Diagnóstico prenatal de una tumoración quística suprarrenal: conducta que hay que seguir / No disponible

Ante el hallazgo ecográfico prenatal de una masa quística suprarrenal se debe hacer un exhaustivo diagnóstico diferencial. Éste incluye procesos benignos, como la hemorragia suprarrenal, quistes renales, secuestros pulmonares, malformaciones adenomatosas pulmonares, quistes mesentéricos y retroperitoneales, y duplicaciones entéricas, y también se tienen que descartar tumores malignos, como el neuroblastoma y el nefroblastoma mesoblástico congénito. El mayor problema de diagnóstico diferencial se presenta entre la hemorragia suprarrenal, que generalmente es un proceso regresivo, con ausencia de vasos en el estudio Doppler color, y el neuroblastoma, que permanece estableo puede ser expansivo, demostrándose con el Doppler color la presencia de vasos intratumorales (AU)

When an adrenal cystic mass is detected on prenatals onography, a differential diagnosis must be made, which should include benign lesions – such as adrenal hemorrhage, simple renal cyst, extralobar pulmonary sequestration, pulmonary cystic adenomatoid malformation,enteric duplication cyst, mesenteric and retroperitonealcyst – and malignant tumors, such as neuroblastoma and congenital mesoblastic nephroblastoma. The main difficulty is to differentiate between adrenal hemorrhage, which is usually a regressive process and shows the absence of vessels on color Doppler sonography, and neuroblastoma, which remains stable ormay grow and shows vessels that invade the tumor on color Doppler sonography (AU)

Omeprazole is superior to ranitidine plus metoclopramide in the short-term treatment of erosive oesophagitis.

Histamine H2-receptor antagonists are moderately effective in symptomatic treatment and healing of erosive oesophagitis, but they are not as effective as the proton pump inhibitor omeprazole. In some studies prokinetic agents seem to increase the effectiveness of H2-antagonists, but no study comparing the efficacy of omeprazole to H2-antagonists plus prokinetic agents has been performed. The purpose of this study was to compare the efficacy and tolerability of 20 mg omeprazole daily with 150 mg ranitidine b.d.s. plus the prokinetic agent 10 mg metoclopramide q.d.s. in patients with erosive oesophagitis. After both 4 and 8 weeks of treatment, omeprazole healed the mucosa in significantly more patients than did ranitidine plus metoclopramide. Omeprazole also provided significantly greater relief from daytime heartburn, nighttime heartburn, and acid regurgitation, and was associated with decreased concomitant antacid use. Although the overall incidence of adverse events was similar in the two treatment groups, a significantly higher number of treatment-related adverse events and more treatment-related withdrawals from the study occurred in the ranitidine plus metoclopramide treatment group. Omeprazole is more effective and better tolerated than the combination of standard dose ranitidine plus metoclopramide for patients with erosive oesophagitis.

Double-blind controlled trial of bethanechol and antacid versus placebo and antacid in the treatment of erosive esophagitis.

To determine the value of bethanechol in the treatment of erosive esophagitis, a double-blind study was undertaken in which 28 patients were randomized to either bethanechol and antacid, or placebo and antacid. Patients were evaluated clinically, endoscopically, and by esophageal manometry before and after 8 wk of therapy. After treatment both groups showed significant improvement in heartburn and in healing of esophageal lesions. Patients who received bethanechol plus antacids did not show a greater improvement than patients who received placebo plus antacids in any category, nor did patients in the bethanechol-treated group have a greater incidence of complete healing. In addition, pretreatment mean lower esophageal sphincter pressure was normal in approximately 30% of patients with erosive esophagitis and this finding was associated with a greater chance for complete healing of esophageal lesions. These results fail to show that the addition of bethanechol to an intensive antacid regimen is more effective than the antacid regimen alone in the treatment of erosive esophagitis and that patients with esophagitis and normal lower esophageal sphincter pressures respond more favorably to medical treatment.

Pseudomembranous (antibiotic-associated) colitis.

We have come to understand the cause of antibiotic-associated pseudomembranous colitis (PMC) only in the last decade. Clostridium difficile produces the intestinal dysfunction and the characteristic finding of exudative plaques on the mucosa by elaborating a toxin in the colon. This report reviews the development of our knowledge of this disease and the rapid adoption of a rational therapy once the cause was specified. C. difficile or its toxin can be cultured or isolated from the stools of 90% of the patients with PMC. This organism is almost never found in healthy people or in any other conditions except inflammatory bowel disease, where its significance is not yet known. The detection of pseudomembranes by sigmoidoscopy establishes the diagnosis. The laboratory technics that confirm the presence of C. difficile and its toxin are being incorporated into many laboratories around the country. Treatment of diagnosed PMC is relatively simple and usually completely effective. The offending antibiotic is stopped, a proper fluid and electrolyte balance maintained, and oral vancomycin begun, 125 to 500 mg four times a day. Cholestyramine can also be used as an adjunct to this regimen. Relapse can occur in patients treated with oral vancomycin, necessitating a repeat course of therapy.