Pancreatitis biliar. Cinética de pruebas funcionales hepáticas y canal común biliopancreático - reflujo biliopancreático / Biliary pancreatitis. Liver function tests and common biliopancreatic channel kinetics - biliopancreatic reflux

OBJETIVO: Estudio de la prevalencia de reflujo biliopancreático (RBP)/canal común biliopancreático (CCBP) en pacientes con pancreatitis biliar (PB) sometidos a colecistetomía (CST) y colangiografía intraoperatoria (CIO) y análisis de la cinética de pruebas funcionales hepáticas (PFH) en comparación con un grupo control (GC) de colelitiasis sintomática. MATERIAL Y MÉTODOS: Estudio retrospectivo de 107 pacientes consecutivos con PB. Se determinó la existencia de RBP-CCBP en la CIO y se analizaron las PFH al ingreso (AI), a las 48 horas y en el examen preoperatorio (AP). La variación analítica se analizó entre grupos según existencia de RBP-CCBP y entre el AI y AP, según intervalo ingreso-intervención (III) y dentro del mismo grupo mediante determinación de la ratio valor observado-valor máximo normal (VO/VMN). RESULTADOS: La incidencia de CCBP fue de 38,3% en PB vs 5,0 en GC (p = 0,0001) y fue independiente del III a diferencia de la odditis apuntando a una alteración anatómica para la primera y funcional para la segunda. Las variaciones analíticas no muestran diferencias entre grupos en función de la existencia de CCBP, pero con ausencia de diferencias al analizar la ratio VO/VMN en FA y GGT, lo que indica un mayor grado de colestasis en los pacientes con RBP-CCBP. La incidencia de dilatación de vía biliar US fue del 10,3% asociándose a CCBP. CONCLUSIONES: El RBP-CCBP en PB genera un mayor grado de colestasis e incertidumbre en la estimación de coledocolitiasis asociada y excesiva sobreindicación de ERCP-EE. Los marcadores US y bioquímicos de coledocolitiasis tienen una baja especificidad en PB por la existencia de CCBP lo que obliga a incluir a la colangiografía por RMN como exploración previa a la ERCP-EE

OBJECTIVE: To determine the prevalence of biliopancreatic reflux (BPR) in patients with biliary pancreatitis (BP) undergoing elective cholecystectomy with intraoperative cholangiography (IOC) in comparison with a control group of symptomatic cholelithiasis (CG). PATIENTS AND METHODS: Retrospective review of 107 consecutive BP cases. BPR was determined by IOC and liver function tests (LFT) were recorded at admission (A), 48hours, and preoperative examination (P). LFT analysis between A and P were analysed between groups with respect to BPR, time interval to cholecystectomy within the same group and by determination of observed value/maximum normal value ratio (OV/MNV). RESULTS: BPR incidence was 38.3% in BP in comparison with 5% in CG (p = 0.0001) it was independent from interval time to cholecystectomy, in contrast with Odditis, suggesting an anatomical condition for CCBP and a functional one for Odditis. LFT analysis showed no differences in relation to BPR incidence. LFT excluding AP and GGT returned to normal values with significant differences in OV/MNV when BPR was present which points to an increased cholestasis in BPR group. US dilatation of CBD was noted in 10.3% and was associated to CCBP. CONCLUSIONS: BPR in BP increases cholestasis and contributes to confusion in the estimation of common bile duct stones increasing ERCP-EE rates. US and biochemical markers of CBDS show a low specificity due to BPR-CCBP which suggests that MRI-cholangiography is a mandatory exploration before ERCP-EE examination

Biliary Pancreatitis. Liver Function Tests and Common Biliopancreatic Channel Kinetics--Biliopancreatic Reflux.

OBJECTIVE: To determine the prevalence of biliopancreatic reflux (BPR) in patients with biliary pancreatitis (BP) undergoing elective cholecystectomy with intraoperative cholangiography (IOC) in comparison with a control group of symptomatic cholelithiasis (CG). PATIENTS AND METHODS: Retrospective review of 107 consecutive BP cases. BPR was determined by IOC and liver function tests (LFT) were recorded at admission (A), 48hours, and preoperative examination (P). LFT analysis between A and P were analysed between groups with respect to BPR, time interval to cholecystectomy within the same group and by determination of observed value/maximum normal value ratio (OV/MNV). RESULTS: BPR incidence was 38.3% in BP in comparison with 5% in CG (p=0.0001) it was independent from interval time to cholecystectomy, in contrast with Odditis, suggesting an anatomical condition for CCBP and a functional one for Odditis. LFT analysis showed no differences in relation to BPR incidence. LFT excluding AP and GGT returned to normal values with significant differences in OV/MNV when BPR was present which points to an increased cholestasis in BPR group. US dilatation of CBD was noted in 10.3% and was associated to CCBP. CONCLUSIONS: BPR in BP increases cholestasis and contributes to confusion in the estimation of common bile duct stones increasing ERCP-EE rates. US and biochemical markers of CBDS show a low specificity due to BPR-CCBP which suggests that MRI-cholangiography is a mandatory exploration before ERCP-EE examination.

Seguridad en la administración de contrastes radiológicos intravenosos con bombas inyectoras de alta presión / Safety in administering intravenous radiocontrast media using high-pressure injection pumps

Objetivos: Identificar los eventos adversos asociados a la administración de contraste radiológico intravascular (CRI) mediante bombas de inyección de contraste (BIC) y las actuaciones para garantizar la seguridad en el uso de las mismas para pruebas diagnósticas por imagen. Método: se llevó a cabo una revisión narrativa, para la que se consultaron las bases de datos: ProQuest Health, Science Direct y Medline, así como libros, guías de práctica y procedimientos de sociedades científicas de radiología, de trabajos en inglés y/o español publicados entre los años 2000-2012. Resultados: los principales eventos adversos relacionados con el uso de las BIC son la lesión y/o rotura vascular, el embolismo iatrogénico, las salpicaduras y manchas por CRI y/o hemoderivados del paciente y la obstrucción del catéter vascular. Existen actuaciones enfermeras específicas para la prevención de cada uno de estos efectos adversos. Conclusiones: la administración del contraste mediante bomba de inyecciónes una práctica segura si se conocen los riesgos potenciales de su utilización y se llevan a cabo los cuidados para prevenir su aparición y/o contrarrestar su efecto en caso de que ocurran (AU)

Purposes: Identify the adverse events associated with the administration of intravascular contrast media (ICM) using contrast injection pumps (CIPs) and the measures for ensuring the safety of their use for diagnostic imaging tests. Method: A narrative review was conducted by querying the ProQuest Health, Science Direct and Medline databases in addition to books, radiological society procedures and practice manuals, studies in English and/or Spanish published within the 2000-2012 period. Results: The main adverse events related to the use of CIPs are vascular injury and/or rupture, iatrogenic embolism, patient blood product and/or ICMs plashing and spattering and vascular catheter blockage. Specific nursing procedures exist for preventing each one of these adverse effects. Conclusions: Contrast media can be administered safely using an injection pump if one is aware of the potential risks involved in the use thereof and one takes care to prevent their occurrence and/or to counteract their effect in the event that they do occur (AU)

[Design of a checklist for interventional radiology]. / Diseño de una lista de verificación para radiología intervencionista.

Avoidable adverse events must be subjected to continuous control to be detected at the time and prevent their occurrence. Its knowledge is essential to prevent them and their consequences and any effective action on the matter of risk management and health safety must be taken into account. Surgical checklists fulfil these requirements, making patient care easier and opening the possibility of effective communication with the group and with the patient. Checklists help in the detection and prevention of avoidable events, providing safety for the patient as well as to the interventional team, and provide continuity of patient care outside the operating room. The objective of this work is to describe the design of a specific checklist for interventional radiology patients, as an essential tool to contribute to safety in the procedure. In the preparation of this checklist, a review was made of other surgical checklists of reference, as well as the recommendations for producing one and the justification of its need in all interventional procedures of risk. A simple checklist has been designed, which is adaptable to the specific characteristics of interventional radiology. Nursing staff are the key professionals on the design and implementation helping to identify those conditions that may threaten the success of the intervention.

Diseño de una lista de verificación para radiología intervencionista / Design of a checklist for interventional radiology

Los eventos adversos evitables deben ser sometidos a un control continuo para detectarse a tiempo y evitar su ocurrencia. Su conocimiento es una condición indispensable en la prevención y cualquier acción eficaz en materia de gestión de riesgos o seguridad asistencial se debe tener en cuenta. Las listas de verificación quirúrgica cumplen estos requisitos facilitándola asistencia del paciente, posibilitando la comunicación efectiva intragrupo y con el paciente. Ayudan en la detección y prevención de eventos evitables proporcionando seguridad tanto al paciente como al propio equipo intervencionista y posibilitan la continuidad de los cuidados del paciente más allá de la sala de intervencionismo. El objetivo de este trabajo es describir el diseño de una lista de verificación específico para los pacientes de radiología intervencionista como medida imprescindible para aportar seguridad en el procedimiento. Para su elaboración se hizo una revisión de otras listas de verificación quirúrgicas de referencia y de las recomendaciones de creación y justificación de su necesidad en todo procedimiento intervencionista de riesgo. Se ha realizado una lista de verificación sencilla y adaptada a las características propias dela radiología intervencionista. Las enfermeras son los profesionales clave en su desarrollo y en la identificación de todas aquellas condiciones que pueden poner en peligro el éxito de la intervención (AU)

Avoidable adverse events must be subjected to continuous control to be detected at the time and prevent their occurrence. Its knowledge is essential to prevent them and their consequences and any effective action on the matter of risk management and health safety must be taken into account. Surgical checklists fulfil these requirements, making patient care easier and opening the possibility of effective communication with the group and with the patient. Checklists help in the detection and prevention of avoidable events, providing safety for the patient as well as to the interventional team, and provide continuity of patient care outside the operating room. The objective of this work is to describe the design of a specific checklist for interventional radiology patients, as an essential tool to contribute to safety in the procedure. In the preparation of this checklist, a review was made of other surgical checklists of reference, as well as the recommendations for producing one and the justification of its need in all interventional procedures of risk. A simple checklist has been designed, which is adaptable to the specific characteristics of interventional radiology. Nursing staff are the key professionals on the design and implementation helping to identify those conditions that may threaten the success of the intervention (AU)