Revista espanola de las enfermedades del aparato digestivo最新文献

Recently, a close relation has been found between infection of the gastric mucosa by Campylobacter pylori and chronic gastritis. To establish the possible existence of characteristic morphologic changes in this disease, which can be differentiated from other unrelated forms of gastritis, we analyzed the antral biopsies obtained from 75 patients, 35 with duodenal peptic ulcer and 40 with nonulcerous dyspepsia. The diagnosis of C. pylori infection is based on positive biopsy culture or, if not, when following three requirements are met: positive urease test before 24 hours, identification of the germ by Gram stain and visualization in the tissue of microorganisms with morphology similar to that of C. pylori. We found that 85.5% of the 55 patients with C. pylori infection present active chronic gastritis with lymphoid nodes (GCA + NL), while this morphology is only found in 5 of the 20 uninfected patients. The association of GCA + NL with C. pylori infection is highly significant (p less than 0.0001). We think that it could be a local immunologic response to the stimulus of the bacterial antigen, and that it has sufficient morphologic entity to differentiate it from other inflammatory processes of the gastric mucosa of still unknown etiology.

Four cases are reported of upper gastrointestinal hemorrhage caused by Dieulafoy's vascular disease treated in our service over the last 15 years. In all these patients bleeding was from an unusually long artery with a tortuous trajectory through the gastric submucosa that eroded the mucosa and caused blood loss. In 75% of the cases it was located 6 cm below the gastroesophageal junction, near the small curvature. The diagnosis is usually made by endoscopy or during emergency gastrostomy. The most effective therapeutic measure is surgical resection.

We made a retrospective study of stomach cancer operated in 46 cases between 1971 and 1988, based on therapeutic aspects and survival, observing that due to the generally late diagnosis of this neoplasm, the treatment, which is mainly surgical, produces a low 5-year survival rate in the majority of patients. In our series, partial gastrectomy was more predominant than total gastrectomy, and the overall 5-year survival is 11% and 13%, depending on whether postoperative mortality is included or not. We recommend the follow-up of all patients operated for benign gastric pathology, basically by endoscopy five years after the operation and throughout life, for the early diagnosis and improved prognosis of this neoplasm.

246 patients with proven common bile duct stones at surgery were studied in order to establish the accuracy of ultrasound scanning in detecting choledocholithiasis and to compare the sensitivity of real-time examinations with those performed by a static scanner. The detection of choledocholithiasis by real-time ultrasound was 45.6% compared to 26.3% for the examinations performed with a static scanner. A dilated common bile duct was detected in 83.6% using real-time scanning compared to 70.3% using a static scanner. When the common bile duct was not dilated ultrasound was unable to detect the stones. Real-time ultrasound detected 66.6% of the patients with residual choledocholithiasis compared to 23.5% of patients examined by a static scanner. Our results show that real-time ultrasound scanning is a very useful screening method in detecting choledocholithiasis and residual lithiasis.

Acute pancreatitis is a serious clinical problem. Many of the etiopathogenic mechanisms are not clear and its pathophysiology is very complex, with multisystemic implications. The outcome may be severe, and there is no general agreement on the therapeutic approach. In the present paper we review the newest etiopathogenic and physiopathologic concepts on acute pancreatitis as well as the diagnostic criteria on this condition.

This was a multicenter study corresponding to 40 services. For each patient, a card containing 90 questions was filled out. At the same time we sent a personal survey card with 11 criteria questions. Our cases corresponded to 805 patients, 457 males and 348 females. The highest frequency was between 50-80 years. The therapeutic methods most often used were: drainage plus Hartmann, 37.1%; drainage plus colostomy, 24.9%; resection and anastomosis without colostomy, 12.45%, and with colostomy, 5.11%; drainage plus exteriorization, 5.98%, and conservative, 4.6%. We studied the morbimortality correlation according to different anatomoclinical groups and techniques used. The results were nonsignificant for mortality and statistically significant for evisceration, eventration, diffuse peritonitis, upper gastrointestinal bleeding, anastomotic dehiscence and type of anastomosis, manual or instrumental.

Surgery of the distal half of the rectum has changed considerably in the last decades; new technical procedures have made possible the conservation of the sphincters in a considerable number of patients. We present the most significant factors of this change in surgical approach. The supporting pilars of the change have been the possibility of automatic sutures (staplers), the reduction of the distal margin and the fact that the rate of complications is similar to that of the abdomino-perineal resection. We review the complications of the surgical treatment (stenosis and fistulas) and the advantages and disadvantages of the instrumental sutures and new surgical procedures.

We have reviewed our experience with 2,430 cases of lithiasis of the biliary tract, 500 of them located in the common bile duct and 104 corresponding to residual lithiasis. We have made a general reflexion on the problems aroused by this very common al condition, which has an imprevisible, some times severe, outcome. The recent acquisition of new conservative methods, as disolvents and lithotrix, and the diagnostic and therapeutic role of endoscopy have revolutionated the state of the art and have introduced controversial points still unsolved. As it is common in clinical practice, biliary lithiasis should be approached in a multidisciplinary fashion, employing the most convenient diagnostic procedure for the clinical situation of the patient; a priori no accredited procedure should be disregarded.

This is the case of a 29 year-old woman, admitted because of diarrhea and incoercible vomiting; later in the course of the disease she developed signs and symptoms of encephalopathy. The diagnosis of Reye's syndrome was made after death.