RESUMEN
OBJECTIVE: The aim of this study was to evaluate in our healthcare area the clinical, ultrasonographic, and evolutionary features of patients with chronic liver disease and angioma-like liver lesions on ultrasonography. MATERIALS AND METHODS: We conducted a retrospective study amongst patients seen at the Ultrasonography Unit, Gastroenterology Department between January 2000 and June 2004. Included in the study were patients that presented with clinical and/or laboratory complaints consistent with chronic liver disease of any etiology, and those in which abdominal ultrasounds revealed the existence of at least one angioma-like liver lesion. All relevant epidemiological, clinical, ultrasonographic, and evolutionary data were carefully collected and recorded. RESULTS: In the course of our study, 58 patients were diagnosed with chronic liver disease and angioma-like liver lesions, of which 13 showed clinical, laboratory, ultrasonographic, and/or histological signs of liver cirrhosis. In 50% of patients these lesions were less than 10 mm in diameter, and in most cases were located in the right hepatic lobe. During an average follow-up period of 35 months (6-168 months) we verified that, in two patients, these lesions, initially interpreted as angiomas were in fact malignancies (one hepatocellular carcinoma and one metastatic adenocarcinoma of the gallbladder). In both cases, the patients were cirrhotic. Thus, our study revealed that 15% of lesions found in cirrhotic patients initially interpreted as angiomas were actually malignant. CONCLUSIONS: Our study revealed that, in patients with chronic liver disease, particularly in cirrhotic patients, a considerable percentage of ultrasonographic lesions originally interpreted as angiomas are in fact malignant tumors.
Asunto(s)
Hemangioma/diagnóstico por imagen , Cirrosis Hepática/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Femenino , Humanos , Hepatopatías/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , UltrasonografíaRESUMEN
BACKGROUND: Patients with inflammatory bowel disease may suffer one or more extraintestinal manifestations during the course of their condition, these being more frequent in Crohn s disease. The aim of our study was to evaluate the prevalence of extraintestinal manifestations in patients with Crohn s disease in our healthcare area, and to assess the relationship between its presence and diverse clinical-evolutionary variables. MATERIAL AND METHODS: Extraintestinal manifestations in 157 patients diagnosed with Crohn s disease in our center were retrospectively studied. The clinical-evolutionary characteristics of this population were compared with respect to the presence or absence of different extraintestinal manifestations. RESULTS: Seventy-two patients (46%) presented at least with one extraintestinal manifestation. Thirty-one percent were colitis-related manifestations (22% rheumatologic, 13% muco-cutaneous, 4% ophthalmologic), 11% cholelithiasis, 8% nephrolithiasis, 3% thromboembolic illness, and other manifestations were less frequent. Fourteen percent presented with more than one extraintestinal manifestation. Rheumatologic and muco-cutaneous manifestations were significantly more frequent in patients with disease confined to the colon. Cholelithiasis was significantly associated to those over 40 and also to males. Nephrolithiasis was also significantly associated to those over 40, and thromboembolic illness was linked to females. CONCLUSIONS: forty-six percent of patients with Crohn s disease presented at least with one extraintestinal manifestation. Thirty-one percent presented with colitis-related manifestations, rheumatologic and muco-cutaneous manifestations being the most frequent, whereas hepatic manifestations were infrequent. Rheumatologic and muco-cutaneous manifestations were more frequent in patients with disease confined to the colon.
Asunto(s)
Enfermedad de Crohn/diagnóstico , Enfermedades Reumáticas/etiología , Enfermedades de la Piel/etiología , Adulto , Anciano , Enfermedad de Crohn/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Enfermedades Reumáticas/epidemiología , Enfermedades de la Piel/epidemiologíaRESUMEN
INTRODUCTION: Aneuploidy has been observed in 6-27% of lesions known to be precursors of colorectal cancer, such as adenomas or ulcerative colitis. It has been suggested that aneuploidy may predispose to malignancy in these cases. However, its role in the adenoma-carcinoma sequence has not been definitely established. The objective of this study was to assess the incidence of aneuploidy in colon adenomas, as well as to study its possible role in the adenoma-carcinoma sequence. MATERIAL AND METHODS: The study was performed on a series of 57 large bowel adenomas measuring 10 mm or more, collected from 54 consecutive patients. All specimens were obtained either by endoscopic or by surgical resection. There were 49 adenomas with low-grade dysplasia, two with high-grade dysplasia, two intramucous carcinomas, and four microinvasive carcinomas. A flow cytometric DNA analysis was performed in fresh specimens following Vindelov's method. RESULTS: Aneuploid DNA was detected in five out of 49 low-grade dysplasia adenomas (10%), in all four high-grade dysplasia adenomas or intramucous carcinomas (100%), and in three out of four microinvasive carcinomas (75%). The association between aneuploidy and high-grade dysplasia adenomas, intramucous, or microinvasive carcinoma was statistically significant (p < 0.001). No association was found between aneuploidy and any of the following features: age, gender, clinical symptoms of patients, and size or location of adenomas. CONCLUSIONS: The incidence of aneuploidy in this series was 10% in low-grade dysplasia adenomas, and 87% in high-grade dysplasia adenomas or carcinomas, and this difference was statistically significant. These findings suggest that aneuploidy may play a role in the adenoma-carcinoma sequence.
Asunto(s)
Adenoma/genética , Aneuploidia , Neoplasias Colorrectales/genética , Lesiones Precancerosas/genética , Adenoma/patología , Anciano , Neoplasias Colorrectales/patología , ADN/análisis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Lesiones Precancerosas/patologíaRESUMEN
Introducción: en patología benigna de intestino grueso precursora del cáncer colorrectal, como adenomas o colitis ulcerosa, se ha observado aneuploidía en el 6-27% de los casos y se ha sugerido que su presencia predispone al desarrollo de malignidad. Sin embargo, su papel en la secuencia adenoma-carcinoma no se ha demostrado de forma concluyente. El objetivo de nuestro trabajo fue valorar la incidencia de aneuploidía en adenomas colónicos,con y sin signos de malignidad, y estudiar su posible papel en la secuencia adenoma-carcinoma. Material y métodos: el estudio se realizó en una serie de 57 adenomas de intestino grueso, de 10 o más milímetros, recogidos de forma consecutiva de 54 pacientes. Las piezas se obtuvieron en todos los casos mediante resección endoscópica o quirúrgica. En 49 casos se trataba de adenomas con displasia de bajo grado, en doscasos de adenomas con displasia de alto grado, dos adenocarcinomas intramucosos y en otros cuatro de adenocarcinomas microinvasivos. El estudio del ADN se realizó en la pieza operatoria en fresco mediante citometría de flujo utilizado el método de Vindelov.Resultados: se detectó ADN aneuploide en cinco de los 49adenomas con displasia de bajo grado (10%), en los cuatro adenomas con displasia de alto grado o adenocarcinomas intramucosos (100%) y en tres de los cuatro adenocarcinomas microinvasivos (75%). Se observó asociación significativa entre el hallazgos deaneuploidía y displasia de alto grado, adenocarcinoma intramucoso o microinvasivo (p < 0,001). No se apreció asociación entre la existencia de aneuploidía y la edad de los pacientes, sexo, sintomatología clínica, tamaño ni localización de los adenomas. Conclusiones: en adenomas colónicos la incidencia de aneuploidía fue del 10% cuando se trataba de adenomas con displasia de bajo grado y del 87% cuando presentaban displasia de alto grado o adenocarcinoma siendo la diferencia estadísticamente significativa. Estos hallazgos sugieren que la aneuploidía juega un papel en la secuencia adenoma-carcinoma
Introduction: aneuploidy has been observed in 6-27% of lesions known to be precursors of colorectal cancer, such as adenomas or ulcerative colitis. It has been suggested that aneuploidy may predispose to malignancy in these cases. However, its role in the adenoma-carcinoma sequence has not been definitely established.The objective of this study was to assess the incidence of aneuploidy in colon adenomas, as well as to study its possible role in the adenoma-carcinoma sequence. Material and methods: the study was performed on a series of 57 large bowel adenomas measuring 10 mm or more, collected from 54 consecutive patients. All specimens were obtained either by endoscopic or by surgical resection. There were 49 adenomas with low-grade dysplasia, two with high-grade dysplasia, two intramucous carcinomas, and four microinvasive carcinomas. A flow cytometric DNA analysis was performed in fresh specimens following Vindelov´s method. Results: aneuploid DNA was detected in five out of 49 lowgrade dysplasia adenomas (10%), in all four high-grade dysplasia adenomas or intramucous carcinomas (100%), and in three out of four microinvasive carcinomas (75%). The association between aneuploidy and high-grade dysplasia adenomas, intramucous, or microinvasive carcinoma was statistically significant (p < 0.001). No association was found between aneuploidy and any of the following features: age, gender, clinical symptoms of patients, and size or location of adenomas. Conclusions: the incidence of aneuploidy in this series was 10% in low-grade dysplasia adenomas, and 87% in high-grade dysplasia adenomas or carcinomas, and this difference was statistically significant. These findings suggest that aneuploidy may play a role in the adenoma-carcinoma sequence
Asunto(s)
Anciano , Humanos , Adenoma/genética , Aneuploidia , Lesiones Precancerosas/genética , Neoplasias Colorrectales/genética , Adenoma/patología , ADN/análisis , Lesiones Precancerosas/patología , Neoplasias Colorrectales/patologíaAsunto(s)
Enfermedades del Íleon/diagnóstico , Carrera , Úlcera/diagnóstico , Adulto , Anemia Ferropénica/diagnóstico , Anemia Ferropénica/etiología , Endoscopía del Sistema Digestivo/métodos , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Pruebas Hematológicas , Humanos , Enfermedades del Íleon/complicaciones , Masculino , Úlcera/complicacionesRESUMEN
Amyloidosis commonly affects the gastrointestinal tract but it rarely causes severe symptoms. We describe here a case of small bowel amyloidosis presenting severe bleeding. The diagnosis was made by histopathological study of the surgical specimen. No other sites of amyloid deposition were found. The only predisposing condition found in this case was a prostate cancer.
Asunto(s)
Amiloidosis/complicaciones , Enfermedades Duodenales/complicaciones , Hemorragia Gastrointestinal/etiología , Anciano , Amiloidosis/patología , Amiloidosis/cirugía , Enfermedades Duodenales/diagnóstico por imagen , Enfermedades Duodenales/cirugía , Duodeno/diagnóstico por imagen , Duodeno/patología , Duodeno/cirugía , Hemorragia Gastrointestinal/patología , Hemorragia Gastrointestinal/cirugía , Humanos , Masculino , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
INTRODUCTION: Infection with the parasite Anisakis simplex is common in Japan and northern European countries. The number of reported cases in Spain has increased since the first description in 1991. The aim of the present study was to evaluate the incidence, clinical patterns, histopathological lesions, treatment, and outcome of Anisakis simplex infection in our environment. MATERIAL AND METHOD: Cases of gastrointestinal anisakiasis diagnosed in our center from December 1999 to January 2002 were studied. Only patients with detection of the parasite in oral endoscopy or the surgical specimen and those with elevated levels of specific IgE to Anisakis simplex, a clinical picture compatible with anisakiasis, or a history of raw fish intake were included. Epidemiological, clinical and laboratory data, as well as diagnostic, histopathologic and therapeutic features, and outcome in these patients were recorded. RESULTS: Twenty-five cases of gastrointestinal anisakiasis were diagnosed during the study period, representing an incidence of 3.87 cases per 100 000 inhabitants/year. All the patients had ingested raw anchovies. Two groups were observed. The first group was composed of 10 patients with a gastric form of the infection, in which the main symptom was epigastralgia (90%). Oral endoscopy was performed in all patients and the parasite was detected in five (50%). The second group was composed of 15 patients with intestinal involvement in which the main manifestations were symptoms mimicking appendicitis (80%). The most frequent finding of laparotomy and/or imaging tests (abdominal ultrasonography, intestinal transit, abdominal CAT) was terminal ileitis (80%). Seven patients underwent surgery: intestinal resection was performed in four with detection of Anisakis simplex in three. Eosinophilic infiltration was found in all surgical specimens. Treatment was symptomatic in most of the patients and outcome was favorable in all. CONCLUSIONS: Infection with Anisakis simplex should be investigated in patients with abdominal pain after intake of raw fish, ileitis of unclear origin, or eosinophilic gastroenteritis.
Asunto(s)
Anisakiasis/epidemiología , Parasitosis Intestinales/epidemiología , Gastropatías/epidemiología , Adulto , Anciano , Animales , Anisakiasis/diagnóstico , Anisakiasis/cirugía , Anisakiasis/transmisión , Anisakis/crecimiento & desarrollo , Anisakis/aislamiento & purificación , Apendicitis/diagnóstico , Diagnóstico Diferencial , Eosinofilia/epidemiología , Eosinofilia/etiología , Eosinofilia/parasitología , Femenino , Peces/parasitología , Contaminación de Alimentos , Parasitología de Alimentos , Humanos , Ileítis/diagnóstico , Ileítis/parasitología , Ileítis/cirugía , Incidencia , Parasitosis Intestinales/diagnóstico , Parasitosis Intestinales/parasitología , Parasitosis Intestinales/cirugía , Parasitosis Intestinales/transmisión , Larva , Masculino , Persona de Mediana Edad , España/epidemiología , Gastropatías/parasitologíaRESUMEN
The case of a young female diagnosed with an IgG deficit and hepatic granulomas is presented. After 6 years of follow up the patient remains asymptomatic without treatment and with moderate biochemical cholestasis. The tests performed did not lead to a definitive etiologic diagnosis, therefore, according to a review of the literature, we believe that the granulomatous reactions are related with the hypogammaglobulinemia itself.
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Agammaglobulinemia/complicaciones , Granuloma/etiología , Hepatopatías/etiología , Adulto , Biopsia , Femenino , Granuloma/patología , Humanos , Deficiencia de IgG/complicaciones , Hígado/patología , Hepatopatías/patologíaRESUMEN
The case of a patient ulcerative colitis involving an autoimmune base who was treated with recombinant alpha-2 interferon for concomitantly presenting chronic hepatitis B in the replicative phase is reported. With this therapy unreplicative seroconversion of the disease was achieved without modification of the course of the chronic inflammatory intestinal disease (CIID) during treatment or over the posttreatment follow up period. A brief review of the literature was performed concerning the role of autoimmunity in ulcerative colitis, treatment with alpha-interferon in chronic hepatitis B and the exacerbation of autoimmune phenomena which may lead to interferon treatment. According to the evolution of this case and the review of the literature, the authors conclude that the existence of CIID does not contra-indicate the use of recombinant alpha-2 interferon in patients with chronic viral hepatitis, although special control of the disease should be carried out during the treatment period.
Asunto(s)
Colitis Ulcerosa/complicaciones , Hepatitis B/complicaciones , Hepatitis B/terapia , Interferón Tipo I/uso terapéutico , Adulto , Enfermedad Crónica , Colitis Ulcerosa/inmunología , Contraindicaciones , Humanos , Masculino , Proteínas RecombinantesRESUMEN
We report a case of solitary rectal ulcer (SRU) in a patient who had been previously diagnosed of granulomatous appendicitis. Both entities were histologically confirmed. The patient is asymptomatic after appendectomy done one and a half years ago, demonstrating the low recurrence rate of granulomatous appendicitis and the silent course of solitary rectal ulcer in many patients. Both entities may be related.
Asunto(s)
Apendicitis/complicaciones , Apéndice , Granuloma/complicaciones , Enfermedades del Recto/complicaciones , Adulto , Enfermedades del Ciego/complicaciones , Humanos , Masculino , Úlcera/complicacionesRESUMEN
OBJECTIVE: To gather epidemiological data about acute pancreatitis (A.P.) in our environment. EXPERIMENTAL DESIGN: A prospective analysis of a series of patients in whom A.P. was diagnosed. PATIENTS: 116 patients with abdominal pain, elevation of pancreatic enzymes and absence of other acute abdominal pathology. RESULTS: These patients made up 2.8% of all emergency admissions to medical departments. Frequency of A.P. was 331 cases per million inhabitants/year. The biliary etiology was the most frequent (70.7%) followed by idiopathic forms (19.8%) and those deriving from alcohol abuse (7.8%). Mean patient age was 64.88 + 15.82 years, while patients with alcoholic A.P. were significantly younger than the other two groups. Women predominated in cases with biliary etiology, while men did so in alcoholic A.P. In cases of biliary A. P. amilasemia levels were significantly higher on admission (2598) than for other groups (1132 in alcohol related cases and 1692 in idiopathic ones). The overall rate of complications was 18.1%. Finally, overall mortality was 5.1%. CONCLUSIONS: Although the mean age of our patients was advanced, morbidity and mortality rates were low.