Characteristics and treatment of pyoderma gangrenosum in inflammatory bowel disease.

BACKGROUND: Pyoderma gangrenosum is a serious cutaneous complication seen in approximately 1 % of patients with inflammatory bowel disease (IBD). Oral corticosteroids are the mainstay treatment, although the evidence supporting their use is weak. AIMS: The purpose of this study was to investigate the characteristics of pyoderma gangrenosum associated with Crohn's disease or ulcerative colitis and which treatments are prescribed in Spanish clinical practice. METHODS: In this retrospective, observational study, the medical records from all patients with IBD and a diagnosis of pyoderma gangrenosum attended by the gastroenterology departments of 12 Spanish hospitals were reviewed. Data on patient demographics and characteristics, underlying IBD and treatment, and pyoderma gangrenosum characteristics, treatment, and outcome were collected and analyzed. RESULTS: The data from 67 patients were analyzed (41 [61.2 %] women, 41 [61.2 %] with Crohn's disease, 25 [37.3 %] with ulcerative colitis, and 1 [1.5 %] with indeterminate disease). The underlying disease was in remission in approximately one-third of patients at the time of presentation of pyoderma gangrenosum. Healing was achieved in all patients (in 3 without any systemic therapy). Oral corticosteroids were taken by 51 patients (76.1 %), almost always as first-line treatment, although definitive healing was attained in 19 (28.4 %). Biologic agents such as infliximab and adalimumab were taken by 31 patients (46.3 %) at some point (first-line in 6 patients [9.0 %]), with definitive healing in 29 patients (93.5 %). CONCLUSIONS: Oral corticosteroid therapy remains the most common treatment for pyoderma gangrenosum associated with inflammatory bowel disease. Biologic therapies such as infliximab and adalimumab should also be considered.

[A case of non Hodgkin Lymphoma in a patient with hepatic cirrhosis by the hepatitis C virus]. / Un caso de linfoma no hodgkiniano en una paciente con cirrosis hepática por el virus de la hepatitis C.

We present a case of non-Hodgkin's lymphoma of B cells in a patient with cirrhosis by hepatitis C virus. Our patient presented scarce symptomatology related with non-Hodgkin's lymphoma. A notable hyperbilirrubinaemia with hypoalbuminaemia were the only features that allowed us to suspect the diagnosis. The diagnostic was proved by necroscopic study. There are several factors involved in the etiology of non-Hodgkin's lymphoma, including infectious agents. Recent Italian studies have suggested an association between C virus infection and non-Hodgkin's lymphoma. We have carried out a bibliographical revision of this association to conclude that important geographical differencies must be pointed out.

[Gastrointestinal hemorrhage secondary to a pancreatic pseudoaneurysm]. / Hemorragia digestiva secundaria a un seudoaneurisma pancreático.

Acute hemorrhage from pancreatic pseudoaneurysm is the most rapidly fatal complication of pancreatitis, with a reported mortality rate of > 90% in untreated patients. The diagnosis of pancreatic pseudoaneurysm requires a high index of suspicion and the abdominal angiography is the gold standard. Transcatheter embolization is an alternative to surgery for treatment in selected patients. Early diagnosis and treatment decrease the mortality dramatically. We describe a patient with a gastrointestinal bleeding from a ruptured pancreatic pseudoaneurysm, with an angiography diagnosis and transcatheter embolization. We treated the pseudocyst with an endoscopic drainage. A review of literature is presented.

[Chronic calcifying pancreatitis and extracorporeal pancreatic lithotripsy]. / Pancreatitis crónica calcificante y litotripsia pancreática extracorpórea.

Abdominal pain is the most frequent symptom of chronic pancreatitis and may, on occasions, lead to great treatment problems. The case of a 35-years-old patient diagnosed with chronic calcifying pancreatitis of enolic etiology who showed dilatation of the main pancreatic duct and intracanalicular lithiasis is reported. Medical, endoscopic and surgical alternatives failed but fragmentation of the lithiasis by extracorporeal lithotripsy was successful.