Development of an E-learning System for the Endoscopic Diagnosis of Early Gastric Cancer: An International Multicenter Randomized Controlled Trial.

BACKGROUND: In many countries, gastric cancer is not diagnosed until an advanced stage. An Internet-based e-learning system to improve the ability of endoscopists to diagnose gastric cancer at an early stage was developed and was evaluated for its effectiveness. METHODS: The study was designed as a randomized controlled trial. After receiving a pre-test, participants were randomly allocated to either an e-learning or non-e-learning group. Only those in the e-learning group gained access to the e-learning system. Two months after the pre-test, both groups received a post-test. The primary endpoint was the difference between the two groups regarding the rate of improvement of their test results. FINDINGS: 515 endoscopists from 35 countries were assessed for eligibility, and 332 were enrolled in the study, with 166 allocated to each group. Of these, 151 participants in the e-learning group and 144 in the non-e-learning group were included in the analysis. The mean improvement rate (standard deviation) in the e-learning and non-e-learning groups was 1·24 (0·26) and 1·00 (0·16), respectively (P<0·001). INTERPRETATION: This global study clearly demonstrated the efficacy of an e-learning system to expand knowledge and provide invaluable experience regarding the endoscopic detection of early gastric cancer (R000012039).

[Diagnosis of early gastric marginal zone lymphoma (MALT lymphoma) in endoscopic biopsies. Report of a case that demonstrates the utility of immunohistochemistry and the molecular analysis.]. / Diagnóstico del linfoma de la zona marginal (linfoma MALT) gástrico temprano, en biopsiasendoscópicas. Informe de un caso que ilustrala utilidad de la inmunohistoquímica y el análisis molecular.

MALT lymphomas are a subtype of low grade lymphomas that represent 7-8% of all B-cell lymphomas originated in extranodal sites. Nearly 50% of the cases present as primary gastric lymphomas.They arise from the acquired MALT developed during the course of H. pylori chronic infection. Microscopically,the presence of lymphoid follicles with follicular colonization, marginal zone ("centrocytoid")cells and lymphoepithelial lesions is characteristic.Histopathological diagnosis may result difficult in superficial endoscopic biopsies showing a typical lymphoid infiltrates. Using Wotherspoon criteria along with molecular analyses is useful in borderline lesions. We present the case of a 62 years old female with chronic gastritis. A small endoscopic biopsy was performed and the presence of a heterogeneous lymphoid infiltrate in the lamina propia was observed. Immuno histochemical profile showed focal co expression of CD20 andCD43 and kappa light chain restriction. The diagnosis of an atypical lymphoid infiltrate highly suspicious of MALT lymphoma was established. PCR molecular analysis corroborated the monoclonal pattern of the lymphoid cells and the diagnosis of lymphoma. Immunohistochemical and molecular analyses in cases of lymphoid infiltrates suspicious of malignancy (Wotherspoon 3 and 4) will aid in the adequate diagnosis between chronic gastritis and MALT lymphoma, which is crucial for prognosis,treatment and patient's outcome.Key words: Chronic reactive gastritis, marginal zone lymphoma, MALT lymphoma, gastriclym.

Erradicación de várices esofágicas con ligadura recargando un ligador múltiple, comparado con escleroterapia: Un análisis de costo / Rubber band ligation is as effective as sclerotherapy for esophageal varices erradication

La ligadura de várices esofágicas es igual de eficaz que la escleroterapia, pero con menos complicaciones y en menor tiempo. Sin embargo, en nuestro país el costo de los ligadores múltiples ha evitado que este método se haga popular. En nuestra Unidad hemos diseñado un método con el que es posible reutilizar los ligadores múltiples en varias ocasiones, con lo cual se reduce el precio. En este trabajo calculamos el costo de esta modalidad terapéutica, comparada con la escleroterapia habitual en pacientes de nuestra institución. MATERIAL Y METODOS: Se incluyeron todos aquellos pacientes en protocolo de erradicación de várices antes de la introducción de las ligaduras y posterior a las mismas. Las variables estudiadas fueron: edad, sexo, grado de las várices, complicaciones durante el procedimiento, duración del mismo, número de sesiones para erradicar, número de ligas/ml por sesión, una gradación de la facilidad del proce-dimiento en una escala análoga visual (0=muy fácil; 5=muy difícil). El costo total de la erradi-cación, se calculó en base al tabulador de nuestra institución para los procedimientos (en la categoría más cara según trabajo social), así como el costo comercial de los artículos utilizados. De esta manera el costo es: esclero-terapia (Grupo 1): endoscopia: $256.00, polidoca nol al 1 por ciento (utilizando al 3 por ciento y diluyendo) = $7.00, másagujas de escleroterapia (comerciales = desechables) = $224.00, para un total de $487.00. Para ligadura (Grupos 2): endoscopia = $256.00, 6 ligas $12.00, ligador comercial: $1,680.00 (reutilizable hasta 70 veces: $24.00, para un total de $292.00 contra $ 1,936.00 que costaría la sesión si se tuviera que utilizar uno nuevo cada vez. El costo total se calculó: precio por sesión x número de sesiones promedio para erradicar. Si se calculan los precios de acuerdo a los datos de la literatura (4 sesiones para erradicación con ligas), el total es de $1,168.00, aún es muy inferior a la escleroterapia. Este ahorro puede extrapolarse también al ambiente privado. Estos costos son para el paciente institucional, sin embargo varían de acuerdo a su nivel socioeconómico y no reflejan el costo real para la Institución. No obstante es evidente un gran ahorro. CONCLUSIONES: La erradicación de várices esofágicas recargando un ligador múltiple es más económica que la escleroterapia

Potentiating effect of EDTA-Tris on the activity of antibiotics against resistant bacteria associated with otitis, dermatitis and cystitis.

Possible synergistic effects of the combination of EDTA-tromethamine (EDTA-Tris) and three antimicrobial agents (cephaloridine, kanendomycin and enrofloxacin) against resistant Gram-positive and Gram-negative bacteria are reported. Bacteria were isolated from eight cases of chronic otitis externa, five cases of chronic dermatitis and four cases of recurrent cystitis in dogs which had previously been treated with one of the three antibiotics without success. Animals exposed to EDTA-tromethamine plus the antibiotic recovered completely within 10 days, and were controlled clinically and bacteriologically for 180 days. Local irrigation with EDTA-tromethamine solution was well tolerated and no side effects were recorded.

[Transrectal endoscopic ileal decompression as treatment of small intestine pseudoobstruction. Report of a case]. / Descompresión ileal endoscópica por vía transrectal como tratamiento de pseudoobstrucción del intestino delgado. Reporte de un caso.

BACKGROUND: Intestinal pseudo-obstruction is a syndrome characterized by recurrent signs and symptoms of intestinal pseudo-obstruction or dilation without any evidence of mechanical pseudo-obstruction. Its cause is unknown, and it is associated with severe alterations of gastrointestinal motility. AIMS: To report the transendoscopic treatment in a case of intestinal pseudo-obstruction as an alternative to a poor response to medical treatment. METHODS: The diagnosis of intestinal pseudo-obstruction was made in a 34-year old male patient who had not responded to conservative treatment; therefore, a colonoscopy was performed and an ileal drainage was introduced with its distal end 50 cm beyond the ileocecal valve. RESULTS: Twenty-four hours after the procedure was performed clinical and radiological improvement was evident. Such improvement was completed at 72 hours when the patient tolerated oral ingestion. CONCLUSIONS: Transrectal ileal drainage could be an alternative to consider in those patients that do not respond to conservative treatment.

[Endoscopic management of pyloric stenosis in patients with high surgical risk]. / Manejo endoscópico de la estenosis pilórica en pacientes con alto riesgo quirúrgico.

Pyloric stenosis is a serious complication of acid peptic disease of the stomach. The treatment with balloon dilation by endoscopy has been reported successfully and with few complications. We use a therapeutic endoscope and different diameter dilators during various sessions. We report our experience in 18 patients with high surgical risk and peptic pyloric stenosis during four years (january 1988 to december 1991). Our results were satisfactory and we believe this technique could be used as a valid alternative to surgical procedures in high risk patients.

[Endoscopic management of postoperative biliary fistulas]. / Manejo endoscópico de fístulas biliares postquirúrgicas.

Biliary fistulas have been managed by surgical correction with no good results. From 1986 to 1990, endoscopic therapy was attempted in 24 patients with postoperative persistent biliary-cutaneous fistulas. Endoscopic retrograde cholangiography demonstrated residual biliary stones in 19 patients (79%). The mean fistula drainage was 540 ml/day, and in 75% the site of the fistula was near the cistic duct stump. Sphincterotomy with or without biliary stent placement resulted in rapid resolution of the fistula in 23 patients (95.8%). In those patients treated with biliary stents the fistula healed spectacularly in 24-72 hrs.

[Endoscopic management of biliary lithiasis]. / Manejo endoscópico de la litiasis biliar.

The management of bile duct stones is one of the most important contributions of therapeutic endoscopy. It is considered the elective method to treat cholecystectomized patients with recurrent or residual stones as well as those that have high surgical risk, choledocholithiasis and intact gallbladder. Discussion must yet come to terms with those patients that have low surgical risk. Patients with severe biliary pancreatitis have better outcome when they are treated endoscopically, making the procedure an alternative therapeutic approach. Stones are usually removed with balloons or dormia baskets. When the stones can not be extracted or there is a giant stone, endobiliary prostheses or nasobiliary catheters can be used. Materials and techniques are described in this paper.

[The endoprosthetic management of biliary calculi larger than 20 mm: the long-term results]. / Manejo con endoprótesis de la litiasis biliar mayor de 20 mm: resultados a largo plazo.

We present our experiences in fifteen high-risk surgical patients, with large bile duct stones, treated with endoscopic home-made biliary stents. We observed good immediate and mediate results in all patients, with a 19.9 months follow-up. In one case, acute cholangitis developed after 25 months and the patient died. Other three died of unrelated causes. None of the patients required surgery. We conclude that endoscopic stenting is a useful procedure in the treatment of large bile duct stones in poor-risk surgical patients.