[Gastric adenocarcinoma in young adults; comparative study with older patients]. / Adenocarcinoma gástrico en adultos jóvenes; estudio comparativo con pacientes mayores.

BACKGROUND: Gastric adenocarcinoma (GA) has been considered a disease of elderly age and has been rarely reported in patients younger than 35 years of age. The aim of thisΩ demographic, clinicopathological and prognosis of gastric cancer in young patients and to compare their features with the behavior in elder adults. METHODS: Between 1993 and 2008, 1536 patients with GA were enrolled in a retrospective database. Clinical and pathologic features of thirty patients aged 35 years or less (young group) were compared with those of 458 aged 75 years or more (elder group). RESULTS: Mean patient age was 31 and 80-years old in the young and elder groups, respectively, with a predominance of females in the last group (61%). Lauren diffuse type carcinoma was more frequent in people younger than 35 years (70%) than in older patients (17.4%). Main symptoms were dyspepsia (40%) and hemorrhage (20%). The most common T stage in young and elder patients was T3 (52.9% and 56.7% respectively). Surgical resection was performed in 68% of cases and the rest received only systemic chemotherapy. CONCLUSION: Gastric adenocarcinoma is rare in young patients and most cases presented at advanced clinical stage similar to elderly patients, so the prognosis in both age groups is poor. For this reason is important to be aware of alarm symptoms and risk factors in order to perform an early endoscopic diagnosis and a treatment with curative intent.

Clinical, endoscopic, immunologic, and therapeutic aspects of oropharyngeal and esophageal candidiasis in HIV-infected patients: a survey of 114 cases.

The medical records of 114 consecutive HIV-infected patients with oropharyngeal and esophageal candidiasis, in whom esophagoscopy was performed, were reviewed. Esophageal candidiasis and isolated oral candidiasis were found in 75% and 25% of patients, respectively. Esophageal candidiasis was the AIDS-defining illness in 65 patients and dysphagia was the commonest symptom, but asymptomatic Candida esophagitis was observed in 43% of them. Symptoms were present in six patients with oropharyngeal candidiasis; three of them had a normal esophagoscopy and the other three had acute nonfungal esophagitis. Invasive fungal esophagitis was confirmed by biopsy in 47/74 patients (64%). The patients with esophageal candidiasis had lower CD4+ cell counts (129/microliter) and CD4:CD8 ratios (0.23) than those with oropharyngeal candidiasis (CD4 179/microliter; CD4:CD8 0.35). Thirty-six patients with esophageal candidiasis were treated with fluconazole, 100 mg/daily, for 28 days, and another 34 patients received the same dose for 10 days. A similar efficacy was seen in both regimens, but a higher incidence of oropharyngeal fungal colonization and liver dysfunction was observed in the longer therapy (p < 0.001). We conclude that asymptomatic C. esophagitis is common in HIV-infected patients. Patients with oropharyngeal candidiasis may complain of esophageal symptoms; it could be due to superficial C. infection or another not-identified opportunistic infection. More severe immunologic impairment was required to develop esophageal candidiasis than oropharyngeal candidiasis. A short course of 10 days of fluconazole therapy could be the standard regimen for the treatment of C. esophagitis in AIDS.

[The retained antrum, its endoscopic diagnosis and clinical significance]. / Antro retenido, diagnóstico endoscópico y significación clínica.

A 65-year-old man was admitted to our hospital with gastrointestinal bleeding. Seventeen years previously, he had a Billroth II procedure for a bleeding duodenal ulcer. A gastroscopy performed on admission showed a stomal ulcer with signs of recent haemorrhage. In the proximal end of the afferent loop, we saw retained gastric mucosa. Histological evaluation confirmed the existence of antrum gastric mucosa. Other diagnostic test for retained gastric antrum were normal. The different approaches in the diagnosis of retained gastric antrum, the importance of our findings and the clinic implications are discussed. We conclude that endoscopic management may be the first diagnostic method in the assessment of retained gastric antrum, and it's possible to find gastric mucosa in the proximal end of the afferent loop (antrum retained), without clinic manifestations.