Lesiones gastroduodenales y "Helicobacter pylori": nuestra experiencia / Gastroduodenal lesions and "Helicobacter pylori": our experience

Objetivo: La enfermedad péptica en la infancia es infrecuente y su incidencia exacta es desconocida. El uso de la endoscopia ha hecho conocer que su prevalencia es mayor de la sospechada, y se ha facilitado la demostración de la asociación entre lesión gastroduodenal y Helicobacter pylori (HP). Con los datos obtenidos en nuestra revisión, se ha querido contribuir a la descripción de las lesiones encontradas y los factores concomitantes relacionados con la enfermedad gastroduodenal primaria. Material y métodos: Revisión de la historia clínica de 28 pacientes evaluados en nuestra sección, que fueron diagnosticados de lesión gastroduodenal macro o microscópica, por endoscopia aisladamente o por endoscopio con biopsia. Se excluyeron los pacientes con lesiones secundarias. Resultados: El 46 por ciento de los pacientes presentó gastritis y/o duodenitis; el 28,5 por ciento no presentó lesión anatómica macroscópica por endoscopia, pero sí microscópica; el 24,9 por ciento manifestó úlcera duodenal o gástrica. El síntoma guía fue epigastralgia en el 64 por ciento. Se encontró positividad de ureasa en el 86 por ciento y visualización del germen en el 71 por ciento de los casos. El tratamiento más frecuentemente pautado fue omeprazol, claritromicina y amoxicilina. Se erradicó HP en el 77 por ciento de los casos. Cuando no se consiguió, se realizó una segunda pauta de tratamiento distinta, que tampoco consiguió la erradicación del germen. Conclusiones: La endoscopio con múltiples biopsias es una exploración necesaria en el diagnóstico del paciente con sospecha de enfermedad ulcerosa o síntomas crónicos de abdomen superior. Aunque los cultivos de HP no son necesarios para el diagnóstico de la enfermedad, pueden ser de gran ayuda cuando falla el tratamiento empírico inicial (AU)

Endoscopic ultrasonography features of calcified gastric cancer.

Calcifications are a rare finding described in benign and malignant tumors located in any site of the body. Their presence in stomach and colon carcinomas is very rare. Most of the cases described are mucinous adenocarcinomas. We present the case of one patient with this disease studied with endoscopic ultrasonography. There were punctate calcifications in the submucosa layer that tended to take on a crown-like shape in the outer-most area, producing an acoustic shadow. The pathological study of the surgical specimen showed amorphic calcifications inside some mucin lakes. More cases need to be studied with this technique in order to define their endosonographic characteristics.

Rotura intramural espontánea de la pared esofágica. Una entidad poco frecuente / Spontaneous rupture of the esophageal wall. A rare entity

No disponible

Multiple solitary leiomyomata of the esophagus.

The present report communicates a case of multiple solitary leiomyomata of the esophagus. This is an uncommon condition in which multiple, non-confluent, benign esophageal tumors arise in the same patient. The ideal treatment is enucleation of the lesions, but when these are--as in the case reported--huge and annular, or affect the gastroesophageal junction, resection of the gullet must be performed.

[Ischemic colitis: a descriptive analysis in a Madrid hospital]. / Colitis isquémica: análisis descriptivo en un hospital madrileño.

BACKGROUND: Ischaemic colitis represents the most common form of intestinal ischaemia and involves more commonly elderly patients with a variety of underlying conditions. This study analyses the epidemiology and clinical characteristics of the disease in our environment. PATIENTS AND METHODS: The IC cases occurred at our institution during the last two years were studied. Twenty-eight cases of IC obtained by reviewing colonoscopy and pathological records were analyzed. RESULTS: The non-occlusive type is the most common presentation form of IC. It affected elderly patients (74 +/- 10 years) with cardiovascular risk factors. Most cases manifested with abdominal pain (68%). In 64% cases, colonoscopy showed ulcerations, located mainly at descending colon and rectosigmoid. The clinical course was generally favourable with conservative measures. The overall mortality rate was 10%. CONCLUSION: The possibility of IC should be considered in the differential diagnosis of elderly patient with abdominal pain and cardiovascular risk factors.

Hydatid liver cyst perforation into the digestive tract.

Complications of liver hydatid disease include those related to the compression of adjacent viscus, to the infection of the cyst's contents or to the perforation of the cyst. Perforations into hollow abdominal organs are rare, and can occur secondary to the infection of the cyst or to a primary pathology of the perforated organ. We report on 2 cases of perforation of a liver cyst into the duodenum, 1 due to the presence of a duodenal ulcer, and 1 secondary to a hydatid abscess. The surgical treatment of the lesions and their complications was, in both cases, successful.

[Treatment with sulindac of adenomatous polyps in familial polyposis]. / Tratamiento con Sulindac de los pólipos adenomatosos en la poliposis familiar.

BACKGROUND: The effect of sulindac, a nonsteroid antiinflammatory drug, has been reported to cause both regression and suppression of colon polyps in patients with familial adenomatous polyposis and Gardner's syndrome. We report our experience with seven patients with diffuse colonic polyposis treated with sulindac. PATIENTS AND METHODS: Seven patients with familiar adenomatous polyposis, four men and three women (mean age, 30 years; range 16 to 41 years) were included in this study. Two patients that underwent prior colectoctomy with ileorectal anastomosis and had polyps in the rectum were also included. The polyps ranged in size from 0.2 to 2.5 cm; most of them were less than 1 cm. Sulindac was given 150 mg. twice a day. Further colonoscopic examination was done at 6-month intervals during follow-up in all patients. RESULTS: A disappearance or a marked reduction in the number and size of polyps was observed in all patients after 24 months of treatment with sulindac. The drug was well tolerated and no side effects were observed during treatment. CONCLUSION: The authors conclude that sulindac is effective in inducing the regression of rectal polyps in familial, adenomatous polyposis.

Operative choledochoscopy in biliary surgery.

Forty-six patients submitted to operative choledochoscopy during biliary surgery are presented. Forty-two had benign diseases, principally calculi (38 cases), with only four patients presenting with malignant neoplasms. Our results bear out the effectiveness of operative choledochoscopy as a complement to cholangiography and conventional exploration of the bile duct, in significantly reducing the number of retained stones found, and in aiding other surgical procedures in the biliary tract.

Cancer of the gastric stump.

28,500 fiberoptic endoscopies were reviewed. 97 cancers of the stump were found in 1,119 patients who had had gastric resection (8.66%), in contrast to the 3.9% of cancers found in nonoperated patients. This suggests that the gastric remnant has a higher tendency to develop cancer than the nonresected stomach. A policy of periodic follow-up of these patients must be considered in order to detect the tumor at an early stage.

Spontaneous intramural oesophageal perforation.

Spontaneous intramural oesophageal perforation appears at any level, but preferably on the posterior wall, and is usually longitudinal. Unlike the Mallory Weiss and the Boerhaave syndromes, females are more frequently affected. It appears with sudden retrosternal pain radiating to the epigastrium, neck and back, followed by haematemesis of small quantity and dysphagia. Vomiting is rare. In contrast to complete rupture, neither pneumomediastinum nor emphysema is observed, barium swallow being the diagnostic test of choice whenever this pathology is suspected. However, when the symptoms are not typical, endoscopy is a useful method for diagnosis. Treatment must be conservative, while surgery is suggested in the case of recurrent symptoms or big intramural haematomas with a high risk of perforation. A 74-year-old woman is presented. Endoscopy was performed as an emergency in suspected food impaction in the oesophagus. This case was diagnosed as spontaneous intramural oesophageal perforation. The patient also presented with oesophageal diverticulum and hiatal hernia. Conservative treatment was given, and the lesion cured.