Uso del agente espamolitico otilonio bromuro (spamonen) en endoscopia digestiva: estudio prospectivo en 63 pacientes / Use of spasmolytic agent otilonium bromide in digestive endoscopy: a prospective study in 63 patients

El otilonio bromuro es un antagonista del calcio con un efecto miolítico directo, el cual está indicado en estados espásticos y disguinesias funcionales del aparato gastroentérico (sindrome del intestino irritable) y como premedicación para procedimientos endoscópicos gastrointestinales. El presente estudio evaluó el otilonio bromuro 40 mg PO la noche anterior y 40 mg PO la mañana de 49 fibroscopías bajas en 63 pacientes, para determinar la presencia o ausencia de peristalsis y relajación del píloro. No se observaron efectos colaterales debido a la medicación. En 46 (93.8 por ciento) endoscopías altas se observó marcada relajación del tracto gastrointestinal y del píloro. En 13 (92.8 por ciento) endoscopías bajas también se observó marcada relajación del tracto colónico. Todos los pacientes toleraron bien las endoscopías. El otilonio bromuro fue útil como premedicación para facilitar las exploraciones endoscópicas altas y bajas, debido a su efecto espasmolítico.

Syphilitic rectal ulcer associated with perforation of the hard palate: case report

We report a case of a patient that presented with a perforated hard palate as a late complication due to an unsuspected syphilis. This disease first presented as a rectal ulcer which was misdiagnosed as an amebic proctitis. The patient received antiamebic treatment with a satisfactory outcome. He did not return for late control of the latter treatment and returned seeking medical advise six years later with the former complication. He tested positive for syphilis and appropiate treatment was performed. In addition, the ORL department recommended a palate prosthesis.

Helicobacter pylori en pacientes con gastritis y ulcera gástrica / Helicobacter pylori in patients with gastritis and gastric ulcer

Seventy patients symptoms and signs compatible with gastritis and/or peptic ulcer were included in the study; they were 41 women and 29 men, with an age range of 9-84 years, and they underwent upper endoscopy. Brushing of the antrum was performed and 4 biopsies were taken from it. With the gastric mucus, a smear was prepared for Gram staining; one sample of tissue was placed directly in urea medium and another tissue sample in Skirrow medium; and two samples of tissue were stained with Hematoxylin-eosin and examined under the light microscope. Those patients who were taking antibiotics capable of inhibiting growth of Helicobacter pylori (Hp), the last four weeks prior endoscopy, were excluded from the study. Twenty-six patients (37.1 percent) were positive (+) for Hp the culture in urea medium. Of these 26 patients, 15 (21.4 percent) were also positive by the Skirrow method, and 11 (15.7 percent) by Gram stain. Epigastric pain was the most predominant sympton in (+) patients (80.7 percent) and (-) patients (68.1 percent) for Hp. Superficial acute gastritis within the antrum was the most frequent endoscopic finding in (+) (84.6 percent) and (-) (68.1 percent) patients. Chronic superficial gastritis was the predominant microscopic finding in (+) (42.3 percent) and (-) (38.6 percent) patients as well. Microscopic examination was positive for Hp in 6 (23 percent) patients by H-E stain. According to these results, there was no statistically significant difference in symptoms, endoscopic and microscopic findings between positive and negative patients for Hp

Fístula colecisto-duodenal asintomática en una paciente con diabetes mellitus e hipotiroidismo primario: presentación de un caso / Asymptomatic cholecystoduodenal fistula in patient with diabetes mellitus and primary hypothyroidism: report of a case

The case of a 60-year-old woman with diabetes mellitus type II and primary hypothyroidism, who presented a clinical picture compatible with intestinal obstruction is reported. An abdominal sonogram revealed acute calculous cholescystitis and ileus. A plain film of the abdomen showed dilatation of small bowel loops. She underwent celiotomy, once stabilized, and gallstone ileus + cholecystoduodenal fistula were diagnosed intraoperatively. Resection of the ischemic segment of distal jejunum and the stone, cholecystectomy and primary repair of the fistula were performed. In spite of the systemic complications (metabolic, cardiovascular and pulmonary), that appeared postoperatively, the patient had a favorable outcome. This patient had an acute calculous cholecystitis anda spontaneous biliary-enteric fistula with intestinal obstruction, without preveious symptoms of biliary tract disease preceding the episode of bowel obstruction

Ascariasis de la vesicula biliar: reporte de dos casos y revisión de la literatura / Ascariasis of the gallbladder: report of 2 cases and review of the literature

Se relatan dos pacientes quienes presentaron un cuadro clínico compatible con colelitiasis; y, en quienes el diagnóstico de ascariasis de la vesícula biliar fue hecho sonográficamente. En el primer paciente, la colecistectomía fue curativa, y corroboró la presencia del parásito. En el segundo paciente, se administró citrato de piperazina. Un segundo sonograma realizado después del tratamiento, no reveló dentro de la vesícula biliar; y el paciente permanece asintomático hasta ahora. Se pone énfasis en la utilidad que la ultrasonografía brinda en el diagnóstico de la ascariasis de la vesícula, y durante la vigilancia en aquellos pacientes quienes son manejados con terapia médica solamente