[Control of upper digestive tract hemorrhage with Nd-Yag laser]. / Control de la hemorragia del tubo digestivo superior con rayo laser Nd-Yag.

Among the emergency procedures in patients with upper gastrointestinal bleeding the endoscopy is the most accurate; it will establish the diagnosis in about 95% of the cases, before an adequate treatment can be prescribed. Several endoscopic techniques have been employed to control the bleeding and laser photocoagulation, which applies luminous energy, restrain the bleeding. Nd-Yag laser photocoagulation was used in a retrospective study of 217 patients with active upper gastrointestinal bleeding. In all of the cases the bleeding was controlled at the moment of the endoscopic procedure. In 29 patients the hemorrhage recurred, mostly due to diffuse lesions like gastritis duodenitis of esophageal varices and only 18 of these patients required emergency surgery. There were no complications with the procedure. According to these results the Nd-Yag laser photocoagulation is an effective procedure for control of the upper gastrointestinal bleeding. It avoids emergency surgery and, if surgery is required later, the patients will be in better conditions. Gastrointestinal Bleeding, emergency endoscopy, Nd-Yag Laser, photocoagulation.

[Esophageal moniliasis]. / Moniliasis del esófago.

Esophageal moniliasis is found rarely. It has been described mainly in chronically ill patients, who receive antibiotics and corticoesteroids. Early diagnosis and treatment betters their prognosis. Nine patients, 5 males and 4 females were studies in Hospital General del Centro Medico Nacional in Mexico City. Their agesranged from 26 to 77 years, with a mean of 49 years. All patients were chronically ill and 7 of them were treated in the intensive care unit. Three had disphagia, 3 retrosternal pain, and 2 gastrointestinal hemorrhage. Eight patients had high W.B.C., 3 irregular filling defects on X ray studies, and on endoscopy, all showed a pseudomembranous white yellowish exudate, underneath it the mucosa was inflamed, irregular and bled scantily. In 5 out of 9 patients biopsy and a smear confirmed the diagnosis. Eight patients treated with nystatin were cured. This disorder must be suspected in patients with disphagia and retrosternal pain; esophagoscopy is the prefered procedure to establish this diagnosis.

[Endoscopic cholangiography in the postcholecystectomy syndrome]. / La colangiografía endoscópica en el síndrome postcolecistectomía.

The purpose of this study was to evaluate the usefulness of endoscopic pancreatocholangiography in a group of patients having undergone surgical operations on bile ducts. This is a retrospective study including 64 patients in whom cholocystectomy was performed both with or without previous exploration of bile ducts. Forty five of these patients were jaundiced and 20 had abdominal pain as main symptoms. Forty nine were females and 15 males, their ages ranging between 18 and 80 years. The canulation of Vate's ampulla and the adequate darkening of the bile ducts was achieved in every case and the cholangiography showed recidual or recurring lithiasis in 75 per cent of the cases; in 67 per cent there was postsurgical stenosis of bile ducts; remnant cystic duct in 74.8 per cent; stenosis of Oddi's sphincter in 50.9 per cent, and in 13.3 a diagnosis of cholestasis was established. This procedure was quite useful in order to establish the correct diagnosis in this group of patients having a postcholecystectomy syndrome.

[Pancreatic changes in patients with liver cirrhosis caused by alcoholism]. / Alteraciones pancreáticas en los pacientes con cirrosis hepática por alcoholismo.

Alcoholism in frequently associated to inflammatory lesions of the pancreas. The changes involved have been duly depicted in necropsis studies. In this paper we have evaluated the association of pancreatic changes in patients undergoing hepatic cirrhosis due to alcoholism by means of endoscopic pancreatography. Forty four patients were studied by endoscopic pancreatography, 25 males and 19 females. Their ages varied between 22 and 81 year old. Three groups were formed; the first one by 19 patients with hepatic cirrhosis due alcoholism; the second group by 7 patients with hepatic cirrhosis in whom no alcoholic antecedents could be ascertained; the third group was formed by 18 non alcoholic, non cirrhotic individuals. Pancreatography was performed by means of a JF-B3 duodenoscope. In 12 out of 19 patients with alcoholic hepatic cirrhosis, the pancreatography showed changes such as irregularities in the ducts, sacular formations, retarded emptying with partial filling, shortening and stenosis of the ducts, changes usually present in patients with chronic pancreatitis. Both in groups II and III no pathologic changes were found in pancreatography. From the radiologic standpoint alone one cannot eestablish the diagnosis of chronic pancreatitis, although we consider that the usefulness of the pancreatography is that of making quite apparent the above said alterations in the alcoholic cirrhotics patients and stablish the adequate therapeutic conduct.

[Diagnosis of carcinoma of Vater's ampulla by duodenoscopy]. / Diagnóstico del carcinoma de la papila de Vater por duodenoscopía.

Cancer of the ampula of Vater occurs in 10% of cases of jaundice caused by malignant neoplasms. Endoscopy with biopsy and citological study helps to establish the diagnosis in most instances, utilizing a duodeno fibroscope JFB-2. Fourteen patients, ten men and four women, were studied in a five year period in the Service of Endoscopy in the General Hospital of National Medical Center of the Mexican Institute of Social Security. All the patients presented with obstructive jaundice and only in four was papilary carcinoma suspected from the clinical and radiological studies. Direct biopsy was performed in all patients and brush biopsy for citology in 9. In all 14 patients a malignant lesion was observed macroscopically in the ampula of Vater projecting in to the duodenum. In thirteen of fourteen the lesion was diagnosed microscopically as adenocarcinoma and in eight of nine citologically. The utilization of this methodology facilitates the early diagnosis of the lesion in this way improves considerably the prognosis.