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Randomización versus estudios “en el mundo real” 随机化与“现实世界”研究
Q4 Medicine Pub Date : 2020-09-28 DOI: 10.52787/TGER9808
Rodolfo Pizarro
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引用次数: 0
Solución del caso. Una causa poco frecuente de dolor abdominal y hemorragia digestiva 案例解决方案。腹痛和消化出血的罕见原因
Q4 Medicine Pub Date : 2020-09-28 DOI: 10.52787/RUOG4186
A. M. Bolívar, N. Larrañaga, Candelaria Tregea, Mariangela Paba Molina, Esteban Jeanmaire, R. Cobeñas
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引用次数: 0
Experiencia con el uso de teduglutide en pacientes pediátricos con fallo intestinal en un centro de Argentina 在阿根廷某中心使用teduglutide治疗小儿肠道衰竭患者的经验
Q4 Medicine Pub Date : 2020-09-28 DOI: 10.52787/REQT4765
María Inés Fraire Martínez, Carolina Rumbo, Dolores García Hervás, J. Trentadue, Gabriel Gondolesi, Adriana Fernández
Introduction. Teduglutide is a synthetic analogue of the glucagon-like peptide type 2, recently approved in Europe and in the United States for paediatric use, to promote intestinal adaptation in short bowel syndrome cases. The experience in children is limited. Objective. The aim of this work is to present the evolution of the first paediatric series treated with teduglutide in Argentina. Material and methods. A prospective study was realized on patient records under 18 years treated in a rehabilitation and intestine transplant unit since 2017. Of 62 children with short bowel syndrome, 5 received teduglutide 0.05 mg/kg/subcutaneous day. Diagnostics, type of anatomy and evolution of parenteral nutrition requirements were realized . Results. Etiology of short bowel syndrome: 3 congenital malformations: 2 atresias, 1 gastroschisis, two causes in older children: 1 volvulus and 1 abdominal trauma. Anatomy. Three patients type 2A, one type 2B and one type 3A, the length of the remaining intestine (mean and DS) 25.7 ± 19 cm, 1 with ileocecal valve and colon, 4 left hemicolon. The age at the beginning of parenteral nutrition was 6.2 ± 0.4 years, time on previous parenteral nutrition was 7.1 ± 4 years. The treatment time with teduglutide was 52.2 ± 39 weeks. The parenteral nutrition requirements were reduced by 56 ± 48%, in all patients, and could be suspended in 2 (at the 29th and 24th weeks of treatment). There was no deterioration of the z score of BMI/age (initial 0.16 ± 0.3 vs. 0.14 ± 1.02), nor of the height/age (-2.01 ± 1.5 vs. -1.76 ± 1.42). Conclusion. It was concluded that the use of teduglutide as a therapeutic alternative in the short bowel syndrome in paediatrics was effective and safe in this group of patients, allowing the restoration of intestinal sufficiency or reducing the requirements of parenteral nutrition.
介绍Teduglutide是胰高血糖素样肽2型的合成类似物,最近在欧洲和美国被批准用于儿科,以促进短肠综合征病例的肠道适应。儿童的经验是有限的。客观的这项工作的目的是介绍阿根廷第一个用替杜鲁肽治疗的儿科系列的进展。材料和方法。自2017年以来,对在康复和肠移植病房接受治疗的18岁以下患者记录进行了一项前瞻性研究。在62名患有短肠综合征的儿童中,5名接受了0.05 mg/kg/皮下注射。实现了胃肠外营养需求的诊断、解剖类型和演变。后果短肠综合征的病因:3例先天性畸形:2例闭锁,1例腹裂,年龄较大儿童的两个原因:1例肠扭转和1例腹部创伤。解剖3例2A型、1例2B型和1例3A型患者,剩余肠道长度(平均值和DS)为25.7±19 cm,1例有回盲瓣和结肠,4例为左半结肠。开始肠外营养的年龄为6.2±0.4岁,既往肠外营养时间为7.1±4岁。替鲁肽治疗时间为52.2±39周。所有患者的肠外营养需求减少了56±48%,并可在2周内(治疗第29周和第24周)暂停。BMI/age的z评分(初始0.16±0.3 vs.0.14±1.02)和身高/年龄(-2.01±1.5 vs.-1.76±1.42)均未恶化。结论是,在这组患者中,使用替丁鲁肽作为儿科短肠综合征的替代治疗方案是有效和安全的,可以恢复肠道充足或减少肠外营养的需求。
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引用次数: 2
Neoplasia sólida pseudopapilar del páncreas. Reporte de un caso 胰腺实性假乳头状肿瘤。病例报告
Q4 Medicine Pub Date : 2020-09-28 DOI: 10.52787/SEVF1305
Ignacio Maldonado Schoijet, Javiera Poblete, Sergio Álvarez Diaz, Javier González Moscoso
Background. Solid pseudopapillary neoplasm of the pancreas is an uncommon exocrine pancreatic tumor of epithelial origin, which represents only 1% to 2% of all pancreatic tumors and mainly affects young women. Objective. To describe clinical and imaging features of these rare entity in a symptomatic young woman. Case report. 41-year-old female patient, without morbid history, consulted for intermittent epigastralgia of one-month evolution. Abdominal ultrasound and magnetic resonance imaging demonstrated the presence of a solid-cystic mass of neoplastic appearance in the body-tail of the pancreas. The case was presented to the institutional hepato-biliary committee where surgical resection was decided. Discussion. Although solid pseudopapillary neoplasm of the pancreas are very uncommon pancreatic tumors, it is necessary to keep them within the differential diagnosis on the one hand due to their low but existing malignant potential and on the other hand due to their good prognosis with surgical treatment.
背景。胰腺实性假乳头状肿瘤是一种罕见的上皮来源的外分泌胰腺肿瘤,仅占所有胰腺肿瘤的1%至2%,主要影响年轻女性。目标。描述这些罕见实体的临床和影像学特征在一个有症状的年轻女性。病例报告。患者女,41岁,无病史,因1个月进展的间歇性上腹痛就诊。腹部超声和磁共振成像显示胰腺体尾有一个实性囊性肿块。该病例被提交给机构肝胆委员会,决定手术切除。讨论。胰腺实性假乳头状瘤虽然是一种非常罕见的胰腺肿瘤,但由于其恶性潜能低但存在,且手术治疗预后良好,因此有必要将其纳入鉴别诊断范围。
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引用次数: 0
Drenaje biliar guiado por ultrasonografía endoscópica en la obstrucción biliar maligna, experiencia inicial en un centro de Argentina. Serie de casos 内镜超声引导下胆管引流治疗恶性胆道梗阻,阿根廷中部的初步经验。病例系列
Q4 Medicine Pub Date : 2020-09-28 DOI: 10.52787/DMWG6500
A. Villaverde, J. Pizzala, Ines Oria, Dante Manazzoni, V. H. Abecia, M. Mahler, Dalila Urgiles, M. Marcolongo
When endoscopic retrograde cholangiopancreatography (ERCP) fails or is not feasible for drainage of the bile duct, endoscopic ultrasound-guided biliary drainage (EUS-BD) is a viable option. This technique of drainage has a lower complication rate and a better quality of life concerning percutaneous or surgical drainage. The aim of this work is to show our initial experience in this technique, in patients with malignant bile duct stenosis, in a referral centre. We performed a descriptive study of case series. Five patients with obstructive jaundice of neoplastic origin, in whom ERCP drainage was not feasible, were included EUS-BD was performed. Technical success of 100% was achieved in all cases and clinical success in four cases (80%). Post-procedural bleeding occurred in one patient, and two late complications: infection and prosthetic migration, all of which were resolved with conservative treatment. No serious adverse events were recorded. EUS-BD is a feasible and effective treatment option in selected cases particularly in cases of malignant biliary obstruction, with high technical and clinical success rates. Complications are usually mild and resolve conservatively.
当内窥镜逆行胆管造影(ERCP)失败或无法引流胆管时,超声内镜引导胆管引流(EUS-BD)是一种可行的选择。该引流技术并发症发生率较低,对于经皮或手术引流有较好的生活质量。这项工作的目的是显示我们在这项技术的初步经验,在恶性胆管狭窄的患者,在转诊中心。我们对病例系列进行了描述性研究。5例肿瘤源性梗阻性黄疸患者,经ERCP引流无效,行EUS-BD。所有病例技术成功率100%,临床成功率4例(80%)。1例患者术后出血,2例后期并发症:感染和假体移位,均经保守治疗解决。无严重不良事件记录。EUS-BD是一种可行的、有效的治疗方案,在某些情况下,特别是在恶性胆道梗阻的情况下,具有很高的技术和临床成功率。并发症通常是轻微的,保守地解决。
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引用次数: 1
Síndrome de Boerhaave. Reporte de un caso y revisión de la literatura 布尔哈夫综合征。案例报告和文献综述
Q4 Medicine Pub Date : 2020-09-28 DOI: 10.52787/RMGG1255
P. Chiaradia, N. Larrañaga, Nicolás Roccatagliata, Mariángela Paba, Esteban Jeanmaire, D. Peralta, Gastón Clemente Ochoteco, J. Vallejos
The esophageal perforation is a well-documented clinical entity, with high morbidity and mortality rates. Although the etiology is usually iatrogenic, it can occur spontaneously without any known pre-existing esophageal patology. Boerhaave first described it in relation to the increased intra-abdominal pressure. Upon clinical suspicion (for the Mackler’s triad), further radiological studies (plain radiograph, chest radiograph with water-soluble contrast medium and computer tomography) are a key factors for a timely and precise diagnosis, leading to adequate treatment and managment. The objective of this study is to present a case report and a bibliographical review of the patology and its radiological signs.
食管穿孔是一个有充分证据的临床实体,具有较高的发病率和死亡率。尽管病因通常是医源性的,但它可以自发发生,而没有任何已知的预先存在的食管病变。Boerhaave首先描述了它与腹腔内压力增加的关系。根据临床怀疑(对于Mackler氏三联征),进一步的放射学研究(平片、水溶性造影剂胸部X线片和计算机断层扫描)是及时准确诊断的关键因素,有助于进行充分的治疗和管理。本研究的目的是提出一个病例报告和文献综述的补丁学及其放射学标志。
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引用次数: 0
Fístula colecistocolónica: abordaje dual endoscópico. Reporte de un caso 胆囊结肠瘘:内镜双重入路。病例报告
Q4 Medicine Pub Date : 2020-09-28 DOI: 10.52787/BGHP2336
C. Curvale, M. Guidi, Raul Matanó, J. María, Dante Manazzoni, Ignacio Málaga
Cholecystocolonic fistula is an unusual and late complication of cholelithiasis. The symptoms usually are nonspecific and most cases are diagnosed intraoperatively. Our patient was a female, 75 years old, smoker, with a severe aortic stenosis history. She had a 6-month evolution diarrhea associated with weight loss, coagulopathy and aerobilia in abdominal ultrasound. On behalf of the clinic manifestations, cholecystocolonic fistula was suspected so an abdominal computer tomography scan and a cholangioresonance confirmed this suspicion. Given the patient comorbidities, we decided not to perform a surgical approach. An endoscopic retrograde cholangiography with extraction of choledocolithiasis and placement of a fully covered self-expanding metallic stent was associated with a video colonoscopy and closure of the colonic fistula with a clip device. The patient had a favourable evolution and was discharged on the second day post-procedure. After 3 months of follow-up, she did not present diarrhea and has recovered her weight loss and nutritional status. Given the unusual nature of the case and the significance of the preoperative diagnosis, which allowed us to carry out a minimally invasive treatment, we believe that its report is useful. We place special emphasis on the aerobic triad, alteration of the prothrombin concentration and chronic diarrhea that allowed us to suspect the diagnosis.
胆囊结肠瘘是胆囊结石的一种不常见的晚期并发症。症状通常是非特异性的,大多数病例是在手术中诊断出来的。我们的患者是一名女性,75岁,吸烟者,有严重主动脉狭窄病史。她患有6个月的进化性腹泻,与体重减轻、凝血障碍和腹部超声检查中的胆汁增多有关。就临床表现而言,胆囊结肠瘘被怀疑,因此腹部计算机断层扫描和胆管共振证实了这一怀疑。考虑到患者的合并症,我们决定不进行外科手术。内窥镜逆行胆管造影术,取出胆管结石并放置完全覆盖的自膨胀金属支架,与视频结肠镜检查和用夹子装置闭合结肠瘘相关。患者病情好转,术后第二天出院。经过3个月的随访,她没有出现腹泻,体重减轻和营养状况已经恢复。鉴于该病例的不寻常性质和术前诊断的重要性,使我们能够进行微创治疗,我们相信其报告是有用的。我们特别强调有氧三联征、凝血酶原浓度的改变和慢性腹泻,这使我们能够怀疑诊断。
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引用次数: 0
Solución del caso. Vecinos que no se encuentran frecuentemente 案例解决方案。不经常见面的邻居
Q4 Medicine Pub Date : 2020-09-28 DOI: 10.52787/GCTB3010
Valeria Porto, Aldana Martin, M. Arias
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引用次数: 0
Vecinos que no se encuentran frecuentemente 不经常见面的邻居
Q4 Medicine Pub Date : 2020-09-28 DOI: 10.52787/IVLI5361
Valeria Porto, Aldana Martin, M. Arias
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引用次数: 0
Frecuencia y comportamiento epidemiológico e histológico en las neoplasias gastrointestinales asociadas a los pacientes portadores de VIH en el Hospital Juárez de México 墨西哥华雷斯医院hiv患者胃肠道肿瘤的频率、流行病学和组织学行为
Q4 Medicine Pub Date : 2020-09-28 DOI: 10.52787/JZEU3893
Andy Gabriel Rivera Flores, J. Rocha, F. Zamarripa-Dorsey, Scherezada Mejía Loza
Background. The gastrointestinal tract is one of the most common sites for the development of primary neoplasms in the patients with a pre-existing infection with the human immunodeficiency virus (HIV). Approximately it is considered that the 40% of HIV patients will develop some type of cancer and there is a common observation that neoplasms are more aggressive in these patients. Only Kaposi’s sarcoma and non- Hodgkin’s lymphoma are located in the gastrointestinal tract in a primary way and are considered as defining acquired immunodeficiency syndrome (AIDS). There is another group of non-defining AIDS Neoplasm, but these are more frequent in these patients, such as anal and the colon neoplasia. Objectives. are to determine the frequency, epidemiology and histology of neoplasia’s of gastrointestinal malignancies associated with patients with HIV. Material and methods. It was a descriptive, cross-sectional and retrospective study conducted in the pathology service of Hospital Juárez de México from 2006 to 2015. The results were analyzed with relative and central frequency measurements to obtain percentages, mean, average and deviation standard. Results. We included 75 HIV patients associated with a Gastrointestinal cancer. The average age was 35.4 ± 8.2 with predominance of the male gender in 83%. The most frequent site of localization was the colon and the rectum with 43% of the cases. The service that most referred was oncology with 57%. The predominant histological type was adenocarcinoma (35%). Conclusions. Gastrointestinal neoplasia in patients with HIV is most frequently seen in the colon and the rectum, with adenocarcinoma being the most common histological type.
背景。胃肠道是先前感染人类免疫缺陷病毒(HIV)的患者发生原发性肿瘤最常见的部位之一。大约40%的HIV患者被认为会发展成某种类型的癌症,并且有一个普遍的观察,肿瘤在这些患者中更具侵袭性。只有卡波西肉瘤和非霍奇金淋巴瘤原发于胃肠道,被认为是获得性免疫缺陷综合征(艾滋病)的定义。还有一组不明确的艾滋病肿瘤,但这些在这些患者中更常见,如肛门和结肠肿瘤。目标。目的:确定与HIV患者相关的胃肠道恶性肿瘤的发生频率、流行病学和组织学。材料和方法。本研究是一项描述性、横断面和回顾性的研究,于2006年至2015年在Juárez de m西戈医院病理服务部进行。用相对频率和中心频率测量对结果进行分析,得到百分比、平均值、平均值和偏差标准。结果。我们纳入了75例与胃肠道癌症相关的HIV患者。平均年龄35.4±8.2岁,以男性为主,占83%。最常见的定位部位是结肠和直肠,占43%。被提及最多的是肿瘤科,占57%。主要组织学类型为腺癌(35%)。结论。HIV患者的胃肠道肿瘤最常见于结肠和直肠,腺癌是最常见的组织学类型。
{"title":"Frecuencia y comportamiento epidemiológico e histológico en las neoplasias gastrointestinales asociadas a los pacientes portadores de VIH en el Hospital Juárez de México","authors":"Andy Gabriel Rivera Flores, J. Rocha, F. Zamarripa-Dorsey, Scherezada Mejía Loza","doi":"10.52787/JZEU3893","DOIUrl":"https://doi.org/10.52787/JZEU3893","url":null,"abstract":"Background. The gastrointestinal tract is one of the most common sites for the development of primary neoplasms in the patients with a pre-existing infection with the human immunodeficiency virus (HIV). Approximately it is considered that the 40% of HIV patients will develop some type of cancer and there is a common observation that neoplasms are more aggressive in these patients. Only Kaposi’s sarcoma and non- Hodgkin’s lymphoma are located in the gastrointestinal tract in a primary way and are considered as defining acquired immunodeficiency syndrome (AIDS). There is another group of non-defining AIDS Neoplasm, but these are more frequent in these patients, such as anal and the colon neoplasia. Objectives. are to determine the frequency, epidemiology and histology of neoplasia’s of gastrointestinal malignancies associated with patients with HIV. Material and methods. It was a descriptive, cross-sectional and retrospective study conducted in the pathology service of Hospital Juárez de México from 2006 to 2015. The results were analyzed with relative and central frequency measurements to obtain percentages, mean, average and deviation standard. Results. We included 75 HIV patients associated with a Gastrointestinal cancer. The average age was 35.4 ± 8.2 with predominance of the male gender in 83%. The most frequent site of localization was the colon and the rectum with 43% of the cases. The service that most referred was oncology with 57%. The predominant histological type was adenocarcinoma (35%). Conclusions. Gastrointestinal neoplasia in patients with HIV is most frequently seen in the colon and the rectum, with adenocarcinoma being the most common histological type.","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45493857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Acta Gastroenterologica Latinoamericana
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