Place of plasma argon coagulation in the treatment of vascular abnormalities of the digestive tract in adults

The aim of our study is to evaluate the value of Argon Plasma Coagulation in the treatment of gastrointestinal vascular abnormalities. Patients and methods: This is a descriptive and analytical retrospective study, from January 2009 to September 2020. 198 patients who have benefited from treatment with Argon Plasma Coagulation for vascular anomalies of the digestive tract divided into 2 groups: -Group A: Patients with radial rectitis lesions (n = 107). -Group B: Patients with lesions of digestive angiodysplasia (n = 91). Results: The mean age of our patients was 64.95 ± 9.88 years [43 - 83] in group A, while in group B the mean age was 65.19 ± 14.29 years [40 - 91] with a clear male predominance in 72.5%. The majority of patients in group A were followed for prostate cancer in 33,8%, and 26.3% of patients in group B had chronic renal failure, followed by stomach cancer in 15.8%, and esophageal cancer in 10.5%. Clinical symptomatology was dominated by rectories in 40.2% in group A versus 46.8% in group B. Rectal involvement was dominated in group A in 98.1%, whereas in group B the lesions were mainly located in the stomach in 60.5%. The endoscopic evolution was favorable in all our patients with a clear improvement of rectal lesions and digestive angiodysplasia lesions. The total complication rate in our series was nil. Conclusion: Plasma Argon coagulation is a very effective method in the endoscopic treatment of digestive haemorrhages with good tolerability and a low complication rate. (AU)

Utility of video capsule endoscopy in clinical practice, experience at King Faisal Specialist Hospital and Research Center, Riyadh

Background: Video capsule endoscopy (VCE) is a valuable diagnostic tool for the evaluation of the small intestine. Evidence shows that it is effective in the diagnosis of occult bleeding and superficial lesions that are not radiographicallyobserved. We evaluated the efficacy and safety of the capsule endoscopy in the diagnosis and management of the common gastrointestinal disorders.Methods: A retrospective chart review of a total of 326 candidates who have met the inclusion criteria and who underwent VCE from the period from January 2006 till December 2018.Results: The main indication for Video Capsule Endoscopy was small bowel overt gastrointestinal bleeding with 106 cases (32.6%) followed by iron deficiency anemia with 104 cases (32%). Capsule retention rate was observed in 11 cases (3.4%) 4 of which were crohn抯 disease patients (22.2%). Overall diagnostic yield was 36%, 64% for overt gastrointestinal bleeding and 41% for occult gastrointestinal bleeding. The most common reported positive finding was Angiodysplasia in 19.9% of cases, followed by ulcers in 13.8% of cases, followed by polyps in 8.3% of cases and erosions in 8% of cases.Conclusions: Video capsule endoscopy proved to be an essential diagnostic tool in gastrointestinal bleeding. Advantages of VCE include; less labor, higher resolution examination of mucosa, relative safety, and noninvasiveness. On the other hand, it does not offer intervention capabilities when compared with enteroscopy and its interpretation was sometimes difficult and time consuming. Risk of capsule retention remains significant especially in patients suffering from crohn抯 disease.

Síndrome de Heyde: Estratégias Terapêuticas e Seguimento de Longo Prazo / Heyde's Syndrome: Therapeutic Strategies and Long-Term Follow-Up

Resumo Fundamentos A síndrome de Heyde é a associação de estenose aórtica importante com episódio de sangramento gastrointestinal por lesões angiodisplásicas. Pouco é conhecido sobre os fatores associados a novos sangramentos e desfechos em longo prazo. Além disso, a maioria dos dados é restrita a relatos de casos e pequenas séries. Objetivo Avaliar o perfil clínico, laboratorial e ecocardiográfico de pacientes com síndrome de Heyde submetidos a intervenção valvar ou tratamento medicamentoso. Métodos Coorte prospectiva de 24 pacientes consecutivos entre 2005 e 2018. Foram avaliados dados clínicos, laboratoriais, ecocardiográficos e relacionados à intervenção valvar e a desfechos após o diagnóstico. Valor de p<0,05 foi considerado estatisticamente significante. Resultados Metade dos 24 pacientes apresentou sangramento com necessidade de transfusão sanguínea na admissão. Angiodisplasias foram encontradas mais frequentemente no cólon ascendente (62%). Intervenção valvar (cirúrgica ou transcateter) foi realizada em 70,8% dos pacientes, e 29,2% foram mantidos em tratamento clínico. Novos episódios de sangramento ocorreram em 25% dos casos, e não houve diferença entre os grupos clínico e intervenção (28,6 vs. 23,5%, p=1,00; respectivamente). A mortalidade no seguimento de 2 e 5 anos foi de 16% e 25%, sem diferença entre os grupos (log-rank p = 0,185 e 0,737, respectivamente). Conclusões Pacientes com síndrome de Heyde tiveram alta taxa de sangramento com necessidade de transfusão sanguínea na admissão, sugerindo ser uma doença grave e com risco elevado de mortalidade. Não encontramos diferenças entre os grupos submetidos ao tratamento clínico e à intervenção valvar em relação a taxas de ressangramento e mortalidade tardia.

Abstract Background Heyde's syndrome is the association of severe aortic stenosis with episodes of gastrointestinal bleeding due to angiodysplastic lesion. Little is known about the factors associated with new episodes of bleeding and long-term outcomes. Furthermore, most data are restricted to case reports and small case series. Objective To assess the clinical, laboratory and echocardiography profile of patients with Heyde's syndrome who underwent valve intervention or drug therapy. Methods Prospective cohort of 24 consecutive patients from 2005 to 2018. Clinical, laboratory and echocardiography data were assessed, as well as those related to valve intervention and outcomes after diagnosis. A P <0.05 was used to indicate statistical significance. Results Half of the 24 patients presented with bleeding requiring blood transfusion on admission. Angiodysplasias were more frequently found in the ascending colon (62%). Valve intervention (surgical or transcatheter) was performed in 70.8% of the patients, and 29.2% remained on drug therapy. News episodes of bleeding occurred in 25% of the cases, and there was no difference between clinical and intervention groups (28.6 vs 23.5%, p = 1.00; respectively). Mortality at 2-year and 5-year was 16% and 25%, with no difference between the groups (log-rank p = 0.185 and 0.737, respectively). Conclusions Patients with Heyde's syndrome had a high rate of bleeding requiring blood transfusion on admission, suggesting that it is a severe disease with high mortality risk. No difference was found between clinical and intervention group regarding the rate of rebleeding and late mortality.

Asociación entre enfermedad de von Willebrand y angiodisplasia: ¿casualidad o causalidad?

Von Willebrand factor (vWf) is a fundamental multimeric plasma glycoprotein in the coagulation process. Its function is to mediate platelet adhesion and to stabilize circulating factor VIII. A functional or quantitative alteration of vWf gives rise to von Willebrand disease (vWD). The association between vWD and angiodysplasia was described in 1967, but it was only until 2011 that Starke et al demonstrated the in vitro and in vivo role of vWf in angiogenesis. Congenital or acquired vWf deficiency, especially of high molecular weight multimeters, not only favors bleeding, but also contributes to increased angiogenesis in these patients. The treatment should be focused both on the control of the acute episode of gastrointestinal bleeding, with vWf replacement therapy and local endoscopic treatment, as well as on the prevention of the progression of angiodysplasia and future bleeding. There are different published therapeutic approaches using vWf replacement that are not effective in all patients. Recently, angiogenesis inhibitor medications have been used.

Síndrome de Heyde / Heyde Syndrome

RESUMEN Introducción: El síndrome de Heyde es la asociación entre estenosis valvular aórtica y sangrado gastrointestinal, por angiodisplasia intestinal. La base fisiopatológica de ese síndrome parece ser una deficiencia adquirida del factor de Von Willebrand, que lleva al sangrado de malformaciones arteriovenosas angiodisplásicas. Las alternativas de tratamiento incluyen la localización de puntos de sangrado y la cauterización, pero tal opción terapéutica está asociada a alta recurrencia. El reemplazo de la válvula parece ofrecer la mejor esperanza de resolución a largo plazo del sangrado y debe ser considerada en la mayoría de las veces. Objetivos: Presentar el caso de un síndrome de Heyde, una causa infrecuente de hemorragia digestiva. Caso clínico: Paciente de 74 años con antecedentes estenosis aórtica y sangrado gastrointestinal debido a angiodisplasia duodenal localizada en la segunda porción de esta, tratada mediante la escleroterapia. Conclusiones: El síndrome de Heyde es una asociación poco frecuente entre una valvulopatía aortica y sangrado digestivo por una angiodisplasia que puede presentarse en cualquier parte del tubo digestivo(AU)

ABSTRACT Introduction: Heyde syndrome is the association between aortic valve stenosis and gastrointestinal bleeding, due to intestinal angiodysplasia. The pathophysiological basis of this syndrome seems to be acquired Von Willebrand factor deficiency, which leads to bleeding from angiodysplastic arteriovenous malformations. Management alternatives include localization of bleeding points and cauterization, but such a therapeutic option is associated with high recurrence. Valve replacement seems to offer the best hope for long-term solving of bleeding and should be considered for most of the cases. Objectives: To present a case of Heyde syndrome, a rare cause of gastrointestinal bleeding. Clinical case: A 74-year-old patient is presented with a history of aortic stenosis and gastrointestinal bleeding due to duodenal angiodysplasia located in the second portion of it, managed by sclerotherapy. Conclusions: Heyde syndrome is a rare association between aortic valve disease and digestive bleeding due to angiodysplasia that can occur in any part of the digestive tract(AU)

Síndrome de Klipper-Trenaunay-Weber con compromiso vesical y uterino tratado por vía endoscópica y endovascular / Klippel-Trenaunay-Weber syndrome with vesical and uterine involvement treated by endoscopic and endovascular routes

El síndrome de Klippel-Trenaunay-Weber (SKTW) es una rara malformación venosa que, en general afecta a los miembros inferiores y, más raramente, a los superiores. Se caracteriza por formaciones angiomatosas cutáneas, várices e hipertrofia del miembro afectado. El compromiso genitourinario es sumamente infrecuente. Se presenta el caso de una paciente de 14 años. Ingresó por hematuria macroscópica de 48 h de evolución y metrorragia con grave compromiso hemodinámico. Se encontraba en estudio por presentar un hemangioma en el miembro inferior izquierdo que se extendía hasta la región pelviana. La uretrocistofibroscopía demostró la presencia de múltiples lesiones angiomatosas diseminadas en forma amplia en la vejiga, algunas de ellas con sangrado activo. La angioresonancia mostró una voluminosa formación hipervascularizada en contacto con la pared vesical a la cual desplazaba y fístulas arteriovenosas a nivel pelviano y en el miembro inferior izquierdo confirmando el diagnóstico etiológico. Se realizó una embolización arterial selectiva de los territorios ilíacos interno y externo e inmediatamente después una endocoagulación láser de los focos angiomatosos sangrantes. La hematuria remitió completamente en las 24 h posteriores al procedimiento. La metrorragia asociada al SKTW fue controlada mediante la utilización de análogos LHRH y progestágenos.

Klippel-Trenaunay-Weber syndrome (KTWS) is a rare venous malformation that generally affects the lower limbs and, more infrequently, the upper limbs. It is characterized by cutaneous angiomatous formations, varicose veins and hypertrophy of the affected limb. The involvement of the genitourinary tract is extremely infrequent. We expose the case of a 14 years old female patient who was admitted for macroscopic hematuria of 48 hours of evolution and metrorrhagia with severe hemodynamic decompensation. The patient was under study for presenting a hemangioma in the lower left limb that extended to the pelvic region. Urethrocystofibroscopy showed the presence of multiple wide-spread angiomatous lesions in the bladder, some of them with active bleeding. The angio-resonance showed a voluminous hypervascular formation in contact with the bladder wall showing several arteriovenous fistulas at the pelvic level and in the left lower limb confirming the etiological diagnosis. A selective arterial embolization of the internal and external iliac territories was performed and then, a laser endocoagulation of the bleeding angiomatous foci was carried out. The hematuria completely stopped within 24 hours later of the procedure. The metrorrhagia associated with KTWS was controlled by the use of LHRH analogs and progestogens.

El papel de la videocápsula endoscópica en la hemorragia digestiva / The role of the endoscopic videocapsule in digestive hemorrhage

Introducción: desde el advenimiento de la cápsula endoscópica, la hemorragia digestiva del intestino delgado ha cambiado su epidemiología y se ha podido identificar diversas causas que antes no se las entendía. Este estudio enmarca nuestra experiencia en esta nueva técnica de gran utilidad en el Hospital Metropolitano para estudiar el sangrado del intestino delgado. Objetivo: determinar los hallazgos identificados por cápsula endoscópica y su utilidad en los 3 grupos de hemorragia digestiva del intestino delgado que son: 1) sangrado evidente, 2) sangrado oculto y 3) anemia ferropénica. Metodología: se realizó un estudio descriptivo retrospectivo transversal. Se revisaron 201 historias clínicas de las cuales se seleccionaron aquellas cuyos pacientes acudían a realizarse un estudio de cápsula endoscópica debido a sospecha de sangrado digestivo del intestino delgado. Variables que se analizaron: edad, sexo, hallazgos y una variable de utilidad del estudio en el sangrado digestivo. El sistema de la cápsula endoscópica que se utilizó fue Pill Cam 2 de la GIVEN de intestino delgado. Resultados: distribución etaria promedio de 58±17 años (56% menores de 65 años y 44% mayores de 65 años). Las causas de sangrado del intestino delgado de los 3 grupos estudiados fue angiodisplasia (9%), múltiples erosiones (8%), tumores del intestino delgado erosionados (5%). La cápsula endoscópica para detectar la etiología de sangrado digestivo fue útil en 84% de los casos: sangrado evidente (85%), en el grupo de anemia (84%) y en el grupo de sangrado oculto (85%). Conclusión: la hemorragia digestiva del intestino delgado se puede presentar en cualquier edad y sexo. Los hallazgos más frecuente de hemorragia del intestino delgado son las angiodisplasias, las cuales se relacionan con la edad y múltiples erosiones de la mucosa intestinal. La cápsula endoscópica es un método de gran utilidad para detectar la detección etiología de la hemorragia de intestino delgado. (AU)

Introduction: Since the advent of the endoscopic capsule, digestive hemorrhage of the small intestine has changed in its epidemiology and it has been possible to identify several causes not previously understood. This study frames our experience in this new technology at the Metropolitan Hospital in the study of small bowel bleeding and its great utility. Objective: The objective of the study was to determine the findings identified by endoscopic capsule and its usefulness in the three groups of digestive hemorrhage of the small intestine, that are evident bleeding, occult bleeding and iron deficiency anemia. Methodology: A transversal retrospective descriptive study was carried out. In the study, 201 clinical records of patients were reviewed and those who attended an endoscopic capsule study with suspicion of digestive bleeding of small bowel origin were selected. The variables analyzed were age, sex, findings and a useful variable of the study in digestive bleeding. The system of the endoscopic capsule that was used was the Pill Cam 2 of the GIVEN of small intestine. Results: Among the results, an average age distribution of 58±17 years of age was found, of which 56% were patients under 65 years of age and 44% were older than 65 years. The most frequent cause of bleeding in the small intestine of the three groups studied was angiodysplasias in 9%. Multiple erosions were found in 8% of the patients. The presence of erosionaded small bowel tumors was observed in 5%. The endoscopic capsule in the detection of causes of digestive bleeding was useful in determining the etiology in 84% of cases. In the evident bleeding it was useful in 85%, in the anemia group 84% and in the group of occult bleeding in 85%. Conclusion: Small intestine digestive hemorrhage can occur at any age and in any gender. The most common findings of small bowel hemorrhage are angiodysplasias that are related to age, as well as multiple erosions of the intestinal mucosa. The endoscopic capsule is a very useful method in the etiological detection of small bowel hemorrhage. (AU)

Assessment of hemodynamic changes of persistent carotid-vertebrobasilar anastomoses by ultrasonography / 中国脑血管病杂志

Objective: Evaluate the hemodynamic characteristics of primitive carotid-vertebrobasilar anastomoses(PCVBA) by the combination of carotid duplex ultrasonography(CDU) and transcranial colorcoded sonography(TCCS). Methods: From July 2016 to July 2018, 14 patients combined screened by CDU and TCCS and confirmed by computed tomography angiography (CTA) in the Department of Neurology and Neurosurgery, Xuanwu Hospital were retrospectively and consecutively enrolled. The hemodynamic parameters, including peak systolic velocity (PSV) and resistance index (RI), were acquired in vertebral artery(VA).basilar artery(BA) and posterior cerebral artery. The vessel diameter of the extracranial VA was measured as well. Results: (1) Of 14 cases, 12 patients(12/14) represented dizziness, and 5 patients had posterior ischemic stroke, from whom there were 4 cases associated with ipsilateral internal carotid artery stenosis ≥50%. (2) Persistent trigeminal artery(PTA) was confirmed in 6 cases with high RI in bilateral extracranial VA. The velocity of distal BA was decreased when compressing the ipsilateral common carotid artery. (3)There were 5 persistent hypoglossal artery(PHA) and 3 proatlantal intersegmental artery (PIA), 1 case with type I PIA and 2 cases with type Jl PIA. CDU showed PHA and type I PIA arising from the extracranial internal carotid artery, and type II arising from the external carotid artery. All patients had ipsilateral VA absent, which has a tiny-lumen with low PSV and high RI or without flow, but TCCS showed normal blood flow in ipsilateral intracranial VA and BA, which was significantly decreased when compressing the ipsilateral common carotid artery. The contralateral VA were absent in 4 patients, and were hypoplastic in the other 4 patients. Conclusions: The abnormal hemodynamic changes of PCVBA could be evaluated by the combination of CDU and TCCS, which has a higher diagnostic accuracy of PHA and PIA than PTA. PHA or PIA have typical ultrasonographic manifestations, such as abnormal branches of the internal or external carotid artery on one side, and bilateral hypoplasia of extracranial VA with normal blood flow of ipsilateral intracranial VA and BA.

Angiodisplasia del apéndice cecal: Una rara causa de hemorragia digestiva grave / Cecal appendix angiodysplasia: An unusual cause of severe lower hemorrhage / Cecal appendix angiodysplasia. An unusual cause of severe lower hemorrhage

Una paciente de sexo femenino, adulta joven se internó con diagnóstico de hemorragia digestiva y descompensación hemodinámica. La colonoscopia mostró sangrado desde el ostium apendicular. Se realizó apendicectomía, con resolución de su cuadro de hemorragia digestiva y buena evolución posoperatoria. La anatomía patológica mostró angiodisplasia del apéndice cecal. Se realiza una revisión bibliográfica de esta rara patología y se hacen consideraciones sobre su frecuencia, forma de estudio y posibilidades terapéuticas.

An adult, female patient was admitted with diagnosis of digestive bleeding and hemodynamic instability. Colonoscopy showed bleeding from the appendicular ostium. An appendectomy was performed, with resolution of the digestive hemorrhage and good postoperative outcome. Pathology showed angiodysplasia of the cecal appendix. A bibliographical revision is done with considerations on the frequency, diagnostic workup and alternative therapies.

An elderly man with gastric cancer, Saint's triad and Heyde's syndrome / Un anciano con cáncer gástrico, tríada de Saint y síndrome de Heyde

This case study describes a 71-year-old man with signet-ring cell gastric adenocarcinoma and malignant sigmoidal polyp; and typical features of Saint's triad and Heyde syndrome. He had digestive bleeding, two types of hernia, diverticulosis, arterial hypertension, malignant polyp, and antecedent of smoking, lung tuberculosis, and surgical correction of aortic valve stenosis. There is a hypothetical inverse relationship between herniosis and development of malignancy; however, the patient herein described presented gastric and sigmoidal cancers. Gastrointestinal malignancies are sometimes associated with paraneoplastic entities, isolated or manifested as syndromes, but neither Saint's triad or Heyde syndrome have been included. This patient persisted clinically stable during the preoperative period, but suddenly died; Trousseau's syndrome would be the most probable mechanism of sudden death in this setting. Case reports can stimulate further studies to get additional knowledge about unusual entities.

Este estudio de caso describe un hombre de 71 años de edad, con adenocarcinoma gástrico con células en anillo de sello y un pólipo maligno sigmoideo; y características típicas de la tríada de Saint y del síndrome de Heyde. Tuvo una hemorragia digestiva, dos tipos de hernias, divertículos, hipertensión arterial, y pólipo maligno; con antecedente de tabaquismo, tuberculosis pulmonar, y corrección quirúrgica de estenosis de la válvula aórtica. Hay una hipotética relación inversa entre hernioses y el desarrollo de malignidades; sin embargo, el paciente que se describe en el presente documento presentó cánceres gástrico y sigmoideo. Neoplasias gastrointestinales se asocian a veces con entidades para neoplásicas aisladas o manifiestan síndromes, pero ni la tríada de Saint ni el síndrome de Heyde se ha incluido. Este paciente persistió clínicamente estable durante el período preoperatorio, pero de repente murió; síndrome de Trousseau sería el mecanismo más probable de muerte súbita en esta situación. Los informes de casos pueden estimular más estudios para obtener un conocimiento adicional sobre esas entidades inusuales.

Effect of vertebral artery hypoplasia on false negative rates in early MRI detection of small posterior circulation infarcts in elderly patients / 中华老年医学杂志

Objective To explore the effects of vertebral artery hypoplasia (VAH)on falsenegative rates with MRI in isolated acute vestibular syndrome (AIVS) patients with small posterior circulation small infarcts (infarct diameter ≤ 10 mm by DWI).Methods A total of 224 AIVS patients with at least one stroke risk factor (defined as high-risk AIVS)were consecutively recruited.Head impulse,nystagmus and test-of-skew(HINTS),brainstem auditory evoked potential (BAEP),and blink reflex(BR)were performed as soon as possible ahead of MRI.Another MRI was carried out in those with negative findings on the first imaging but suspected of a central lesion based on HINTS + BAEP + BR.Patients were divided into a VAH group and a non-VAH group.Results Of the 98 cases with posterior circulation infarcts,37 cases were small infarcts,including 16 in the VAH group(16/61,26.2％)and 21 in the non VAH group(21/163,12.9％),with a significant difference between the groups(x2 =4.58,P ＜ 0.05).Nine VAH patients (9/16,56.3 ％)and 4 non-VAH patients(4/21,19.0％)presented false negative results on cranial MRI-DWI,and the difference was also statistically significant(x2 =6.23,P＜0.001).HINTS + BAEP + BR showed a higher sensitivity than early MRI in identifying small infarcts(VAH group:100.0％ vs.44.0％ or 7/16,U=6.41,P＜0.001;non-VAH group:100.0％ vs.81.0％ or 17/21,U=4.46,P＜0.0S).V wave peak latency,Ⅲ-Ⅴ and Ⅰ-Ⅴ wave interpeak latency,and the latency of R1,R2,and R2' in the VAH group were longer than in the non-VAH group(each P＜0.05).Conclusions When VAH is present in high-risk AIVS patients,small infarcts are common,with high false-negative rates on MRI-DWI.HINTS + BAEP + BR may help identify small infarcts and thus improve diagnostic sensitivity.

Klippel-Trenaunay and Parkes-Weber syndromes: two case reports / Síndromes de Klippel-Trenaunay e Parkes-Weber: dois relatos de caso

Abstract Parkes-Weber syndrome is a congenital vascular disease that comprises capillary, venous, lymphatic, and arteriovenous malformations. Although Parkes-Weber syndrome is a clinically distinct entity with serious complications, it is still frequently misdiagnosed as Klippel-Trenaunay syndrome, which consists of a triad of malformations involving the capillary, venous, and lymphatic vessels, without arteriovenous fistulas. Both syndromes are generally diagnosed with Doppler ultrasound and confirmed by magnetic resonance angiography. The aim of this study is to describe one case of Klippel-Trenaunay syndrome, in a 36-year-old patient, and one case of Parkes-Weber syndrome, in a 21-year-old patient. We review the literature in order to discuss the possible causes and consequences of these diseases related to venous hypertension and angiodysplasia, taking a clearer approach to their differences, and discussing their treatment.

Resumo A síndrome de Parkes-Weber é uma doença vascular congênita que consiste em malformações capilares, venosas, linfáticas e arteriovenosas. Embora seja uma entidade clinicamente distinta com complicações graves, essa síndrome ainda é frequentemente diagnosticada erroneamente como síndrome de Klippel-Trenaunay, que consiste em uma tríade de má formação nos vasos capilares, venosos e linfáticos, sem fístula arteriovenosa. Ambas as síndromes são geralmente diagnosticadas através de ultrassom Doppler e confirmadas pela angiografia por ressonância magnética. O objetivo deste estudo é descrever um caso de síndrome de Klippel-Trenaunay em um paciente de 36 anos de idade e um caso de síndrome de Parkes-Weber em uma paciente de 21 anos. A literatura foi revisada com o objetivo de discutir as possíveis causas e consequências dessa doença e sua associação à hipertensão venosa e angiodisplasia. O presente trabalho também levanta discussão a respeito das diferenças sintomatológicas de ambas as síndromes e seus respectivos tratamentos.

Resultados del proceder de Nirschl en la epicondilosis lateral de codo / Results of Nirschl procedure in lateral elbow epicondylosis

Fundamento: la epicondilosis lateral de codo, también conocida como epicondilitis o codo de tenista, es una condición común resultante de una tendinopatía no inflamatoria del origen de los tendones extensores en el epicóndilo lateral con una incidencia entre el 1 % y el 3 % de la población adulta por año. La clínica se caracteriza por dolor a nivel del epicóndilo lateral, asociado a debilidad al agarrar o elevar objetos con el antebrazo en pronación. Un 15 % de los enfermos son tributarios de cirugía. Objetivo: caracterizar los resultados de la técnica de Nirschl en los pacientes con epicondilosis lateral de codo desde septiembre de 2012 hasta septiembre de 2015. Métodos: se realizó un estudio prospectivo, descriptivo y transversal. La muestra no probabilística quedó constituida por 46 pacientes y 48 codos, seleccionados según criterios. Se utilizaron las técnicas de estadísticas descriptivas e inferenciales. Resultados: predominaron las mujeres con 36 casos. Los enfermos se encontraban en el grupo de 30 a 59 años y 35 casos iniciaron los síntomas entre ocho y 12 meses de la cirugía. El miembro dominante predominó con 43 casos y en dos casos la afectación fue bilateral. La evaluación posoperatoria de los pacientes, mostró una evolución entre excelente y bueno en 46 codos al año de operados. Conclusiones: la técnica de Nirschl para la epicondilosis lateral de codo es efectiva en la mayoría de los pacientes, se logra una mejoría clínica que se mantuvo en el transcurso del tiempo. Se considera una terapia segura al acompañarse de un mínimo de complicaciones. La efectividad y seguridad del procedimiento dependen de una técnica depurada y de una selección adecuada de los pacientes.

ABSTRACT Background: lateral elbow epicondylosis, also known as epicondylitis or tennis elbow, is a common condition resulting in a non inflammatory tendinopathy of the extensor tendons at the lateral epicondyle, with an incidence between one and three percent in adult population per year. The clinical group of signs is characterized by pain in the lateral epicondyle, associated with weakness of the grip force and difficulties to lift objects in prone position. About a 15 % of the cases can undergo surgery. Objective: to characterize the results of the Nirschl technique in patients with lateral elbow epicondilosis from September 2012 to September 2015. Methods: a prospective, descriptive and transversal study was conducted. The non probabilistic sample was composed of 46 patients and 48 elbows, selected by criteria. Descriptive and inferential statistics techniques were used. Results: women prevailed with 36 cases. The ill patients were in the 30 to 59 age group, and 35 cases began with the symptoms between eight and twelve month after surgery. The dominant limb was predominant with 43 cases and in two patients the affection was bilateral. Postoperatory evaluation showed excellent and good results in 46 elbows up to a year after surgery. Conclusions: Nirschl technique for lateral epicondilosis is effective in the majority of the patients, because of the clinical improvement which last in time. It is considered a save therapy with less complications. The effectiveness and safety of this procedure depend on a pure technique and adequate selection of patients.

Síndrome de Klippel Trenaunay / Klippel-Trenaunay Syndrome

El Síndrome de Klippel Trenaunay es una malformación vascular congénita caracterizada por una triada de manifestaciones clínicas que comprende una malformación vascular venular, linfática y venosa, junto con hipertrofia esquelética y aumento de tejidos blandos de uno o más miembros. De etiología desconocida, patogénicamente se cree que se produce una alteración en el desarrollo del mesodermo en el feto, que afecta a las líneas angioblástica, linfoblástica y osteoblástica. Se presenta el caso de un paciente femenino de 5 años de edad quien presenta una malformación vascular, diagnosticada inicialmente como hemangioma vascular y posteriormente se asoció a Síndrome de Klippel Trenaunay. El objetivo de la presentación de este caso es generar conocimiento sobre las características clínicas del síndrome de Klippel Trenaunay para un diagnóstico y tratamiento oportuno(AU)

Klippel - Trenaunay -Weber congenital vascular malformation characterized by a triad of clinical manifestations comprising a venular, venous and lymphatic vascular malformation, with hypertrophy increased skeletal and soft tissue of one or more members. Of unknown etiology, it is believed to pathogenically an alteration occurs in mesoderm development in the fetus, which affects angioblastic , and osteoblastic lymphoblastoid lines. Is presentedthe case of a 5 year old that has a vascular malformation, initially diagnosed as vascular hemangioma and later was associated with Klippel- Trenaunay -Weber.Objective: To generate knowledge about the clinical features of KlippelTrenaunay Syndrome for diagnosis and treatment(AU)

Imaging diagnosis of congenital absence of the internal carotid artery / 中华神经科杂志

Objective To discuss the clinical and radiological features of congenital absence of the internal carotid artery.Methods Four patients of the congenital absence of the internal carotid artery were reported and the clinical and radiological features were summarized by a review of the literature.Results Four patients were shown subarachnoid hemorrhage ( SAH) , transient ischemic attack ( TIA) , epilepsy and headache, respectively.All of the four patients presented the absence of unilateral or bilateral carotid arteries in cervical computed tomography angiography ( CTA) or magnetic resonance angiography ( MRA).Carotid canal was absent in all the patients in CT base of skull and multiple intracranial vascular dysplasia was shown in all the patients.Basilar or posterior communicating artery was presented as dolichoectasia in 3 patients.There were 2 patients who suffered aneurysm.Conclusions The onset of the congenital absence of the internal carotid artery can be presented in any age.Sudden severe headache as initial symptom caused by SAH is showed more common in children and adolescents.TIA is commonly seen in the elderly.CT shows carotid canals are absent in the base of skull.Unilateral or bilateral carotid arteries are shown absent in CTA or MRA.Multiple intracranial vascular dysplasia is shown in CTA or MRA.Carotid artery CTA has been considered as the optimal imaging method of showing the congenital absence of the internal carotid artery.

Diagnostic Value of Small Bowel Capsule Endoscopy in Patients with Mid-gastrointestinal Bleeding and Follow-up Study / 胃肠病学

Background:Small bowel capsule endoscopy(SBCE)has become a first-line procedure for examining small bowel diseases. Aims:To evaluate the diagnostic value of SBCE in patients with mid-gastrointestinal bleeding(MGIB). Methods:MGIB patients who underwent SBCE from Jan. 2012 to Dec. 2014 at the Third People’s Hospital of Bengbu were enrolled. Diagnostic value of SBCE in MGIB was analyzed. Re-bleeding was followed up by outpatient visit and telephone. Results:Forty-four consecutive MGIB patients underwent SBCE procedures,the detection rate was 95. 5% and the positive rate was 65. 9% . Vascular abnormality(37. 9% ),inflammation(31. 0% )and tumor(20. 7% )were the three major etiology in SBCE positive patients. Follow-up results showed that re-bleeding rate in SBCE positive group was significantly higher than in non-positive group(41. 4% vs. 13. 3% ,P < 0. 05). Conclusions:Vascular abnormality is still the most major etiology of MGIB,meanwhile the proportions of inflammation and tumor are increasing. SBCE has a high detection rate and positive rate in initial screening of MGIB,and the risk of re-bleeding in patients with negative SBCE is low.

Hematochezia due to Angiodysplasia of the Appendix

Common causes of lower gastrointestinal bleeding include diverticular disease, vascular disease, inflammatory bowel disease, neoplasms, and hemorrhoids. Lower gastrointestinal bleeding of appendiceal origin is extremely rare. We report a case of lower gastrointestinal bleeding due to angiodysplasia of the appendix. A 72-year-old man presented with hematochezia. Colonoscopy showed active bleeding from the orifice of the appendix. We performed a laparoscopic appendectomy. Microscopically, dilated veins were found at the submucosal layer of the appendix. The patient was discharged uneventfully. Although lower gastrointestinal bleeding of appendiceal origin is very rare, clinicians should consider it during differential diagnosis.

The role of capsule endoscopy in etiological diagnosis and management of obscure gastrointestinal bleeding

BACKGROUND/AIMS: To investigate the various etiologies, yields, and effects of capsule endoscopy (CE) on management and complications, along with follow up of patients with obscure gastrointestinal (GI) bleeding. METHODS: The study group of patients included those having obscure, overt, or occult GI bleeding. The findings were categorized as (A) obvious/definitive, (B) equivocal, or (C) negative. Any significant alteration in patient management post CE in the form of drug or surgical intervention was noted. RESULTS: Total patients included in the study were 68 (48 males and 20 females). The ratio of male:female was 2.4:1. The age ranged between 16 years to 77 years. Mean age for males was 62+/-14 years, for females 58+/-16 years. The total yield of CE with definitive lesions was in 44/68 (65.0%) of patients. In descending order (A) angiodysplasia 16/68 (23.53%), (B) Crohn's disease 10/68 (14.70%), (C) non-steroidal anti-inflammatory drug enteropathy 8/68 (11.76%), (D) small bowel ulcers 4/68 (5.88%), (E) jejunal and ileal polyps 2/68 (2.94%), (F) intestinal lymphangiectasis 2/68 (2.94%), and (G) ileal hemangiomas 2/68 (2.94%) were followed. Equivocal findings 12/68 (17.65%) and negative study 12/68 (17.65%) was found. Complications in the form of capsule retention in the distal ileum were noted in 2/68 (2.94%) subjects. Statistically, there was a higher probability of finding the etiology if the CE was done during an episode of bleeding. CONCLUSIONS: CE plays an important role in diagnosing etiologies of obscure GI bleeding. Its role in influencing the management outcome is vital.

Multiple Polypoid Angiodysplasia with Obscure Overt Bleeding

Angiodysplasia (AD) is increasingly being recognized as a major cause of gastrointestinal bleeding. Morphologically flat lesions are common types of AD, whereas the polypoid types are rare. We report a case of multiple polypoid AD in the small bowel causing severe anemia and requiring surgical treatment. A 60-year-old male patient visited our hospital with dyspnea and hematochezia. He had a history of myocardial infarction and was taking both aspirin and clopidogrel. Capsule endoscopy, enteroscopy, computed tomography, and angiography revealed multifocal vascular lesions with a polypoid shape in the jejunum. Surgical resection was performed because endoscopic treatment was considered impossible with the number and the location of lesions. The risk of recurrent bleeding related to the use of antiplatelet agents also contributed to the decision to perform surgery. AD was histologically diagnosed from the surgical specimen. He resumed taking both aspirin and clopidogrel after surgery. He fully recovered and has been doing well during the several months of follow-up.