Hiperoxaluria primaria tipo 2 y oxalosis sistémica: Reporte de caso / Primary hyperoxaluria type 2 and systemic oxalosis: A case report

La hiperoxaluria primaria tipo 2 es una enfermedad rara caracterizada por sobreproducción de oxalato por una deficiencia enzimática intrahepática, lo que lleva a litiasis renal, nefrocalcinosis y daño renal crónico. Varón de 17 años con antecedentes de infecciones urinarias, y litiasis renal desde los 6 años. Desarrolló insuficiencia renal crónica terminal a los 11 años ingresando a terapia de diálisis peritoneal crónica ambulatoria. Durante su evolución presentó dolor a nivel de la columna vertebral y grandes articulaciones como tobillos, rodillas y hombros, deformación progresiva de las articulaciones distales de las manos. La resonancia magnética de columna reporto aplastamiento de cuerpos vertebrales en D8 y D9. La biopsia ósea de vértebra mostró depósito de cristales de oxalato de calcio. El estudio genético confirmó el diagnóstico de hiperoxaluria primaria tipo 2, esta enfermedad debe sospecharse en niños que forman cálculos a temprana edad, sería el primer caso reportado en Perú.

Primary hyperoxaluria type 2 is a rare disease characterized by over production of oxalate due to a deficiency of an intra hepatic enzyme leading to renal lithiasis, nephrocalcinosis and chronic kidney damage. We report the case of 17-year-old male patients with history of urinary tract infections and renal lithiasis since the age of 6 years. The patient developed end-stage kidney disease at the age of 11 years receiving chronic ambulatory peritoneal dialysis. He developed back pain and polyarthralgia of the ankles, knees, shoulders and progressive deformity of the hands. The magnetic resonance of the spine revealed flattening of D9-D9. Bone biopsy of the affected area showed presence of calcium oxalate. A genetic study confirmed the diagnosis of primary hyperoxaluria type 2. This entity should be suspected in children with renal stones at an early age, this may be the first case in Peru.

Síndrome de Frasier, primer caso reportado en Perú: first reported case in Peru / Frasier´s syndrome: first reported case in Peru

El síndrome de Frasier es una enfermedad rara producida por la mutación del gen WT1, caracterizado por pseudohermafroditismo masculino, disgenesia gonadal 46XY y enfermedad glomerular. Reportamos el caso de una mujer de 18 años, diagnosticada a los 12 años de síndrome nefrótico con desarrollo precoz de enfermedad renal crónica terminal y requerimiento de diálisis. A los 17 años se le detectó una tumoración abdominal. La laparotomía exploratoria reveló tumoración anexada a la trompa derecha que se extendía hasta la pared posterior del útero. Se le realizó histerectomía abdominal total con salpingo-ooforectomía bilateral. El diagnóstico anátomo-patológico fue disgerminoma. La paciente tenía amenorrea primaria y ausencia de caracteres sexuales secundarios. El estudio de corpúsculo de Barr de células de mucosa bucal fue negativo para cromatina sexual y el cariotipo fue 46, XY (Disgenesia Gonadal). El estudio genético reportó mutación heterocigótica en el intrón 9 del gen WT1. El cuadro es compatible con síndrome de Frasier, primer caso reportado en Perú. (AU)

Frasier´s syndrome is a rare disease caused by a mutation in the WT1 gene and is characterized by male pseudo hermaphroditism, gonadal dysgenesis 46XY and glomerular disease. We report the case of an 18-year-old female patient diagnosed at the age of 12 years of age of nephrotic syndrome who rapidly progressed to chronic failure needing dialysis. At the age of 17-years of age she presented an abdominal tumor, a laparotomy revealed a tumor attached to the right fallopian tube. An hysterectomy with bilateral fallopian tube extirpation, pathological findings revealed a dysgerminoma. The patient had a history of primary amenorrhea and absence of secondary sexual features. The study of Barr´s corpuscle of the oral mucosa was negative for sexual chromatin and the karyotype was 46 XY (gonadal dysgenesis). The genetic study revealed heterozygous mutation in the 9 gene WT1. The clinical presentation is compatible with Frasier´s syndrome, fist time reported in Peru. (AU)

[Duodenal melanoma: a case report and review of the literature]. / Melanoma duodenal: reporte de caso y revisión de la literatura.

We report the case of a male patient of 75 years old who presents with abdominal pain, hyporexia, early satiety, general malaise and watery stools, admitted in emergency for an episode of syncope. On physical examination, hepatomegaly of 6cm below the right costal margin was detected. CT scan showed multiple liver metastases. An upper endoscopy found multiple hyperpigmented lesions on the second portion of the duodenum. Histology and immunohistochemistry studies concluded it was duodenal melanoma. Skin and ocular examination did not reveal associated neoplastic lesions.

[Gastric hemangioma as a cause of upper gastrointestinal bleeding]. / Hemangioma gástrico como causa de hemorragia digestiva alta.

Gastric hemangioma as a cause of upper gastrointestinal bleeding (UGIB) is a rare event. We present the case of an 83 years old male with a history of abdominal pain, vomiting and melena, along with an 8 Kg weight loss. The upper gastrointestinal endoscopy showed an elevated, ulcerated lesion in the gastric antrum with a visible vessel, for which he receives endoscopic therapy. In the abdominal computed tomography, a contrast enhancing, well-circumscribed mass attached to the gastric wall is observed. Due to the persistence of the UGIB, the patient suffers hemodynamic decompensation and undergoes exploratory laparotomy, where a vascularized mass is found. The pathology report informs a gastric cavernous hemangioma.

Nefroblastoma quístico parcialmente diferenciado: Reporte de caso / Cystic partially differentiated nephroblastoma: Case report

El nefroblastoma quístico parcialmente diferenciado, es una variante de tumor de Wilms, de presentación muy poco común, es quístico totalmente multilocular con tabicaciones finas que muestran en su interior cúmulos de elementos de blastema o epiteliales en diferenciación. Se manifiesta principalmente en menores de dos años. Se presenta el caso de un varón de 6 meses que desarrolló una tumoración renal derecha. Los hallazgos histopatológicos de la pieza extirpada por nefrectomía fueron: presentación de formaciones quísticas, con septos fibrovasculares que muestran tejido renal primitivo con presencia de túbulos y glomérulos en diferenciación sin efecto de masa. El diagnóstico final fue de nefroblastoma quístico parcialmente diferenciado. La evolución del paciente fue favorable. (AU)

Cystic partially differentiated nephroblastoma is a clinical variant presentation of Wilms tumor. It is very uncommon and it is composed of multiloculated cysts with fine trabecula containing epithelial cells in process of differentiation. It usually affects children below 2 years of age. We present the case of a 6-month male patient who presented with a right renal tumor. Pathological findings of the resected kidney showed cystic lesions with multiple fibro vascular septum that contained primitive tubular and glomerular kidney cells with no mass effect. The final diagnosis was cystic partially differentiated nephroblastoma. The clinical evolution was favorable. (AU)

Melanoma duodenal: reporte de caso y revisión de la literatura / Duodenal melanoma: a case report and review of the literature

Se presenta el caso de un paciente varón de 75 años que acude por dolor abdominal, hiporexia, llenura precoz, malestar general y deposiciones líquidas, ingresando a emergencia por un episodio de síncope. Al examen físico se palpa borde hepático 6 cm por debajo del reborde costal derecho. Por ello se solicita estudios de imagen, hallando lesiones compatibles con metástasis hepáticas múltiples. Posteriormente se solicita endoscopía digestiva alta, hallando lesiones hiperpigmentadas múltiples en la segunda porción duodenal. El estudio histopatológico e inmunohistoquímico concluyó melanoma duodenal. El examen físico no reveló lesiones neoplásicas dérmicas u oculares asociadas.

We report the case of a male patient of 75 years old who presents with abdominal pain, hyporexia, early satiety, general malaise and watery stools, admitted in emergency for an episode of syncope. On physical examination, hepatomegaly of 6cm below the right costal margin was detected. CT scan showed multiple liver metastases. An upper endoscopy found multiple hyperpigmented lesions on the second portion of the duodenum. Histology and immunohistochemistry studies concluded it was duodenal melanoma. Skin and ocular examination did not reveal associated neoplastic lesions

Coriocarcinoma: reporte de 3 casos / Choriocarcinoma: report of 3 cases

La enfermedad trofoblástica gestacional (ETG) es un trastorno proliferativo de las células del trofoblasto. La ETG más agresiva es el coriocarcinoma, debido a su rápida invasión vascular y formación de múltiples metástasis. Presentamos tres casos de coriocarcinoma poco frecuentes. Tres mujeres de 30, 47 y 44 años, respectivamente, acudieron a Emergencia por ginecorragia y tumoración vaginal con variaciones de presentación y antecedentes significativos, encontrándose en todas ellas metástasis diversas y raras. Se presenta estos casos, por ser una patología poco frecuente pero extremadamente agresiva, con amplio espectro clínico, presentaciones inusuales y necesidad de un diagnóstico precoz para su óptimo tratamiento.

Gestational trophoblastic disease is a proliferative disorder of trophoblast cells. Choriocarcinoma is the most aggressive type due to its rapid vascular invasion and metastasis formation. We present three rare cases of choriocarcinoma. Three women 30, 47, and 44 years old respectively were admitted for vaginal bleeding and vaginal tumor as main complaints with different presentations of the disease and past medical history; various and rare metastases were found. We report these cases because of their rarity and aggressive pathology, showing a wide clinical spectrum, unusual presentations and the need for early diagnostic and optimal treatment.

Enfermedad de Wilson: forma hepática / Wilson disease: liver form

La enfermedad de Wilson (EW) es un trastorno del metabolismo del cobre que se hereda de forma autosómica recesiva, lo cual produce acumulación tóxica del cobre principalmente en el hígado y el cerebro, en general tiene dos formas de presentación, la hepática en edades tempranas y la neurológica en edades más tardías. Se presenta el caso de una paciente mujer de 21 años diagnosticada de EW en su forma hepática en estadio cirrosis que debutó con un síndrome ascítico edematoso sin ninguna manifestación neurológica a pesar de su edad. En sus estudios de laboratorio presentó descenso de la ceruloplasmina sérica y cupruria elevada en 24 horas, datos característicos de esta enfermedad. Aunque la EW no es una enfermedad común debe ser sospechada en toda hepatopatía crónica de etiología no determinada con marcadores virales y de autoinmunidad negativos con o sin manifestaciones neurológicas ya que su reconocimiento temprano e inicio del tratamiento con quelantes del cobre principalmente conlleva a una mejora sustancial del pronóstico de vida de estos pacientes...

Wilson disease (WD) is a disorder of copper metabolism that is inherited as an autosomal recessive, which produces toxic copper accumulation mainly in the liver and brain, in general has two ways presentation, liver at early ages and neurological in later ages. We present the case of a female patient of 21 years diagnosed of WD in liver cirrhosis that started with an edematous ascites without any neurological symptoms despite the age. Their laboratory studies showed decrease in serum ceruloplasmin and high cupruria within 24 hours of the disease , characteristic data of WD. Although WD is not a common disease should be suspected in all chronic liver disease of unknown etiology with negative viral markers and autoimmunity with or without neurological manifestations as soon as posible and starting treatment with copper chelating mainly leads to a substantial improvement the prognosis of these patients...

[Wilson disease: liver form]. / Enfermedad de Wilson: forma hepática.

Wilson disease (WD) is a disorder of copper metabolism that is inherited as an autosomal recessive, which produces toxic copper accumulation mainly in the liver and brain, in general has two ways presentation, liver at early ages and neurological in later ages. We present the case of a female patient of 21 years diagnosed of WD in liver cirrhosis that started with an edematous ascites without any neurological symptoms despite the age. Their laboratory studies showed decrease in serum ceruloplasmin and high cupruria within 24 hours of the disease , characteristic data of WD. Although WD is not a common disease should be suspected in all chronic liver disease of unknown etiology with negative viral markers and autoimmunity with or without neurological manifestations as soon as posible and starting treatment with copper chelating mainly leads to a substantial improvement the prognosis of these patients.

[Assesing the effect of Lepidium meyenii "Maca" on the gastric mucosa in patients with functional dyspepsia]. / Evaluacióndel efecto de la Lepidium meyenii "Maca" en la mucosa gástrica en pacientes con dispepsia funcional.

OBJECTIVE: The present study was designed to determine the histological effect of Lepidium meyenii "Maca" on the gastric mucosa in patients with functional dyspepsia. MATERIAL AND METHODS: This study consists of a clinical case series, in which the effect of Maca on the gastric histopathology of 29 Peruvian patients diagnosed with functional dyspepsia was examined. The presence of H. pylori, as well as the degree and depth of the gastric mucosa inflammation was evaluated from biopsies obtained before and after the treatment based solely of Maca 3 grams per day for four weeks. RESULTS: Average values of the degree and depth of mucosal inflammation before and after the treatment were compared showing no statistical difference among the samples. Sixteen patients were infected with H. pylori, and they remained infected after the treatment with Maca. CONCLUSIONS: A four week long treatment with Maca does not produce significant changes on gastric mucosa of patients with functional dyspepsia, neither on H. pylori eradication.

Evaluación del efecto de la Lepidium meyenii “Maca” en la mucosa gástrica en pacientes con dispepsia funcional / Assesing the effect of Lepidium meyenii “Maca” on the gastric mucosa in patients with functional dyspepsia

Objetivo: Determinar el efecto que tiene Lepidium meyenii “Maca” en la histología de la mucosa gástrica en pacientes con dispepsia funcional. Material y métodos: Serie de casos realizado en el Hospital Nacional Cayetano Heredia en la que se evaluó el efecto de la Maca administrada por cuatro semanas 3 gramos por día en la histopatología gástrica de pacientes con diagnóstico clínico y endoscópico de dispepsia funcional. Se evaluó el grado y la profundidad de la inflamación en la lámina propia y el efecto sobre la presencia de H. pylori (en aquellos que tenían la infección), a través de biopsias obtenidas antes y después del tratamiento. Resultados: Se reclutaron 29 pacientes con dispepsia funcional entre el 2010 y 2012. Las biopsias antes y después del tratamiento, revisadas por un solo patólogo, no demostraron cambios significativos en los parámetros histológicos, ni tuvo efecto en la erradicación del H. pylori. Conclusiones: La Maca no produce cambios significativos en la mucosa gástrica ni tiene efecto en la erradicación del H. pylori al ser brindada por cuatro semanas a pacientes con dispepsia funcional.

Objective: The present study was designed to determine the histological effect of Lepidium meyenii “Maca” on the gastric mucosa in patients with functional dyspepsia. Material and methods: This study consists of a clinical case series, in which the effect of Maca on the gastric histopathology of 29 Peruvian patients diagnosed with functional dyspepsia was examined. The presence of H. pylori, as well as the degree and depth of the gastric mucosa inflammation was evaluated from biopsies obtained before and after the treatment based solely of Maca 3 grams per day for four weeks. Results: Average values of the degree and depth of mucosal inflammation before and after the treatment were compared showing no statistical difference among the samples. Sixteen patients were infected with H. pylori, and they remained infected after the treatment with Maca. Conclusions: A four week long treatment with Maca does not produce significant changes on gastric mucosa of patients with functional dyspepsia, neither on H. pylori eradication.

Inserción velamentosa de cordón y desaceleración variable en el monitoreo cardiaco fetal / Velamentous cord insertion and variable deceleration of fetal heart rate monitoring

La inserción velamentosa de cordón es una patología inusual de la inserción de cordón, el cual carece de gelatina de Wharton. Presentamos el caso de una paciente que ingresó con diagnóstico presuntivo de corioamnionitis que presentó desaceleración variable (DIP III) durante el monitoreo fetal. La paciente fue operada sin estar en labor de parto y con membranas integras; el diagnóstico post cesárea fue inserción velamentosa de cordón. (AU)

Velamentous cord insertion is an unusual condition, Wharton´s gelly protection is absent in this entity. We report a patient admitted with a presumptive diagnosis of chorioamnionitis that presented variable deceleration of fetal heart rate. A cesarean section was performed despite of not being in labor and having intact membranes. A velamentous cord insertion was confirmed. (AU)

[Obscure gastrointestinal bleeding as initial presentation of Crohn's disease diagnosed by small intestinal capsule endoscopy]. / Hemoragia Digestiva Oscura como presentación inicial de Enfermedad de Crohn del Intestino Delgado diagnosticada por Cápsula Endoscópica.

The present case illustrates a patient with obscure gastrointestinal bleeding which MiroCam capsule endoscopy showed erosions and ulcers from distal jejunum to ileum. Considering that ileal ulcers where closer to ileocecal valve, ileoscopy was repeated. Diagnosis with new biopsies was Crohn disease. Capsule endoscopy is an innovative technology, which let us have high resolution color pictures through gastrointestinal tract for more effective and diagnostic view of small bowel in a minimal invasive way. New guidelines in obscure GI bleeding agreed that initial diagnostic imaging of the small bowel should be performed using capsule endoscopy. Ballon assisted enteroscopy, angiography and laparoscopy should be used as a follow-up procedure for targeted endoscopic treatment or for obtaining histopathological diagnosis.

Hemorragia digestiva oscura como presentación inicial de enfermedad de Crohn del intestino delgado diagnosticada por cápsula endoscópica / Obscure gastrointestinal bleding as initial presentation of Crohn's disease diagnosed by smal intestinal capsule endoscopy

Presentamos el caso de una paciente con sangrado digestivo oscuro que la cápsula endoscópica MiroCam® (CE) demostró lesiones erosivas y ulcerativas que comprometían yeyuno distal e ileón. Esto orientó a repertir la ileoscopía para biopsiar y precisar el diagnóstico de Enfermedad de Crohn. La cápsula endoscópica es una tecnología innovadora que nos permite tener fotografías de alta resolución a lo largo del tracto digestivo para un diagnóstico más preciso de patologías del intestino delgado de una manera mínimamente invasiva. Actualmente, las guías en sangrado oscuro aconsejan realizar el estudio de cápsula endoscópica antes de otros métodos más complejos. La enteroscopía asistida por balón, angiografía o laparoscopía deberían ser realizados teniendo en consideración los resultados obtenidos por CE con la finalidad de realizar terapéutica u obtener biopsias.

The present case illustrates a patient with obscure gastrointestinal bleeding which MiroCam® capsule endoscopy showed erosions and ulcers from distal jejunum to ileum. Considering that ileal ulcers where closer to ileocecal valve, ileoscopy was repeated. Diagnosis with new biopsies was Crohn disease. Capsule endoscopy is an innovative technology, which let us have high resolution color pictures through gastrointestinal tract for more effective and diagnostic view of small bowel in a minimal invasive way. New guidelines in obscure GI bleeding agreed that initial diagnostic imaging of the smallbowel should be performed using capsule endoscopy. Ballon assisted enteroscopy, angiography and laparoscopy should be used as a follow-up procedure for targeted endoscopic treatment or for obtaining histopathological diagnosis.

Infección por Polyoma virus en un paciente con transplante renal. A propósito de un caso / BK virus infection in kidney transplantation. A case report

La nefropatia por polyoma virus (NVBK) esta siendo reconocida como causa importante de falla del injerto, usualmente confundido con rechazo agudo. A la fecha, no se han reportado casos en el Perú. Se presenta el caso de un niño trasplantado, 17 años de edad, quien presentó elevación persistente de la creatinina sérica en el primer mes postrasplante. Fue tratado como rechazo agudo. Al no presentar mejoría se realizó biopsia renal que mostró marcado daño del epitelio tubular con necrosis parcial y desprendimiento hacia la luz tubular y la presencia de células atípicas con escaso citoplasma e inclusiones intranucleares basofilicas, hallazgos compatibles con infección por virus BK. No se evidenció signos de rechazo. Además, en el papanicolao de orina, se encontró Decoy cells. La carga viral de virus BK fue elevada en sangre y en orina. Se suspendió el tratamiento con mofetil micofenolato, se redujo la dosis de tacrolimus y se inició el tratamiento con leflunomide 40 mg/dia. Seis meses después la función renal del paciente se estabilizó, pero sin mejoría completa quedando con una depuración de creatinina de 30 ml/min/1,73 m2 SC.

Nephropathy polyoma virus (NVBK) is being recognized as a major cause of graft failure, usually confused with acute rejection. To date, no cases have been reported in Peru. We report a case of a child transplant, 17 years old, who presented persistent elevation of serum creatinine in the first month after transplantation. He was treated as acute rejection. Renal biopsy was made. It showed marked tubular epithelial damage with necrosis and partial detachment toward luminal space and presence of atypical cells with little cytoplasm and inclusions intranuclearesbasophilic, findings consistent with BK virus infection. It was not found signs of rejection. In addition, papanicolao in urine was found Decoy cells. Viral load of BK virus in blood and urine was high. It was discontinued therapy with mycophenolate mofetil, was reduced dose of tacrolimus and began treatment with leflunomide 40 mg/day. Six months after the kidney function of the patient was stabilized, he was staying with creatinine clearance of 30 ml/min/1.73 m2 SC.

Helicobacter pylori en niños atendidos en el Hospital Nacional Cayetano Heredia durante los años 2003 al 2006 / Helicobacter pylori in children treated at the Cayetano Heredia National Hospital during the years 2003 to 2006

INTRODUCCION: La prevalencia de la infección por Helicobacter pylori (HP) y su caracterización histopatológica en niños en el Perú es insuficientemente conocida. OBJETIVOS: Reportar las características clínicas e istopatológicas de la infección porHP en niños del Hospital Nacional Cayetano Heredia (HNCH) en Lima, Perú. METODOS: Se obtuvo información sobre endoscopías y biopsias realizadas en niños en el periodo de julio 2003 a noviembre 2006. RESULTADOS: De 210 endoscopías se obtuvo biopsias gástricas en 111. La prevalenciade HP fue de 45.9% (51 de 111 pacientes). Los niños HP positivos tuvieron mayor edad que los HP negativos (11 versus 8.9 años, p = 0.009). En los HP positivos la presenciaendoscópica de ôgastritis nodularõ (GN) fue significativamente mayor (p=0.001), mientras que la "esofagitis" fue más frecuente entre los HP negativos (p = 0.001). 8/11 (72.7%)de úlceras pépticas tuvieron HP positivo. Biopsias HP positivas comparadas a las HP negativas tuvieron mayor presencia de: Actividad inflamatoria - polimorfonucleares (PMNs) en la lámina propia -, Gastritis crónica - linfomononucleares (LMNs) en la lámina propia -, Folículos linfoides. Ninguna de las biopsias presentó displasia, atrofia o metaplasiaintestinal. CONCLUSION: Se encontró alta prevalencia de infección por HP en niños sometidos a endoscopía alta. Estuvieron ausentes la metaplasia, atrofia o displasia intestinal. La presencia en la endoscopía de "GN", en la biopsia de gastritis crónica, actividad inflamatoria y folículos linfoides estuvieron independientemente asociados a infección por HP.

INTRODUCTION: There is a lack of awareness of the prevalence of infection by Helicobacterpylori (HP) and its histopathological characterization in children in Peru. OBJECTIVES: To report the clinical and histopathological characteristics of infection byHP in children in Cayetano Heredia Public Hospital (HNCH) in Lima, Peru. METHODS: Information was obtained on endoscopies and biopsies done on children between July 2003 and November 2006. RESULTS: Biopsies were done in 111 of 210 endoscopies. HP prevalence was 45.9% (51 out of 111 patients). HP positive patients were older than HP negative (11 versus 8.9 years, p = 0.009). Endoscopic "nodular gastritis" (NG) was HP status dependent(p = 0.001), "oesophagitis" was most frequent among HP negative (p<0.05). 8 out 11 ulcers were HP positive. Histopathological findings in HP positive included more: Inflammationactivity - polymorphonuclears (PMNs) in the proper lamina-, Chronic gastritis- lymphomononuclears (LMNs) in the proper lamina-, and Lymphoid follicles. Dysplasia,atrophy or intestinal metaplasia were absent in our biopsies. CONCLUSION: A high prevalence of infection by HP was found in children who underwent anupper endoscopy. Metaplasia, atrophy and intestinal dysplasia were absent. The presence of "NG" in the endoscopy, and chronic gastritis, inflammatory activity and lymphoid follicles inthe biopsy were independently associated to infection by HP.

[New ultrashort scheme for helicobacter pylori infection eradication using tetracyline, furazolidone and colloidal bismuth subcitrate in dyspeptic patients with or without peptic ulceration in the National Hospital Cayetano Heredia]. / Nuevo esquema ultracorto para erradicar la infección por Helicobacter pylori utilizando tetraciclina, furazolidona y subcitrato de bismuto coloidal en pacientes dispépticos con o sin úlcera peptica en el Hospital Nacional Cayetano Heredia.

BACKGROUND: Helicobacter pylori (Hp) infection has been associated with the presence of duodenal ulcer, gastric ulcer and chronic active gastritis. It is also speculated that Hp may have a major role in gastric cancer development. Due to rising antibiotic resistance, probably lack of compliance and the expense of the currently used antimicrobial regimens, it's important to develop efficacious, short-duration and low cost therapies, especially for the treatment of low-income populations from underdeveloped countries. The goal of the present study is to asses the efficacy of two ultrashort antibiotic schemes against Hp infection. METHODS: Patients with diagnosis of Hp infection, found in antral gastric biopsies, were included. They were randomly assigned to receive one of the following therapeutic schemes: tetracycline 500 mg qid, furazolidone 100 mg qid and colloidal bismuth subcitrate 120 mg qid for 3 days (Scheme I) or 4 days (Scheme II). Patients were instructed to come back for follow-up at least 8 weeks after starting medication. At the control visit, an upper endoscopy was performed and an average of 3 antral biopsies was taken. Biopsies were stained with hematoxylin-eosin for histological assessment and with Warthin-Starry silver staining for Hp diagnosis. A single experienced pathologist read all biopsies. In both, the initial biopsy and the control one, we evaluated: presence of Hp; presence, depth and grade of chronic gastritis; presence and grade of inflammatory activity; presence, grade and extent of mucinous damage; presence of glandular atrophy, intestinal metaplasia and lymphoid follicles. We also evaluated dyspeptic symptoms prior and after the treatment, and the presence of adverse events. RESULTS: 80 patients were enrolled, 2 were excluded because of intense nausea and vomits, 4 patients didn't follow the indications properly and 8 patients couldn't be contacted for the control visit. From the remaining 66 patients, 32 were assigned to Scheme I and 34 to Scheme II, both groups were comparable. Eradication rate was 68.8% (22/32) (CI = 52.1% - 82.7%) for Scheme I and 88.2% (30/34) (CI = 74.9% - 96.2%), significant higher, for Scheme II. There was decrease of dyspeptic symptoms and significant improvement of the histological pattern for both groups, except for presence of chronic gastritis, intestinal metaplasia, glandular atrophy and lymphoid follicles. Hp eradication was associated with significant symptoms decrease, normal endoscopy raising and improvement of all the histological parameters, except for presence of intestinal metaplasia and glandular atrophy. Treatment was well tolerated, 57.6% of the patients reported only mild adverse events, nausea was the most frequent (19.7%) and there was no difference between schemes. CONCLUSIONS: The triple ultrashort duration scheme including tetracycline, furazolidone and bismuth for 4 days is efficacious against Hp, with a high eradication rate (88.2%). The Hp disappearance is followed by improvement in every histological parameter that we evaluated, except for glandular atrophy and intestinal metaplasia; and it's also accompanied by a decrease in dyspeptic symptoms.

Nuevo esquema ultracorto para erradicar la infección por Helicobacter pylori utilizando tetraciclina, furazolidona y subcitrato de bismuto coloidal en pacientes dispépticos con o sin úlcera péptica en el Hospital Nacional Cayetano Heredia / New ultrashort squeme for Helicobacter pylori infection erradication using tetracycline, furazolidone and colloidal bismuth subcitrate in the National Hospital Cayetano Heredia

Antecedentes: La infección por Helicobacter pylori (Hp) está asociada al desarrollo de úlcera duodenal, úlcera gástrica y gastritis crónica activa. Además se especula que puede desempeñar un rol mayor en el desarrollo del cáncer gástrico.

Estudio prospectivo de la verruga peruana recurrente / Prospective study of recurrent peruvian verruga

Introducción: La verruga peruana recurrente es un evento raro que se caracteriza por recurrencia de un brote eruptivo verrucoso tiempo después de episodio inicial. Objetivo: Demostrar la existencia de formas recurrentes de verruga peruana en personas nativas y foráneas de zonas endémicas. Material y Métodos: Pacientes regstrados en el Departamento de Enfermedades Transmisibles y Dermatológicas del Hospital Nacional Cayetano Heredia con cuadro clínico de verruga peruana, desde 1980 hasta noviembre de 2003. Resultados: De los 137 pacientes estudiados con verruga peruana se encontraron siete con forma recurrente, la mayoría de los 137 pacientes tenían lesiones miliares, 70 por ciento eran menores de 15 años, 20 por ciento provenían de zonas endémicas. Los pacientes fueron tratados con Rifampicina, Ciprofloxacina, Azitromicina o Eritromicina. Conclusiones: De los siete pacientes encontrados con verruga peruana recurrente dos eran originarios de zonas endémicas y cinco fueron foráneos, éstos últimos no retornaron a las zonas prevalentes, lo cual nos afirma la existencia de estados latentes de Batonella bacilliformes en algunos tejidos aún no precisados, que debe ser motivo para investigar.