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Manejo actual de la estenosis de carótida: Tratamiento endovascular comparado con endarterectomía Current management of carotid stenosis: Endovascular treatment versus endarterectomy  [cached]
Elvira Jiménez G,Rafael Oteros F,Fernando Delgado A,Antonio Cano S
Revista Chilena de Radiología , 2012,
Abstract: En estenosis carotidea, la única manera de prevenir nuevos eventos cerebrovasculares era mediante antiagregación. Después de los estudios NASCET y ECST se estableció que la endarterectomía conseguía mejores resultados. Ahora se ha establecido la terapia endovascular como alternativa. Nuestro objetivo es mostrar la evolución de la terapia endovascular en estenosis carotidea, contrastar los resultados entre tratamiento endovascular, médico y quirúrgico y exponer la situación actual de la terapia endovascular. Algunos estudios se realizaron hace décadas y tanto la técnica endovascular como los tratamientos médicos, no son comparables con los de hoy. Varios estudios coinciden en que el stenting beneficia a menores de 70 a os y presenta al menos iguales resultados que la endarterectomía a corto plazo, con mayor tasa de reestenosis a largo plazo. Quedan por resolver la indicación de tratamiento en pacientes asintomáticos o la utilización de sistemas de protección. El tratamiento debe ser individualizado en un equipo multidisciplinar. Antiplatelet therapy used to be the only way to prevent further cerebrovascular events in patients with carotid stenosis. After publication of final results of the European Carotid Surgery Trial (ECST) and North American Symptomatic Carotid Endarterectomy Trial (NASCET), endarterectomy was considered the best treatment option. Currently, endovascular treatment of atherosclerotic carotid artery stenosis has been established as an alternative to surgical endarterectomy. Our aim is to show the evolution of endovascular therapy in carotid stenosis, to compare outcomes between endovascular, medical and surgical treatments, and to analize the current state of endovascular therapy. It is worth underscoring that many of the studies were conducted decades ago and consequently both the endovascular technique and medical treatments used then greatly differ from current practices. Several studies agree stenting benefits patients under 70 years of age and exhibits, at least, same short-term results as endarterectomy, along with higher rate of long-term restenosis. Indication for treatment in asymptomatic patients and the use of protection systems remain an unresolved issue. A multidisciplinary team should implement an individualized treatment plan for each patient.
Current management of gastric cancer
Viúdez-Berral,Antonio; Miranda-Murua,Coro; Arias-de-la-Vega,Fernando; Hernández-García,Irene; Artajona-Rosino,Alicia; Díaz-de-Lia?o,álvaro; Vera-García,Ruth;
Revista Espa?ola de Enfermedades Digestivas , 2012, DOI: 10.4321/S1130-01082012000300006
Abstract: gastric cancer is a disease with high incidence and mortality in our population. the prognosis of patients with this disease is closely related to the neoplasm stage at diagnosis, including the following characteristics of the tumor: extension into the gastric wall thickness, spread to locoregional lymph nodes and the ability to generate distant metastases, as described by the tnm classification. for localized tumors characterized only by invasion of mucosa or submucosa at diagnosis, survival at 5 years is between 70 and 95% with exclusive surgical management; however, when extension into the gastric wall is higher and/or there is locoregional nodal involvement, survival decreases to 20-30% at 5 years. currently, at high-volume centers, the extent of gastrectomy is individualized based on several parameters, which in an increasing number of cases allows a total gastrectomy with d2 lymphadenectomy and preservation of the spleen and pancreas. this improved procedure increases the chance of r0 surgery and improves the relationship between resected and affected lymph nodes, resulting in a decreased risk of the long-term locoregional recurrence. to improve these results, different therapeutic strategies combining chemotherapy or chemoradiotherapy with surgery have been tested. previously, the intergroup 0116 clinical trial, published in 2001, which changed clinical practice in the united states, showed that adjuvant chemoradiotherapy improved survival (from 26 to 37 months overall survival) of these patients. in europe, perioperative chemotherapy has been considered the standard treatment, since the publication of two randomized phase iii trials showed an increase at 5 years survival in the group treated with chemotherapy.
Disección endoscópica de la submucosa (DES) en cáncer gástrico temprano: Estado del arte Endoscopic submucosal dissection (ESD) for early gastric cancer: State of the art
Elías Alfonso Forero Pi?eros,Vitor Arantes,Takashi Toyonaga
Revista Colombiana de Gastroenterologia , 2012,
Abstract: El tratamiento del cáncer gástrico temprano ha experimentado revolucionarios cambios en las últimas décadas con el advenimiento de su manejo endoscópico. Actualmente, la disección endoscópica de la submucosa (DES) es el tratamiento de la mayoría de estas lesiones tempranas, y casi de la mitad de los casos de cáncer gástrico tratados en Japón, gracias al excelente programa de tamización implementado. El objetivo de este artículo de revisión es mostrar el estado actual de las indicaciones y limitaciones de esta técnica junto con una descripción minuciosa de la misma, con miras a facilitar que los médicos endoscopistas latinoamericanos la conozcan y, por ende, a aumentar su utilización y beneficio para nuestros pacientes. Este estudio es realizado por endoscopistas entrenados en este procedimiento en Japón, supervisados por un endoscopista japonés experto (TT), con experiencia de más de 4.000 casos de DES realizados hasta el 2012. The treatment of early gastric cancer has undergone revolutionary changes in the decades since the advent of endoscopic management. Currently, most of these early lesions are treated with endoscopic submucosal dissection (ESD). Due to the excellent screening program implemented in Japan almost half of all cases of gastric cancer there are treated with ESD. The aim of this review article is to facilitate the use of this technique by Latin American endoscopists and thus benefit our patients. To this end we provide a detailed description of ESD, show the current state of indications for this technique, and explain the limitations of this technique. This study was conducted by endoscopists trained in ESD in Japan and supervised by an expert Japanese endoscopist (TT) who had performed more than 4,000 with endoscopic submucosal dissections as of the beginning of 2012
Tratamiento actual de la litiasis vesicular Current treatment of vesicular lithiasis  [cached]
Oscar García Rodríguez
Revista Cubana de Cirugía , 2010,
Abstract: El tratamiento quirúrgico de la litiasis vesicular ha cambiado en los últimos a os. La incorporación de las nuevas conductas en la práctica médica diaria no siempre es inmediata. Se argumentan las razones relativas a cuándo operar a un paciente con cálculos en la vesícula biliar, y se documenta cómo este procedimiento se reserva fundamentalmente para los pacientes sintomáticos, considerando el dolor como el síntoma por excelencia. También se expone cómo se ha enfrentado este cambio. Surgical treatment of vesicular lithiasis has changed in past years. The addition of the new techniques in daily medical practice not always is immediate. Reasons relative to when to operate a patient presenting with gall bladder calculi are argued and documenting how this procedure is mainly reserved for symptomatic patients where pain is considered as a symptom par excellence . Also, it is exposed how this change has been faced.
EUS in the management of gastric cancer
Ioannis S. Papanikolaou,Maria Triantafyllou,Konstantinos Triantafyllou,Thomas Rosch
Annals of Gastroenterology , 2011,
Abstract: In this review we summarize latest data on the role of endoscopic ultrasonography (EUS) in the diagnosis and management of gastric carcinoma. Since its initial introduction in clinical practice, EUS has been considered a valuable tool for the diagnosis and locoregional staging of gastric cancer and a method of inarguable value for the assessment of gastric wall involvement and presence of infiltrated paragastric lymph nodes. Moreover, another application of EUS, i.e. its role in the assessment of early gastric cancer has come into focus, especially nowadays in the era of endoscopic mucosal resection and endoscopic submucosal dissection. These topics, together with other aspects of EUS in gastric cancer are discussed. On the other hand, despite its indisputable value, EUS for gastric cancer evaluation is “threatened” nowadays by other modern cross-sectional imaging methods (including trans-abdominal ultrasound, CT, MRI and PET), whose quality has lately improved. A brief comparison between the available imaging methods, attempts to show that their role ismore complementary than competitive. Keywords endoscopic ultrasonography, EUS, gastric cancer, locoregional staging, TNM Ann Gastroenterol 2011; 24 (1): 9-15
Current status of endoscopic submucosal dissection for the management of early gastric cancer: A Korean perspective  [cached]
Hoon Jai Chun,Bora Keum,Ji Hyun Kim,Sang Young Seol
World Journal of Gastroenterology , 2011, DOI: 10.3748/wjg.v17.i21.2592
Abstract: The early diagnosis of gastric cancer allows patients and physicians to pursue the option of endoscopic resection, which is significantly less invasive than conventional surgical resection. In Korea, the use of endoscopic submucosal dissection (ESD) has been increasing, and many reports on ESD have been published. In addition, Korean gastroenterologists from several hospitals performing ESD have conducted formal meetings to discuss useful information regarding ESD. Here, we discuss the Korean experience with ESD, including outcomes and prospects of endoscopic treatments.
Manejo actual en síndrome de Pierre Robin Current management of Pierre Robin syndrome  [cached]
Carmen Gloria Morovic I
Revista chilena de pediatría , 2004,
Abstract: Introducción: La dificultad respiratoria del síndrome Pierre Robin (SPR) puede ser determinante en su pronóstico y calidad de vida. Este estudio evalúa la eficacia de la distracción mandibular como tratamiento precoz en PRS con dificultad respiratoria severa. Pacientes y Método: Lactantes SPR controlados en Unidad Cirugía Plástica Hospital Luis Calvo Mackenna entre enero 1998 y marzo 2003. La indicación de distracción se basa en evaluación clínica, radiología, nasofibroscopía, saturación de oxígeno y/o polisomnografía. El seguimiento tardío evalúa complicaciones, evolución nutricional, crecimiento y desarrollo facial. Resultados: 23/31 lactantes SPR se les realizó distracción mandibular, presentando 100% alivio de sintomatología obstructiva. Dos casos presentaban traqueotomía desde RN, que se retiraron durante el procedimiento. Dos casos presentaban hipertensión pulmonar que revirtieron post distracción. Hubo mejoría significativa de las curvas de crecimiento ponderal. Conclusión: La distracción mandibular es un método efectivo en lactantes con micrognatia, aliviando la obstrucción respiratoria, facilitando alimentación, evitando raqueotomías y/o permitiendo decanulación precoz Introduction: Airway obstruction in children with Pierre Robin syndrome (PRS)could be an important determinant of the prognosis and quality of life of the child. Objective: to analyze mandibular distraction as an early management in children with PRS and airway obstruction. Method: PRS patients treated between January 1998 and March 2003 at the Luis Calvo Mackenna Hospital were included. Clinical evaluation, lateral cephalograms, nasoendoscopy, oxygen saturation and polysomnograms were used as parameters in the decision to perform mandibular distraction. Long term follow up included evaluation of complications, nutritional evolution, facial growth and development. Results: 23/31 PRS patients underwent mandibular distraction, relieving airway obstruction in all the cases. 2 cases underwent tracheotomy at birth that were removed during the process. 2 patients had pulmonary hypertension and reversed clinical signs after distraction. Their weight charts improved significantly after the operation. Conclusion: Mandibular distraction is a successful method for young patients with PRS to relieve airway onstruction, improve feeding and avoid tracheotomy or early decannulation in previously tracheotomized patients
Tumores estromales gastrointestinales: enfoque actual Presentación de seis casos Gastrointestinal stromal tumors: current management and report of six cases
Manuel Santiago Mosquera Paz,Akram Kadamani Abiyoma,Gabriel Sánchez de Guzmán,Luis Jaime Téllez
Revista Colombiana de Cirugía , 2004,
Abstract: Se presentan seis pacientes con diagnóstico inmuno-histoquímico de tumores estromales gastrointestinales y extragastrointestinales localizados en diferentes órganos del tracto digestivo y otras áreas, estudiados e intervenidos en nuestra institución a partir del a o 2000, con seguimiento en su evolución clínica hasta la fecha por los servicios de hemato- oncología y cirugía; a excepción de una paciente. En su mayoría sin diagnóstico claro en su preoperatorio o con alta sospecha de presentar tumores mesenquimales complicados por masa compresiva, oclusión intestinal o sangrado. Se plantean de manera concreta los aspectos relevantes en su diagnóstico y clasificación patológica, manejo quirúrgico y tratamiento en relación a la literatura actual, exponiendo algunas de las controversias existentes. Además de fijar nuestra posición como grupo terapéutico frente a esta neoplasia, con base en la revisión realizada y nuestra limitada experiencia. We hereby report six patients with inmunohistochemical diagnosis of GIST located in different organs of the gastrointestinal tract and other areas, who were managed at our institution, except one case, starting in 2000 and followed until now in the services of hemato-oncology and surgery. The majority of these patients did not have a clear preoperative diagnosis or presented with high suspicion of a mesenchyunal tumor, complicate by a compressing mass, intestinal obstruction, or bleeding. We describe the most relevant aspects pertinent to diagnosis and pathologic classification, surgical management in the context of current literature reports, with emphasis on the ongoing controversies. Furthermore, we define our policy as a group on the basis of the literature review and the careful analysis of our limited experience.
Estado actual del manejo de la fiebre en ni os. Current status of management of fever in children
Fabian Alberto Rueda Zambrano, MD,Paola Caceres Corredor, MD
MedUNAB , 2010,
Abstract: Es muy frecuente en el ambiente médico y entre los padres de familia el uso y abuso de antipiréticos buscando disminuir abruptamente la temperatura, mejorar los síntomas derivados de la fiebre y contrarrestar las reacciones adversas de la misma. Por otro lado, existen diferentes conceptos acerca de la elección del antipirético más eficaz y seguro en ni os y su ruta de administración, así como su utilidad en la prevención de convulsiones febriles, entre otras. Este artículo pretende dar claridad a las controversias en el manejo de la fiebre mediante la revisión de la literatura, incluyendo solo ensayos clínicos, meta análisis, guías de manejo y revisiones de tema, publicadas en las dos últimas décadas. Para tal fin se revisaron las bases de datos Cochrane, PubMed y Medscape.Antipyretics are very often used between physicians and parents to treat fever and relief its symptoms and prevent vaccination side effects. Indeed, there is a misconception about the prevention of recurrence of febrile seizures with antipyretics and this leads to overdoses, side effects and, therefore, more parent′s anxiety. There are contradictory concepts about the election of safer and better antipyretic in children and its better administration via: oral and rectal paracetamol, ibuprofen, ketoprofeno, nimesulide, oral and intramuscular metamizol, paracetamol plus ibuprofen and ponging/lukewarm bath. All these alternatives have been studied by many researchers without consensus because more trials with bigger samples and longer time of study are needed. No clarity exists between doctors and parents about the antipyretic's effects over febrile seizure prevention and prophylaxis of post vaccine symptoms. This article pretends to find actual evidence about fever , its implications and use of antipyretics in children through searching on data bases like PubMed, Cochcrane, and Medscape.
Helicobacter pylori: Tratamiento actual. Un importante reto en gastroenterología Helicobacter pylori: Current treatment An important challenge for gastroenterology  [cached]
William Otero Regino,Alba Alicia Trespalacios,Elder Otero
Revista Colombiana de Gastroenterologia , 2009,
Abstract: Desde cuando se descubrió Helicobacter pylori, su erradicación ha constituido uno de los más importantes retos en gastroenterología. En muchas partes se desconocen las prevalencias de resistencia primaria del microorganismo a los diferentes antibióticos que empíricamente utilizan y por no realizar de rutina pruebas para verificar la erradicación, en la práctica diaria, se ignora la efectividad de los esquemas prescritos. Conocer estos dos factores, permite, no solo identificar los que aún persisten infectados, sino también elegir la próxima terapia de rescate de una manera más racional. El no disponer de la información sobre resistencia pretratamiento es un inconveniente que impide evaluar el impacto de la resistencia con el fracaso terapéutico. A nivel mundial, la triple terapia estándar ha perdido la eficacia que tenía en el pasado y la terapia secuencial no es igualmente eficaz en todos los sitios, en especial en regiones en donde existe alta resistencia a claritromicina y metronidazol. Los esquemas con levofloxacina han demostrado eficacia en triples terapias de primera línea o como terapia de rescate, pero es necesario que cada región adopte sus propios esquemas de tratamiento fundamentados en pruebas de susceptibilidad y en estudios farmacogenómicos. Since when Helicobacter pylori was discovered, the eradication has been one of the most important challenges in gastroenterology. In many places, the prevalence of primary resistance of microorganism to the different antibiotics is not known, and these are used empirically. In daily practice, no routine test is used to verify the eradication, and therefore do not know the effectiveness of the schemes. Knowing these two factors is possible identify those still infected and choose the next rescue therapy in a rational form. The absence of information on pre-treatment resistance is a problem that cannot measure the impact of resistance to therapeutic failure. A global level, the standard triple therapy has lost the effectiveness that it had in the past and sequential therapy is not equally effective everywhere, especially in regions where there is high resistance to clarithromycin and metronidazole. The schemes have proved effective with levofloxacin triple therapies as first line therapy or rescue, but it is necessary that each region takes its own schemes of treatment based on susceptibility tests and pharmacogenomic studies.
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