Risk factors for ulcerative colitis: A population-based, case-control study in Spain.

BACKGROUND: Environmental factors seem to be very important in the aetiology of Ulcerative Colitis (UC), with smoking, contraceptive use, and hygiene being the factors most commonly linked to disease. AIM: To analyse the association between different risk factors and development of UC in our community. PATIENTS AND METHODS: This is a case-control, population-based study. The UC population consists of an inception-case population of all cases diagnosed, using Lennard-Jones criteria, in our community from 1st February 1992 to 31st January 1995 that were prospectively included. Controls were selected from healthy population and matched with patients for age, sex and rural/urban habitat. We used the SPSS/PC+ software, EpiInfo and Statistix for statistical analysis, giving the rates as point estimates and 95% confidence intervals (95%CI) or as mean±standard deviation in quantitative variables. For multivariate analysis we used conditional logistic regression. RESULTS: 205 patients were diagnosed of UC. 38 patients (18.5%) with UC were smokers, compared with 84 (40.8%) controls (p<0.001). Smoking behaved as a protector factor for UC (OR=0.55 (CI 95% 0.33-0.92) and ex-smoker acted as a risk factor (OR=1.94 (CI 95% 1.14-3.34). After the multivariate analysis, both associations were maintained. We did not detect statistical differences in the analysis of previous appendectomy, childhood hygiene or oral contraceptive use. Five of the 12 cases with family aggregation had first-degree relatives and 7 of them second-degree relatives. None of the controls had previous IBD history (p=0.0002). CONCLUSION: Ex-smoking and previous family history of inflammatory bowel disease appeared as risk factors for developing ulcerative colitis while current smoking behaved as a protective factor in this population.

Necrotizing fasciitis after liposuction.

Necrotizing fasciitis is a progressive soft tissue infection (skin, subcutaneous tissue and fascia) caused in the main by Streptococcus pyogenes, which gains entry into the organism through any type of wound and even through intact skin. Diagnosis is essentially clinical, being the sum of non-specific, insidious skin lesions, associated with intense pain and multiorgan failure. Treatment is radical surgical excision of the affected tissues, combined antibiotic therapy and supportive care. However, mortality rates are still very high. It is therefore a disease to be taken very seriously, not only in the population as a whole, but following any surgical intervention, including cosmetic surgery, where there have been reports of cases. We present a case treated in our Department, with the aim of augmenting the references available on the subject and consequently increasing awareness and interest in this serious condition which has such terrible consequences.

Liver adenoma and focal nodular hyperplasia associated with oral contraceptives.

We report the case of a woman, with a 15-year history of high-dosage oral contraceptive use, who came to our center for a gynecological screening. Elevated liver enzymes were detected in blood samples and an abdominal ultrasound showed a hypoechogenic nodular image of 8 cm in the right hepatic lobe of the liver. Routine examinations, including hepatitis B surface antigen, hepatitis C viral antibody and alpha-fetoprotein, were all negative. Imaging studies, including computerized tomography scan, magnetic resonance imaging, sulfur colloid gammagraphy and hepatic angiography, were performed and confirmed the presence of the lesion, detecting the characteristic central scar structure of focal nodular hyperplasia. Discontinuation of oral contraceptives and follow-up showed no change in lesion size so that a surgical approach was adopted in order to remove the hepatocellular carcinoma. Pathological findings confirmed focal nodular hyperplasia.

Non-steroidal anti-inflammatory drugs and prostaglandin effects on pepsinogen secretion by dispersed human peptic cells.

The effects of aspirin and ibuprofen on pepsinogen secretion were studied in isolated human peptic cells prepared from endoscopically obtained biopsy specimens after collagenase digestion, mechanical disruption, and percoll gradient centrifugation. Pharmacological concentrations of aspirin and ibuprofen (10(-8)-10(-4) M), potentiated histamine (10(-6)-10(-4)M) and forskolin (10(-5)M) stimulated pepsinogen secretion without affecting basal secretion, acetylcholine (10(-6)M) stimulated pepsinogen secretion or cell vitality. Augmentation of secretagogue stimulated pepsinogen secretion was dependent on extracellular calcium because potentiation was abolished by calcium depletion of the medium. Cimetidine inhibited the potentiation effect on histamine but not on forskolin stimulated pepsinogen secretion, thus suggesting that this augmentation was independent of histamine H2 receptors. Of interest, potentiation was also independent of endogenous prostaglandin inhibition because exogenous addition of prostaglandin E2 and D2 increased both basal and acetylcholine stimulated pepsinogen secretion in a dose dependent way, but they did not modify histamine or histamine plus aspirin or ibuprofen stimulated pepsinogen secretion. In conclusion, aspirin and ibuprofen potentiate secretagogue stimulated pepsinogen secretion by dispersed human peptic cells and this might be an additional mechanism of non-steroidal anti-inflammatory drug (NSAID) induced gastric injury. This potentiation effect is regulated by calcium, independent of endogenous prostaglandin inhibition and seems to act on pepsinogen secretion at a post-receptor site.

[Deficiency polyneuropathy secondary to immunoproliferative disease of the small intestine]. / Polineuropatía carencial secundaria a enfermedad inmunoproliferativa de intestino delgado.

We report a new case of immunoproliferative small intestinal disease with neurological involvement expressed as deficiency polyneuropathy. In spite of non identifiable plasmatic paraprotein, the use of immunohistochemical techniques showed the characteristic proliferation in the intestinal mucosa of plasma cells with a prevalence of IgA cells, which define this disease.

[Gammagraphy with labeled leukocytes as an activity and extension index of Crohn disease]. / Gammagrafía con leucocitos marcados como índice de actividad y extensión de la enfermedad de Crohn.

The knowledge of the location and extent of bowel involment and disease activity can be an important aspect on the evaluation of inflammatory bowel disease. Thirty five patients of Crohn's disease (CD) have been studied in this sense. We performed a total of 44 scintigraphic examinations using 99mTc-HMPAO labeled leukocytes and the results were compared with several clinical-biological indexes and with radiology and endoscopy. The Tc scan was the most sensitive (84.3%) and specific (100%) activity index and showed an excellent correlation with radiology and/or endoscopy in the assessment of extent of disease. Leukocyte scanning brought useful information for the management of stenosis in CD.

[The epidemiological aspects of Crohn's disease in Zaragoza]. / Aspectos epidemiológicos de la enfermedad de Crohn en Zaragoza.

Crohn's disease (CD) incidence is characterized by a wide variability in different countries. In our area it hasn't developed yet any epidemiologic study about this disease. We have reviewed fifty-four new cases diagnosed in Zaragoza University Clinical Hospital (Spain) during the period 1974-1988. The most striking facts were that the incidence of Crohn's Disease increased steadily during the 15-year period studied and the existence of a statistical association between smoking and CD. Other features were similar those previously described in the literature.