La macrobiopsia endoscópica en el diagnóstico de la enfermedad de Menetrier

For the anatompathological diagnosis of Menetrier's disease to be made, it is necessary to have a biopsy covering the entire thickness of the mucosa. Until a few years ago, to obtain this it was necessary to resort to a surgical biopsy performed during the course of a laparotomy. We present our experience in 6 patients suffering from this disease, in whom the conventional biopsies taken during the course of a gastroscopy, did not enable us to make the anatomopathological diagnosis of the said entity. The performing during the same exploration of an endoscopic macrobiopsy taken with a polypectomy loop provided us with the diagnosis. The simplicity, harmlessness and abscence of complications as well as its diagnostic efficiency, along with the fact that a laparotomy is avoided, mean that this technique is vitally important in the diagnosis of Menetrier's disease

Pituitary apoplexy: results of surgical and conservative management clinical series and review of the literature

Pituitary apoplexy is associated with visual, cranial nerve, and endocrine dysfunction. In this article, the results of surgical and conservative management of pituitary apoplexy in a single center are evaluated and a review of the literature is presented. A retrospective analysis was made of patients with pituitary apoplexy who underwent surgery or conservative management at our center between January 2007 and June 2017. Surgery was typically selected for patients who presented with acute deterioration of visual status and/or level of consciousness. Patients with no visual field deficit and those who had medical contraindications to undergo a surgical procedure because of previous comorbidities typically had conservative treatment. Baseline characteristics and clinical and radiologic outcomes were reviewed. A review of the literature (1990-2018) was performed according to PRISMA guidelines. Studies comparing the results of conservative and surgical management were identified. Visual, cranial nerve, and endocrine outcomes and tumor recurrence were analyzed. Forty-nine patients (73.1%) were managed surgically and 18 (26.9%) conservatively. After careful case selection, patients underwent surgical or conservative treatment. Patients who underwent conservative treatment had fewer visual deficits. At diagnosis, visual deficit (38.8% vs. 75.5%; P = 0.008) and cranial nerve palsy (27.7% vs. 51%; P = 0.058) were less common in the conservative group. Conservative and surgical treatments had similar visual and cranial nerve improvement rates (75% vs. 58.3%, P = 0.63 and 75% vs. 692%, P = 1.0, respectively). In the conservative group, tumor shrinkage was observed in 76.4% of cases. The systematic review retrieved 11 studies. No significant difference between conservative and surgical treatment for clinical outcomes (visual field recovery, odds ratio [OR], 1.45; 95% confidence interval [CI], 0.72-2.92; cranial nerve recovery, OR, 2.30; 95% CI, 0.93-5.65; and hypopituitarism, OR, 1.05; 95% CI, 0.64-1.74) or tumor recurrence (OR, 0.68; 95% CI, 0.20-2.34) was observed. A tailored approach to pituitary apoplexy, one that does not include an absolute need for surgery, is appropriate. Conservative management is appropriate in selected patients presenting without visual deficits.130E988E99