How to improve the diagnosis of eosinophilic esophagitis: Experience from a case series in Mexico. / Cómo mejorar el diagnóstico de esofagitis eosinofílica: experiencia de una serie de casos en México.

INTRODUCTION: Eosinophilic esophagitis (EoE) is a chronic, immune disorder mediated largely by food antigens. It shares nonspecific symptoms with gastroesophageal reflux disease (GERD). EoE is rarely reported in Mexico, perhaps due to the racial characteristics of the population or because of insufficient diagnostic suspicion. AIMS: Our aim was to describe a Mexican cohort with EoE and evaluate the usefulness of the clinical history and endoscopy in the EoE diagnosis, in comparison with GERD patients. MATERIALS AND METHODS: A retrospective study was carried out on the clinical characteristics and endoscopic and histopathologic findings in patients with EoE, along with a case-control study on patients with GERD. The endoscopic images obtained were interpreted in a blind and randomized manner by 4 gastroenterologists, before and after providing them with information on the characteristic alterations of EoE. The esophageal biopsies were also blinded to 2 pathologists that evaluated their diagnostic correlation. The Fisher's exact test and Mann-Whitney U test were used in the statistical analysis. RESULTS: Fourteen patients with EoE were included in the study. Ten (71%) of them were men and the mean age of the patients was 35 years. There were more subjects with a personal history of asthma (p=0.0023) and food impaction (p=0.04) in the EoE group. The initial evaluation of the endoscopic findings showed 53% correct EoE interpretations and rose to 96% in the second revision (sensitivity 100%, specificity 71%, PPV 65%, NPV 100%). CONCLUSIONS: Mexican patients with EoE have similar characteristics to those of patients in western case series. Clinical awareness of the disorder increases endoscopic diagnosis in up to 40% of cases.

[Whipple's disease: a case report and review of the literature]. / Enfermedad de Whipple. Presentación de un caso y revisión de la literatura.

Whipple's disease is a systemic infectious condition caused by a gram-positive bacteria belonging to the family of actinomycetes called Tropherima whipplei. It presents most often in males and 13% of patients present with severe diarrhea, fever, adenopathy, weight loss and pigmentation of the skin. Diagnosis is made through duodenal biopsy by which shows foamy macrophages PAS positive. In cases where the histology is negative, we can make the identification of the infectious agent by polymerase-chain reaction (PCR). We describe a 47 years old woman with Whipple's disease whose diagnosis was made through the duodenum and colon biopsies showing infiltration by PAS-positive macrophages.

[Autoimmune pancreatitis: case report.]. / Pancreatitis autoinmune: informe de un caso.

Autoimmune pancreatitis represents a chronic inflammatory pancreatic disease with distinct clinical, morphologic and histopathological features. We report the case of a 64 year old man with obstructive jaundice in whom the imaging studies showed diffuse enlargement of the pancreas, and a mass in its head. Fine needle aspiration biopsy of the mass guided by endoscopic ultrasound showed lymphocytic infiltration and fibrosis. The size of the pancreas, laboratory abnormalities, and clinical manifestations subsided promptly after treatment with steroids. Autoimmune pancreatitis should be included in the differential diagnosis of patients with obstructive jaundice and/or pancreatic masses.

[Para-tubal cysts: frequency and clinical, ultrasonographic and histological correlations]. / Quistes paratubarios: Frecuencia y correlación clínica, ultrasonográfica e histológica.

We Reviewed 5,100 biopsies, between November 1994 to November 1995 We found 100 paratubval cysts. The 80% of the cases were surgical findings. The 40% of the cases had pain. The 3% of the patients had acute pain, that made necessary an urgent surgery. The ultrasonogram revealed an ovarian cyst in 38% of the cases and it couldn't detect them in 63% of the cases. The cysts sizes were: 6 cm. (84%) *12% 9 between 6-12 cm. and 43% between 12-18 cm. The histopathology report was: 57% of serous cyst and 43% simple cyst.

[Evaluation of ultrasonographic variables of the endometrium in relation with histopathologic findings in patients with postmenopausal uterine bleeding]. / Evaluación de las variables ultrasonográficas del endometrio en relación con los hallazgos histopatológicos en pacientes con sangrado uterino posmenopáusico.

The purpose of this study was to determine the sensitivity, specificity, positive and negative predictive value of analyzed variables in the ultrasonographic endometrial study in patients with postmenopausal uterine bleeding. Nineteen women with postmenopausal uterine bleeding were studied, in all of them and in the same day a transvaginal ultrasound and endometrial biopsy were performed. It was observed that endometrial thickness median was 4 mm; most of the endometria were proliferative (n = 12), and a greater trend to obesity and upper segment fat distribution was found. Endometrial thickness, refringence and liquid on uterine cavity had a sensitivity and a negative predictive value NPV) of 100%, specificity and positive predictive value were lower. When endometrial thickness and refringence were associated also a sensitivity and NPV of a 100% was found. It can be concluded that transvaginal ultrasound is useful to define in which patient with postmenopausal uterine bleeding the endometrial biopsy is indicated.

[Correlation of histopathologic findings with ultrasonography variables of the endometrium according to body weight and adipose tissue distribution in postmenopause]. / Correlación de los hallozgos histopatológicos con las variables ultrasonográficas del endometrio conforme al peso corporal y distribucióndel tejido adiposo en la posmenopausia.

The purpose of this work was to correlate the histologic findings and ultrasonographic variables of the endometrium in relation to corporal weight and body fat distribution, in two groups of women: one with posmenopausal uterine bleeding and other under hormonal replacement therapy (HRT). Thirty one posmenopausal women were studied and divided into two groups: I. women with posmenopausal uterine bleeding (n = 19) and II women with HRT (conjugated estrogens and chlormadinone) (n = 12). In both groups transvaginal ultrasound was accomplished the same day previous to the endometrial biopsy (EB). The EB was taken in the group I the day they attended the hospital referring transvaginal bleeding and in group I a statistical significant correlation was found among the corporal weight and histologic findings and among the endometrial refringence and the histologic findings. In group II there was a statistical significant correlation among the body fat distribution and endometrial refringence and among the endometrial thickness and histologic findings. It can be concluded that in women with posmenopausal bleeding the corporal weight influences the histologic findings and the refringence is related with histologic findings, while those under HRT is more important the body fat distribution over endometrial refringence and the endometrial thickness is related with histologic findings.

[Modification of the Abbe-Wharton-McIndoe technique using regenerated oxidized cellulose instead of a skin graft]. / Modificación a la técnica de Abbe-Wharton-McIndoe, utilizando celulosa oxidada regenerada en vez de injerto de piel.

Many conditions have an abnormal development of the vagina, which impair satisfactory sexual activity. Non-surgical and surgical procedures have been developed to correct this situation, the Abbe-Wharton-McIndoe operation is one with the best results, but it has the disadvantage that the scar produced in the place where the skin graft is taken has an awful appearance. Although the oxidized regenerated cellulose (ORC) has been extensively used in pelvic surgery to avoid or diminish the adhesion formation, no other uses have been described for this material; we decided to use ORC instead of skin graft at the moment of the Abbe-Wharton-McIndoe procedure, in order to achieve rapid epithelization of the recently created cavity and avoiding skin graft taken. This is the report of four cases with Rokitansky syndrome in which a vagina was created using the McIndoe procedure and ORC was used instead of skin graft. At 12 weeks after surgery a complete epithelization of the new open cavity was achieved with the presence of mature vaginal epithelium. The conclusion is that ORC is an alternative instead of skin graft, with the advantage of avoiding the skin graft taken as well as the scar obligatorily produced with that procedure, and also achieving a complete and quick epithelization of the new cavity.