Revista espanola de las enfermedades del aparato digestivo最新文献

In a group of patients with chronic diarrhea of unknown origin, a study of cellular and humoral immunity was carried out with in vitro tests and the results are compared to those obtained in a group of patients with ulcerative colitis or Crohn's disease, and to normal controls. In the chronic diarrhea group there was evidence of an immunological deficiency affecting the B and T lymphocytes that had specific characters in relation to IgG, although the IgG deficit was not as important as in intestinal inflammatory disease.

A group of 53 with angina pectoris-like chest pain and normal coronary arteriography was studied. Nine of these patients had a positive ergonovine test and were diagnosed as coronary spasm or vasospastic angina. In four of these nine patients there was evidence of an accessory esophageal disease responsible for the chest pain. In 44 patients organic or functional ischemic heart disease was excluded. The possible esophageal origin of the pain was studied by means of esophageal manometry and acid and endofonium provocation. The final results were that 15 patients had pain of an esophageal origin and 13 had an esophageal disease that made the esophagus a likely, or at least possible, source of pain.

A rare case is reported of dextrogastria associated with congenital elevation of the right hemidiaphragm and partial inclusion of the subdiaphragmatic right colon. The main embryological, epidemiological and clinical characteristics are commented.

A 65-year-old farmer who had used arsenic as a plaguicide for many years developed a hepatosplenic hemangiosarcoma with metastasis in the colonic serosa, mesentery and omental. The tumor was complicated with intraabdominal hemorrhage originated by spontaneous intraperitoneal rupture. The echographic and post-mortem findings are presented. This is the first case of hepatic hemangiosarcoma reported in Uruguay.

A comparative study of clinical and biological features and of the immediate prognosis was made in 46 patients with alcoholic hepatitis and 19 patients with alcoholic hepatitis with liver cirrhosis. The presence of cirrhosis has different clinical manifestations and a more intense alteration of albumin, prothrombin, total bilirubin and immunoglobulins (p less than 0.01). The development of ascites, encephalopathy and hepatorenal syndrome (p less than 0.05) and albumin, prothrombin and total bilirubin values at admission (p less than 0.01) were the best parameters to identify the patients with a poorer prognosis. There were no significant differences between both groups in mortality, frequency of encephalopathy or renal failure.

A case of malacoplakia associated with rectal adenocarcinoma is reported. Optical and electron microscopic study disclosed a histiocytic infiltrate adjacent to the adenocarcinoma containing spherical and concentric inclusions designated as Michaelis-Gutmann bodies. The pathogenesis is discussed and the literature is reviewed.

Internal pancreatic fistulas are a well-known complication of chronic pancreatitis and should be added to the classic complications of malabsorption, diabetes, pain and pseudocyst. The fact that it is an infrequent complication (Bradley compiled about 200 reported cases in 1982) motivated us to make this clinical report. The importance of total parenteral nutrition (NPT), which leads to cure in 50% of these patients, and the usefulness of endoscopic retrograde cholangiopancreatography (ERCP) are evaluated in the cases in which surgery is contemplated.

Choledocholithiasis in patients with a gallbladder "in situ" is presently one of the most frequent indications of endoscopic sphincterotomy. The crucial problem of these patients is whether or not they require eventual cholecystectomy to avoid the risks of potential complications of cholelithiasis. Of the 39 patients (mean age 80.1 +/- 8.2 years) with choledocholithiasis and gallbladder "in situ" released from this hospital from October 1979 to December 1985 after a successful endoscopic sphincterotomy (expulsion, spontaneous or not, of gallstones), 33 (84.6%) have been followed-up for an average of 41.5 +/- 20.8 months (7-92 range). During this time only one patient (3%) developed acute cholecystitis that required cholecystectomy, and two (6%) denoted mild pains in the right upper quadrant, while the other 30 (91%) remained asymptomatic. Over these years 10 patients (30.3%) died from nonbiliary causes. In conclusion, in elderly or high surgical risk patients who present choledocholithiasis and gallbladder "in situ", endoscopic sphincterotomy is effective. Later cholecystectomy to prevent the complications of cholelithiasis would not be justified as a routine measure in most of these patients.

Carbimazole, an antithyroid agent of the thioimidazole group, can induce unpredictable liver alterations, presumably by hypersensitivity. We describe the case of a hyperthyroid woman who suffered acute submassive cholestatic hepatitis in the course of treatment with this drug. We also review the other seven cases of carbimazole hepatotoxicity previously communicated in the literature.