[Microhematuria secondary to mucocele and appendicular cystoadenoma]. / Microhematuria secundaria a mucocele y cistoadenoma apendicular.

Appendiceal mucocele is a rare entity consisting of cystic dilatation of the appendix as a result of increased mucus production. Most cases are related to the presence of a cystadenoma. This appendiceal neoplasm is frequently associated with other extraintestinal and colonic tumors and therefore adequate abdominal examination is necessary. The clinical presentation is nonspecific and varies from asymptomatic forms to abdominal discomfort and, less frequently, to urological manifestations. We describe the case of a woman with hematuria associated with an appendiceal mucocele. Only a few cases have been reported in the medical literature. The treatment of choice of cystadenoma is surgery and simple mucocele cannot be macroscopically differentiated from cystadenoma and cystadenocarcinoma. Survival in patients with appendiceal cystadenoma is excellent. The 5-year survival rate is reduced by at least half in patients with cystadenocarcinoma associated with pseudomyxoma peritonei.

Influence of the transmission route and disease duration in the histopathology of chronic hepatitis C: a study of 101 patients.

OBJECTIVE: Different studies have demonstrated that factors such as transmission route, disease duration and age at the time of infection can influence the histological evolution of chronic hepatitis by the hepatitis C virus (HCV). The aim of this study was to determine if epidemiological factors such as disease duration and transmission route influence the severity of the histological lesions of patients with chronic hepatitis by HCV. DESIGN: A prospective study. METHODS: The hepatic biopsies of 101 patients diagnosed with chronic hepatitis by HCV were studied. The patients were divided into three groups according to transmission mode: (1) post-transfusional (n = 28), (2) associated with the use of drugs by parenteral route or intravenous drug use (n = 28), and (3) sporadic hepatitis (n = 45). RESULTS: We found more severe forms of hepatopathy in post-transfusional hepatitis and sporadic groups than in the intravenous drug user group of patients. The disease evolution time was significantly higher in patients diagnosed as having chronic active hepatitis with or without cirrhosis (13.8 +/- 9 years) than in patients with chronic persistent hepatitis (8 +/- 4 years), P < 0.01. We found a significant correlation between the evolution time of the infection by HCV and the Histology Activity Index (P < 0.01). The multivariate analysis showed that only the transmission route and the disease evolution time are predictive variables of Histology Activity Index in chronic hepatitis C. CONCLUSION: These results suggest that the post-transfusional and sporadic transmission routes and a greater evolution time of the disease are epidemiological variables that are associated with the presence of more severe histological lesions in chronic hepatitis C.

Side-effects of sodium valproate, mainly related to its hepatic and pancreatic toxicity.

A study was made of 134 patients (67 males and 67 females) treated with sodium valproate, with ages from 1.5 to 70 years (50 on monotherapy and 84 on multitherapy), to detect side-effects of this treatment. To meet this goal, a clinical questionnaire was used with special emphasis on biological parameters to detect hepatic and pancreatic toxicity. 71.6% developed side-effects, without differences either between groups of sex or age, or patients on monotherapy and multitherapy, or the duration of the treatment, longer or shorter than six months. The side-effects were mild and transient, and without relationship with doses or plasma levels of the drug. The most noticeable side-effects in the study were the increase in amylase values, mainly in urine (23.9%), eosinophilia (30% in the monotherapy group), increase in gamma-glutamyltranspeptidase (20.2% in the polytherapy group) and weight gain in 25% of adult women on polytherapy. Only a 4.7% developed mild and transient elevation of transaminases, that did not differ from the control population. The relevance of using a clinical questionnaire and biological parameters to evaluate the side-effects of a drug is emphasized.

[Treatment with somatostatin of variceal digestive hemorrhage: a one-year prospective]. / Tratamiento con somatostatina de la hemorragia digestiva por varices: estudio prospectivo a un año.

Twenty-two patients with variceal bleeding were treated with somatostatin, receiving a bolus of 250 mcg followed by an infusion at a rate of 250 mcg/hour. Bleeding stopped in sixteen patients (72.7%). Definitive control was attained in 13 patients (59.2%). Mortality was 31.8%. Somatostatin was not effective in patients with large varices, jet bleeding and hepatic insufficiency. Only minor side effects were recorded in four patients (18.2%).

[Non-variceal upper digestive hemorrhage: evaluation of endoscopic sclerosing treatment]. / Hemorragia digestiva alta no varicial: valoración del tratamiento endoscópico esclerosante.

We appraise the efficacy of endoscopic injection treatment in 112 patients with gastroduodenal bleeding lesion versus 78 control patients (historical group), employing adrenaline (29 patients), absolute ethanol (52 patients) o adrenaline and ethanol (31 patients) as sclerosants. We observe in the treated group a diminution in rebleeding, lower transfusional blood needs and shorter hospital staying, with high stadistic significance versus the control group (p less than 0,001). Among treated patients the larger relapsing index (29.6%) was in patients treated with adrenaline injection only, against the group treated with ethanol or adrenaline and ethanol (10.2%) (p less than 0.05). The demand of surgical treatment was not significant between both groups, except in patients with actively jet bleeding, because urgent treatment was necessary in 37.5% of endoscopically treated patients versus 88.8% in not endoscopically treated. The mortality was similar in both groups.

[The usefulness of reactive protein C in managing patients with ulcerative colitis and Crohn's disease]. / Utilidad de la proteína C reactiva en el manejo de los pacientes con colitis ulcerosa y enfermedad de Crohn.

Serum concentrations of C-Reactive protein (CRP) were measured in 40 patients with inflammatory bowel disease (22 with ulcerative colitis and 18 with Crohn's disease). In the evaluation of disease activity, CRP was a more sensitive (98.6% vs 71.4%) and specific (95% vs 84.6%) activity index in Crohn's disease than in ulcerative colitis. The CRP concentrations were significantly higher in Crohn's disease (57.7 +/- 55.7 mg/dl) than in ulcerative colitis (16.3 +/- 18.8 mg/dl), particularly in severely affected patients (104.8 +/- 54.3 vs 29 +/- 24.2 mg/dl). The CRP levels correlated significantly with clinical activity indices. There was poor or no correlation between CRP levels and the endoscopic activity indices, the extent of inflammatory bowel disease, and the days of hospitalization. We conclude that the determination of CRP levels provide a simple objective index of inflammatory activity with may be useful in the assessment, management and study of inflammatory bowel disease.

[A psoas abscess in a patient with Crohn's disease]. / Absceso del psoas en un paciente con enfermedad de Crohn.

We report a case of Crohn's disease diagnosed 13 years ago, complicated by a psoas abscess. The main symptoms were flexion deformity of the hip, pain and fever. Diagnosis was made by CT-scan. Surgical and CT-guided percutaneous drainage was ineffective and the abscess relapsed. Surgical resection of the affected bowel with abscess drainage, provided patient's healing.

[Fibro-endoscopic therapy of intraesophageal foreign bodies]. / Terapéutica fibroendoscópica de los cuerpos extraños intraesofágicos.

We have studied by means of flexible endoscopy 298 patients with a suspicion of esophageal foreign body. Only a third of them were proven, prevailing in women older than 60 years. We verify the meaning of some symptoms (dysphagia, odynophagia, retrosternal pain, and pharyngeal parestesias) according to the presence or not of the foreign body, and we confirm its general tendency to locate in the proximal esophagus and Killian's ring becoming nailed or impacted in a high percentage (73.8%) of cases. The lesions caused by such foreign bodies were slight in general, and no special treatment was required. The incidence of serious complications was very low (0.97%). The success of treatment by flexible endoscopy was 92.3%, making this the best method for extracting the foreign bodies of the upper digestive tract.

[Ulcerative colitis associated with idiopathic thrombocytopenic purpura]. / Colitis ulcerosa asociada a púrpura trombocitopénica idiopática.

Multiple hematological anomalies have been described in association with chronic inflammatory bowel disease. Idiopathic thrombocytopenic purpura is an autoimmune disease characterized by the presence of isolated thrombopenia with a normal or increased number of megakaryocytes in bone marrow and absence of splenomegaly. Several case reports of idiopathic thrombocytopenic purpura associated with chronic inflammatory bowel disease, mostly ulcerative colitis, have been published in the literature. The pathogenic mechanism through which these entities are associated is unknown. Several treatments have been used, varying from short courses of steroids to the use of immunosuppressive agents and splenectomy, depending on the severity of the symptoms. We describe the case of a woman with ulcerative colitis and idiopathic thrombocytopenic purpura, in which the latter first presented when the patient was undergoing treatment with corticosteroids and cyclosporin, one of the therapeutic options for controlling thrombopenic purpura. Platelet deficiency persisted despite treatment with azathioprine and colectomy, also described as a possible curative treatment.

[Hepatitis C virus infection and porphyria cutanea tarda]. / Infección por el virus de la hepatitis C y porfiria cutánea tarda.

The prevalence of antibodies versus the hepatitis C virus (antiHCV) was studied in a group of 10 patients diagnosed with porphyria cutanea tarda (PCT) and the possible existence of subclinical forms of PCT was determined in 64 patients with chronic anti HCV positive liver diseases. The prevalence of anti HCV was found to be 40% in patients with PCT. In the group of patients with chronic anti HCV positive liver disease only one patient (1.5%) presented an increase in the urinary elimination of porphyrias in the absence of cutaneous lesions of photosensitivity. This study confirms the importance of the hepatitis C virus as a triggering agent of PCT. These results demonstrate the existence of a low prevalence of subclinical forms of PCT among patients with chronic anti HCV positive liver diseases.

[Good's syndrome and chronic diarrhea]. / Síndrome de Good y diarrea crónica.

Good's syndrome is an infrequent disorder associated with humoral immunodeficiency and thymoma. Patients usually present severe or chronic infections. The most frequent are sinopulmonary infections sometimes associated with bronchiectasias. Another complication is chronic diarrhea, frequently associated with malabsorption, which can be due to a mucosal lesion, infection with gastrointestinal pathogens, or bacterial overgrowth. We describe a patient with Good's syndrome and chronic diarrhea due to bacterial overgrowth.

[Malignant lymphoproliferative neoplasms and chronic hepatitis C virus infection]. / Neoplasias linfoproliferativas malignas e infección crónica por el virus del la hepatitis C.

It has been suggested that chronic hepatitis C virus (HCV) infection predisposes to the development of benign and malignant lymphoproliferative disorders. We present 2 cases of malignant lymphoproliferative neoplasias (a non-Hodgkin lymphoma [NHL] and a chronic lymphoid leukemia [CLL]) associated to chronic hepatitis C virus (HCV). The possible etiological role of HCV in the development of these tumors is discussed.

[Alterations in iron metabolism in chronic anti-HCV positive hepatitis. The relationship with response to interferon treatment]. / Alteraciones del metabolismo del hierro en las hepatitis crónicas anti-VHC positivo. Relación con la respuesta al tratamiento con interferón.

A prospective study in which the existence of iron metabolism alterations (increase in the serum levels of iron and ferritin and the presence of iron in liver tissue) in a group of 53 patients diagnosed with chronic anti-HCV positive hepatitis was performed. The aim of the study was to determine whether these parameters influence the response to interferon treatment. Elevations were observed in the serum levels of iron and/or ferritin in 17 (32%) of the patients. Higher than normal values of serum iron or ferritin in pretreatment analyses were associated with worse therapeutic response. The basal serum levels of iron and ferritin were significantly higher in non responding patients. No relationship was found between the presence of iron in the hepatic parenchyma and response to interferon treatment.

[Sinusoidal portal hypertension secondary to nodular regenerative hyperplasia of the liver]. / Hipertensión portal sinusoidal secundaria a hiperplasia nodular regenerativa hepática.

Regenerative hepatic nodular hyperplasia is infrequent and generally appears in association with many other diseases, the most frequent being the Felty syndrome. It may cause portal hypertension and variceal bleeding. A histologic study is necessary for diagnosis since certain biologic data and the nodular appearance of the hepatic surface may be confused with hepatic cirrhosis from which it may basically be, apart from the histologic features, distinguished by its good prognosis due to the absence of liver failure. We present the case of a seropositive patient with regenerative hepatic nodular hyperplasia and rheumatoid arthritis with marked portal hypertension shown in the hemodynamic study performed by our department for presentation of a persistent elevation in transaminases and ultrasonography alterations suggesting hepatic cirrhosis.

[The histological lesions of chronic hepatitis C as predicting factors of sustained response to the treatment with interferon]. / Las lesiones anátomo-patológicas de la hepatitis crónica C como factores predictivos de respuesta mantenida al tratamiento con interferón.

BACKGROUND: Although many studies have been implemented in order to determine the pre-treatment factors that can predict patients' response to interferon (IFN) therapy, it is not yet clear whether characteristic histologic abnormalities in chronic hepatitis C can predict such response. AIMS: The aim of this study were to evaluate, in patients with chronic hepatitis C, (i) the predictive value of histologic lesions for the sustained response to IFN therapy (ii) other pre-treatment (epidemiological and analytical) factors known to be predictive of response. PATIENTS AND METHODS: Sustained response was retrospectively evaluated in two hundred one patients who had been treated with IFN for at least 3 months in four different hospitals from Castilla y León. The following histological parameters were studied as predictors of response: histological diagnosis, Knodell index, grading and stage, characteristic histologic lesions of HCV infection. Epidemiological and analytical parameters were also evaluated. RESULTS: The rate of patient's sustained response to IFN treatment was 16%. None of the histological parameters was useful to predict this response. By univariate analysis, age, disease evolution time, mode of viral transmission, GGT, ferritin and viral genotype were associated with a sustained response. The most powerful, and only independent predictive factor, however, was the genotype (the response odds ratio was 8.6). CONCLUSIONS: Histological parameters do not predict the response to IFN treatment. Other factors (mainly the viral genotype) are associated with a higher response percentage, although no one is useful to decide which patients are going to respond.

Histological, ultrastructural and mitochondrial oxidative phosphorylation studies in liver of rats chronically treated with oral valproic acid.

The effects of oral administration of valproic acid (VPA) have been studied on the liver of female adult Wistar rats, at doses of 60 and 120 mg/kg/day during 4 and 18 weeks (periods I and II). Other groups received the same doses of VPA with phenobarbital (PB). The animals developed periportal steatosis, more intense at the end of period II and in groups non-induced by PB, and also some degree of mitochondrial swelling. An uncoupling of the oxidative phosphorylation was also evident with both doses in the non-induced groups, and only with the high dose of VPA in the induced group. An in vitro study on isolated liver mitochondria showed uncoupling only with very high concentration of VPA (10 mM). We comment on these findings and propose a chronic model of experimental hepatotoxicity of oral VPA in the rat.

Idiopathic portal hypertension and angiosarcoma associated with arsenical salts therapy.

We describe a 60-year-old man with idiopathic portal hypertension and hepatic angiosarcoma. The patient had taken an arsenical preparation for the treatment of psoriasis for 10 years. Five cases of this association have been reported previously; in one only, exposure to arsenical salts was present.