Biomedical subjects
Publications and source records attributed to J Monés.
An endoscopic cytology procedure was performed in 25 patients with a final diagnosis of carcinoma of the ampulla of Vater. A diagnosis of malignancy was made cytologically in 22 instances, and in 9 patients cytology was the only positive finding before operation. In two cases endoscopic biopsy was positive while the cytologic examination did not confirm the histological diagnosis.
BACKGROUND: We evaluate two different commercially available kits for detecting specific antibodies against Helicobacter pylori in a group of 48 patients with gastrointestinal symptoms that underwent an endoscopic procedure. We also study the seroprevalence of anti-H. pylori antibodies in asimptomatic individuals from our area. METHODS: Microbiologic and pathologic studies were performed in 48 gastric biopsies, in relation with antibodies detection using ELISA (Pylori stat test, Whittaker) and latex particles agglutination (Pyloriset, Orion). We also used ELISA tests for determining the seroprevalence of H. pylori antibodies in 139 asimptomatic individuals. RESULTS: Ninety-four percent of patients with peptic ulcer disease and 81% of patients without peptic ulcer disease but complaining of dyspepsia were infected by H. pylori. None of the patients with normal gastric mucosae was found to be infected. Sensitivity and specificity of ELISA test were 100% and 73%. Latex test sensitivity and specificity were 46% and 82%. The seroprevalence of antibodies among healthy individuals in our area increases with age (19% among children under 9 years of age) and reaches a peak at 40-49 years of age (84%), with a mean value of 60% in all ages' groups. CONCLUSIONS: There is a high correlation between Helicobacter pylori infection and gastric mucosa alterations. The ELISA test is best correlated with other laboratory data used for defining infection. The seroprevalence of H. pylori antibodies is also high, and therefore we recommend that the use of serologic diagnostic test must be highly selective.
PURPOSE: To assess the prevalence and clinico-biologic characteristics of pernicious anaemia (PA) showing subtle or atypical onset. MATERIAL AND METHODS: One-hundred and twenty-four patients were found to fulfill criteria for PA (serum vitamin B12 deficiency due to absence of intrinsic factor secretion because of severe gastric atrophy). Of them were disclosed those lacking macrocytosis (MCV less than 98 fL), with or without anaemia (Hb less than 120 g/L in women and less than 14 f/L in men), but showing decreased serum B12 rates (less than 150 pmol/L). RESULTS: Macrocytosis was absent in 15 out of the 124 cases (12.1%); either they had anaemia or not, serum B12 rates were decreased in all cases. Eight patients had concurrent iron deficiency, one had secondary anaemia, two had polycythaemia and four were normal from a haematological standpoint. Serum B12 assays were performed because of neuropsychiatric impairment (2 cases), polycythaemia study (3 cases), or positive anti-parietal cell antibodies found in an immunologic study (4 cases). The remaining patients were studied for chronic atrophy of the gastric mucosa (2 cases), and Plummer-Vinson syndrome, leucopenia and nutritional assessment (1 case of each condition). CONCLUSIONS: Atypical presentation of pernicious anaemia, whose frequency is probably underestimated, was confirmed in our environment. This condition must be suspected and ruled out in patients with characteristics similar to those described above.
Gastropathy by portal hypertension constitutes the second cause of digestive hemorrhage in these patients following esophagogastric varices. Beta-blocker drugs seem efficient in treatment as occasionally does therapeutic endoscopy. The case of a patient with chronic liver disease with upper digestive hemorrhage is presented. The patient did not respond to medical treatment with beta-blockers nor to endoscopy (thermic and sclerosant). Portocaval anastomosis was performed with no posterior hemorrhagic relapse. The use of shunt surgery has been suggested in this pathology given the rarity of its presentation in patients with this type of operation. The satisfactory evolution of the patient seems to confirm this hypothesis.
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The rate of gastric emptying of two antacids, magaldrate and Maalox, was investigated using scintigraphy. Successful labelling of the antacids was carried out with 99mTc. The stability of the 99mTc-labelled antacids was satisfactory and there was no difference in antacid capacity between the labelled and unlabelled antacids. The studies were carried out on 15 healthy male volunteers. After an eight hour fast each subject ingested a standardised meal of 95.7 MJ (400 kcal). One hour later 10 ml of one of the two antacids previously labelled with 99mTc was administered. Serial detection by anterior and posterior projection of the amount of antacid retained in the stomach was performed to determine gastric emptying of antacid. One week later the study was repeated under the same conditions with the other antacid also labelled with 99mTc. The mean (SD) percentages of antacid retained in the stomach fit a linear model with a t1/2 of 86.6 (15.3) minutes for magaldrate and 52.3 (5.2) minutes for Maalox (p less than 0.01). When the mean percentages of retention at six time intervals were compared for both antacids, it was found that Maalox emptied much faster (p less than 0.01 at 15 and 30 minutes, p less than 0.02 at 45, 60, 75, and 90 minutes).
The usefulness of culturing gastric biopsies obtained by endoscopic visualization, Gram stain, immediate and late urease test, and histologic observation of Campylobacter pylori in the diagnosis of gastric mucosa infection by Campylobacter pylori was assessed in 75 patients. Four antral biopsies were obtained in 75 patients, 35 with duodenal ulcer and 40 with nonulcerous dyspepsia and all specimens were subjected to the above procedures. Positive criteria for infection were either a positive culture or the concurrence of positive Gram stain, positive urease test before 24 hours and observation of the Campylobacter pylori at the histologic preparations. The sensitivity and specificity of every test was calculated. The most useful tests were the biopsy culture and the early urease reaction. It should be pointed out that the ureasa test is rapidly done, has a low cost, and possess a high degree of reliability. Therefore it is very useful to the clinician and to the endoscopist.
The gastric emptying of solids was evaluated with radionuclide techniques in 16 patients with reflux esophagitis, demonstrated by two of the following methods: endoscopy, pathology, and/or pH measurement. The percentage of radionuclide remaining within the stomach was 80.8 +/- 17% after 45 minutes, 63.3 +/- 10% after 75 minutes, and 48.8 +/- 19% after 105 minutes, with a half time (T1/2) of gastric emptying of 103.4 +/- 6 minutes. These results showed significant differences in T1/2 with those from a control group of healthy individuals, the gastric emptying being slower in patients with esophagitis (103.4 min vs 85.3 min; p less than 0.01). Subsequently, a double blind study to assess the effect of metoclopramide and cinitapride on gastric emptying in patients with reflux esophagitis was carried out. Cinitapride accelerated the gastric emptying of solids with statistically significant differences when compared with placebo (84 min vs 104 min, p less than 0.05). In this study, metoclopramide showed a tendency to accelerate gastric emptying, although it did not achieve a significant difference with placebo.
The concept of acute febrile neutrophilic dermatosis (Sweet's syndrome) has evolved and expanded to include, under the denomination of neutrophilic dermatosis (ND), both pyoderma gangrenosum and the intestinal bypass syndrome, with or without intestinal bypass, vesicular and pustular rash associated with ulcerative colitis (UC), and Sweet's syndrome itself. Among the skin lesions associated with UC several types of vesicular and pustular rash have been reported and, very rarely, the association of UC and Sweet's syndrome has been reported. We report a female with UC who developed a vesicular and pustular rash associated with an exacerbation of her colonic disease. Two years later she developed a characteristic Sweet's syndrome coincident with another exacerbation of UC. The concurrence of two different forms of ND associated with successive exacerbations of UC supports the concept of ND as an individual condition with several types of clinical presentation.
Bezoars are conglomerates of undigested material in the stomach, which appear as a late complication of gastric surgery and are presumably related to secondary motility changes. We studied the gastric emptying of a technetium-99m-(Tc 99m) labelled solid meal in 10 patients who presented with a bezoar 1 to 20 years after vagotomy and pyloroplasty, vagotomy and antrectomy, vagotomy and gastrojejunostomy, or hemigastrectomy. The results were compared with the emptying data of operated patients without bezoars. The gastric retention of Tc 99m-labelled solids at 45, 75, and 105 minutes was 85 +/- 15 percent (mean +/- SD), 79 +/- 17 percent, and 65 +/- 24 percent, respectively. No differences were found when results were compared with those of operated patients without bezoars. We concluded that factors other than the gastric digestive phase are the main contributors to bezoar formation.
The present prospective randomized trial has been carried out to assess the efficacy of the endoscopic injection of epinephrine plus polidocanol, in the prompt treatment of upper gastrointestinal bleeding due to peptic lesions. Over a period of one year, 72 patients were admitted to the study. Thirty-six of these underwent endoscopic treatment (group A), while the others received medical treatment (group B). Definitive hemostasis was achieved in 29 patients in group A, and in 21 in group B (p less than 0.05). Seven patients in group A and 12 in group B underwent emergency surgery for persistent or recurrent bleeding (p = NS). Three patients from group B received endoscopic treatment owing to relative surgical contraindications. It was successful in all of them. Patients from group A needed a significantly lower number of units of packed red cells (p less than 0.05). Our results show that it is justified to employ endoscopic injection as the first therapeutic step in upper GI bleeding due to peptic gastroduodenal lesions.
We have studied the gastric (fundic and antral) emptying of solids and liquids by a radionuclide method in 20 patients after truncal vagotomy and pyloroplasty (TVP) and in 10 control subjects. Gastric emptying of solids in TVP patients was similar to that of the control group (NS), but fundic emptying did not show a lag phase and was significantly faster. A significantly higher percentage of the solid fraction of the test meal filled the antrum (32 +/- 16% versus 20 +/- 9%; p less than 0.05), and this quantity was constant during the study period. Gastric emptying of liquids was greatly hastened after surgery. In 22 min 50 +/- 16% had left the stomach (versus 40 +/- 14% in controls; p less than 0.001). At 90 min the amount of liquid remaining in the stomach was similar to that in the control subjects. TVP accelerates fundic emptying of solids, which are transferred to an overfilled, paretic antrum. Liquids are emptied by a bimodal pattern with a precipitous initial emptying followed by a second slower phase.
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The main source of circulating immunoreactive somatostatin (IRS) seems to be the gastrointestinal tract. We therefore investigated plasma IRS in patients with various gastrointestinal diseases. Mean basal IRS oscillated between 46 and 73 pg/ml. A postprandial rise was observed in all patients and age-matched controls. However, the increment was significantly higher in patients with duodenal ulcer (159 +/- 20 pg/ml), active ulcerative colitis (176 +/- 17 pg/ml), and irritable bowel syndrome (194.4 +/- 20.4 pg/ml). Patients with duodenal ulcers who underwent vagotomy showed a decreased postprandial increment (107 +/- 10 pg/ml) when compared with active duodenal ulcer patients. No difference was demonstrable between controls and individuals with gastric ulcer, and patients with inactive ulcerative colitis. These results suggest that vagal innervation plays a role in postprandial IRS stimulation, whereas gastric hyperacidity, acute lesions of the colonic mucosa, and hypermotility of the gastrointestinal tract are associated with an exaggerated postprandial IRS response. Since somatostatin is known to influence many gastrointestinal functions, these variations in circulating IRS concentrations may be of pathophysiologic importance.
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