Hydrocephalus due to aqueductal stenosis presenting with acute bilateral ptosis: case report.

Hydrocephalus may cause Parinaud's syndrome which consists of vertical gaze palsy, convergence palsy, lid retraction and pupil light-near dissociation. We are aware of only two prior reports of hydrocephalus presenting with bilateral ptosis. Both were cured by ventriculoperitoneal shunts. We report a 28-month-old girl who presented acute bilateral ptosis but full eye movements both sides. Neuroimages revealed chronic hydrocephalus and aqueductal stenosis. The bilateral ptosis resolved quickly after endoscopic third ventriculostomy (ETV).

Postoperative abdominal collections drainage: Percutaneous versus guided by endoscopic ultrasound.

BACKGROUND AND AIM: Postoperative fluid collections (POFC) have high mortality. Percutaneous drainage (PD) is the preferred treatment modality. Drainage guided by endoscopic ultrasound (EUS-GD) represents a good alternative. The aim of the present study was to compare clinical success and complication rates of EUS-GD versus PD. METHODS: Data collected prospectively were analyzed in a retrospective manner. Patients with POFC from October 2008 to November 2013 were included. All collections were drained percutaneously or by EUS-GD. RESULTS: Sixty-three procedures in 43 patients with POFC were analyzed; 13 patients were drained using EUS-GD and 32 patients with PD. Two patients assigned initially to the PD group were reassigned to EUS-GD. Surgery procedures most often related to the collections were intestinal reconnection, distal pancreatectomy, biliary-digestive bypass, and exploratory laparotomy. Technical success (100% vs 91%; P = 0.25), clinical success (100% vs 84%; P = 0.13), recurrence (31% vs 25%; P = 0.69), hospital stay days (median 22 vs 27; P = 0.35), total costs (8328 ± 1600 USD vs 11 047 ± 1206 USD; P = 0.21), complications (0% vs 6%; P = 0.3), and mortality (8% vs 6%; P = 0.9) were each evaluated in the EUS-GD and PD groups, respectively. In the PD group one death was related to the procedure. CONCLUSIONS: EUS-GD is as effective and safe as PD in patients with POFC. The advantage of not requiring external drainage and a trend to higher clinical success and lower total costs must be considered.

Long-Term Postoperative endoscopic findings after gastric bypass procedure: a co-occurrence analysis / Achados endoscópicos no pós-operatório tardio após bypass gástrico: análise de co-ocorrência

ABSTRACT Background A multitude of endoscopic findings post-gastric bypass procedures have been previously reported in the literature, but to our knowledge, no present rules exist that could guide clinicians regarding which findings should be actively sought, once an initial finding is identified. Objective To identify co-occurrence patterns among endoscopic findings of patients having undergone past gastric bypass procedure. Methods Our registry involves all consecutive patients undergoing an upper endoscopic evaluation after a gastric bypass procedure. We collected information on the presence of the endoscopic findings in post-gastric bypass surgery patients. Co-occurrence evaluation involved the use of intersection, cluster and item factor analyses. Results A total of 396 endoscopic evaluations were made on 339 patients. Most patients were female (81.1%), with an average BMI of 31.88±6.7 at the time of endoscopy. Esophagitis was the most common isolated finding (35.3%). Endoscopic findings clustered around two groups, (1) the ring-related complications involving ring displacement, ring slips and gastric pouch, while (2) stenosis-related findings involved dilation and stenosis (P<0.01). Conclusion While most endoscopic findings after gastric bypass endoscopic procedures are isolated, ring and stenosis-related clusters should be used as a set of rules by clinicians, as it might enhance their probability of finding co-occurring conditions.

RESUMO Contexto Uma grande quantidade de achados endoscópicos após procedimentos de bypass pós-gástricos foram previamente relatados na literatura, mas, que seja de nosso conhecimento, não existem regras atuais que poderiam orientar os médicos sobre quais achados devem procurar uma vez que um achado inicial é identificado. Objetivo Identificar padrões de co-ocorrência entre os achados endoscópicos de pacientes submetidos ao procedimento de bypass gástrico no passado. Métodos O nosso registo envolve pacientes consecutivos submetidos a uma avaliação endoscópica alta após um procedimento de bypass gástrico. Foram colhidas informações sobre a presença de achados endoscópicos após cirúrgica de bypass gástrico à Y de Roux com ou sem anel. Avaliação de co-ocorrência envolveu o uso de cruzamento, agrupamento e fator de produto de análise. Resultados Um total de 396 avaliações endoscópicas foram realizadas em 339 pacientes. A maioria dos pacientes eram do sexo feminino (81,1%), com IMC médio de 31,88±6,7 no momento da endoscopia. Esofagite foi o achado isolado mais comum (35,3%). Achados endoscópicos agrupados em torno de dois grupos, as complicações relacionadas ao anel envolveram deslocamento anel, deslizamentos anel e bolsa gástrica e relacionadas a estenoses envolveram dilatação e estenose (P<0,01). Conclusão Enquanto a maioria dos achados endoscópicos após procedimentos de bypass gástrico são isolados, agrupamento relacionado a anel e estenose poderiam ser usados como um conjunto de regras para médicos, uma vez que pode melhorar a sua probabilidade de ser encontrando em condições co-ocorrentes.

Hemorragia digestiva alta / Upper gastrointestinal bleeding

Hemorragia digestiva alta é uma condição grave e potencialmente fatal associada com muitas doenças sistêmicas e gastrointestinais. Embora a mortalidade varia de acordo com a etiologia do sangramento, em geral, é cerca de 10%. Metade desses pacientes têm mais de 60 anos de idade, e neste grupo etário de mortalidade é ainda maior. que podem ser provenientes de várias fontes, principalmente: úlcera péptica, hypertesion portal, anomalias vasculares e neoplasias. Avaliação inicial inclui a estabilização do quadro hemodinâmico e de reposição de sangue sempre que necessário. Endoscopia desempenha um papel importante no diagnóstico e tratamento da maioria das condições de sangramento. O tratamento farmacológico inclui agentes anti-secretores octreotide, e vasopressina. A cirurgia é eventualmente necessário.

Upper gastrointestinal bleeding is a serious and potentially life threatening condition associated with many systemic and gastrointestinal diseases. Although mortality varies according to the etiology of the bleeding, in general, it is around 10%.Half of these patients are over 60 years of age, and in this age group mortality is even higher. it may originate from a number of sources, mainly: peptic ulcer disease, portal hypertesion, vascular anomalies and neoplasms. Initial evaluation includes stabilization of the hemodynamic status and blood replacement whenever necessary. Endoscopy plays an important role in diagnosis and treatment of most bleeding conditions. Pharmacological treatment includes anti-secretory agents, octreotide and vasopressin. Surgery is eventually necessary.