Analysis of CXCL12 3'UTR G>A polymorphism in colorectal cancer.

Colorectal cancer is one of the most prevalent cancers in developed countries. However, the genetic factors influencing its appearance remain far from being fully characterized. Recently, a G>A functional transition mapping the 3' untranslated region of the CXCL12 gene (rs1801157) has been found to be under-represented among rectal cancer patients when compared to colon cancer patients from a Swedish series. Here we present the results from an independent analysis of CXCL12 rs1801157 in a larger CRC series of Spanish origin in order to analyse the robustness of this association within a different European population. No significant difference was observed between controls and colon or rectal cancer patients. We were also unable to find a correlation between rs1801157 and different prognostic markers such as metastasis development or disease-free survival time. The epidemiologic data involving CXCL12 rs1801157 in colorectal cancer risk are discussed.

Diagnostic yield and safety of capsule endoscopy.

INTRODUCTION: the capsule endoscopy (CE), from his approval, has become a first line diagnostic procedure for the study of the small bowel disease. The aim of this study is to report our experience since the implantation of this technique in our hospital. MATERIAL AND METHODS: retrospective review of the CE undertaken in Department of Endoscopy. There was gathered in every case the age, sex, motive of consultation, previous diagnostic procedures, capsule endoscopy findings and complication of the technique. One took to end a descriptive and analytical analysis. RESULTS: there was achieved a total of 416 explorations in 388 patients. The obscure gastrointestinal bleeding was the most frequent indication (83.30%) followed by suspected Crohn s disease (7.5%). Angiodisplasia was the endoscopic lesion more frequently detected (42.2%), especially, in patients with digestive bleeding of obscure origin (OR 3.13 p < 0.001), followed by the flebectasia (10.6%) and the ulcer suspicious of Crohn s disease (9.9%). The global diagnostic yield as for the detection of injuries was 77.34% with a case of "not defecation of the capsule" and therefore need of laparotomy. CONCLUSIONS: the capsule endoscopy is a technique consolidated and as his potential is known, his indications are extended. The obscure gastrointestinal bleeding is the most frequent indication and the angiodisplasia the most identified injury. Once known his diagnostic yield, larger studies are needed that assess the influence of capsule endoscopy on clinical outcoumes.

Rendimiento diagnóstico seguridad de la cápsula endoscópica / Diagnostic yield and safety of capsule endoscopy

Introducción: la cápsula endoscópica desde su aprobación seha convertido en un procedimiento diagnóstico de primera líneapara el estudio del intestino delgado. El objetivo del estudio es exponerla experiencia desde la implantación de esta técnica ennuestro hospital.Material y métodos: se hizo una revisión retrospectiva de losestudios realizados en el Servicio de Endoscopia. Se recogió encada caso la edad, sexo, motivo de consulta, procedimientos diagnósticosprevios, diagnósticos endoscópicos e incidencias inherentesa la técnica y se llevó a cabo un análisis descriptivo y analítico.Resultados: se realizaron un total de 416 exploraciones en388 pacientes. La hemorragia digestiva de origen oscuro fue la indicaciónmás frecuente (83,30%) seguida de la sospecha de enfermedadde Crohn (7,5%). La angiodisplasia fue la lesión endoscópicamás detectada (42,2%) cuando se analizó la hemorragiadigestiva oscura (OR 3.13 p < 0,001) seguida de la flebectasia(10,6%) y las úlceras sugerentes de enfermedad de Crohn (9,9%).La rentabilidad global en cuanto a la detección de lesiones fue del77,34% con un caso de “no defecación de la cápsula” y por lotanto de necesidad de laparotomía.Conclusiones: la cápsula endoscópica es una técnica consolidaday a medida que se conoce su potencial, se van ampliando susindicaciones. La hemorragia digestiva de origen oscuro es la indicaciónmás frecuente y la angiodisplasia la lesión más identificada.Una vez conocida su eficacia diagnóstica se hace necesario determinarmediante estudios a gran escala y con metodología precisala rentabilidad clínica de la misma

Introduction: the capsule endoscopy (CE), from his approval,has become a first line diagnostic procedure for the study of thesmall bowel disease. The aim of this study is to report our experiencesince the implantation of this technique in our hospital.Material and methods: retrospective review of the CE undertakenin Department of Endoscopy. There was gathered inevery case the age, sex, motive of consultation, previous diagnosticprocedures, capsule endoscopy findings and complication ofthe technique. One took to end a descriptive and analytical analysis.Results: there was achieved a total of 416 explorations in388 patients. The obscure gastrointestinal bleeding was the mostfrequent indication (83.30%) followed by suspected Crohn's disease(7.5%). Angiodisplasia was the endoscopic lesion more frequentlydetected (42.2%), especially, in patients with digestivebleeding of obscure origin (OR 3.13 p < 0.001), followed by theflebectasia (10.6%) and the ulcer suspicious of Crohn´s disease(9.9%). The global diagnostic yield as for the detection of injurieswas 77.34% with a case of “not defecation of the capsule” andtherefore need of laparotomy.Conclusions: the capsule endoscopy is a technique consolidatedand as his potential is known, his indications are extended.The obscure gastrointestinal bleeding is the most frequent indicationand the angiodisplasia the most identified injury. Once knownhis diagnostic yield, larger studies are needed that assess the influenceof capsule endoscopy on clinical outcoumes

¿Quién debe responsabilizarse de la realización de las técnicas de sedación en endoscopia digestiva? / Who should be responsible for sedation techniques in digestive endoscopy?

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Cleaning and disinfection practices in digestive endoscopy in spain: results of a national survey.

BACKGROUND AND STUDY AIMS: Disinfection and surveillance of it are important for ensuring safety in gastrointestinal endoscopy. The aim of this survey was to assess the current status of disinfection in gastrointestinal endoscopy units in Spain. MATERIALS AND METHODS: An anonymous questionnaire on cleaning and disinfection methods was sent to gastrointestinal endoscopy units at 244 public hospitals in Spain. A minimum standard of disinfection (MSD) was defined to evaluate the appropriateness of disinfection practices. RESULTS: A total of 144 centers responded (58 %). All units perform manual washing of endoscopes before disinfection. Automatic washers are available in only 23 % of the centers. Selective cleaning of internal channels is systematically performed in 85 % of the centers. Glutaraldehyde-based disinfectants are the most commonly employed (84 % of units). The time of exposure to the disinfectant is at least 10 min in 97 % of units, but 20 min or more in only 36 % of them. Endoscopic accessories are sterilized in 57 % of centers. The MSD was complied with by 79 % of the units evaluated. Compliance with the MSD was significantly lower in small units (P = 0.0005) performing small numbers of examinations per month. Quality control tests on the efficacy of disinfection methods are conducted at 66 % of the centers. Specialized personnel record disinfection procedures in 85 % of the centers and supervise them in 55 % of the centers. Half of the units have inadequate equipment and facilities. CONCLUSIONS: This survey suggests that cleaning and disinfection practices in gastrointestinal endoscopy units in Spain have improved in recent years, and that there is a good compliance with standard guidelines. Most units should improve their equipment and facilities in order to provide better comfort and safety for patients and staff.

Endoscopic ultrasonography features of calcified gastric cancer.

Calcifications are a rare finding described in benign and malignant tumors located in any site of the body. Their presence in stomach and colon carcinomas is very rare. Most of the cases described are mucinous adenocarcinomas. We present the case of one patient with this disease studied with endoscopic ultrasonography. There were punctate calcifications in the submucosa layer that tended to take on a crown-like shape in the outer-most area, producing an acoustic shadow. The pathological study of the surgical specimen showed amorphic calcifications inside some mucin lakes. More cases need to be studied with this technique in order to define their endosonographic characteristics.

[Microbiologic diagnosis of Helicobacter pylori and its resistance to antibiotics]. / Diagnóstico microbiológico de Helicobacter pylori y su resistencia a los antimicrobianos.

From March 1995 to February 1996 a total of 386 gastroduodenal biopsies were processed for microbiological diagnosis of Helicobacter pylori which included culture, Gram staining and urease test. For susceptibility studies to five antimicrobial agents, 35 additional gastroduodenal biopsies (n = 421) were added. There were 272 (70.4%) positive cultures, 220 (56.9%) samples with positive urase test and 244 (63.2%) with positive result in Gram-staining; both tests were statistically significant compared with culture (p < 0.05). Considering culture as the reference method, sensitivity and specificity values for the urease test were 77.0% and 92.1% and for Gram staining 86.7% and 92.9%, respectively. A total of 11 isolates were recovered from the 35 biopsies processed only for culture. Susceptibility testing of 283 isolates (272 + 11) was performed to the following antimicrobials: amoxicillin, metronidazole, clarithromycin, azythromycin and tetracycline. Resistance to metronidazole was 25.4% and the corresponding values for clarithromycin and azithromycin 9.5%. No resistance to amoxicillin or tetracycline was observed. Urease test and Gram staining are two easy-to-perform tests and when taken together allow the microbiological diagnosis of Helicobacter pylori infection. Culture should be performed to know the evolution of resistance to antimicrobials used for treatment of this infection.

[Endoscopic diagnosis of an ileocolic intussusception in an adult]. / Diagnóstico endoscópico de una intususcepción ileocólica en un adulto.

Although intussusception is the most frequent cause of intestinal obstruction in children, it only represents 5-10% of all adults. The preoperative diagnosis is difficult and it is rarely done by endoscopy. We present a case of adult ileocolic intussusception caused by an ileon terminal hamartoma. The diagnosis was done by colonoscopy.

Nitrite/nitrate and cytokine levels in bronchoalveolar lavage fluid of lung cancer patients.

BACKGROUND: Cytokines are produced by tumor cells in vitro, but evidence for in vivo increased production of cytokines in cancer patients is controversial. Conversely, nitric oxide (NO) is implicated increasingly in the mediation of cytokine effects. Lung cancer patients may show an increased local production of cytokines and NO, and chronic paracrine exposure of epithelial lung cells to these medicators may influence the production of surfactant phosphatidylcholine. METHODS: The presence of the cytokine tumor necrosis factor (TNF alpha), interleukin-1 (IL-1), and interleukin-6 (IL-6), as well as NO, cyclic guanosine 3'5' monophosphate (cGMP) and phosphatidylcholine levels in bronchoalveolar lavage fluid (BLF) of lung cancer patients were investigated. Bronchoalveolar lavage fluid was obtained from 30 male smokers: 22 patients with squamous cell lung cancer and 8 subjects without cancer. RESULTS: When compared with the control subjects, the cancer patients had elevated BLF levels of TNF alpha (1.58 +/- 0.47 vs. 0.04 +/- 0.02 pg/microgram protein, P < 0.001), IL-6 (1.39 +/- 0.29 vs. 0.04 +/- 0.02 pg/microgram protein, P < 0.001), and NO2-/NO3- (23.3 +/- 5.6 vs 1.1 +/- 0.6 nmol/mg protein, P < 0.001). However, phosphatidylcholine levels were lower in those with cancer than in the control subjects (3.0 +/- 1.2 vs. 24.8 +/- 6.4 micrograms protein, P < 0.001). CONCLUSIONS: The results showed in vivo production of inflammatory cytokines in human lung cancer and increased tumor-associated NO production, as suggested by increased levels of nitrite/nitrate in the BLF. A decreased phosphatidylcholine content in the BLF also was found in patients with lung cancer.

[Cardial adenocarcinoma following sclerotherapy of esophageal varices: presentation of a case and review of the literature]. / Adenocarcinoma de cardias después de escleroterapia de varices esofágicas: presentación de un caso y revisión de la literatura.

The case of a patient with a diagnosis of chronic alcoholic hepatopathy is discussed. This patient developed an adenocarcinoma of the esophageal-gastric union after several sessions of sclerotherapy indicated to treat hemorrhage of esophageal varices. Similar cases published until now are reviewed.

[Incidence of foreign bodies in endoscopic emergencies]. / Incidencia de cuerpos extraños en urgencias endoscópicas.

Retrospective study on 617 foreign bodies (FB) located in the upper digestive tract in the years 1981, 1988 and 1989. Of them pertain 541 to adults (greater than 14 years) and 76 to children (less than or equal to 14 years). The youngest was a girl aged 11 months and the oldest, a male aged 98. In adults, the most frequently encountered FB was impacted food. In children, coins. Clinical findings in adults were mainly dysphagia or FB sensation. In children it is more frequent that another person sees the child swallowing or notices the absence of any object. In adults, its most frequent location was Killian's recess. In children it was the stomach. The removal was achieved in 96% of adults and 100% of children. There weren't any serious complications and mild ones were 0.55%.

[Therapy in nonvaricose upper digestive hemorrhages]. / Terapéutica en hemorragias digestivas altas no varicosas.

In the Central Endoscopy Service of the "San Carlos" University Hospital 218 therapeutic endoscopy procedures have been performed during 1988-1989 in patients with non-variceal upper digestive hemorrhage. Ages of patients were between 6 and 95. Bleeding was more frequent in men over 50. The majority of procedures were done in the first 12 hours (48%), Type IIa Forrest lesions were identified in 57% of cases and gastric and duodenal locations were about the same. Melena was seen in 40%, hematemesis in 28% and both in 32% of patients. In 53% adrenalin and absolute alcohol were injected and in 24% BICAP techniques, in the remaining patients combined procedures were used. Procedures were successful in 93% of cases. No complications were recorded.