A novel endoscopic device for repeated right-side colonic access during colonoscopy (with video).

BACKGROUND: Megachannel is a newly developed colonic access system allowing rapid and multiple passes of the colonoscope to the right side of the colon. OBJECTIVE: The aim of this study was to evaluate the safety and clinical feasibility of placing a 100 cm Megachannel prototype in the right side of the colon. SETTING: Six centers, international, both surgeons and gastroenterologists performing endoscopy. DESIGN AND INTERVENTION: Patients scheduled for colonoscopy with suspected right-side colonic polypoid lesions were included. The prototype was loaded onto a 160 cm lower GI endoscope and introduced via colonoscopic guidance. MAIN OUTCOME MEASUREMENT: The ability to place this device in the right side of the colon. RESULTS: The Megachannel prototype was introduced in 41 patients (19 female, mean age 54 years) undergoing colonoscopy. The cecum was reached in 27 cases (66%) within 18 minutes (range, 3-35 minutes) and with 73 cm (range, 40-100 cm) of the device being inserted into the colon. Mild tissue bruises and mild pain were observed in 5 and 3 patients, respectively. In 14 patients, the device assisted the removal of multiple polyps (2-12) as tissue was repeatedly retrieved through the channel. The device also allowed delivery of an endoscopic US scope or suction caps to the right side of the colon. LIMITATIONS: Prototype performance may differ from the actual product (80 cm in length, redesigned introducer plugs). Small number of patients, difficult in diverticular disease. CONCLUSIONS: This newly developed colonic access system can be safely placed in the right side of the colon and is useful for a variety of advanced procedures that require repeated insertion of the colonoscope or delivery of bulky instruments. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT00987896.).

[Evaluation of serology as a diagnostic method for Helicobacter pylori infection in the local population of Guayaquil]. / Valoración de la serología como método diagnóstico de Helicobacter pylori en la población local de la ciudad de Guayaquil.

INTRODUCTION: The infection with Helicobacter pylori (H. pylori), and the diagnostic efficacy of the serologic tests has certain variability among the different geographic regions. OBJECTIVE: The objective of the present work was to find the local validation of serological methods for diagnosis of H. pylori infection and to determine the best cutoff value for the local population. MATERIALS AND METHODS: Forty-eight patients were evaluated, 27 males and 21 females, with a mean age of 29.2 years. On each patient, 3 tests for H. pylori diagnosis were performed: IgG serology, IgA serology and histology. We performed IgG and IgA serologic test for H. pylori infection and a histological examination for each patient. Efficacy parameters as well as the ROC curve were obtained for the IgG and IgA serology using histology as the gold standard. RESULTS: The cutoff point with the highest efficacy for IgG serology was 16 U/ml (sensitivity 81%, specificity 65%, positive predictive value 81%, negative predictive value 65%, and accuracy 75%), and for IgA serology was 17 U/ml (sensitivity 61%, specificity 53%, positive predictive value 70%, negative predictive value 43%, and accuracy 58%). The area under the curve was 67.1% (CI 95%: 50 to 84.1) and 54.4% (CI 95%: 38.3 to 72.5) for IgG and IgA respectively. CONCLUSION: The serology is a valuable tool in our population with high prevalence of H. pylori, especially due to its low cost and easy performance, but a reduction ofthe cutoff value was necessary to obtain more sensibility and a more adequate identification of true positives cases.

Valoración de la serología como método diagnóstico de Helicobacter pylori en la población local de la ciudad de Guayaquil / Evaluation of serology as a diagnostic method for Helicobacter pylori infection in the local population of Guayaquil

Introducción: la infección con Helicobacter pylori (H. pylori) y la eficacia de las pruebas serológicas para su diagnóstico presentan variabilidad entre diferentes regiones geográficas. Objetivo: el objetivo del presente trabajo fue determinar la eficacia de la serología como diagnóstico de infección por H. pylori y el mejor valor de corte para la población local. Materiales y métodos: se evaluaron 48 pacientes, 27 hombres y 21 mujeres, con una edad promedio de 29.2 años. En cada paciente se realizaron 3 pruebas para el diagnóstico de H. pylori: erología dosaje de anticuerpos tipo IgG (MÉTODO), serología dosaje de anticuerpos de tipo IgA (MÉ- TODO) e histología. Se obtuvieron los parámetros de eficacia y la curva de rendimiento diagnóstico de la serología IgG e IgA utilizando a la histología como estándar ideal. Resultados: el punto de corte de mayor eficacia para la serología IgG fue de 16 U/ml [sensibilidad 81%, especificidad 65%, valor predictivo positivo (VPP) 81%, valor predictivo negativo (VPN) 65% y exactitud diagnóstica 75%] y para la serología IgA fue de 17 U/ml (sensibilidad 61%, especificidad 53%, valor redictivo positivo 70%, valor predictivo negativo 43% y exactitud diagnóstica 58%). El área bajo la curva fue de 67% (IC 95%: 50 a 84) y de 54.4% (IC 95%: 38 a 72) para la IgG e IgA respectivamente. Conclusiones: la serología es una herramienta valiosa para el diagnóstico de infección por H. pylori en nuestra oblación donde hay alta prevalencia, especialmente por su bajo costo y fácil realización, pero fue necesaria una disminución del valor de corte sugerido para obtener mayor eficacia diagnóstica.

Introduction: The infection with Helicobacter pylori (H. pylori), and the diagnostic efficacy of the serologic tests has certain variability among the different geographic regions. Objective: The objective of the present work was to find the local validation of serological methods for diagnosis of H. pylori infection and to determine the best cutoff value for the local population. Materials and methods: Forty-eight patients were evaluated, 27 males and 21 females, with a mean age of 29.2 years. On each patient, 3 tests for H. pylori diagnosis were performed: IgG serology, IgA serology, and histology. We performed IgG and IgA serologic test for H. pylori infection and a histological examination for each patient. Efficacy parameters as well as the ROC curve were obtained for the IgG and IgA serology using histology as the gold standard. Results: The cutoff point with the highest efficacy for IgG serology was 16 U/ml (sensitivity 81%, specificity 65%, positive predictive value 81%, negative predictive value 65%, and accuracy 75%), and for IgA serology was 17 U/ml (sensitivity 61%, specificity 53%, positive predictive value 70%, negative predictive value 43%, and accuracy 58%). The area under the curve was 67.1% (CI 95%: 50 to 84.1) and 54.4% (CI 95%: 38.3 to 72.5) for IgG and IgA respectively. Conclusion: The serology is a valuable tool in our population with high prevalence of H. pylori, especially due to its low cost and easy performance, but a reduction of the cutoff value was necessary to obtain more sensibility and a more adequate identification of true positives cases.

[Biliary stenosis, hepatitis A and valsartan: multifactorial hepatotoxicity in a surgical patient]. / Estenosis biliar, hepatitis A y valsartán: hepatotoxicidad multifactorial en un paciente quirúrgico.

We present the case of a male patient with a history of hypertension who developed acute lithiasic cholecystitis. Shortly before the patient's admission, valsartan was prescribed to control his blood pressure. Surgery was performed without complications, but during the immediate postoperative period he developed marked jaundice, light colored stools, dark urine, and malaise. A cholangiogram showed a mild stricture of the common bile duct, and laboratory analyses revealed IgM antibodies against hepatitis A virus. Moreover, the patient reported the he continued to take valsartan. The patient improved with conservative treatment without any further complaints. In patients with jaundice after biliary surgery, exhaustive studies must be carried out before reintervention is performed, including investigation of the administration of drugs with potential hepatotoxic effects.

[Efficacy of stool antigen and serologic tests in the diagnosis of Helicobacter pylori in Ecuadorian population]. / Eficacia de las pruebas de antigenos en heces y serológica para el diagnóstico de helicobacter pylori en la población ecuatoriana.

OBJECTIVE: To assess the effectiveness in the Ecuadorian population of 2 non-invasive methods for the detection of the Helicobacter pylori: the stool antigens immunoassay (HpSAg) and the determination IgG serum of'antibodies. MATERIALS AND METHODS: Eighty six dyspeptic patients were evaluated. In each, Helicobacter pylori presence was investigated with three methods: histology, HpSAg and serology. Sensibility and specificity values were obtained, as well as the positive and negative predictive values. RESULTS: The prevalence of Helicobacter pylori with the 3 tests was 89.53%. The sensibility, specificity, positive predictive value, and negative predictive value were: 42.5%, 69.2%, 88.6% and 17.6% with histology; 69.2%, 42.9%, 78.9% and 31% with HpSAg; 64.2%, 47.7%, 81.1% and 27.3% with serology. CONCLUSIONS: In the highly prevalent Ecuadorian setting, HpSAg and serology have relative low sensibility and specificity values. Based on our results, it is necessary to assess for conditions that could alter their results, and strategies to increase the sensibility of these tests, including the histology.

[Seroprevalence of Helicobacter pylori among the child population of Ecuador]. / Seroprevalencia de Helicobacter pylori en la poblacion infantil Ecuatoriana.

OBJECTIVES: To determine the prevalence of anti-Helicobacter pylori IgG antibodies among the children population of Ecuador and the possible relation with the presence of recurring gastrointestinal symptoms. MATERIALS AND METHODS: Children randomly selected from different geographical areas were included and the presence of serum antibodies was tested using the enzyme-linked immunosorbent assay (ELISA). The gastrointestinal symptoms between patients with serum antibodies and those without serum antibodies were analyzed, excluding children who had not been treated for intestinal parasites before. RESULTS: A total of 257 children was studied, with a mean age of 8.3 years (age range between 6 months and 16 years). A seroprevalence of 63.03% was found, the most affected being the children from the Andes mountains, in the range 0 to 4 years old. A significant relation was found between the presence of anti-Hp antibodies and symptoms (p=0.001). CONCLUSIONS: There is a high prevalence of anti-Helicobacter pylori IgG antibodies among the Ecuadorian children, related with the presence of recurring gastrointestinal symptoms.

Repair of bile duct injuries with Gore-Tex vascular grafts: experimental study in dogs.

Bile duct injury is the most feared complication related to biliary tract operations. The goal of this investigation was to offer an alternative treatment that might prevent this complication. Twelve mongrel dogs, thin-walled FEP-ringed Gore-Tex vascular grafts, and Gore-Tex sutures were used in this study. The dogs were randomized into three groups of four according to the length of time of graft implantation: group 1 = 1 month; group 2 = 2 months; and group 3 = 3 months. During the first part of the study, a biliary injury was induced by ligating the middle choledocus after performing a conventional cholecystectomy. During the second part of the study, biliodigestive and biliobiliary anastomosis were performed using Gore-Tex vascular grafts prior to resection of the stenotic area. Initially, an increase in serum bilirubin and alkaline phosphatase levels was noted. Two weeks later, after implantation of the grafts, these values returned to normal. Thin-walled FEP-ringed Gore-Tex vascular grafts were found to be useful in the repair of bile duct injuries, especially in complete transections of the common bile duct. The ductility and flexibility of the material allows any type of anastomosis to be performed, especially when bile duct-gut anastomosis is technically difficult.

Seroprevalencia del helicobacter pylori en pacientes del litoral ecuatoriano / Seroprevalencia of helicobacter pylori in patients of the Ecuadorian litorial

Desde 1994, OMS categorizó al helicobacter pylori como carcinógeno tipo 1. Conscientes de la importancia de determinar la prevalencia de esta bacteria en nuestro medio, nos decidimos investigar ésta última en un muestreo de 206 pacientes provenientes del litoral ecuatoriano con sintomatología del tracto gastrointestinal superior, sus hallazgos endoscópicos y sus resultados histopatológicos, cuyos resultados citamos a continuación...

Carcinoma de la vesicula biliar: una revisión de 15 pacientes / Carcinoma of the biliary vesicle: an overhaul of 15 patients

Los registros de 15 pacientes diagnosticados histológicamente como carcinoma de la vesícula biliar dentro de un período de 10 años (1980-1990) fueron revisados. Hubieron 13 mujeres y 2 varones con una edad rango de 45-72 años (media de 57 años). Todos los pacientes tuvieron una historia de colelitiasis y dolor abdominal localizado en el cuadrante superior derecho, 5 pacientes tuvieron una masa palpable y 3 tuvieron ictericia. Una laparotomía fue realizada en todos los pacientes y en 3 (20xciento)pacientes se encontró que tenían un carcinoma, posterior a una colecistectomía electiva debido a colelitiasis. Un adenocarcinoma fue encontrado en 14 pacientes (93xciento)y en un paciente se diagnóstico un carcinoma mucoepidermoide de primario. Una alta incidencia de enfermedad metastásica fue encontrado en esta serie. La sobrevida media fue de 6,2 meses...

Comparison of closure vs non-closure of the peritoneal layer in the formation of postoperative adhesions to the abdominal wall

Este estudo experimental foi realizado em 21 caes submetido quer a sutura manual, quer a sutura mecanica de anastomose colo-colica. Nestes animais foi analizada a formacao de aderencias a parede abdominal nos casos em que a camada peritoneal foi fechada (n=6) e nos casos em que o peritoneo foi fechado com sutura continua de fio poligalactina 910 (n=5), catgut cromado (n=5) e seda (n=5). Tambem procurou-se verificar qual material causou o menor grau de aderencias a linha de sutura. A divisao em grupos foi randominzada quanto a sutura (n=5) e nao sutura do peritoneo (n=6). No grupo em que o peritoneo nao foi fechado, todos os animais foram submetidos a anastomose colo-colica com sutura manual em plano unico com seda 3-0. No grupo em que o peritoneo foi fechado com fio de poligalactina, a anastomose colo-colica tambem foi manual...

Lyophilized human dura mater versus pericardium in the repair of abdominal wall defects: experimental study in guinea pigs

Foi efetuado estudo experimental em 20 cobaias, para estudo da correcao de defeitos da parede abdominal, utilizando-se dura mater humana liofilizada e pericardio humano. Em todos os animais foi criado defeito de parede abdominal de 1,5 x 1 cm no quadrante inferior direito, incluindo tecido subcutaneo, aponeurose, musculo e peritonio. Tal foi corrigido com a aposicao e fixacao aos tecidos vizinhos, atraves de pontos, de retalho de dura-mater liofilizada (Grupo I - n = 10) e de pericardio (Grupo II - n = 10). A pele era fechada com pontos separados de seda. Os animais foram sacrificados no 30§ (n = 6), 60§ (n = 6), 90§ (n = 8) dias pos-operatorios para avaliar os enxertos em microscopio optico e eletronico. Em todos os animais, houve completa integracao entre a pele e os enxertos. Nao foram encontradas aderencias entre os enxertos e as visceras intra-abdominais. Nenhuma deiscencia foi observada, bem como nao foram notados sinais de infeccao. Sempre o enxerto era encontrado recoberto por tecido de granulacao. A penetracao de fibroblastos da-se da linha de sutura ao centro dos retalhos-depositos de colageno sao ...

Primary epidermoid carcinoma of the gallbladder

Se presenta un caso de carcinoma epidermoide primitivo de la vesícula biliar. Es un proceso patológico muy raro. Se recalca la posible asociación etiológica de la infectación con Clonorchis Sinesis con el carcinoma de las vías biliares. Se debe hacer notar que en nuestro país existen informes de eéste parásito en la región noreste, el mismo lugar del que provenía la paciente. El cuadro clínico así como el de cualquier carcinoma incipiente, semejaba una colecistitis aguda; su comportamiento patológico es aún imposible de determinar por razones obvias. Suponemos que la cirugía fue curativa porque la paciente se hallaba en buen estado general hasta 8 meses más tarde; lamentablemente la paciente murió por una causa diferente (hematemesis aguda por ruptura de várices esofágicas)

Surgical decisions in the treatment of pancreatic pseudocysts

Durante os anos de 1969 a 1979 foram operados 35 pacientes com pseudocistos pancreáticos no Departamento de Cirurgia do Hospital Universitário de Göttingen, República Federal da Alemanha. Utilizaram-se como meios diagnósticos exames de laboratório, em especial amilase sérica e urinária seriada e creatinina, ecografia abdominal, estudo contrastado do trato digestivo superior, Rx de tórax, enema opaco e colangiografia. Apesar do alto número de acidentes de trânsito, os pseudocistos de origem traumática foram raros e a maioria foi operada como resultado de uma pancreatite crônica. O mesmo ocorreu com os que sucederam pancreatite aguda ou recidivante. Uma única operaçäo foi necessária em 31 casos, enquanto um dos casos de ressecçäo pancreática, de um total de quatro, constituiu a única ocasiäo em que se teve que recorrer a re-intervençöes. Drenagem externa exclusiva foi realizada em três casos, utilizando-se drenagem interna 28 vezes, dentre as quais 21 derivaçöes em Y de Roux. Este método demonstrou-se o mais apropriado do ponto de vista cirúrgico e funcional. Näo houve mortalidade na série, sendo que apenas três pacientes tiveram curso pós-operatório complicado. O tempo médio de hospitalizaçäo foi de 25 dias. Recomenda-se a cistojejunostomia em Y de Roux como tratamento cirúrgico de escolha para drenagem de pseudocisto pancreático

Tratamiento de la catarata cortical en estadio inicial: experiencia con la sal de lisina de bendazac / Treatment of cortical cataract in initial stage: experience with bendazac lysine salt

Se efectua una evaluación de la acción de la bendalina sobre la evolución de la catarata cortical senil o presenil en su etapa inicial