[Appropriate use of diagnostic esophagogastroduodenoscopy and its relation with positive results]. / Uso appropriado de las esofagogastroduodenoscopia diagnóstica y su relación con hallazgos positivos.

INTRODUCTION: Upper gastrointestinal endoscopy is a sensitive and safe procedure, but expensive and with certain risks. The range of inappropriate use of upper gastrointestinal endoscopy in open access system is between 5.6 to 61.7%. In our department we use restricted access system. OBJECTIVE: To determine the accuracy of Gastrointestinal Endoscopy American Society guidelines in the diagnosis through the upper gastrointestinal endoscopies performed in a reference hospital setting with restricted access. METHODS: We review requests for diagnostic upper gastrointestinal endoscopies and their reports between March 1st 2003 and February 29th 2004. It was defined as an appropriate diagnostic esophagogastroduodenoscopy which followed the American Gastrointestinal Endoscopy society guidelines. It was done statistical descriptive analysis. RESULTS: A total of 3033 requests and reports of upper gastrointestinal endoscopies were reviewed. The proportion of clinical diagnoses that followed the guidelines was 74.3%. We found a 56.3% of abnormal positive endoscopy findings, concordance between clinical diagnosis and abnormal positive endoscopy findings was 46.8%. CONCLUSION: The proportion of upper gastrointestinal endoscopies that follow the American Gastrointestinal Endoscopy Society guidelines in our restricted access system is low.

[Association between symptomatic gastroesophageal reflux and Barrett's esophagus]. / Asociación entre reflujo gastroesofágico sintomático y esófago de Barrett.

BACKGROUND DATA: Barrett esophagus is a proximal displacement of the squamocolumnar junction relative to the gastroesophageal junction with intestinal metaplasia, it has been linked to gastroesophageal reflux disease. However, it has been observed in individuals without gastroesophageal reflux symptoms, with prevalence up to 25% in 50 years older men. OBJECTIVE: Assess the association between symptomatic gastroesophageal reflux and Barrett's esophagus. METHODS: Consecutive patients undergoing endoscopy at our center were studied. Before endoscopy, through a direct interview all subjects were asked to complete the Carlsson-Dent questionnaire for determining 2 groups (patients with and without gastroesophageal reflux symptoms). Those subjects with suggestive image of Barrett's esophagus, biopsy specimens were obtained from the distal esophageal mucosa with the intention of find intestinal metaplasia. We compared prevalence of Barrett's esophagus between groups. RESULTS: One hundred and nine patients were studied. Prevalence of symptomatic gastroesophageal reflux disease was 37.6%. Barrett's esophagus was found in 9.7% of symptomatic gastroesophageal reflux disease patients and in 9.6% of subjects without symptoms of gastroesophageal reflux disease (p = 0.87). Gender and age were similar between groups. Prevalence of hernia hiatal was bigger in patients with Barrett's esophagus (90 vs. 42%) (p = 0.004). CONCLUSION: Our study didn't show association between symptomatic gastroesophageal reflux detected by a questionnaire and Barrett's esophagus.

[Intragastric migration of a plastic prosthesis placed for repair of a diaphragmatic perforation. Case report]. / Migración intragástrica de una prótesis plástica colocada para reparación de una perforación diafragmática. Reporte de un caso.

CASE: We report the case of a 21-year old female with multiple surgeries. Her problem began after last surgery, which got complicated by a diaphragmatic perforation on the left side so it was necessary to repair the defect with a plastic prosthesis, since that time she complained of abdominal pain. In an abdominal computed axial tomography prosthesis was observed and by endoscopy its presence into stomach was confirmed, because its size and rigidity its endoscopic extraction was impossible, so it was surgically extracted. One and half month after surgery the patient's evolution was satisfactory. DISCUSSION: Migration is one of the most common complications of medical prosthesis placed into abdominal cavity. However precise incidence is unknown, neither intraluminal migration to the gastrointestinal tract. We didn't find previews reports about intragastric migration of a prosthesis that was used to repair a diaphragmatic defect.

Antagonismo del midazolam con flumazenil en pacientes ambulatorios / Flumazenil antagonism of midazolam in ambulatory patients

El objetivo fue comprobar la efectividad de flumazenil para la reversion de los efectos de midazolam, mejorar las condiciones psicomotosas del paciente ambulatorio y disminuir el tiempo de estancia hospitalario. Se estudiaron 60 pacientes divididos en 3 grupos de 20 cada uno, siendo 18 del sexo femenino y 42 del sexo masculino. El grupo I solamente recibió anestésico tópico a base de lidocaina spray. El grupo II recibió midazolam + flumazenil y el grupo III recibió únicamente midazolam. A los 3 grupos se les aplicó la Prueba Gestaltica visomotora de Bender. La primera prueba antes de administrar medicamento; de segunda prueba a los 30 min de administrar medicamento y la tercera prueba a los 45 min de la última dosis. Los cambios que se encontraron en las pruebas psicométricas después de las endoscopías gástricas en los grupos II y III nos indican que hubo disminución de la función psicomatora y percepción, sin embargo se mantuvo la estabilidad cardiovascular y respiratoria. El fulmazenil revierte los efectos del midazolam en una forma inmediata por lo que es favorable para pacientes externos que requieren de una pronta recuperación tanto hemodinámica como psicomotora, y así disminuir el tiempo de estancia hospitalaria