[Three prognostic utility scales to determine early mortality in patients with alcoholic hepatitis in the General Hospital of Mexico]. / Utilidad de tres escalas pronósticas para determinar mortalidad temprana en pacientes con hepatitis alcohólica en el Hospital General de México.

BACKGROUND: There are many models to predict survival in patients with alcoholic hepatitis (AH). The most commonly used are the modified Maddrey's index, the Glasgow scale and the Model for End stage Liver Disease (MELD). OBJECTIVE: To evaluate three prognostic scales ability to predict early mortality (first 30 days) in patients with AH. METHODS: We retrospectively reviewed the database of hospitalized patients with AH during a 3-years period. Seventy one patients were included. We calculated the modified Maddrey's index, the Glasgow scale and the MELD scores. We evaluated if the scales predicted early (30-day) mortality. For each scale we determined sensitivity, specificity, positive and negative values (PPV and NPV) and likelihood value of each scale. RESULTS: For modified Maddrey's index, the values obtained were sensitivity 98.8%, specificity 11.7%, PPV 61.6%, NPV 87.5% and likelihood ratio 1.12. For Glasgow scale corresponding values were sensitivity 98.8%, specificity 61.7%, PPV 78.7%, NPV 97.4% and likelihood ratio 2.64. For the MELD scale sensitivity 98.8%, specificity 0.1%, PPV 59%, NPV 50% and likelihood ratio 1. CONCLUSIONS: The three scales were very sensitive. Glasgow's scale was the most specific and, maybe, the most exact test.

[Endoscopic gastrostomy]. / Gastrostomía endoscópica.

Endoscopic gastrostomy is one procedure that is recommended for feeding or for gastric drainage, when the permanence of the feeding tube is required for a long time. This has arisen as a better alternative than surgical gastrostomy, because of its simplicity, efficiency, lower costs, and scarce morbidity-mortality. The most commonly recommended technique consists of gastric punction by percutaneous route and traction of the feeding tube from the mouth with the aid of an endoscopy. The indications are the necessity of feeding patients in a critical state who have gastric disorders and in whom prolonged gastric suction is required. It is contraindicated in morbid obesity, tension ascites, distension of intestinal loops, gastric carcinoma, pyloric obstruction, liver cirrhosis, previous gastric resective surgery, very voluminous hepatomegaly, and in patients who have had previous high abdominal surgery and who are suspected of having many loop adherences. The procedure may not be carried out when there exists the impossibility of passing the endoscope to the stomach. Complications occur is nearly 5% of the patients, and consist of wound infection due to the dragging of the oropharynx, periostomal leaks, peritonitis, gastrocolic fistulas, and pneumonia by aspiration. Mortality occurs in some 2%.

[Gastric plasmacytoma. Review of the literature and report of a case]. / Plasmocitoma gástrico. Revisión de la literatura y reporte de un caso.

A case of gastric plasmacytoma without evidence of tumor in other localizations is reviewed. Based upon the clinical and laboratory findings we can conclude this was a non secretory plasmacytoma of the stomach. Clinical and hystopathological aspects are reviewed.

[Mirizzi's syndrome: a rare cause of obstructive jaundice]. / Síndrome de Mirizzi: una causa rara de ictericia obstructiva.

We present five patients with Mirizzi syndrome diagnosed by ERCP. This syndrome is a rare cause of obstructive jaundice due to common biliary duct compression by a gallstone impacted in the cystic duct, neck of the gallbladder or Hartmann's pouch. Complications are bilio-biliary fistula, cholangitis and secondary biliary cirrhosis. Diagnostic methods, importance of preoperative diagnosis and surgical technics are reviewed.

[A comparative study of 2 methods of preparation for colonoscopic procedure]. / Estudio comparativo de dos esquemas de preparación para procedimiento colonoscópico.

BACKGROUND: Although ingestion of polyethylene glycol solution has become the standard preparation for colonoscopy since 1980, there is investigation of new safe, comfortable and cheap methods. OBJECTIVE: We carried out a prospective study in order to compare the utility and tolerance related to the preparation of the colon for colonoscopy, using a dioctyl sodium sulfosuccinate enema (SD) versus our conventional preparation. METHOD: Group A was prepared the day previous to the study with liquid diet, oral laxative and application of an SD, prior to the endoscopy received another SD. Group B was prepared three days with liquid diet, the day previous to the colonoscopy they ingested oral laxative and used a water enema (W(e)), and they used another W(e) the day of the procedure. The patients' tolerance in each case was compared using a scale assigned as good, fair and poor. The cleaning obtained in the colon was also evaluated in a scale of good, regular and bad, considering three colon segments. RESULTS: Forty-four patients had been studied, 19 men and 25 women; each group with 22 patients. In group A: the preparation tolerance was good in 14 cases (63.6%), fair in seven (31.8%) and poor in one (4.5%); also, the obtained cleaning up to the cecum was good in nine cases (40.9%) and fair in 13 (59%). In group B: the tolerance was good in five cases (22.7%) fair in 12 (54.5%) and poor in five (22.7%); the obtained cleaning in this group up to the cecum was good in two cases (9%), fair in 19 (86.3%) and poor in one (4.5%). CONCLUSIONS: The SD preparation was better tolerated and more effective in order to achieve the cleaning of the colon than the conventional one.

[Gastric leiomyosarcomas and leiomyoblastomas]. / Leiomiosarcomas y leiomioblastomas gástricos.

The authors review the cases with smooth muscle tumors of the stomach (SMTS), excluding the leiomyomas, at the Mexico's General Hospital in a period of 5 years. They found 8 cases in women and 3 in men, with 51.3 years average. The average of evolution of symptoms was 5 months, prevailing: anaemia, digestive bleeding and abdominal pain. Barium radiology and endoscopy guided to the diagnosis. The tumors were located 7 at the fundus, 3 at the body and one at the gastric antrum. The size oscillated between 1.5-28 cm., average 8 cm. Endoscopic specimens were positive in 2/7 cases and cytologic samples were negative in all cases. Eight tumors were leiomyosarcomas (LMS) and 3 were leiomyoblastomas (LMB); the histologic criteria in order to differentiate them was based on the number of mitosis for 50 fields (50 csf), the size and their hypercellularity. A patient died before being operated. Two cases were subjected to emergency surgery, and died after that. In the cases treated with elective surgery the authors performed subtotal gastrectomy with major omentectomy in 4 and surgical resection of the tumor in the remaining 4 patients. The mortality rate for surgery was 27.2%.

[Choledochal cyst. Review of the literature and presentation of a case]. / Quiste de colédoco. Revisión de la literatura y presentación de un caso.

A 20 years old female patient with a history of 15 years with intermittent abdominal pain, who was diagnoses as type I choledochal cyst at the Division of Gastroenterology at the Hospital General de Mexico SS is presented. The clinical studies, treatment and evolution of this case are discussed and a literature review is presented with special attention to the new diagnostic and therapeutical approaches.

[Surgical treatment of achalasia]. / Tratamiento quirúrgico de la acalasia.

Primary achalasia is a motor dysfunction of the esophagus with unknown aetiology. We present our results obtained in 39 patients treated by Heller's Cardiomyotomy. The procedure was successful in 92.3% of the cases and when it is performed in conjunction with an antirreflux technique, it offers excellent results with a very low frequency of gastroesophageal reflux symptoms and complications.

[Crohn disease. Medico-surgical experience. A 10-year retrospective study]. / Enfermedad de Crohn. Experiencia médico-quirúrgica. Estudio retrospectivo de 10 años.

Crohn's disease is rare in Mexico. The regarding of this pathology at Gastrointestinal Unit of the General Hospital of Mexico city, between january 1980 and december 1989, is presented. There were six cases of Crohn's disease, two women (33%) and four men (66%). The definitive diagnosis was done preoperatively only in one case, the other were diagnosed postoperatively. In all, intestinal obstruction was the surgical indication. A patient died (16.6%), three cases were followed for 12 months, only two patients are still under surveillance after 15 months.

[Treatment of duodenal ulcer with famotidine. (Multicenter study)]. / Tratamiento de la ulcera duodenal con famotidina. (Estudio multicéntrico).

A multicenter open study aimed at evaluating the effect of famotidine in the treatment of duodenal ulcer was performed in several institutions located in 15 different cities of Mexico. One-hundred-and-fourteen patients with duodenal ulcer demonstrated by endoscopy were given 40 mg. of famotidine daily, administered as a single dose at night. After 4 and 6 weeks of treatment, healing of the ulcer was observed in 81.6% and 95.6% of patients, respectively. Side-effects were very unusual. In only one patient, who experienced vertigo during the treatment, administration of the drug had to be stopped.

[Treatment of gastric ulcer with famotidine. (Multicenter study)]. / Tratamiento de la ulcera gástrica con famotidina. (Estudio multicéntrico).

A multicentric open study designed to evaluate the effect of famotidine in the treatment of gastric ulcer was performed in several institutions located in 15 different cities of Mexico. 54 patients with gastric ulcer demonstrated by endoscopy were given 40 mg of famotidine daily, administered as a single dose at night. After 6 and 8 weeks of treatment, healing of the ulcer was observed in 63% and 88.9%, respectively. Side-effects were very unusual.