RESUMEN
Interleukin 6 (IL-6) is a pro-inflammatory cytokine involved in the development of rheumatoid arthritis (RA). The present study aimed to determine the possible association of the IL6 (rs1800795, G > C) polymorphism with RA susceptibility, disease progression and protein serum levels. Distribution of IL6 alleles and genotypes was similar in RA patients and controls. As expected, patients before induction of anti-tumour necrosis factor agents had significantly higher IL-6 levels as compared with controls (P = 0.002). The CC homozygous patients were characterised with the highest average concentrations of this pro-inflammatory cytokine before treatment (P = 0.028), and they also more frequently presented with more active disease (P = 0.048). These results imply that the IL6 rs1800795 CC homozygosity may play a rather unfavourable role in RA.
Asunto(s)
Artritis Reumatoide/genética , Predisposición Genética a la Enfermedad , Homocigoto , Interleucina-6/genética , Polimorfismo de Nucleótido Simple , Adulto , Anciano , Alelos , Antirreumáticos/uso terapéutico , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/inmunología , Estudios de Casos y Controles , Femenino , Expresión Génica , Frecuencia de los Genes , Humanos , Interleucina-6/sangre , Interleucina-6/inmunología , Masculino , Persona de Mediana Edad , Polonia , Índice de Severidad de la Enfermedad , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Factor de Necrosis Tumoral alfa/sangre , Factor de Necrosis Tumoral alfa/genética , Factor de Necrosis Tumoral alfa/inmunologíaRESUMEN
Whether to restart or continue the series when anthrax vaccine doses are missed is a frequent medical management problem. We applied the noninferiority analysis model to this prospective study comparing the Bacillus anthracis protective antigen (PA) IgG antibody response and lethal toxin neutralization activity at day 28 to the anthrax vaccine adsorbed (AVA) (Biothrax®) administered on schedule or delayed. A total of 600 volunteers were enrolled: 354 in the on-schedule cohort; 246 in the delayed cohort. Differences were noted in immune responses between cohorts (p<0.0001) and among the racial categories (p<0.0001). Controlling for covariates, the delayed cohort was non-inferior to the on-schedule cohort for the rate of 4-fold rise in both anti-PA IgG concentration (p<0.0001) and TNA ED50 titers (p<0.0001); as well as the mean log10-transformed anti-PA IgG concentration (p<0.0001) and the mean log10-transformed TNA ED50 titers (p<0.0001). Providing a missed AVA dose after a delay as long as 5-7 years, elicits anti-PA IgG antibody and TNA ED50 responses that are robust and non-inferior to the responses observed when the 6-month dose is given on-schedule. These important data suggest it is not necessary to restart the series when doses of the anthrax vaccine are delayed as long as 5 or more years.
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Vacunas contra el Carbunco/administración & dosificación , Carbunco/prevención & control , Formación de Anticuerpos , Esquemas de Inmunización , Adolescente , Adulto , Anticuerpos Antibacterianos/sangre , Anticuerpos Neutralizantes/sangre , Antígenos Bacterianos/inmunología , Bacillus anthracis , Toxinas Bacterianas/inmunología , Femenino , Humanos , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Pruebas de Neutralización , Estudios Prospectivos , Factores de Tiempo , Adulto JovenRESUMEN
The prevalence of autoantibodies in multiple sclerosis (MS) patients and their clinical associations differ between various studies. This study investigated antiphospholipid and antinuclear antibodies in 85 patients with multiple sclerosis (MS) and clinically isolated syndrome (CIS) with regard to their association with demographic features, MS specific clinical features and symptoms of connective tissue diseases. Autoantibodies tested included antinuclear antibodies (ANA) with their specificities and anticardiolipin (aCL) and anti-beta-2-glycoprotein I (anti-ß2GPI) antibodies. Antinuclear antibodies were more prevalent in MS patients than in controls (63.5% vs. 3.3%; p < 0.01) and in 19% of patients specific antinuclear antibodies were detected. Anti-ß2GPI IgM antibodies were more frequent in MS patients than in the control group (20% vs. 3.3%; p < 0.05). The frequency of anticardiolipin antibodies did not differ between MS patients and controls. MS patients seropositive for ANA and extractable nuclear antigens (ENA) had significantly shorter disease duration than seronegative patients (p < 0.05) and a lower disability score (Expanded Disability Status Score; EDSS) (p < 0.05). Anti-ß2GPI antibodies were more frequent in patients with secondary progressive MS (SP-MS) and specific ANA antibodies were more frequent in patients with clinically isolated syndrome (CIS) (p < 0.05). The presence of autoantibodies was not associated with the predominant site of neurological involvement or the clinical features of connective tissue diseases.
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Anticuerpos Antinucleares/sangre , Anticuerpos Antifosfolípidos/sangre , Enfermedades del Tejido Conjuntivo/inmunología , Esclerosis Múltiple Crónica Progresiva/inmunología , Esclerosis Múltiple Recurrente-Remitente/inmunología , Adolescente , Adulto , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Enfermedades del Tejido Conjuntivo/sangre , Enfermedades del Tejido Conjuntivo/diagnóstico , Evaluación de la Discapacidad , Progresión de la Enfermedad , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple Crónica Progresiva/sangre , Esclerosis Múltiple Crónica Progresiva/diagnóstico , Esclerosis Múltiple Recurrente-Remitente/sangre , Esclerosis Múltiple Recurrente-Remitente/diagnóstico , Polonia , Pronóstico , Pruebas Serológicas , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
BACKGROUND AND STUDY AIMS: Capsule endoscopy (CE) is an effective means of investigating the small bowel in patients with gastrointestinal diseases. Computerized reports are frequently used in endoscopy, and the Minimal Standard Terminology (MST) has been promoted by endoscopy societies as the official vocabulary for endoscopy. The aims of this study were to design a lexicon for CE reports based on the principles of the MST and to validate lists of terms for describing findings and reasons for performing a CE by cross-matching them with the results of CE procedures collected during ongoing clinical studies. MATERIALS AND METHODS: A consensus-based Capsule Endoscopy Structured Terminology (CEST) was developed by experts involved in CE studies. Lists of terms suitable for CE were designed for the various sections of an endoscopic report. They were then correlated with the corresponding MST lists for duodenal and intestinal endoscopy. The results of 766 CE procedures, collected in an electronic case record form (eCRF), were analyzed to provide lists of reasons for performing the procedures and of the findings. The eCRF provided only a limited number of items for each data field, along with free-text facilities. Only descriptions pertaining to the small bowel were analyzed. Lists of terms were then reviewed by two experts to group obvious synonyms. The accuracy of the CEST was defined beforehand as the capability to describe 90 % of entries. RESULTS: A total of 766 CE procedures were analyzed. The eCRF included 824 entries as reasons for the examination in 655 CEs (1.3 per procedure). These represented 122 different expressions. After grouping of synonyms, 28 expressions remained. Among them, 10 were matched with terms from the list of reasons for performing CE offered in the CEST. These were the most frequently used, accounting for 768 entries in this field (93.2 %). All eCRFs contained at least one description of findings. A total of 109 CE procedures were classified as normal (14.3 %). A total of 2624 entries for abnormal findings were recorded for 657 procedures (4.0 per procedure). In all, 213 different expressions were used to describe abnormal findings. After grouping of synonyms, 52 expressions remained. Among these, 27 were matched with terms from the list of findings in the CEST, covering 2403 entries (91.6 %). CONCLUSIONS: In this study, CEST terms were capable of describing more than 90 % of the reasons for performance and of the findings in an unselected set of CE procedures. CEST is therefore suitable for use as the standard lexicon for CE reports. Adopted as a standard, it could significantly improve the quality of the data collected and reported in CE studies.
Asunto(s)
Endoscopía Gastrointestinal/métodos , Enfermedades Intestinales/diagnóstico , Intestino Delgado/patología , Miniaturización , Telemetría/instrumentación , Terminología como Asunto , Humanos , Estudios Retrospectivos , Grabación en VideoRESUMEN
PURPOSE: In patients in whom bone marrow transplantation (BMT) fails, recurrence often occurs at sites known to have contained disease before initiating BMT. The purpose of this study was to find the maximal tolerable dose of locoregional irradiation (LRT) between 1000 and 2000 cGy that could be integrated with our Cytoxan-total body irradiation (TBI) BMT conditioning regimen in the treatment of lymphoma. METHODS AND MATERIALS: Patients had Hodgkin's or non-Hodgkin's lymphoma in chemotherapy-refractory relapse. All patients received LRT to a maximum of three sets of fields encompassing either all current or all previously known sites of disease. Cytoxan-TBI consisted of cyclophosphamide 50 mg/kg daily for 4 days followed by TBI of 1200 cGy given in four fractions. RESULTS: Twenty-one patients were enrolled. Radiation Therapy Oncology Group Grade 3 in-field acute toxicity was observed in 1 patient at each dose level up to 1500 cGy and in 3 of 6 patients receiving 2000 cGy. Clinically evident late toxicities were limited to hypothyroidism and one second malignancy occurring outside the LRT fields. CONCLUSION: Low-dose-rate, LRT with concurrent Cytoxan-TBI before BMT has acceptable rates of in-field toxicity for doses up to 1500 cGy in five fractions. This regimen safely permits the use of a total combined radiation dose of up to 2700 cGy during 2 weeks, with encouraging in-field response rates in treatment-refractory patients.
Asunto(s)
Ciclofosfamida/uso terapéutico , Enfermedad de Hodgkin/tratamiento farmacológico , Enfermedad de Hodgkin/radioterapia , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/radioterapia , Dosis Máxima Tolerada , Irradiación Corporal Total/métodos , Adolescente , Adulto , Anciano , Trasplante de Médula Ósea , Terapia Combinada/efectos adversos , Terapia Combinada/métodos , Relación Dosis-Respuesta en la Radiación , Enfermedad de Hodgkin/mortalidad , Enfermedad de Hodgkin/terapia , Humanos , Linfoma no Hodgkin/mortalidad , Linfoma no Hodgkin/terapia , Persona de Mediana Edad , Dosificación Radioterapéutica , Resultado del Tratamiento , Irradiación Corporal Total/efectos adversosRESUMEN
Borderline personality disorder (BPD) is a disorder characterized by severe disturbances in emotion regulation. In Dialectical Behavior Therapy (DBT), affect dysregulation is seen as a consequence of a transaction between a biological predisposition to emotion vulnerability and invalidating environmental experiences. In the past few years, a growing body of research has accumulated demonstrating the efficacy of DBT in treating severely disordered, chronically suicidal, and substance-dependent individuals with BPD. This article describes a DBT approach to the treatment of emotion regulation in individuals with BPD.
Asunto(s)
Síntomas Afectivos/terapia , Terapia Conductista/métodos , Trastorno de Personalidad Limítrofe/terapia , Adulto , Síntomas Afectivos/psicología , Trastorno de Personalidad Limítrofe/psicología , Femenino , Humanos , Teoría Psicológica , Procesos Psicoterapéuticos , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
This article describes an integrated treatment program for individuals with concurrent mental health and substance use disorders. Principles of dialectical behaviour therapy (DBT), originally developed by Linehan (l993a ; 1993b) for chronically suicidal individuals with borderline personality disorder, provided the framework for the organization of a program of specialized treatment services in the following areas ; substance use and borderline personality disorder, substance use and anger, and substance use and eating disorders. An overview of DBT and the rationale for founding a concurrent disorder program upon this approach is discussed. A description of our treatment protocols for the three subgroups of concurrent disordered patients is provided with attention to the similarities and differences from the standard DBT protocol. The principal elements of the program are highlighted.
RESUMEN
PURPOSE: (1) To determine the toxicity of an intensified postoperative adjuvant regimen for periampullary adenocarcinoma (pancreatic and nonpancreatic) utilizing concurrent 5-fluorouracil (5-FU), leucovorin (LV), dipyridamole (DPM), and mitomycin-C (MMC) combined with split-course locoregional external beam radiotherapy (EBRT) to 50 Gy. This was followed by 4 cycles of the same chemotherapy as adjuvant therapy. (2) To determine preliminary estimates of the overall and disease-free survival associated with the use of this regimen. (3) To compare the toxicities and early survival results of patients treated with the current regimen to those of patients who completed our prior trial of concurrent chemoradiation infusion with 5-FU/LV chemotherapy and regional nodal and prophylactic hepatic irradiation. METHODS: Postpancreaticoduodenectomy, patients received every 4 weeks bolus administration of 5-FU, (400 mg/m(2)), and LV, (20 mg/m(2), Days l-3), DPM (75 mg p.o., 4 times per day, Days 0-3, and every 8 weeks), MMC, (10 mg/m(2); maximum of 20 mg, Day l during EBRT). This was followed by 4 months of the same chemotherapy, beginning 1 month following the completion of EBRT. EBRT consisted of split-course 5000 cGy/20 fractions with a 2-week planned rest after the first 10 fractions (2500 cGy). RESULTS: From 4/96 to 6/99, 45 patients were enrolled and treated. Their experience constitutes the basis of this analysis. There were 29 patients with pancreatic cancer and 16 with nonpancreatic periampullary cancer. Seventeen patients had tumors of 3 cm or more, and 39 patients had at least 1 histologically involved lymph node. Thirteen patients had a histologically positive margin of resection. The mean time to start of treatment was 63 days following surgery. During chemoradiation therapy there were no Grade 3 or worse nonhematologic toxicities and 47% Grade 3 or Grade 4 hematologic toxicities of short duration. Following chemoradiation, during chemotherapy treatment only, there was one Grade 3 hepatic and one Grade 3 pulmonary toxicity which was nondebilitating (2% each case) and 42% Grade 3 or 4 hematologic toxicity. There were 2 episodes of neutropenic fever requiring admission and no treatment-related mortalities. One patient developed a mild case of HUS, which responded to standard management. One patient developed persistent shortness of breath (nondebilitating), and another patient had occasional dyspnea on exertion, both occurring after all therapy. The majority of patients complained of increased fatigue (Grade 1-2), greatest during the combined therapy and improving post all treatment. As of 6/23/99, 20 of 45 patients have relapsed, 13 in the liver. Twelve patients have died. Median follow-up for surviving patients is 14.3 months. Disease-free survival at 12 months following surgery is 66% (as compared to 25% in our prior study), and the median disease-free survival is 17 months (as compared to 8. 3 months in our prior study). Median survival has not yet been reached, but will be greater than 17 months. CONCLUSION: With a 14.3-month median follow-up, acute toxicity has been acceptable and manageable. Observed relapses were seen 9-13 months following surgical resection. Early survival analysis suggests a trend toward increased median disease-free survival (8.3 vs. 17 months), especially for patients with nonpancreatic periampullary adenocarcinoma.
Asunto(s)
Adenocarcinoma/terapia , Neoplasias Pancreáticas/terapia , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia Adyuvante , Dipiridamol/administración & dosificación , Dipiridamol/efectos adversos , Supervivencia sin Enfermedad , Neoplasias Duodenales/mortalidad , Neoplasias Duodenales/patología , Neoplasias Duodenales/terapia , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Estudios de Seguimiento , Humanos , Leucovorina/administración & dosificación , Leucovorina/efectos adversos , Masculino , Persona de Mediana Edad , Mitomicina/administración & dosificación , Mitomicina/efectos adversos , Recurrencia Local de Neoplasia , Neoplasias Pancreáticas/mortalidad , Neoplasias Pancreáticas/patología , Pancreaticoduodenectomía , Dosificación Radioterapéutica , Radioterapia Adyuvante , Factores de TiempoRESUMEN
STUDY OBJECTIVE: To evaluate the effectiveness, safety, and costs associated with a formulary conversion from amlodipine to alternative calcium channel blockers. DESIGN: Retrospective study. SETTING: Veterans Affairs Medical Center. PATIENTS: One hundred patients with hypertension who were receiving amlodipine. INTERVENTION: Data from a random sample of 100 patients who were taking amlodipine and converted to a formulary calcium channel blocker from February 1, 1999-October 30, 1999, were entered into an Excel database for evaluation of the conversion. MEASUREMENTS AND MAIN RESULTS: Patients were required to have a diagnosis of hypertension and have had two consecutive clinic visits with blood pressure measurements (and no changes in antihypertensive therapy) before conversion. End points were changes in average systolic blood pressure, diastolic blood pressure, and mean arterial pressure (MAP) from the two clinic visits before and after conversion. In addition, data were collected and analyzed with regard to adverse drug reactions, average dosage of the alternative calcium channel blocker, number of additional antihypertensives begun or discontinued, and number of dosage changes in antihypertensives within the two visits after conversion, and the overall cost impact of conversion. Average systolic blood pressure was reduced from 141.6 +/- 15.1 to 139.2 +/- 15.3 mm Hg after the conversion (NS). Average diastolic blood pressure was significantly reduced from 74 +/- 9.5 to 72.6 +/- 10.1 mm Hg after conversion (p=0.032), as was MAP (97.0 +/-q 9.3 to 94.8 +/- 10.0 mm Hg, p=0.026). Five patients had other changes in therapy made concurrently at the time of conversion, and 19 had changes after conversion. When these patients were excluded from analysis, the reduction in systolic blood pressure after conversion was significant (141.4 +/- 14.5 to 137.7 +/- 14.3 mm Hg, p=0.022), as were reductions in diastolic blood pressure (74.4 +/- 9.4 to 71.7 +/- 9.8 mm Hg, p=0.014) and MAP (96.7 +/- 9.1 to 93.7 +/- 9.3 mm Hg, p=0.007). Of patients who had postconversion changes in therapy, 8 (42%) were converted to diltiazem ER, nifedipine CC, or doses of felodipine that were 50% of the original dose of amlodipine. The overall cost impact of the conversion was a net savings of $14,858/year for each 100 patients converted. CONCLUSION: Conversion from amlodipine to other calcium channel blockers resulted in statistically significant reductions in diastolic blood pressure and MAP, and was safe as well as cost-effective. Conversion to calcium channel antagonists other than felodipine or less than equal dosages of felodipine may require dosage titration. When converting patients from amlodipine, dosages usually should be equal to those of felodipine; if converting to other calcium channel antagonists, the need for adjustments should be anticipated.
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Amlodipino/administración & dosificación , Presión Sanguínea/efectos de los fármacos , Bloqueadores de los Canales de Calcio/administración & dosificación , Hipertensión/tratamiento farmacológico , Amlodipino/economía , Bloqueadores de los Canales de Calcio/economía , Diltiazem/administración & dosificación , Felodipino/administración & dosificación , Femenino , Humanos , Hipertensión/economía , Masculino , Nifedipino/administración & dosificación , Estudios RetrospectivosRESUMEN
We conducted a prospective, randomized, double-blind, placebo-controlled, parallel-group trial to evaluate the effect of the moderate consumption of snacks containing olestra on the international normalized ratio (INR) in 40 patients receiving long-term warfarin therapy. Patients continued their warfarin regimen and were assigned to receive 1.5 servings/day (42 g) for 2 weeks of Pringles Original Flavor Fat Free Potato Crisps with Olean (12 g olestra/1.5 servings) or Pringles Original Flavor Potato Crisps (placebo group). Patients' INRs were measured weekly for 2 weeks. Thirty-six patients completed the first week of the trial. After 1 week, the mean change in the INR from baseline increased by 0.02 +/- 0.5 in the olestra group and by 0.17 +/-0.4 in the placebo group (p= 0.327). Ten patients in the olestra group and 12 in the placebo group completed the second week of the study. Mean change in the INR from baseline was similar at week 2, -0.18 +/- 0.38 and 0.09 +/- 0.53 (p=0.193), respectively. Gastrointestinal side effects (diarrhea, gas, bloating) occurred in three patients in the olestra group and five in the placebo group (p=0.3). Moderate consumption of snacks containing olestra did not significantly affect the INR (> 0.3 U) at 1 week in patients receiving long-term anticoagulation with warfarin. It does not appear that moderate consumption of these snacks would affect the INR after 2 weeks, but this must be confirmed in a larger sample with adequate power at 2 weeks.
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Anticoagulantes/uso terapéutico , Sustitutos de Grasa/efectos adversos , Sustitutos de Grasa/farmacología , Ácidos Grasos/efectos adversos , Ácidos Grasos/farmacología , Sacarosa/análogos & derivados , Warfarina/uso terapéutico , Anciano , Método Doble Ciego , Interacciones Farmacológicas , Sustitutos de Grasa/administración & dosificación , Ácidos Grasos/administración & dosificación , Femenino , Humanos , Relación Normalizada Internacional , Masculino , Placebos , Sacarosa/administración & dosificación , Sacarosa/efectos adversos , Sacarosa/farmacología , Factores de TiempoRESUMEN
Esophageal cancer ranks among the 10 most common cancers in the world, and is almost uniformly fatal. The genetic events leading to the development of esophageal carcinoma are not well established. To identify genomic regions involved in esophageal carcinogenesis, we performed a systematic screening for loss of heterozygosity (LOH) in 24 samples of squamous cell carcinomas, initially focusing the analysis on chromosome 18. Thirteen short tandem repeat markers spanning 18p and 18q were used. We found a broad peak of LOH spanning 18p11.2 and 18q21.1 with the most frequent LOH (72%) at D18S978 on 18q12.2, which coincides with a known fragile site FRA18A. This region is 4 cM proximal to known tumor suppressor genes and therefore suggests the possible existence of a yet undiscovered tumor suppressor gene.
Asunto(s)
Carcinoma de Células Escamosas/genética , Cromosomas Humanos Par 18 , Neoplasias Esofágicas/genética , Pérdida de Heterocigocidad , Alelos , Genes Supresores de Tumor , HumanosRESUMEN
The large number of endoscopies and endoscopic reports produced in the United States represents a large repository of clinical data. However, reports are highly variable in content and structure and therefore cannot be used to create clinical databases. The introduction of automated endoscopic reporting systems should permit database creation only if acceptable standards for the structure and content of the report are developed. The structure of an endoscopic report is the framework in which the specific details of the endoscopy can be recorded. The basic components can consist of the following: Patient, Visit, Study, Result, Diagnosis, and Recommendation. Precise definition of each of these components requires consensus on what the minimum included elements should be. Experience with the Minimal Standard Terminology indicates that it is possible to create a broadly acceptable lexicon of descriptive endoscopic terms which can be included as a Result. The systematic development of the structure and content of endoscopic reports is mandatory before it is possible to create large, clinically useful databases of endoscopic reports.
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Endoscopía Gastrointestinal/normas , Bases de Datos Factuales/normas , Endoscopía Gastrointestinal/clasificación , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/terapia , Humanos , Estándares de ReferenciaRESUMEN
La perforación esofágica es rara en los niños,siendo la causa más frecuente el accidente durante una dilatación por estenosis.El objetivo del trabajo es analizar la evolución de los pacientes con esta complicación sometidos a tratamiento conservador.En el período comprendido entre Junio de 1984 y Junio de 1998 se realizó un estudio retrospectivo de 14 niños con preforación esofágica post-dilatación en el servicio de cirugía.La etiología de las estenosis fue:por ingesta de cáusticos en 7 pacientes,postoperatorio de atresia de esófago en 4 y estenosis congénita en 3.El diagnóstico se confirmó con esofagograma.En todos los casos el tratamiento inicial consistió en la supensión de la ingesta por vía oral,antibióticos endovenosos y analgésicos.Se efectuaron estudios radiológicos contrastados semanales para conocer la evolución.El 100 por ciento de los pacientes cursaron con dolor e hipertemia en las primeras 24 horas.Ocho pacientes evolucionaron favorablemente con tratamiento médico(57 por ciento).Seis pacientes (42 por ciento)presentaron derrame pleural y neumomediastino tratados con tubo de drenaje bajo agua.Tres evolucionaron favorablemente pero en 2 se rellizó toracotomía y tolette y en otro,portador de atresia de esófago,se efectuó resección de la estenosis reanastomosis.Uno requirió esofagostoma de derivación.El tiempo promedio de internación fue de 29,7 días con un rango entre 16 y 70 días.No se registraron caso fatales y el 50 por ciento resolvió su estenosis,el resto necesitó continuar con dilataciones
Asunto(s)
Niño , Dilatación , Estenosis EsofágicaRESUMEN
La perforación esofágica es rara en los niños,siendo la causa más frecuente el accidente durante una dilatación por estenosis.El objetivo del trabajo es analizar la evolución de los pacientes con esta complicación sometidos a tratamiento conservador.En el período comprendido entre Junio de 1984 y Junio de 1998 se realizó un estudio retrospectivo de 14 niños con preforación esofágica post-dilatación en el servicio de cirugía.La etiología de las estenosis fue:por ingesta de cáusticos en 7 pacientes,postoperatorio de atresia de esófago en 4 y estenosis congénita en 3.El diagnóstico se confirmó con esofagograma.En todos los casos el tratamiento inicial consistió en la supensión de la ingesta por vía oral,antibióticos endovenosos y analgésicos.Se efectuaron estudios radiológicos contrastados semanales para conocer la evolución.El 100 por ciento de los pacientes cursaron con dolor e hipertemia en las primeras 24 horas.Ocho pacientes evolucionaron favorablemente con tratamiento médico(57 por ciento).Seis pacientes (42 por ciento)presentaron derrame pleural y neumomediastino tratados con tubo de drenaje bajo agua.Tres evolucionaron favorablemente pero en 2 se rellizó toracotomía y tolette y en otro,portador de atresia de esófago,se efectuó resección de la estenosis reanastomosis.Uno requirió esofagostoma de derivación.El tiempo promedio de internación fue de 29,7 días con un rango entre 16 y 70 días.No se registraron caso fatales y el 50 por ciento resolvió su estenosis,el resto necesitó continuar con dilataciones
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Niño , Estenosis Esofágica , DilataciónRESUMEN
OBJECTIVE: To support clinically relevant indexing of biomedical images and image-related information based on the attributes of image acquisition procedures and the judgments (observations) expressed by observers in the process of image interpretation. DESIGN: The authors introduce the notion of "image acquisition context," the set of attributes that describe image acquisition procedures, and present a standards-based strategy for utilizing the attributes of image acquisition context as indexing and retrieval keys for digital image libraries. METHODS: The authors' indexing strategy is based on an interdependent message/terminology architecture that combines the Digital Imaging and Communication in Medicine (DICOM) standard, the SNOMED (Systematized Nomenclature of Human and Veterinary Medicine) vocabulary, and the SNOMED DICOM microglossary. The SNOMED DICOM microglossary provides context-dependent mapping of terminology to DICOM data elements. RESULTS: The capability of embedding standard coded descriptors in DICOM image headers and image-interpretation reports improves the potential for selective retrieval of image-related information. This favorably affects information management in digital libraries.