Cytokines - their pathogenic and therapeutic role in chronic viral hepatitis.

Cytokines make up a network of molecules involved in the regulation of immune response and organ functional homeostasis. Cytokines coordinate both physiological and pathological processes occurring in the liver during viral infection, including infection control, inflammation, regeneration, and fibrosis. Hepatitis B and hepatitis C viruses interfere with the complex cytokine network brought about by the immune system and liver cells in order to prevent an effective immune response, capable of viral control. This situation leads to intrahepatic sequestration of nonspecific inflammatory infiltrates that release proinflammatory cytokines, which in turn favor chronic inflammation and fibrosis. The therapeutical administration of cytokines such as interferon alpha may result in viral clearance during persistent infection, and revert this process.

Cytokines – their pathogenic and therapeutic role in chronic viral hepatitis

Cytokines make up a network of molecules involved in the regulationof immune response and organ functional homeostasis. Cytokinescoordinate both physiological and pathological processesoccurring in the liver during viral infection, including infection control,inflammation, regeneration, and fibrosis. Hepatitis B and hepatitisC viruses interfere with the complex cytokine networkbrought about by the immune system and liver cells in order to preventan effective immune response, capable of viral control. This situationleads to intrahepatic sequestration of nonspecific inflammatoryinfiltrates that release proinflammatory cytokines, which in turnfavor chronic inflammation and fibrosis. The therapeutical administrationof cytokines such as interferon alpha may result in viral clearanceduring persistent infection, and revert this process(AU)

Colitis microscópica / No disponible

No disponible

[Evolution and treatment response in microscopic colitis]. / Curso evolutivo y respuesta al tratamiento de las colitis microscópicas.

AIM: To study the clinical characteristics, treatment response and evolution in patients with microscopic colitis. MATERIAL AND METHODS: We performed a retrospective analysis of 24 patients (15 with collagenous colitis and 9 with lymphocytic colitis). Clinical and diagnostic features, treatment response and evolution according to the presence of maintenance therapy were evaluated. RESULTS: The mean age of the patients was 59.7 years and most were male. Nine patients took non-steroidal anti-inflammatory drugs (NSAID). No significant association was found with other drugs. Four patients presented associated rheumatological disease. Most patients presented insidious-onset diarrhea without pathological products, which was frequently associated with other symptoms (abdominal pain, bloating, weight loss, asthenia, tenesmus, and incontinence). Seven patients showed a slight increase in globular sedimentation rate. Fat in stools and radiological investigations (transit and opaque enema) were normal in patients who underwent these tests. Endoscopy revealed non-specific alterations in 42% of the patients while results were normal in the remaining patients. One patient showed clinical improvement on withdrawal of NSAIDs and 4 patients improved spontaneously. Clinical response was achieved in 7 of 13 patients treated with antimotility drugs, in 8 of 9 patients treated with salicylates, in 3 treated with oral corticoids, in 1 treated with cholestyramine and in 1 treated with topical budesonide. Nineteen patients required no maintenance therapy, 4 were administered salicylates and 1 was administered cholestyramine. After a mean follow-up of 42 months, evolution was chronic and intermittent in 14 patients and chronic and continuous in 1; 9 patients presented a single episode. No significant differences were found between patients administered maintenance therapy and those who were not or between collagenous colitis and lymphocytic colitis in the parameters analyzed. CONCLUSIONS: Microscopic colitis constitutes a group of diseases characterized by chronic diarrhea, few systemic effects and minimal radiological and/or endoscopic alterations. Evolution is characterized by recurrent episodes, with good response to treatment with cholestyramine, salicylates or corticoids when required.

[Atypical colonic stromal tumor]. / Tumor estromal colónico de características atípicas.

We present the case of a female patient with atypical gastrointestinal stromal tumor. The young woman presented asymptomatic colonic perforation and showed atypical immunohistochemical findings. The various clinicopathologic characteristics and diagnostic tests, as well as treatment and distinct behavior of these tumors, are discussed.

Colitis colágena: una entidad con diversas opciones terapéuticas / Collagenous colitis: an entity with different therapeutic options

La colitis colágena es una enfermedad cuya frecuencia ha aumentado progresivamente en los últimos años debido fundamentalmente a la toma rutinaria de biopsias en el estudio de pacientes con diarrea crónica. Se han comunicado buenas respuestas con numerosos tratamientos, aunque hay pocos ensayos clínicos realizados por el escaso número de pacientes con esta patología. Presentamos dos casos de colitis colágena cuyo interés reside en su manejo terapéutico, revisando las distintas alternativas existentes en el tratamiento de esta entidad de creciente importancia en la práctica clínica diaria (AU)

[Collagenous colitis: an entity with diverse therapeutic options]. / Colitis colágena: una entidad con diversas opciones terapéuticas.

Collagenous colitis is a disorder which has been diagnosed with increasing frequency in the last few years, probably due to the routine obtention of colon biopsy specimens in the study of patients with chronic diarrhoea. Good responses have been reported with a number of therapies, although only a scarce number of clinical trials have been performed, partly because of the small number of patients studied. Two cases of collagenous colitis with different therapeutic approaches are here reported. All medical therapy options for this interesting disorder are reviewed.

[Impact of zidovudine treatment and the pneumocystis carinii prophylaxis in natural history of patients with HIV infection]. / Influencia del tratamiento con zidovudina y de la profilaxis contra Pneumocystis carinii en la historia natural de los enfermos con infección por VIH.

INTRODUCTION: Early use of prophylactic regimens against Pneumocystis carinii and zidovudine therapy, may have modified the natural history of patients with HIV-1 infection. We describe the incidence of opportunistic infections and analize the mortality rate in those patients to check the occurrence of any change in the above mentioned natural history. PATIENTS: Clinical charts of patients with HIV-1 infection attending our hospital are reviewed, from november 1987 to june 1994. RESULTS: We found 200 patients with AIDS, documenting 64 (32%) deaths and 69 (34.5%) patients lost to follow-up. Seven HIV-1 infected patients (3.5%) received primary prophylaxis against Pneumocystis carinii and 17 (8.5%) zidovudine therapy before developing AIDS. Patients with AIDS receiving zidovudine therapy had a higher survival (median 50 months) than those not receiving such therapy (median 17 months; p < 0.001). Ninety one patients with tuberculosis receiving zidovudine therapy had also a higher survival than those not receiving antirretroviral therapy (p < 0.01). Eighty six patients with Pneumocystis carinii pneumonia receiving zidovudine had also a higher survival (p < 0.001). Likewise, patients on zidovudine treatment had a lower reduction on CD4 lymphocyte count. CONCLUSIONS: The spectrum of AIDS-defining illnesses is similar to the whole country. We have not found any difference in the incidence of opportunistic infections, but we observed a trend to reduction in the incidence rate of PCP. The introduction of zidovudine therapy seems to have a positive influence on the survival of AIDS patients. This advantage is highlighted in those patients more immunodeficients at first.