Melanoma anorrectal primario: una causa infrecuente de rectorragia en el adulto mayor / Primary anorectal melanoma: an uncommon source of rectal bleeding in the elderly

El melanoma anorrectal primario es un tumor maligno muy infrecuente y con un pobre pronóstico. Se presenta un paciente de 66 años con rectorragia, en el cual el diagnóstico de melanoma anorrectal se efectuó por colonoscopia e histología. Se trató mediante una resección abdominoperineal. Se efectúa revisión de la literatura.

Primary anorectal melanoma is a very rare malignant tumor, with poor prognosis. A 66 years old man presenting with rectal bleeding is reported. The diagnosis of anorectal melanoma was confirmed by colonoscopy and histological findings. An abdominoperineal resection was performed. A review of the literature is presented.

Diagnóstico y tratamiento de las várices esófago gástricas en Chile: realidad nacional / Management of bleeding esophageal varices in public and private institutions in Chile

Background: The better treatment modalities for bleeding esophageal varices have improved the prognosis of cirrhosis. Aim: To inquire about diagnostic and treatment modalities for esophageal bleeding in Chile. Material and methods: An enquiry about diagnosis and treatment of esophageal bleeding was designed and electronically sent to public and private health institutions that could admit patients and were located in cides with more than 100,000 inhabitants. Results: The enquiry was answered by 31 of 35 public and 17 of 19 private health institutionis that were consulted. Emergency endoscopy was available in 6 of 27 public and in the 16 private institutionis that had an emergency room. Rubber band ligation was available in 16 public (52 percent) and in all private institutions. Cyanoacrylate injections were done in 10 public (32 percent) and 11 (65 percent) private institutions. No public institution installed transjugular intrahepatic portosystemic shunts, but 8 had occasional access to this technique. This procedure was done in 7 (41 percent) private institutions and all had access to it. Surgical treatment was feasible in 20 public (65 percent) and all private institutions. Primary prophylaxis was done in 18 public (58 percent) and 14 private (82 percent) institutions. Secondary prophylaxis was carried out in 26 public (84 percent) and 16 private (94 percent) institutions. Conclusions: Public health institutions have poor access to adequate diagnostic and treatment methods for esophageal bleeding. The primary and secondary prophylaxis of esophageal varices must be improved in both types of institutions.