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El presente estudio, describe la experiencia realizada en screening de diabetes gestacional con las nuevas pautas de la A.L.A.D a 3293 pacientes que fueron asistidas en las Policlínicas del Departamento de Ginecología y Obstetricia del Hospital Militar en el período comprendido entre el 1/1/'98 y el 30/6/'00. Se diagnosticaron 167 pacientes con diabetes gestacional, 164 fueron controladas en la Policlínica de Alto Riesgo Obstétrico; 160 habían finalizado su embarazo, naciendo 164 niños. El factor de riesgo más frecuentemente encontrado fue la obesidad; destacándose una relación directa entre el incremento del riesgo relativo en función del peso, así como también de la edad materna. No se encontraron diferencias significativas en cuanto a vías de finalización del embarazo, la edad gestacional de finalización y el puntaje del Apgar del recién nacido con relación al resto de la población. Se observó una frecuencia doble en pequeños y grandes para la edad gestacional. El 76 por ciento de los recién nacidos fueron sanos. El 48 por ciento de las pacientes se reclasificaron

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The authors report the case of an alcoholic 49-year-old man hospitalized because of epigastric pain and hematemesis. Upper endoscopy showed a tear in a hiatus hernia (interpreted as a Mallory-Weiss lesion) and a bleeding duodenal ulcer. Upper barium examination performed 16 days later revealed a mediastinal collection communicating with the hiatus hernia. Retrospective evaluation of chest roentgenograms obtained at admission showed a limited mediastinal gas collection. With medical management, the collection progressively disappeared. From a theoretical point of view, this case illustrates Watts' theory on the effect of hiatus hernia on the site of postemetic injury. From a practical point of view, it confirms that conservative management is indicated in contained spontaneous perforations.

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In vitro binding properties of eight clay and/or aluminium-containing antacids for bile salts and lysolecithin were measured in comparison with cholestyramine binding capacity, taking into account the final medium pH. Dihydroxy-bile salt adsorption was greater when the initial pH was 1.8 and the intensity varied according to the drugs. Trihydroxybile salts were less bound and the binding was less related to the medium pH. Lysolecithins were bound by clay-containing antacids with the same intensity as cholestyramine, while the binding capacity of aluminium-containing antacids was weaker and related to the final pH. There were close relationships between binding capacities and the final pH so that bile salts are bound by antacids with a great intensity in acid medium and released by alkalinisation in contrary to the binding capacity of cholestyramine. Lysolecithins should be also bound more intensively in acid medium by aluminium-containing antacids. Binding capacities of the antacids were related to their composition, their antacid effect and to the final pH.

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The endoscopic features of the gastric mucosa in patients with cirrhosis have not been systematically investigated. In these patients, we observed an endoscopic aspect, consisting of multiple small erythematous areas, outlined by a subtle yellowish network (resembling a mosaic), mainly located in the proximal part of the stomach. We tested the value of this sign by comparing two groups: 100 patients with portal hypertension due to cirrhosis, and 300 control patients without signs of liver disease or portal hypertension. This endoscopic pattern was observed in 94 of the patients with cirrhosis, whereas oesophageal varices were seen in 78 only. In contrast, only one patient of the control group had this aspect. Moreover, this sign was also found in seven of eight patients with non cirrhotic portal hypertension, but was seen neither in 100 patients with chronic alcoholism but without liver disease, nor in 10 cirrhotic patients with end-to-side portacaval shunts. These endoscopic changes might be because of mucosal and/or submucosal oedema and congestion highlighting the normal areae gastricae pattern and related to raised portal pressure. We conclude that the mosaic pattern of the gastric mucosa is a sensible and specific sign for diagnosis of portal hypertension, whatever the cause.

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A number of studies have demonstrated a high incidence of synchronous or metachronous esophageal carcinoma in association with carcinoma of head and neck. Carcinoma of the esophagus must be systematically looked for before the treatment of head-neck carcinomas and during follow-up. The aim of this study was to determine the incidence of synchronous esophageal carcinoma in patients with head and neck carcinoma and to evaluate the advantages of lugol and toluidine blue vital staining in fiberoptic endoscopy. One hundred patients (97 males and 3 females, mean age 54.9 years) were studied. A fiberoptic esophagoscopy was performed in all patients. Vital staining was realized with 5 p. 100 lugol in 40 cases and with 1 p. 100 toluidine blue e in 20 cases. Squamous cell carcinoma of the esophagus was observed in 12 patients, typical grossly in 5 cases and occult in 7 cases. In these latter cases, lugol (2 cases) or toluidine blue (5 cases) stain facilitated the forceps biopsies. Histological examination was positive in all cases. The incidence of esophageal carcinoma synchronous to carcinoma of the mouth was high (35.3 p. 100). Lugol vital staining seems to be sensitive, non-specific and easy to realize. Toluidine blue staining calls for a more difficult and prolonged technique. Although it can reveal occult carcinoma, false positive or negative results may be observed.

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Since 1960, about 250 cases of leiomyoblastoma of the stomach have been reported. The diagnosis was always made after surgical resection or necropsy. We report the first case of gastric leiomyoblastoma successfully treated by endoscopic resection, in a 76-year-old woman presenting with upper gastrointestinal bleeding. This therapeutic procedure would seem to be the one of choice, in view of the age of the patient, the limited size and the pedunculated form of the tumor. Endoscopic follow-up should be instituted since local recurrence of the tumor and distal metastases have been reported.

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Distal esophageal varices are most frequently associated with portal hypertension, while varices of the upper esophagus are occasionally observed in patients with vena caval obstruction. One hundred and nineteen cases of upper esophageal varices (downhill varices) have been reported in the literature. We report 6 cases (4 men and 2 women), with vena caval obstruction. Upper gastrointestinal hemorrhage occurred in one patient. Endoscopy showed varices in the proximal third of the esophagus in 5 patients and in the proximal half of the esophagus in the other patient. Superior vena cavogram demonstrated total or partial occlusion of the vena cava in 6 cases, with opacification of the right azygos vein in 4 cases and thrombosis of this vein in one case. Superior vena caval obstruction was secondary to malignant lymphoma in 2 cases, to malignant thymoma in 2 cases, to malignant thyroid tumor in one case and to anaplastic bronchogenic carcinoma in one case. Clinical symptoms of vena caval obstruction are present in 91.4 p. 100 of the cases in the literature. Upper gastrointestinal hemorrhage are observed in 7.6 p. 100 of cases. It is generally agreed that the predominant factors involved in the determination of the downward extension of varices along the esophagus are the level of superior vena caval obstruction and its duration. Because of the risk of digestive hemorrhage and of the topographic meaning of the degree of extension, upper esophageal varices should be routinely searched in patients with vena caval hypertension.

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A 47-yr-old man presented with dysphagia 4 yr after mediastinal radiotherapy for Hodgkin's disease. X-ray series, fiberoptic endoscopy, and computerized transverse tomography showed mucosal bridges in the upper esophagus. Histologically, these bridges were constituted from normal epithelium overlying a chronic inflammatory lamina propria, without evidence of Hodgkin's disease recurrence or of squamous cell carcinoma. Swallowing was improved by endoscopic electrocoagulation and Eder-Puestow dilatations. Several arguments favor the hypothesis that these mucosal bridges were the late sequelae of radiation esophagitis.

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A case of gastric retention without outlet obstruction in a 44-year-old patient with esophageal carcinoma is reported. Radiological (and particularly C.T.) examinations support the opinion that the gastric motility disorders were due to the autovagotomy secondary to malignant involvement of the intrathoracic vagus nerve.

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A patient is described in whom a segment of colon used to construct an artificial vagina was therefore removed from intestinal continuity and was affected by typical idiopathic ulcerative colitis. The onset of disease was simultaneous in this loop of colon and in the rectum. There was no evidence of local infection. An increased ratio of IgE-plasma cells was found in both the mucosa of the grafted colon and that of the rectum, but anticolonic antibodies were not detected in the serum. After removal of the loop of colon used for colpopoiesis, the patient continued to suffer from distal proctocolitis for almost a year, but has since then maintained a stable remission without treatment. The etiology of ulcerative colitis is discussed, and attention is drawn to the unusual psychologic aspects of this case.

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Vitamin B12 Urinary excretion, stool weight, fecal fat excretion, fecal 14C glycocholate excretion and 14CO2 output after I-14C glycocholate ingestion, were measured in 13 patients with non-operated ileal Crohn's disease (NOC), 14 patients with ileal resection for ileal Crohn's disease, with or without right colectomy (RC), and 11 patients with ileal resection with or without right colectomy for pathology other than Crohn's disease (RNC). A positive linear relationship was found between stool weight and 14C glycocholate fecal excretion. The logs of fecal fat and 14C glycocholate excretions were related to the extent of the ileal lesion of resection; a similar but negative relationship was observed for vitamin B12 urinary excretion. Fecal fat excretion and respiratory 14CO2 output were significantly higher in patients with right colectomy.

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