B. Velayos Jiménez

Problemas diagnósticos en la enfermedad celiaca del adulto

INTRODUCTION Celiac disease (CD) is a chronic immune-mediated enteropathy, resulting from a gluten intolerance in genetically predisposed individuals. OBJECTIVE a) to describe clinical features, associated disorders and serology of CD in adults; and b) to study the main that serology displays in diagnosis, clinical and histological expression. PATIENTS AND METHODS 31 patients diagnosed of CD in adulthood have been reviewed retrospectively, including clinical presentation, associated disorders, biochemical results, serological tests (anti-gliadin and anti-endomysial antibodies) and genetical features (HLA-DQ2). It has been studied the relation between typical presentations and AEm with clinical, serological or histological findings. RESULTS Almost 50% of patients had atypical clinical manifestations and gastrointestinal symptoms were absent in 33%. Typical manifestations are associated with villous atrophy stage III b-c of Marshs classification (87 vs. 53%, p = 0,03). 70% of patients shows AEm mostly in women (78 vs. 37%, p = 0.03) and stage III b-c of Marsh (84 vs. 50%, p = 0.05). 68,4% were DQ2 positive. CONCLUSIONS Clinical features of CD varies greatly. AEm and DQ2 are less common than others studies. There may be an association with clinical and serological findings and villous atrophy stage. Genetical features could help AEm in diagnosis.

Estudio de los tiempos de tránsito gastrointestinal con cápsula endoscópica

INTRODUCTION: Until the introduction of capsule endoscopy (CE), studies of gastrointestinal transit times were based on indirect data or data obtained with radiographic techniques. We analyzed gastric and intestinal transit times through the images obtained with EC and evaluated the influence of age, sex, body mass index (BMI) and abdominal perimeter on these times. PATIENTS AND METHOD: Of the total number of procedures performed over one year, we reviewed 89 in which CE reached the blind gut. Transit times through the pylorus and the ileocecal valve, as well as a series of clinical and epidemiological characteristics of the patients, were recorded. RESULTS: The mean age of the patients was 59.2 years with a mean BMI of 25.5. Gastric transit times ranged from 0.7 to 171 min (mean 22.6) while small intestine transit times ranged from 91 to 416 min (mean 283.3). No significant associations were found between gastric and intestinal transit times with age, sex, BMI, or abdominal perimeter. A significant negative correlation (p < 0.05) was found between transit time of CE through the stomach with respect to the time taken between the pylorus and the cecal pole. CONCLUSION: CE is a good method to study gastrointestinal transit times directly and could lead to greater knowledge of the pathogenesis of various gastrointestinal entities. Age, sex and nutritional status do not seem to influence intestinal kinetics. In contrast, longer or shorter gastric emptying times have an inverse effect on the transit of CE through the small intestine.

Tumores de la estroma gastrointestinal (GIST): aspectos clínicos

Introduction: gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract. One of their features is the expression of the c-KIT / CD117 recepINTRODUCTION: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract. One of their features is the expression of the c-KIT/CD117 receptor. AIMS AND METHODS: We will focus on describing the symptoms, clinical studies prior to diagnosis, histologic and immunohistochemical characteristics, as well as the progression of disease in a group of patients. RESULTS: Seventeen cases were diagnosed between December 1999 and April 2005. Mean age of patients was 64.5 (+/-11.9); 47% were women. Tumor location was as follows: 52.9% in the jejunum or ileum, 29.4% were gastric, 11.7% were in the duodenum, and 5.8% were located in the mesentery. Tumor size was 6.0 cm on average (+/-5.0); 47% were asymptomatic, and to a lesser degree caused abdominal pain or digestive bleeding; 94.1% of tumors expressed CD117. Most of them were discovered while performing a laparotomy or ultrasound scan; 94.1% of tumors were removed; 35.2% (6 out of 17) of patients suffering from GIST met consensus criteria for aggressive behavior. Over 25.6 months (+/-22.5) metastasis or tumor relapse occurred in 23.5% (4 out of 17) of patients--those with more frequent high-risk criteria, symptomatic and bigger tumors, and tumors not expressing CD117. The three patients with tumor relapse were prescribed imatinib mesylate. Three patients died because of the tumor, and four from other causes unrelated to GIST. CONCLUSIONS: GIST was diagnosed in around 12 cases per million a year. Its diagnosis was usually an incidental finding during a medical evaluation, and tumors were malignant in nearly one fourth of cases. We can predict its outcome depending on different aspects.

Late mortality in patients with liver transplantation: causes and risk factors

LIVER TRANSPLANTATION (OLT) has become the treatment of choice for end-stage liver failure. Survival after OLT has improved over recent years owing to improved surgical and medical management of these patients. The majority of deaths occur during the first 3 months after liver transplantation, mainly due to infections, allograft failure following primary allograft dysfunction and nonfunction, and technical causes. Although causes of early mortality are well defined, there is a paucity of data on causes of death in long-term survivors of liver transplantation. The aim of this study was to review the causes of late mortality (more than 1 year after OLT) in liver transplant patients in a single adult Liver Transplantation Center.

Distribución de la enfermedad polipoidea en la comarca interior de Vizcaya: implicación en pruebas diagnósticas y cribado del cáncer colorrectal

Introduccion La relevancia de los polipos colonicos cada dia es mayor por ser el hallazgo en que se basa el cribado del cancer colorrectal (CCR). Sin embargo, este cribado esta lejos del consenso en cuanto a las tecnicas que deben emplearse: se compara la colonoscopia frente a otros metodos, como la sigmoidoscopia, que solo explora con buena sensibilidad los tramos distales del colon. Hemos estudiado las caracteristicas y la topografia de la enfermedad polipoidea en nuestro medio con el objetivo de verificar la tendencia al cambio en su localizacion y las implicaciones en el cribado que esto conlleva. Material Y Metodos Se reviso la prevalencia y las caracteristicas de los polipos colonicos en 3.604 pacientes que por algun motivo acudieron para que se les practicara una colonoscopia en nuestro servicio, asi como su distribucion en los 837 pacientes con diagnostico de polipos y colonoscopia completa. Analizamos su situacion proximal o distal al angulo esplenico y su tamano ( Resultados Se encontraron polipos en el 28,3% de los 3.604 pacientes (en el 11,7% si consideramos los ≥ 1 cm). En un 44,9% de los 837 pacientes con colonoscopia completa habia polipos proximales (14,6% para los ≥ 1 cm), mientras que en un 79,9% se observaron en el colon distal (un 30,3% al valorar los ≥ 1 cm). Un 24,8% de los pacientes los presentaba en ambas localizaciones. La probabilidad de encontrar una lesion proximal si existia una distal se situo en el 31%. En un 20% de los casos existia algun polipo proximal sin lesion distal (un 5,6% para los ≥ 1 cm), por lo que la sigmoidoscopia perderia el 15,6% de los polipos ≥ 1 cm. Conclusiones Un porcentaje relativamente elevado de pacientes con polipos proximales ≥ 1 cm quedarian sin diagnosticar si solo se hiciera una colonoscopia completa a los que presentaban polipos distales. Debido a la notoria y progresiva mayor frecuencia de polipos proximales y al relevante numero de ellos que se presenta sin lesion centinela distal, cada vez hay mas argumentos para considerar la colonoscopia como la tecnica fundamental para el cribado del CCR.

Tumor submucoso en el fondo del ciego

Varón de 52 años con antecedentes de cirugía de tumor de parótida. Se le exploró con colonoscopia por tenesmo y cambio del ritmo intestinal. Las figuras 1 y 2 corresponden al polo cecal. El examen de las biopsias de la mucosa demostró un infiltrado inflamatorio de carácter agudo y crónico sin signos específicos. Se realizó una resonancia magnética de abdomen (Figs. 3 y 4). La laparotomía confirmó una tumoración en la base del apéndice de 2 cm. Se practicó un cequectomía parcial. La descripción macroscópica de la pieza fue: dilatación de 1,3 cm en la parte más proximal del apéndice, al corte se aprecia una formación pseudopolipoidea con material denso mucoide y parduzco. El diagnóstico fue cistoadenoma mucinoso del apéndice. El cistoadenoma mucinoso del apéndice, el quiste de retención, la hiperplasia mucosa y el cistoadenocarcinoma del apéndice son los diferentes tipos de mucocele apendicular (MCA). El MCA es una dilatación del apéndice vermiforme por la acumulación de moco. Supone menos del 1% de las apendicectomías y el 8% de los tumores apendiculares. En el Hospital Ramón y Cajal de Madrid se operaron 35 casos en 21 años (1). En otra serie se diagnosticaron con colonoscopia 7 casos en 14 años (2). El MCA puede ser asintomático o manifestarse como una apendicitis aguda o una masa en fosa iliaca derecha (1-3). Con ecografía y tomografía computerizada se demuestra una masa yuxtaapendicular encapsulada con pared de varias capas, a veces calcificadas. Con endoscopia se describe el signo del volcán (el orificio apendicular correspondería al cráter sobre el efecto masa) (1). En 1989 se llegaba al diagnóstico preoperatorio en el 15% de los casos (3), ahora en el 29% (1). El MCA puede coexistir con otros tumores colorrectales, de mama, ovario o riñón (1,2). El pseudomixoma peritoneal es consecuencia del cistoadenocarcinoma, pero también puede serlo de la apendicectomía. En el caso del cistoadenocarcinoma se indica la hemicolectomía derecha. El estudio patológico debe ser minucioso y se recomienda el seguimiento de los pacientes por describirse pseudomixomas peritoneales y adenocarcinomas de ciego tras apendicectomías de MCA benignos (1-4).