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Ultrasound is being increasingly used to study the digestive tract because it has certain advantages over other techniques such as endoscopy, CT enterography, and MR enterography. Ultrasound can be used to evaluate the bowel wall and the elements that surround it without the need for contrast agents; its ability to evaluate the elasticity and peristalsis of these structures is increasing interest in its use. This article describes the techniques and modalities of bowel ultrasound, as well as the normal features of the bowel wall and contiguous structures. It uses a practical approach to review the main pathological findings and their interpretation, and the different patterns of presentation, which will help orient the diagnosis.

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Los leiomiomas gástricos son tumoraciones submucosas benignas, poco comunes, que se originan del músculo liso. Clínicamente son asintomáticos, con buen pronóstico y con pocas complicaciones a largo plazo. Reportamos el caso de un joven de 16 años que se presenta a la clínica con melena y dolor abdominal. En la endoscopia se reporta una tumoración prepilórica, ulcerada y cubierta de fibrina. El estudio histopatológico mostró una neoplasia mesenquimal con positividad inmunohistoquimica para desmina y actina, así como negatividad para C-kit, DOG-1 y S-100, compatible con leiomioma gástrico. Fue intervenido quirúrgicamente realizándose antrectomía laparoscópica con reconstrucción en Y de Roux de manera exitosa.Gastric leiomyomas are rare, benign submucosal tumors originating from smooth muscle cells. They are usually asymptomatic, having good prognosis with limited long-term complications. A 16-year-old young man comes to our clinic and reports melena and abdominal pain. Upper endoscopy revealed a prepyloric, ulcerated, fibrin-covered tumor. Histopathological examination showed a positive immunohistochemical stain mesenchymal neoplasm for desmin and muscle actin, being negative for C-kit, DOG-1 and S100 proteins, consistent with gastric leiomyoma. Antrectomy with Roux-en-Y gastrojejunostomy was successfully performed.

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INTRODUCTION AND AIMS: Double-balloon enteroscopy has been improving the visualization of the entire intestine for more than a decade. It is a complementary method in the study of intestinal diseases that enables biopsies to be taken and treatments to be administered. Our aim was to describe its main indications, insertion routes, diagnostic/therapeutic yield, and complications. MATERIALS AND METHODS: All patients referred to our unit with suspected small bowel pathology were included. The insertion route (oral/anal) was determined through diagnostic suspicion. The variables measured were: insertion route, small bowel examination extent, endoscopic diagnosis/treatment, biopsy/histopathology report, complications, and surgical findings. RESULTS: The study included 28 double-balloon enteroscopies performed on 23 patients, of which 10 were women and 13 were men (mean age of 52.95 years). The oral approach was the most widely used (n=21), the main indication was overt small bowel bleeding (n=16), and the general diagnostic yield was 65.21%. The therapeutic intervention rate was 39.1% and the procedure was effective in all the cases. The most widely used treatment was argon plasma therapy (n=7). The complication rate was 8.6%; one patient presented with low blood pressure due to active bleeding and another had deep mucosal laceration caused by the argon plasma. CONCLUSIONS: Double-balloon enteroscopy is a safe and efficacious method for the study and management of small bowel diseases, with an elevated diagnostic and therapeutic yield.

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INTRODUCTION AND AIMS: Cardiovascular disease is a growing public health problem. Forty percent of the general population will suffer from the disease by 2030, consequently requiring antithrombotic therapy. Cardiogastroenterology is a new area of knowledge that evaluates the gastrointestinal effects and complications of antithrombotic therapy. Our aim was to evaluate, through a validated questionnaire, the knowledge held by a group of specialists and residents in the areas of gastroenterology and internal medicine, about pharmacology and drug prescription, as well as gastrointestinal risks and complications, in relation to antithrombotic therapy. PATIENTS AND METHODS: A validated questionnaire composed of 30 items was applied to a group of specialists and residents in the areas of gastroenterology and internal medicine. The questions were on indications, pharmacology, evaluation of risks for gastrointestinal bleeding and thromboembolic events, and use of antithrombotic therapy during endoscopic procedures. Sufficient knowledge was defined as 18 or more (≥ 60%) correct answers. RESULTS: The questionnaire was answered by 194 physicians: 82 (42%) internal medicine residents and gastroenterology residents and 112 (58%) specialists. Only 40 (20.6%) of the participants had sufficient knowledge of cardiogastroenterology. Residents had a higher number of correct answers than specialists (53 vs. 36%, P<.0001). The gastroenterology residents had more correct answers than the internal medicine residents, gastroenterologists, and internists (70 vs. 53, 40, and 46%, respectively, P<.001). Only residents had sufficient knowledge regarding pharmacology and the use of antithrombotic therapy in endoscopy (P<.0001). All groups had insufficient knowledge in evaluating the risk for gastrointestinal bleeding and thrombosis. CONCLUSIONS: Knowledge of cardiogastroenterology was insufficient in the group of residents and specialists surveyed. There is a need for medical education programs on the appropriate use of antithrombotic therapy.

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An alternative control to soybean caterpillar has been the use of insect resistant plants that present phenolic flavonoids. The midgut is the main access pathway of food and chemical substances ingested. The present study examined morphological alterations in the midgut epithelium of the soybean caterpillar, after the ingestion of soybean genotypes containing the flavonoids rutin and genistin. The caterpillars and genotypes (BRS 257 - control, BR 16, Dowling, PI 229358, IAC 100 and PI 227687) were obtained from the insect rearing facility at the Embrapa Soja. The midguts were collected, fixed in Karnovsky, processed and analyzed under a light microscope. All treatments caused alterations in the midgut epithelial cells. These alterations in the columnar cells were more assiduous than the on other cell types, showing an increase of cytoplasmic protrusions and vacuoles. The goblet cells showed few changes for all genotypes tested, while the regenerative cells presented alterations mainly for the Dowling and PI 227687 treatments. The peritrophic membrane was absent for genotypes IAC100 and PI 227687. We conclude that the Dowling and PI 227687 genotypes were effective and promoted great morphological alterations in the midgut of the soybean caterpillars, being able to be very effective for the control of this plague.

Um controle alternativo para a lagarta da soja tem sido o uso de plantas resistentes a insetos que contém flavonoides fenólicos. O intestino médio é a principal via de acesso do alimento e substâncias químicas ingeridas. O presente estudo examinou as alterações morfológicas no epitélio do intestino médio da lagarta da soja, após a ingestão de genótipos de soja contendo os flavonoides rutina e genistina. As lagartas e os genótipos (BRS 257 - controle, BR 16, Dowling, PI 229358, IAC 100 e PI 227687) foram obtidos do laboratório de criação de insetos da Embrapa Soja. Os intestinos médios foram coletados, fixados em Karnovsky, processados e analisados ao microscópio de luz. Todos os tratamentos causaram alterações nas células epiteliais do intestino médio. As alterações foram mais assíduas nas células colunares do que nos demais tipos celulares. Essas apresentaram grande quantidade de protrusões citoplasmáticas e de vacúolos. As células caliciformes apresentaram poucas alterações para todos os genótipos testados, enquanto as células regenerativas apresentaram alterações principalmente nos tratamentos Dowling e PI 227687. A membrana peritrófica estava ausente para os genótipos IAC100 e PI 227687. Conclui-se que os genótipos Dowling e PI 227687 foram bastante efetivos e promoveram grandes alterações morfológicas no intestino médio das lagartas da soja, podendo ser bastante eficaz para o controle desta praga.

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BACKGROUND: Gallstone ileus is a non-strangulated mechanical obstruction of the small bowel or colon as a result of the passage of gallstones through a biliary enteric fistula. It is a rare complication of cholelithiasis, affects patients over 65 years, and the disease occurs predominantly in females. Preoperative diagnosis is difficult due to the lack of specific signs and symptoms in elderly patients with multiple comorbidities. CLINICAL CASE: A 93-year-old female presenting with a one-week history of upper gastrointestinal bleeding, electrolyte imbalance and community- acquired pneumonia pneumonia. During her prolonged hospital stay she presented an intestinal obstruction. The diagnosis of gallstone ileus was made by CT scan. Despite surgical treatment, she died due to late diagnosis. CONCLUSIONS: Gallstone ileus is a rare pathology, difficulty in diagnosis prolongs hospital stay, which directly influences mortality.

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BACKGROUND: The gastrointestinal stromal tumours (GIST) are the most common soft tissue sarcomas of the digestive tract. They are usually found in the stomach (60-70%) and small intestine (25-30%) and, less commonly, in the oesophagus, mesentery, colon, or rectum. The symptoms present at diagnosis are, gastrointestinal bleeding, abdominal pain, abdominal mass, or intestinal obstruction. The type of symptomatology will depend on the location and size of the tumour. The definitive diagnosis is histopathological, with 95% of the tumours being positive for CD117. CLINICAL CASES: This is an observational and descriptive study of 5cases of small intestinal GIST that presented with gastrointestinal bleeding as the main symptom. The period from the initial symptom to the diagnosis varied from 1 to 84 months. The endoscopy was inconclusive in all of the patients, and the diagnosis was made using computed tomography and angiography. Treatment included resection in all patients. The histopathological results are also described. CONCLUSION: GIST can have multiple clinical pictures and unusual symptoms, such as obscure gastrointestinal bleeding. The use of computed tomography and angiography has shown to be an important tool in the diagnosis with patients with small intestine GISTs.

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[{"text": "Objetivo: determinar la relación entre hábitos alimentarios y la presencia de síntomas digestivos altos en estudiantes de la Universidad Nacional de San Luis. Metodología: estudio transversal descriptivo, en el cual participaron 150 sujetos (mujeres = 86, hombres = 64), estudiantes de 20 a 30 años de edad, de la Universidad Nacional de San Luis, sede San Luis; se utilizó una encuesta validada del Ministerio de Desarrollo Social de Argentina, adaptada a los fines de la presente investigación. Resultados: la mayoría de los estudiantes consume casi siempre las cuatro comidas principales; las formas de cocción predominantes fueron: horno, plancha y hervido. Se observó escasa y poco variada selección de frutas y verduras, un consumo ocasional de bebidas alcohólicas y de productos ricos en grasas, sal y azúcares. La elección de dulces y azúcares, mate cebado, té y café fue elevada. Los síntomas más recurrentes fueron: distensión abdominal, hambre dolorosa, regurgitación, náuseas y pirosis; los que menos aparecieron fueron vómito y anorexia. Los estudiantes asociaron la recurrencia de los síntomas al consumo de comidas con salsa, comidas picantes, mate cebado, té y café. En el sexo masculino, las bebidas alcohólicas también se asociaron a la sintomatología digestiva. Conclusiones: se pudo observar la presencia de más de un síntoma digestivo alto simultáneo en cada estudiante, unido a la presencia de hábitos alimentarios perjudiciales. Por ello, es indispensable impartir educación alimentaria nutricional.", "_i": "es"}, {"text": "Objective: To determine the relationship between the eating habits and the presence of upper digestive problems of 150 university students. Methodology: This is a descriptive cross-sectional study in which 150 individuals participated (86 females, 64 males). The students ranged from 20 to 30 years of age and were from the Universidad Nacional de San Luis. The study used a survey validated by the Ministry of Social Development of Argentina, which was adapted to the purposes of the present investigation. Results: The majority of the students almost always consumed four main meals, the main methods of cooking were: to bake, to grill and to boil. It was observed that there was hardly any variety in the selection of fruits and vegetables, in the occasional consumption of alcoholic drinks or in food products rich in fat, salt and sugar. The choice of sweets and sugars, mate "cebado" tea and coffee was high. The most recurring symptoms were: stomach distension, painful hunger, regurgitation, nausea, and heartburn. Those symptoms that occurred less were vomiting and anorexia. The students associated the recurrences of symptoms with the consumption of these fares: foods with sauce, spicy meals, mate "cebado", tea and coffee. In males, alcoholic beverages were also associated with digestive problems. Conclusions: It was possible simultaneously to observe the presence of more than one upper digestive problem in each of the students in correlation to harmful eating habits. For this reason, it is essential to provide education in nutritional eating.", "_i": "en"}, {"text": "Objetivo: determinar a relação entre hábitos alimentares dos alunos da Universidade Nacional de San Luis e a presença de sintomas digestivos superiores. Metodologia: estudo descritivo, transversal, em que participaram 150 estudantes (femininos = 86, masculinos = 64) de 20 a 30 anos de idade, da Universidade Nacional de San Luis, sede San Luis, usando um inquérito validado pelo Ministério do Desenvolvimento Social da Argentina, adaptado aos fins da presente investigação. Resultados: a maioria dos estudantes realiza quase sempre as quatro principais refeições, as formas de cocção predominantes foram: forno, na chapa e fervido. Observou-se escasso e pouco variado consumo de frutas e vegetais, um consumo ocasional de bebidas alcoólicas e produtos ricos em gorduras, sal e açúcares. O consumo de doces e açúcares, chimarrão, chá e café foram elevados. Os sintomas mais frequentes foram: distensão abdominal, fome dolorosa, regurgitação, náuseas e pirose, e os que menos apareceram foram: vômito e anorexia. Os estudantes associaram a recorrência dos sintomas ao consumo de: comidas com molho, comidas picantes, chimarrão, chá e café. No sexo masculino, as bebidas alcoólicas foram também associadas à sintomatologia digestiva. Conclusões: observou-se a presença de mais de um sintoma simultaneamente em cada estudante e, por sua vez, a prática de comportamentos alimentares prejudiciais para eles mesmos. Portanto, é essencial a realização de educação alimentar nutricional.", "_i": "pt"}]

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Resumen: Objetivo: Comprobar la capacidad pronóstica como predictor de mortalidad de la clasificación de Child-Pugh lactato en la población de pacientes cirróticos que ingresan en la Unidad de Cuidados Intensivos de la Fundación Clínica Médica Sur. Material y métodos: Estudio de investigación clínica, cohorte no concurrente, donde se obtuvieron datos en el periodo comprendido del 1 de enero de 2012 al 31 de diciembre de 2014. Resultados: Ingresaron 28 casos a la Unidad de Terapia Intensiva de la Fundación Clínica Médica Sur con diagnóstico de cirrosis hepática; de ellos, fallecieron un total de 16 (57.1%) sujetos dentro de los primeros 40 días posteriores a su ingreso y sobrevivieron 12 (42.9%). Se calculó si existía correlación entre la defunción y el puntaje de la clasificación Child-Pugh lactato mayor de 14, y se encontró una r = 0.708. El puntaje mayor a 14 puntos se asoció a mortalidad en 87.5%, así como el puntaje menor a 14 se vinculó a supervivencia a 40 días en 83.33%. Conclusiones: La clasificación de Child-Pugh más lactato mayor de 14 puntos tiene una fuerte correlación con la mortalidad.

Abstract: Objective: This study aimed to establish if the Child-Pugh+lactate score is a reliable prognostic scoring tool as mortality predictor in cirrhotic patients admitted to the Médica Sur Clinic Foundation Intensive Care Unit. Material and methods: This was a 3-year, single-centered retrospective cohort study performed in a general ICU. Results: Twenty-eight cases were collected in the period from January 1, 2012 to December 31, 2014, of which a total of 16 patients (57.1%) died within the first 40 days after admission and 12 survived (42.9%). It was assessed if there was a correlation between death and a Child-Pugh lactate score greater than 14, finding an r = 0.708. Conclusions: A Child-Pugh+lactate score with a numerical value above 14 points has a direct relation with mortality in cirrhotic patients admitted to the ICU.

Resumo: Objetivo: Comprovar a capacidade prognóstica como preditor de mortalidade da Child Pugh lactato na população de pacientes cirróticos admitidos na terapia intensiva da Fundação Clínica Médica Sur. Material e métodos: Estudo de investigação clínica, coorte não concorrente, onde os dados foram coletados no período de 1 de Janeiro de 2012 a 31 Dezembro de 2014. Resultados: 28 casos admitidos na unidade de terapia intensiva da Fundação Clínica Médica Sur, diagnosticados com cirrose hepática, dos quais faleceram um total de 16 pacientes (57.1%) nos primeiros 40 dias após a admissão e sobreviveram 12 (42.9%). Calculou-se a existência de uma correlação entre a defunção e a Classificação Child Pugh lactato maior de 14 pontos, encontrando um r = 0.708. A pontuação CPL maior a 14 pontos está associado à mortalidade em 87.5% e inferior a 14 foi associado a sobrevida à 40 dias em um 83.33%. Conclusões: A Clasificação Child Pugh lactato maior a 14 pontos tem uma forte correlação com a mortalidade.

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Antecedentes: El sangrado del tubo digestivo es una situación alarmante para padres y médi- cos. Las causas varían de acuerdo a la edad de los pacientes, aunque la mayoría no ponen en peligro la vida, se requiere un enfoque que permita al médico realizar un diagnóstico tem- prano y valorar la severidad del sangrado, así como la selección de estudios complementa- rios diagnósticos y terapéuticos. Objetivo: Identi car los hallazgos endoscópicos en niños con sangrado digestivo en el Hospital Nacional Mario Catarino Rivas (HNMCR), período de junio a agosto del 2016. Pacientes y Métodos: estu- dio descriptivo transversal. La población estu- diada fue de 43 pacientes a los que se le realizó estudio endoscópico en el HNMCR en el perío- do de estudio. Resultados: 58% de quienes se les realizó el estudio endoscópico eran niñas, y 58% fueron adolescentes. Los hallazgos endos- cópicos en los sangrados digestivos altos son gastropatía erosiva (n=20), erosión de esófago (n=8), varices gástricas y esofágicas (n=2 y n=2 respectivamente). En las colonoscopias se encontraron pólipos (n=6), y hemorroides externas (n=1). El 66% de los pacientes estudia- dos fue el primer episodio de sangrado digesti- vo. Conclusión: el sangrado digestivo en pedia- tría tiene causas variadas, desde lesiones trata- bles en la mucosa del tubo digestivo hasta enfermedades crónicas de las cuales hay que evitar complicaciones a largo plazo...(AU)

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BACKGROUND: Gastrointestinal stromal tumors (GIST) were identified only recently. These tumors usually have no symptoms, although they are localized, operable and curable. Although rare, if they are not diagnosed and treated early, they become very aggressive. The most common manifestation is gastrointestinal bleeding from mucosal erosion. Their presentation as severe lower gastrointestinal bleeding is exceptional. CLINICAL CASE: We report a patient with severe lower gastrointestinal bleeding stabilized by interventional radiology that subsequently required surgery for definitive care. CONCLUSIONS: Therapeutic use of radiological embolization is increasingly widespread in bleeding at various levels, achieving hemodynamic stabilization of patients. However, it must be kept in mind that, in cases of unknown etiology of lower gastrointestinal bleeding, possible causes must be investigated.

Antecedentes: los tumores del estroma gastrointestinal (GIST) se identificaron hace muy poco tiempo. Son tumores que no suelen alertar con síntomas mientras permanecen en fase localizada, operable y curable. Aunque son poco frecuentes, cuando no se diagnostican y tratan oportunamente son muy agresivos. Su manifestación clínica más común es la hemorragia gastrointestinal por erosión de la mucosa, pero su presentación como hemorragia baja del tubo digestivo severa es excepcional. Caso clínico: se comunica un caso de hemorragia baja del tubo digestivo severa estabilizada por radiología intervencionista, que posteriormente requirió cirugía para su tratamiento definitivo. Conclusiones: la embolización radiológica está cada vez más difundida como tratamiento de hemorragias en distintos sitios porque permite la estabilización hemodinámica de los pacientes. No hay que olvidar, sin embargo, que en los casos de hemorragia baja del tubo digestivo, de origen desconocido, es necesario investigar las posibles causas.

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Introducción: Los quistes de duplicación intestinal son anormalidades poco frecuentes que se presentan principalmente en el período perinatal, y pueden causar problemas respiratorios y para la alimentación. Los quistes sublinguales de duplicación intestinal pueden presentar solo epitelio del aparato digestivo, del respiratorio o de ambos. En los dos últimos casos se denominan coristomas. Caso clínico: Se describe un caso de un paciente de 10 meses de edad que presentó una masa quística sublingual desde el nacimiento. Se realizó la resección total con abordaje transoral y la reconstrucción de la lengua en planos. La pieza quirúrgica resultó una estructura quística de contenido mucoide, de 23 × 17 × 11 mm y color marrón. El revestimiento del quiste estaba formado por mucosa gástrica, con epitelio foveolar y glándulas formadas por células parietales y principales. Conclusiones: El quiste de duplicación intestinal es una entidad extremadamente rara. El abordaje quirúrgico es eficaz y curativo con mínima morbilidad y mortalidad, sin recurrencia en su seguimiento.

Background: Intestinal duplication cysts are rare abnormalities that occur primarily during the perinatal period and may cause problems for feeding and/or breathing. Sublingual intestinal duplication cysts can present either gastrointestinal epithelium or respiratory or both; the latter two cases are called choristomas. Case report: We describe a 10-month-old infant who presented a sublingual cystic mass at birth. Total successful transoral resection and reconstruction of the tongue was performed in planes. The surgical specimen was a brown cystic structure of mucoid content with dimensions of 23 × 17 × 11 mm. The cyst lining consists of gastric mucosa with foveolar epithelium and glands composed of parietal and chief cells. Conclusions: The intestinal duplication cyst is an extremely rare entity. The surgical approach is effective and curative with minimal morbidity and mortality and without recurrence in follow-up.

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A obra ensina as técnicas deste tipo de exame de forma detalhada, analisando os aspectos normais e anormais das alterações ultrassonográficas do trato gastrointestinal, assim como as alterações Doppler que acarretam oferecendo conhecimento amplo, detalhado e útil sobre a matéria. A autora é reconhecida por sua técnica meticulosa do protocolo ultrassonográfico, que lhe garantiu a obtenção de ilustrações pertinentes a cada caso com alta qualidade visual.“Este é um assunto pouco abordado na área de Ultrassonografia, em Congressos ou até em livros especializados. Mas o tema vem ganhando importância devido à grande disseminação do exame ultrassonográfico na prática clínica, permitindo que a patologia intestinal seja detectada casualmente em rastreamentos de rotina. Estudos realizados recentemente permitiram caracterizar uma grande variedade de patologias intestinais detectáveis e diagnosticáveis pela ultrassonografia ao ponto do método ter um papel importantíssimo na investigação primária em algumas condições. Entre eles a apendicite, a diverticulite aguda e a Doença de Crohn”, explica a médica.Segundo a doutora as sondas ultrassonográficas de alta resolução ampliaram o universo diagnóstico e a precisão da avaliação de toda a parede intestinal e suas patologias (além da mucosa, o que não é possível com a endoscopia convencional). O trato gastrointestinal é um assunto do qual a especialista tem larga experiência na prática clínica de mais de 20 anos. Agora, pretende compartilhar com a classe médica seu aprendizado. Dedicou-se a escrevê-lo nos últimos dois anos. “Para você ter uma idéia, a parte de Doppler, por exemplo, estudada internacional”.

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Se comunica un caso de heterotopia gástrica en rectosigmoides con sangrado rectal como manifestación clínica, por lo que se efectuó la revisión bibliográfica del tema. Caso: Varón de 21 años de edad con rectorragia de una semana de evolución. Durante el estudio del caso se tomaron biopsias de lesiones ulceradas en mucosa rectal, que fueron enviadas para su estudio histopatológico. Resultados: En la muestra recibida se observaron fragmentos entremezclados de mucosa de colon y mucosa gástrica de tipo oxíntico (fúndica) cuyos adenómeros se hallaban en estrecha relación con las criptas de Lieberkühn. Conclusión: La heterotopia gástrica es un hallazgo infrecuente, más aún cuando se observa en segmentos muy apartados en el colon distal. Suele acarrear un curso indolente y benigno, sin embargo, en ocasiones conlleva ciertas malformaciones asociadas o complicaciones derivadas de la misma actividad secretora fisiológica del tejido ectópico. Raramente puede experimentar malignización.

We report a case of gastric heterotopia in the rectum and sigmoid colon clinically presented as rectal bleeding; a review of the literature on the topic is also presented. Case: Twenty-one-year-old male who had experienced rectal bleeding for one week. biopsies from ulcerated lesions in the rectum were taken and sent forward for histopathological assessment. Results: In the sample received, fragments of colon mucosa and oxyntic (fundus) gastric mucosa, which adenomeres were closely related to the crypts of Lieberkuhn. Conclusion: Gastric heterotopia is an unusual finding, even less common when it is located in distant segments of the distal colon. Although usually being a condition with an indolent and benign evolution, it may also produce certain malformations o complications, consequence of the same secretory activity of the ectopic tissue. It rarely becomes a malignant disease.

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En el presente trabajo se describe anatómica e histológicamente el tubo digestivo y aparato venenoso de Gemmula periscelida (Gastropoda: Turridae) en ejemplares colectados al Noroeste de la Plataforma Continental Yucateca. Se determinó que el tipo de epitelio que reviste a cada una de las zonas del tubo digestivo (probóscide, esófago anterior, medio y posterior, estómago, glándula digestiva e intestino) y al aparato venenoso, es diferente a lo reportado para otros túrridos; por lo que se infiere el posible mecanismo de alimentación para esta especie.

In this paper we realized anatomical and histologically description of the digestive tract and venom apparatus of Gemmula periscelida (Gastropoda: Turridae) specimens collected northwest of the Yucatan Shelf. Results of analysis show that there are differences in the type of epithelium coating each of the areas of the digestive tract (proboscis, anterior, middle and posterior esophagus, stomach, digestive gland and intestine) and of a venom apparatus with respect to that reported for other turrid snails. This suggests the possible feeding mechanism for this species.

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Most diminutive polyps (< 5 mm) detected during colonoscopy are hyperplastic, with no cancer risk. Endoscopic diagnosis would prevent unnecessary resection. Objective: To assess diagnostic accuracy of a simple endoscopic classification of diminutive polyps, applicable with current standard endoscopes. Methods: Subjects included patients with diminutive polyps, detected during colonoscopy. A generational cohort served for suggesting an endoscopic classification that was prospectively validated in a new cohort. Colonoscopies were performed by two experienced endoscopists, with standard colonoscopes (CFH180AL, Evis Exera II; Olympus), with narrow-band imaging (NBI). Endoscopic diagnosis was assessed in terms of Sensitivity, Specificity, Positive (PPV) and Negative Predictive Values (NPV) and Accuracy, using histological diagnosis as gold standard. Results: Generational cohort included 42 polyps. To classify polyps as ‘neoplastic’ or ‘non-neoplastic’ we used pit pattern (regular or irregular) and vascular marks (visible or non-visible). Validation cohort included 235 polyps, 63 percent of them hyperplastic. Neoplastic polyps were more frequent in proximal colon (49.2 percent) than in rectosigmoid (21.4 percent; p < 0.05). Endoscopic diagnosis revealed: Sensitivity = 75 percent; Specificity = 70 percent; PPV = 59 percent; NPV = 82 percent, and Accuracy = 72 percent. Diagnostic performance was better in rectosigmoid compared to proximal colon (NPV 90 percent vs 74 percent, respectively; p = NS). Both endoscopists showed significant differences in terms of their sensitivity (89 percent vs 60 percent, respectively; p < 0.05). The endoscopist with best results reached NPV = 97 percent in the rectosigmoid (n = 60). Conclusions: The proposed classification can be used in real-time. Endoscopic assessment may replace histological assessment of diminutive polyps of the rectosigmoid. Formal training is needed to reach the required diagnostic accuracy.

La mayoría de los pólipos < 5 mm detectados durante una colonoscopia son hiperplásticos, sin riesgo de cáncer. Su diagnóstico endoscópico evitaría resecciones innecesarias. Objetivo: Evaluar la precisión diagnóstica de una clasificación endoscópica de pólipos colónicos diminutos, aplicable con endoscopios habituales. Métodos: Se incluyeron pacientes con pólipos diminutos detectados durante colonoscopia. Una cohorte de generación sirvió para proponer una clasificación endoscópica, que se validó prospectivamente en una segunda cohorte. Las colonoscopias fueron realizadas por dos endoscopistas experimentados, con colonoscopios estándar (CFH180AL, Evis Exera II; Olympus), con narrow-band imaging (NBI). El diagnóstico endoscópico fue evaluado en términos de sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y precisión, usando el diagnóstico histológico como ‘gold standard’. Resultados: La cohorte de generación incluyó 42 pólipos. Para clasificar los pólipos como ‘neoplásico’ o ‘no neoplásico’ se utilizó el patrón superficial (regular o irregular) y las marcas vasculares (visibles o no visibles). La cohorte de validación incluyó 235 pólipos, 63 por ciento hiperplásticos. Los pólipos neoplásicos fueron más frecuentes en colon proximal (49,2 por ciento) que en rectosigmoides (21,4 por ciento; p < 0,05). El diagnóstico endoscópico indicó: Sensibilidad = 75 por ciento; Especificidad = 70 por ciento; VPP = 59 por ciento; VPN = 82 por ciento y Certeza Diagnóstica = 72 por ciento, y fue mejor en rectosigmoides que en colon proximal (VPN = 90 vs 74 por ciento, respectivamente; p = NS). Se observaron diferencias significativas en la sensibilidad al comparar ambos (89 vs 60 por ciento, respectivamente; p < 0,05). El endoscopista con mejor resultado alcanzó VPN = 97 por ciento en rectosigmoides (n = 60). Conclusiones: La clasificación propuesta es utilizable en tiempo real...

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Objective: to evaluate a barium study of the upper gastrointestinal tract in early postoperative monitoring of bariatric surgery patients, recording the anatomical characteristics of the gastric remnant and the frequency of complications such as leakage of contrast and emptying difficulties. Materials and Methods: we retrospectively evaluated the barium study of the upper gastrointestinal tract performed in 168 patients after gastric bypass (GBP) and 98 patients after vertical subtotal gastrectomy (VSG). All evaluated examinations were performed in the first five days after surgery. Gastric remnant volume was registered in relation to the T12 vertebral body (only in GBP), the presence and site of contrast leakage and gastric remnant emptying difficulties. Results: the average age of patients undergoing GBP was 43 years, and 37 years for VSG. The average volume of gastric remnant of patients with GBP was 1.5 T12 vertebral bodies. Two GBP operated patients (1.2 percent) had leakage of the contrast medium at the level of the gastroenteric anastomosis; in VSG operated patients the contrast leakage occurred in 7 cases (7.1 percent), the most frequent site being the left side cephalic portion of the gastric remnant. All cases with contrast leakage were subsequently studied using computed tomography, finding the presence of wound dehiscence or fluid collections adjacent to the gastric remnant. Emptying difficulty was observed in 12 patients operated for GBP (7.1 percent); there was no record of this complication in patients undergoing VSG. Conclusion: the upper gastrointestinal barium study is useful in patients after bariatric surgery to assess the early postoperative anatomy and volume of the gastric remnant, as well as to detect possible complications. It is a simple test, which should be applied as a routine control in these patients.

Objetivo: evaluar el estudio baritado del tubo digestivo alto en el control postoperatorio precoz de pacientes operados de cirugía bariátrica, registrando las características anatómicas del remanente gástrico y la frecuencia de complicaciones como filtración del medio de contraste y dificultad al vaciamiento. Materiales y método: se evaluó retrospectivamente el estudio baritado del tubo digestivo alto realizado en 168 pacientes postoperados de bypass gástrico (BPG) y 98 pacientes postoperados de gastrectomía subtotal vertical (GSV). Todos los exámenes evaluados fueron realizados en los primeros cinco días postcirugía. Se registró volumen del remanente gástrico en relación al cuerpo vertebral T12 (sólo en BPG), presencia y sitio de filtración del medio de contraste y dificultad al vaciamiento del remanente gástrico. Resultados. La edad promedio de los pacientes sometidos a BPG fue de 43 años y GSV 37 años. El volumen promedio del remanente gástrico de los pacientes con BPG fue 1,5 cuerpos vertebrales T12. Dos pacientes operados de BPG (1,2 por ciento) presentaron filtración de medio de contraste a nivel de la anastomosis gastro-enteral; en los pacientes operados de GSV la filtración del medio de contraste ocurrió en 7 casos (7,1 por ciento), siendo el sitio más frecuente la porción cefálica lateral izquierda del remanente gástrico. Todos los casos de filtración de medio de contraste fueron posteriormente estudiados con tomografía computada, comprobándose la presencia de dehiscencia de la sutura o bien colecciones líquidas adyacentes al remanente gástrico. Se observó dificultad al vaciamiento en 12 pacientes operados de BPG (7,1 por ciento); no se registró esta complicación en los pacientes operados de GSV. Conclusión: el estudio baritado del tubo digestivo alto es útil en pacientes postoperados de cirugía bariátrica para conocer la anatomía y el volumen del remanente gástrico en el postoperatorio precoz, así como también para detectar posibles complicaciones...

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La ingestión de cuerpo extraño es una condición frecuente en los servicios de urgencias. Aunque la mayoría de los objetos son eliminados sin causar sintomatología, algunas veces producen manifestaciones según la localización y las características del mismo o pueden pasar desapercibidos y producir complicaciones severas que amenazan la vida del paciente. Se reportan tres casos de cuerpo extraño como hallazgo incidental durante endoscopia digestiva alta y se realiza una revisión de la epidemiología de esta condición, así como la variedad de presentaciones clínicas según el órgano comprometido, complicaciones secundarias y aproximaciones diagnósticas. Finalmente se propone un diagrama de flujo diagnóstico y terapéutico que unifica los propuestos en la literatura médica.

Foreign body ingestion is a common condition in the emergency department. Although most objects get away without symptoms, events occur depending of their location and characteristics or may go unnoticed and later cause severe complications that threaten the patient’s life. We report three cases of foreign bodies identified during upper gastrointestinal endoscopy as an incidental finding and a review of the epidemiology of this condition, and the variety of clinical presentations depending on the organ involved, secondary complications and diagnostic approaches. Finally, we propose a flow chart diagnosis and treatment that unifies those proposed in the literature.

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The macroscopic anatomy and vascularization of the stomach compartments of Bradypus torquatus were examined in five animals from the University of São Paulo College of Veterinary Medicine and Zootechny collection. The method included aqueous perfusion of the arterial network, colored latex injection, fixation in formaldehyde (10 percent) and preservation in Laskovisk solution. Dissections were performed under mesoscopic light and photo documentations were performed for description and data analysis. In these animals, the largest abdominal organ was the stomach, which internally presented the cardiac, fundic and prepyloric regions, subdivided in six compartments (cardiac right, middle and left; fundic; pre-pyloric I and II). The stomach was irrigated by the left gastric and celiac arteries, which are ventral visceral branches of the abdominal aorta. These arteries emerged in the retroperitoneal region and reached the viscera through the mesogastric region, distributed in the large and small stomach curvatures, in the spleen and the pancreas. The primary collateral branches of the left gastric artery are directed to the large stomach curvature, and the celiac artery irrigated the spleen, the pancreas and the small stomach curvature. The vascular pattern differed in some aspects from that observed in the other multi-cavity stomachs of recent vertebrates.

Fue descrita la anatomía macroscópica y vascularización de los compartimientos del estómago en 5 Bradypus torquatus, animales pertenecientes al acervo de la Facultad de Medicina Veterinaria y Zootecnia de la Universidad de São Paulo - Brazil. El método incluyó: perfusión acuosa de la red arterial, inyección de látex coloreado, fijación en formaldehido (10 por ciento) y conservación en solución de Laskovisk. Para la descripción y análisis de los datos se realizaron disecciones bajo mesoscopía de luz y archivos fotográficos. Los animales presentaron el estómago como la víscera abdominal más abundante, que posee internamente las regiones: cardiaca, fúndica y pre-pilórica, subdivididas en seis compartimientos (cardiaco, derecho, medio e izquierdo; fúndico; pre-pilórico I y II). Estaba irrigado por las arterias gástricas izquierda y celiaca, que son ramas viscerales ventrales de la parte abdominal de la aorta. Estas arterias emergían en el retroperitoneo y a tráves del mesogastrio alcazaban las vísceras distribuyéndose en la gran y pequeña curvatura del estómago, bazo y páncreas. Las ramas colaterales primarias de la arteria gástrica izquierda estaban destinadas a la gran curvatura del estómago y los de la arteria celíaca irrigaban el bazo, páncreas y pequeña curvatura del estómago. El estándar vascular del Bradypus torquatus más conocido como oso perezoso de tres dedos demostró ser diferente, en algunos aspectos, al de otros estómagos pluricavitarios en vertebrados.

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Introducción: Cada año en todo el mundo se identifica alrededor de un millón de casos nuevos de cáncer colorrectal y medio millón de muertes. En México es la segunda neoplasia maligna gastrointestinal, después del cáncer de estómago. La sobrevida a cinco años en etapas tempranas es mayor de 90 %. No es raro el diagnóstico incidental por los cirujanos generales. El propósito de este trabajo es analizar el manejo por el cirujano general del cáncer de colon que se diagnostica incidentalmente. Caso clínico: Hombre de 74 años de edad quien ingirió accidentalmente su prótesis dental al estar comiendo; 72 horas previo al ingreso al servicio de urgencias inició con abdomen agudo por obstrucción intestinal. Por laparotomía exploradora se observó una masa estenosante en colon descendente, donde se alojó la prótesis dental; el informe de patología indicó adenocarcinoma de colon izquierdo Dukes A. El paciente evolucionó satisfactoriamente y fue integrado a un protocolo oncológico. Al momento de este informe el paciente tenía cinco años sin actividad tumoral. Conclusiones: Es conveniente que los cirujanos que se enfrentan a obstrucción intestinal por la ingestión accidental de un cuerpo extraño en la edad adulta, sospechen siempre una estenosis por posible neoplasia.

BACKGROUND: Approximately one million new cases of colorectal cancer are detected worldwide, causing about one million deaths per year. In Mexico it is the second most common gastrointestinal malignancy, after stomach cancer. The 5-year survival in early stages is > 90%. This condition is incidentally diagnosed by the general surgeon in many cases because ingestion of foreign bodies is a not uncommon condition in adults, reported more frequently in older people because of their dentures. One complication of ingestion of any foreign body is intestinal obstruction. The aim of this study is to analyze management of colon cancer diagnosed incidentally by the general surgeon. CLINICAL CASE: We report the case of a 74-year-old male who accidentally swallowed his dentures while eating. After 72 h of admission to our emergency department, his clinical diagnosis was acute abdomen due to intestinal obstruction. Laparotomy was performed and revealed a stenosing mass in the left colon where the dentures were located. Pathology later reported a left colon adenocarcinoma staged as Dukes A. The patient evolved satisfactorily and is currently at 5 years without tumor activity. CONCLUSIONS: It would be useful for surgeons who are faced with an intestinal obstruction due to the accidental ingestion of a foreign body in an adult to always suspect stenosis for possible malignancy.

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