Stapled transanal longitudinal posterior proctectomy (STALPP) in total rectal prolapse: a 7-year experience.

BACKGROUND: Surgical management of complete rectal prolapse is challenging. We present our results with the novel technique stapled transanal longitudinal posterior proctectomy (STALPP) in patients with complete rectal prolapse. METHODS: We performed a retrospective study in two hospitals from January 2005 to December 2012. Twenty-one patients with complete rectal prolapse were included. In all patients, STALPP was performed. The study variables were operative time, intraoperative bleeding, number of cartridges used, length of rectum prolapsed through the anus, length of rectal wall resected, length of hospital stay and preoperative and postoperative Wexner continence score and manometric measurement of anal canal resting tone and squeeze pressure. RESULTS: The median length of prolapsed tissue was 13 cm; the mean Wexner score in the preoperative and postoperative period was 15.95 and 4.95, respectively (p = 0.025). The mean resting tone improved from 23.3 to 32.85 mmHg postoperatively (p = 0.03), as did maximal squeeze pressure from 31 to 62.7 mmHg (p = 0.003). Median operative time was 65 min; median intraoperative bleeding was 12 ml; there was no postoperative bleeding, and no reinterventions were required. The median number of cartridges used was 4. The median length of resected wall in the right posterolateral sector was 8 and 6 cm in the left. The median length of hospital stay was 4 days, and the mean follow-up period was 2 years. No mortality was reported. CONCLUSIONS: Stapled transanal longitudinal posterior proctectomy is a safe and feasible surgical alternative for patients with complete rectal prolapse.

[Staging gastritis with the OLGA system: prevalence of advanced stages of gastric atrophy in Mexican patients]. / Estadificación de la gastritis con el sistema OLGA; prevalencia de estadios avanzados de atrofia gástrica en pacientes mexicanos.

INTRODUCTION: Gastric adenocarcinoma of intestinal type is preceded by inflammation, which produces mucosal atrophy and intestinal metaplasia, progressing eventually to dysplasia and invasive cancer. Recently an international group, the Operative Link on Gastritis Assessment (OLGA) proponed a staging system for gastric biopsies. OBJECTIVE: To recognize the distribution of advanced stages of gastric mucosal atrophy in Mexican patients with dyspepsia according to the OLGA system. METHODS: We apply the OLGA system for cancer risk (Stages 0 to IV) to 322 gastric biopsies from consecutive patients with dyspepsia. Using the Sydney protocol, we recorded the presence of atrophy, dysplasia and the relationship with ulcer disease. We report the stage of atrophy for each region and the Helicobacter pylori infection status. RESULTS: We documented 72 (22.4%) cases with atrophy, 50 of them (69.4%) were metaplastic-type. Overall, nine biopsies (2.78%) were stage III (all of them with metaplastic-type atrophy) and there was not stage IV cases. We did not find high-grade dysplasia or intramucosal carcinoma. In 8 of subjects with stage III, we observed low-grade dysplasia. We documented gastric ulcer in 5 patients with stage II, 60% of them with associated low-grade dysplasia. Five patients with duodenal ulcer were found in stages 0 and I. CONCLUSIONS: We found low prevalence of advanced stages of mucosal gastric atrophy among patients with dyspepsia. However we recognized 9 patients with stage III according to OLGA system worthy of follow-up because the high risk for developing gastric cancer.

[Concordance between pathologists in the diagnosis of gastric atrophy according with the OLGA system]. / Concordancia en el diagnóstico de atrofia gástrica entre patólogos según el sistema OLGA.

BACKGROUND: The intestinal gastric cancer is preceded by a sequence of pathological changes whose link is mucosal atrophy. The modified Sydney system for atrophy is a parameter not reproducible among pathologists. AIM: To know the interobserver variability using the OLGA system (Operative Link on Gastritis Assessment). METHODS: We selected 116 histologic slides. Sixty cases of both types of atrophy and 56 without atrophy were included. Three general pathologists, interested in gastrointestinal biopsies independently review the slides and established a diagnosis. For statistical analyses we employed singles frequencies in order to describe the individual diagnosis and the kappa test for evaluate the concordance between 2 and 4 observers with 2 and 3 categories. RESULTS: The global concordance has a kappa index of 0.48 (IC 95% 0.4-0.57). When we compared two pathologists the kappa index varies from 0.82(IC 95% 0.73-0.91) to 0.36 (IC 95% 0.22-0.5). The consensus among three pathologists was achieved in 25 out 30 slides in the metaplastic variety and 11 out 30 for the non-metaplastic type. The concordance for the atrophy scale has a kappa index between 0.2 and 0.5. CONCLUSION: The problematic atrophic evaluation with the Sydney system justify every effort to improve the interobserver evaluation. The OLGA system seems reproducible, although laborious,it requires a careful application, but with daily practice it could be applied easier. The clinician acceptation becomes crucial.

[Bronchial nodules produced by Strongyloides stercoralis as the cause of bronchial obstruction]. / Nódulos bronquiales producidos por Strongyloides stercoralis como causa de obstrucción bronquial.

Infection by Strongyloides stercoralis can cause asthma-like symptoms through mechanisms that have not yet been clarified. A 55-year-old male farm worker with a 2-year history of illness diagnosed as asthma and treated unsuccessfully with bronchodilators and corticosteroids was referred to our hospital with severe dyspnea. The initial chest radiograph showed mild air trapping, and pulmonary function tests detected airway obstruction that did not respond to salbutamol. Bronchoscopy revealed multiple nodules protruding into the airway lumen. S. stercoralis larvae were detected in bronchoalveolar lavage fluid and stool samples. Although treatment with albendazole was initiated, the patient's condition worsened over the next 3 days, hemoptysis presented, and the process ended in death. Autopsy demonstrated Strongyloides larvae in the bronchial nodules. Infection by S. stercoralis should be considered in the differential diagnosis of asthmatic-like symptoms refractory to treatment. In such cases nodules may be responsible for obstruction.

Nódulos bronquiales producidos por Strongyloides stercoralis como causa de obstrucción bronquial / Bronchial Nodules produced by strongyloides stercoralis as the cause of bronchial obstruction

La infección por Strongyloides stercoralis puede ocasionar síntomas parecidos al asma, pero su mecanismo de producción no se ha esclarecido. Un campesino de 55 años de edad, con enfermedad de dos años de evolución diagnosticada como asma y tratada sin éxito con broncodilatadores y corticoides, fue enviado a nuestro hospital por disnea grave. La radiografía inicial de tórax mostró leve atrapamiento aéreo y las pruebas de función pulmonar detectaron obstrucción de las vías aéreas que no mejoró con salbutamol. La broncoscopia reveló múltiples nódulos que se proyectaban hacia la luz de las vías aéreas. En el lavado broncoalveolar y en las heces se identificaron larvas de S. stercoralis. Se inició tratamiento con albendazol, pero en los siguientes tres días el estado de salud del paciente empeoró, presentó hemoptisis y, finalmente, falleció. La autopsia demostró larvas de Strongyloides dentro de los nódulos bronquiales. La infección por S. stercoralis debe considerarse en el diagnóstico diferencial de síntomas asmatiformes refractarios al tratamiento, y en estos casos la producción de nódulos podría ser el mecanismo de obstrucción (AU)

[Androgen-producing steroid cell ovarian tumor. Report of a case]. / Tumor ovárico de células esteroideas productor de andrógenos. Informe de caso.

UNLABELLED: Ovarian Tumors with Endocrine Repercussion make-up 5% of neoplasms in this gland, occupying the first place are the estrogen-producing tumors, in the second place are the androgen-producing tumors, progesterone, corticosteroids and renin are exceptional. In these tumors' nomenclature has existed a kind of synonyms that create confusion about their histogenesis and their difficult use in the literature. CASE REPORT: A 23 yr-old woman with opsomenorrhea of several years evolution, secondary amenorrhea, deep voice and progressive hirsutism. Weight: 98.500 kg. Height: 1.74 m. Body Mass Index (BMI): 32.61 (kg/m2). Vellus hair in the face (beard and moustache), android distribution in abdomen, forearms, thighs and legs (Ferriman score of 20), acne and bilateral breast involution. All paraclinic exams were negative. Human chorionic gonadotropin quantification in urine of 24 hours was negative. X-Ray: Right ovarian tumor was demonstrated with pelvic ultrasound and computerized axial tomography of abdomen. Cytogenetic study expressed 46 XX chromosomes. Presurgery endocrinologic studies were: total and free testosterone: 3.55 ng/mL and 14.30 pg/mL, respectively. Insulin: 43.3 microU/mL and C peptide: 5.7 ng/mL. The glucose tolerance test demonstrate intolerance to carbohydrates. During operation, the hormone levels in the right ovarian vein were: total and free testosterone of 2.70 ng/mL and 12.70 pg/mL respectively, which normalized after 12 hours of surgery. Other steroid hormones were normal. After six months of surgery the patient had Ferriman score of 10 and eumenorrhea. Weight: 98.100 kg, glucose tolerance test and basal hormone levels were normal. Electron Microscopy showed characteristic data of a steroid producing tumor without crystalloids of Reinke.

Prevalencia de displasia en casos de metaplasia gástrica. Estudio retrospectivo de 89 casos / Gastric dysplasia in gastric intestinal metaplasia

La tinción histológica de rutina: la hematoxilina eosina, continúa siendo la herramienta básica que evalúa los precursores de cáncer gástrico. Se le considera el estándar de oro vs. cualquier otro marcador debe compararse. En nuestro hospital recibimos anualmente 54 casos nuevos de cáncer gástrico, todos ellos en etapa avanzada al momento del diagnóstico y sólo con esperanza de paliación de la enfermedad. En un intento por reconocer marcadores preneoplásicos separamos los casos de metaplasia intestinal de cualquier índole en búsqueda de displasia. Entre 2160 biopsias gástricas de adultos recuperamos las preparaciones histológicas de 89 en quienes se hizo originalmente el diagnóstico de metaplasia. Se revisaron los casos por dos patólogos individualmente y se tabularon los diagnósticos. Encontramos 30 casos con evidencia de algún grado de displasia según los criterios de Morson. 14 correspondieron a displasia leve, 12 a moderada y cuatro a intensa. Los promedios de edad fueron de 59, 64 y 72 años respectivamente. En 21 casos el diagnóstico de ambos patólogos fue semejante. En los nueve restantes el diagnóstico difirió más de un grado, por lo que se decidió realizar la revisión simultánea de las preparaciones histológicas y el diagnóstico fue de común acuerdo. Concluimos que: 1) la aplicación simultánea de los criterios de Morson son evidentemente reproducibles y obligan al patólogo a asignar un grado de confianza, 2) Uno de cada tres casos de metaplasia en nuestro material cursa con displasia de algún grado, 3) De entre los casos de displasia más de la mitad (16/30) ameritarían seguimiento cuidadoso en búsqueda de neoplasia sincrónica o metacrónica

[Bronchial mucoepidermoid carcinoma in a child]. / Carcinoma mucoepidermoide bronquial en un niño.

A case of mucoepidermoid carcinoma in a seven year old girl is reported. This represents the eleventh case of this bronchial neoplasm seen in pediatric ages. For our knowledge this is first case which corroborates by immunohistochemistry, it originates from the salivary bronchial glands. The poor knowledge of this illness frequently delays its diagnosis. We are obligated to report these types of cases in order to have a better understanding of the clinical and pathological presentation of the lesion.