[Herpetic esophagitis]. / Esofagitis herpética.

Herpetic esophagitis is an infrequent ulcerative infection of the esophagus caused by Herpes Virus type I. It is usually seen in immunocompromised patients though it may present in immunocompetent ones. Odynophagia and/or dysphagia associated with chest pain are the most frequent clinical symptoms. Radiology, endoscopy, biopsy and serological markers are the basis for diagnosis. We report 3 patients with herpetic esophagitis diagnosed between 1984-1989 and evaluated the clinical, endoscopic and biopsy characteristics. Certain clinical and endoscopic findings common to our patients tend to identify the disease, with biopsy and or serological markers the diagnosis may be established.

[Alcoholic liver disease in Venezuela. Clinical hepato-functional and histopathologic course]. / Hepatopatía alcohólica en Venezuela. Comportamiento clínico, funcional hepático e histopatológico.

24 patients with alcoholic intake were classified according to the amount of alcohol ingestion; clinical symptoms and signs, liver function tests (bilirubin, aminotransferases and prothrombin time) were analyzed. In all patients a percutaneous liver biopsy was performed and tissue stained by hematoxylin-eosin, wilder reticulin and Mallory trichromic. 9 Histologic criteria were analyzed. 4 groups according to the histology were identified. Group 1 (5 patients) hepatic fibrosis and/or fatty liver. Group 2 (5 patients) alcoholic hepatitis. Group 3 (10 patients) cirrhosis. Group 4 (4 patients) normal. 20% of patients with fatty liver, 80% of alcoholic hepatitis and 100% of cirrhotics referred ingestion or more than 160 g of ethanol and important correlation between liver histological damage and alcohol ingestion. Telangiectasia was the most common clinical finding and present in all hepatitis, 70% of cirrhotics and only 20% of fatty livers. Hemosiderosis was found in 60% of cirrhotics and in alcoholic hepatitis. Only 40% of patients with fatty liver and inflammatory cells while this was evident in all patients with alcoholic hepatitis and those with cirrhosis. Mallory bodies were identified in only 20% of cirrhotics and in none of the alcoholic hepatitis. The results suggest that there are significant differences from a histological and clinical point of view that distinguish alcoholic liver disease as seen in Venezuela from that reported in other countries.

[Dieulafoy's lesion as a cause of massive gastrointestinal hemorrhage]. / Lesión de Dieulafoy como causa de hemorragia gastrointestinal masiva.

Dieulafoy's lesion also known as exulceration simplex with submucosal arterial malformation is a rare cause of massive upper gastrointestinal hemorrhage with high mortality. Surgery that has been considered as the preferred diagnostic and therapeutic option has been supplemented by endoscopy; gastroscopy may be a valid alternative for diagnosis and therapy. Between 1981 and 1988 we report 4 cases with massive upper gastrointestinal hemorrhage, haematemesis and hemodynamic decompensation consistent with Dieulafoy's lesion. In all patients emergency gastroscopy was performed, monopolar electrocoagulation was successfully applied in two patients. One patient died during surgery and another sixteen days after surgery from multiple organ failure. Rebleeding was seen in one of the coagulated patients, the site of bleeding was identified as Dieulafoy's lesion in three patients during the first endoscopy and was arterial spurting with normal surrounding gastric mucosa. All lesions were found in the upper third of the stomach. Diagnosis is not easy, especially when the bleeding is intermittent but once identified, endoscopic treatment should be attempted and if this fails surgery may be promptly performed with possible lowering of mortality.

[Endoscopic diagnosis of stenosis of Oddi's sphincter]. / Diagnóstico endoscópico de estenosis del esfinter de Oddi.

Thirty-two patients with biliary or pancreatic disease were evaluated by duodenoscopy so as to establish the macroscopic characteristics of the papilla of Vater. In two cases, endoscopic pancreatography was performed as a diagnostic evaluation of the papilla, 30 patients were operated. Our results seem to indicate that the diagnosis of Odditis may be established by endoscopy.

[Diagnosis of tumor or metastasis in the liver by means of laparoscopy and gammagraphy]. / Diagnóstico del hígado tumoral o metastásico mediante laparoscopia y gammagrafía.

Fifty-four patients with proven malignancy of the gastrointestinal tract or suspicion of primary or metastatic hepatic carcinoma were studied to evaluate the effectiveness of different diagnostic methods. Gammagraphic and laparoscopic evaluations were emphasized. The results indicated that laparoscopy was the most effective method for diagnosing primary or metastatic neoplastic liver disease.