Dysphagia and stenosis secondary to intramural esophageal pseudodiverticulosis.

We present the case of a patient with smoking, alcoholism, cirrhosis and HIV who was endoscopically diagnosed with esophageal candidiasis due to an episode of dysphagia. After treatment with antifungals and PPIs, the patient remained asymptomatic for almost 3 years. He presented an event of food impaction that was resolved by an upper endoscopy in which an esophageal stenosis and multiple esophageal pseudodiverticulosis were visualized. The biopsies only showed chronic nonspecific esophagitis. The stenosis was dilated with a balloon and PPIs were continued, with good response. Esophageal intramural pseudodiverticulosis is rare and can lead to motor disorders and strictures. It has a doubtful association with HIV and a clearer relationship with alcoholism, smoking, diabetes, reflux and candidiasis. The endoscopic diagnosis can be difficult so in order to make an accurate diagnosis is necessary an esophagram or CT. Treatment is based on controlling risk factors and dilating stenosis. The prognosis is usually favorable.

Crohn´s disease: beyond the intestine.

We present the case of a 41-year-old patient under study for chronic diarrhea, iron deficiency, and elevated fecal calprotectin. After ileocolonoscopy, magnetic resonance and capsule endoscopy without alterations, an upper endoscopy was performed visualizing fibrinated serpinginous ulcers, confluent with each other, with erythematous mucosa between them, suggestive of isolated gastric Crohn's disease, a rare entity in the adult population.

A rare complication of jejunal extension of a percutaneous endoscopic gastrostomy tube for levodopa-carbidopa intestinal gel administration.

Direct intestinal administration of levodopa-carbidopa gel has shown good results in selected patients with Parkinson's disease (1, 2). We want to present a complication related to the device necessary for the administration of this drug. A 58-year-old man, diagnosed with Parkinson's disease, treated for six months with levodopa-carbidopa intestinal gel, administered through a percutaneous endoscopic gastrostomy (PEG) tube with jejunal extension, presented at the emergency department for abdominal pain. The patient complained abdominal discomfort that lasted two months. It was described as pain around the umbilical area that radiated to the left lumbar region, worsened after ingestion, and did not subside with conventional analgesia.

Brunneroma: an infrequent duodenal neoplasm.

An 83-year-old male presented to the Emergency Department with long lasting epigastric discomfort, weight loss and diarrhea. Physical exam and basic laboratory tests showed no remarkable findings. Upper endoscopy revealed a sessile lesion (Paris 0-IIa) in the anterior wall of the duodenal bulb, with smooth surface and slightly ulcerated at the top.

Seguridad cardiovascular del uso recreativo de cannabis asociado a sildenafilo: revisión sistemática / Cardiovascular safety of the recreational use of cannabis associated to sildenafil: systematic review

OBJETIVOS: La utilización con fines recreativos de sustancias de abuso asociadas a algunos medicamentos también empleados en estos contextos obliga al profesional a conocer la posibilidad de interacciones entre ambos. El objetivo de la presente revisión sistemática es actualizar la información disponible sobre la seguridad cardiovascular de la asociación de cannabis y sildenafilo. MATERIALES Y MÉTODOS: Se llevó a cabo una revisión sistemática en las bases de datos PubMed, PreMedline, Medline, Embase, ChemID, HSRPROJ, POPLINE y TOXLINE, desde el inicio de las bases de datos hasta el 1 de marzo del 2018 con los términos clave «sildenafil», «vardenafil», «tadalafil», «phosphodiesterase inhibitors» y «cannabis», combinándolos y cruzándolos mediante operadores booleanos con «adverse effects» y «cardiovascular». No se restringió por idioma ni por tipo de estudio. RESULTADOS: Se encontraron 13 publicaciones, de las cuales 5 analizaban la combinación de cannabis y sildenafilo como un nuevo estilo de uso recreativo, no médico, del consumo conjunto de ambas sustancias, pero solo 3lo relacionaban con alteraciones cardiacas: un infarto posterior sin onda Q, otro sin elevación ST y un síndrome coronario agudo. CONCLUSIONES: La gravedad de los eventos cardiovasculares de sildenafilo asociado a cannabis obliga al profesional a tenerlos en cuenta ante cuadros de miocardiopatía isquémica de difícil filiación

OBJECTIVES: The recreational use of drugs of abuse associated to therapeutically used drugs in sexual contexts forces the health care professional to know the possibility of drug-drug interactions among them. The aim of this review is updating the available information on cardiovascular safety of recreational use of sildenafil and cannabis. MATERIALS AND METHODS: A systematic search in databases PubMed, PreMedline, Medline, Embase, ChemID, HSRPROJ, POPLINE and TOXLINE, from the start of the databases until to March 1, 2018 was made. Search terms were "sildenafil", "vardenafil", "tadalafil", "phosphodiesterase inhibitors" and "cannabis", combining and crossing them by means of Boolean operators with "adverse effects" and "cardiovascular". No restrictions for language or type of study were made. RESULTS: Thirteen papers were found, 5out of them analyzed cannabis and sildenafil combination as a new style of recreational non-medical use. Only 3papers related sildenafil-cannabis association with cardiovascular events: one posterior myocardial infarction without Q wave, one myocardial infarction without ST elevation and one acute coronary syndrome. CONCLUSIONS: Severity of sildenafil-cannabis-related cardiovascular events forces the healthcare professionals to take them into account and considering them in clinical pictures of an ischemic cardiomyopathy hard to classify

[Cardiovascular safety of the recreational use of cannabis associated to sildenafil: Systematic review]. / Seguridad cardiovascular del uso recreativo de cannabis asociado a sildenafilo: revisión sistemática.

OBJECTIVES: The recreational use of drugs of abuse associated to therapeutically used drugs in sexual contexts forces the health care professional to know the possibility of drug-drug interactions among them. The aim of this review is updating the available information on cardiovascular safety of recreational use of sildenafil and cannabis. MATERIALS AND METHODS: A systematic search in databases PubMed, PreMedline, Medline, Embase, ChemID, HSRPROJ, POPLINE and TOXLINE, from the start of the databases until to March 1, 2018 was made. Search terms were "sildenafil", "vardenafil", "tadalafil", "phosphodiesterase inhibitors" and "cannabis", combining and crossing them by means of Boolean operators with "adverse effects" and "cardiovascular". No restrictions for language or type of study were made. RESULTS: Thirteen papers were found, 5out of them analyzed cannabis and sildenafil combination as a new style of recreational non-medical use. Only 3papers related sildenafil-cannabis association with cardiovascular events: one posterior myocardial infarction without Q wave, one myocardial infarction without ST elevation and one acute coronary syndrome. CONCLUSIONS: Severity of sildenafil-cannabis-related cardiovascular events forces the healthcare professionals to take them into account and considering them in clinical pictures of an ischemic cardiomyopathy hard to classify.