In a prospective endoscopic and bioptic study, 141 control subjects and 359 patients with symptoms of gastroesophageal reflux (GER) were included to determine the prevalence of cardial epithelium inflammation or 'carditis' and to determine the prevalence of Helicobacter pylori in this area. Two biopsies at the antrum, four distal to the squamous-columnar junction and two proximal in the esophageal mucosa, were taken. Patients with gastroesophageal reflux were divided into four groups, according to the severity of endoscopic findings: patients without esophagitis, patients with erosive esophagitis, patients with short-segment and long-segment Barrett's esophagus (BE). Control subjects had normal histological findings at the cardia in 90% of cases, fundic mucosa being present twice as cardial epithelium. Carditis was present in 8% of cases and intestinal metaplasia (IM) in 2%. On the contrary, patients with GER had carditis in nearly 50% of cases. Intestinal metaplasia was present in 12% of cases with GER without esophagitis or erosive esophagitis, in 35% of cases with short-segment BE and in 65% of the cases with long-segment BE. IM at the antrum was present in only 5% of cases. Helicobacter pylori at the squamous-columnar junction was present in 13% of control subjects and in 30% of the patients with GER. It is concluded that carditis is an easy and objective marker for the presence of chronic gastroesophageal reflux and the presence of Helicobacter pylori at this region must be carefully evaluated in order to determine some pathogenic role for the development of Barrett's esophagus.
). Palabras Clave► alargamiento óseo ► clavo endomedular ► osteogénesis por distracción ResumenObjetivo Evaluar los resultados de alargamiento óseo sobre clavo endomedular (LON) en extremidades inferiores; comparar resultados locales con la literatura. Material y Método Estudio retrospectivo de pacientes operados con LON entre los años 2011 y 2015, con información de ficha clínica e imagenología. Descripción del paciente, procedimiento y evolución; con cálculo del Índice de Consolidación Radiológica (RCI) e Índice de Fijación Externa (EFI). Comparación con la literatura.Resultados Se reunieron 8 pacientes, con 12 procedimientos LON. 4 pacientes tuvieron alargamiento bilateral por talla baja constitucional y 4 pacientes tuvieron alargamiento unilateral por defectos de longitud, congénitos o adquiridos. En fémur (6) el alargamiento promedio fue 51 mm con 134 días de uso de tutor externo. El EFI promedio fue 0,87 meses/centímetro y RCI 1.83 meses/centímetro. En tibia (4) el alargamiento promedio fue 82 mm con 121 días de uso de tutor externo. El EFI promedio fue 0,49 meses/centímetro y RCI 1.64 meses/ centímetro. Todos los pacientes presentaron infección superficial de pines, requiriendo antibioterapia oral. 4 pacientes con LON de tibia presentaron contractura en equino y requirieron de alargamiento aquiliano percutáneo. 3 pacientes con LON de fémur presentaron retardo de consolidación, 2 requirieron aporte de injerto óseo. Discusión El LON es una excelente alternativa a los métodos tradicionales de alargamiento, con tiempos más cortos de uso de tutor externo. Se observan complicaciones relacionadas con la contractura músculo-tendinosa, manejadas al momento del retiro de tutor externo, con resultados satisfactorios para el paciente. Nivel de evidencia evidencia tipo 4, serie de casos clínicos AbstractObjective To evaluate the results of bone lengthening over an intramedullay nail (LON) in lower limbs and compare our results with the literature.
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