[Blue nevus syndrome: endoscopic treatment by sclerosis and banding ligation]. / Síndrome del nevus azul: tratamiento endoscópico mediante esclerosis y ligadura con bandas.

The blue rubber bleb nevus syndrome is a rare entity characterized by the presence of cavernous hemangiomas in the skin and gastrointestinal tract with frequent digestive hemorrhages. Different therapeutic modalities exist: medical treatment, surgical resection; and most recently, endoscopic therapy has been described. We present a patient with blue rubber bleb nevus syndrome treated with combined endoscopic therapy: sclerosis and band ligation.

[Pancreatic trauma successfully treated by endoscopy]. / Traumatismo pancreático tratado con éxito por vía endoscópica.

Acute post traumatic pancreatitis is an infrequent disease representing 0.4% of the acute pancreatitis with pseudocyst formation. Few data have been reported in the literature with regard to response to treatment, particularly in cases of small or multiple pseudocysts. Internal surgical drainage is the usual treatment. Different therapeutic alternatives have been proposed among which conservative treatment with total parenteral nutrition, somatostatin or octreotide, or more recently, endoscopy may be included. We herein present one case of acute post traumatic pancreatitis initially treated with conservative treatment which evolved to the formation of pseudocysts which were satisfactorily drained by endoscopic cystogastrostomy.

[Esophageal achalasia with apparently normal relaxation of the lower sphincter: clinical significance and therapeutic response to pneumatic dilatation]. / Acalasia esofágica con relajación aparentemente normal del esfínter inferior: significado clínico y respuesta terapéutica a la dilatación neumática.

OBJECTIVE: To evaluate if the clinical presentation and the response to pneumatic dilation is different in patients with achalasia with an apparent normal lower esophageal sphincter relaxation. DESIGN: Prospective study to compare clinical, radiographic and manometric characteristics and the response to pneumatic dilation according to the ability of the lower esophageal sphincter to relax normally. PATIENTS: One hundred and fifty seven consecutive patients with achalasia were included. Relaxation of the lower esophageal sphincter was abnormal in 130 patients and apparently normal in 27. The response to pneumatic dilation was evaluated in 116 patients, 94 with abnormal function of the lower esophageal sphincter and 22 with normal function. RESULTS: Clinical findings, esophageal diameter and basal pressure of the lower esophageal sphincter were similar in both groups. The efficacy of the dilation, the number of dilations and the rate of complications were also similar. CONCLUSIONS: Patients with achalasia and an apparent normal lower esophageal sphincter relaxation are not different from patients with typical achalasia and present a similar response to pneumatic dilation.

[Are there clinical differences between typical and vigorous achalasia and response to pneumatic dilatation?]. / Existen diferencias clínicas y en la respuesta a la dilatación neumática entre la acalasia típica y la vigorosa?

The aim of this study was to analyze whether the vigorous character of esophageal contraction conditions differences in the clinical characteristics or in response to pneumatic dilatation treatment in patients with achalasia. To do so, a prospective protocol study was designed in which the clinical, radiological, and manometric characteristics of the patients and the response to pneumatic dilatation were compared on the basis of the presence or absence of severe contraction of the esophageal body. One hundred fifty-seven consecutive patients diagnosed with achalasia were included on presentation of a compatible clinical picture and absence of peristalsis in the esophageal body. Out of these patients, 120 presented a manometric pattern of typical achalasia and 37 had vigorous achalasia. Response to pneumatic dilatation was analyzed in 116 patients, 90 with typical achalasia and 26 with vigorous achalasia. Significant differences were only found between the two groups with respect to the greater response tone of the lower esophageal sphincter observed in the patients with vigorous achalasia. There were no differences in the remaining clinical, radiologic or manometric variables compared. Neither were any differences observed in regard to therapeutic response to pneumatic dilatation in the two groups of patients. It may be concluded that differentiation between typical and vigorous achalasia has no clinical or therapeutic significance.

[Computer-assisted analysis of the prognosis in patients with upper gastrointestinal hemorrhage]. / Análisis asistido por ordenador del juicio pronóstico en pacientes con hemorragia digestiva alta.

The prognosis of 189 patients with upper gastrointestinal bleeding was studied with the assistance of a computer. The safety of the prognosis given by the doctor was partially improved with the computer. However, when both judgements were simultaneously considered, the best results were obtained. A scoring-system constructed with simple clinical data proved useful to obtain prognostic judgements with high sensitivity and specificity. It is concluded that the reliability of the prognosis given in patients with upper gastrointestinal bleeding can be improved with objective methods. The improvement is maximal if objective information is evaluated together with clinical information.