Peritonitis meconial, una complicación no descrita de la hepatitis E durante la gestación / Meconium peritonitis, a non-described complication of hepatitis E during pregnancy

La infección por el virus de la hepatitis E es una causa clásica de hepatitis fulminante en la gestación que puede acarrear graves consecuencias materno-fetales. Las complicaciones fetales se derivan fundamentalmente de la transmisión vertical durante la gestación o el parto (hipotermia, hipoglucemia, hepatitis aguda, necrosis masiva hepática) y de un aumento de la prematuridad que conllevaría una mayor mortalidad neonatal. La peritonitis meconial se ha descrito como complicación de la infección materno-fetal por parvovirus B19, citomegalovirus, rubeola, virus de la hepatitis A y virus de la hepatitis B, sin que hayan sido comunicados en la bibliografía casos secundarios a la infección por virus de la hepatitis E. Presentamos el caso de una gestante de 19 semanas que ingresa por un cuadro de hepatitis aguda E, con diagnóstico fetal ecográfico prenatal compatible con peritonitis meconial (AU)

Hepatitis E virus infection is a classical cause of fulminant hepatitis during pregnancy, which can lead to severe maternal and fetal complications. Fetal complications are mainly derived from the vertical transmission during pregnancy or delivery (hypothermia, hypoglycaemia, acute hepatitis, massive liver necrosis) and from and increase in prematurity that would lead on to a greater neonatal mortality. Meconium peritonitis has been described as a complication of maternal and fetal infection by parvovirus B19, cytomegalovirus, rubella, hepatitis A virus and hepatitis B virus. There have been no published cases relating meconium peritonitis and hepatitis E virus infection. We present the case of a 19 week pregnant woman admitted with an acute hepatitis E, with a fetal prenatal ultrasound diagnosis of meconium peritonitis (AU)

Ionizing radiation in patients with Crohn´s disease. Estimation and associated factors.

INTRODUCTION: exposure to ionizing radiation is associated with an increased risk of developing tumors. Patients with Crohn's disease (CD) usually require multiple imaging tests using this type of radiation. OBJECTIVES: the objectives of this study were to estimate the total dose of ionizing radiation received by patients with Crohn's disease during their course and to identify the factors associated with higher radiation doses. METHODS: two hundred thirty-five CD patients diagnosed between 1972 and 2010 were included. The effective dose (ED) received by each patient was calculated retrospectively based on the number of gastrointestinal transit studies and computed tomography scans performed. Considering recent epidemiological studies, an ED greater than or equal to 50 mSv was used as the cut-off point for increased risk of developing cancer. RESULTS: the mean ED received per patient was 33.4 mSv (95% CI 29.3-37.5). A total of 49 (20.8%) patients received an ED ≥ 50 mSv. The following factors were identified as independent predictors associated with an ED ≥ 50 mSv: Age older than 40 years, need for surgery, age under 16 years at diagnosis and disease duration over 8 years. CONCLUSIONS: a substantial proportion of patients with Crohn's disease receive high doses of potentially carcinogenic ionizing radiation. Identification of the most susceptible patients to receive high doses of radiation, monitoring of effective doses received and the use of imaging techniques that do not require ionizing radiation (MR enterography, abdominal ultrasound) could contribute in reducing patients' exposure to potentially carcinogenic ionizing radiation.

Radiación ionizante en pacientes con enfermedad de Crohn. Estimación y factores asociados / Ionizing radiation in patients with Crohn's disease. Estimation and associated factors

Introducción: la exposición a radiación ionizante se asocia a un mayor riesgo de desarrollar tumores. Los pacientes con enfermedad de Crohn requieren habitualmente múltiples pruebas de imagen que utilizan este tipo de radiación. Objetivos: los objetivos de este estudio son estimar la dosis total de radiación ionizante recibida por pacientes con enfermedad de Crohn a lo largo de su evolución e identificar los factores asociados a dosis de radiación más altas. Métodos: se incluyeron 235 pacientes con enfermedad de Crohn diagnosticados entre 1972 y 2010. Se calculó retrospectivamente la dosis efectiva (DE) recibida por cada paciente, teniendo en cuenta los tránsitos gastrointestinales y las tomografías computarizadas que se habían realizado. Basados en estudios epidemiológicos previos, se consideró un valor umbral de DE ≥ 50 mSv de mayor riesgo de desarrollar cáncer. Resultados: la media de DE recibida por paciente fue 33,4 mSv (IC 95% 29,3-37,5). Un total de 49 (20,8%) pacientes recibió una DE >= 50 mSv. Se identificaron como factores predictivos independientes asociados a una DE >= 50 mSv: edad mayor de 40 años, necesidad de cirugía, edad al diagnóstico menor 16 años y tiempo de evolución mayor de 8 años. Conclusiones: un porcentaje considerable de pacientes con enfermedad de Crohn recibe dosis elevadas de radiación ionizante potencialmente carcinogénicas. La identificación de los pacientes mas susceptibles a recibir dosis altas de radiación, la monitorización de la dosis efectiva recibida y la utilización de pruebas de imagen que no utilizan radiación ionizante (enterorresonancia, ecografía abdominal), podrían contribuir a reducir la exposición a la radiaciones ionizantes potencialmente carcinogénicas(AU)

Introduction: exposure to ionizing radiation is associated with an increased risk of developing tumors. Patients with Crohn’s disease (CD) usually require multiple imaging tests using this type of radiation. Objectives: the objectives of this study were to estimate the total dose of ionizing radiation received by patients with Crohn’s disease during their course and to identify the factors associated with higher radiation doses. Methods: two hundred thirty-five CD patients diagnosed between 1972 and 2010 were included. The effective dose (ED) received by each patient was calculated retrospectively based on the number of gastrointestinal transit studies and computed tomography scans performed. Considering recent epidemiological studies, an ED greater than or equal to 50 mSv was used as the cut-off point for increased risk of developing cancer. Results: the mean ED received per patient was 33.4 mSv (95% CI 29.3-37.5). A total of 49 (20.8%) patients received an ED >= 50 mSv. The following factors were identified as independent predictors associated with an ED >= 50 mSv: Age older than 40 years, need for surgery, age under 16 years at diagnosis and disease duration over 8 years. Conclusions: a substantial proportion of patients with Crohn’s disease receive high doses of potentially carcinogenic ionizing radiation. Identification of the most susceptible patients to receive high doses of radiation, monitoring of effective doses received and the use of imaging techniques that do not require ionizing radiation (MR enterography, abdominal ultrasound) could contribute in reducing patients’ exposure to potentially carcinogenic ionizing radiation(AU)