RESUMO
Background and study aims Several Latin American countries, including Mexico, have reported an increase in colorectal cancer (CRC) mortality. The effectiveness of a colonoscopy in preventing CRC depends on the quality of the procedure, for which the adenoma detection rate (ADR) is one of the most trusted indicators. Awareness of ADR can improve the quality of colonoscopies through proper feedback and training of the specialists. The goal of this study was to estimate the ADR among Mexican endoscopists with experience in CRC screening and to compare it with previously reported data from this country. Methods We carried out a retrospective study to analyze ADR data in Mexico. The information was obtained from a group of certified endoscopists and compared with the former published data from Mexico. Results We found a current ADR of 24.6â% (95â%CI, 22.4â%-26.8â%) from 1,478 colonoscopies performed by eight endoscopists in two third-level private hospitals. The average ADR reported in previous publications was 15.2â% (95â%CI, 13.3â%-17.1â%). Statistical analysis showed differences between our results and those from previous studies (24.6 % vs. 15.2â%, P â<â0.001). Conclusions The actual ADR in Mexico is higher than previously reported. Previous low ADR values could be explained by poorly performed colonoscopies rather than by low adenoma and CRC incidence in our country.
RESUMO
BACKGROUND: Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) is safe and effective for the diagnosis of pancreatic adenocarcinoma. Although rapid on-site evaluation (ROSE) can improve tissue collection and increase diagnostic yield, its utility has been recently questioned. OBJECTIVE: Determine the diagnostic efficacy of EUS-FNB with ROSE of pancreatic masses in a new echoendoscopy unit. METHOD: Cross-sectional and comparative study of patients who underwent EUS-FNB of pancreatic masses between January and July 2017. Patient demographics, ultrasonographic details and pathology reports were examined. RESULTS: A total of 23 procedures were analyzed. Median age was 59 years (range: 46-77). The group with ROSE had 13 patients (56.5%) and the group without ROSE 10 (43.5%). The final pathology report showed enough and adequate sample in 100% of the group with ROSE (13/13 vs. 5/10; p = 0.007). Diagnosis of malignancy was established in 84.6% of the biopsies (11/13 vs. 2/10; p = 0.003) in the group with ROSE. CONCLUSIONS: ROSE is useful to improve the diagnostic efficacy of EUS-FNB of pancreatic masses, especially in new EUS centers or in centers with a low diagnostic yield.
ANTECEDENTES: La biopsia con aguja fina guiada por ultrasonido endoscópico (BAF-USE) es segura y eficaz para el diagnóstico del adenocarcinoma pancreático. La revisión citológica rápida en sala (ROSE, rapid on-site evaluation) puede mejorar la calidad de la muestra y el rendimiento diagnóstico; en años recientes se ha cuestionado su utilidad. OBJETIVO: Determinar la eficacia diagnóstica de la ROSE durante las BAF-USE de lesiones pancreáticas sólidas en un nuevo centro de ecoendoscopia. MÉTODO: Estudio transversal y comparativo en el que se incluyeron todos los pacientes a quienes se realizó BAF-USE de lesiones pancreáticas sólidas entre enero y julio de 2017. Se evaluaron datos demográficos, ecográficos y de patología de las BAF-USE. RESULTADOS: Se analizaron 23 procedimientos. La mediana de edad fue de 59 años (rango: 46-77). En el grupo con ROSE hubo 13 pacientes (56.5%) y en el grupo sin ROSE hubo 10 (43.5%). En el grupo con ROSE, el reporte de patología mostró muestra adecuada en el 100% (13/13 vs. 5/10; p = 0.007), así como diagnóstico de malignidad en el 84.6% (11/13 vs. 2/10; p = 0.003). CONCLUSIONES: La ROSE es una herramienta útil para mejorar el diagnóstico de BAF-USE de lesiones pancreáticas sólidas, principalmente cuando hay bajo rendimiento diagnóstico y en nuevas unidades de ecoendoscopia.
Assuntos
Adenocarcinoma/patologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Pâncreas/patologia , Neoplasias Pancreáticas/patologia , Adenocarcinoma/diagnóstico por imagem , Idoso , Estudos Transversais , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagemRESUMO
BACKGROUND: Rectal Dieulafoy's lesions (DLs) are very rare; however, they can be life threatening when presented with massive hemorrhage. CASE SUMMARY: A 44-year-old female with medical history of chronic renal failure who was on renal replacement therapy presented with lower gastrointestinal hemorrhage. Physical examination revealed signs of hypovolemic shock and massive rectal bleeding. Complete blood count revealed abrupt decrease in hematocrit. After hemodynamic stabilization, an urgent colonoscopy was performed. A rectal DL was diagnosed, and it was successfully treated with two hemoclips. There were no signs of recurrent bleeding at thirty days of follow-up. CONCLUSION: Rectal DLs represent an unusual cause of lower gastrointestinal bleeding. Massive hemorrhage can increase the morbidity and mortality of these patients. Endoscopic management continues to be the reference standard in the diagnosis and therapy of these lesions. Thermal, mechanical (hemoclip or band ligation), or combination therapy (adrenaline injection combined with thermal or mechanical therapy) should be considered the first choice for treatment.
RESUMO
OBJECTIVE: Describe the main activation and inhibitory pathways and receptors by which pDC regulate type I interferon secretion, as well as its association with autoimmune pathology. METHODS: A PubMed search for articles was conducted using the following key words: plasmacytoid dendritic cells, autoimmune diseases, viral infections and type I interferon. The search was limited to publications in English and from 1957 to 2012. Sixty-five of these articles are included in this review. The most relevant primary research articles identified were critically evaluated and compiled together. Particularly, areas of consensus and controversy were identified and analyzed. RESULTS: Plasmacytoid dendritic cells have been closely related to viral infections and autoimmune disease, mainly because of these immune cells are able to secrete large amounts of type I interferon. This function is linked with their expression of Toll-like receptors, specially TLR7 and TLR9, which are designed to sense nucleic acids in the early endosomes. Activated pDC can promote immunity and autoimmunity, however, the exact mechanisms by which pDC promote one vs. the other are not well understood. CONCLUSIONS: Plasmacytoid dendritic cells play a key role in both, immunity and autoimmunity. Current evidence suggests that the sustained overproduction of type-I interferon drives aberrant immune responses and the development of autoimmune pathology.