Enfermedad de Castleman multicéntrica: hallazgos ecoendoscópicos / Multicentric Castleman disease: endoscopic ultrasonographic findings

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Esophagoenteral stents in patients with recurrent gastric adenocarcinoma.

One of the problems that can appear in patients with total gastrectomy for adenocarcinoma with esophagoenteral anastomosis is the appearance of a stenosis of the anastomosis. These stenosis are frequently malignant due to relapse of neoplasia. The therapeutic possibilities available are the surgical bypass or palliative treatment. There is very little experience described in the literature (21 cases) on the placing of self-expandable metal stents as a palliative treatment for the symptoms of stenosis.We present our experience of 3 patients, in whom 4 esophageal stents were fitted (1 covered and 3 uncovered) with good results. The dysphagia disappeared or improved, it allowed the ingestion of a soft diet and meant an improvement in the quality of life and at the same time stopped the weight loss. It seems an effective palliative treatment as a treatment for dysphagia in patients with tumoral relapse in the anastomosis of total gastrectomies.

Hepatitis inducida por infliximab en un paciente con enfermedad de Crohn / Infliximab-induced hepatitis in a patient with Crohn’s disease

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Prótesis esofagoenterales en pacientes con recidiva de adenocarcinoma gástrico / Esophagoenteral stents in patients with recurrent gastric adenocarcinoma

Uno de los problemas que puede aparecer en los pacientescon gastrectomía total por adenocarcinoma con anastomosis esofagoenterales la aparición de estenosis de la anastomosis o próximaa ella. Estas estenosis con frecuencia son malignas debido a laaparición de recidiva en la neoplasia. Las posibilidades terapéuticasde las que disponemos son el bypass quirúrgico o bien el tratamientopaliativo. Existe muy poca experiencia descrita en la literatura(21 casos) sobre la colocación de prótesis metálicasautoexpandibles como tratamiento paliativo de los síntomas de laestenosis.Presentamos nuestra experiencia en 3 pacientes, en los que secolocaron 4 prótesis esofágicas (1 recubierta y 3 no recubiertas)con buenos resultados. Desapareció o mejoró la disfagia, permitióla ingesta de dieta blanda y supuso una mejora en la calidad devida a la vez que impide la pérdida ponderal. Parece un tratamientopaliativo eficaz como tratamiento de la disfagia en pacientescon recidiva tumoral en la anastomosis de las gastrectomías totales

One of the problems that can appear in patients with total gastrectomyfor adenocarcinoma with esophagoenteral anastomosisis the appearance of a stenosis of the anastomosis. These stenosisare frequently malignant due to relapse of neoplasia. The therapeuticpossibilities available are the surgical bypass or palliativetreatment. There is very little experience described in the literature(21 cases) on the placing of self-expandable metal stents as a palliativetreatment for the symptoms of stenosis.We present our experience of 3 patients, in whom 4esophageal stents were fitted (1 covered and 3 uncovered) withgood results. The dysphagia disappeared or improved, it allowedthe ingestion of a soft diet and meant an improvement in the qualityof life and at the same time stopped the weight loss. It seemsan effective palliative treatment as a treatment for dysphagia inpatients with tumoral relapse in the anastomosis of total gastrectomies

Hepatitis autoinmune tras hepatitis colestásica inducida por risperidona / Autoimmune hepatitis after risperidone-induced cholestatic hepatitis

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Endoscopic resection of large colorectal polyps.

BACKGROUND: Endoscopic polypectomy is a common technique, but there are discrepancies over which treatment--surgical or endoscopic--to follow in case of polyps of 2 cm or larger. OBJECTIVES: To analyse the efficacy and complications of colonoscopic polypectomy of large colorectal polyps. PATIENTS AND METHODS: 147 polypectomies were performed on 142 patients over an eight-year period. The technique used was that of submucosal adrenaline 1:10000 or saline injection at the base of the polyp, followed by resection of the polyp using a diathermic snare in the smallest number of fragments. Remnant adenomatous tissue was fulgurated with an argon plasma coagulator. Lately, prophylactic hemoclips have been used for thick-pedicle polyps. Complete removal was defined as when a polyp was completely resected in one or more polypectomy sessions. Polypectomy failure was defined as when a polyp could not be completely resected or contained an invasive carcinoma. RESULTS: The mean patient age was 67.9 years (range, 4-90 years), with 68 men and 79 women. There were 74 sessile polyps, and the most common location was the sigmoid colon. The most frequent histology was tubulovillous. Most of the polyps (96.6%), were resected and cured. This was not achieved in four cases of invasive carcinoma, and a villous polyp of the cecum. All pedunculated polyps were resected in one session, whereas the average number of colonoscopies for sessile polyps was 1.35 +/- 0.6 (range, 1-4). The polypectomy was curative in all of the in situ carcinomata except one. As for complications, 2 colonic perforations (requiring surgery) and 8 hemorrhages appeared, which were controlled via endoscopy. There was no associated mortality. CONCLUSIONS: Endoscopic polypectomy of large polyps (> or =2 cm) is a safe, effective treatment, though it is not free from complications. Complete resection is achieved in a high percentage, and there are few relapses. It should be considered a technique of choice for this type of polyp, except in cases of invasive carcinoma.

[Usefulness of the guide of standards for the duration of processes of transient work disability published by Insalud for the attending physician]. / Utilidad de la guía de estándares de duración de procesos de incapacidad laboral transitoria publicada por el Insalud para el médico de cabecera.

OBJECTIVE: To compare the duration average of the ten most frequent causes of unfitness for work (ILT) observed in a services company's staff, with the duration standards registered in the guide published by the Insalud. Besides, some of the factors that could influence these ten diseases duration will be analyzed. DESIGN: An observational, retrospective, population-based study. SETTING: Sanitary district in Madrid area. POPULATION: Hospital Universitario de la Princesa's staff. From 1-1-93 to 31-12-94, a total of 1835 ILTs have been registered among the 2147 workers. MEASURES AND RESULTS: Among the ten most frequent causes of ILT analysed, influenza, acute gastroenteritis, lumbalgia, anide sprain, lumbociatica, contusions, tonsillitis and bronchitis have a duration median included within the Insalud's references. Acute respiratory infection duration is situated out of the intervals. Depressive syndrome does not appear in the guide. It has been proved that all the previous causes have a greater incidence on women except for contusions, tonsillitis and bronchitis. Ankle sprain has a longer duration in workers over fifty years old. CONCLUSIONS: We consider that Insalud's standards guide should be promoted and improved in order to be used as a reference handbook by general practitioners.