[Colorectal polyps: update on diagnosis]

Histological diagnosis determines the clinical behavior of colorectal polyps. Recently new types of polyps have been described and the classification has become wider and more complex. Our aim is update the current concepts in the knowledge of colorectal polyps.

[Increase of intraepithelial lymphocytes in patients with irritable bowel syndrome]

Several studies have shown increased numbers of intraepithelial lymphocytes (IEL), mast cells, enterochromaffin cells in colonic mucosa of patients with Irritable Bowel Syndrome (IBS). Many of these findings are based is based on immunohistochemistry results, which is not available in general hospitals. Our objective is to study the histological findings observed in colon biopsies from patients with IBS compared with a group without IBS, using only histochemistry. Twenty five (25) patients were included: 16 with IBS and 9 without IBS. We found increased numbers of IEL in patients with IBS (p=0,002). A group of patients with IBS (41.9%) who fulfilled histological criteria for lymphocytic colitis were excluded. There was no significant difference in mast cells, enterochromaffin cells or eosinophils.

Low serological positivity in patients with histology compatible with celiac disease in Perú

OBJECTIVE

To study the frequency of positive serology for celiac disease (CD) in patients with duodenal biopsies suggestive of this disease.

MATERIAL AND METHODS

Cross sectional study. We included patients with duodenal biopsies histologically compatible with CD and antigliadin, antiendomysial and IgA antitransglutaminase antibodies. We defined a "case" of CD if there was a positive biopsy and either antiendomisial or antitransglutaminase positive antibodies.

RESULTS

Thirty one patients were included in our study. Six were antiendomysial positive and 5 antitransglutaminase positive while the antigliadin was positive in 14 cases. Therefore, out of 31 patients only 10 had a serology compatible with CD and only one had positive both antibodies, antiendomysial and antitransglutaminase.

CONCLUSIONS

a) We have found that most of the duodenal biopsies compatible with CD are not diagnosed with positive serology; and b) we found a low correlation between serological diagnostic tests.

Prevention of clinical mastitis with barium selenate in dairy goats from a selenium-deficient area

Mastitis is one of the most negative factors involved in the economy of dairy goat farms. The effect of selenium on mammary gland resistance to infectious diseases has been demonstrated. This work evaluates the efficacy of a slow-release Se salt (barium selenate) to reduce the incidence of clinical mastitis in goats reared on Se-deficient areas. Six hundred milking goats of the Malagueña breed, from 4 commercial dairy farms located in a Se-deficient area, were randomly allotted to 2 groups: treated group (given a subcutaneous injection of barium selenate at a dose of 1 mg of Se/kg of body weight 15 d before mating) and control group (no supplement). During the lactation the does were monitored to assess the occurrence of clinical mastitis by physical examination, California Mastitis Test performance, and microbiological study. The Se content of the ration consumed previously by the animals did not meet the requirements for dairy goats. The Se injection significantly increased glutathione peroxidase activity in the treated group and had evident beneficial effects in the subsequent lactation. The somatic cell count and the incidence of clinical mastitis were significantly lower in the treated group than in the control group. However, no significant differences were found for milk composition. Thus, in Se-deficient areas, the supplementation with Se of any source in programs for prevention of clinical mastitis and improvement of milk quality is strongly recommended.

[Medical-surgical experience of intestinal intussusception. Experience of a university institution]

BACKGROUND

Management of intestinal intussusception in children has evolved from exclusively surgical treatments to nonoperative reduction under fluoroscopic monitoring.

AIM

To report a 10 year experience in a University Hospital in the management of intestinal intussusception.

PATIENTS AND METHODS

Seventy two patients, aged 2 to 72 months of age, with an uncomplicated intussusception, that were treated by barium or air enema, were studied.

RESULTS

The success rate was 73% with barium reductions, and 100% with air reductions. In 17 patients (24%), enema reduction was unsuccessful and were subjected to a surgical reduction.

CONCLUSIONS

Nonsurgical reduction is safe and effective as the initial treatment of uncomplicated intussusception in children.

[Hydrostatic reduction of intestinal intussusception in children. Experience in 43 cases]

BACKGROUND

Intestinal intussusception, a medical emergency, is more commonly idiopathic and ileocolic and occurs with higher frequency in children aged 6 months to 2 years. Barium enema confirms the diagnosis and allows its hydrostatic reduction, that is the treatment of choice of this condition.

AIM

To report our experience with hydrostatic reduction of intestinal intussusception in children.

PATIENTS AND METHODS

Hydrostatic reduction was attempted in 43 children with intestinal intussusception: 20 male, aged 2 to 48 months, that consulted at the Clinical Hospital of the Catholic University in Santiago.

RESULTS

Hydrostatic reduction was successful in 33 children (77%) that were discharged from the hospital 24 to 96 hours after the procedure. A partial reduction was achieved in 10 patients (23%) who required surgery and were discharged from the hospital 5 to 8 days after the procedure.

CONCLUSIONS

Our results are similar to those reported abroad and allow the recommendation of hydrostatic reduction as the treatment of choice for intestinal intussusception.

[Results of surgical treatment of metastases of renal carcinomas in 65 operated cases]

Several reports have assessed that the prognosis of metastatic renal cell carcinoma was better if patient's general condition was good, if primary tumor had been resected, if the time between nephrectomy and metastasis was long, if metastases are only pulmonary and bone marrow was not involved. The bone metastases of renal cell cancer have a bad reputation because of their haemorragic caracteristics and their resistance to radiotherapy.In the Orthopaedic and Traumatologic Department of the University hospital in Strasbourg, the authors had operated on 65 metastatic renal cell cancers. There were 55 patients (41 were men and 14 female), aged of 60 (range 41-84). Eight of them had 2 operations and 1 had 3 metastatic localisations.In 23% the metastases were present at the time of primary tumor diagnosis; in 17% the metastasis was even a signal metastasis. There were pathologic fractures in half of the cases (33 cases) and in the other half the metastasis had not fractured. The commonest site was the femur (40 of the 65 cases). The second site was the humerus (15 cases). There were also 7 vertebrae, 6 of them with neurologic deficit.The authors performed closed osteosynthesis in 27 cases (15 intramedullary nails, 7 Ender nails, 4 bipolar pinnings, 1 gamma nail), arthroplasty in 19 cases (6 standard prosthesis and 13 reconstruction prostheses) and an open osteosynthesis in 12 cases. They performed also 3 vertebrectomies by an anterior approach and 4 posterior decompressions and stabilisations.The average post operative survival was 15 months (range 0-109). Six patients died in the first post-operative month. Three non specific complications were observed: 2 prosthetic dislocations and one infected nail failure. 6 tumor extensions were observed on 2 prostheses, 3 intramedullary nails and 1 open osthesynthesis.The results were good for pain in 83% of the patients, the functional result good or fair in 78%.The efficacy of adjuvant medications was discussed, based on the literature data. Two groups of metastatic renal cell cancer were studied: the first with multiple metastases and a high speed progressive disease, the other with single metastasis and a low speed progressive disease. The surgical indications should be different in the two groups.

[Ultrasonography: the diagnostic method of choice in hypertrophic pyloric stenosis. Experience with 67 patients]

Hypertrophic pyloric stenosis (HPS) is a common medical emergency in newborns and lactating infants. Ultrasonography (US) is the diagnostic imaging procedure of choice in most centers, leaving the radiological study with barium for those cases in which US is negative and clinical symptoms persist or when other causes of vomiting must be discarded. We report our experience in 67 children (58 male) with suspected HPS. The US findings were consistent with HPS in 45 patients, and the diagnosis was surgically confirmed in all. In the remaining 22 patients with negative US findings, symptoms improved during follow up, with medical treatment. In one patient US was negative for HPS but showed an antral web, that was surgically confirmed. Since there were no false positive or negative results, the specificity and sensitivity of US for HPS diagnosis was 100%. We strongly recommend the use of US in patients with suspected HPS.

[Vascular rings]

22 cases of several types of vascular rings are presented. Most of them were double aortic arch (15): 12 were operated on without mortality before the first years of age because of the great severity of the symptoms. The precocity of the symptomatology and the predominance of the respiratory distress is emphasized. Our data point out to the importance of the differential diagnosis of vascular rings in newborns and infants in the presence of laryngeal stridor or respiratory distress, essentially because the surgical correction is very effective and the risk of the intervention is minimal.

[Parenteral nutrition in critically ill newborns]

In nine critically ill newborns, five of them with intractable diarrhea and four surgical patients, we administered a 5% crystalline aminoacids solution (AA) and glucose in sufficient amount to provide 120 cal times kg. in 24 hours. Six of them recovered after receiving parenteral alimentation for 3 to 15 days, gained weight during or after treatment and were discharged from the hospital in good conditions. Three died, one of them presented septicemia and two pneumonia and pulmonary infarcts. The solution used generated few metabolic alterations, the acid-base status remained within normal range and there were not important changes in the sodium and potassium serum concentrations. On the contrary, children with hyponatremia and hypokalemia at the beginning of the treatment, normalized these constants within the first hours, as diarrhea ceased. The most frequent complications were infiltrations and reaction of the surrounding tissue of the catheterized vein and local skin infection. Only one patient died of septicemia, possibly caused by this proceeding. In summary, parenteral alimentation though not free from risk, seems to be a useful proceeding when oral feeding is impossible or inadvisable. The utmost danger is septicemia. Metabolic changes are minimal and they do not mean a risk for child's life; nevertheless, there is a need for long term studies to bring up definite conclusions. The solutions in actual use are probably not the most physiological for the newborn. It is necessary to adequate them according to the new advances made on child nourishment during his first days of life.