[Value of intraductal biopsies and intraductal cytology in the etiological diagnosis of biliary stenoses]. / Intérêt des biopsies et de la cytologie endocanalaires pour le diagnostic étiologique des sténoses biliaires.

Endobiliairy tissue specimens were obtained for cytologic and histologic examinations at the site of stenosis after percutaneous biliary drainage or endoscopic retrograde sphincterotomy in 49 patients with benign (10 cases) or malignant (39 cases) biliary stricture. Final etiologic diagnosis was obtained by surgery (18 cases), autopsy (one case), aspiration cytology of metastasis (2 cases), serology (2 cases), and in 26 cases, was determined by the course and outcome of the disease. As the sensitivity of each method, cytology and histology, was weak, it was necessary to associate them to improve results. Accurate etiologic diagnosis was achieved in 77 p. 100 of cases. The specificity of the method was satisfactory and specimen examination allowed to correct and confirm the initial etiologic diagnosis in 12 and 65 p. 100 of cases, respectively. The specificity of the method and its low morbidity prompt us to recommend it during transhepatic or retrograde therapeutic drainage as it can serve as a guide for later treatment. On the other hand, achievement of a transhepatic drainage or an endoscopic sphincterotomy only to obtain endobiliairy tissue specimens means taking into account the poor sensitivity of the method and the complications inherent to transhepatic drainage and endoscopic sphincterotomy. The practice of obtaining specimens by the retrograde technique without sphincterotomy or under cholangioscopy should be developed.

[Recurrent non-diabetic acido-ketotic coma. Apropos of a case]. / Coma acido-cétosique itératif non diabétique. A propos d'un cas.

A case of recurrent transient episodes of acido-ketosis with complete recovery in a 3-year-old girl with normal development is reported. Investigations failed to determine the cause but this case is compatible with recurrent organic acidemia.

[Calcification of the intervertebral disks in children: apropos of a case]. / Calcification des disques intervertébraux chez l'enfant à propos d'une observation.

The authors report a case of calcifications of an intervertebral cervical disk in a 12-year-old boy. A torticollis was the clinically revealing event. As in the majority of the published cases, the etiology remained unknown and the evolution was simple with complete regression of the calcifications.

[Hydatid cyst of the pericardium and diaphragm. Apropos of a case]. / Kyste hydatique du péricarde et du diaphragme. A propos d'une observation.

A rare cas of hydatic disease is reported, located both in the pericardium and diaphragm. The pericardial cyst was diagnosed on the basis of clinical examination and echocardiography. The diaphragmatic cyst was only discovered during surgery.

[The association of diabetes and celiac disease: the value of assaying antireticulin antibodies]. / Association diabète et maladie coeliaque: intérêt du dosage des anticorps antiréticuline.

The authors studied the specificity and the sensitivity of serum anti-reticulin IgA type antibody determination for the diagnosis of coeliac disease in diabetic patients. They observed a frequency of 11.1% coeliac disease among a group of 54 type I juvenile diabetic patients. The search for serum antireticulin IgA type antibodies appears to be an efficient method for identifying patients with coeliac disease; it has a specificity of 98% and a sensitivity of 95%. This marker appears to be particularly well suited for the identification of asymptomatic forms, and also for surveillance of diet during the course of coeliac disease.

Los rayos laser en gastroenterologia. / Laser rays in gastroenterology

Se hace una breve descripcion de los rayos Laser, de sus principales fuentes, variedades y caracteristicas. Se discuten las indicaciones actuales de los rayos Laser en gastroenterologia, destacando el tratamiento de los sangramientos digestivos (varices esofagicas, ulcera peptica, gastritis erosivas, angiodisplasias, etc.) y el de los tumores benignos y malignos de esofago, estomago y colon. En cada uno de estos campos se resumen las indicaciones actuales, los resultados alcanzados, las limitaciones y los riesgos. Uno de los aspectos mas interesantes es la posibilidad de detectar y de tratar focos neoplasicos mediante el empleo de Laser a colorantes que son captados por las celulas neoplasicas y luego activados por los rayos, ejerciendose una accion local selectiva

Consideraciones generales sobre evaluacion del estado nutricional. / General considerations on the evaluation of nutritional status

Se enfatizam las repercusiones de la desnutricion, sea calorica-proteica (marasmo o caquexia) sea proteica pura (kwashiorkor), sobre la capacidad de defensa y recuperacion de los pacientes y, por ende, de su pronostico. La desnutricion, en sus diversos grados, existe en el 30 a 50% de los adultos que se hospitalizan. Por ello cada paciente debe ser objeto de una evaluacion y de un plan nutricional que puede o no implicar asistencia nutricional. Esta puede ser no intensiva o intensiva (enteral o parenteral, parcial o total). Se enumeran las ventajas relativas de la alimentacion enteral. Se establecen y describen los principales parametros antropometricos, bioquimicos, inmunologicos y citologicos en los que se fundamenta la evaluacion del estado nutricional: reserva calorica (depositos grasos); reverva proteica (muscular y visceral); grado de catabolismo. Esta evaluacion debe complementarse, en todos los casos con el estudio de la suficiencia respiratoria, hepatica y renal

Alimentacion enteral. / Enteral alimentation

Se destallan las indicaciones y las principales contraindicaciones de la alimentacion enteral, asi como los niveles de soporte nutricional requeridos en diversas circunstancias clinicas.Se senalan las bases que permiten calcular los aportes caloricos, proteico, glucidico, lipidicos y de vitaminas y minerales. Con respecto al aporte calorico, este se determina precisando el gasto energetico basal. Para ello se utiliza la formula propuesta por Harris y Benedict. Los valores ostentan diferencias atribuibles al sexo y deben corregirse segun el grado de actividad fisica; la patologia existente y al estado del metabolismo. Se describe la tecnica de intubacion con o sin control fluoroscopico y el tipo de sondas disponibles.Se analisan las caracteristicas de las mezclas nutritivas disponibles y la forma de administrarlas.Finalmente se destacan las posibles complicaciones del procedimiento, mencionando las mecanicas; gastrointestinales y metabolicas