Diverticulosis yeyunal masiva: causa infrecuente de malabsorción intestinal / Massive jejunal diverticulosis: Rare cause of intestinal malabsorption

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Epidemiología de la dispepsia en una comunidad del sur de España. Prevalencia de la infección por Helicobacter pylori / Epidemiology of dyspepsia in a random mediterranean population. Prevalence of Helicobacter pylori infection

OBJETIVO: la verdadera prevalencia de la dispepsia en la comunidad es poco conocida, pues la mayoría de los estudios se han realizado sobre muestras no representativas de la -población general. El objetivo fue estudiar la prevalencia de la dispepsia en una muestra aleatoria de una población general, así como sus características sociodemográficas y epidemiológicas. DISEÑO EXPERIMENTAL Y PARTICIPANTES: se realizó un estudio epidemiológico prospectivo basado en una encuesta directa y personal en una muestra de 264 sujetos, elegida al azar, entre una población del sur de España. RESULTADOS: la prevalencia de dispepsia fue del 24 por ciento, sin apreciarse relación entre ésta y diversos parámetros demográficos, hábitos tóxicos o subgrupos de dispepsia. El 49 por ciento de la población se automedicaba y el 44 por ciento acudió en busca de ayuda médica por su dispepsia. Mostraron un síndrome de intestino irritable 36 sujetos (13,6 por ciento) y 20 de ellos referían también síntomas de dispepsia (55,5 por ciento). Habían sido investigados 40 sujetos con dispepsia (80 por ciento mediante radiología con papilla de bario, 45 por ciento con ecografía y 18 por ciento con gastroscopia), obteniéndose un diagnóstico de enfermedad orgánica en el 45 por ciento de ellos. El subgrupo de dispepsia similar a reflujo gastroesofágico fue el más frecuente (60 por ciento), observándose un amplio solapamiento entre los diversos subgrupos de dispepsia. Los anti-H. Pylorí-IgG fueron positivos en el 52 por ciento, pero no hubo relación entre la infección bacteriana y la presencia de dispepsia. CONCLUSIONES: la dispepsia afecta a una cuarta parte de nuestra población, asociándose a síndrome de intestino irritable en la mitad de los casos, pero sin relación con la presencia de una infección por H. pylori (AU)

Epidemiology of dyspepsia in a random mediterranean population. Prevalence of Helicobacter pylori infection.

AIM: The prevalence of dyspepsia in the community is poorly known, because most studies have used samples that were not representative of the general population. This study was intended to determine the prevalence of dyspepsia in a random sample of the general population, and its epidemiologic and sociodemographic characteristics. METHODS: In this descriptive study we used a questionnaire administered during a personal interview to survey a random sample of 264 subjects in a Mediterranean population. RESULTS: The prevalence of dyspepsia was 24%; we found no relation between prevalence and demographic characteristics, smoking and drinking, or type of dyspepsia. Forty subjects with dyspepsia were examined and the specific diagnosis was found in 18 (45%) of them. The subgroup with reflux-like dyspepsia was the largest (60%), although there was considerable overlap between subgroups with reflux-like, ulcer-like and dysmotility-like dyspepsia. Anti-Helicobacter pylori antibodies (IgG) were found in 52% of the subjects, but bacterial infection was not related with dyspepsia. CONCLUSIONS: Up to one-fourth of the general population in the city where the subjects reside may have dyspepsia. This disorder was associated with irritable bowel syndrome in half of the cases, but was not associated with H. pylori infection.

[Endoscopic, histologic and morphometric evaluation of the gastric mucosa in patients with osteoarthritis treated with piroxicam and zinc acexamate]. / Evaluación endoscópica, histológica y morfométrica de la mucosa gástrica en pacientes con osteoartritis tratados con piroxicam y acexamato de cinc.

Zinc acexamate (ZAM) is an antiulcer agent with antisecretory and gastroprotective properties. The aim of this study was to evaluate endoscopically and morphometrically the efficacy of ZAM in the prophylaxis of gastroduodenal lesions induced by pyroxicam. Thirty nine patients from 30 to 70 years of age diagnosed with osteoarthritis without lesions in the upper digestive tract on basal endoscopy were studied. A randomized, double blind study was designed in which the patients received 20 mg/day of pyroxicam together with 300 mg/day of ZAM or placebo for 4 weeks. Clinical controls were undertaken on days 0, 14, 28 and endoscopic and histologic controls performed on days 0 and 28. The two groups were homogeneous regarding basal parameters. Endoscopic grading of the gastroduodenal lesions at the end of the study was lower in the group treated with ZAM (p < 0.001). Ulcers were found in only 2 patients (one antral and one duodenal) both of whom were in the placebo group (10.5%). Histologic scoring following treatment demonstrated higher values in the placebo group (p < 0.001) and scarce alterations with respect to base values in the group treated with ZAM. Morphometric quantification showed lower cell densities in both groups at the body level (p < 0.001). However, these did not vary in the antrum in the group treated with ZAM but increased in the placebo group (p < 0.001) as an expression of proliferative cell response to mucosal damage. At a single nightly dosis of 300 mg ZAM is effective in the prophylaxis of gastric and duodenal lesions induced by pyroxicam.

[Pancreatic glucagonoma and deep vein thrombosis]. / Glucagonoma pancreático y trombosis venosa profunda.

Glucagonoma is an endocrine tumor of almost exclusively pancreatic origin which is rarely associated with a clinical syndrome mainly characterized by migratory necrolytic erythema, hyperglycemia, weight loss, hypoaminoacidemia and anemia. Ten to 30% of the patients may present thromboembolic phenomenon, deep vein thrombosis and pulmonary embolism which often lead to the death of the patient. We report the case of a patient diagnosed with pancreatic glucagonoma the presentation of which consisted in episodes of repeated deep vein thrombosis without associated migratory necrolytic erythema.

[Multifocal Langerhans-cell granulomatosis with hepatic lesions simulating tumors]. / Granulomatosis multifocal de células de Langerhans con lesiones hepáticas que simulan una afectación tumoral.

Langerhans cells granulomatosis is a rare disease characterized by the clonal proliferation of the Langerhans cell, a cell element pertaining to the mononuclear phagocytes system. Hepatic involvement may be presented, particularly in the multifocal or disseminated form, together with the remaining surrounding organs. Radiologic findings have recently been reported including echographic, computerized tomography and magnetic resonance of the hepatic lesion of the disease. The case of a patient whose initial radiographic study suggested the existence of hepatic metastasis and which was later diagnosed with multifocal granulomatosis of Langerhans cells with hepatic involvement is reported. Radiologic and histologic images are provided and the data reported in the literature concerning this disease are reviewed.

[Asymptomatic chronic intrahepatic cholestasis and multiple hypodense nodules in the liver and the spleen: manifestations of a case of sarcoidosis]. / Colestasis intrahepática crónica asintomática y múltiples nódulos hipodensos en hígado y bazo: manifestaciones de un caso de sarcoidosis.

Sarcoidosis is a systemic granulomatous disease of unknown etiology which may present multiple clinical manifestations. Liver involvement is observed among 21-79% of the cases. Nonetheless, hepatic sarcoidosis is usually asymptomatic and the finding of cholestasis is an infrequent complication. In the last few years, the presence of multiple hypodense nodules in the liver and spleen has been described in 5-15% of these patients following the application of dynamic intravenous techniques in abdominal CT scan. Although the histopathologic study of these nodules suggests that their formation is due to the coalescence of the microscopic granulomas, the cause of this aggregation remains unknown. A case of hepatic sarcoidosis presenting chronic cholestasis and whose abdominal tomographic study with intravenous contrast demonstrated the existence of hypodense lesions in the liver and spleen suggesting malignant disseminated disease is reported.