Cystic dystrophy of the duodenal wall: A rare but need-to-know disease.

Cystic dystrophy of the duodenal wall (CDDW) is a serious but uncommon complication of heterotopic pancreatic tissue characterized by increased duodenal wall thickness associated with intraparietal cystic lesions. It is mainly observed in middle-aged male patients with alcoholic chronic pancreatitis. Clinical symptoms are usually nonspecific and it is important to take them into account in patients with the abovementioned history. Imaging techniques have been useful for diagnosis, especially endoscopic ultrasound (EUS), to visualize cystic lesions in the wall. There is some controversy regarding treatment, because although good results have been obtained with surgical techniques, the recent emergence of EUS-guided drainages has also achieved acceptable results and they are suggested as a good alternative to traditional surgery. Following is our experience in the diagnosis and treatment of four patients with CDDWs; all of whom had a history of alcoholism and smoking, and were studied due to clinical signs of abdominal pain and vomiting. EUS was particularly useful in reaching the final diagnosis.

Current role of capsule endoscopy in Crohn's disease.

Capsule endoscopy (CE) currently plays an important role in Crohn's disease (CD). It is a noninvasive technique that has led to a breakthrough in the endoscopic diagnosis of diseases of the small intestine. Its superior diagnostic performance and excellent safety profile lead to its considerable acceptance on the part of the patient. This paper reviews current indications of CE in three stages of clinical practice: Suspected CD, unclassified colitis and its extensive role in diagnosed CD. The diagnostic and therapeutic impact of the results of CE on the monitoring of this disease is also reviewed. Knowledge of its applications, the interpretation of its results in an appropriate context and the existence of a validated endoscopic activity index could change the way in which these patients are managed. The definition of mucosal healing and postoperative recurrence by means of endoscopic scoring systems will endow CE with new applications in the management of CD in the near future.

Pseudoaneurisma asociado a pseudoquiste pancreático complicado / Pseudoaneurysm associated with complicated pancreatic pseudocysts

El pseudoaneurisma asociado a pseudoquiste es una complicación grave e infrecuente de la pancreatitis crónica. Su tratamiento es complejo por su elevada mortalidad y la necesidad de un manejo multidisciplinar. La medida inicial consiste en la localización de la hemorragia mediante tomografía computarizada dinámica y arteriografía. El tratamiento de elección es controvertido por la ausencia de estudios controlados. Para el manejo de la hemorragia en pacientes estables, la medida terapéutica inicial más aceptada actualmente es la embolización arterial. Ante fracaso de la misma, inestabilidad hemodinámica o imposibilidad de drenaje del pseudoquiste la cirugía es la siguiente opción terapéutica (AU)

A pseudoaneurysm associated with a pseudocyst is a serious and unusual complication of chronic pancreatitis. Its treatment is complex due to its elevated mortality and the need for multidisciplinary management. Initial measures consist in locating the hemorrhage through computerized dynamic tomography and arteriography. The treatment of choice is controversial due to the lack of controlled studies. For managing hemorrhages in stable patients, the most accepted initial measure currently is arterial embolization. In the event of failure of the same, hemodynamic instability or the impossibility of drainage of the pseudocyst, surgery is the subsequent therapeutic option(AU)

Experiencia con prótesis metálica autoexpandible con diseño específico para la dehiscencia de sutura tras gastrectomía tubular / Experience with a new self-expanding metal stent specifically designed for wound dehiscence after sleeve gastrectomy

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Pseudoaneurysm associated with complicated pancreatic pseudocysts.

A pseudoaneurysm associated with a pseudocyst is a serious and unusual complication of chronic pancreatitis. Its treatment is complex due to its elevated mortality and the need for multidisciplinary management. Initial measures consist in locating the hemorrhage through computerized dynamic tomography and arteriography. The treatment of choice is controversial due to the lack of controlled studies. For managing hemorrhages in stable patients, the most accepted initial measure currently is arterial embolization. In the event of failure of the same, hemodynamic instability or the impossibility of drainage of the pseudocyst, surgery is the subsequent therapeutic option.

[Effectiveness of maintenance azathioprine therapy without oral cyclosporine after severe attacks of ulcerative colitis refractory to endovenous steroids]. / Eficacia del mantenimiento con azatioprina sin ciclosporina oral tras un brote grave de colitis ulcerosa refractario a esteroides intravenosos.

INTRODUCTION: Intravenous (i.v.) cyclosporine (CsA) has proved effective in controlling acute attacks of ulcerative colitis unresponsive to IV steroids. After the initial response to i.v. CsA, two alternatives for maintaining remission have been proposed: either double or triple association with immunosuppressors. The aim of this study was to evaluate the effectiveness of i.v. CsA, its adverse effects, and the subsequent long-term effectiveness of azathioprine/6-mercaptopurine without oral CsA. MATERIAL AND METHODS: Intravenous CsA was administered for 10 days, at a dose of 4 mg/kg per day, to 20 patients diagnosed with a severe attack of ulcerative colitis who did not respond to IV steroid treatment. Patients who responded to CsA and could be discharged were administered azathioprine or 6-mercaptopurine associated with a decreasing dose of oral steroids, without oral CsA. RESULTS: Sixty per cent (12/20) of the patients showed clinical-biological improvement after CsA administration, thus avoiding colectomy, and were discharged from hospital. Nine of the 12 responders (three withdrew from the study) were followed-up long term. Of these nine patients, four (44.4%) underwent colectomy, all before the sixth month of discharge. All adverse effects were mild, except for one death. CONCLUSIONS: Intravenous CsA is effective in inducing remission of ulcerative colitis in severe attacks resistant to i.v. steroids. When treatment with azathioprine is administered without oral CsA, patients requiring colectomy need this procedure within the first 6 months of discharge.

Eficacia del mantenimiento con azatioprina sin ciclosporina oral tras un brote grave de colitis ulcerosa refractario a esteroides intravenosos / Effectiveness of maintenance azathioprine therapy without oral cyclosporine after severe attacks of ulcerative colitis refractory to endovenous steroids

INTRODUCCIÓN: La ciclosporina (CyA) intravenosa (i.v.) hademostrado ser eficaz en el control de los brotes agudos gravesde colitis ulcerosa que no responden a esteroides i.v.Tras la respuesta inicial a la CyA i.v., se han propuesto dosalternativas para mantener la remisión, la doble o triple asociaciónde inmunosupresores. Los objetivos de nuestro estudiohan sido valorar la eficacia de CyA i.v., sus efectos secundariosy la efectividad posterior a largo plazo de laazatioprina/6-mercaptopurina sin CyA oral.MATERIAL Y MÉTODOS: Se administró CyA i.v. durante 10días, en dosis de 4 mg/kg/día a 20 pacientes diagnosticadosde colitis ulcerosa en brote grave y que no respondieron atratamiento con esteroides i.v. A los que respondieron y pudieronser dados de alta se les administró azatioprina o 6-mercaptopurina asociadas a esteroides orales en pauta descendentey sin CyA oral.RESULTADOS: El 60% (12/20) de los pacientes presentó unamejoría clínico-biológica tras la administración de CyA, loque permitió evitar la colectomía y que fueran dados de altahospitalaria. Se siguieron a largo plazo 9 de los 12 pacientesque respondieron (3 se excluyeron del estudio), y de ellos 4(44,4%) tuvieron que ser colectomizados, todos antes delsexto mes del alta. Los efectos secundarios fueron todos leves,excepto un fallecimiento.CONCLUSIONES: La CyA i.v. es eficaz para inducir la remisiónde la colitis ulcerosa en los brotes graves resistentes aesteroides i.v. Con la estrategia de administrar azatioprinasin CyA oral, los pacientes que requieren colectomía la precisanen los primeros 6 meses tras el alta (AU)

INTRODUCTION: Intravenous (i.v.) cyclosporine (CsA) hasproved effective in controlling acute attacks of ulcerative colitisunresponsive to IV steroids. After the initial response toi.v. CsA, two alternatives for maintaining remission havebeen proposed: either double or triple association with immunosuppressors.The aim of this study was to evaluate theeffectiveness of i.v. CsA, its adverse effects, and the subsequentlong-term effectiveness of azathioprine/6-mercaptopurinewithout oral CsA.MATERIAL AND METHODS: Intravenous CsA was administeredfor 10 days, at a dose of 4 mg/kg per day, to 20 patientsdiagnosed with a severe attack of ulcerative colitis who didnot respond to IV steroid treatment. Patients who respondedto CsA and could be discharged were administeredazathioprine or 6-mercaptopurine associated with a decreasingdose of oral steroids, without oral CsA.RESULTS: Sixty per cent (12/20) of the patients showed clinical-biological improvement after CsA administration, thusavoiding colectomy, and were discharged from hospital. Nineof the 12 responders (three withdrew from the study) werefollowed-up long term. Of these nine patients, four (44.4%)underwent colectomy, all before the sixth month of discharge.All adverse effects were mild, except for one death.CONCLUSIONS: Intravenous CsA is effective in inducing remissionof ulcerative colitis in severe attacks resistant to i.v.steroids. When treatment with azathioprine is administeredwithout oral CsA, patients requiring colectomy need thisprocedure within the first 6 months of discharge (AU)