Ultrasonography is an accurate technique for the diagnosis of gastrointestinal tumors in patients without localizing symptoms.

INTRODUCTION AND OBJECTIVES: This study compared the accuracy of ultrasonography in the diagnosis of gastrointestinal tumors in patients with several degrees of clinical suspicion. MATERIAL AND METHODS: We recruited patients that were suspect for gastrointestinal neoplasia but with no evidence of localizing symptoms (group A), and patients that were suspect for colon cancer (group B) or for gastric cancer (group C). Accuracy in the diagnosis was compared for: gastric cancer in groups A and C, and for colon cancer in groups A and B. The comparison was made by using the contingency coefficient, which quantifies coincidence of endoscopic and ultrasonographic diagnoses. RESULTS: Seventy-nine patients were included in group A (48 males), wherein 12 colon and 5 gastric neoplasms were detected. Group B was comprised of 153 patients (78 males) and included 66 patients with colorectal cancer (CCR). Group C contained 58 patients (35 males), 31 of whom were diagnosed with gastric cancer. The accuracy of sonography for diagnosing colon cancer was 95.5% for group A and 87.5% for group B. The contingency coefficient for endoscopy vs. ultrasonography was greater for group A: 0.658 than for group B: 0.549. The diagnostic accuracy for gastric cancer was 97.4% for group A and 86.2% for group C. The contingency coefficient between endoscopic and ultrasonographic diagnoses was also greater in group A (0.618) than in group C (0.588). CONCLUSIONS: The accuracy of ultrasonography in diagnosing colon and gastric cancer is not lower in patients without localizing symptoms.

La ecografía es una técnica sensible en el diagnóstico de las neoplasias gastrointestinales en pacientes sin síntomas localizadores / Ultrasonography is an accurate technique for the diagnosis of gastrointestinal tumors in patients without localizing symptoms

Introducción y objetivos: en todos los estudios publicadoshasta la fecha se ha evaluado la precisión de la ecografía en eldiagnóstico del cáncer de colon y del cáncer gástrico en pacientesen los que esta era la sospecha diagnóstica o ya con un diagnósticoestablecido de esta patología. Nosotros, en este estudio, comparamosla sensibilidad de la ecografía en pacientes con diferentesgrados de sospecha clínica.Material y método: reclutamos pacientes con sospecha deneoplasia digestiva, sin evidencia de síntomas localizadores (grupoA), pacientes con sospecha de cáncer de colon (grupo B) y pacientescon sospecha de cáncer gástrico (grupo C). Comparamosla precisión de la ecografía en el diagnóstico del cáncer gástricoen los grupos A y C, y la precisión en el diagnóstico del cáncer decolon en los grupos A y B. El parámetro usado en la comparaciónes el coeficiente de contigencia que cuantifica la coincidencia dediagnóstico endoscópico y ecográfico.Resultados: se han incluido 79 pacientes en el grupo A (48varones y 31 mujeres, con una edad media de 69,3 años), en losque se han diagnosticado 12 neoplasias colónicas y 5 gástricas. Elgrupo B se compone de 153 pacientes (78 varones y 75 mujeres,con una edad media de 66,5 años) e incluye 66 pacientes conCCR. Finalmente, el grupo C está formado por 58 pacientes (35varones y 23 mujeres, con una edad media de 67,4 años), siendodiagnosticados de cáncer gástrico 31 pacientes. La precisión de laecografía en el diagnóstico del cáncer de colon fue del 95,5% enel grupo A y del 87,5% en el grupo B. El coeficiente de contingenciaentre los diagnósticos endoscópico y ecográfico tambiénfue superior en el grupo A: 0,658 frente a 0,549. La precisión dela ecografía en el diagnóstico del cáncer gástrico fue del 97,4% enel grupo A y del 86,2% en el grupo C...(AU)

Introduction and objectives: this study compared the accuracyof ultrasonography in the diagnosis of gastrointestinal tumorsin patients with several degrees of clinical suspicion.Material and methods: we recruited patients that were suspectfor gastrointestinal neoplasia but with no evidence of localizingsymptoms (group A), and patients that were suspect for coloncancer (group B) or for gastric cancer (group C). Accuracy in thediagnosis was compared for: gastric cancer in groups A and C,and for colon cancer in groups A and B. The comparison wasmade by using the contingency coefficient, which quantifies coincidenceof endoscopic and ultrasonographic diagnoses.Results: seventy-nine patients were included in group A (48males), wherein 12 colon and 5 gastric neoplasms were detected.Group B was comprised of 153 patients (78 males) and included66 patients with colorectal cancer (CCR). Group C contained 58patients (35 males), 31 of whom were diagnosed with gastric cancer.The accuracy of sonography for diagnosing colon cancer was95.5% for group A and 87.5% for group B. The contingency coefficientfor endoscopy vs. ultrasonography was greater for groupA: 0.658 than for group B: 0.549. The diagnostic accuracy forgastric cancer was 97.4% for group A and 86.2% for group C.The contingency coefficient between endoscopic and ultrasonographicdiagnoses was also greater in group A (0.618) than ingroup C (0.588).Conclusions: the accuracy of ultrasonography in diagnosingcolon and gastric cancer is not lower in patients without localizingsymptoms(AU)

[Usefulness of ultrasonography in diagnosing patients suspect for digestive tract neoplasms]. / Utilidad de la ecografía en el diagnóstico de los pacientes con sospecha de neoplasias del tubo digestivo.

BACKGROUND: The Positive Predictive Value (PPV) of signs and symptoms for the diagnosis of colon and gastric cancer is low. Furthermore, many patients are referred to us to discard a digestive tract neoplasm with no symptoms suggestive of its whereabouts, in whom clinical PPV is even lower. This study evaluates the usefulness of ultrasonography as a first approach to diagnosis. MATERIAL AND METHODS: Seventy-nine patients were recruited into the study (48 males with an average age of 69.3 years). Ultrasonography was performed on all patients prior to endoscopy. Parameters studied included diagnostic accuracy for colon and gastric cancer, ultrasonographic diagnoses, and number of endoscopies that can be avoided. Predictive factors for neoplasm location were also studied. RESULTS: Five gastric cancers (6.3%), 12 colon cancers (15,1%), 3 pancreatic cancers (3.8%), 2 uterine neoplasms (2.5%), and 2 hypernephromas (2.5%) were diagnosed. The figures for sensitivity, specificity, PPV, Negative Predictive Value (NPV) and global accuracy of ultrasonography were 80%, 98.6%, 80%, 98.6%, and 97.4%, respectively, for gastric cancer, while these figures were 100%, 94.5%, 80%, 100%, and 95.5%, respectively, for colon cancer. Ultrasonography enabled to avoid 10% of endoscopic explorations. The only parameter that helps locate a neoplasm is the presence of anemia, which is more frequently associated with a diagnosis of colon cancer: 30.4 versus 4.3% (p = 0.033). CONCLUSIONS: In patients without specific symptoms who were sent to us for discarding digestive tract neoplasm, "extra-digestive" neoplasms were frequently diagnosed. If we further take into account the high diagnostic accuracy of ultrasonography, then this procedure could be a very good first approach towards such diagnosis.

Utilidad de la ecografía en el diagnóstico de los pacientes con sospecha de neoplasias del tubo digestivo / No disponible

Introducción: el valor predictivo positivo de síntomas y signosen el diagnóstico del cáncer de colon y gástrico es bajo. Además,muchos pacientes son remitidos para descartar una neoplasiadigestiva, sin síntomas que sugieran su localización, siendo elVPP de la clínica aún menor. En este trabajo evaluamos la utilidadde la ecografía como primera aproximación diagnóstica.Material y método: se han reclutado 79 pacientes (48 varones,edad media 69,3 años). En todos ellos se realiza una ecografíaantes de la endoscopia. Se evalúa la precisión en el diagnósticodel cáncer de colon y gástrico, los diagnósticos ecográficos y elnúmero de endoscopias que se evitarían. También se buscan factorespredictivos de la localización de la neoplasia.Resultados: se han diagnosticado 5 neoplasias gástricas(6,3%) y 12 de colon (19%), 3 cáncer de páncreas (3,8%), 2 neoplasiasuterinas (2,5%) y 2 hipernefromas (2,5%). Las cifras desensibilidad, especificidad, VPP, VPN y precisión de la ecografíafueron 80%, 98,6%; 80%; 98,6%; y 97,4% respectivamente enel diagnóstico del cáncer gástrico, y del 100%, 94,5%; 80%;100% y 95,5% respectivamente en el diagnóstico del cáncer decolon. La ecografía permitió evitar el 10% de las endoscopias. Elúnico dato que orienta la localización de la neoplasia es la presenciade anemia, que se asocia con mayor frecuencia al diagnósticode cáncer de colon: 30,4 versus 4,3% (p = 0,033).Conclusiones: en los pacientes remitidos para descartar unaneoplasia digestiva, con síntomas inespecíficos, se diagnostica confrecuencia de patología neoplásica ajena al tubo digestivo. Si consideramos,además, la elevada precisión diagnóstica de la ecografía,esta podría ser una muy buena primera aproximación diagnóstica

Background: the Positive Predictive Value (PPV) of signs andsymptoms for the diagnosis of colon and gastric cancer is low. Furthermore,many patients are referred to us to discard a digestive tractneoplasm with no symptoms suggestive of its whereabouts, in whomclinical PPV is even lower. This study evaluates the usefulness of ultrasonographyas a first approach to diagnosis.Material and methods: seventy-nine patients were recruitedinto the study (48 males with an average age of 69.3 years). Ultrasonographywas performed on all patients prior to endoscopy. Parametersstudied included diagnostic accuracy for colon and gastriccancer, ultrasonographic diagnoses, and number of endoscopies thatcan be avoided. Predictive factors for neoplasm location were alsostudied.Results: five gastric cancers (6.3%), 12 colon cancers (15,1%), 3pancreatic cancers (3.8%), 2 uterine neoplasms (2.5%), and 2 hypernephromas(2.5%) were diagnosed. The figures for sensitivity, specificity,PPV, Negative Predictive Value (NPV) and global accuracy ofultrasonography were 80%, 98.6%, 80%, 98.6%, and 97.4%, respectively,for gastric cancer, while these figures were 100%,94.5%, 80%, 100%, and 95.5%, respectively, for colon cancer. Ultrasonographyenabled to avoid 10% of endoscopic explorations.The only parameter that helps locate a neoplasm is the presence ofanemia, which is more frequently associated with a diagnosis ofcolon cancer: 30.4 versus 4.3% (p = 0.033).Conclusions: in patients without specific symptoms who weresent to us for discarding digestive tract neoplasm, “extra-digestive”neoplasms were frequently diagnosed. If we further take into accountthe high diagnostic accuracy of ultrasonography, then this procedurecould be a very good first approach towards such diagnosis

Dolor abdominal como forma de presentación rara del carcinoma hepatocelular: utilidad de la ecografía en el diagnóstico / No disponible

No disponible

[Usefulness of digestive ultrasonography in the assessment of ulcerative colitis extent]. / Utilidad de la ecografía en la valoración de la extensión de la colitis ulcerosa.

INTRODUCTION: A full examination of the colon should be avoided upon finding severe endoscopic lesions in patients with ulcerative colitis. However, knowledge of the precise extent of disease is quite important for disease prognosis and the making of therapeutic decisions. Therefore, any validation of a non-invasive technique to assess the extent of ulcerative colitis gains a lot of interest and importance. MATERIAL AND METHOD: The study included patients that were previously diagnosed of having ulcerative colitis or were beginning to suffer from the disease. A prospective and blind evaluation was carried out to determine the precision of digestive ultrasonography in assessment of ulcerative colitis extent. All ultrasonography was carried out by the same person and was always performed prior to carrying out a full endoscopic study, which is used as the gold standard. The hydrocolonic ultrasonograpy technique was not used in any of the cases. RESULTS: A total of 20 patients -13 males (65%) and 7 females (35%), with an average age of 51.7 years (aged between 24-82 years)- were included in the study. Endoscopic studies revealed severe disease in 5 cases (25%), moderate disease in 12 patients (60%), and mild lesions in the 3 remaining cases (15%). A colonic ultrasonogram was considered satisfactory in 18 cases (90%), and the extent of disease as established by ultrasonography was in all cases consistent with that established through colonoscopy: 3 patients (16.6%) had ulcerative proctitis, 9 patients (50%) had left-sided ulcerative colitis, and 6 (33.3%) had extensive colitis. CONCLUSIONS: Digestive ultrasonography allows to study the colon in most patients, especially when inflammatory activity is present, and provides a greater accuracy in assessing ulcerative colitis extent, which is independent of its activity level.

Utilidad de la ecografía en la valoración de la extensión de la colitis ulcerosa / Usefulness of digestive ultrasonography in assessment of ulcerative colitis extent

Introducción: el hallazgo de lesiones endoscópicas severasen un paciente con colitis ulcerosa desaconseja la realización deuna exploración completa del colon. No obstante el conocimientode la extensión precisa de la enfermedad tiene gran importanciaen las decisiones terapéuticas a tomar y también en el pronósticode la enfermedad. Por todo ello, la validación de una técnica noinvasiva para el estudio de extensión de la colitis ulcerosa cobragran interés e importancia.Material y método: se incluyen en el estudio pacientes condiagnóstico previo de colitis ulcerosa o en el debut de la enfermedady, de forma prospectiva y ciega se evalúa la precisión de laecografía digestiva en la valoración de la extensión de la colitis ulcerosa.Las exploraciones ecográficas son realizadas todas ellaspor el mismo explorador y siempre con anterioridad al estudio endoscópicocompleto, que se usa como patrón oro. No se empleala técnica hidrocolónica en ningún caso.Resultados: han sido incluidos en el estudio 20 pacientes, 13varones (65%) y 7 mujeres (35%), con una edad media de 51,7años (rango de 24 a 82 años). Los estudios endoscópicos mostraronuna afectación severa en 5 casos (25%), moderada en 12 pacientes(60%) y lesiones leves en los 3 casos restantes (15%). Elestudio ecográfico del colon fue considerado satisfactorio en 18casos (90%) y la extensión de la enfermedad establecida en el estudioecográfico coincide en todos los casos con la determinadapor la colonoscopia: 3 pacientes (16,6%) presentaban una proctitisulcerosa, 9 (50%) una colitis izquierda y 6 (33,3%) una colitisextensa.Conclusiones: la ecografía digestiva permite el estudio delmarco colónico en la mayoría de los pacientes, especialmente siexiste actividad inflamatoria, permitiendo establecer con gran precisiónla extensión de la colitis ulcerosa, independientemente delgrado de actividad de la misma

Introduction: a full examination of the colon should be avoidedupon finding severe endoscopic lesions in patients with ulcerativecolitis. However, knowledge of the precise extent of disease isquite important for disease prognosis and the making of therapeuticdecisions. Therefore, any validation of a non-invasive techniqueto assess the extent of ulcerative colitis gains a lot of interestand importance.Material and method: the study included patients that werepreviously diagnosed of having ulcerative colitis or were beginningto suffer from the disease. A prospective and blind evaluation wascarried out to determine the precision of digestive ultrasonographyin assessment of ulcerative colitis extent. All ultrasonographywas carried out by the same person and was always performedprior to carrying out a full endoscopic study, which is used as thegold standard. The hydrocolonic ultrasonograpy technique wasnot used in any of the cases.Results: a total of 20 patients –13 males (65%) and 7 females(35%), with an average age of 51.7 years (aged between 24-82years)– were included in the study. Endoscopic studies revealed severedisease in 5 cases (25%), moderate disease in 12 patients(60%), and mild lesions in the 3 remaining cases (15%). A colonicultrasonogram was considered satisfactory in 18 cases (90%), andthe extent of disease as established by ultrasonography was in allcases consistent with that established through colonoscopy: 3 patients(16.6%) had ulcerative proctitis, 9 patients (50%) had leftsidedulcerative colitis, and 6 (33.3%) had extensive colitis.Conclusions: digestive ultrasonography allows to study thecolon in most patients, especially when inflammatory activity ispresent, and provides a greater accuracy in assessing ulcerativecolitis extent, which is independent of its activity level

Use of adefovir in the treatment of the chronic hepatitis B virus infection with resistance to lamivudine.

Current therapies for the treatment of chronic hepatitis B virus (HBV) infection do not eliminate viral replication once therapy is stopped, resulting in a rapid rebound of viremia in a majority of patients. Prolonged therapy results in emergence of resistant virus, which is a major clinical concern. The appearance of resistant HBV is associated with decreased seroconversion rates as well as worse liver histology. Adefovir dipivoxil, a nucleotide analogue with potent antiviral activity against HBV and human immunodeficiency virus (HIV), has shown in vivo and in vitro to have activity against lamivudine-resistant HBV. We present a series of 6 patients with chronic HBV infection and lamivudine-resistant HBV treated with adefovir dipivoxil. The viremia decreased in all patients; in 4 of them, serum HBV DNA was negative by chain reaction (PCR) in a mean period of 10 months from beginning of treatment. Resistance to adefovir after 12 months of treatment has not been detected. Alanine aminotransferase (ALT) levels decreased in all patients and, at this moment, 5 of 6 patients present normal levels. There were no toxic side effects due to adefovir treatment. The data confirm that adefovir treatment has efficacy against HBV lamivudine-resistant forms.

Hipertensión portal extrahepática: trombosis espleno-portal secundaria a déficit de proteína C / Extrahepatic portal hypertension: portal and splenic vein thrombosis secondary to protein C deficiency

La trombosis portal es la causa más común de hipertensión portal prehepática. Representa un trastorno poco frecuente, que aparece normalmente relacionado con la existencia de cirrosis, enfermedades malignas hepatobiliares o alteraciones de la coagulación, siendo estas últimas uno de los factores de riesgo más importantes. El tratamiento anticoagulante debe emplearse en todos los casos de trombosis portal aguda y en la trombosis portal crónica cuando se identifique un factor protrombótico causal. Presentamos el caso de un varón de 29 años, diagnosticado de hipertensión portal prehepática, secundaria a trombosis portal y esplénica, que debutó con la aparición clínica de esplenomegalia y de alteraciones de la coagulación. Tras detectar un déficit de proteína C se instauró tratamiento anticoagulante. Un año después el paciente no ha presentado complicaciones en relación con su patología ni con el tratamiento pautado (AU)

Portal vein thrombosis (PVT) is the most frequent cause of hypertension portal extrahepatic. It is a rare disorder an the main risk factors are cirrhosis, hepatobiliary malignancies and prothrombotic disorders, which have been identified as major risk . Therapy with anticoagulants must to be considered in acute portal trombosis or chronic one and proven hypercoagulability. We present the case of a twenty-nine years old patient, with extrahepatic portal hypertension secondary to portal and splenic vein thrombosis, who was diagnosed because of splenomegaly and a coagulation disorder. A protein C deficiency were discovered and anticoagulation and beta-blocker therapy were iniciated. One year later the patient had not presented complications concerning to the disease or to the treatment (AU)

[Extrahepatic portal hypertension: spleno-portal thrombosis secondary to protein C deficiency]. / Hipertensión portal extrahepática: trombosis espleno-portal secundaria a déficit de proteína C.

Portal vein thrombosis (PVT) is the most frequent cause of hypertension portal extrahepatic. It is a rare disorder an the main risk factors are cirrhosis, hepatobiliary malignancies and prothrombotic disorders, which have been identified as major risk. Therapy with anticoagulants must to be considered in acute portal thrombosis or chronic one and proven hypercoagulability. We present the case of a twenty-nine years old patient, with extrahepatic portal hypertension secondary to portal and splenic vein thrombosis, who was diagnosed because of splenomegaly and a coagulation disorder. A protein C deficiency were discovered and anticoagulation and beta-blocker therapy were initiated. One year later the patient had not presented complications concerning to the disease or to the treatment.