Poliposis gástrica en PAF / Gastric polyposis in familiar adenomatous polyposis

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Sulindac in familial adenomatous polyposis: evaluation by nuclear morphometry.

OBJECTIVE: To find out if nuclear morphometry is a useful indicator of prognosis in patients with familial adenomatous polyposis (FAP) before and after treatment with sulindac. DESIGN: Open study. SETTING: Teaching hospital, Spain. SUBJECTS: 29 patients (17 women and 12 men) with FAP who had been treated by colectomy. There were two control groups: 17 people with healthy rectal mucosa and 10 patients with colorectal cancer. INTERVENTIONS: The 29 patients with FAP were treated with sulindac 150 mg orally twice daily for 6 months. MAIN OUTCOME MEASURES: Results of histological examination of biopsy specimens and nuclear morphometry. RESULTS: Before treatment, all patients with FAP had nuclei of cells in the rectal mucosa that were intermediate in size between those in healthy mucosa (small nuclei) and those in cancer (large nuclei). After 6 months' treatment with sulindac the patients with FAP no longer had any polyps and the size of the nuclei was similar to those in healthy mucosa. Only 1 patient failed to respond, and in this patient one of the polyps subsequently became malignant. CONCLUSIONS: Nuclear morphometry may be useful in identifying patients with FAP who are at high risk of malignant degeneration.

Influencia de la tiroidectomía sobre la pérdida de masa ósea en relación con el déficit de calcitonina y el tratamiento con tiroxina / Influence of thyroidectomy and thyroxin treatment on bone mass loss and calcitonin deficit

Introducción. Durante las últimas décadas se ha intentado valorar si la tiroidectomía y el tratamiento con tiroxina tienen un efecto negativo sobre la masa ósea. Los resultados publicados presentan discrepancias, faltan, además, estudios en pacientes con tratamiento sustitutivo. Material y métodos. Se realiza un estudio de casos y controles, comparando a mujeres tiroidectomizadas (n = 60) con mujeres sin enfermedad tiroidea, de la misma situación estrogénica y edad, peso y talla similares. Se determinan T3, T4, TSH, PTH, vitamina D, calcitonina basal e inducida, densitometría ósea lumbar y femoral (AXD) y marcadores de la actividad ósea (osteocalcina, FATR, hidroxiprolina y deoxipiridinolina), así como las dosis de tiroxina y el tiempo de tratamiento en cada paciente. Resultados. La comparación entre casos y controles no presentó diferencias en edad, peso, talla, PTH y vitamina D. No se hallaron diferencias densitométricas globales ni aumento de pérdida de densidad ósea en los subgrupos estrogénicos de las tiroidectomizadas. Tampoco se apreciaron diferencias en la osteocalcina y en la deoxipiridinolina. La calcitonina basal fue de 6,9 ñ 4,4 pg/ml en los controles y de 4,6 ñ 1,9 pg/ml en los casos (p < 0,01). No hubo respuesta al estímulo en las tiroidectomías totales, que presentó un incremento mínimo a los 5 minutos en las subtotales. Conclusiones. No existe aumento de pérdida de mineral óseo en mujeres tiroidectomizadas por enfermedad benigna no hipertiroidea tratadas con tiroxina. Éstas presentan valores de calcitonina inferiores a los controles con incapacidad de respuesta al estímulo con calcio (AU)

Tumoración estromal gastrointestinal / Gastrointestinal stromal tumors

Los tumores estromales gastrointestinales son tumores mesenquimales originados en la pared muscular de vísceras huecas. Pueden ser de naturaleza benigna o maligna. Inmunohistoquímicamente, en la mayoría de los casos presentan diferenciación muscular, pero en ocasiones pueden presentarla de tipo neural, neuromuscular, ausencia de diferenciación o diferenciación gangliónica. El número de figuras de mitosis por 10 campos de gran aumento es el mejor parámetro desde el punto de vista pronóstico, mientras que otros, como el p53, la ploidía o el Ki-S5, por el momento no han podido ser utilizados en la práctica clínica (AU)

Tumor adrenal en un paciente con poliposis adenomatosa familiar / Adrenal tumor in a patient with familial adenomatous polyposis

Introducción. El incremento de la expectativa de vida en los pacientes con poliposis adenomatosa familiar está permitiendo, entre otras circunstancias, apreciar una mayor variabilidad de formas y localizaciones en las manifestaciones extracolónicas de la enfermedad. A pesar de ser muy escasas las referencias bibliográficas, para algunos autores la prevalencia de masas adrenales en la poliposis adenomatosa familiar es mayor que en el resto de la población. Caso clínico. Se presenta el caso de un paciente al que 10 años antes se le había realizado una colectomía total y anastomosis ileorrectal por poliposis adenomatosa familiar, que fue diagnosticado de un pólipo degenerado en el muñón rectal y una masa adrenal derecha no funcionante simultáneamente. Conclusión. Cuál es la mejor actitud diagnóstica ante estas lesiones y cuál la estrategia terapéutica más adecuada en el contexto de una enfermedad genética, caracterizada por su tendencia a la proliferación celular y la degeneración maligna, son aspectos controvertidos. Por el momento, nada indica que las pautas de diagnóstico, seguimiento y tratamiento de dichas lesiones deban ser diferentes de las empleadas en la población general (AU)

Tumor adrenal. Una manifestación extracolónica infrecuente en la poliposis adenomatosa familiar / Adrenal tumour. An infrequent extracolonic manifestation of the familial adenomatous polyposis

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Prognostic value of nuclear morphometry in colorectal cancer.

PURPOSE: In many types of cancer, certain morphometric characteristic of tumor cells correlate with patient survival. Our observations suggested that the survival of patients with colorectal carcinomas is negatively correlated with tumor-cell nucleus size. METHODS: We investigated relationships between postsurgery survival and nucleus morphometrics in 90 patients who had undergone resection for a colorectal tumor. The nucleus-size variables considered were maximum diameter, minimum diameter, perimeter, area, and form factor (means for 100 nuclei from each patient were used in all cases). RESULTS: Our results confirmed that patients with large maximum nucleus diameter (where large = greater than the first quartile) have significantly worse survival than patients with smaller maximum nucleus diameter (mean survival, 28 vs. 43 months). Similar results were obtained for the other nucleus-size variables. Stepwise Cox regression analysis was then performed, with postsurgery survival time as the dependent variable and the following candidate independent variables: age, gender, Dukes class, degree of histologic differentiation, the various nucleus-size variables, and relative frequencies of different nucleus shapes (spherical, oval, cylindrical, fusiform, and irregular). The variables selected for the prognostic model were Dukes class, relative frequency of irregular nuclei, and maximum nucleus diameter. CONCLUSIONS: These findings indicated that nucleus size and shape are useful predictors of survival. Even if Dukes class is known, consideration of nucleus size and shape significantly improves prediction of survival.

Botulinum toxin for the treatment of anal fissure.

BACKGROUND: The classic treatment for uncomplicated anal fissure is surgical sphincterotomy, i.e. cutting of the internal anal sphincter, thus eliminating spasm of this muscle and breaking the vicious circle of pain, spasm and inflammation. Recently, however, botulinum toxin has become available for the treatment of muscular dystonias, and thus for anal fissure. In the present study, we investigated the effectiveness of treatment with botulinum toxin in 76 patients with uncomplicated anal fissure. MATERIAL AND METHOD: The 76 patients received an injection of 40 U of botulinum toxin on each side of the fissure. Response was monitored 7, 30 and 90 days later. All patients who did not show clear improvement after 30 days received a second dose of 40 U on each side. RESULTS: After 90 days, 51 patients (67%) showed complete recovery, 19 patients (25%) substantial improvement though not complete recovery, and 6 patients (8%) no significant improvement. Transitory gas incontinence was reported by 2 patients (2.6%), and 1 patient presented hemorrhoidal thrombosis. DISCUSSION: Botulinum toxin enables chemical denervation of the internal sphincter, facilitating healing of the anal fissure. Its principal advantages with respect to surgical sphincterotomy are the absence of the general risks of surgery, and reduced incidence of incontinence, which even if it occurs tends to be transitory. The technique does not require hospitalization and is well tolerated. It appears suitable for the initial treatment of uncomplicated anal fissure, reserving surgical treatment for those cases which fail to response adequately.

[Prognosis of acute pancreatitis: Ranson or APACHE II?]. / Pronóstico de la pancreatitis aguda: Ranson o Apache II?

OBJECTIVE: The aim of this paper is to determine which is the best early prognostic score in acute pancreatitis among those we have studied. DESIGN: Prospective study of acute pancreatitis cases during a 5 year period. PATIENTS: 113 patients, biliary etiology in 93 cases, (average age: 63 years) and 66% females. The diagnostic accuracy of Ranson, Imrie, Osborne and apache II scores was analyzed. RESULTS: There were complications in 12%, and mortality was 8%. Among all the systems analyzed the Ranson criteria achieved the highest sensitivity (79%), although sensitivity was improved with Apache II at admission to the hospital (86%). We have obtained the best specificity with the Apache II (89%) and with the Osborne criteria (88%). The modification of Ranson's criteria for biliary etiology didn't improve the sensitivity (56%) to detect severe cases of acute pancreatitis. CONCLUSIONS: The Apache II system was the best for the early detection of severe acute pancreatitis. Its diagnostic sensitivity was higher than the multiple laboratory criteria analyzed.

[Hepatic cystadenoma: report of a case]. / Cistoadenoma hepático: presentación de un caso.

A case is presented of bilobar hepatic cystadenoma. This is a rare benign tumor in which an adequate preoperative diagnosis is important for correct treatment. A review is made of the literature and controversial aspects of this infrequent lesion are discussed.