Endoscopic localization of colorectal cancer: study of its accuracy and possible error factors.

INTRODUCTION: accurate preoperative localization of colorectal cancer (CRC) is very important, with a wide range of published error rates. AIMS: to determine accuracy of endoscopic localization of CRC in comparison with preoperative computed tomography (CT). To analyse variables that could be associated with a wrong endoscopic localization. PATIENTS AND METHODS: endoscopic and CT localization of a series of CRC without previous surgery were reviewed. We studied the concordance between endoscopic and radiologic localization against operative findings comparing accuracy of endoscopy and CT. We analysed the frequency of wrong endoscopic diagnoses with regard to a series of patient, endoscopy and tumor variables. RESULTS: two hundred thirty seven CRC in 223 patients were studied. Concordance with surgical localization was: colonoscopy = 0.87 and CT = 0.69. Endoscopic localization accuracy was:91.1%; CT: 76.2%: p = 0.00001; OR = 3.22 (1.82-5.72). Obstructive cancer presented a higher rate of wrong localization: 18 vs. 5.7% in non-obstructive tumors (p = 0.0034; OR = 3.65 (1.35-9.96). Endoscopic localization mistakes varied depending on tumor location, being more frequent in descending colon: 36.3%, p = 0.014; OR = 6.23 (1.38-26.87) and cecum: 23.1%, p = 0.007; OR = 3.92 (1.20-12.43). CONCLUSIONS: endoscopic accuracy for CRC localization was very high and significantly better than CT accuracy. Obstructive tumor and those located in the descending colon or cecum wereassociated with a significant increase of the error risk of CRC endoscopic localization.

[Severe lower gastrointestinal bleeding in a 25-year-old patient]. / Hemorragia digestiva baja grave en joven de 25 años.

Lower gastrointestinal bleeding refers to blood loss originating from a site distal to the ligament of Treitz. The aetiology varies depending on the age of patients. Excluding benign anorectal pathology in children and young people, Meckel's diverticulum, juvenile polyps and inflammatory bowel disease are the main causes. Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, being present in about 2% of the general population. Most Meckel's diverticulum are asymptomatic and are diagnosed incidentally. The risk of complications is 4-6%, with bleeding as one of them.

Epidermal growth factor receptor ligands in murine models for erythropoietic protoporphyria: potential novel players in the progression of liver injury.

Activation of the epidermal growth factor receptor (EGFR) plays an important role in liver regeneration and resistance to acute injury. However its chronic activation participates in the progression of liver disease, including fibrogenesis and malignant transformation. Hepatobiliary disease represents a constant feature in the clinically relevant Fechm1pas/Fechm1pas genetic model of erythropoietic protoporphyria (EPP). Similarly, chronic administration of griseofulvin to mice induces pathological changes similar to those found in patients with EPP-associated liver injury. We investigated the hepatic expression of the EGFR and its seven most relevant ligands in Fechm1pas/Fechm1pas mice bred in three different backgrounds, and in griseofulvin-induced protoporphyria. We observed that the expression of amphiregulin, betacellulin and epiregulin was significantly increased in young EPP mice when compared to aged-matched controls in all genetic backgrounds. The expression of these ligands was also tested in older (11 months) BALB/cJ EPP mice, and it was found to remain induced, while that of the EGFR was downregulated. Griseofulvin feeding also increased the expression of amphiregulin, betacellulin and epiregulin. Interestingly, protoporphyrin accumulation in cultured hepatic AML-12 cells readily elicited the expression of these three EGFR ligands. Our findings suggest that protoporphyrin could directly induce the hepatic expression of EGFR ligands, and that their chronic upregulation might participate in the pathogenesis of EPP-associated liver disease.

Tratamiento de lesiones vasculares binignas cutaneas toracocervicofaciales por luz pulsada / Treating benign vascular lession cutaneous thoraxccervicofacial for intence pulsed light

Durante el siglo pasado numerosos procedimientos fueron descriptos para resolver aquella afecciones cutáneas benignas con componente vascular. Estps procedimientos solían dejar coimo secuelas del tratamiento cicatrices, hipopigmentación, hiperpigmentación o eran ineficaces para la resolución de la patología. Desde 1962 se agregó el uso de láseres vasculares. Estos presentaban todavía la posibilidad de efectos indeseados como así tambien la dificultad para la resolución de la amplia gama de las lesiones vasculares benignas. Se presentan los resultados obtenidos sobre 27 lesiones vasculares benignas cutáneas (angiomas y malformaciones vasculares) y dermopatías con compònente vascular localizadas en tórax, cuello y/o rostro de 25 pacientes, tratados entre junio de 1999 y marzo de 2001, mediante el uso de tecnología luz pulsada. Los autores hacen referencia a diferencias y similitudes entre laser y la luz pulsada, y presentan otras dermatopatías con componente vascular plausibles de ser tratadas mediante esta tecnología.

Tumores abdominopelvianos retroperitoneales, error diagnostico en ginecologia. Aporte de dos observaciones. / Retroperitoneal pelvic abdominal tumors, diagnostic error in gynecology.Contribution to 2 observations

Se realiza una revision del espacio retroperitoneal y de su patologia. Los autores consideran dos casos de pacientes portadoras de patologia organica retroperitoneal que requirieron tratamiento quirurgico. Se pone enfasis en la importancia de un diagnostico preoperatorio acertado, el que no siempre es sencillo. Los tumores retroperitoneales deben ser incluidos en el diagnostico diferencial de cualquier masa abdominal. El tratamiento quirurgico es de eleccion para todos los tumores, exceptuando los linfomas que son radiosensibles