VALORACIÓN DEL TIEMPO DE TRÁNSITO COLÓNICO (TTC) EN EL DIAGNÓSTICO DEL ESTREÑIMIENTO CRÓNICO FUNCIONAL (ECF) Y SU RELACIÓN CON LOS DATOS DE UN DIARIO CLÍNICO (30 DÍAS)

Introduccion El estrenimiento es un sintoma relatado por el paciente y el medico verifica que cumple los criterios consensuados para sentar el diagnostico de ECF. Para algunos autores el TTC seria el metodo objetivo para la definicion de estrenimiento. Objetivos Relacionar los datos clinicos recogidos mediante diario de 30 dias con el TTC determinado por marcadores radioopacos en pacientes con ECF. Material y metodos Grupo de estudio constituido por 220 pacientes diagnosticados de ECF (Roma II) de edad media 38,3±15 anos (IC95% 36,3–40,3, mediana 37 anos), integrado por 204 mujeres (38,4±15,2, IC95% 36,3–40,5, mediana 37) y 16 hombres (36,1±12,9, IC95% 29,2–43, mediana 31,5 anos). Se han re…

RELACIÓN DE COMPLICACIONES LOCALES EN PANCREATITIS AGUDA CON LA PERSISTENCIA DE LAS COMPLICACIONES SISTÉMICAS

Antecedentes De acuerdo con la clasificacion de Atlanta, la pancreatitis aguda grave se define por la presencia de complicaciones locales (CL) y/o sistemicas (CS). Recientemente se ha sugerido que aquellos pacientes con complicaciones sistemicas de inicio (CSI) que aparecen en la primera semana, pero duran menos de 48 horas, no deberian considerarse como indicadores de gravedad. Objetivo Analizar la evolucion y aparicion de complicaciones locales en pacientes con Pancreatitis Aguda (PA) en funcion de la presencia o no de CSI transitorias o permanentes. Metodos Se han recogido prospectiva y consecutivamente todos los pacientes con un primer episodio de PA entre enero de 2000 y diciembre de 2…

Prevalence of silent fecal and urinary incontinence in women from the town of Teruel

OBJECTIVES To study the prevalence of fecal (FI) and urinary incontinence (UI) in women from Teruel (Spain), as well as the clinical conditions associated with these disorders. METHODS We studied prospectively women with an age range of 20-64 years who were randomly selected from the population seen in a primary care center because of medical disorders not related to incontinence. Patients with functional or cognitive impairment were excluded. Medical and obstetric antecedents, as well as the type and frequency of incontinence symptoms were collected in a questionnaire. RESULTS Out of 115 women, 103 completed the study (mean age: 41+/-12 years range 20-64). UI was present in 34.9% (stress 3…

Recurrence of Acute Gallstone Pancreatitis and Relationship with Cholecystectomy or Endoscopic Sphincterotomy

To determine the prevalence of recurrence of gallstone pancreatitis, its clinical features, and the presence of prognostic factors of recurrence.From January 1, 2000 to August 31, 2003, 233 patients admitted with acute gallstone pancreatitis (AGP) were prospectively studied. Patients were divided into two groups: recurrent and nonrecurrent group. Clinical, analytical, radiological, prognostic parameters, and severity (Atlanta criteria) were assessed, along with the performance of cholecystectomy or endoscopic sphincterotomy (ES). Clinical features of recurrence were analyzed. Univariate (chi(2), Student's t-test) and multivariate tests were performed. Statistical significance was assumed if…

Absence of cardiovascular autonomic dysfunction and vagal pancreatic impairment in idiopathic achalasia of the oesophagus

Abstract  Extra-oesophageal autonomic dysfunction in idiopathic achalasia is not well documented, due to contradictory results reported. We aimed to study the cardiovascular and pancreatic autonomic function in patients with idiopathic achalasia. Thirty patients with idiopathic achalasia (16M/14F; 34.5 ± 10.8 years) and 30 healthy volunteers (13M/17F; 34.8 ± 10.7 years) were prospectively studied. Age >60 years and conditions affecting results of autonomic evaluation were excluded. Both groups underwent the sham feeding test and plasmatic levels of pancreatic polypeptide (PP) were determined by radioimmunoassay (basal, at 5, 10, 20 and 30 min). Cardiovascular parasympathetic (deep breathing…

Therapeutic effects of different doses of botulinum toxin in chronic anal fissure

PURPOSE: The aim of this study was to evaluate the clinical and manometric results of three different doses of botulinum toxin and two methods of injection for the treatment of chronic idiopathic anal fissure. METHODS: Sixty-nine patients with chronic anal fissure were included in a nonrandomized, prospective trial of intrasphincteric injection of botulinum toxin. All patients reported postdefecatory anal pain lasting more than two months. Scoring systems were developed for anal pain, bleeding, and defecatory difficulty. Maximum resting and squeeze anal pressures were determined before and one month after treatment. Twenty-three patients undergoing a 5-U injection of diluted botulinum toxin…

Oesophageal motility disorders in type 1 diabetes mellitus and their relation to cardiovascular autonomic neuropathy.

The relationship between cardiovascular autonomic neuropathy (CVAN) and oesophageal dysfunction in diabetes mellitus has not been well established because reports are contradictory. The aim of this study was to assess oesophageal function and its correlation with CVAN in type 1 diabetic patients without oesophageal symptoms. Forty-six type 1 diabetic patients without oesophageal symptoms (DG) and 34 healthy volunteers (CG) were studied. Both groups underwent CVAN tests and oesophageal manometry and pH-metry. Differences between groups regarding results of cardiovascular autonomic tests and oesophageal studies were statistically analysed. Compared with the CG, the DG group showed insufficien…

Outcome of esophageal function and 24-hour esophageal pH monitoring after vertical banded gastroplasty and Roux-en-Y gastric bypass.

Background: One of the co-morbidities frequently associated with morbid obesity is gastro-esophageal reflux disease (GERD), present in >50 % of morbidly obese individuals. We compared the anti-reflux effect of vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGBP), and their effect on esophageal function. Methods: 10 patients underwent VBG and 40 patients underwent RYGBP. Anthropometric parameters, symptomatology of GERD, esophageal manometry (EM), isotopic esophageal emptying (IEE) and 24hr esophageal pH monitoring were recorded in all patients preoperatively, and at 3 months and 1 year postoperatively. Results: Preoperatively, there was a high prevalence of GERD, symptoma…

Long-term follow-up (42 months) of chronic anal fissure after healing with botulinum toxin.

Abstract Background & Aims: Botulinum toxin is an effective treatment in idiopathic chronic anal fissure, but the long-term outcome after healing is not well documented. We analyzed the long-term outcome of patients in whom an anal fissure had healed after botulinum toxin injection and the factors contributing to recurrence. Methods: Fifty-seven patients who had completely healed 6 months after injection of botulinum toxin were reassessed every 6 months. The follow-up was 42 months in all patients. Clinical and manometric differences between the permanently healed and the relapsed group were statistically analyzed. Results: Four patients were lost to follow-up. A fissure recurrence was show…

Unstimulated salivary flow rate, pH and buffer capacity of saliva in healthy volunteers

Objectives: To assess the salivary flow rate, pH, and buffer capacity of healthy volunteers, and their relationships with age, gender, obesity, smoking, and alcohol consumption, and to establish the lower-end value of normal salivary flow (oligosialia). Methods: A prospective study was conducted in 159 healthy volunteers (age > 18 years, absence of medical conditions that could decrease salivary flow). Unstimulated whole saliva was collected during ten minutes, and salivary flow rate (ml/min), pH, and bicarbonate concentration (mmol/l) were measured using a Radiometer ABL 520. The 5 percentile of salivary flow rate and bicarbonate concentration was considered the lower limit of normality. R…

Methotrexate induced sprue-like syndrome

A 52 year-old male patient diagnosed of ankylosing spondylitis presented with an iron deficiency anemia after a ten-month treatment of methotrexate. He did not respond to treatment with oral iron not a proton pump inhibitor and an upper endoscopy was performed. The histological study of the duodenal biopsies showed villus atrophy. After removing the methotrexate, administrating intramuscular iron and undertaking a gluten-free diet, the histological and analytical alterations progressively resolved.

Elevated serum eotaxin levels in patients with inflammatory bowel disease.

OBJECTIVE: Eotaxin is a recently characterized chemokine with potent and selective chemotactic activity for eosinophils. Previous studies indicating that eosinophils accumulate and become activated in inflammatory bowel disease (IBD) led us to hypothesize that eotaxin is potentially involved in the pathophysiology of IBD and, therefore, that eotaxin would be increased in the serum of patients with IBD. The objective of this study was to test those assumptions. METHODS: We investigated 72 patients with IBD, 35 with ulcerative colitis, and 37 with Crohn’s disease. A total of 27 patients had active and 45 inactive disease; 26 were receiving corticosteroids. Eotaxin serum levels were determined…

A risk score system for identification of patients with upper-GI bleeding suitable for outpatient management.

Abstract Background The aim of this study was to develop a risk score system for identification of patients with upper-GI hemorrhage who are suitable for outpatient management. Methods From a prospective cohort of 983 consecutive patients with upper-GI hemorrhage not associated with portal hypertension, 581 cases that did not meet pre-established criteria for admission were selected, and a logistic regression analysis was performed to identify factors associated with two adverse outcomes: recurrent bleeding and/or the need for emergency surgery. The risk score system was developed by using the beta coefficients of the logistic model, and its performance was evaluated. The results of this mo…

Malondialdehyde in early phase of acute pancreatitis

Aims: to assess oxidative stress in acute pancreatitis, its evolution over time and its relationship with the severity of the disease. Methods: during a two-year period, patients with acute pancreatitis with less than 24 hours of pain were evaluated. Serum was obtained the first, second and fourth day from admittance, if complications were detected, and after recovery. Malondialdehyde was determined by high performance liquid chromatography. Twenty healthy volunteers constituted the control group. Malondialdehyde between groups was compared with Mann-Whitney and Kruskal-Wallis tests; malondialdehyde evolution was studied with Wilcoxon test. Results: one hundred and sixty-nine patients were …

UTILIDAD DE LA LATENCIA MOTORA TERMINAL DE NERVIOS PUDENDOS EN PACIENTES CON INCONTINENCIA ANAL

Antecedentes El examen de la Latencia Motora Terminal de Nervios Pudendos (LMTNP) se utiliza habitualmente para valorar la existencia o no de Neuropatia Pudenda (NP). Sin embargo, la utilidad de esta tecnica es motivo de controversia dado que unicamente evalua las fibras nerviosas de conduccion rapida. Objetivos Establecer la prevalencia de NP medida mediante la LMTNP en pacientes con Incontinencia anal (IA) y evaluar la relacion existente entre NP y funcion ano-rectal en estos pacientes. Metodos Se revisaron un total de 380 pacientes con IA, 348 (91,6%) mujeres, con edad media de 59 anos (rango 15–84 anos). Todos ellos fueron estudiados mediante ecografia endoanal, manometria ano- rectal, …

DATOS CLÍNICOS NO INVASIVOS RELACIONADOS CON LA MORTALIDAD DE PACIENTES CON INGESTA DE CÁUSTICOS

Introduccion La mortalidad inmediata en la ingesta causticos se relaciona con la intensidad de las lesiones esofagogastricas; ocasionalmente no es factible realizar endoscopia por malas condiciones clinicas del paciente/negativa de este/no disponibilidad de la tecnica; en esta situacion la valoracion de la gravedad del paciente y posible evolucion fatal se debe realizar mediante datos clinicos y analiticos. Objetivos Identificar los datos clinicos relacionados con la mortalidad de pacientes con ingesta de causticos. Material y metodos Estudio prospectivo protocolizado (1995–2008) incluyendo datos demograficos, clinicos, analiticos, endoscopicos y evolutivos sobre 242 pacientes (107 hombres …

Angiodisplasia intestinal asociada a estenosis subaórtica hipertrófica: ¿una variante del síndrome de Heyde?

Predictive value of the balloon expulsion test for excluding the diagnosis of pelvic floor dyssynergia in constipation

Abstract Background & Aims: The aim of this study was to establish a simple method to exclude the possibility of pelvic floor dyssynergia (PFD) in constipated patients and thus avoid unnecessary expensive physiologic studies. Methods: Patients with suspicion of functional constipation (FC) were studied prospectively between 1994 and 2002, excluding those with severe systemic, psychological, or symptomatic anorectal/colonic disorders or taking medications that might modify symptoms or results of studies. Diagnosis of PFD was established retrospectively by manometric plus defecographic findings according to Rome II criteria. Two groups of patients were identified: FC without PFD (FC group) an…

Dental and periodontal lesions in patients with gastro-oesophageal reflux disease.

Dental erosion has been considered an extraesophageal manifestation of gastro-oesophageal reflux disease, but few reports have studied the relationship between this disease and other periodontal or dental lesions. The aim of this study was to investigate the prevalence of dental and periodontal lesions in patients with gastro-oesophageal reflux disease.A total of 253 subjects were prospectively studied between April 1998 and May 2000. Two study groups were established: 181 patients with gastro-oesophageal reflux disease and 72 healthy volunteers. Clinical assessment, including body mass index and consumption of tobacco and alcohol, was performed in all subjects, as well as a dental and peri…