Enfermedad de Crohn fistulosa perianal / Perianal Crohn´s disease

La enfermedad fistulosa perianal (EFPA) en la enfermedad de Crohn (EC) constituye una complicación que afecta a la calidad de vida de los pacientes y muchas veces precisa una atención urgente. El tratamiento debe ser individualizado y combinar procedimientos médicos y quirúrgicos. Los aspectos clave para un adecuado manejo de la EFPA son determinar la existencia o no de afectación rectal, las características anatómicas y tipo de fístulas, y descartar la existencia de abscesos perianales. Para lograrlo es necesaria una aproximación diagnóstica que incluya inspección y tacto rectal, endoscopia y exploración bajo anestesia combinado con resonancia magnética pélvica o ecoendoscopia recto-anal (AU)

The treatment of perineal fistulas in Crohn disease should be defined according to the each patient. A combined medical and surgical approach is the optimal treatment. The management of perianal fistula disease is based on the presence or absence of active proctitis, the anatomic location and type fistula, and identify perianal abscess. This evaluation includes digital rectal examination, endoscopy, and examination under anesthesia combined with pelvic magnetic resonance imaging or anorectal endoscopy ultrasonography findings (AU)

[Spontaneous rupture of the esophagus: diagnostic problem in the emergency service]. / Rotura espontánea de esófago: un problema diagnóstico en la urgencia.

We present two case of a spontaneous perforation of the esophagus (Boerhaave's syndrome), they were associated with different symptoms. Both of them the diagnosis was make on the second admission to the emergency service. The Boerhaave's syndrome is potentially lethal, relatively rare and the difficult diagnosis in the initial phases. It's a life threatening condition demanding early diagnosis and rapid aggressive management to prevent fulminant death.

Rotura espontánea de esófago: un problema diagnóstico en la urgencia / Spontaneous perforation of the esophagus: difficult diagnosis on the emergency service

Presentamos dos casos de rotura espontánea de esófago (síndrome de Boerhaave) que acudieron a urgencias por distintos síntomas, en ambos casos el diagnóstico se realizó en una segunda visita tras varias horas de evolución del cuadro. El síndrome de Boerhaave es una entidad grave, infrecuente y de difícil diagnóstico debido a su presentación inespecífica, y en el que es fundamental lograr un diagnóstico y tratamiento precoz por su alta morbimortalidad (AU)

Hidroneumotórax a tensión de aparición brusca / Sudden ondet of tight hydropneumothorax

No disponible

[Analysis of evaluation process of research projects submitted to the Fondo de Investigación Sanitaria, Spain]. / Análisis del proceso evaluador de los proyectos de investigación en el Fondo de Investigación Sanitaria.

BACKGROUND: At the present time it seems very clear that research improvement is both an unquestionable fact and the right way to develop technological innovation, services and patents. However, such improvement and corresponding finances needs to be done under fine and rigorous evaluation process as an assessment tool under which all the research projects applying to a public or private call for proposals should be submitted to assure a coherence point according to the investment to be made. At this end, the main target of this work has been focused to analysis and study the evaluation process traditionally made by Fondo de Investigación Sanitaria (FIS) as well as to propose most adequate modifications. MATERIAL AND METHOD: A sample of 431 research projects corresponding to year 1998 proposal was analysed. The evaluation from FIS and ANEP (National Evaluation and Prospective Agency) was evaluated and scored (evaluation quality) in its main contents by 3 independent evaluators, the showed results submitted to a comparative frame between these agencies at indoor (FIS) and outdoor (FIS/ANEP) level. RESULTS: FIS evaluation had 20 commissions or areas of knowledge. The analysis indoor (FIS) clearly showed that evaluation quality was correlated to the assigned commission (F = 3.71; p < 0.001) and to the time last of the researched proposal (F = 3.42; p < 0.05) but no related to the evaluator. On the other hand, the quality of ANEP evaluation showed a correlated dependency of the three mentioned facts. In all terms, the ANEP evaluation was better than FIS for the three years time projects, but in did not show significant differences in one or two years time projects. In all cases, the evaluation with final results as negative (financing denied) showed an average quality higher than positive evaluation. CONCLUSIONS: The obtained results advice about the convenience of making some changes in the evaluative structure and to review the sort of FIS technical commissions focusing an improvement of the evaluation process.

[Diagnosis of Gilbert's syndrome: current status of the fasting test. Review of the literature]. / Diagnóstico del síndrome de Gilbert: situación actual del test del ayuno. Revisión de la literatura.

UNLABELLED: Gilbert's syndrome is a benign, often familial condition characterized by recurrent but asymptomatic jaundice. AIM: To describe the involvement of the reduced caloric intake test, used as a diagnostic test in Gilbert's syndrome. METHOD: 49 patients were diagnosed of Gilbert's syndrome for 6 years. 39 patients took 400 kcal/day for three days. The unconjugated bilirubinemia levels were measured at 0, 24, 48 and 72 hours. RESULTS: The 82.05% of test were diagnostics at 24 hours (p < 0.001), while it was necessary 48 hours to 100% of tests were diagnostics (p < 0.05). In any case was necessary to determinate the unconjugated bilirubinemia at 72 hours (p < 0.5). CONCLUSIONS: The best diagnostic efficiency of the reduced caloric intake test is at 48 hours, while the 24 hours determination could be considered diagnostic in a big percentage of the cases. It is not necessary the determination at 72 hours in any case.