2010) fue de 1683,4±295,8 (1234-2216) mg/día.Conclusiones: Duodopa® pudiera ser un tratamiento efectivo, seguro, y bien tolerado alternativo a la cirugía y apomorfina subcutánea en pacientes con EP avanzada adecuadamente seleccionados (AU)

Introduction: Continuous levodopa delivery by enteral infusion (Duodopa®) is an alternative to deep brain stimulation and subcutaneous apomorphine to control motor fluctuations and dyskinesias in advanced Parkinson's disease (PD). We report our experience with Duodopa® therapy in 11 patients with advanced PD.Methods: We retrospectively assessed clinical and quality of life changes in all patients with PD with severe motor fluctuations and dyskinesias who started continuous daily levodopa duodenal infusion through percutaneous endoscopic gastrostomy from September 2006 (Duodopa® was approved for advanced PD treatment in Spain at that date) until April 2010 at the A. Marcide Hospital of Spain.Results: Nine patients received Duodopa® [62.7±10.6 (44-74) years, 63.6% male)]. Pre-Duodopa® clinical characteristics of patients were: disease duration 14.5±8.9 (3-34) years, oral levodopa dose 918.2±277.7 (450-1300) mg/day, and Hoehn and Yahr staging 3.7±0.5 (3-4). Nine patients are still receiving Duodopa®. Patients improved motor fluctuations (72.7% significant improvement), dyskinesia (55.5% significant improvement), daily off-time (90.9%) and daily duration dyskinesia (66.6%) after total infusion time of 170.5 months (3-31). The improvement in Parkinson's Disease Quality of Life Questionnaire-39 (PDQ-39) and Schwab&England Capacity for Daily Living Scale were 38.5±19.8 and 24±12.5 respectively (P<0.05). Equivalent daily dose of levodopa (April 2010) was 1683.4±295.8 (1234-2216) mg/day.Conclusions: Intraduodenal infusion of levodopa offers an important alternative in treating patients with advanced Parkinson disease (AU)

[Experience with continuous levodopa enteral infusion (Duodopa(®)) in patients with advanced Parkinson's disease in a secondary level hospital]. / Experiencia con la infusión continua de levodopa intraduodenal (Duodopa(®)) en pacientes con enfermedad de Parkinson avanzada en un hospital de segundo nivel asistencial.

INTRODUCTION: Continuous levodopa delivery by enteral infusion (Duodopa(®)) is an alternative to deep brain stimulation and subcutaneous apomorphine to control motor fluctuations and dyskinesias in advanced Parkinson's disease (PD). We report our experience with Duodopa(®) therapy in 11 patients with advanced PD. METHODS: We retrospectively assessed clinical and quality of life changes in all patients with PD with severe motor fluctuations and dyskinesias who started continuous daily levodopa duodenal infusion through percutaneous endoscopic gastrostomy from September 2006 (Duodopa(®) was approved for advanced PD treatment in Spain at that date) until April 2010 at the A. Marcide Hospital of Spain. RESULTS: Nine patients received Duodopa(®) [62.7±10.6 (44-74) years, 63.6% male)]. Pre-Duodopa(®) clinical characteristics of patients were: disease duration 14.5±8.9 (3-34) years, oral levodopa dose 918.2±277.7 (450-1300) mg/day, and Hoehn and Yahr staging 3.7±0.5 (3-4). Nine patients are still receiving Duodopa(®). Patients improved motor fluctuations (72.7% significant improvement), dyskinesia (55.5% significant improvement), daily off-time (90.9%) and daily duration dyskinesia (66.6%) after total infusion time of 170.5 months (3-31). The improvement in Parkinson's Disease Quality of Life Questionnaire-39 (PDQ-39) and Schwab&England Capacity for Daily Living Scale were 38.5±19.8 and 24±12.5 respectively (P<0.05). Equivalent daily dose of levodopa (April 2010) was 1683.4±295.8 (1234-2216) mg/day. CONCLUSIONS: Intraduodenal infusion of levodopa offers an important alternative in treating patients with advanced Parkinson disease.

Sedation at endoscopic units in Galicia: results of the "Sociedad Gallega de Patología Digestiva" inquiry.

AIM: To evaluate the human and material resources available for sedation, and the usual manner of handling them at endoscopic units in Galicia. METHODS: A prospective and descriptive study based on the performance, distribution, and analysis of a clinical practice inquiry. We requested information about endoscopies performed, available means for sedation, sedation monitoring, and level of sedation used in each procedure. RESULTS: Our inquiry was answered by twenty endoscopic units (thirteen were in public hospitals, and eleven performed complex procedures). Of these units, 80% had a pulse oximeter, 42% had continuous electrocardiography, 40% had a defibrillator, and 45% had a recovery area. The drug most commonly used in gastroscopies was midazolam (76%), and the combination midazolam-meperidine was most frequent in both colonoscopies (72%) and ERCPs (60%). An anesthesiologist was usually available for certain procedures in 15% of units, and as an exception in 65%. Of those inquired, 35% wished to have a full-time anesthesiologist in the unit, 25% wished to have an anesthetist only for certain procedures, and 35% on an exceptional basis. Finally, endoscopists considered that 83% of therapeutical gastroscopies, 87% of therapeutical colonoscopies, 98% of ERCPs, 95% of enteroscopies, and 98% of echoendoscopies deserved sedation. CONCLUSIONS: Although endoscopists consider that endoscopic procedures should benefit from sedation in a high proportion, the available resources to safely monitor patients are inadequate in some units.

Sedación en las Unidades de Endoscopia de Galicia. Resultados de la encuesta de la Sociedad Gallega de Patología Digestiva / Sedation at Endoscopic Units in Galicia: results of the “Sociedad Gallega de Patología Digestiva” inquiry

Objetivo: evaluar los medios materiales y humanos disponiblespara la sedación y el modo habitual de manejarla en las unidadesde endoscopia de Galicia.Métodos: estudio prospectivo, descriptivo, basado en la realización,distribución y análisis de una encuesta sobre práctica clínica.Se solicitó información sobre las exploraciones realizadas, losmedios disponibles para la sedación, el modo de controlarla y elnivel de sedación usado y deseable en cada exploración.Resultados: la encuesta fue respondida por veinte unidades deendoscopia (trece de titularidad pública y once realizaban exploracionesde alta complejidad). El 80% de las unidades estaban dotadasde pulsioximetría, el 42% de monitorización electrocardiográfica, el40% de defibrilador y finalmente, el 45% de sala de recuperación.El fármaco más utilizado en las gastroscopias fue el midazolam(76%) siendo la asociación midazolam-meperidina la sedación másutilizada en las colonoscopias (72%) y la CPRE (60%). El anestesistaestaba disponible para determinadas exploraciones de forma habitualen el 15%, y de forma excepcional en el 65% de las unidades.El 35% de los encuestados desearía tener un anestesista en la unidada tiempo completo, el 25% sólo para exploraciones determinadasy el 35% sólo para casos excepcionales. Finalmente, los encuestadosconsideran que es necesario algún grado de sedación en el83% de las gastroscopias terapéuticas, en el 87% de las colonoscopiasterapéuticas, en el 98% de las CPRE, en el 95% de las enteroscopiasy en el 98% de las ecoendoscopias.Conclusiones: aunque los endoscopistas consideran que losprocedimientos endoscópicos deben ser sedados en una proporciónelevada, en algunas unidades los medios disponibles paramonitorizar con seguridad a los pacientes son insuficientes

Aim: to evaluate the human and material resources availablefor sedation, and the usual manner of handling them at endoscopicunits in Galicia.Methods: a prospective and descriptive study based on theperformance, distribution, and analysis of a clinical practice inquiry.We requested information about endoscopies performed,available means for sedation, sedation monitoring, and level of sedationused in each procedure.Results: our inquiry was answered by twenty endoscopic units(thirteen were in public hospitals, and eleven performed complexprocedures). Of these units, 80% had a pulse oximeter, 42% hadcontinuous electrocardiography, 40% had a defibrillator, and 45%had a recovery area. The drug most commonly used in gastroscopieswas midazolam (76%), and the combination midazolammeperidinewas most frequent in both colonoscopies (72%) andERCPs (60%). An anesthesiologist was usually available for certainprocedures in 15% of units, and as an exception in 65%. Of thoseinquired, 35% wished to have a full-time anesthesiologist in theunit, 25% wished to have an anesthetist only for certain procedures,and 35% on an exceptional basis. Finally, endoscopistsconsidered that 83% of therapeutical gastroscopies, 87% of therapeuticalcolonoscopies, 98% of ERCPs, 95% of enteroscopies,and 98% of echoendoscopies deserved sedation.Conclusions: although endoscopists consider that endoscopicprocedures should benefit from sedation in a high proportion,the available resources to safely monitor patients are inadequatein some units

Quemaduras en la mucosa oral y erosiones cutáneas / "Burns" in the oral mucosa and skin erosions

No disponible