RESUMEN
The goal of this study was to determine the prevalence, epidemiology and clinical-therapeutical evolution of hepatolithiasis (HL) in Argentina. With this purpose a survey was conducted sending a questionnaire to ten referencial and interventional radiology centers in the country. Seven centers answered on time. In the last five years a total of 8,736 consecutive patients were examined for cholangiography (endoscopic retrograde cholangiography, PTC). A total of 5,920 (68%) were biliary lithiasis and 53 (0.9%, range 0.5-2.6%) of these were HL. In case of HL the diagnostic procedure was the ERCP in 68% of the cases, and the PTC in the remainder 32%. The patients with HL (53% females, mean age 52, range 23-85) clinically presented cholangitis (79%); pancreatitis (6%) and five (9.4%) showed evolution to a biliary cirrhosis. Associated diseases or abnormalities of the biliary tree were: biliary postsurgical strictures (BPS), 28%; Caroli's Syndrome, 20%; and choledocholithiasis, 28%. While a 9.4% presented a "biliary history" (that was defined as two or more episodes of biliary surgery) and a 5.7% lacked associated or predisposing diseases. Follow-up was lost in 23% of the cases and in 77% a follow up of 38 months (range 8-60) was observed with 4.8% mortality rate. The treatment was hepatobiliary surgery in 58% of the cases; endoscopic papillotomy in 17% and combined treatments that included extracorporeal shock wave lithotripsy and ursodeoxycholic acid (UDCA) in 15%. Four out of 53 cases (7.5%) received UDCA as the only successful therapy. HL is an entity with high biliary morbidity in 85% of the cases and development in to cirrhosis in 9.4%. When the diagnosis is made in the western world both BPS and Caroli must be discarded first. Combined treatments or only UDCA are new therapeutical alternative in the western world.
Asunto(s)
Enfermedad de Caroli/complicaciones , Litiasis/complicaciones , Litiasis/epidemiología , Hepatopatías/complicaciones , Hepatopatías/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Argentina , Enfermedad de Caroli/diagnóstico , Enfermedad de Caroli/epidemiología , Diagnóstico Diferencial , Femenino , Humanos , Litiasis/diagnóstico , Litiasis/terapia , Hepatopatías/diagnóstico , Hepatopatías/terapia , Masculino , Persona de Mediana Edad , Prevalencia , Encuestas y CuestionariosRESUMEN
OBJECTIVE: In a randomized, controlled, multicenter trial, we tested the hypothesis that high-frequency ventilation (HFV) with a high lung volume strategy results in fewer treatment failures than intermittent positive pressure ventilation (IPPV) with high rates and low peak inspiratory pressures. STUDY DESIGN: Infants with a gestational age between >/=24 weeks and <30 weeks, requiring mechanical ventilation within 6 hours of birth, were randomly assigned to receive either IPPV or HFV until 240 hours after randomization, extubation, or meeting treatment failure criteria. Treatment failure, the primary end point, was determined when air leaks, an oxygenation index >35 to 45 (depending on gestational age), death, or chronic lung disease occurred. Chronic lung disease was defined as persistent requirement of mechanical ventilation, continuous positive airway pressure, or supplemental oxygen at a postmenstrual age of 36 weeks. Secondary end points included the incidence of intracranial hemorrhage. RESULTS: The third scheduled interim analysis led to termination of the trial after recruitment of 284 infants. Treatment failure criteria were met by 46% of infants receiving IPPV and 54% of infants receiving HFV (1-tailed primary hypothesis, P =.92; 2-tailed chi2 test, P =.15). Air leaks occurred in 31% and 42% (P =.042), CLD in 23% and 25%, and grade 3-4 intracranial hemorrhage in 13% and 14% of IPPV-treated and HFV-treated patients, respectively. The mortality rate before discharge was 10% in both groups. CONCLUSION: HFV with a high lung volume strategy did not cause less lung injury in preterm infants than IPPV with a high rate and low peak inspiratory pressures.
Asunto(s)
Ventilación de Alta Frecuencia , Enfermedades del Prematuro/terapia , Ventilación con Presión Positiva Intermitente , Insuficiencia Respiratoria/terapia , Displasia Broncopulmonar/prevención & control , Femenino , Alemania/epidemiología , Humanos , Recién Nacido , Masculino , Análisis de Regresión , Insuficiencia Respiratoria/mortalidad , Mecánica Respiratoria , Tasa de SupervivenciaRESUMEN
The goal of this study was to determine the prevalence, epidemiology and clinical-therapeutical evolution of hepatolithiasis (HL) in Argentina. With this purpose a survey was conducted sending a questionnaire to ten referencial and interventional radiology centers in the country. Seven centers answered on time. In the last five years a total of 8,736 consecutive patients were examined for cholangiography (endoscopic retrograde cholangiography, PTC). A total of 5,920 (68
) were biliary lithiasis and 53 (0.9
, range 0.5-2.6
) of these were HL. In case of HL the diagnostic procedure was the ERCP in 68
of the cases, and the PTC in the remainder 32
. The patients with HL (53
females, mean age 52, range 23-85) clinically presented cholangitis (79
); pancreatitis (6
) and five (9.4
) showed evolution to a biliary cirrhosis. Associated diseases or abnormalities of the biliary tree were: biliary postsurgical strictures (BPS), 28
; Carolis Syndrome, 20
; and choledocholithiasis, 28
. While a 9.4
presented a [quot ]biliary history[quot ] (that was defined as two or more episodes of biliary surgery) and a 5.7
lacked associated or predisposing diseases. Follow-up was lost in 23
of the cases and in 77
a follow up of 38 months (range 8-60) was observed with 4.8
mortality rate. The treatment was hepatobiliary surgery in 58
of the cases; endoscopic papillotomy in 17
and combined treatments that included extracorporeal shock wave lithotripsy and ursodeoxycholic acid (UDCA) in 15
. Four out of 53 cases (7.5
) received UDCA as the only successful therapy. HL is an entity with high biliary morbidity in 85
of the cases and development in to cirrhosis in 9.4
. When the diagnosis is made in the western world both BPS and Caroli must be discarded first. Combined treatments or only UDCA are new therapeutical alternative in the western world.