RESUMEN

Polypoid tumours of the esophagus present diagnostic and therapeutic problems. Liposarcomas are infrequent among them. We report a recent case. A 73-year-old male patient was seen in May 1995 in the Ear, Nose and Throat (ENT) Department, Clinica Modelo de Morón, with intermittent dysphagia and dyspnoea due to recurrent vomiting. A laryngeal lineal tomography showed a subglottic obstruction due to extrinsic compression. The patient was referred to the Gastroenterology Department, where an upper gastrointestinal (upper GI) series demonstrated mega-esophagus with abundant retained food. Endoscopy showed a large intraluminal mass covered by normal mucosa which arose on the posterior wall. Videofluoroscopy and chest CT diagnosed a probable polypoid lipoma due to its densitometric characteristics. The tumour was resected by left cervicotomy and left esophagotomy. The patient's progress to date is favourable. Pathology studies showed a well-differentiated liposarcoma. According to the literature, the first case was reported in 1983, and ours is only the seventh case in the world to be documented.

Asunto(s)

RESUMEN

Endoscopic Ultrasonography (EUS) was performed in 520 patients. In 78 subjects, it was indicated because of endoscopic suspicion of submucosal tumors (SMT), later confirmed in 67 patients. Thirty seven patients were symptomatic; in 22 patients the finding was incidental and in 7 the indication was unknown. According to the ecogenic pattern of the lesions found and the layer of the tumor origin the following were diagnosed: 14 leiomyomas, 1 lipoma, 3 granular cell tumors and 2 without precise diagnosis in the esophagus. Thirty leiomyomas, 6 leiomyosarcomas, 4 lipomas, 4 ectopic pancreas and 2 without precise diagnosis in the stomach. One leiomyoma in the duodenum. From the 11 SMT initially suspected by endoscopy which showed an integrity of the wall there were 10 extrinsic compressions and 1 without pathological findings. To date, surgery was performed on 22 patients with SMT complicated with ulcer and/or hemorrhage and on those larger than 3 cm with an ecogenic pattern, suspected of malignancy. Thirteen gastric leiomyomas, 2 gastric lipomas and 1 ectopic pancreas, with a 100% correlation in the postresection histological studies, 2 Abricosoff tumors of the esophagus, 2 leiomyosarcomas with 100% correlation and a giant lipoma of the esophagus which resulted in a liposarcoma, and 1 leiomyoma which resulted in a leiomyosarcoma were found. According to these results 90% diagnostic specificity and 100% sensitivity make this imaging technique the ideal method to evaluate these lesions and one of the main indications together with the staging of gastrointestinal tumors.

Asunto(s)

RESUMEN

Polypoid tumors of the esophagus present diagnostic and therapeutic problems. Liposarcomas are infrequent among them. We report a recent case. A 73-year-old male patient was seen in May 1995 in the Ear, Nose and Throat (ENT) Department, Clínica Modelo de Morón, with intermittent dysphagia and dyspnoea due to recurrent vomiting. A laryngeal lineal tomography showed a subglottic obstruction due to extrinsic compression. The patient was referred to the Gastroenterology Department, where an upper gastrointestinal (upper GI) series demonstrated mega-esophagus with abundant retained food. Endoscopy showed a large intraluminal mass covered by normal mucosa which arose on the posterior wall. Videofluoroscopy and chest CT diagnosed a probable polypoid lipoma due to its densitometric characteristics. The tumour was resected by left cervicotomy and left esophagotomy. The patient's progress to date is favourable. Pathology studies showed a well-differentiated liposarcoma. According to the literature, the first case was reported in 1983, and ours is only the seventh case in the world to be documented.

Asunto(s)

RESUMEN

La ultrasonografía endoscópica (EUS) fue realizada en 520 pacientes. En 78 pacientes fue indicado por sospecha endoscópica de tumor submucoso (TSM) posteriormente confirmado en 67 pacientes. Treinta y siete pacientes estaban sintomáticos, en 22 pacientes el hallazgo fue casual y en 7 pacientes no se conoce la indicación. De acuerdo al patrón ecogénico de las lesiones halladas y la capa de origen del tumor se diagnosticaron en esófago 20 TSM, en estómago 46 TSM y en duodeno 1 TSM. De 11 TSM inicialmente sospechados por endoscopia resultaron 10 compresiones extrínsecas (con integridad de la pared) y 1 estudio normal. Hasta la fecha se operaron 22 TSM complicados con úlcera y/o hemorragia y los mayores de 3 cm con patrón ecogénico sospechoso de malignidad. En 20 casos (90.9 por ciento) la histopatología postquirúrgica confirmó el diagnóstico endosonográfico. Correspondieron a 13 leiomiomas gástricos, 2 lipomas gástricos, 1 pancreas ectópico, 2 de los tumores de Abricosoft de esófago, con diagnóstico previo por la biopsia endoscópica y 2 leiomiosarcomas gástricos con 100 por ciento de correlación. En 2 casos el diagnóstico de malignidad fue posterior a la cirurgía: el liposarcoma gigante de esófago y 1 leiomiosarcoma gástrico. Según estos resultados con 90 por ciento de especificidad y 100 por ciento de sensibilidad hacen de esta técnica por imágenes el método ideal para evaluar estas lesiones siendo una de las indicaciones principales junto a la estadificación de los tumores gastrointestinales.

Asunto(s)

RESUMEN

La ultrasonografía endoscópica (EUS) fue realizada en 520 pacientes. En 78 pacientes fue indicado por sospecha endoscópica de tumor submucoso (TSM) posteriormente confirmado en 67 pacientes. Treinta y siete pacientes estaban sintomáticos, en 22 pacientes el hallazgo fue casual y en 7 pacientes no se conoce la indicación. De acuerdo al patrón ecogénico de las lesiones halladas y la capa de origen del tumor se diagnosticaron en esófago 20 TSM, en estómago 46 TSM y en duodeno 1 TSM. De 11 TSM inicialmente sospechados por endoscopia resultaron 10 compresiones extrínsecas (con integridad de la pared) y 1 estudio normal. Hasta la fecha se operaron 22 TSM complicados con úlcera y/o hemorragia y los mayores de 3 cm con patrón ecogénico sospechoso de malignidad. En 20 casos (90.9 por ciento) la histopatología postquirúrgica confirmó el diagnóstico endosonográfico. Correspondieron a 13 leiomiomas gástricos, 2 lipomas gástricos, 1 pancreas ectópico, 2 de los tumores de Abricosoft de esófago, con diagnóstico previo por la biopsia endoscópica y 2 leiomiosarcomas gástricos con 100 por ciento de correlación. En 2 casos el diagnóstico de malignidad fue posterior a la cirurgía: el liposarcoma gigante de esófago y 1 leiomiosarcoma gástrico. Según estos resultados con 90 por ciento de especificidad y 100 por ciento de sensibilidad hacen de esta técnica por imágenes el método ideal para evaluar estas lesiones siendo una de las indicaciones principales junto a la estadificación de los tumores gastrointestinales. (AU)

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RESUMEN

The case of a 71 year old woman who developed a Cronkhite-Canada syndrome is presented, with generalized gastrointestinal polyposis, skin hyperpigmentation, onychodystrophia and alopecia. She had severe diarrhea with hypoalbuminemia and unusual dermal and articular changes. The patient had a partial remission following important protein diet therapy supplemented with vitamins and antibiotics for the intestinal bacterial over-growth. This is the first report of this entity in Argentina.

Asunto(s)

RESUMEN

Se presenta una paciente del sexo femenino de 71 años con antecedentes de una gastrectomía parcial por gastritis erosiva y que desarrolla un síndrome de Cronkhite-Canada con sudopoliposis gastrointestinal generalizada, hiperpigmentación de la piel, onicodistrofia y alopecía. Presentaba diarrea severa con intensa hipooalbuminemia y alteraciones asociadas inusuales con hiperelasticidad cutánea e hiperextensibilidad articular en los dedos. Se observó remisión parcial del síndrome luego de intenso tratamiento dietético y de desinfección con antibióticos del tracto gastrointestinal

Asunto(s)

RESUMEN

The case of a 71 year old woman who developed a Cronkhite-Canada syndrome is presented, with generalized gastrointestinal polyposis, skin hyperpigmentation, onychodystrophia and alopecia. She had severe diarrhea with hypoalbuminemia and unusual dermal and articular changes. The patient had a partial remission following important protein diet therapy supplemented with vitamins and antibiotics for the intestinal bacterial over-growth. This is the first report of this entity in Argentina.

RESUMEN

Se presenta una paciente del sexo femenino de 71 años con antecedentes de una gastrectomía parcial por gastritis erosiva y que desarrolla un síndrome de Cronkhite-Canada con sudopoliposis gastrointestinal generalizada, hiperpigmentación de la piel, onicodistrofia y alopecía. Presentaba diarrea severa con intensa hipooalbuminemia y alteraciones asociadas inusuales con hiperelasticidad cutánea e hiperextensibilidad articular en los dedos. Se observó remisión parcial del síndrome luego de intenso tratamiento dietético y de desinfección con antibióticos del tracto gastrointestinal (AU)

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RESUMEN

Ten patients with postprandial upper abdominal discomfort, 4 of them having delayed gastric emptying, were included in a single-blind y camera study aimed at comparing the effects of cisapride and metoclopramide on gastric emptying. The two drugs were given sequentially, at a one-week interval, at a single oral dose of 10 mg, 15 minutes before intake of a labelled ordinary test meal. Applying a power exponential mathematical model to the y-camera data, T1/2 and the shape of the emptying curve were determined. The median half-emptying time (T1/2) was reduced from 81.5 min. in the basal condition to 62.5 min (-23%) after cisapride and to 84.5 min. (-9%) after metoclopramide. As compared with the basal values cisapride significantly (P less than 0005, Wilcoxon Test) reduced the % RRAD from 45 min. after intake of the meal on wards. The onset of action of cisapride was faster (P less than 0.05) than that of metoclopramide. In the main, each of these drugs accelerated evacuation of the meal in the cases of delayed emptying. Cisapride particularly shortened the initial emptying lag and was superior to metoclopramide in this respect.

Asunto(s)

RESUMEN

Ten patients with postprandial upper abdominal discomfort, 4 of them having delayed gastric emptying, were included in a single-blind y camera study aimed at comparing the effects of cisapride and metoclopramide on gastric emptying. The two drugs were given sequentially, at a one-week interval, at a single oral dose of 10 mg, 15 minutes before intake of a labelled ordinary test meal. Applying a power exponential mathematical model to the y-camera data, T1/2 and the shape of the emptying curve were determined. The median half-emptying time (T1/2) was reduced from 81.5 min. in the basal condition to 62.5 min (-23

) after cisapride and to 84.5 min. (-9

) after metoclopramide. As compared with the basal values cisapride significantly (P less than 0005, Wilcoxon Test) reduced the

RRAD from 45 min. after intake of the meal on wards. The onset of action of cisapride was faster (P less than 0.05) than that of metoclopramide. In the main, each of these drugs accelerated evacuation of the meal in the cases of delayed emptying. Cisapride particularly shortened the initial emptying lag and was superior to metoclopramide in this respect.