Serum proteolytic activities and antiproteases in human colorectal carcinoma.

Some proteolytic enzymes, trypsin, cathepsin B, cathepsin D, collagenase, elastase and their inhibitors, API and AMG, in serum of patients with colorectal carcinoma have been evaluated. Twenty patients belonged to stage B of colorectal carcinoma, twenty two patients to stage D (Astler and Coller classification) and a control group of thirty healthy volunteers were evaluated. Except in cathepsin D, patients exhibit higher enzymatic activities than healthy subjects, and both groups have all the proteolytic activities assayed in serum. Patients with disseminated disease have increased cathepsin B and collagenase levels, with a decrease of trypsin activity, showing an increment in API and AMG in sera. However, only the API values were significantly higher in patients with metastases. The coexistence of proteolytic activities in human sera together with their inhibitors is considered as well as the origin of these, tumoral and/or reactive, increments. Cathepsin B levels are raised in colorectal neoplasms and contribute to the destruction of the extracellular matrix and the proliferation of tumoral cells. There is evidence that a relation between collagenase like activity and tumor invasiveness exists. Cathepsin B and collagenase increases agree with the tumoral mass. On the other hand, trypsin decrease in metastatic carcinoma is probably related to the increment of their inhibitors, API and AMG, acute phase reactant proteins.

[Analysis of suggestive endoscopic characteristics in the preoperative diagnosis of gastric lymphoma]. / Análisis de los rasgos endoscópicos sugestivos en el diagnóstico preoperatorio del linfoma gástrico.

We study the diagnostic value of some macroscopic features which might be considered suspicious of lymphoma (RESL): thickened gastric folds, diffuse involvement, shallow star shaped ulcers, net lesion limits, size > 6 cm., supracisural location and duodenal involvement. We analyze their overall incidence in 36 primary gastric lymphomas, considering possible differences of each feature between pre and post surgery diagnostic achievement. Preoperative diagnosis was related with the total number of RESL (p < 0.01). Diagnosis of lymphoma was highly suspicious when two or more of these features were present. Supracisural location (p = 0.0008) and shallow star shaped ulcers (p = 0.07) were the most significant RESL. Although RESL sensitivity has been low in the diagnosis of gastric lymphoma, we have found a high specificity for the presence of star shaped ulcers, diffuse involvement and duodenal involvement, which might be an aid in differential diagnosis.

[Massive lower digestive hemorrhage caused by colonic ulcers secondary to cholesterol embolism]. / Hemorragia digestiva baja masiva por úlceras cólicas secundarias a embolismo de colesterol.

Cholesterol crystal embolization has been considered an unusual entity with poor short term prognosis. However, it is an underestimated complication according to post-mortem findings. Patients have quite characteristic risk and precipitating factors which may be an aid to suspect the diagnosis. Gastrointestinal bleeding of different severity occurs in only 10% of patients with visceral embolization. We present the case of a patient with massive lower gastrointestinal bleeding secondary to several ulcerations in the hepatic flexure due to bowel cholesterol embolization.

[A patient with Mirizzi's syndrome. The diagnostic and therapeutic considerations]. / Paciente con síndrome de Mirizzi. Consideraciones diagnósticas y terapéuticas.

A 35-year-old woman presented with a 4-month history of jaundice and pruritus. Endoscopic retrograde cholangiography (ERC) showed a partially obstructed common hepatic duct with a smooth and curved laterally based compression defect having the appearance of being secondary to an impacted gallbladder stone. Gallbladder filled with contrast medium but the cystic duct was not visualized, thus suggesting cholecystobiliary fistula formation. According to these radiologic findings, the diagnosis of Mirizzi syndrome was made. We discuss differential diagnosis, therapeutic aspects and the importance of preoperative diagnosis.

[Complications and possible risk factors in endoscopic polypectomy of the colon]. / Complicaciones y eventuales factores de riesgo en la polipectomía endoscópica del colon.

We review the incidence of iatrogenic complications in a serie of 661 patients who underwent endoscopic polypectomy, performed by the same team of endoscopists and using similar technique. We discuss the role of age, sex, associated diseases, coagulation abnormalities and polyp features (size, location, shape and malignancy) in the development of complications. Five severe complications (0.75%, 3 hemorrhages and 2 perforations) were detected. Two patients required blood transfusion and two other patients surgical treatment. Recovery was successful in all patients. In eight patients (1.21%) mild complications which did not required further treatment were present. According to previously published data, these results are satisfactory. Polyp size proved to be the only risk factor with statistical significance; 23.36 +/- 14.17 mm. in complicated polypectomies vs 8.12 +/- 4.21 mm. in non-complicated cases (p less than 0.001). The remaining parameters analyzed showed no significance and therefore no predictive value.