RESUMO
BACKGROUND: Ostomized patients usually have some concerns such as absence of sphincter control, noisy bowel movements, changes in passage of gas, social discomfort due to odors, concerns about bag filling, peristomal and skin irritation as well as psychological changes such as body image distortion, among others, that will determine quality of life. We undertook this study to measure quality of life in ostomized patients attending the Coloproctology Unit in Hospital General de México. METHODS: We carried out a cross-sectional descriptive study from January 1, 2009 to May 29, 2009 in ostomized patients. Two scales were used to determine quality of life. The first was quality of life SF-36 (version 2) with 36 items that measured eight aspects. The other scale used was the Montreux scale. RESULTS: For the Montreux scale, quality of life section, a range between 60.8 and 81.2 points was obtained. The results obtained with the quality of life scale SF36 were as follows: physical function, 67.04; physical role, 56.06; physical pain, 68.28; general health, 57.16; with an overall average of 62.14 points. For mental aspects, results were as follows: vitality, 68.37; social function, 71.53; emotional role, 71.48; and mental health, 68.67; with an overall average of 70.01 points. CONCLUSIONS: Quality of life of subjects included was classified as good. Fear of stoma leaks and sexual function were the aspects that most affected the patients, and those are responsible for a decrease in quality of life in this study.
Assuntos
Colostomia/psicologia , Ileostomia/psicologia , Qualidade de Vida , Adulto , Idoso , Estudos Transversais , Diverticulose Cólica/psicologia , Diverticulose Cólica/cirurgia , Feminino , Neoplasias Gastrointestinais/psicologia , Neoplasias Gastrointestinais/cirurgia , Humanos , Doenças Inflamatórias Intestinais/psicologia , Doenças Inflamatórias Intestinais/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/psicologia , Autocuidado , Fatores Socioeconômicos , Estomas Cirúrgicos/efeitos adversos , Inquéritos e Questionários , Adulto JovemRESUMO
The use of intestinal stent is considered the palliative treatment of choice in patients with severe compromised cardiopulmonary reserve or functional class IV who have blockage in the intestinal lumen by tumor growth. The endoscopist should recognize the indications for prosthesis, which depend on the patient and the lesion. This article reviews the characteristics, indications and results of the prosthesis achieved to date. The use of stents has been reported to achieve a technical success of 94%, although clinical success is variable. In general, less serious complications appear in 27% of the patients and, of these, 17% are due to tumor growth within the prosthesis or in its ends, 5% to migration, pain in 2%, and obstruction of the biliary route in 1%. Serious complications occur in 1% of the patients, among which hemorrhage is included. Mortality is infrequent. We conclude that the use of an enteral prosthesis is effective and safe. It is an accessible method that requires an experienced surgeon. For management of obstruction, it has shown to have good results as a cost-effective palliative option.
Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/métodos , Colestase/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Obstrução Intestinal/cirurgia , Implantação de Prótese/métodos , Stents , Assistência ao Convalescente , Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/cirurgia , Perda Sanguínea Cirúrgica , Contraindicações , Endoscopia do Sistema Digestório , Desenho de Equipamento , Neoplasias Esofágicas/cirurgia , Estenose Esofágica/etiologia , Estenose Esofágica/cirurgia , Junção Esofagogástrica/cirurgia , Neoplasias Gastrointestinais/complicações , Neoplasias Gastrointestinais/cirurgia , Humanos , Cuidados Paliativos , Complicações Pós-Operatórias , Stents/efeitos adversosRESUMO
Introduction. Hepatic encephalopathy (HE) refers to a complex neuropsychiatric syndrome that is progressive but potentially reversible and may have a significant impact on quality of life, as it is characterized by alterations in cognitive function, behavior and personality as well as transient neurological symptoms and electroencephalographic abnormalities. Objective. The aim of this study was to evaluate scientific evidence for the effectiveness and safety of LOLA infusions for treatment of clinical hepatic encephalopathy in patients with chronic liver disease. Material and methods. We included all randomized, controlled, double-blind, and humans' studies that were published in indexed journals. Results. Were identified 48 references (17 using PubMed, 12 using Medline and 19 using the Cochrane database). Of these, six were selected as having met the inclusion criteria. A total of 623 patients were randomized in these publications. Conclusion. The available scientific evidence supports the adoption of LOLA infusion as a treatment for clinical encephalopathy in patients with liver failure, because it has been shown to improve neuropsychiatric status and decrease serum levels of ammonia with a low incidence of adverse effects (less than 5%).
Assuntos
Dipeptídeos/uso terapêutico , Encefalopatia Hepática/tratamento farmacológico , Encefalopatia Hepática/etiologia , Falência Hepática/complicações , Adulto , Idoso , Amônia/sangue , Dipeptídeos/administração & dosagem , Dipeptídeos/efeitos adversos , Encefalopatia Hepática/sangue , Humanos , Infusões Intravenosas , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
BACKGROUND: Esophageal metaplasia progression is a consequence of chronic gastroesophageal reflux (CGR). Patients with this condition are frequently infected by Helicobacter pylori and show several symptoms including gastritis as well as ulcer formation. In addition, they present an increased risk for the development of gastric adenocarcinoma. Several pathogenic markers for Helicobacter pylori such as ureC, vacA and cagA genes have been described. Evidence indicates that direct injury to the epithelial mucosa is caused by cytotoxins and enzymes codified by these genes. We undertook this study to establish a relationship between the presence of pathogenic Helicobacter pylori strains and the presence of metaplasia progression in patients with CGR. METHODS: We detected the presence of Helicobacter pylori cagA and vacA positive strains in patients with CGR. Using polymerase chain reaction, we analyzed 120 samples obtained from 60 patients with CGR and 60 control group patients, including samples from both anatomic areas: cardia and gastric antrum. RESULTS: We detected 56% of Helicobacter pylori positive patients; 57.5% of these patients were positive for either cagA(+) and/or vacA(+) Helicobacter pylori strains. Cardiac intestinal metaplasia was observed in 35% of the patients. A marked tendency was observed to develop cardiac intestinal metaplasia in those patients diagnosed with high-pathogenicity strains infected in both anatomic areas. CONCLUSIONS: These results suggest that infection with Helicobacter pylori can be considered a risk factor for developing gastric cardiac intestinal metaplasia.
Assuntos
Antígenos de Bactérias/genética , Proteínas de Bactérias/genética , Esôfago de Barrett/epidemiologia , Cárdia/patologia , Gastrite Atrófica/patologia , Infecções por Helicobacter/patologia , Helicobacter pylori/patogenicidade , Adulto , Idoso , Esôfago de Barrett/etiologia , Esôfago de Barrett/microbiologia , Esôfago de Barrett/patologia , Biópsia , Estudos Transversais , Feminino , Gastrite Atrófica/complicações , Gastrite Atrófica/microbiologia , Refluxo Gastroesofágico/complicações , Gastroscopia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/microbiologia , Helicobacter pylori/genética , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Metaplasia/epidemiologia , Metaplasia/etiologia , Pessoa de Meia-Idade , Neutrófilos/patologia , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/etiologia , Lesões Pré-Cancerosas/microbiologia , Lesões Pré-Cancerosas/patologia , Estudos Prospectivos , Especificidade da Espécie , Virulência , Adulto JovemRESUMO
OBJECTIVE: The course of Helicobacter pylori infection and antibody response to CagA in patients with preneoplastic lesions and gastric cancer has not been thoroughly studied. We aimed to study H. pylori infection and antibody response to CagA in patients with non-atrophic gastritis, preneoplastic lesions, and gastric cancer. METHODS: We studied patients attending one Oncology Hospital and one General Hospital in Mexico City. Diagnosis was based on endoscopy and histopathology in biopsies from six stomach regions. H. pylori infection was assessed by histology and serology, and antibodies against CagA were measured with immunoassay. RESULTS: We included 618 patients, 368 with non-atrophic gastritis, 126 with precancerous lesions, and 65 with gastric cancer; in addition, 59 patients with duodenal ulcer were studied. Detection of infection and IgG against CagA had a significant increase from non-atrophic gastritis to mild and up to advanced stages of metaplasia (P < 0.05), followed by decreased infection and IgG to CagA in patients with gastric cancer (P < 0.05). However, infection and CagA antibodies were associated with young gastric cancer cases. Duodenal ulcer showed a significant association with infection detected by histology and serology, particularly among women, and a trend to associate with IgG to CagA. CONCLUSIONS: This study shows that H. pylori infection and CagA are risk markers for intestinal metaplasia. The prevalence of these risk markers decreases in gastric cancer, probably reflecting that infection decreases after advanced atrophy and metaplasia in the gastric mucosa. State of the disease, age, and sex influence the association of H. pylori infection and IgG response to CagA with gastroduodenal diseases.