Left-sided portal hypertension due to retroperitoneal fibrosis treated with an oesophagus preserving, modified Sugiura procedure

Left-sided portal hypertension is a very uncommon condition and retroperitoneal fibrosis has rarely been reported as a cause. We present the case of a 77-year-old man with retroperitoneal fibrosis obstructing the splenic vein and causing recurrent episodes of upper gastrointestinal bleeding. Computed tomography showed a retroperitoneal mass as being responsible for the obstruction of the splenic vein, splenomegaly, and diffuse varices around the gastrosplenic and gastrohepatic ligaments. An oesophagus preserving, modified Sugiura procedure was performed with disconnection of the gastric vessels on the lesser curve of the stomach, preserving the pylorus branches of the nerves of Latarjet.

Reproducibility of ambulatory cutaneous electrogastrography in healthy volunteers

OBJECTIVE

Cutaneous electrogastrography (cEGG) is a technique used for recording gastric electrical activity through electrodes placed on the abdominal skin. Given its increasing use for different pathologies, we decided to study its reliability (or reproducibility), that had never been appropriately assessed before.

METHODS

Ambulatory cutaneous electrogastrogram was recorded after US location of the gastric antrum in 26 healthy volunteers with ages ranging from 20 to 60 years. cEGG was recorded during 60 minutes in fasting state and 60 minutes after a standard meal and it was repeated in a different day but under the same conditions.

RESULTS

ANOVA analysis showed significant individual differences regarding dominant frequency (DF) (p = 0.19) and power ratio (PR) (p = 0.11), and before and after the meal, except for DF (p = 0.12), dominant power (DP) (p = 0.59) and bradygastria (p = 0.09). No significant differences were found related to the day of the recording. The intra-observer agreement index showed a good agreement in the DF and the percentage of normogastria (0.91).

CONCLUSIONS

Currently, DF and normogastria percentage are the most reliable variables for the non-invasive study of gastric electric activity.

Normal values and influence of anthropometric and demographic factors on ambulatory cutaneous electrogastrography in healthy volunteers

INTRODUCTION

Cutaneous Electrogastrography (EGGc) is a technique used for recording the Gastric Electrical Activity by means of electrodes placed on the abdominal skin. The aim of the present study was to determine normal values in healthy volunteers as well as the influence of factors such as age, gender, Body Mass Index (BMI) and echographic location of the gastric antrum.

METHODS

An abdominal echography was initially performed in 35 of the 44 healthy volunteers in order to locate the gastric antrum and to place along its axis the skin electrodes, whereas in the other 9, the electrodes were placed according to anatomical references. Afterwards, the echography was also performed in those 9 volunteers in order to have all the 44 baseline echographic records. In every case, a record of ambulatory EGGc over 60 minutes was obtained, along with other record over the same period after eating a standard meal. The analysis of data was conducted through visual inspection and combined computer analysis.

RESULTS

Eighty per cent of the study subjects showed a dominant frequency ranging from 2 to 4 cpm during both periods. After the meal, the parameters showed a characteristic variation. A significant difference was found when comparing subjects under 40 years of age versus subjects between 40 and 60 years of age in terms of preprandial dominant frequency instability coefficient (DFIC) (p = 0.002) and bradygastria (p = 0.03). Subjects with BMI < 25 kg/m2 showed preprandially a smaller dominant power instability coefficient (DPIC) (p = 0.035) and a greater Dominant Power (DP) (p = 0.045). In subjects without echographic control, DFIC (p = 0.001), bradygastria (p = 0.016) and tachygastria (p = 0.02) were more frequent, with a shorter period of normogastria (p = 0.001) during the postprandial period.

CONCLUSIONS

Normogastria is the predominant rhythm in healthy people, although brief dysarrhythmias can be recorded that do not have any pathological meaning. Age and BMI, but not sex, seem to influence the Gastric Electrical Activity. The percentage of gastric dysarrhythmias decreases when the electrodes are placed along the longitudinal axis of the gastric antrum through echographic control.

[Changes in the use of percutaneous liver biopsy over time]

AIM

To study, through the pathology diagnosis obtained, the current use of percutaneous liver biopsy and its change with time.

MATERIALS AND METHODS

Pathology diagnosis of 759 liver biopsies performed during last 5 years are reviewed and compared with our previously published experience.

RESULTS

Neoplasms have decreased from 16% of all pathologic diagnosis obtained in 1961-81 to less than 1% in the last 5 years. In 1985-87, liver cirrhosis was the final diagnosis in 60% of all biopsies, while currently it is only 18%, with a steady absolute number of cirrhosis each year. The most remarkable change is the number of biopsy diagnosis of chronic hepatitis, which has increased from 19% in 1985-87 to 51% in the last 5 years. Ten percent of all biopsies was performed in HIV-positive patients; granulomatous hepatitis and tuberculosis were more prevalent in them.

CONCLUSIONS

Percutaneous liver biopsy has been displaced for the diagnosis of liver cirrhosis and has been focussed on the diagnosis of chronic hepatitis. HIV-positive patients represent an important population for those who perform liver biopsy.