Fighting Hepatitis B in North Korea: Feasibility of a Bi-modal Prevention Strategy

In North Korea, the prevalence of hepatitis B is high due to natural factors, gaps in vaccination, and the lack of antiviral treatment. Aid projects are urgently needed, however impeded by North Korea's political and economical situation and isolation. The feasibility of a joint North Korean and German humanitarian hepatitis B prevention program was assessed. Part 1: Hepatitis B vaccination catch-up campaign. Part 2: Implementation of endoscopic ligation of esophageal varices (EVL) by trainings in Germany and North Korea. By vaccinating 7 million children between 2010 and 2012, the hepatitis B vaccination gap was closed. Coverage of 99.23% was reached. A total of 11 hepatitis B-induced liver cirrhosis patients (mean age 41.1 yr) with severe esophageal varices and previous bleedings were successfully treated by EVL without major complications. A clinical standard operating procedure, a feedback system and a follow-up plan were developed. The bi-modal preventive strategy was implemented successfully. Parts of the project can serve as an example for other low-income countries, however its general transferability is limited due to the special circumstances in North Korea.

Estenose péptica do esôfago em crianças: incidência e achados clínicos / Esophageal peptic stricture in children: incidence and clinical findings

Introdução: estenose péptica de esôfago resulta da inflamação crônica da mucosa, causada pela doença do refluxo gastroesofágico. O objetivo deste estudo é apresentar a experiência com estenose péptica de esôfago, em um serviço de endoscopia digestiva pediátrica, analisando os achados clínicos e, principalmente, a diminuição da incidência dessa entidade nos dias atuais. Métodos: estudo retrospectivo de janeiro de 1996 a setembro de 2002. As dilatações foram realizadas com velas de Savary-Gilliard. O número de estenoses por ano, relativo ao número de endoscopias, foi avaliado através dos testes do qui-quadrado e da tendência linear. Resultados: no período de 6,5 anos, 1.636 crianças e adolescentes foram submetidos a endoscopia digestiva alta. Desses, 26 eram portadores de estenose péptica. As idades desses pacientes variaram de 10 meses a 16 anos, com uma média de 6,5 anos, sendo que 69% eram meninos.Treze pacientes eram portadores de condições predisponentes ou associadas a refluxo mais grave. Nenhum era portador de esôfago de Barrett. Foram realizadas 69 sessões de dilatação (2,65/paciente). Um paciente apresentou pneumomediastino, após a dilatação. Todos os outros apresentaram boa resposta às dilatações. O número de estenoses pépticas diminuiu com o passar dos anos, embora o número total de endoscopias tivesse aumentado. Conclusões: as dilatações com velas de Savary foram eficazes em diminuir a disfagia dos pacientes portadores de estenose péptica. Houve uma diminuição da incidência de estenose péptica, apesar do aumento do número de endoscopias nesse serviço pediátrico (AU)

Introduction: esophageal peptic stricture results of chronic mucosal inflammation caused by gastroesophageal reflux disease. The aim of this study is to present the experience with esophageal peptic strictures in a pediatric gastrointestinal endoscopy unit showing clinical aspects and mainly the decreasing incidence of this entity nowadays. Methods:retrospective study from January 1996 to September 2002. The esophageal dilations were performed with Savary-Gilliard bougies. The number of the strictures per year, relatively to endoscopies number, was evaluated by qui-square test and linear tendency. Results: in the period of 6.5 years 1,636 children and adolescents were submitted to upper digestive endoscopy. Twenty-six individuals had a peptic esophageal stricture. The ages varied between 10 months and 16 years with a mean age of 6.5 years and 69% were male patients. Thirteen patients had an associated or predisposing condition to more severe gastroesophageal reflux. There was no Barrett esophagus. We have done 69 esophageal dilations sessions (2.65/patient). One patient presented with pneumomediastine post-dilation. All the others presented a good outcome. The total number of strictures decreased with time although total number of endoscopic procedures increased. Conclusions: dilations with Savary-Gilliard bougies were efficacious to decrease the disphagia of the esophageal peptic strictures in children. There was a decreasing incidence of peptic strictures although the increasing incidence of endoscopic examinations performed in this pediatric endoscopy unit (AU)

Cardiomiotomía por videotoracoscopía en acalasia esofágica grave / Cardiomiotomy by video thoracoscopy in severe esophageal achalasia

Se presenta el primer caso en nuestro país de acalasia operada por videotoracoscopía. Se siguió la técnica empleada por Pellegrini y Hasbún. El postoperatorio y la evolución de los primeros meses ha sido excelente a pesar de tratarse de un caso muy avanzado, grado III con dilataciones sacciformes. Para un equipo quirúrgico con experiencia en videotoracoscopía y en cirugía convencional de la acalasia, el procedimiento presentado es más simple y fácil de ejecutar. Hemos preferido la vía toracoscópica ya que no daña el ligamento freoeofágico; ello es necesario en la vía laparoscópica para poder efectuar la miotomía del esófago torácico distal. Es valioso, por lo menos en los primeros casos, la ayuda del endoscopio flexible, que permite identificar el esófago y señalar el límite de la mucosa esofágica y gástrica

Dispepsia no ulcerosa: relaciones entre sintomatología, gstritis y helycobacter pylori / Non ulcerative dyspepsia: relationship between symptomatology, gastritis and helycobacter pylori

Background: histological alterations of gastric mucosa and its colonization by Helicobacter pylori are postulated to be implicated in the pathogenesis of non ulcer dyspepsia. Aim: to study the possible relationships between histological gastriitis and Helicobacter pylori in non ulcer dyspepsia symptomatology. Patients and Methods: 54 patients (39 female) with non ulcer dyspepsia whose ages ranged from 17 to 68 years were subjected to an upper Gl endoscopy with gastric mucosa biopsy samples for histological study and microbiological identification of Helicobacter pylori. Gastrointestinal complains were blindy quantified using a scored questionnaire. Results: 31 subjects (57.4 per cent) had Helicobacter pylori in their gastric mucosa. There was acute inflammatory activity in 26 of the 31 patients with Helicobacter pylori (81 per cent) and 15 of 23 without Helicobacter (65 per cent). The median score of symptoms was 7 (range 2-13) in patients with Helicobacter and 6 (range 2-10= in patients without Helicobacter. Conclusions: there were no significant differences in gastric mucosa acute inflammatory activity and non ulcer dyspepsia symptomatology between patients with or without Helicobacter pylori colonization of gastric mucosa

Endoscopías de vías aerodigestivas: experiencia de 8 años / Endoscopies of aerodigestive vias: experience of eight years

El presente es un estudio restropectivo de las endoscopías de vías aerodigestivas realizadas en el departamento de Otorrinolaringología del Hospital Universitario "Dr. José E. González" de la UNAL; en el período comprendido entre marzo de 1983 y diciembre de 1990. Durante este período se realizaron 95 endoscopías, 65 de las cuales correspondieron a broncoscopías, de estas 45 (69.2 por ciento) se realizaron para extraer un cuerpo extraño del árbol traqueobronquial; además se revisaron 30 esofagoscopías de las cuales (83.3 por ciento) correspondieron a extracciones de un cuerpo extraño en hipofaringe o en esófago cervical. La edad en la que los cuerpos extraños en vías aerodigestivas se presentaron con mayor frecuencia, fué en la edad pediátrica, aumentando significativamente entre el primero y segundo año de vida; sin embargo, en pacientes ancianos adentulos se encontraron bolos alimenticios retenidos en esófago causando sintomatología de cuerpo extraño.

La endoscopia como procedimiento diagnostico en la patologia del tracto gastrointestinal superior / Endoscopy as diagnosis procedure in upper gastrointestinal tract pathology

En el presente estudio se describen las endoscopias realizadas en el Hospital Universitario del Valle durante el periodo de octubre de 1977 a septiembre de 1980. El resultado positivo o negativo de la biopsia en cada entidad, se comparo con los diagnosticos clinicos, radiologicos o endoscopicos para establecer de esta forma asociaciones y estimar la sensibilidad, especificidad y concordancia en cada diagnostico. El examen endoscopico mostro consistentemente sensibilidad y especificidad altas para los diagnosticos de gastritis cronica, cancer gastrico y ulcera gastrica frente al diagnostico clinico y radiologico. Para el cancer gastrico el examen endoscopico es el ideal pues presento una alta sensibilidad (92.4%) y especificidad (93.6%). la concordancia medida por la prueba de Kappa fue significativa para los examenes clinicos y endoscopicos