ABSTRACT
Se presenta la experiencia en el diagnóstico y tratamiento de 9 pacientes portadores de una enfermedad de Hirschsprung (EH) diagnosticados en la edad adulta en un período de 10 años, en el contexto de un estudio prospectivo de la constipación crónica pertinaz. Se trata de 6 mujeres y 3 hombres con una edad promedio de 24 años (extremos 15-46), con una historia de constipación desde la infancia en 5 y desde la adolescencia en 4, complicados con un fecaloma en forma iterativa en 6 casos. El enema baritado demostró un segmento contraído en embudo en 4 pacientes, megarrecto en 2 y dolicosigmoides en 3. La manometría anorrectal mostró ausencia del reflujo recto anal inhibitorio (RRAI) en los 5 pacientes en que el examen se realizó. La esfinteromiectomía anorrectal (EM) se efectuó con fines diagnósticos en 8 pacientes, fue exitosa en una paciente con EH de segmento ultracorto que completa 156 m de seguimiento. En el resto la respuesta fue nula o transitoria, motivo por el cual 6 pacientes se intervienen con la técnica de Duhamel-Haddad, una paciente rechaza la cirugía y otro se interviene en otro centro. El control alejado es de 76 meses como promedio (extremos 36-156), de los cuales 7 casos superan los 6 años. En el seguimiento a largo plazo fallece una paciente a los 3 años por obstrucción intestinal reiterada y complicaciones sépticas, confirmándose en ella una aganglionosis intestinal total. El resto de los pacientes sometidos a cirugía resectiva han corregido su hábito defecatorio con continencia plena. La EH debe sospecharse en todo paciente adulto que sufre de una constipación crónica pertinaz. Aunque el enema baritado y la manometría anorrectal pueden sugerir esta condición, sólo la biopsia de grosor total permite establecer el diagnóstico definitivo y puede ser terapéutica en casos seleccionados
Subject(s)
Humans , Male , Adolescent , Adult , Female , Middle Aged , Barium Sulfate , Enema , Hirschsprung Disease , Manometry , Biopsy , Constipation , Hirschsprung Disease , Prospective Studies , Sphincterotomy, EndoscopicABSTRACT
Background: Endoscopic mucosectomy is a routine treatment mode for benign and malignant gastric lesions. The prognosis of patients with endoscopically treated early gastric cancer does not differ from patients subjected to surgical gastrectomy, when the indications for endoscopic mucosectomy are respected. Aim: To report the experience in endoscopic mucosectomy for early gastric cancer. Patients and methods: Between 1990 and 1997, 12 lesions in 10 patients, aged 48 to 107 years old, were treated with endoscopic mucosectomy. Clients were followed for 1 to 72 months after the procedure. Results: Treated lesions ranged in size from 7 to 20 mm. Ten patients had differentiated carcinomas, one had an undifferentiated carcinoma and one had a primary gastric carcinoid. Endoscopic appearance was II a in six lesions, II c + II a in two, II a + II c in one. II c in one, I in one and II c + III in one. In two patients, the tumor persisted and were subjected to oncologic surgery. In one of these, no malignant lesion was recognized in the pathological specimen. The other patient had a multicentric carcinoma that was already detected by endoscopy. Neither had lymph node metastases. Endoscopical and pathological follow up in the other 8 patients has not shown persistence or reappearance of malignant lesions during a follow up ranging from 3 to 72 months. Conclusions: Endoscopic mucosectomy can be a valuable therapeutic alternative in early gastric cancer
Subject(s)
Humans , Middle Aged , Stomach Neoplasms/surgery , Gastric Mucosa/surgery , Stomach Neoplasms/pathology , Biopsy , Carcinoid Tumor/surgery , Carcinoid Tumor/pathology , Endoscopy, Gastrointestinal , Neoplasm Invasiveness/pathologyABSTRACT
Background: The traditional methods to distinguish Chronic Follicular Gastritis and Primary Gastric Lymphoma do not allow an adequate definitive diagnosis in a significant number of cases. The Molecular Biology diagnostic methods are based on the rearrangement of immunoglobulin genes. The polymerase chain reaction (PCR) specifically amplifies this rearrangement and allows molecular analysis of minimal tissue samples obtained with endoscopical biopsies. Aim: To test the usefulness of this PCR method in the differential diagnosis between Chronic Follicular Gastritis and Primary Gastric Lymphoma. Material and methods: We analyzed the endoscopical biopsies of six Chronic Follicular Gastritis cases and eight surgically treated Primary Gastric Lymphoma cases, six with the correct diagnosis in the endoscopical biopsies and two with a diagnosis of Chronic Follicular Gastritis. Results: A policlonal immunoglobulin rearrangement was found in the six cases with Chronic Follicular Gastritis. A monoclonal arrangement was found in 5 of 6 biopsies with the diagnosis of Primary Gastric Lymphoma. The same monoclonal rearrangement was observed in the two biopsies incorrectly diagnosed as Chronic Follicular Gastritis. Conclusions: PCR analysis of immunoglobulin rearrangement is a useful method in the differential diagnosis between Chronic Follicular Gastritis and Primary Gastric Lymphoma
Subject(s)
Humans , Stomach Neoplasms/diagnosis , Immunoglobulins , Lymphoma/diagnosis , Gastritis, Hypertrophic/diagnosis , Stomach Neoplasms/etiology , Stomach Neoplasms/pathology , Biopsy , Polymerase Chain Reaction , Lymphoma/etiology , Lymphoma/pathology , Diagnosis, Differential , Gastritis, Hypertrophic/complications , Gastritis, Hypertrophic/pathologyABSTRACT
Se discute el caso de una mujer de 91 años portadora de la enfermedad del Nodo, que fue diagnosticada de un cáncer gástrico precoz antral tipo III+IIc. Rechazó ser sometida a cirugía resectiva. Se intentó terapia local ablativa con APC (Argón Plasma Coagulator) como terapia paliativa/curativa? con excelente resultado. Las biopsias sobre la cicatriz fueron negativas para neoplasia en los controles posteriores. Se discute las opciones terapeúticas no quirúrgicas para el tratamiento del cáncer gástrico precoz. (Resección mucosa endoscópica -musectomía- como también la ablación eléctrica, mediante láser o APC)
Subject(s)
Humans , Female , Aged , Catheter Ablation/methods , Argon , Stomach Neoplasms , Argon , Palliative Care , Laser Coagulation/methods , Electrocoagulation/methods , Endoscopy , Stomach NeoplasmsABSTRACT
Se revisan los resultados alejados de la técnica de la esfinteromiectomia (EM) en el estudio y manejo de la constipación crónica idiopática refractaria. Se trata de 25 pacientes, con un promedio etario de 30 años, intervenidos en un período de 10 años en forma prospectiva. La biopsia demostró una aganglionosis en 4 casos, hipoganglionosis en 2, hiperganglionosis en 2 y fue normal en 17. El seguimiento a largo plazo es completo entre 2 y 10 años. Del análisis global se desprende que el 44 porciento de los pacientes se considera curado del estreñimiento, efecto que es independiente del estudio histopatológico y por lo tanto sin carácter predictivo. El tiempo de tránsito colónico efectuado en 11 pacientes por persistencia de la constipación, reveló un patrón de inercia colónica en 7, obstrucción de salida en 1 y fue normal en 3. Por este motivo, 8 pacientes se han sometido a una resección colónica, con resultados satisfactorios
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Anal Canal/surgery , Anus Diseases/surgery , Constipation/surgery , Chronic Disease , Hirschsprung Disease/surgeryABSTRACT
We report a 67 years old male that consulted due to bloody diarrhea of several months of evolution and emaciation. According to endoscopic and radiological findings, the diagnosis of severe ulcerative colitis was made. Fifteen days after admission, the patient was subjected to an emergency total colectomy due to a toxic megacolon. The pathological study showed an eschemic colitis with extensive longitudinal ulcers in the antimesenteric border, presence of granulation tissue with inflammation and transmural fibrosis. Intestinal transit was reconstituted 6 months later and after 12 months of follow up, the patient is in good conditions
Subject(s)
Humans , Male , Aged , Colitis, Ischemic/complications , Megacolon, Toxic/etiology , Colitis, Ischemic/diagnosis , Colitis, Ischemic/therapy , Diagnosis, Differential , Megacolon, Toxic/diagnosis , Megacolon, Toxic/therapyABSTRACT
To analyze the clinical presentation, pathological aspect and trealment of gastric adenomas, a retrospective analysis of 75 patients aged 26 to 88 years in whom a gastric adenoma was diagnosed. Seventy one patients had elevated endoscopical lesions and two had depressed or flat lesions. Ninety percent of lesions were located in the gastric antrum. Pathological study detected 6 focal carcinomas within the adenomas and 5 concomitant carcinomas located elsewhere in the stomach. Fifty four patients were subjected to endoscopical resection. Among patients with focal carcinomas, a gastrectomy was performed in four and endoscopical resection in two. Gastric adenomas must be considered in the differential diagnosis of gastric elevated lesions and may be confused in early gastric cancer. There is a histological resemblance between adenomas and gastric dysplasia descibed by several authors though only in our cases and in the Japanese literature the adenoma is referred to as mostly a polypoid sessile lesion