RESUMO
The gastric vascular ectasia (GAVE) or watermelon stomach (WS) is an unfrequent cause of anemia or evident upper gastrointestinal bleeding in elderly patients. We presented five female patients, average age 79 years, 4 of them with a long evolution anemia and one with melena. Three of them showed a typical WS endoscopy, 2 of them with diffuse patent. All 5 cases with positive pathologic findings: vascular ectasia, fibrin thrombi and fibromuscular hyperplasia. The endoscopic biopsy is as accurate as the study of the antrectomy piece. None of them had portal hypertension although the GAVE would be different entity from the cirrhotic vascular gastropathy. The treatment consisted in monopolar electrocoagulation of the lesions after the failure with the medical treatment in one case, corticosteroid and ferrous therapies in the three cases and one of them didn't require treatment up to now.
Assuntos
Anemia Ferropriva/etiologia , Antro Pilórico/irrigação sanguínea , Doenças Vasculares/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Anemia Ferropriva/tratamento farmacológico , Biópsia , Doença Crônica , Endoscopia do Sistema Digestório , Feminino , Seguimentos , Humanos , Ferro/uso terapêutico , Melena/diagnóstico , Melena/tratamento farmacológico , Melena/etiologia , Prednisolona/uso terapêutico , Antro Pilórico/patologia , Doenças Vasculares/complicações , Doenças Vasculares/tratamento farmacológicoRESUMO
La ectasia vascular del antro (EVA) o watermelon stomach (WS) es una causa poco frecuente de anemia o hemorragia digestiva alta manifesta en pacientes de edad avanzada. Presentamos 5 apcientes, todas mujeres, edad promedio 79 años, 4 anémicas de larga evolución y 1 con melena. Tres tenían endoscopía típica de WS, 2 tenían patente difusa. Las 5 con anatomía patológica positiva: ectasias vasculares y/o microtrombos fíbrinosos y proliferación fibromuscular en la l mina propria. La biopesia esdoscópica es tan fiel como el estudio de la pieza de antrectomía. Ninguna tenía hipertensión portal, aunque la EVA sería una entidad diferente a la gastropatía vascular del cirrótico. El tratamiento conssitió en electrocoagulación monopolar de las lesiones tras fracaso del tratamiento médico en 1 caso, corticoterpia mas ferroterapia en 3, mientras que el restante no requiere tratamiento por el momento. Conclusiones: la EVA debe tenerse presente en pacientes anémicos crónicos sien diagnóstico, de edad avanzada. Las im genes endoscópicas no siempre son las típicas del estómago en sandía (WS). Se debe biopsiar el antro gastrico ante la duda. Si no responden al tratamiento con corticoides y/o hierro, el tratamiento de elección es el laser o el "heat electrocoagulación monopolar o la esclerosis. La cirurgía es el último recurso a aplicar.
Assuntos
Idoso , Feminino , Humanos , Anemia Ferropriva/etiologia , Antro Pilórico/irrigação sanguínea , Doenças Vasculares/diagnóstico , Idoso de 80 Anos ou mais , Anemia Ferropriva/tratamento farmacológico , Biópsia , Doença Crônica , Eletrocoagulação , Endoscopia do Sistema Digestório , Seguimentos , Hiperplasia/diagnóstico , Hiperplasia/tratamento farmacológico , Hiperplasia/patologia , Ferro/uso terapêutico , Melena/diagnóstico , Melena/tratamento farmacológico , Melena/etiologia , Prednisolona/uso terapêutico , Antro Pilórico/patologia , Doenças Vasculares/complicações , Doenças Vasculares/tratamento farmacológicoRESUMO
La ectasia vascular del antro (EVA) o watermelon stomach (WS) es una causa poco frecuente de anemia o hemorragia digestiva alta manifesta en pacientes de edad avanzada. Presentamos 5 apcientes, todas mujeres, edad promedio 79 años, 4 anémicas de larga evolución y 1 con melena. Tres tenían endoscopía típica de WS, 2 tenían patente difusa. Las 5 con anatomía patológica positiva: ectasias vasculares y/o microtrombos fíbrinosos y proliferación fibromuscular en la l mina propria. La biopesia esdoscópica es tan fiel como el estudio de la pieza de antrectomía. Ninguna tenía hipertensión portal, aunque la EVA sería una entidad diferente a la gastropatía vascular del cirrótico. El tratamiento conssitió en electrocoagulación monopolar de las lesiones tras fracaso del tratamiento médico en 1 caso, corticoterpia mas ferroterapia en 3, mientras que el restante no requiere tratamiento por el momento. Conclusiones: la EVA debe tenerse presente en pacientes anémicos crónicos sien diagnóstico, de edad avanzada. Las im genes endoscópicas no siempre son las típicas del estómago en sandía (WS). Se debe biopsiar el antro gastrico ante la duda. Si no responden al tratamiento con corticoides y/o hierro, el tratamiento de elección es el laser o el "heat electrocoagulación monopolar o la esclerosis. La cirurgía es el último recurso a aplicar. (AU)
Assuntos
Idoso , Feminino , Humanos , Antro Pilórico/irrigação sanguínea , Doenças Vasculares/diagnóstico , Anemia Ferropriva/etiologia , Antro Pilórico/patologia , Anemia Ferropriva/tratamento farmacológico , Doenças Vasculares/complicações , Doenças Vasculares/tratamento farmacológico , Seguimentos , Biópsia , Endoscopia do Sistema Digestório , Hiperplasia/diagnóstico , Hiperplasia/patologia , Hiperplasia/tratamento farmacológico , Melena/diagnóstico , Melena/etiologia , Melena/tratamento farmacológico , Eletrocoagulação , Ferro/uso terapêutico , Prednisolona/uso terapêutico , Doença Crônica , Idoso de 80 Anos ou maisRESUMO
We are reporting 35 cases of gallbladder cancer in elderly people. 9 of them (25.7%) were operated with the diagnosis of acute cholecystitis. We point out the high incidence of the association of acute cholecystitis and gallbladder cancer, being the cholelithiasis a predominant factor in the pathogenesis of cancer. Considering that we found gallbladder cancer in 6.1% of the cholecystectomies, we advise to perform the surgical treatment in all the patients suffering of cholelithiasis.
Assuntos
Colecistite/complicações , Neoplasias da Vesícula Biliar/etiologia , Doença Aguda , Fatores Etários , Idoso , Colecistectomia , Colecistite/cirurgia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
We are reporting 35 cases of gallbladder cancer in elderly people. 9 of them (25.7
) were operated with the diagnosis of acute cholecystitis. We point out the high incidence of the association of acute cholecystitis and gallbladder cancer, being the cholelithiasis a predominant factor in the pathogenesis of cancer. Considering that we found gallbladder cancer in 6.1
of the cholecystectomies, we advise to perform the surgical treatment in all the patients suffering of cholelithiasis.
RESUMO
Twenty five hundred esophagogastroduodenoscopies were examined, separating all the duodenal erosions' cases. The most important conclusions refer to two facts in relations to the existence of duodenal erosions (DE) with respect to duodenal erosions when coexisting with gastric erosions (gastroduodenal erosions-GDE). In the duodenal erosions symptomatology dominated frankly, mainly ulcerous syndrome, typical or atypical (P less than 0,01). The GDE had a clear predominancy of bleeding referring to DE (P less than 0,01), suggesting that the DE are to be considered a nosologic entity different as the GDE. The ulcerogenious antecedents (drugs, stress, alcohol, etc.) were frankly positive in both cases when there was bleeding, but of low percentage in the cases without bleeding, suggesting that its presence is important in the causing of bleeding but not in the generating erosions in itself.
Assuntos
Duodenopatias , Adulto , Fatores Etários , Idoso , Duodenopatias/patologia , Duodenoscopia , Duodeno/patologia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores SexuaisRESUMO
According to Gerald Rogers et. al., we believe about the usefulness of colonoscopy and endoscopic biopsy using Williams' forcep (hot biopsy forcep) for the diagnosis and final treatment of colon vascular ectasias. This method should be used immediately after the hemorrhage has finished. Angiography is prescribed when: 1) endoscopy suggests or confirm the presence of vascular ectasias in order to establish the degree of lesions and the therapeutic management. 2) When the caecum cannot be reached by the colonoscope. 3) When endoscopy is negative and there is firm clinic assumption of ectasias but the colonoscopic study has been done to much later after the bleeding stopped. Selective angiography would be the first prescription in case of bleeding which doesn't stop quickly with the necessity of immediate therapeutic measures taking into account the difficulties of intrahemorrhagic colonoscopy. Five cases are presented to support this point of view concerning the diagnosis of vascular ectasias of the right colon and considerations are made about local treatment by mean of colonoscopy and hot biopsy forcep which, when it's possible, has less morbidity and mortality than surgery, specially in attention than this is an entity concerning elderly patients.
Assuntos
Colo/irrigação sanguínea , Doenças do Colo/diagnóstico , Colonoscopia , Eletrocoagulação/métodos , Idoso , Biópsia/instrumentação , Colo/patologia , Dilatação Patológica , Feminino , Hemorragia Gastrointestinal/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Se analizaron 2.500 esofagogastroduodenoscopias de nuestra Institucion separando todos los casos de erosiones duodenales.Las conclusiones mas importantes se refieren a dos hechos en relacion a la existencia de EDP con respecto a las EGD.En las EDP predomino francamente la sintomatologia, fundamentalmente sindrome ulceroso (dolor epigastrico), tipico o atipico (P < 0,01). A su vez las EGD tuvieron una clara predominancia de sangrado sobre las EDP (P < 0,01), sugiriendo que las EDP deben considerarse una entidad nosologica distinta a las EGD. Los antecedentes ulcerogenos (drogas, stress, alcohol, etc), fueron francamente positivos en ambos grupos cuando hubo sangrado, mientras que existieron en muy bajo porcentaje en los casos sin hemorragia, sugiriendo que su presencia es importante en la produccion del sangrado, pero no en la formacion de las erosiones en si
Assuntos
Duodenopatias , Hemorragia GastrointestinalAssuntos
Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Colonoscopia , Doenças do Colo , DilataçãoRESUMO
Twenty five hundred esophagogastroduodenoscopies were examined, separating all the duodenal erosions cases. The most important conclusions refer to two facts in relations to the existence of duodenal erosions (DE) with respect to duodenal erosions when coexisting with gastric erosions (gastroduodenal erosions-GDE). In the duodenal erosions symptomatology dominated frankly, mainly ulcerous syndrome, typical or atypical (P less than 0,01). The GDE had a clear predominancy of bleeding referring to DE (P less than 0,01), suggesting that the DE are to be considered a nosologic entity different as the GDE. The ulcerogenious antecedents (drugs, stress, alcohol, etc.) were frankly positive in both cases when there was bleeding, but of low percentage in the cases without bleeding, suggesting that its presence is important in the causing of bleeding but not in the generating erosions in itself.
RESUMO
According to Gerald Rogers et. al., we believe about the usefulness of colonoscopy and endoscopic biopsy using Williams forcep (hot biopsy forcep) for the diagnosis and final treatment of colon vascular ectasias. This method should be used immediately after the hemorrhage has finished. Angiography is prescribed when: 1) endoscopy suggests or confirm the presence of vascular ectasias in order to establish the degree of lesions and the therapeutic management. 2) When the caecum cannot be reached by the colonoscope. 3) When endoscopy is negative and there is firm clinic assumption of ectasias but the colonoscopic study has been done to much later after the bleeding stopped. Selective angiography would be the first prescription in case of bleeding which doesnt stop quickly with the necessity of immediate therapeutic measures taking into account the difficulties of intrahemorrhagic colonoscopy. Five cases are presented to support this point of view concerning the diagnosis of vascular ectasias of the right colon and considerations are made about local treatment by mean of colonoscopy and hot biopsy forcep which, when its possible, has less morbidity and mortality than surgery, specially in attention than this is an entity concerning elderly patients.
RESUMO
Se analizaron 2.500 esofagogastroduodenoscopias de nuestra Institucion separando todos los casos de erosiones duodenales.Las conclusiones mas importantes se refieren a dos hechos en relacion a la existencia de EDP con respecto a las EGD.En las EDP predomino francamente la sintomatologia, fundamentalmente sindrome ulceroso (dolor epigastrico), tipico o atipico (P < 0,01). A su vez las EGD tuvieron una clara predominancia de sangrado sobre las EDP (P < 0,01), sugiriendo que las EDP deben considerarse una entidad nosologica distinta a las EGD. Los antecedentes ulcerogenos (drogas, stress, alcohol, etc), fueron francamente positivos en ambos grupos cuando hubo sangrado, mientras que existieron en muy bajo porcentaje en los casos sin hemorragia, sugiriendo que su presencia es importante en la produccion del sangrado, pero no en la formacion de las erosiones en si
Assuntos
Duodenopatias , Hemorragia GastrointestinalAssuntos
Pessoa de Meia-Idade , Idoso , Humanos , Masculino , Feminino , Colonoscopia , Doenças do Colo , DilataçãoRESUMO
The authors report a case of a male 53 years old with a leiomyoma and a leiomyoblastoma in his stomach. The signs of clinical presentation were given by the leiomyoma. The leiomyoblastoma was a surgical finding. The rarity of the association of these two lesions and the malignant potentiality of them are reviewed, according to the previous literature.
Assuntos
Leiomioma/patologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Gástricas/patologia , Gastroscopia , Humanos , Leiomioma/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Neoplasias Gástricas/diagnóstico por imagemRESUMO
1.897 patients with upper gastrointestinal bleeding (UGIB) were studied and the cause was diagnosed in 1.756 (92.6%). The most frequently found pathology was the acute bleeding gastropathy (24.5%). Considering the gastric duodenal and anastomotic ulcer as a whole, in 47.5% of the cases the ulcer was observed. Both pathologies together make out that 72 out of 100 patients with UGIB have bleeding due to an ulcer or gastritis. It comes out that the low incidence of neoplasy as a consequence of UGIB and that the 31% of the diagnosed pathology could not have been diagnosed by X-ray.
Assuntos
Endoscopia/métodos , Hemorragia Gastrointestinal/diagnóstico , Doença Aguda , Duodeno , Varizes Esofágicas e Gástricas/complicações , Esôfago , Hemorragia Gastrointestinal/etiologia , Humanos , Úlcera Péptica/complicações , EstômagoRESUMO
Three cases of gastric leiomyoblastomas are presented (according to Stout's denomination) or epithelioid leiomyomas (according to Appelman). The subject is actualized and the low malignant potential of these tumors is pointed out. Leiomyoblastomas have to be classified among the leiomyomas (absolutely benign) and the leiomyosarcomas (malign). The lack of reliable criteria to determine the future of the patient is established, being the evolutive control the only way to make that clear. The mitotic counts--more than 5 for each 50 high-power dry objective field--is the most important isolated criterion to predict the probable malignancy of the lesion.
Assuntos
Leiomioma/patologia , Neoplasias Gástricas/patologia , Feminino , Mucosa Gástrica/patologia , Gastroscopia , Humanos , Leiomioma/diagnóstico , Masculino , Pessoa de Meia-Idade , Índice Mitótico , Prognóstico , Neoplasias Gástricas/diagnósticoRESUMO
1.897 patients with upper gastrointestinal bleeding (UGIB) were studied and the cause was diagnosed in 1.756 (92.6
). The most frequently found pathology was the acute bleeding gastropathy (24.5
). Considering the gastric duodenal and anastomotic ulcer as a whole, in 47.5
of the cases the ulcer was observed. Both pathologies together make out that 72 out of 100 patients with UGIB have bleeding due to an ulcer or gastritis. It comes out that the low incidence of neoplasy as a consequence of UGIB and that the 31
of the diagnosed pathology could not have been diagnosed by X-ray.
RESUMO
Three cases of gastric leiomyoblastomas are presented (according to Stouts denomination) or epithelioid leiomyomas (according to Appelman). The subject is actualized and the low malignant potential of these tumors is pointed out. Leiomyoblastomas have to be classified among the leiomyomas (absolutely benign) and the leiomyosarcomas (malign). The lack of reliable criteria to determine the future of the patient is established, being the evolutive control the only way to make that clear. The mitotic counts--more than 5 for each 50 high-power dry objective field--is the most important isolated criterion to predict the probable malignancy of the lesion.
RESUMO
1.897 patients with upper gastrointestinal bleeding (UGIB) were studied and the cause was diagnosed in 1.756 (92.6
). The most frequently found pathology was the acute bleeding gastropathy (24.5
). Considering the gastric duodenal and anastomotic ulcer as a whole, in 47.5
of the cases the ulcer was observed. Both pathologies together make out that 72 out of 100 patients with UGIB have bleeding due to an ulcer or gastritis. It comes out that the low incidence of neoplasy as a consequence of UGIB and that the 31
of the diagnosed pathology could not have been diagnosed by X-ray.
RESUMO
Three cases of gastric leiomyoblastomas are presented (according to Stouts denomination) or epithelioid leiomyomas (according to Appelman). The subject is actualized and the low malignant potential of these tumors is pointed out. Leiomyoblastomas have to be classified among the leiomyomas (absolutely benign) and the leiomyosarcomas (malign). The lack of reliable criteria to determine the future of the patient is established, being the evolutive control the only way to make that clear. The mitotic counts--more than 5 for each 50 high-power dry objective field--is the most important isolated criterion to predict the probable malignancy of the lesion.