Factores genéticos del huésped y respuesta terapéutica en la hepatitis C / No disponible

No disponible

Capnography is superior to pulse oximetry for the detection of respiratory depression during colonoscopy

Background: pulse oximetry is a widely accepted procedurefor ventilatory monitoring during gastrointestinal endoscopy, butthis method provides an indirect measurement of the respiratoryfunction. In addition, detection of abnormal ventilatory activitycan be delayed, especially if supplemental oxygen is provided.Capnography offers continuous real-time measurement of expiratorycarbon dioxide.Objective: we aimed at prospectively examining the advantagesof capnography over the standard pulse oximetry monitoringduring sedated colonoscopies.Patients and methods: fifty patients undergoing colonoscopywere simultaneously monitored with pulse oximetry and capnographyby using two different devices in each patient. Several sedationregimens were administered. Episodes of apnea or hypoventilationdetected by capnography were compared with the occurrence ofhypoxemia.Results: twenty-nine episodes of disordered respiration occurredin 16 patients (mean duration 54.4 seconds). Only 38% ofapnea or hypoventilation episodes were detected by pulse oximetry.A mean delay of 38.6 seconds was observed in the events detectedby pulse oximetry (two episodes of disturbed ventilationwere simultaneously detected by capnography and pulse oximetry).Conclusions: apnea or hypoventilation commonly occursduring colonoscopy with sedation. Capnography is more reliablethan pulse oximetry in early detection of respiratory depression inthis setting(AU)

Epidemiologic study on the current incidence of inflammatory bowel disease in Madrid

Introduction: the incidence of inflammatory bowel disease(IBD) varies widely according to geographical area and has beenreported to have increased in the last few years. No data are availableon the current incidence of this disease in Madrid (Spain).Aim: to determine the incidence of inflammatory bowel diseasein the area of influence of University Hospital Fundación Alcorcón(Madrid), and to compare our results with those from otherSpanish and European series.Patients and methods: a prospective, population-basedstudy was performed to determine the incidence of IBD in thearea of University Hospital Fundación Alcorcón in Madrid between2003 and 2005. Total population: 213,587 inhabitants(177,490 older than 14 years). Crude rates and age- and sex-specificrates adjusted to the European standard population were calculated.A retrospective study (1998-2003) was also performed.Results: a total of 69 cases were diagnosed –Crohn´s disease(CD): 35, ulcerative colitis (UC): 33, indeterminate colitis: 1– inthe prospective period. Crude rates of CD and UC were 7.92 and7.47 cases/100,000 inhabitants/year, respectively (the populationaged 0-14 years). Specific rates were 8.0 (95% CI, 7.03-8.97) and 7.47 (95% CI, 6.5-8.4), respectively. Mean age at diagnosiswas 31.02± 10.76 and 39.91±16.19 years for CD andUC, respectively. Incidence in the retrospective study was 7.13and 6.22 cases/100,000 inhabitants/year, respectively for CDand UC.Conclusions: the incidence of CD and UC in Madrid has increasedin the last decades, with rates close to those in northernEuropean countries for CD, higher than those recently publishedin Spanish prospective studies and similar to those previously describedin Spain and southern countries for UC. Rates were higherin the prospective period than in the retrospective one(AU)

Efecto de la pentoxifilina en la supervivencia, la función cardiaca y en la hemodinámica portal y sistémica de la cirrosis alcohólica avanzada / No disponible

Objetivo: valorar el efecto de la pentoxifilina (un potente inhibidordel factor de necrosis tumoral alfa) en la supervivencia, en lahemodinámica sistémica y portal y en la función cardiaca en la cirrosisalcohólica avanzada.Diseño: estudio aleatorizado, doble-ciego, controlado con placebo.Contexto: estudio unicéntrico utilizando grupos de pacientesen paralelo para comparar pentoxifilina y placebo.Pacientes: se incluyeron 24 pacientes con cirrosis alcohólica(8 en estadio B de Child-Pugh y 16 en estadio C de Child-Pugh).Intervención: los pacientes fueron aleatorizados a recibirpentoxifilina (400 mg, 3 veces al día, n = 12) o placebo (n = 12)durante 4 semanas.Determinaciones: el objetivo principal fue la supervivencia acorto/largo plazo. Los objetivos secundarios fueron observar beneficioshemodinámicos (mejoría en la función cardiaca y/o en elíndice de resistencias vasculares sistémicas o disminución de lapresión portal).Resultados: la presión portal y la función cardiaca no se modificarony no hubo diferencias en la supervivencia a corto y largoplazo entre los grupos tratados y placebo. Los índices de resistenciavascular sistémica y cardiaco cambiaron en el grupo de pentoxifilina(de 1.721 ± 567 a 2.082 ± 622 Din.seg1 cm-5 m-2 y de4,17 ± 1,4 a 3,4 ± 0,9 lm-2, p = 0,05).Conclusiones: aunque la pentoxifilina parece producir algúnbeneficio hemodinámico a corto plazo en pacientes con cirrosis alcohólicaavanzada, no tiene efecto sobre la tasa de supervivencia, lafunción cardiaca ni sobre la presión portal en estos pacientes

Objective: to assess the effect of pentoxiphylline (a potent inhibitorof tumor necrosis factor alpha) on survival, on systemicand portal hemodynamics, and on cardiac function in patientswith alcoholic cirrhosis.Design: a randomized double-blind placebo-controlled trial.Setting: a single center using parallel groups of patients tocompare pentoxiphylline with placebo.Patients: we recruited 24 patients with alcoholic cirrhosis (8Child-Pugh B and 16 Child-Pugh C).Interventions: patients were randomly assigned to receivepentoxiphylline (400 mg tid; n = 12) or placebo (n = 12) over a 4-week period.Outcome measures: the primary outcome was to extendshort-term and long-term survival. Secondary outcomes includedhemodynamic benefits (improvement in cardiac function and/orsystemic vascular resistance index, or decrease in portal pressure).Results: portal pressure and cardiac function remained unchangedand there were no significant differences in short-term orlong-term survival between treatment and placebo groups. Thegroup on pentoxiphylline increased systemic vascular resistanceand decreased cardiac indices (from 1,721 ± 567 to 2,082 ± 622dyn.sec-1 cm-5 m-2 and from 4.17 ± 1.4 to 3.4 ± 0.9 l.m-2, p =0.05).Conclusions: although pentoxiphylline seems to providesome short-term aemodynamic benefits in patients with advancedalcoholic cirrhosis, this drug has no effect on survival or portalpressure in these patients

Síndrome metabólico y progresión de la lesión hepática en la infección por el virus de la hepatitis C y el hígado graso no alcohólico / No disponible

No disponible

Abordaje diagnóstico y terapéutico del síndrome colestásico / Diagnostic and therapeutic approach to cholestatic liver disease

Ante la presencia de colestasis, se debe determinar si su naturaleza es extra o intrahepática. Si la ecografía hepática no muestra dilatación de la vía biliar ni lesiones' ocupantes de espacio, se debe iniciar el estudio de una colestasis intrahepática. Si la obstrucción de la vía biliar extrahepática es cuestionable o la probabilidad de intervencionismo terapéutico es baja, se debe completar el estudio mediante colangio-pancreatografia-RM (CPRM). Si la probabilidad de intervencionismo es alta, se debe realizar colangiopancreatografía retrógrada endoscópica (CPRE) o colangiografía transparieto-hepática (CTPH). En caso de colestasis intrahepática, determinadas situaciones específicas ayudan a orientar el diagnóstico. Si la colestasis intrahepática ocurre en ancianos, se debe sospechar colestasis por fármacos, mientras que en pacientes jóvenes con antecedentes de riesgo, la hepatitis viral es la causa más frecuente. En el primer trimestre del embarazo la hiperemesis gravídica es la causa más probable y en el segundo o tercero la colestasis gravídica. La historia familiar y el curso recurrente deben orientar hacia una colestasis intrahepática recurrente benigna. La presencia de colestasis intrahepática en una mujer de edad media debe hacer sospechar CBP, mientras que en un varón joven con EIIC, una colangitis esclerosante primaria. La presencia de arañas vasculares, ascitis e historia de abuso de alcohol, apuntan hacia una hepatitis alcohólica como causa más probable. En el periodo neonatal, los síndromes colestásicos incluyen infecciones por CMV, toxoplasma, rubeola o defectos metabólicos como la fibrosis quística, el déficit de alfa1-antitripsina, defectos en la síntesis de ácidos biliares o atresia biliar. El tratamiento de la colestasis debe incluir el manejo de complicaciones como el prurito, la osteopenia y el déficit de vitaminas liposolubles. En caso de insuficiencia hepatocelular o complicaciones de la hipertensión portal, el manejo es similar al de otras etiologías y se debe valorar el trasplante hepático (AU)

When cholestatic liver disease is present, liver ultrasound should be performed to ascertain if cholestasis is extrahepatic or intrahepatic. If bile ducts appear dilated and the probability of interventional treatment is high, endoscopic retrograde cholagio-pancreatography (ERCP) or trans-hepatic cholangiography (THC) should be the next step. If the probability of interventional therapeutics is low, cholangio-MRI should be performed. Once bile duct dilation and space occupying lesions are excluded, a work up for intrahepatic cholestasis should be started. Some specific clinical situations may be helpful in the diagnostic strategy. If cholestasis occurs in the elderly, drug-induced cholestatic disease should be suspected, whereas if it occurs in young people with risk factors, cholestatic viral hepatitis is the most likely diagnosis. During the first trimester of pregnancy cholestasis may occur in hyperemesis gravidorum, and in the third trimester of gestation cholestasis of pregnancy should be suspected. A familial history of recurrent cholestasis points to benign recurrent intrahepatic cholestasis. The occurrence of intrahepatic cholestasis in a middle-aged woman is a frequent presentation of primary biliary cirrhosis, whereas primary sclerosing cholangitis should be suspected in young males with inflammatory bowel disease. The presence of vascular spider nevi, ascites, and a history of alcohol abuse should point to alcoholic hepatitis. Neonatal cholestasis syndromes include CMV, toxoplasma and rubinfections or metabolic defects such as cystic fibrosis, alpha1-antitrypsin deficiency, bile acid synthesis defects, or biliary atresia. The treatment of cholestasis should include a management of complications such as pruritus, osteopenia and correction of fat soluble vitamin deficiencies. When hepatocellular failure or portal hypertension-related complications occur, liver transplantation should be considered (AU)