G.E.N最新文献

Von Recklinghausen's neurofibromatosis is one of the most common autosomal dominant disease with an estimated frecuency of 1:3000 live births. Characteristic lesions include cafe-au-lait spots and neurofibromas following the path of peripheral nerves. Liver involvement by neurofibromatosis is rare and very few cases have been reported. We present a case of a young man with Von Recklinhausen's disease and hepatic neurofibromatosis with multiple caf-au-lait spots, cutaneous neurofibromas, short stature and osseous lesions and compare the clinical, radiological, surgical and anatomopathological findings with others describe previously in the literature.

The present report describes a case of a 27 year old patient with epigastric pain of moderate intensity, accompanied by hiporexia, weight loss and melena who was hospitalized in August 1.994 after 17 days of these signs and symptoms. Colonoscopy revelead a 6 cms polypoid, ulcerated lesion in the hepatic angle of the colon. At surgery, a 5 x 5 cms tumoral lesional 1.5 cms from the Treitz adhered to the small bowel was found. The gross findings of the specimen revealed an exophitic ulcerated tumor that measured 10 x 10 x 9 cms. Satellite nodules up to 2 cms in diameter were seen in contact with the large bowel mucosae. Light microscopy, immunohistochemical and ultrastructural studies, indicated a diagnosis of PLEXOSARCOMA.

In order to find out the variations in the Prevalence of HAV ab and identify the persons who should be vaccinated against Hepatitis A virus, we assessed HAV ab to 200 patients without any occupational risk. They were classified by their socioeconomic status; in the following categoris: High (level I n = 0); Medium-High (level II n = 50); Medium-Low (level III, n = 50); Low (level IV, n = 50); and Very Low (level V, n = 50). The percentage of positivity ofr serum HAV ab was: Level II: 12%, Level III: 18%, Level IV: 38% and Level V: 40%. The difference between levels II and III and between levels IV and V was no significant (p > 0.05), but after making a comparation between levels II and III as a group and levels IV V as another one, we found a statistical significant difference (p < 0.005). We concluded: There is a bimodal behavior for the prevalence of serum HAV ab in our study: one group with high prevalence (78%) and another one with low prevalence (30%). The massive Vaccination government programs and the vaccionation in particular cases in the daily medical practice should be done after assessing the personal Socioeconomic status in order to improve the use of this tool and achieve a progressive reduction in the morbiditi and high endemicity of HAV in our city.

Patients with partial gastrectomy are a High risk group to develop gastric cancer. Risk is higher in remnant estomach after partial gastrectomy by malignancy than benign disease. We present a case of a male patient, 64 years old, who was admitted in our Hospital with Hypovolaemia. We found during Endoscopic examination early gastric Cancer IIc + III type in the site of anastomosis. Partial gastrectomy was performed in this patient by Duodenal ulcer 11 years ago.

Since their aparition in 1980, percutaneus endoscopic gastrostomy (PEG), represented a dramatic impact in the enteral nutrition thecnics and their indication have expanded. The PEG have many advantages over the surgical gastrostomy. In this paper, we present our experience with the use of PEG in patients with head and neck cancer using a new home made gastrostome. Included were 61 patients 37 males (64.8%), 21 females (36.2%) with ages betwen 11 and 72 years. In 3 patients the PEG was not intended because tight esophageal stenoses. The PEG was completed in 56 cases (91.8%). In 5 patients (8.6%) there were minor complications (4 infections and 1 patient with pain). We have only one case of major complication which consisted in migration of gastrotome to the abdominal wall (Buried Bumper Syndrome). The gastrostome was patent between 15 and 312 days with a median of 125 days. The gastrostomies was made with siliconed 22Fr Foley catheter, crazy glue, and plastic tops. The Foley catheter is acid resistant and not deteriorate like other materials like latex. There was not adverse reaction at the ostomy site. The cost of the kit is about 11 US$ and the commercial kit is 125 US$, on the other hand the internal diameter is 15% wider than the commercial one.

Rectosigmoidoscopy and rectal biopsies specimens were taken from thirty six HIV infected patients in the Vargas Hospital of Caracas. There were thirty three males and three females. the mean age was thirty two years. Seventy three per cent were homosexuals. The sexual behaviour was the most important risk factor for the infection with the HIV. Forty four per cent of the rectosigmoidoscopies were abnormal, presenting hiperemic or petechiae mucosas. Alterations in rectal biopsies were reported on all specimens, twenty six with inespecific chronic rectitis. Two bipsies reported Kaposi's Sarcoma and eight bipsies demonstrated opportunistic agents.

Unlabelled: Helicobacter pylori is a gram negative curved bacillus recognized as etiologic agent of chronic gastritis and an important factor in the development of duodenal ulcer and gastric cancer. The purpose of this work is to evaluate three microbiologic methods for diagnosing H. pylori infection. We studied 375 samples from 218 patients, who consulted at the Department of Gastroenterology of the Hospital Vargas and were candidates for endoscopy. Samples of gastric mucous tissue were taken at level of the antrum and each sample was stained with Gram, tested for urease and cultured.

Results: whit H. pylori positive 123 patients with duodenal ulcer at the endoscopy (91.1%), 17 had gastric ulcer (76.5%), 40 gastritis and/or duodenitis (60.0%), 1 duodenal ulcer and gastric (100.0%) and 37 normal endoscopies (56.8%). Evaluating the three methods used we found that of the 286 H. pylori positive samples, the Gram stain detected 282 (sensibility 98.6% and specificity 96.6%); the urease test 276 (sensibility 96.5% and specificity 98.6%) and culture was positive in 255 samples (sensibility 89.2% and specificity 100.0%). These results show that both the Gram stain and Urease test are useful for diagnosing H. pylori infection due to their high sensitivity and specificity, rapidness, low cost for the Gram stain, and easy interpretation for Urease test. Culture, even though less sensitivity++, represents the most unquestionable diagnosis and permits carrying out susceptibility to antimicrobials tests.

14 cases that were admitted to the Hospital Universitario de Caracas, between 1.989 and 1.994, with a definitive diagnosis of Leptospirosis by microaglutination of live antigens were studied. Most of them hospitalized at the gastroenterology service. The serovar most frequently found was icterohemorragiae 11 cases. There was a predominium for the male gender 12/2 and the majority of patients belonged to the range of age between 31 and 40. The most common forms of presentations were: fever (14), jaundice (10) and myalgias (10) while the most relevant findings at physical examination were: jaundice (12), fever (11) and hepatomegaly (8). All patients had abnormal laboratory tests and among these, aminotransferases, bilirrubin, creatinin, CPK, platelets and urinary sediment were more frequently altered. Only half of the patients were diagnosed as Leptospirosis at the moment of admission. We conclude that even though Leptospirosis is an infectious disease distributed worldwide only few cases are hospitalized and differential diagnosis is difficult because of diversity of clinical presentations and lack of laboratory resources. It is important for gastroenterologists because most of complicated cases present as jaundiced patients.