Short article: Hormone therapy for severe gastrointestinal bleeding due to multiple angiodysplastic lesions.

OBJECTIVE: This study aims to assess the efficacy of hormone therapy in patients with severe gastrointestinal bleeding due to multiple angiodysplastic lesions. PATIENTS AND METHODS: Between May 2010 and July 2017, we included 12 consecutive patients with anaemia or recurrent bleeding due to angiodysplasia who had been started on hormone therapy. The therapy given was a combination of levonorgestrel (between 0.10 and 0.25 mg) and ethinylestradiol (between 0.02 and 0.05 mg). We determined the mean number of transfusions required in the 6 months before and after the start of the treatment, as well as the mean haemoglobin levels, number of admissions for anaemia due to gastrointestinal bleeding and length of hospital stay in these periods. RESULTS: The mean age of patients included was 77.83 years old and 75% were male. The follow-up period after treatment initiation was 6 months. Of the 12 patients included, only one stopped the treatment owing to it not being effective. Overall, 83.3% of the patients reported subjective improvement. Furthermore, we found significant differences comparing before and after starting treatment regarding the mean number of transfusions (7±4.8 vs. 3.4±4.6; P=0.005), the mean haemoglobin levels (9.5±1.2 vs. 10.8±2.6; P=0.034) and the mean number of admissions (1.6±1.6 vs. 0.2±0.4; P=0.024). On the contrary, differences between pretreatment and post-treatment length of hospital stay were not significant. CONCLUSION: Hormone therapy is a potentially useful therapeutic tool in patients with refractory bleeding and anaemia due to angiodysplasia.

[Tonsillar hypertrophy and mesenteric adenopathies as the main manifestations in a patient with Whipple's disease]. / Hipertrofia amigdalar y adenopatías mesentéricas como manifestaciones predominantes en un paciente con enfermedad de Whipple.

Whipple's disease is an infrequent chronic infection caused by Tropheryma whipplei, identified in 1992. Intestinal, articular, central nervous system and cardiac involvement is common. The presence of abdominal adenopathies, especially mesenteric adenopathies, without peripheral adenopathies or gastrointestinal, articular, neurological or cardiac symptoms is rare. We present the case of a male patient with tonsillar hypertrophy, mesenteric adenopathies, fever and constitutional syndrome, leading to suspicion of lymphoma. Biopsy findings of the lingual tonsil and mesenteric adenopathies were compatible with Whipple's disease. The diagnosis was confirmed by blood polymerase chain reaction.

Hipertrofia amigdalar y adenopatías mesentéricas como manifestaciones predominantes en un paciente con enfermedad de Whipple / Tonsillar hypertrophy and mesenteric adenopathies as the main manifestations in a patient with Whipple’s disease

La enfermedad de Whipple es una infección crónica poco habitual, cuyo germen causal, Tropheryma whipplei, fue identificado en 1992. En esta entidad es frecuente la participación del intestino, las articulaciones, el sistema nervioso central y el corazón. La presencia de adenopatías abdominales, sobre todo mesentéricas, sin adenopatías periféricas ni síntomas digestivos, articulares, neurológicos o cardíacos, es rara. Se presenta el caso de un paciente con hipertrofia amigdalar, adenopatías mesentéricas, fiebre y síndrome constitucional, en el que se sospechó un linfoma. La biopsia de la amígdala lingual y las adenopatías mesentéricas fueron compatibles con enfermedad de Whipple, diagnóstico que se confirmó mediante reacción en cadena de la polimerasa en sangre

Whipple's disease is an infrequent chronic infection caused by Tropheryma whipplei, identified in 1992. Intestinal, articular, central nervous system and cardiac involvement is common. The presence of abdominal adenopathies, especially mesenteric adenopathies, without peripheral adenopathies or gastrointestinal, articular, neurological or cardiac symptoms is rare. We present the case of a male patient with tonsillar hypertrophy, mesenteric adenopathies, fever and constitutional syndrome, leading to suspicion of lymphoma. Biopsy findings of the lingual tonsil and mesenteric adenopathies were compatible with Whipple's disease. The diagnosis was confirmed by blood polymerase chain reaction (AU)

Migración proximal de prótesis del colédoco distal al conducto hepático izquierdo / Proximal migration of a distal common bile duct prosthesis to the left hepatic duct

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