[MALT lymphoma in a patient with Crohn's disease. A causal or incidental association?]. / Linfoma intestinal tipo MALT en una paciente con enfermedad de Crohn: asociación causal o casual?

We present the case of a 79-year-old woman who had received a diagnosis of Crohn's disease 3 years previously and who developed a mucosa-associated lymphoid tissue (MALT) lymphoma of the right colon while undergoing treatment with mesalazine. The patient had not received immunosuppressive drugs or infliximab. The possible association between Crohn's disease and the development of intestinal lymphomas is analyzed. The incidence, pathogenic mechanisms, diagnostic strategy, treatment and prognosis of these neoplasms are described, mainly with reference to MALT lymphomas of the colon.

Prevalence and Predictors of Metabolic Syndrome After Liver Transplantation.

BACKGROUND: The development of metabolic syndrome (MS) after liver transplantation (LT) is a major source of mortality derived from cardiovascular events. The aim of the present study was to determine the prevalence and risk factors of MS after LT. METHODS: One-hundred seventy-four consecutive LT patients from January 2004 to June 2010 surviving longer than 1 year after LT were included. Median follow-up after LT was 48 months. Independent predictors of MS were obtained by means of multivariate logistic regression. RESULTS: At 3 years after LT, 25.5% of patients reached a body mass index (BMI) ≥30 kg/m2, 35.6% of patients developed arterial hypertension, 54.2% showed impaired fasting glucose, 22.5% had serum cholesterol >200 mg/dL, and 22.5% showed hypertriglyceridemia >150 mg/dL. The prevalence of MS ranged from 49% to 86% depending on the considered period. The pre-LT variables associated with MS were age at LT (odds ratio [OR], 1.08; P = .002), BMI of recipient before LT (OR, 1.23; P = .001), serum glucose (OR, 1.02; P = .005), and non-heart-beating donor (OR, 1.02; P = .046). The post-LT predictors of MS were body weight (OR, 1.04; P = .005), arterial hypertension (OR, 1.02; P = .047), and serum glucose (OR, 1.02; P = .011) at 6 months. CONCLUSIONS: LT patients develop MS in a high proportion and progressively despite current efforts (ie, lifestyle modifications and aggressive management of hypertension, diabetes, and hyperlipidemia). The associated risk factors include age, increased BMI, and pre- and post-LT glucose.

[Prognostic factors in liver transplantation. Is the lidocaine test usefull?]. / Factores pronósticos en el trasplante hepático. Es útil el test de lidocaína?

UNLABELLED: With continuous development of liver transplantation, the need of better tests for selecting donors and improving diagnosis of postransplant hepatic dysfunction, is increasing. OBJECTIVE: To determine the prognostic value of a number of parameters, including the lidocaine test (MEGX) in selecting donors, and assessing the efficacy of this test in the postransplant follow-up as an indicator of morbidity and mortality. METHODS: A consecutive series of forty donor-receptor pairs was studied for six months postransplant. In addition to the lidocaine test, different clinical, analytical and histological variables were analysed. Death, retransplantation, graft dysfunction and days in hospital were considered as indicators of morbimortality. RESULTS: Among the variables selected by univariate analysis, only ALT value at day 1 and Child-Pugh score at day 7 reached independent prognostic value in a Cox's regression model. However, both a cut-off level of 50 ng/ml for MEGX in donors and 40 ng/ml for MEGX test at day 1 postransplant, allowed to identify statistically different survival curves (p < 0.05). The lidocaine test at day 7 showed a significant association with the number of rejection episodes. CONCLUSIONS: ALT value at day 1 and Child-Pugh score at day 7 turned out to be the only variables with independent prognostic value for survival during the first six months postransplant. The MEGX value may be of help in selecting donors and a subgroup of receptors (day 1 < 40 ng/ml) with a high risk of mortality.

[Comparison of 2 treatment strategies with prednisone and interferon in chronic hepatitis B]. / Comparación de dos esquemas de tratamiento con prednisona interferón en la hepatitis crónica por virus B.

Twenty patients with chronic B hepatitis and viral replication were included in a randomized study comparing the efficacy of sequential treatment with prednisone for 6 weeks followed by alpha-2a interferon (IFN) for 6 months (group A, 9 cases), versus concomitant administration of both drugs (group B, 11 cases). There were no significant differences between the two groups regarding age, sex, AST, ALT, DNA-VHB values, index of histological activity or type of underlying chronic hepatitis. Two patients from each group were excluded. The mean follow-up of the patients was 22.2 months. In group A, four responses were achieved (57.1%), of which 2 were complete and 2 partial. The overall response rate in group B was 77.7% (7 cases), 6 of them were complete responses (66.7%). Among HBsAg-positive patients from group B, one seroconverted to anti-HBs. A total of 7 patients with anti-HBe were included in the study. Two belonged to group A, in which a partial response was achieved, and another 5 were in group B, with 4 reaching a complete response and one reaching a partial response. There were no statistical differences with regards to the type of response in both groups. The AST, ALT values, as well as the pre-treatment levels of DNA-VHB, showed a significant statistical association with the response (p < 0.05). In all patients responding to treatment a histological improvement was observed that became even more evident in the biopsy performed 12 months after IFN withdrawal. In conclusion, concomitant therapy with prednisone and IFN is as effective as sequential therapy in the treatment of chronic B hepatitis. The results achieved with concomitant therapy suggest that new controlled trials are need to establish if this therapeutic schedule is the elective treatment in chronic B hepatitis.

[Doxycycline-induced esophageal ulcer]. / Ulcera esofágica por doxiciclina.

We present the case of a 25-year-old woman who presented an esophageal ulcer due to doxycycline. We show the endoscopic image of the lesion and analyse the incidence, pathogenic mechanisms, symptomatology, diagnosis, treatment, and prevention of doxycycline-induced esophageal lesions.

Biliary complications after liver transplantation using side-to-side choledochocholedochostomy reconstruction with or without T-tube.

BACKGROUND: Biliary complications are a frequent cause of morbidity, graft loss, and death after orthotopic liver transplantation (OLT). The choledochocholedochostomy anastomosis without a T-tube is controversial, as it has been related to more biliary complications. AIMS: The aims of this study were to determine the incidence and to identify the risk factors of post-OLT biliary complications after reconstruction with or without a T-tube. MATERIALS AND METHODS: Ninety-five consecutive adult patients with deceased donor liver transplantations (overall survival rate, 86.3%; mean follow-up, 22.2 months) were analyzed to determine the incidence and type of biliary complications in 2 groups: choledochocholedochostomy with (45 patients, Group I) or without a T-tube (50 patients, Group II). The incidence of biliary complications in Groups I and II was 40% (18/45) and 30% (15/50), respectively (P > .05). In Group I, 49% of the complications were directly related to the T-tube. Biliary anastomosis stricture was more frequent in Group II (28% vs 8.9% in Group I; P = .018). Endoscopic retrograde cholangiopancreatography (ERCP) was the most common therapeutic procedure for the resolution of biliary complications in both groups (Group I, 66.5%; Group II, 58.2%). Arterial thrombosis, high pretransplantation Model for End-Stage Liver Disease (MELD) score, and donor obesity were identified as risk factors for biliary complications after OLT. CONCLUSION: OLT biliary reconstruction without a T-tube is not related to an increased risk of biliary complications, although stricutre of the anastomosis is more frequent in this group of patients. Donor obesity, arterial thrombosis, and high pretransplantation MELD score are associated with a higher incidence of biliary complications after OLT.

Hepatotoxicidad asociada a hipérico (hierba de San Juan) / Hepatotoxicity associated with Hypericum (St. John’s wort)

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Linfoma intestinal tipo MALT en una paciente con enfermedad de Crohn: ¿asociación causal o casual? / MALT lymphoma in a patient with Crohn’s disease. A causal or incidental association?

Se presenta el caso de una mujer de 79 años diagnosticada hacía 3 años de enfermedad de Crohn del colon, que desarrolló un linfoma tipo MALT de colon derecho estando en tratamiento con mesalazina y no habiendo recibido previamente fármacos inmunodepresores ni infliximab. Se analiza la posible asociación entre la enfermedad de Crohn y el desarrollo de linfomas intestinales: incidencia, mecanismos patogénicos, estrategia diagnóstica, tratamiento y pronóstico de esta neoplasia, haciendo alusión fundamentalmente al linfoma MALT de colon

We present the case of a 79-year-old woman who had received a diagnosis of Crohn's disease 3 years previously and who developed a mucosa-associated lymphoid tissue (MALT) lymphoma of the right colon while undergoing treatment with mesalazine. The patient had not received immunosuppressive drugs or infliximab. The possible association between Crohn's disease and the development of intestinal lymphomas is analyzed. The incidence, pathogenic mechanisms, diagnostic strategy, treatment and prognosis of these neoplasms are described, mainly with reference to MALT lymphomas of the colon