Enfermedad poliquística hepática / Polycystic liver disease

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Results of a survey about specific inflammatory bowel disease units in Andalusia.

BACKGROUND: Inflammatory bowel disease (IBD) has become one of the most prevalent pathologies in Gastroenterology Units, which added to its clinical outcome, treatment, the complexity of affected patients and the need to be continuously updated for the correct management of the disease, have made essential the presence of specific IBD units in each hospital. OBJECTIVES: The primary aims of this study were: a) to reveal the existence of these units in our area and how they work; and b) to draw conclusions regarding the necessary resources in these units and their aims. MATERIAL AND METHODS: In order to analyse the presence of these specialized units and the available resources in Andalusian hospitals, a 24-question survey was designed, being answered by 11 hospitals. The evaluated questions included the number of days patients are attended and the number of physicians attending the unit, the number of available healthcare assistants, if emergencies are attended or not, if there is an activated telephone number for patient consultation, if a day care unit is available and if new treatments are easily accessible. RESULTS: A specific IBD unit is present in all studied hospitals attending more than 11 patients each, although in the 63.4% of the cases patients are not attended more than 3 days per week. On the other hand, the 81.8% of the included hospitals attend emergencies although only the 54.5% of them had a specific telephone number for patient attendance. CONCLUSIONS: A specific IBD unit is present in many Andalusian hospitals, although some deficiencies can be observed. The general opinion of this Group is that these units are necessary in order to properly attend, monitorize and treat patients affected by IBD.

[A high-resolution gastroenterology clinic in Andalusia: what is it, and how should it work]. / Consulta de alta resolución de digestivo en Andalucía: qué es y cómo debe funcionar?

INTRODUCTION: The present concept in our healthcare system is that medical care should be given on an outpatient basis with hospitalization occurring only when essential. We therefore put forth the development of the "all in one" outpatient office or "high resolution" outpatient clinic. For such purpose we administered a questionnaire to various Andalusian hospitals to define and determine those aspects necessary in the development of the aforementioned outpatient office. MATERIALS AND METHODS: The questionnaire was filled out by 10 Andalusian hospitals. This is a prospective-descriptive study of responses from all 10 participating hospitals. The 27 questions inquired on the existence of such an outpatient office and the infrastructure needed to develop this service: How many patients are seen, where is it physically located, where do patients come from, criteria for assigning patients to this medical office, condition of incoming patients, whether ultrasound scans are performed, whether an integrated hospital computer system exists, nursing staff, how many visits are required before coming to a diagnosis, and finally whether this type of outpatient office is needed, and if so, why. RESULTS: Of all 10 hospitals, 5 of them had this type of clinic. All of them considered this type of outpatient service essential. The number of patients treated should be "10", in the hospital itself. There are differences as to whether patients should come from the emergency room or a primary care physician. It seems logical to assume that only patients who can be diagnosed via ultrasounds or endoscopy should be chosen. To allow an ultrasonogram the patient should visit the outpatient office in a state of "fasting" and with standard blood counts from the primary care physician. The outpatient clinic should have a computer system and its own nurse. According to participating hospitals this type of outpatient visits is very useful in our present healthcare system, as it allows higher levels of collaboration between Primary Care and the specialist; it also provides a rapid orientation regarding patient pathology, and acts as a "filter" for the rest of the healthcare system. CONCLUSIONS: The outpatient office should be tended to by an attending specialist in the field (FEA) with knowledge and experience in ultrasounds and gastrointestinal endoscopy, as well as user competency with the required computer programs. In our present-day system this can be considered a modality of high-resolution outpatient services and a model of efficiency.

Granulocitoaféresis en la enfermedad inflamatoria intestinal. Eficacia a 32 semanas con protocolo de inducción y sesiones de mantenimiento / Granulocytapheresis in inflammatory bowel disease. Efficacy of an induction plus maintenance sessions protocol at 32 weeks

Introducción: la granulocitoaféresis (GCAF) retira de la circulacióngranulocitos-monocitos activados, modificando el pool circulantee induciendo una reducción en la inflamación intestinal.Objetivo: valorar la eficacia de la GCAF en la enfermedad inflamatoriaintestinal (EII) mediante sesiones de inducción y mantenimiento.Material y método: análisis retrospectivo en pacientes conEII activa corticodependiente y corticorrefractaria. Aplicamos 5sesiones de inducción en colitis ulcerosa (CU) y 7 en enfermedadde Crohn (EC) y 1 sesión mensual hasta semana 32. Evaluamosindices clínicos de actividad y empleo de corticoides.Resultados: incluimos a 18 pacientes (10 CU, 8 EC), 10 deellos corticodependientes y 8 corticorrefractarios. Catorce pacienteseran refractarios y 4 intolerantes a inmunosupresores (IS). No completaronla inducción 2-CU (brotes graves) y 1-EC (secundarismos).Abandonaron el mantenimiento 1-CU y 3-EC. De aquellos quecompletaron inducción alcanzaron respuesta o remisión el 87,5%de las CU (2 y 5 pacientes), y el 71,4% de EC (1 y 4 pacientes) respectivamente.Estos resultados a 32 semanas eran del 75% en CU(3 y 3 pacientes) y del 42,8% en EC (1 y 2 pacientes) respectivamente.De los que completaron la inducción, suprimieron corticoidesel 14,2% de EC por el 62,5% de CU (25% de estas en remisióny 37,5% en respuesta). Registramos 2 secundarismos graves (tromboflebitisy síncope). Ninguna CU que completó inducción sufrió colectomíatras 97,6 (72-128) semanas de seguimiento.Conclusiones: tanto CU como EC responden bien a induccióncon GCAF pero mientras la CU mantiene tras 32 semanastasas similares de respuesta-remisión (87,5 vs. 75%) casi 1/3 delos pacientes con EC recaen tras alcanzar respuesta. La granulocitoaféresises una alternativa de tratamiento para inducir y mantenerremision en CU, ahorrando corticoides, pero en la EC se precisauna adecuada selección de pacientes y un esquema demantenimiento aún por definir

Introduction: granulocytapheresis (GCAP) eliminates activatedgranulocytes-monocytes from peripheral blood, thus modifyingthe circulating pool of leukocytes and reducing intestinal inflammation.Objective: tto evaluate the efficacy of GCAP in inflammatorybowel disease (IBD) using an induction and maintenance protocol.Material and method: a retrospective study including patientswith active corticosteroid-dependent or refractory IBD. Inductionincluded 5 sessions in ulcerative colitis (UC) and 7 sessionsin Crohn´s disease (CD); one monthly session was usedthereafter until week 32. Clinical activity indices and use of corticosteroidswere monitored.Results: eighteen patients were included (10 with UC, 8 withCD), 10 of them dependent on and 8 refractory to corticosteroids.Fourteen of them were refractory and a further 4 were intolerantto immunosuppressants (IS). Induction was not completedin 2 UC (severe relapses) and 1 CD (side-effects) patients. OneUC and 3 CD patients withdrew during maintenance. Among patientswho completed induction, response or remission wasachieved in 87.5% of UC cases (2 and 5 patients) and 71.4% ofCD cases (1 and 4 patients), respectively. At week 32 responseremissionrates reached 75% in CU (3 and 3 patients) and 42.8%in CD (1 and 2 patients) cases, respectively. Corticosteroid withdrawalwas possible in 14.2% of CD and in 62.5% of UC patients(25% in remission and 37.5% with response). There were twomajor side effects (thrombophlebitis and syncope). No colectomieswere performed for UC patients who completed GCAP inductionafter a mean follow-up of 97.6 weeks (range: 72-128).Conclusions: both UC and CD respond well to GCAP induction.At 32 weeks UC patients maintain similar response-remissionrates (87.5 vs. 75%), whereas almost one-third of CD patientsloose response. Granolocytapheresis is an alternative,steroid-sparing treatment modality to induce and maintain remissionin UC, while good patient selection and a maintenance protocolnot well defined yet are needed for CD (AU)

Hematemesis y vómitos persistentes en paciente anticoagulada / Hematemesis and persistent vomiting in an anticoagulated patient

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Hallazgos endoscópicos del tumor mucinoso de páncreas / Endoscopic signs of mucinous tumor of the pancreas

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Abdomen agudo en la enfermedad celiaca: yeyunoileítis ulcerativa / Acute abdomen in celiac disease: Ulcerative jejunoileitis

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