Fístula colecisto-duodenal asintomática en una paciente con diabetes mellitus e hipotiroidismo primario: presentación de un caso. / [Asymptomatic cholecystoduodenal fistula in a patient with diabetes mellitus and primary hypothyroidism: report of a case]

The case of a 60-year-old woman with diabetes mellitus type II and primary hypothyroidism, who presented a clinical picture compatible with intestinal obstruction is reported. An abdominal sonogram revealed acute calculous cholecystitis and ileus. A plain film of the abdomen showed dilatation of small bowel loops. She underwent celiotomy, once stabilized, and gallstone ileus+cholecystoduodenal fistula were diagnosed intraoperatively. Resection of the ischemic segment of distal jejunum and the stone, cholecystectomy and primary repair of the fistula were performed. In spite of the systemic complications (metabolic, cardiovascular and pulmonary), that appeared postoperatively, the patient had a favorable outcome. This patient had an acute calculous cholecystitis and a spontaneous biliary-enteric fistula with intestinal obstruction, without previous symptoms of biliary tract disease preceding the episode of bowel obstruction.

Uso del agente espamolitico otilonio bromuro (spamonen) en endoscopia digestiva: estudio prospectivo en 63 pacientes / Use of spasmolytic agent otilonium bromide in digestive endoscopy: a prospective study in 63 patients

El otilonio bromuro es un antagonista del calcio con un efecto miolítico directo, el cual está indicado en estados espásticos y disguinesias funcionales del aparato gastroentérico (sindrome del intestino irritable) y como premedicación para procedimientos endoscópicos gastrointestinales. El presente estudio evaluó el otilonio bromuro 40 mg PO la noche anterior y 40 mg PO la mañana de 49 fibroscopías bajas en 63 pacientes, para determinar la presencia o ausencia de peristalsis y relajación del píloro. No se observaron efectos colaterales debido a la medicación. En 46 (93.8 por ciento) endoscopías altas se observó marcada relajación del tracto gastrointestinal y del píloro. En 13 (92.8 por ciento) endoscopías bajas también se observó marcada relajación del tracto colónico. Todos los pacientes toleraron bien las endoscopías. El otilonio bromuro fue útil como premedicación para facilitar las exploraciones endoscópicas altas y bajas, debido a su efecto espasmolítico. (AU)

Fístula colecisto-duodenal asintomática en una paciente con diabetes mellitus e hipotiroidismo primario: presentación de un caso / Asymptomatic cholecystoduodenal fistula in patient with diabetes mellitus and primary hypothyroidism: report of a case

The case of a 60-year-old woman with diabetes mellitus type II and primary hypothyroidism, who presented a clinical picture compatible with intestinal obstruction is reported. An abdominal sonogram revealed acute calculous cholescystitis and ileus. A plain film of the abdomen showed dilatation of small bowel loops. She underwent celiotomy, once stabilized, and gallstone ileus + cholecystoduodenal fistula were diagnosed intraoperatively. Resection of the ischemic segment of distal jejunum and the stone, cholecystectomy and primary repair of the fistula were performed. In spite of the systemic complications (metabolic, cardiovascular and pulmonary), that appeared postoperatively, the patient had a favorable outcome. This patient had an acute calculous cholecystitis anda spontaneous biliary-enteric fistula with intestinal obstruction, without preveious symptoms of biliary tract disease preceding the episode of bowel obstruction (AU)

Ascariasis de la vesícula biliar. Reporte de dos casos y revisión de la literatura. / [Ascariasis of the gallbladder. Report of 2 cases and review of the literature]

Two patients who complained of a clinical picture compatible with cholelithiasis; and in whom the diagnosis of ascariasis of the gallbladder was made sonographically, are reported. In the first patient, cholecystectomy was curative and corroborated the presence of the roundworm. In the second patient, piperazine citrate was given. A second sonogram performed after therapy showed no roundworm within the gallbladder; and the patient remains asymptomatic until now. The usefulness of ultrasonography in the diagnosis of gallbladder ascariasis, and during surveillance in those patients who are managed with medical therapy only, is emphasized.

Helicobacter pylori en pacientes con gastritis y úlcera gástrica. / [Helicobacter pylori in patients with gastritis and gastric ulcer]

Seventy patients symptoms and signs compatible with gastritis and/or peptic ulcer were included in the study; they were 41 women and 29 men, with an age range of 9-84 years, and they underwent upper endoscopy. Brushing of the antrum was performed and 4 biopsies were taken from it. With the gastric mucus, a smear was prepared for Gram staining; one sample of tissue was placed directly in urea medium and another tissue sample in Skirrow medium; and two samples of tissue were stained with Hematoxylin-eosin and examined under the light microscope. Those patients who were taking antibiotics capable of inhibiting growth of Helicobacter pylori (Hp), the last four weeks prior endoscopy, were excluded from the study. Twenty-six patients (37.1

) were positive (+) for Hp the culture in urea medium. Of these 26 patients, 15 (21.4

) were also positive by the Skirrow method, and 11 (15.7

) by Gram stain. Epigastric pain was the most predominant symptom in (+) patients (80.7

) and (-) patients (68.1

) for Hp. Superficial acute gastritis within the antrum was the most frequent endoscopic finding in (+) (84.6

) and (-) (68.1

) patients. Chronic superficial gastritis was the predominant microscopic finding in (+) (42.3

) and (-) (38.6

) patients as well. Microscopic examination was positive for Hp in 6 (23

) patients by H-E stain. According to these results, there was no statistically significant difference in symptoms, endoscopic and microscopic findings between positive and negative patients for Hp.

Helicobacter pylori en pacientes con gastritis y ulcera gástrica / Helicobacter pylori in patients with gastritis and gastric ulcer

Seventy patients symptoms and signs compatible with gastritis and/or peptic ulcer were included in the study; they were 41 women and 29 men, with an age range of 9-84 years, and they underwent upper endoscopy. Brushing of the antrum was performed and 4 biopsies were taken from it. With the gastric mucus, a smear was prepared for Gram staining; one sample of tissue was placed directly in urea medium and another tissue sample in Skirrow medium; and two samples of tissue were stained with Hematoxylin-eosin and examined under the light microscope. Those patients who were taking antibiotics capable of inhibiting growth of Helicobacter pylori (Hp), the last four weeks prior endoscopy, were excluded from the study. Twenty-six patients (37.1 percent) were positive (+) for Hp the culture in urea medium. Of these 26 patients, 15 (21.4 percent) were also positive by the Skirrow method, and 11 (15.7 percent) by Gram stain. Epigastric pain was the most predominant sympton in (+) patients (80.7 percent) and (-) patients (68.1 percent) for Hp. Superficial acute gastritis within the antrum was the most frequent endoscopic finding in (+) (84.6 percent) and (-) (68.1 percent) patients. Chronic superficial gastritis was the predominant microscopic finding in (+) (42.3 percent) and (-) (38.6 percent) patients as well. Microscopic examination was positive for Hp in 6 (23 percent) patients by H-E stain. According to these results, there was no statistically significant difference in symptoms, endoscopic and microscopic findings between positive and negative patients for Hp (AU)

Ascariasis de la vesícula biliar. Reporte de dos casos y revisión de la literatura. / [Ascariasis of the gallbladder. Report of 2 cases and review of the literature]

Two patients who complained of a clinical picture compatible with cholelithiasis; and in whom the diagnosis of ascariasis of the gallbladder was made sonographically, are reported. In the first patient, cholecystectomy was curative and corroborated the presence of the roundworm. In the second patient, piperazine citrate was given. A second sonogram performed after therapy showed no roundworm within the gallbladder; and the patient remains asymptomatic until now. The usefulness of ultrasonography in the diagnosis of gallbladder ascariasis, and during surveillance in those patients who are managed with medical therapy only, is emphasized.

Ascariasis de la vesicula biliar: reporte de dos casos y revisión de la literatura / Ascariasis of the gallbladder: report of 2 cases and review of the literature

Se relatan dos pacientes quienes presentaron un cuadro clínico compatible con colelitiasis; y, en quienes el diagnóstico de ascariasis de la vesícula biliar fue hecho sonográficamente. En el primer paciente, la colecistectomía fue curativa, y corroboró la presencia del parásito. En el segundo paciente, se administró citrato de piperazina. Un segundo sonograma realizado después del tratamiento, no reveló dentro de la vesícula biliar; y el paciente permanece asintomático hasta ahora. Se pone énfasis en la utilidad que la ultrasonografía brinda en el diagnóstico de la ascariasis de la vesícula, y durante la vigilancia en aquellos pacientes quienes son manejados con terapia médica solamente (AU)

Use of a polytetrafluoroethylene tube and patch in the repair of a difficult duodenal stump.

In the cases where a primary anastomosis is unable after a duodenal resection, special care must be taken to avoid any complication in the duodenal stump such as suture dehiscence. Wall inflammation is an important factor in the development of this complication. We report a case of a 35-year-old woman who had previously undergone to pyloric exclusion due to a wall defect occurred after a bilio-digestive anastomosis, which complicated with a posterior duodenal stump dehiscence. The acute edema of the stump walls that resulted after it because exposure to bile conducted to heroic measures for its closure: first, the use of a polytetrafluoroethylene tube as duodenostomy and posteriorly a patch of the same material for its final closure. Both gave successful results in the repair of a refractory duodenal stump dehiscence.

Syphilitic rectal ulcer associated with perforation of the hard palate: case report

We report a case of a patient that presented with a perforated hard palate as a late complication due to an unsuspected syphilis. This disease first presented as a rectal ulcer which was misdiagnosed as an amebic proctitis. The patient received antiamebic treatment with a satisfactory outcome. He did not return for late control of the latter treatment and returned seeking medical advise six years later with the former complication. He tested positive for syphilis and appropiate treatment was performed. In addition, the ORL department recommended a palate prosthesis. (AU)