[Bleeding esophageal varices: evaluation of medical and emergency surgical treatment]. / Várices esofágicas sangrantes: evaluación del tratamiento médico y quirúrgico de emergencia.

The results of medical and emergency surgical treatment of 55 patients with bleeding esophageal varices were studied. Eighteen patients died (32.7%). Mortality relates to the severity of the liver disease and the number of blood transfusions required. There was a high incidence of recurrent hemorrhage. We recommend definitive porto-sistemic shunt after the bleeding episode has been controled.

[Esophageal lesions caused by human papillomaviruses (HPV)]. / Lesiones esofágicas causadas por el virus del papiloma humano (VPH).

Twenty two patients are presented with histologic lesions on esophageal biopsy compatible with infection by human papillomavirus. Symptoms were uncharacteristic, there was no sex difference and the mean age was 40 years. Upper GI endoscopy showed the following: a) multiple ulcers in the middle esophagus, most of less than 10 mm in diameter, rounded or oval in shape, separated by normal appearing mucosa, well delimited erythematous margins, with a smooth white base; b) In five patients, multiple white elevated lesions were found in the middle esophagus, separated by normal appearing mucosa. One patient had 2 papillomas; c) In two cases there was an epidermoid carcinoma at 25 and 28 cm from the dental arcade. Biopsy taken at the border of the lesions were compatible with papilloma virus infection. The possible relation of the lesions with papillomavirus infection was established only on histologic criteria. The described lesions regress without treatment or with nonspecific treatment, some cases of our series have responded to empiric antiviral medication.

[Humoral immunologic changes in inflammatory colonic diseases]. / Alteraciones inmunológicas humorales en las enfermedades inflamatorias del colon.

We present the humoral immunological findings in 18 patients with ulcerative colitis and two with Crohn's disease. All of them had the disease for 3 months to five years. Fifteen were hispanics and five from European origin. There were ten males and ten females, and an average age of 38 years. All patients had active disease from clinical and endoscopy points of view. Thirteen patients had abnormal values in one of the immunoglobulins and normal in seven patients. IgA was increased in eleven, normal in seven and decreased in two. IgG increased in two, decreased in one and normal in seventeen cases. IgM was found to be increased in five and normal in the rest. IgA secretory determination in saliva, was performed twelve patients and was positive in all of them. Antinuclear antibodies were negative in eight. Anti-smooth muscle were positive in three of fifteen. Anti-mitochondrial were present in one and negative in thirteen. Values of C3 and C4 were lower than normal in 3 and 2 cases respectively from 4 cases studied. CH50 was decreased in 2 of 11 cases studied. In the patients, no correlation was found between low complement values, the positivity of auto antibodies and the clinical parameters previously mentioned. We conclude that there is quantitative alterations of the humoral response and it is necessary the immunological study in persons with inflammatory bowel disease others studies are needed to establish the real value of these findings.

[Ultrastructural study of the antral mucosa to determine the presence of Helicobacter pylori and its association with chronic active gastritis]. / Estudio ultraestructural de la mucosa antral para determinar Helicobacter pylori y su asociación con gastritis crónica activa.

We present the results of ultrastructural studies of gastric mucosa obtained through upper digestive endoscopy of eight patients with suspicious symptoms of non ulcer dyspepsia or peptic ulcer. Two were male and six female with a median age of 54 years. The urease test to determine the presence of HP and Hematoxylin-Eosin and Warthin-Starry staining techniques were practiced with the purpose of a better detection of bacteria and gastritis. We did not find any correlation between the endoscopic results and the presence of gastritis or HP. Of the 8 patients only one had negative results for HP and for Electron microscopy studies. Chronic active gastritis was seen with light microscopy in all of the cases. Three in this group presented mild focal dysplasia and one case intestinal metaplasia type IIa. The main ultrastructural findings were: a) diminished or absent microvilli underneath the bacteria; b) HP inside phagolysosomes in the cytoplasm of the epithelial cells; c) in some cases, the bacteria was attached to the cell membrane; d) the cellular wall of HP contains mucopolysaccharides and up to four polar flagella; e) there are polymorphonuclear leucocytes in the epithelium. We conclude that Electron Microscopy is not a routine method for studying HP, but it constitutes a good method to study pathogenicity of the bacteria.

Varices colonicas. Presentacion de dos casos y revision de la literatura / Colonic varices. Report of 2 cases and review of the literature

Se presentan 2 pacientes con varices colonicas. Se hace una breve revision de la literatura, la cual incluye un total de otros 33 casos. La mayoria de los pacientes tienen hipertension portal. El motivo de consulta mas frecuente es el sangramiento rectal. La endoscopia es el metodo mas util para el diagnostico. El tratamiento que mejores resultados parece dar en los casos de hemorragia masiva es la anatomosis porto-cava