J. M. González Hernández

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.

Patrón de ingesta en un grupo de pacientes con síndrome de intestino irritable: relación de la ingesta de fibra con los síntomas

Objectives: The aim of our study was to evaluate the oral dietary intake of a group of patients with irritable bowel syndrome and to compate with international recommendations. Patients and methods: A total of 53 patients with irritable bowel syndrome was enrolled in a non-propabilistic sample. Patiens were diagnose with Roma II criteria. In all patients were determined, weight, height, body mass index, dietary intake of 3 days and a symptoms scoring system. Results: The average age of 53 patients was 45.67±13.6 years with a distribution of sex (22 males/31 females). Caloric intakes was righ in absolut terms and corrected by weight. Distribution of calories was 41.5% of carbohidrates, a 19.8% of proteins, and a 38.7% of lipids, showing a high intake of lipids and low of carbohidrates. A low intake of vitamin A and D was detected. High intake of vitamin B12, vitamin C and niacine was observed. A low intake of calcium, magnesium, yodo and zinc was detected. Intake of soluble fiber was lower than insoluble fiber (1.46±0.74 g/day) (19%) vs 6.21±2.67 g/day (71%). Intake of fiber corrected by calories was low 4.5±1.2 g/1000 calories. In correlation analysis, insoluble fiber (r=0.46; p < 0.05) and soluble fiber (r=0.42; p < 0.05) were inverse correlated with general symptoms. Conclusions: Patients with irritable bowel syndrome showed a desviation of mineral and vitamin dietary . Fiber intake is low, a correlation between fiber intake and general symptoms was detected.

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.

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).