Chronic hepatitis C treatment in a cystic fibrosis patient in the pulmonary pre-transplant stage.

The standard treatment of chronic hepatitis C, pegylated interferon and ribavirin (pegI/R), has many limitations in both effectiveness and secondary effects, which makes it unsuitable or even contraindicated for some patients. In hepatitis C virus-infected cystic fibrosis patients this treatment could increase respiratory infections with subsequent pulmonary function deterioration. On the contrary, hepatitis C virus (HCV) infection may make lung transplant (LT) unfeasible. We present the case of a cystic fibrosis-young man diagnosed with HCV infection during LT assessment who was treated with pegI/R. In spite of the lung function worsening and respiratory infections, he managed to complete treatment and even sustained virological response (SVR). At present he is on LT waiting list.

Eosinophilic esophagitis in adults, an emerging cause of dysphagia. Description of 9 cases.

BACKGROUND: Eosinophilic esophagitis is a rare condition mainly affecting children, although the number of cases reported in adults is on the increase. It is characterized by intense infiltration of eosinophilic leukocytes in the esophageal mucosa, without involvement of other sections of the alimentary canal. MATERIAL AND METHODS: Over the past year, following the performance of endoscopies and biopsies, our service identified nine patients who were diagnosed with suffering from this disorder. Each patient sought medical help for episodes of long-term, self-limited dysphagia or food impaction in the alimentary canal. RESULTS: Endoscopy revealed esophageal stenosis in the form of simultaneous contraction rings or regular stenosis. In six cases, the manometric study showed a nonspecific motor disorder of severe intensity affecting the esophageal body, and another patient had a disorder characterized by the presence of simultaneous waves and secondary peristaltic waves in the three thirds of the organ. These disorders are presumably due to eosinophilic infiltration of the muscular layer or ganglionar cells of the esophagus, and account for symptoms in these patients. Although the etiopathogenesis of this illness is uncertain, it is clearly an immunoallergic manifestation. CONCLUSIONS: As the number of diagnosed cases is on the increase, eosinophilic esophagitis is in adults a specific entity within the differential diagnosis of dysphagia in young males with a history of allergies. Eosiniphilic esophagitis responds in a different number of ways to therapies used. We successfully used fluticasone propionate, a synthetic corticoid applied topically, which proved to be efficient in the treatment of this illness by acting on the pathophysiological basis of the process. It does not have any adverse effects, thus offering advantages over other therapies such as systematic corticoids or endoscopic dilations.

[Ultrasonographic aspects of cystic papillary tumor of the pancreas. Apropos of 2 cases]. / Aspectos ecográficos del tumor papilar quístico del páncreas. A propósito de 2 casos.

Cystic papillary pancreatic tumor is an infrequent neoplasm of unknown origin which is presented almost exclusively in young women. It is characterized by an anodyne clinical symptomatology with it frequently treated as an accidental finding. Ultrasonography and computerized axial tomography have a priority role in the study of this entity but the definitive diagnosis is based on the histologic findings. The treatment of choice is surgical removal and although it is a malignant tumor, good evolution is observed with recurrence not being expected. Two new cases of cystic papillary tumor are presented comparing the ultrasonographic appearance of the same with other pancreatic cystic neoplasms. Although the ultrasonographic findings are not characteristic they may be suggestive of papillary tumor.

[The prognostic value of the endoscopic signs in the recurrence of peptic ulcer hemorrhage]. / Valor pronóstico de los signos endoscópicos en la recidiva de la hemorragia por ulcus péptico.

The endoscopic signs of hemorrhage in bleeding peptic ulcers are considered as prognostic factors for rebleeding and mortality. The value of these signs has been examined in several studies of patients with known high risk factors. In this survey, we studied the prognostic value of the endoscopic signs of hemorrhage in bleeding peptic ulcer in a group of patients without clinical risk factors such as age > 60 years, concomitant malignancy or respiratory and heart disease. Endoscopic findings were examined in fifty patients without rebleeding (group I) and twenty five with rebleeding (group II). Endoscopic findings results were spurting arterial bleeding in 9.3% of the cases, oozing hemorrhage in 17.3% of the cases, visible vessel in 9.3% of the cases, and adherent clot in 82.3% of the cases. In 9.3% of the cases endoscopic findings were negative. No statistical differences were found in the endoscopic signs among the two groups. The visible vessel and the spurting arterial bleeding cases presented in more than 50% of the rebleeding, (visible vessel and spurting arterial 57.1%). Oozing hemorrhage and the adherent clot were present in 30% of the cases. The endoscopic signs of bleeding can assist in choosing the group of patients with prospective high risk of rebleeding and possible candidates for the new treatment of endoscopic hemostatic therapy.

[Digestive hemorrhage caused by gastric varices: usefulness of the techniques of endoscopic sclerosis]. / Hemorragia digestiva por varices gástricas: utilidad de las técnicas de esclerosis endoscópica.

Upper gastrointestinal hemorrhage secondary to gastric varices still has a high death rate. Fourteen patients were admitted to our unit with bleeding gastric varices from November 1989 to August 1991. Endoscopic injection sclerotherapy obtained control of the bleeding in 92.3%; however, recurrences occurred in 33% of these cases in the first 24-48 hours, with a death rate of 50% during the second stage of the upper gastrointestinal hemorrhage. Total mortality rate was 21.4%. Of the fourteen patients, nine exhibited junctional varices, while five hand fundic varices. In ten of the fourteen patients, gastric varices developed during esophageal sclerotherapy. While hospitalized, it was observed that patients with gastric varices in the fundus had more recurrences and mortality, than those located next to the cardio-esophageal junction. Sclerosis of the varices only obtained temporary control of the bleeding with greater frequency of recurrences and mortality.