Inés Gil

Características clinicopatológicas y supervivencia de los pacientes con cáncer de esófago. Resultados de 200 casos consecutivos

BACKGROUND AND OBJECTIVE The esophageal cancer (EC) is a slightly frequent but serious disease. Our aim is to describe the characteristics of the patients with EC in our Hospital. PATIENTS AND METHOD We included 200 patients consecutively diagnosed and/or treated for CE between between January, 2003 and December, 2007. The location of the tumor was analyzed, the histological type, the proofs realized for to establish the classification, the treatments, the survival and the morbi-mortality of the surgery. RESULTS The endoscopic ultrasonography (EUS) modified the therapeutic strategy in 12% of the patients. The survival to the year, 3 years and 5 years was 48%, 25% and 21%, respectively. 74 (32%) patients were operated, 48 (65%) of them was treated with neoadjuvant chemoradiotherapy. The postsurgical mortality was 8% (6 patients) and the morbidity was 57% (114 patients). In multivariate analysis, after adjustment for traditional risk factors, were the location in the average third ( [HR, hazard ratio]=2.3; confidence interval [IC] of 95%, 1.3-4.1) and not accomplishment of surgery after the chemotherapy and radiotherapy (HR=1.9; IC to 95%, 1.15-3). CONCLUSIONS The diagnosis is realized very later. The EUS has contributed a better therapeutic strategy to our patients. The mortality continues being high.

Diagnosis of Whipple's disease using molecular biology techniques

The diagnosis of Whipples disease (WD) is based on the existence of clinical signs and symptoms compatible with the disease and in the presence of PAS-positive diastase-resistant granules in the macrophages of the small intestine. If there is suspicion of the disease but no histological findings or only isolated extraintestinal manifestations, species-specific PCR using different sequences of the T. whippleii genome from different tissue types and biological fluids is recommended.This study reports two cases: the first patient had diarrhea and the disease was suspected after an endoscopic examination of the ileum, while the second patient had multi-systemic manifestations,particularly abdominal, thoracic, and peripheral lymphadenopathies. In both cases, the diagnosis was confirmed using molecular biology techniques to samples from the small intestine or from a retroperineal lymph node, respectively.

Triple synchronous gastric tumors: A rare combination diffuse adenocarcinoma, B-cell MALT lymphoma and large cell neuroendocrine carcinoma

The gastrointestinal tract is the site of 70% of synchronous cancers. Simultaneous occurrence of gastric carcinoma and lymphoma are relatively common, but the synchronous presence of triple primary cancer occurring in the stomach is exceptionally rare.1 Only a few cases of triple synchronous gastric malignancies have been reported in the literature.2,3 Here we present an exceptional case of a male with Helicobacter pylori (HP) infection and incomplete intestinal metaplasia (IIM) who developed three synchronous gastric tumors: signet ring cell carcinoma, MALT lymphoma and large cell neuroendocrine carcinoma (NEC). In November 2011, a 48-year-old Caucasian man was admitted to our hospital with hematemesis. The patient was heavy smoker and was not taking gastro-erosive medications. Routine laboratory tests showed a normocytic and normochromic anemia. Fiberoptic endoscopy revealed subcardial mucosa laceration, bleeding signs, erythematous mucosa in gastric body with inflammation and edematous duodenal bulb without peptic ulcer. Biopsy from antrum revealed inflammation compatible with chronic gastritis and intestinal metaplasia. Urease test resulted positive. Eleven months later after HP treatment failure to OCA-10 and OLA-10, subsequent gastroscopy demonstrated gastric wall thickening with pseudonodular appearance, antrum mucosa with mixed white and erythematous areas and protruded spots. Biopsies from body and antrum showed signet-ring carcinoma, atrophic gastritis, IMM and HP infection. Computerized tomography (CT) scanning showed

Hiperamilasemia debida a macroamilasemia como primera manifestación de enfermedad celíaca

podemos descartar que otros factores etiológicos estuvieran involucrados, ya que la presencia del bezoar podría haber contribuido de alguna manera a modificar la secreción ácida o a disminuir algunos de los mecanismos de protección de la barrera mucosa gástrica. Quizás propiciado por la toma de un procinético, como la metoclopramida, y pese a la propia motilidad gastrointestinal deficiente, un primer fitobezoar pudo atravesar el píloro y se encalló en el yeyuno, provocando el cuadro oclusivo intestinal días después. Lo curioso es que el segundo fitobezoar escapara a la exploración fibrogastroscópica, lo que atribuimos o bien porque pasó inadvertido al explorador, o bien porque atravesó el píloro volviendo de nuevo al interior del estómago, siendo ambas posibilidades difíciles de explicar.

Screening colonoscopy and risk of adverse events among individuals undergoing fecal immunochemical testing in a population-based program: A nested case-control study

Background Screening by means of biennial fecal occult blood test has provided a reduction in overall colorectal cancer mortality. Notwithstanding, we should not underestimate the harms that it can produce. Aim The aim of this article is to identify the independent risk factors of complications after a screening colonoscopy. Methods A six-year, nested case-control study was conducted. Mortality/complications within 30 days after colonoscopy were registered and its predictors identified through logistic regression. Results After 39,254 colonoscopies, the complication rate was 1.0%. Independent predictors were sex (OR 1.68 for men; CI 95% 1.18–2.39), ASA physical status classification system (OR 1.73 for ASA II–III; CI 95% 1.53–3.69), history of abdominal surgery (OR 2.37; CI 95% 1.72–4.08), diverticulosis (OR 2.89; CI 95% 1.94–4.30), inadequate cleansing (OR 29.35; CI 95% 6.52–132.17), detection of advanced neoplasia (AN) (OR 4.92; CI 95% 3.29–7.36), detection of stage I adenocarcinoma (OR 9.44; CI 95% 4.46–20.0), polyps in right colon OR 2.27 CI 95% 1.38–3.74) and complex polypectomy (OR 2.00; CI 95% 1.25–3.20). The logistic model explained 82% of the complications (CI 95% 0.798–0.854, p < 0.001). Conclusions Colonoscopy, with or without removal of a lesion, is an invasive procedure with a non-deniable risk of major complications. Factors like inadequate cleansing or detection of AN are determinants. Therefore, it is vital to know which aspects predict their appearance to implement countermeasures.