Utilidad de la colonoscopia en la colitis isquémica / Usefulness of colonoscopy in ischemic colitis

Introducción: la colitis isquémica es la causa más frecuentede isquemia intestinal. Realizamos un estudio con el objetivo deanalizar las características demográficas, clínicas y la utilidad de lacolonoscopia en los pacientes diagnosticados de colitis isquémicaen nuestro centro en relación a un cambio de actitud terapéutica.Método: estudio retrospectivo en el que se seleccionaron 112pacientes diagnosticados de colitis isquémica mediante colonoscopiay biopsia, en un periodo de tiempo de cinco años. Se analizaron:edad, sexo, motivo de exploración, factores de riesgo cardiovascular,grado endoscópico de isquemia, cambio en la actitudterapéutica, tratamiento y evolución.Resultados: la edad media de nuestros pacientes fue de 73,6± 12,1 años con una incidencia similar en ambos sexos (50,9%mujeres y 49,1% hombres). Los factores de riesgo asociados fueronla hipertensión arterial (61,1%), el tabaco (37,2%) y antecedentede accidente cardiovascular previo (52,2%). El motivo másfrecuente de realización de colonoscopia fue rectorragia (53,6%)seguido de dolor abdominal (30,4%), realizándose de forma urgenteen el 65,3% de los casos. La colonoscopia permitió uncambio en la actitud terapéutica en el 50% de los casos, aumentandoen la urgente al 65,75%. La mortalidad global fue del27,67%. La colitis isquémica grave (25%) fue más frecuente envarones (64,3%), y cuando la indicación de colonoscopia fue urgente(85,71%) y cursó con mortalidad alta (53,57%). En estos serealizó tratamiento quirúrgico en el 57,14% de los casos con unaevolución favorable en el 50%, mientras que los pacientes con colitisisquémica leve o moderada tuvieron un pronóstico mejor, conevolución favorable en el 80,95% de los casos y con menor requerimientode tratamiento quirúrgico (4,76%, p < 0,05).Conclusión: la colitis isquémica es más frecuente en la edadavanzada. La sintomatología más común es la rectorragia y el dolorabdominal...(AU)

Background: the ischemic colitis is intestinal the most frequentcause of ischemia. With this work we determine the demographicand clinical characteristics, and the usefulness of thecolonoscopy in the patients with ischemic colitis diagnosed in ourcentre in relation to a change of therapeutic attitude.Method: retrospective study in which were selected 112 patientsdiagnosed with ischemic colitis by colonoscopy and biopsy,in a period of five years. It was analyzed: age, sex, reason for examination,factors of cardiovascular risk, endoscopic degree of ischemia,change in the therapeutic attitude, treatment and outcome.Results: the average age was of 73.64 ± 12.10 years with anequal incidence in women (50.9%) and the men (49.1%). The associatedfactors were the HTA (61.1%), tobacco (37.2%) and antecedentsof cardiovascular episode (52.2%). The most frequentreason for colonoscopy was rectorrhagia (53.6%) followed of theabdominal pain (30.4%), being urgent the 65.3%. Colonoscopyallowed a change in the therapeutic attitude in the 50 increasingin the urgent one to the 65.75%. Global mortality was of27.67%. The serious ischemic colitis (25%) was more frequent inmen (64.3%) in urgent indication (85.71%) and attends with highmortality (53.57%). Surgical treatment in the 57.14% was madewith a good evolution in the 50%, whereas the patients with mildor moderate ischemic colitis had a better prognosis (favourableevolution in 80.95%) with smaller requirement of the surgicaltreatment (4.76%), p < 0.05.Conclusion: the colitis ischemic are more frequent in the olderage. The most frequent symptoms are the rectorrhagia and theabdominal pain. The colonoscopy is a useful technique to evaluatethe gravity and it induces a change of attitude according to the resultof the same one. The evidence of a serious colitis supposedan increase of the necessity of surgery and worse prognosis(AU)

Usefulness of colonoscopy in ischemic colitis.

BACKGROUND: the ischemic colitis is intestinal the most frequent cause of ischemia. With this work we determine the demographic and clinical characteristics, and the usefulness of the colonoscopy in the patients with ischemic colitis diagnosed in our centre in relation to a change of therapeutic attitude. METHOD: retrospective study in which were selected 112 patients diagnosed with ischemic colitis by colonoscopy and biopsy, in a period of five years. It was analyzed: age, sex, reason for examination, factors of cardiovascular risk, endoscopic degree of ischemia, change in the therapeutic attitude, treatment and outcome. RESULTS: the average age was of 73.64 + or - 12.10 years with an equal incidence in women (50.9%) and the men (49.1%). The associated factors were the HTA (61.1%), tobacco (37.2%) and antecedents of cardiovascular episode (52.2%). The most frequent reason for colonoscopy was rectorrhagia (53.6%) followed of the abdominal pain (30.4%), being urgent the 65.3%. Colonoscopy allowed a change in the therapeutic attitude in the 50 increasing in the urgent one to the 65.75%. Global mortality was of 27.67%. The serious ischemic colitis (25%) was more frequent in men (64.3%) in urgent indication (85.71%) and attends with high mortality (53.57%). Surgical treatment in the 57.14% was made with a good evolution in the 50%, whereas the patients with mild or moderate ischemic colitis had a better prognosis (favourable evolution in 80.95%) with smaller requirement of the surgical treatment (4.76%), p < 0.05. CONCLUSION: the colitis ischemic are more frequent in the older age. The most frequent symptoms are the rectorrhagia and the abdominal pain. The colonoscopy is a useful technique to evaluate the gravity and it induces a change of attitude according to the result of the same one. The evidence of a serious colitis supposed an increase of the necessity of surgery and worse prognosis.

[Survey of informed consent in a gastrointestinal endoscopy unit]. / Encuesta de opinión sobre el consentimiento informado en una unidad de endoscopia digestiva.

OBJECTIVES: Gastrointestinal endoscopy, like all diagnostic and therapeutic techniques, must be preceded by written informed consent. The aim of this study was to evaluate the patients' acceptance and understanding of the aim of informed consent as well as to determine their perception of the investigation. METHODS: For 2 months, informed consent forms were given together with a questionnaire to 221 consecutive patients who underwent diagnostic gastrointestinal endoscopy. RESULTS: Distribution of the patients according to level of education was: university graduated (6.5%), high-school graduate (21.1%) those who had completed primary school (48.6%) and those with no schooling (23.9%). The document was read by 144 patients (65.1%) and the attending physician had previously explained it to 69.6%. Informed consent was understood by 90.7% of the patients who read the document. Understanding was related to education (university and high-school graduates (83.3%) vs. those who had completed primary school or who had no schooling (60%); p < 0.005) and was not related to the information given by the attending physician. Patients' opinion on the aim of informed consent was: absolve the doctor of responsibility (42%), provide information in the patients' interests (51.1%) and senseless document (42%). Signing the document provoked fear in 20% of those surveyed. This fear was greater in patients who had not been informed by the attending physician (31.2% vs. 14.5%; p > 0.01). CONCLUSIONS: Informed consent is understood by most patients who read the form but a significant proportion perceive it as designed to defend the physician. When the technique is explained by the attending physician and the doctor performing the procedure, acceptance is increased and fear is reduced.

Rheumatologic and autoimmune manifestations in patients with chronic hepatitis C virus infection.

Hepatitis C virus (HCV) has been associated with several autoimmune and rheumatologic disorders. The aim of this study was to determine the incidence of these abnormalities in patients with chronic HCV. We studied 56 patients, 29 of whom (52%) had biochemical abnormalities that suggested immunological disorders. Cryoglobulinemia was detected in nine patients (22%), antinuclear antibodies in eleven (20%), rheumatoid factor in seven (19.27%) and hypocomplementemia in fourteen (29.16%). The most common clinical manifestations were: arthralgias (52%), myalgias (16%), xerostomia (28.5%) and xerophthalmia (14%). These results indicate the existence of a relationship between HCV and rheumatologic disorders. We conclude that HCV may play a role in the pathogenesis of these autoimmune phenomena, but more studies are required to define the extent of this role.

[Ischemic hepatitis following liver biopsy in a patient with transplanted liver]. / Hepatitis isquémica tras biopsia hepática en paciente transplantada hepática.

We report a case of ischemic hepatitis following a percutaneous liver biopsy in a 51 year old female patient, who had had an orthotopic liver transplant 6 months before. The angiographic study demonstrated a marked stenosis in the hepatic artery at the anastomosis site and a small arterioportal fistula. We suggest that the percutaneous liver biopsy was partially responsible for the ischemic hepatitis, due to the development of a small arterioportal fistula in a previously damaged vascular area with hepatic artery stenosis.

[The response to hepatitis B vaccine prior to orthotopic liver transplantation]. / Respuesta a la vacuna de la hepatitis B previa al trasplante hepático ortotópico.

UNLABELLED: HBV hepatitis is a severe complication of orthotopic liver transplantation (OLT) due to the immunosuppression therapy. OBJECTIVES: The aim of this study is to evaluate the efficacy of the active HBV immunization on these patients before OLT. PATIENTS AND METHODS: This was a prospective trial, with 34 patients (20 M and 14 F), that received a double dose (40 micrograms) of HBV surface proteic Ag, on the 0th, 30th and 60th days of the study and posterior control of anti-HBs levels. If there wasn't a response, they received two more doses on the 90th and 120th days. RESULTS: There was a seroconversion in 22 patients (64.7%). Chronic alcoholism determined a lower rate of response than other etiologies (p < 0.05); this was the same in HCV chronic liver disease (p < 0.01). During their follow up, two patients had acute HBV hepatitis: one of them presented a negative response from the beginning, and in the other, anti-HBs developed transiently, when the HBV markers appeared. CONCLUSIONS: Previous HBV active immunization in OLT patients with double dose in a quick sequence, determined a positive response in a high number of patients with a higher rate of seroconversion than in other studies. The response was not so high in patients with chronic alcoholism or HVC chronic liver disease. We conclude that HVB vaccination should be done in these patients.

[Mixed cryoglobulinemia associated with hepatitis C virus]. / Crioglobulinemia mixta asociada al virus de la hepatitis C.

We report six cases of essential mixed cryoglobulinemia associated with chronic liver disease and positive HCV markers, who showed several acute symptoms of vasculitis, arthralgias, neuropathy and glomerulonephritis. The presence in the serum and cryoprecipitates of anti HCV antibodies detected by the second-generation ELISA (ELISA 2) and the of HCV RNA by PCR in the serum in all six cases, suggest an important role for this virus in the pathogenesis of mixed cryoglobulinemia.

[Hepatic angiosarcoma with splenic metastasis]. / Angiosarcoma hepático con metástasis esplénica.

Angiosarcoma of the liver is an extremely rare tumor with a rapidly fatal course. This report describes the case of a 52-year-old male with an hepatic angiosarcoma not related to any known carcinogen. The hepatosplenic metastases and the brief clinical course, did not let us to complete diagnostic and therapeutic strategies.

Acute pancreatitis associated with milk allergy.

We are reporting the case of a 23-yr-old patient who had recurring episodes of acute pancreatitis characterized by the typical abdominal pain, elevated serum levels of pancreatic enzymes, and enlargement of the pancreas and edema on sonogram. These episodes were accompanied by facial erythema with conjunctival injection, generalized pruritus, diarrhea, and eosinophilia, and they were induced by the consumption of milk. The serum levels of IgE specific to cow milk proteins and to beta-lactoglobulin were increased. We suggest that these episodes are caused by a milk allergy (milk), that has been described as an unusual cause of acute pancreatitis.

[Transjugular hepatic biopsy. Apropos the first 100 cases and a review of the literature]. / Biopsia hepática transyugular: a propósito de los cien primeros casos y revisión de la literatura.

Under certain conditions a percutaneous liver biopsy cannot be carried out. In many of these patients transjugular liver biopsy is the correct option. We present our first hundred biopsies: in 92 cases a liver specimen was obtained; in 80 cases (87%) the tissue specimen allowed the histopathologic diagnosis; in five cases perforation of the hepatic capsule was observed, without producing hemoperitoneum. The mortality in our series was nil. In our experience and the revision of the literature, we consider that transvenous (transjugular) needle biopsy is an efficient and reliable procedure.

[The epidemiological aspects of chronic inflammatory intestinal disease in a catchment area of the Autonomous Community of Madrid]. / Aspectos epidemiológicos de la enfermedad inflamatoria intestinal crónica en un área asistencial de la Comunidad Autónoma de Madrid.

124 cases of chronic inflammatory bowel disease were retrospectively reviewed between 1983 and 1988 (44 affected by Crohn's disease (CD) and 80 by ulcerative colitis (UC)). A median annual incidence of 1.30/100,000 inhabitants/year for CD and 2.37 for UC was found, observing an increase in the incidence of CD and a stabilization of UC.