translation translation |
|---|
{
"en": "The biopsy size generally ranges from 0.3 to 0.5 cm which is sufficient if the sample is carefully handled.",
"es": "El tamaño de la biopsia oscila generalmente entre 0,3 a 0,5 cm, suficiente si se tiene cuidado en su manejo."
} |
{
"en": "Our pathology service recommends that the surgeon avoid areas of the mucosa which look like they contain micronodules, as these samples are generally lymphoid aggregates occupying the submucosa and displacing Meissners plexus.",
"es": "Como recomendación de parte del servicio de patología, le sugerimos al... |
{
"en": "Unlike routine biopsies in which the pathologists duties are limited to counting the fragments received, measuring them, and putting them into the processing cassettes, testing of biopsies taken for diagnosis of HD should be guided by a specialist. For these cases the layer necessary for diagnosis is the su... |
{
"en": "I recommend placing the fragment on a piece of paper with the mucosa side down. Then, stretch the tissue carefully so as not to crush it, and make as many parallel cuts as possible along the minor axis with distance between each cut of approximately 0.10 cm Figure 2 and 3.",
"es": "Recomiendo colocar el fr... |
{
"en": "The purpose of this procedure is to avoid to the extent possible oblique inclusions which contain very little of the submucosa, and to avoid samples of only the \"head\" which in which the observable tissue is either rectal mucosa or muscularis mucosa Figure 4.",
"es": "El propósito de este procedimiento e... |
{
"en": "In our service technicians have already been shown Figures 2 and 3 and have been taught that for these samples, unlike other gastrointestinal tract biopsies, the key part to study is the submucosa. Given that the technician has already received guidance on the type of samples to be tested, we send the materi... |
{
"en": "This result is between 60 and 120 slides per biopsy.",
"es": "Si tenemos en cuenta que cada fragmento se ha dividido en 2, 3 ó 4 pedazos esto da entre 60 y 120 niveles por biopsia."
} |
{
"en": "It is important to order the series from the start to ensure that tissue is not wasted in mounting and remounting the slices.",
"es": "Es importante ordenar el seriado desde el principio ya que garantiza que no se desperdicie tejido en la \"monta\" y \"remonta\" del bloque."
} |
{
"en": "In most cases this is sufficient to diagnose or rule out aganglionosis.",
"es": "La mayoría de las veces este seriado es suficiente para diagnosticar o descartar una aganglionosis."
} |
{
"en": "At the same time, usually is a small remnant of tissue in the block which can be used to add to the series in problematic cases or which can be tested with supplementary immunohistochemistry.",
"es": "Al mismo tiempo, generalmente queda un pequeño remanente de tejido en el bloque que puede ser utilizado en... |
{
"en": "It is important that a pathologist who is not an expert in HD to have clear concepts about the classic indications of this disease.",
"es": "Es muy importante que el patólogo, así no sea un experto en EH, maneje conceptos claros sobre los hallazgos clásicos de esta enfermedad."
} |
{
"en": "You can not confuse, \"I see no ganglion cells,\" with, \"There are no ganglion cells.\"",
"es": "No puede confundirse el \"no veo células ganglionares\" con el \"no hay células ganglionares\"."
} |
{
"en": "Since this is a disease the diagnosis of which is based on the absence of an element of histology, it is essential that the pathologist is sure that, both in terms of technology and knowledge, everything is consistent with aganglionosis.",
"es": "Ya que esta es una enfermedad donde el diagnóstico se basa e... |
{
"en": "In general terms classical HD, i.e. short segment HD which occurs in 75% to 80% of cases, involves the distal sigmoid colon and rectum and is characterized histologically by nerve filaments which are large, thick, and compact. Nerve filaments are generally larger than 40 microns in diameter, and there are de... |
{
"en": "If the filaments are few, small or lax, and do not look like neurons, it is valid to question the diagnosis and to suspect other diseases 3, 9.",
"es": "Si los filetes son escasos, pequeños o laxos, así no se vean neuronas, es válido poner en duda el diagnóstico y sospechar otras enfermedades 3, 9."
} |
{
"en": "It is important to remember that long segment aganglionosis, especially total colonic aganglionosis, contrary to usual there can be decreased or nearly absent plexus. In these cases, as in almost all pathological studies, history and correlation are essential to guide the pathologist.",
"es": "Es important... |
{
"en": "It is also vitally important to determine when a biopsy is insufficient or inadequate for diagnosis.",
"es": "Es igualmente de vital importancia determinar cuándo una biopsia es insuficiente o inadecuada para el diagnóstico."
} |
{
"en": "Anatomically, the lower level of sampling is should be one or ideally 2 cms above the pectinate line.",
"es": "Desde el punto de vista anatómico se recomienda que el nivel inferior de toma de la muestra sea de 1, idealmente 2 cm por encima de la línea pectínea."
} |
{
"en": "Biopsies which are very low or close to the anal sphincter may not have ganglion cells even when the patient does not have aganglionosis.",
"es": "Las biopsias muy bajas o cercanas al esfínter anal pueden normalmente no tener células ganglionares sin que necesariamente signifique que el paciente tiene agan... |
{
"en": "When ganglion cells are not observed in a biopsy and there are islands of squamous epithelium or sphincter muscle fibers, it is the unequivocal signature that the sample was obtained from below the pectinate line. This should always be reported as a sample which is inadequate for diagnosis.",
"es": "Cuando... |
{
"en": "If in doubt about the sampling site, I recommend making a note to remind the clinician and avoid misinterpretations.",
"es": "Si existen dudas del sitio de toma de la muestra recomiendo hacer una nota para recordarle este concepto al clínico y así evitar interpretaciones erradas."
} |
{
"en": "From the histological point of view a rectal biopsy is considered appropriate when the amounts of mucosa and muscularis mucosa together are equivalent in thickness to the amount of submucosa Figure 6 10.",
"es": "Desde el punto de vista histológico se considera que la biopsia rectal es adecuada cuando la c... |
{
"en": "If the amount of submucosa in the sample is good, but it contains a lymphoid follicle, this must also be considered unsuitable for making a HD diagnosis Figure 7.",
"es": "Si la submucosa es de buen tamaño pero está ocupada por un folículo linfoide debe igualmente considerarse inadecuada para el diagnóstic... |
{
"en": "For any type of sample received, the pathologist should look judiciously at all cuts. Sometimes neurons can be identified in the periphery of the follicle, or immersed in the muscularis mucosa, in which cases aganglionosis can certainly be ruled out even when biopsies seemed inappropriate for the study Figur... |
{
"en": "The easiest diagnosis to establish in biopsies of rectal mucosa-submucosa is that normal innervation is present. In fact, this is the most often seen case, and it can be confirmed with a review of just a few levels.",
"es": "El diagnóstico más fácil de establecer en las biopsias de mucosa-submucosa de rect... |
{
"en": "On the other hand, sometimes it is important to perform differential diagnoses.",
"es": "Por otro lado, en algunas ocasiones es importante tener presente otros diagnósticos diferenciales."
} |
{
"en": "Mucosa-submucosa biopsies are not adequate to rule out entities such as myopathies or hypoganglionosis, but they do allow us to confirm diagnoses of immature plexuses and to cause us to suspect intestinal neuronal dysplasia IND 6, 7.",
"es": "Las biopsias de mucosa-submucosa no son adecuadas para descartar... |
{
"en": "This entity has generated much discussion. While some pathologists consider that it exists, others accept it only as a secondary disorder associated with intestinal motility problems such as HD.",
"es": "Esta última es una entidad que ha suscitado muchas discusiones y de hecho, mientras algunos patólogos c... |
{
"en": "The most recent criteria determined that establishing a diagnosis of IND requires examination of at least 25 submucosal ganglions among which at least 20% must be giants having more than 8 ganglion cells in a cross-section. Taking biopsies 8 to 10 cm above the pectinate line is recommended. The criteria also... |
{
"en": "Within our institution, endo-rectal biopsies are almost never done at levels as high as 10 cm above the pectinate line.",
"es": "Prácticamente nunca, al menos en nuestra institución, se hacen biopsias endorrectales a un nivel tan alto como 10 cm por encima de la línea pectínea."
} |
{
"en": "Therefore, when we find indications of \"hyperganglionosis\" in the submucosa of a patient who is over 1 year old, we refer the finding and suggest that it be correlated with clinical examination and radiology to rule out the possibility of IND.",
"es": "Por lo anterior, cuando encontramos un cuadro de \"h... |
{
"en": "If it is appropriate, the surgeon then maps endorectal biopsies to obtain 5 at the same level in order to have the minimum number needed to confirm or rule out dysplasia.",
"es": "Si el cirujano lo considera pertinente entonces hace un mapeo obteniendo 5 biopsias endorrectales al mismo nivel para hacer el ... |
{
"en": "These patterns are aggregated into rosette structures with minimal neuropils. Their morphology is different from that of mature neuron cells: they are smaller and bluish-gray, have darker nuclei, are eccentric, their nucleoli are not that prominent, and their cytoplasm is less elongated 11, 12.",
"es": "En... |
{
"en": "It is important to learn to recognize these cells and interpret them correctly in order to avoid misdiagnoses of aganglionosis Figure 9.",
"es": "Es importante aprender a reconocer estas células pues el no interpretarlas correctamente puede llevar a diagnósticos errados de aganglionosis figura 9."
} |
{
"en": "When a series of slides from a good quality biopsy does not show ganglion cells, I do not recommend specific immunostaining studies for bcl-2 or NSE immunoreactive ganglion cells or for Schwann cells Synaptophysin or S100 because the images are difficult to interpret Figure 10. My opinion is that if in 60 to... |
{
"en": "When the issue is whether the cells observed are immature neurons or not, I believe that immunohistochemistry may help clarify the diagnosis. I recommend using conventional markers for neurons such as those already mentioned: bcl-2 or NSE immunoreactive ganglion cells.",
"es": "Cuando el problema es defini... |
{
"en": "Within the wide range of commercially available markers, I especially recommend calretinin, a calcium-binding protein involved in the signaling pathway that plays an important role in the organization and operation of the central nervous system 13.",
"es": "Dentro de la gran variedad de marcadores del merc... |
{
"en": "This marker is considered to be an alternative to the acetylcholinesterase technique 5, 8. It gives a positive pattern in patients who do not have the disease while it is negative or very weakly positive in cases of aganglionosis Figures 11 and 12.",
"es": "Este marcador se considera una alternativa a la t... |
{
"en": "In normal patients it is positive in the muscularis mucosa, in the lamina propria and in the submucosal plexus where it stains the Schwann cells and Bly highlights the nuclei of neurons.",
"es": "En los pacientes normales hay positividad en la muscular de la mucosa, en la lámina propia y en el plexo submuc... |
{
"en": "In cases of aganglionosis there may be discrete calretinin positivity in nerve fibers, but negativity in the muscularis mucosa, in the lamina propria and, of course, in the nuclei.",
"es": "En casos de aganglionosis puede existir discreta positividad para calretinina en las fibras nerviosas pero se describ... |
{
"en": "Again, in these cases as in almost all pathology studies, immunohistochemistry should be interpreted in conjunction with hematoxylin and possible false positives or negatives taken into account.",
"es": "De nuevo, en estos casos como en casi todos los estudios de patología, las técnicas de inmunohistoquími... |
{
"en": "Classically HD is histologically characterized by large, thick nerve fibers which are generally greater than 40 microns in diameter. They are compact and definitely have no ganglion cells.",
"es": "La EH clásica se caracteriza histológicamente por tener filetes nerviosos gruesos, grandes generalmente mayor... |
{
"en": "Observation of the histological picture in a series of 100 cuts on average is sufficiently specific to establish a diagnosis.",
"es": "El observar este cuadro histológico en un seriado de 100 cortes en promedio tiene suficiente especificidad para establecer el diagnóstico."
} |
{
"en": "The presence of a few small, lax nerve fibers in the absence of ganglion cells must be evaluated with caution: it is prudent to suspect other diseases.",
"es": "La presencia de filetes nerviosos escasos, pequeños o laxos, en ausencia de células ganglionares debe ser evaluada con cautela y es prudente sospe... |
{
"en": "It is important to remember that this image may correspond to rare types such as long-segment aganglionosis or total colon aganglionosis. In these cases, contrary to the usual, there may be decreased or near absence of plexuses.",
"es": "Es importante recordar que esta imagen puede corresponder a los tipos... |
{
"en": "The morphology of immature ganglion cells is different than that of mature cells. Immature cells have rosette structures only a minimum amount of neuropils.",
"es": "Las células ganglionares inmaduras tienen morfología diferente, se agregan en estructuras rosetoides y tienen mínima cantidad de neuropilo."
... |
{
"en": "Learning how to recognize this is vital in order to avoid incorrect interpretations and misdiagnoses of aganglionosis.",
"es": "Aprender a reconocerlas es de vital importancia pues el no interpretarlas correctamente puede llevar a diagnósticos errados de aganglionosis."
} |
{
"en": "Immunohistochemistry with conventional markers such as NSE and BCL2 neurons is useful when there is a serious doubt about whether the cells observed are immature neurons since positive results from these tests will confirm the diagnosis.",
"es": "La inmunohistoquímica con marcadores convencionales para neu... |
{
"en": "If the laboratory has access to calretinin, this is a simple and reliable method to help establish a diagnosis of HD. It is considered to be an alternative to the acetylcholinesterase technique. It results in a positive pattern in patients without the disease, but is negative or very weakly positive in cases... |
{
"en": "My final recommendation is that we must not forget our responsibilities as pathologists when confirm or rule out a diagnosis of HD.",
"es": "Mi última recomendación es que no olvidemos la responsabilidad que tenemos los patólogos cuando confirmamos o descartamos una EH."
} |
{
"en": "Mortality rates from untreated aganglionic megacolon among children are as high as 80%.",
"es": "La mortalidad de un megacolon agangliónico sin tratamiento en la infancia es tan alta como el 80%."
} |
{
"en": "These include stenosis or leakage from the anastomosis, intestinal obstructions, pelvic abscesses or lesions, incontinence, and enterocolitis. It is a grave mistake not to diagnose the disease, but the picture is not better when a false diagnosis of HD is made since the patient will not only be subject to th... |
{
"en": "1 Internist and Gastroenterologist, Gastroenterology Unit, Hospital Universitario San Ignacio.",
"es": "1 Médico Internista. Gastroenterólogo, Unidad de Gastroenterología, Hospital Universitario San Ignacio."
} |
{
"en": "Pontificia Universidad Javeriana.Bogotá, Colombia.",
"es": "Pontificia Universidad Javeriana."
} |
{
"en": "2 Internist and Fellow of Gastroenterology and Digestive Endoscopy, Hospital Universitario San Ignacio.",
"es": "Bogotá, Colombia. 2 Médico Internista. Fellow de Gastroenterología y Endoscopia Digestiva, Hospital Universitario San Ignacio."
} |
{
"en": "We report on the case of a patient with pancreatic pseudocysts.",
"es": "El paciente fue remitido para manejo a nuestra institución."
} |
{
"en": "They presented as complications of an episode of acute pancreatitis which had manifested as epigastric pain, vomiting, and a postprandial sensation of fullness.",
"es": "Paciente masculino de 54 años quien fue remitido a la consulta de gastroenterología. Tenía antecedente de pancreatitis aguda PA dos años ... |
{
"en": "After 12 months of watchful waiting the patient had not improved.",
"es": "En el examen físico del paciente durante la consulta se encontró dolor en epigastrio a la palpación con ruidos intestinales positivos, no se sentía masa, no tenía fiebre ni taquicardia."
} |
{
"en": "Instead, an abdominal CAT scans revealed that the lesion persisted and had grown an additional 4 cm in diameter.",
"es": "Tenía un peso de 65 kg y un índice de masa corporal de 23,8."
} |
{
"en": "The patient was referred to our institution for treatment.",
"es": "La vía biliar se encontró normal."
} |
{
"en": "A magnetic resonance cholangiopancreatography MRCP image revealed that the pseudocyst passed through the proximal pancreatic duct.",
"es": "En el control a los 15 días posteriores a la inserción del stent, el paciente refería mejoría clínica notable con disminución del dolor y tolerancia a la vía oral."
} |
{
"en": "Endoscopic transpapillary drainage was successfully performed with the insertion of a pancreatic stent.",
"es": "En ecografía de abdomen de control se evidenció disminución del tamaño del pseudoquiste a 2 x 1 x 1 cm. Se decidió retirar el stent pancreático."
} |
{
"en": "The lesion had disappeared 30 days after drainage.",
"es": "Se realizó nuevo control 30 días después de la inserción del stent."
} |
{
"en": "Symptoms had not recurred 60 days after drainage.",
"es": "En el seguimiento a 60 días el paciente permanecía asintomático."
} |
{
"en": "A 54 year old male patient was referred to gastroenterology.",
"es": "Están comunicados con el ducto pancreático ya sea directamente o a través del parénquima pancreático 2."
} |
{
"en": "Two years earlier he had had acute pancreatitis following blunt trauma.",
"es": "La principales factores causales son la pancreatitis de etiología alcohólica, seguida de la biliar, y luego, del trauma de abdomen 3."
} |
{
"en": "Three months after the acute pancreatitis the patient began to present dull upper abdominal pain that was exacerbated by food intake associated with vomiting.",
"es": "Existen varias clasificaciones del pseudoquiste pancreático, una de ellas es la clasificación de Nealon y Walser 4 que basa en la anatomía ... |
{
"en": "An abdominal CT scan was requested.",
"es": "Tipo I: ducto normal/no comunicado con el quiste."
} |
{
"en": "It showed a pancreatic pseudocyst of 2.8cm x 3cm x3.1 cm located in the body of the pancreas.",
"es": "Tipo II: ducto normal comunicado con el quiste."
} |
{
"en": "Expectant management and clinical observation were decided upon.",
"es": "Tipo III: ducto con estenosis no comunicado con el quiste."
} |
{
"en": "However, after six months the patients pain had persisted and intensified.",
"es": "Tipo IV: ducto con estenosis y comunicación con el quiste."
} |
{
"en": "It was associated with vomiting and postprandial fullness.",
"es": "Tipo V: ducto con obstrucción completa."
} |
{
"en": "Another CT scan was performed.",
"es": "Tipo VI: pancreatitis crónica sin comunicación del ducto con el quiste."
} |
{
"en": "It showed that the pancreatic pseudocyst had grown to a size of 3cm x 4cm x 3.5cm.",
"es": "Tipo VII: pancreatitis crónica con comunicación del ducto con el quiste."
} |
{
"en": "The patient continued under medical care, taking hyoscine butylbromide and acetaminophen for pain with partial relief of symptoms.",
"es": "La mayoría de los pseudoquistes se resuelven espontáneamente en más del 50% de los casos por lo que se considera que el manejo inicial del paciente es con tratamiento ... |
{
"en": "The physical examination during the patients check-up showed epigastric pain with positive bowel sounds upon palpation.",
"es": "Se ha encontrado, en reportes individuales, que el pseudoquiste pancreático está conectado con el sistema ductal pancreático entre el 22 y 57% de los casos 7, 9."
} |
{
"en": "No masses were evident during palpitation. The patient had no fever or tachycardia.",
"es": "No se han publicado estudios prospectivos aleatorizados que den respuesta a las preguntas sobre la duración necesaria del tratamiento con stent en el ducto pancreático, el tiempo óptimo del stent o cada cuánto se d... |
{
"en": "His weight was 65 kg and his body mass index was 23.8.",
"es": "En un estudio publicado por Catalano y col con 37 pacientes, en 17 pacientes la resolución fue inmediata y 16 pacientes estaban libres de recurrencia a los 37 meses."
} |
{
"en": "SPatient underwent magnetic resonance cholangiopancreatography MRCP.",
"es": "El stent fue recambiado cada 6-8 semanas si el pseudoquiste permanecía sin resolver 8."
} |
{
"en": "It showed a unilocular cystic lesion in the body of the pancreas in continuity with the main pancreatic duct.",
"es": "En el caso de este paciente el pseudoquiste tenía 4 cm de diámetro mayor y estaba comunicado con el ducto pancreático principal."
} |
{
"en": "Its dimensions were 3.7cm x3.0cm x 4.1 cm which is consistent with a pseudocyst Figure 1.",
"es": "Con la inserción del stent la lesión se resolvió en 4 semanas con desaparición de los síntomas y sin recurrencia de los mismos a los 60 días de seguimiento."
} |
{
"en": "",
"es": ""
} |
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