Treatment of chronic he1patitis C genotype 1 with peginterferon-alpha2a (40 kDa) plus ribavirin under routine clinical practice in Spain: early prediction of sustained virological response rate.

BACKGROUND: Sustained virological response rates of up to 52% have been obtained with peginterferon alpha2a (40 kDa) plus ribavirin in patients suffering from chronic hepatitis C genotype 1 in randomized-controlled trials. AIM: To assess early virological response and its clinical utility in predicting an sustained virological response in patients suffering from chronic hepatitis C genotype 1 in routine clinical practice in Spain. METHODS: Treatment-naïve patients received pegylated interferon alpha2a (40 kDa) 180 microg/week plus ribavirin 1000/1200 mg/day for 48 weeks, and were followed for a further 24 weeks. Overall, 475 patients received at least one dose of medication and were included in the efficacy population. RESULTS: The overall sustained virological response rate was 48%. Of those with week 12 virological data, 83% had an early virological response. The negative predictive value of an early virological response was 93%. CONCLUSION: If sustained virological response is the goal, a treatment-decision based on a 12-week evaluation during routine clinical practice is feasible.

Visceral leishmaniasis diagnosed by colonoscopy.

Zoonotic visceral leishmaniasis is common in western Mediterranean countries. A strong link between visceral leishmaniasis and human immunodeficiency virus (coinfection) has been proved, especially in Spain, which is an endemic area. This suggests that Leishmania may behave opportunistically. We report a case of colonic leishmaniasis in a 23-year-old Spanish woman infected with the human immunodeficiency virus.

[Diffuse gastrointestinal angiodysplasia associated with cryptogenic hepatic cirrhosis and coagulopathy simulating von Willebrand disease]. / Angiodisplasia gastrointestinal difusa asociada a cirrosis hepática criptogenética y coagulopatía que simulaba una enfermedad de von Willebrand.

Angiodysplasic lesions can be located anywhere in the gastrointestinal tract, but most of them are found in the cecum and right colon. Angiodysplasias are very infrequent in the stomach and small bowel. These lesions can be associated with several clinical conditions, such as certain coagulation disorders and liver diseases. We report the case of a diffuse gastrointestinal angiodysplasia in a female patient with idiopathic cirrhosis of the liver who developed a coagulopathy which mimicked von Willebrand disease. After repeated blood transfusions, which were not able to control the anemia of the patient, an antrectomy was performed because most lesions were located in the antrum. The procedure did not achieve a suitable control of the bleeding. Finally, a hormonal therapy combining estrogens and progestagens, was able to control, at least partially, the patient's chronic gastrointestinal bleeding.

[Primary gastric lymphoma in an HIV positive patient]. / Linfoma gástrico primario en paciente VIH positivo.

We report the case of a young male patient, VIH (+), who was admitted in our hospital with severe epigastric pain. Endoscopical and histological diagnosis was primary gastric non-Hodgkin lymphoma without Helicobacter pylori. The patient was treated with chemotherapy by CHOP scheme (6 cycles), with high clinical improvement and endoscopical and histological regression of the lesion. We comment some features of this peculiar association.

[Epithelioid hemangioendothelioma: a rare hepatic tumor]. / Hemangioendotelioma epitelioide: Un raro tumor hepático.

We present a case of epithelioid hemangioendothelioma of the liver (EHL). The imaging techniques did not permit the diagnosis. A liver biopsy was done under laparoscopy. One year later, the patient remains without symptoms in spite of the presence of lung metastases and the therapeutic abstention. The most outstanding aspects of this rare hepatic tumor are discussed.

[Omeprazole and cimetidine in the treatment of upper digestive hemorrhage]. / Omeprazol y cimetidina en el tratamiento de la hemorragia digestiva alta.

AIM: To compare the efficacy of omeprazole (40 mgs/12 h i.v.) and cimetidine (1,200 mgs/i.v./day) in the management of upper gastrointestinal bleeding. EXPERIMENTAL DESIGN: Randomized, prospective open clinical trial. The end points are: mortality, surgical requirements, transfusion requirements, and length of hospitalization in Bleeding Unit and Hospital. PATIENTS: We study patients with upper gastrointestinal bleeding from peptic sources (duodenal ulcer, gastriculcer, acute gastric erosions and peptic esophagitis). 462 patients are evaluated and 282 finally included. RESULTS: 151 patients were given cimetidine and 131 omeprazole. No significant differences in any of the end points were found. CONCLUSIONS: The use of omeprazole does not improve cimetidine efficacy in the entire group of patients with upper gastrointestinal bleeding.

[The endoscopic management of postoperative biliary fistulae]. / Manejo endoscópico de las fístulas biliares postquirúrgicas.

We report a series of 15 patients with a postoperative biliary fistula treated by endoscopic sphincterotomy. The exact location of the bile leak was revealed by ERCP in 13 cases (87%): cystic duct remnant in 6 (39%), intrahepatic biliary tree in 4 (26%), and main bile duct in 3 (20%). In all cases a distal obstacle (ie: retained stones, hydatid material) to bile flow was also found in ERCP. Treatment consisted of endoscopic sphincterotomy and subsequent removal of the distal obstacle, and could be completed in 13 (87%) cases. In our experience the treatment of postoperative biliary fistula with a distal obstruction bile flow by endoscopic sphincterotomy is a safe and effective procedure, and should be recommended as the first option in those patients.

[Effectiveness of maintenance treatment with cimetidine in duodenal ulcer. Variations depending on the risk group]. / Eficacia del tratamiento de mantenimiento con cimetidina en el ulcus duodenal. Variaciones según el grupo de riesgo.

One hundred and twenty-two patients with confirmed duodenal ulcer were treated with cimetidine during 6 or 12 weeks. After gastroscopic confirmation of healing, treatment was suppressed during 3 months. Patients were randomized into two therapeutic regimens: intermittent according to recurrence of symptoms and maintenance with 400 mg cimetidine. In patients considered as having mild disease (healing at 6 weeks without recurrence) fared better with maintenance therapy than with intermittent dosage. All patients with moderate to severe disease on intermittent therapy had a recurrence (criterion: more than 6 weeks for healing the ulcer or recurrence before three months). Those on maintenance therapy had the following results: no recurrences 28%, one recurrence 56% and more than one 16%. Ninety three patients were followed during one entire year. There was also a statistical difference in the number of severe complications among patients on continuous maintenance (nil) and those on intermittent therapy (8%, p less than 0.05).

[Esophageal motility disorders in cirrhotics treated by sclerosing the varices]. / Trastornos motores esofágicos en cirróticos tratados con esclerosis de varices.

We performed esophageal manometry on 17 cirrhotic patients (group I) treated with repeated varicose sclerosis (VS) after the varices had been completely eradicated. We used 5% ethanolamine oleate with the free hand technique, administering intra-varix injections at the cardia level, never exceeding 25 cc per session. The first two sessions were spaced a week apart, and the consecutive ones were on a monthly basis. The mean number of VS sessions was 5.52. The esophageal motility study was carried out on the average 12.3 months after the last VS session, with a minimum of six and maximum of 17 months. As controls we used 16 cirrhotic patients with unsclerosed varices (group II) and 26 healthy subjects (group III). The mean age and patient distribution were similar, according to Pugh grading. The length of the lower esophageal sphincter (LES) and the amplitude of the propulsive waves in the middle esophagus were similar in all three groups. We found the LES pressure to be significantly reduced in group I (17.52 +/- 2.8 mmHg) in relation to group II (20.26 +/- 2.49 mmHg) (p less than 0.001) and group III (22.86 +/- 3.73 mmHg) (p less than 0.01). The group II patients showed significantly lower pressure levels than the group III ones (p less than 0.05). The amplitude of peristaltic waves in the distal esophagus was significantly less in group I (22.94 +/- 7.31 mmHg) than in group II (37.46 +/- 10.95 mmHg) (p less than 0.01) and group III (44.8 +/- 11 mmHg) (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Combined therapy using ranitidine and sucralfate in duodenal ulcer resistant to cimetidine]. / Tratamiento combinado con ranitidina y sucralfato en úlceras duodenales resistentes a la cimetidina.

122 patients with duodenal ulcus have been treated with a cimetidine's single night dose of 800 mg over 6 or 12 weeks. After this period of time, 18 patients still had their wounds without complete healing. This group of patients had been afterwards treated with a combination of ranitidine and sulfacrate over a six weeks period. Only 3 of them achieved a complete ulcus reepitelization, although all of them were clinically asymptomatic. These 3 patients moved to a nightly maintenance treatment guideline of 150 mg of ranitidine, but they quickly presented relapses. A significantly higher consumption of tobacco and alcohol was observed among the patients who did not heal after 12 weeks of treatment with cimetidine. On the other hand the rest of the general facts and ulcus endoscopic characteristics have been similar both in patients resistant to cimetidine and in those who had a favorable evolution.