[Humoral immunologic changes in inflammatory colonic diseases]

We present the humoral immunological findings in 18 patients with ulcerative colitis and two with Crohn's disease. All of them had the disease for 3 months to five years. Fifteen were hispanics and five from European origin. There were ten males and ten females, and an average age of 38 years. All patients had active disease from clinical and endoscopy points of view. Thirteen patients had abnormal values in one of the immunoglobulins and normal in seven patients. IgA was increased in eleven, normal in seven and decreased in two. IgG increased in two, decreased in one and normal in seventeen cases. IgM was found to be increased in five and normal in the rest. IgA secretory determination in saliva, was performed twelve patients and was positive in all of them. Antinuclear antibodies were negative in eight. Anti-smooth muscle were positive in three of fifteen. Anti-mitochondrial were present in one and negative in thirteen. Values of C3 and C4 were lower than normal in 3 and 2 cases respectively from 4 cases studied. CH50 was decreased in 2 of 11 cases studied. In the patients, no correlation was found between low complement values, the positivity of auto antibodies and the clinical parameters previously mentioned. We conclude that there is quantitative alterations of the humoral response and it is necessary the immunological study in persons with inflammatory bowel disease others studies are needed to establish the real value of these findings.

[Esophageal lesions caused by human papillomaviruses (HPV)]

Twenty two patients are presented with histologic lesions on esophageal biopsy compatible with infection by human papillomavirus. Symptoms were uncharacteristic, there was no sex difference and the mean age was 40 years. Upper GI endoscopy showed the following: a) multiple ulcers in the middle esophagus, most of less than 10 mm in diameter, rounded or oval in shape, separated by normal appearing mucosa, well delimited erythematous margins, with a smooth white base; b) In five patients, multiple white elevated lesions were found in the middle esophagus, separated by normal appearing mucosa. One patient had 2 papillomas; c) In two cases there was an epidermoid carcinoma at 25 and 28 cm from the dental arcade. Biopsy taken at the border of the lesions were compatible with papilloma virus infection. The possible relation of the lesions with papillomavirus infection was established only on histologic criteria. The described lesions regress without treatment or with nonspecific treatment, some cases of our series have responded to empiric antiviral medication.

[Preoperative endoscopic sphincterotomy]

We present a prospective unrandomized series of 40 patients with symptomatic choledocholithiasis and symptomatic cholelithiasis. The patients were divided in two groups of 20 patients each one. The patients fallen in the first group had endoscopic sphincterotomy and elective cholecystectomy on a later date in the same hospital course as the recommended treatment. The second group underwent elective cholecystectomy and common bile duct exploration. There was no difference in the percentage of morbidity and mortality between the groups. In the first group the figures on morbidity and mortality were not different from that seen when each process was performed alone. Endoscopic Sphincterotomy plus elective cholecystectomy is a therapeutic alternative in choledocholithiasis when there is gallbladder with stones.