Linitis plástica intestinal, metástasis tardía de adenocarcinoma gástrico en anillo de sello / Intestinal linitis plastica, late metastases in signet-ring gastric adenocarcinoma

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[Anisakiasis: an infestation to be known by surgeons]. / Anisakiase: une parasitose que le chirurgien doît connaître.

BACKGROUND: Anisakis infestation is related to the consumption of raw or undercooked fish. It can cause allergic reactions, or abdominal pain when the gastrointestinal tube is involved. Its incidence is rising in Europe. OBJECTIVE: To analyze a group of patients complaining of right iliac fossa pain with ileitis or colitis and establish its relationship with Anisakis spp. infection. PATIENTS AND METHODS: During a 3-months period, 28 patients with abdominal pain were referred to the hospital with a diagnosis of ileitis or colitis by imaging, endoscopy or surgery. Specific serology for Anisakis was performed in all of them. RESULTS: At imaging study, 14 patients had ileitis or colitis, three intestinal obstruction and one acute appendicitis. Fourteen patients were operated on and 7 of them underwent resection; histopathologic diagnosis were eosinophilic ileitis (2 cases) or colitis (3 cases), non specific ileitis (1 case) and Crohn's disease (1 case). Another patient had an endoscopic biopsy that concluded eosinophilic colitis. Anisakis serology was positive in 25 (89%), negative in two and unknown in one. All patients were discharged uneventfully. CONCLUSIONS: Digestive anisakiasis may present as acute abdomen. Surgeons should know and consider this diagnosis in patients with ileitis or colitis, moreover if an antecedent of raw or undercooked fish ingestion is present. A conservative approach is best performed but the clinical picture can require an emergent laparotomy.

Efecto protector de la vagotomía sobre la mucosa gástrica en un modelo de estrés en la rata / Protective effect of vagotomy on the gastric mucosa in a stress model in rats

Introducción: la utilización de la vagotomía se ha basado clásicamente en sus efectos inhibidores sobre la secreción ácida. La sección vagal provoca modificaciones celulares y endocrinas que podrían estar implicadas en sus acciones protectoras. Nuestro objetivo es estudiar los cambios morfológicos que provoca la vagotomía sobre la mucosa gástrica y su relación con la protección frente al estrés a corto, medio y largo plazo. Material y métodos: se ha empleado un modelo de estrés de inmovilización y frío y 80 ratas Wistar divididas en dos grupos, control (con y sin estrés) y vagotomía (a 7, 30 y 120 días). Se han estudiado los cambios provocados en la mucosa gástrica por el estrés, con y sin vagotomía, así como la relación entre estos cambios y la acción protectora frente al mismo. Resultados: el sangrado tuvo una relación muy significativa con el estrés (p< 0,0001). La incidencia de sangrado tuvo una diferencia significativa entre ratas vagotomizadas y no vagotomizadas (p< 0,0001) lo que ocurrió a corto, medio y largo plazo (la vagotomía fue protectora frente al estrés). Los signos de regeneración se relacionaban significativamente con la vagotomía (p< 0,0001) y no se relacionaban con el estrés (p= 0,208). Sin embargo, no había relación significativa entre la acción protectora y la presencia de signos de regeneración (p= 1). Conclusiones: la vagotomía tiene efectos tróficos sobre la mucosa gástrica y es protectora frente al estrés. Esta acción protectora se mantiene a corto, medio y largo plazo. Sin embargo, estos cambios no son suficientes para explicar la protección. En esta acción podría estar implicado un fenómeno de adaptación mediado por factores hormonales y peptídicos. (AU)

Protective effect of vagotomy on the gastric mucosa in a stress model in rats.

INTRODUCTION: The use of vagotomy is classically based on its inhibiting effects on acid secretion. Vagotomy induces both cellular and endocrine changes that may be involved in protective actions. Our aim was to study morphologic changes induced by vagotomy on the gastric mucosa and their relation to stress protection in the short, medium and long term. MATERIAL AND METHODS: An immobilization and cold stress model was used with 80 Wistar rats divided into two groups--control (with and without stress) and vagotomy (at 7, 30 and 120 days). Changes induced in the gastric mucosa by stress were studied with and without vagotomy, as well as relationship between these changes and the intended protective action. RESULTS: Bleeding showed a very significant relation to stress (p < 0.0001). Bleeding incidence exhibited a significant difference between vagotomised and non-vagotomised rats (p < 0.0001) in the short, medium and long term (vagotomy was protective against stress). Regeneration signs related significantly to vagotomy (p < 0.0001) but not stress (p = 0.208). However, no significant relationship was found between the protective action and the presence of regeneration signs (p = 1). CONCLUSIONS: Vagotomy has tropic effects on the gastric mucosa and is protective against stress. This protective action is maintained in the short, medium and long term. However, these changes are not sufficient to explain protection. An adaptation phenomenon mediated by hormonal and peptidic factors may be involved in this action.

[Massive lithiasis of the intra and extrahepatic bile ducts. Presentation of a clinical case]. / Litiasis masiva de la vía biliar intra y extrahepática. Presentación de un caso clínico.

A case of massive intra and extrahepatic lithiasis in a 52 year-old-man is presented. Diagnosis was confirmed by ultrasonography, CT and percutaneous cholangiography. The value of the different diagnostic procedures is analyzed. The need for elective surgical treatment is insisted on in order to remove the majority of the calculi, treatment of stenosis and adequate biliary drainage. Our case was treated with an hepatico-jejuno-duodenostomy (end to side) on an isolated jejunal loop with sphincteroplasty for drainage of the distal choledochus. In the postoperative period the patient was treated with Methyl-tert-butyl-ether for dissolution of the remaining calculi.