Gastroent Hepat Barc
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Gastroent Hepat Barc · Nov 2009
Case Reports[Cerebral artery air embolism secondary to endoscopic retrograde cholangiopancreatography].
Stroke secondary to an air embolism is an uncommon complication of gastrointestinal endoscopy. We report the case of a patient who developed a cerebral artery air embolism during endoscopic retrograde cholangiopancreatography. ⋯ The complications of endoscopic techniques are increasingly frequent and varied, due to the major increase in the use of these procedures in our hospitals. Greater knowledge of this infrequent complication would allow rapid diagnosis, which is essential to provide specific treatment and prevent fatal outcome.
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Gastroent Hepat Barc · Oct 2009
Review[Chemical or immunological tests for the detection of fecal occult blood in colorectal cancer screening?].
Colorectal cancer (CRC) can be prevented by screening programs in the population at average risk (men and women aged between 50 and 74 years) and at high risk (first degree relatives, CRC hereditary syndromes and chronic inflammatory bowel disease). Early CRC (with submucosal invasion) and advanced adenomas (size > or =10mm, with severe dysplasia or >20% villous component) produce intermittent microscopic blood losses that can be detected through chemical and immunological testing for fecal occult blood (C-FOBT and I-FOBT). Among the screening strategies in the population at average risk, annual or biannual fecal occult blood testing is the most widely used due to its non-invasiveness and low cost. ⋯ In the last few years, major developments have occurred in immunological tests (I-FOBT), based on an antigen-antibody reaction that specifically detects human Hb, and these tests are currently available as an alternative to C-FOBT. Their main advantages are as follows: firstly, I-FOBT specifically detect human Hb in stools and at much lower levels (40-300microgHb/gfeces) than C-FOBT; secondly, automated analysis avoids subjectivity in reading qualitative tests and allows large population groups to be studied in a short time, making I-FOBT ideal for population-based screening; thirdly, I-FOBT fairly accurately selects individuals for colonoscopy so that approximately half of patients with an I-FOBT test show clinically significant colorectal neoplasia (advanced adenoma or invasive CRC); fourthly, the cut-off point for fecal Hb detection can be modified, depending on the availability of endoscopic resources; fifthly, when cut-off points for fecal Hb of 50-150microgHb/gfeces are used, more than twice the number of CRC and advanced adenomas are detected than with C-FOBT, with a reasonable false-positive rate; and sixthly, I-FOBT are better accepted by the population due to their simplicity and ease of use, increasing participation in screening programs. For all these reasons, the current recommendation is that the new quantitative I-FOBT tests replace C-FOBT tests when the strategy of population-based screening through annual or biannual fecal occult blood testing is considered.
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Cannabinoid hyperemesis is characterized by recurring episodes of nausea and vomiting, with a stereotyped pattern, related to cannabis consumption. This syndrome is a paradoxical reaction to cannabis that develops in susceptible chronic cannabis users after several years of exposure. There is a direct relationship between cannabis use and the onset of the hyperemesis and between cessation of cannabis use and symptom resolution. ⋯ The symptoms were relieved by hot baths. A complete gastroenterological study was performed and no alterations were found. Cannabis use and its cessation are related to the presence or absence of the symptoms.
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Gastroent Hepat Barc · May 2009
[Reliability of hemoglobin measurement by HemoCue in patients with gastrointestinal bleeding].
Gastrointestinal hemorrhage is a frequent complication in digestive diseases, requiring follow-up by specialized units such as the digestive bleeding unit. Hemoglobin is determined daily in the management of these patients, and consequently a rapid and reliable method for hemoglobin determination is required. ⋯ There is a good correlation between HemoCue and laboratory determinations. Consequently, HemoCue is a quick and reliable method both in the acute and stable phases of gastrointestinal bleeding.