Hepatotoxicity after high-dose intravenous methylprednisolone in multiple sclerosis patients.

Hepatotoxicity is a rare adverse event of methylprednisolone that should be considered in clinical practice. In patients at risk, we propose liver function surveillance, by measuring hepatic enzymes concentration 15-30 days after methylprednisolone administration. Additionally, we propose ACTH, dexamethasone, or plasma exchange as alternate treatment options for these patients.

Coste-efectividad y seguridad de telaprevir y boceprevir para el tratamiento de la hepatitis C crónica en la práctica clínica / Cost-effectiveness and safety of telaprevir and boceprevir for chronic hepatitis C in real-world clinical practice

INTRODUCCIÓN: La triple terapia con telaprevir o boceprevir ha resultado efectiva en el tratamiento de la hepatitis C crónica, con porcentajes de respuesta de hasta el 88%. Se asocia a importantes efectos adversos y supone un alto impacto económico. OBJETIVO: Valorar el coste-efectividad y la seguridad de telaprevir y boceprevir. MÉTODOS: Estudio observacional retrospectivo. Se incluyó a pacientes que iniciaron tratamiento con inhibidores de proteasa antes del 31 de julio del 2013. Se valoraron la respuesta virológica sostenida, el coste por paciente curado y el coste de las medidas para el manejo de los efectos adversos. RESULTADOS: Se incluyó a 59 pacientes, 35 con telaprevir (59,3%) y 24 con boceprevir (40,7%). Obtuvieron respuesta virológica sostenida 38 (64,4%) pacientes, 24 (68,6%) con telaprevir y 14 (58,3%) con boceprevir. El coste por paciente curado fue 43.555 Euros (IC del 95%, 35.389-51.722 Euros), sin diferencias significativas entre telaprevir, 43.494 Euros (IC del 95%, 34.795 Euros-55.092 Euros), y boceprevir, 42.005 Euros (IC del 95%, 32.122-64.243 Euros). El coste medio por paciente del manejo de los efectos adversos supuso 1.500 Euros, con un máximo 11.374 Euros. Para el tratamiento de los efectos adversos requirieron ingreso hospitalario 8 (13,6%) pacientes, visitas a Urgencias 22 (37,3%) pacientes y visitas médicas adicionales 26 (44,1%) pacientes. CONCLUSIONES: El tratamiento con triple terapia basada en telaprevir o boceprevir ha supuesto un alto coste por paciente curado. Los efectos adversos desarrollados han requerido que un alto número de pacientes necesiten medidas de soporte, cuyo coste hay que añadir al del tratamiento con triple terapia

INTRODUCTION: Triple therapy with telaprevir or boceprevir has proven to be effective in the treatment of chronic hepatitis C with response rates of up to 88%. However, the treatment may be associated with important adverse effects and a high economic impact. OBJECTIVE: To assess the cost-effectiveness and safety of triple therapy with telaprevir or boceprevir for the treatment of chronic hepatitis C. METHODS: Retrospective observational study. We included all patients who had started treatment with protease inhibitors before July 31st, 2013. We evaluated sustained virological response, the cost per patient achieving sustained virological response, and the cost of the supportive treatment for adverse events associated with triple therapy. RESULTS: Fifty-nine patients were included; 35 had been treated with telaprevir (59.3%) and 24 with boceprevir (40.7%). Sustained virological response was achieved by 38 (64.4%) patients: 24 (68.6%) patients in the telaprevir treatment arm and 14 (58.3%) patients in the boceprevir treatment arm. The cost per patient with sustained virological response was 43,555 Euros (95% CI 35,389-51,722 Euros). There were no statistically significant differences between the overall costs of therapy with telaprevir, 43,494 Euros (95% CI 34,795 Euros-55,092 Euros) versus boceprevir, 42,005 Euros (95% CI 32,122-64,243 Euros). The mean cost of supportive care per patient was 1,500 Euros, while the maximum cost was 11,374 Euros. Due to adverse events, 8 (13.6%) patients required hospital admission, 22 (37.3%) patients attended the accident and emergency department, and 26 (44.1%) patients needed additional medical consultations. CONCLUSIONS: The treatment of triple therapy with telaprevir or boceprevir resulted in high cost per patient with sustained virological response. Due to adverse events, a high number of patients required supportive care, whose costs should be added to those of triple therapy

[Cost-effectiveness and safety of telaprevir and boceprevir for chronic hepatitis C in real-world clinical practice]. / Coste-efectividad y seguridad de telaprevir y boceprevir para el tratamiento de la hepatitis C crónica en la práctica clínica.

INTRODUCTION: Triple therapy with telaprevir or boceprevir has proven to be effective in the treatment of chronic hepatitis C with response rates of up to 88%. However, the treatment may be associated with important adverse effects and a high economic impact. OBJECTIVE: To assess the cost-effectiveness and safety of triple therapy with telaprevir or boceprevir for the treatment of chronic hepatitis C. METHODS: Retrospective observational study. We included all patients who had started treatment with protease inhibitors before July 31(st), 2013. We evaluated sustained virological response, the cost per patient achieving sustained virological response, and the cost of the supportive treatment for adverse events associated with triple therapy. RESULTS: Fifty-nine patients were included; 35 had been treated with telaprevir (59.3%) and 24 with boceprevir (40.7%). Sustained virological response was achieved by 38 (64.4%) patients: 24 (68.6%) patients in the telaprevir treatment arm and 14 (58.3%) patients in the boceprevir treatment arm. The cost per patient with sustained virological response was 43,555 € (95% CI 35,389-51,722 €). There were no statistically significant differences between the overall costs of therapy with telaprevir, 43,494 € (95% CI 34,795 €-55,092 €) versus boceprevir, 42,005 € (95% CI 32,122-64,243€). The mean cost of supportive care per patient was 1,500 €, while the maximum cost was 11,374 €. Due to adverse events, 8 (13.6%) patients required hospital admission, 22 (37.3%) patients attended the accident and emergency department, and 26 (44.1%) patients needed additional medical consultations. CONCLUSIONS: The treatment of triple therapy with telaprevir or boceprevir resulted in high cost per patient with sustained virological response. Due to adverse events, a high number of patients required supportive care, whose costs should be added to those of triple therapy.

Pseudo-pseudoxantoma elástico inducido por D-penicilamina en un paciente con enfermedad de Wilson: ¿qué puede hacer el hepatólogo? / Penicillamine induced pseudo-pseudoxanthoma elasticum in a patient with Wilson's disease, which role plays the hepatologist?

No disponible

Octreotide long-active release in the treatment of gastrointestinal bleeding due to vascular malformations: Cost-effectiveness study.

INTRODUCTION: Gastrointestinal hemorrhage due to vascular malformations has a negative impact on patients´ quality of life and consumes an important quantity of resources. OBJECTIVE: Analyze the cost-effectiveness of long-active releasing octreotide (OCT-LAR) in the treatment of gastrointestinal haemorrhage secondary to vascular malformations. MATERIAL AND METHODS: Retrospective study, including 19 pacients that were treated with mensual injections of OCTLAR between 2008-2013. The number of blood transfusions, hemoglobin levels, hospital admissions and possible side effects during the year before treatment and the year after the start of the treatment were assessed, and cost-effectiveness was analyzed. RESULTS: After the beginning of the treatment with OCTLAR, complete response was observed in 7 patients (36.8 %), partial response in 7 patients (36.8 %) and 5 patients (26.3 %) continued to require admissions, blood transfusions and/or endoscopic treatment. We observed significant reduction in the length of admission per year (in days) before and after the start of the treatment (22.79 versus 2.01 days, p < 0.0001) as well as in the number of blood transfusions administered (11.19 versus 2.55 blood transfusions per year, p = 0.002). The mean haemoglobin levels increased from 6.9 g/dl to 10.62 g/dl (p < 0.0001). We observed reduction of costs of 61.5 % between the two periods (from 36,072.35 € to 13,867.57 € per patient and year, p = 0.01). No side effects related to treatment were described. CONCLUSION: In conclusion, OCT-LAR seems to be a costefficient and safe pharmacological treatment of gastrointestinal haemorrhage secondary to vascular malformations, mainly in patients in whom endoscopic or surgical treatment is contraindicated.

Octreótido de acción prolongada (LAR) en el tratamiento de hemorragia digestiva por lesiones vasculares: estudio de coste-eficiencia / Octreotide long-active release in the treatment of gastrointestinal bleeding due to vascular malformations: cost-effectiveness study

INTRODUCCIÓN: la hemorragia digestiva por lesiones vasculares (HDLV) deteriora la calidad de vida de los pacientes y requiere el consumo de una importante cantidad de recursos. OBJETIVO: analizar la coste-eficiencia de octreótido de depósito (OCT-LAR) en el tratamiento de hemorragia gastrointestinal por lesiones vasculares. MATERIAL Y MÉTODOS: estudio retrospectivo, incluyendo a 19 pacientes que fueron tratados con inyecciones mensuales de OCTLAR entre los años 2008-2013. Se revisaron los requerimientos transfusionales, niveles de hemoglobina, necesidad de ingreso hospitalario y posibles efectos secundarios en el año previo y posterior al inicio del tratamiento, se analizó la coste-eficiencia. RESULTADOS: tras el inicio de OCT-LAR observamos respuesta completa en 7 pacientes (36,8 %), parcial en otros 7 pacientes (36,8 %) y 5 pacientes (26,3 %) siguieron precisando ingresos, trasfusiones de hemoderivados y/o tratamiento endoscópico. Observamos disminución significativa de los días de ingreso al año, antes y después de tratamiento (22,79 vs. 2,01 días, p < 0,0001) y del número de concentrados de hematíes transfundidos (11,19 vs. 2,55 concentrados de hematíes por paciente/año, p = 0,002). La media de hemoglobina mejoró de 6,95 a 10,62 g/dl (p < 0,0001). Observamos una reducción del 61,5 % del coste entre los dos periodos (de 36.072,35 Euros a 13.867,57 Euros por paciente/ año, p = 0,01). No se observaron efectos secundarios asociados al tratamiento. CONCLUSIÓN: en conclusión, OCT-LAR parecer ser un tratamiento farmacológico coste-eficiente y seguro para la hemorragia digestiva secundaria a malformaciones vasculares, especialmente en pacientes no subsidiaros de tratamiento endoscópico o quirúrgico

INTRODUCTION: Gastrointestinal hemorrhage due to vascular malformations has a negative impact on patients' quality of life and consumes an important quantity of resources. OBJECTIVE: Analyze the cost-effectiveness of long-active releasing octreotide (OCT-LAR) in the treatment of gastrointestinal haemorrhage secondary to vascular malformations. MATERIAL AND METHODS: Retrospective study, including 19 pacients that were treated with mensual injections of OCTLAR between 2008-2013. The number of blood transfusions, hemoglobin levels, hospital admissions and possible side effects during the year before treatment and the year after the start of the treatment were assessed, and cost-effectiveness was analyzed. RESULTS: After the beginning of the treatment with OCTLAR, complete response was observed in 7 patients (36.8 %), partial response in 7 patients (36.8 %) and 5 patients (26.3 %) continued to require admissions, blood transfusions and/or endoscopic treatment. We observed significant reduction in the length of admission per year (in days) before and after the start of the treatment (22.79 versus 2.01 days, p < 0.0001) as well as in the number of blood transfusions administered (11.19 versus 2.55 blood transfusions per year, p = 0.002). The mean haemoglobin levels increased from 6.9 g/dl to 10.62 g/dl (p < 0.0001). We observed reduction of costs of 61.5 % between the two periods (from 36,072.35 Euros to 13,867.57 Euros per patient and year, p = 0.01). No side effects related to treatment were described. CONCLUSION: In conclusion, OCT-LAR seems to be a costefficient and safe pharmacological treatment of gastrointestinal haemorrhage secondary to vascular malformations, mainly in patients in whom endoscopic or surgical treatment is contraindicated

Enfermedad de Wilson: espectro clínico de la enfermedad hepática / No disponible

La enfermedad de Wilson es un trastorno hereditario autosómico recesivo del metabolismo del cobre (gen ATP7B), que se caracteriza por la acumulación del mismo en diferentes órganos, principalmente el hígado y el cerebro. Es una enfermedad poco frecuente, difícil de diagnosticar en muchas ocasiones y con un espectro clínico muy amplio y, por lo tanto, debemos sospecharla siempre en un paciente con hepatopatía de causa no clara. En el siguiente artículo presentamos 2 pacientes con diferentes formas de manifestación de la enfermedad hepática, uno de ellos requirió trasplante hepático urgente por fallo hepático fulminante y el otro recibió tratamiento médico. El objetivo de esta observación clínica es analizar el diagnóstico de la enfermedad de Wilson en 2 pacientes en los que se inició de forma diferente y, por tanto, el amplio espectro clínico de la enfermedad y su tratamiento (AU)

Wilson’s disease is a hereditary autosomal recessive disorder of copper metabolism, characterized by copper accumulation in the liver and brain. This rare entity, which has abroad clinical spectrum, is often difficult to diagnose and should therefore always be suspected in patients with liver disease of unclear cause. We describe two types of manifestation of liver disease in two patients; the first developed fulminant hepatic failure requiring urgent liver transplantation and the second showed advanced chronic liver disease and received standard medical treatment. The objective of this clinical observation is to analyze the diagnosis of Wilson’s disease in two patients with distinct onset, illustrating the broad clinical spectrum of the disease, and its treatment (AU)

[Wilson's disease: clinical spectrum of liver disease]. / Enfermedad de Wilson: espectro clínico de la enfermedad hepática.

Wilson's disease is a hereditary autosomal recessive disorder of copper metabolism,characterized by copper accumulation in the liver and brain. This rare entity, which has a broad clinical spectrum, is often difficult to diagnose and should therefore always be suspected in patients with liver disease of unclear cause. We describe two types of manifestation of liver disease in two patients; the first developed fulminant hepatic failure requiring urgent liver transplantation and the second showed advanced chronic liver disease and received standard medical treatment. The objective of this clinical observation is to analyze the diagnosis of Wilson's disease in two patients with distinct onset, illustrating the broad clinical spectrum of the disease, and its treatment.

Optimización del cultivo de líquido ascítico en el contexto clínico de la peritonitis bacteriana espontánea / Optimization of ascitic fluid culture in spontaneous bacterial peritonitis

Introducción y objetivosLa peritonitis bacteriana espontánea (PBE) es la infección del líquido ascítico (LA) en ausencia de foco infeccioso intraperitoneal en pacientes con enfermedad hepática e hipertensión portal. El objetivo del estudio fue la evaluación de la rentabilidad de los cultivos microbiológicos tras la optimización de la sistemática en su recogida en la práctica clínica habitual.MétodosSe analizaron 2 series, la primera retrospectiva con datos de 156 episodios de PBE consecutivos de enero de 2003 a diciembre de 2005 (grupo R), y la segunda con un grupo prospectivo desde octubre de 2007 a octubre de 2008, constituido por 79 episodios, en los que se optimizó el protocolo diagnóstico de PBE (grupo P), con la recogida sistemática de 10ml de LA por bote de hemocultivo.ResultadosLas características basales epidemiológicas y clínicas entre los episodios fueron similares, salvo mayor incidencia de insuficiencia renal, ascitis a tensión e íleo adinámico, y en la etiología de la hepatopatía, más frecuente de origen etílico, en el grupo P. Se consiguió aislamiento microbiológico en LA en el 12,2% de los episodios del grupo R, frente al 53,2% del grupo P (p=0,001) y en hemocultivos en el 8,5 y 26,6% (p=0,001), respectivamente. Se obtuvo aislamiento microbiológico en el 65,8% de los episodios del grupo P frente al 19,2% del grupo R (OR 8; IC 95%: 4,4-14,9; p=0,001). El microorganismo más frecuentemente aislado en la en el grupo P fue Escherichia coli (42,9%).ConclusionesLa optimización en la realización de la sistemática diagnóstica en la práctica asistencial del paciente cirrótico con ascitis aumenta su rendimiento microbiológico diagnóstico (AU)

Introduction and aimsSpontaneous bacterial peritonitis (SBP) is ascitic fluid (AF) infection in the absence of an intraperitoneal source of infection in patients with liver disease and portal hypertension. The aim of this study was to evaluate the yield of microbiological cultures to optimize their collection and systematic implementation in routine clinical practice.MethodsWe analyzed two cohorts: the first consisted of retrospective data from the clinical records of 156 consecutive episodes of SBP from January 2003 to December 2005 (group R), and the second was composed of data collected prospectively from October 2007 to October 2008, consisting of 79 episodes (group P), with systematic inoculation of 10 cc of AF in each blood culture bottle.ResultsNo significant differences were demonstrated in baseline epidemiological or clinical characteristics among episodes, except the more frequent presence of alcoholic liver disease and the incidence of tense ascites, paralytic ileus and kidney failure at diagnosis in group P. Microbiological isolation in AF was achieved in 12.2% of the episodes in group R compared with 53.2% in group P (p=0.001) and 8.5 and 26.6% (p=0.001) in blood culture, respectively. Microbiological isolation was achieved in 65.8% of episodes in group P versus 19.2% in group R (OR 8; 95% CI: 4.4-14.9; p=0.001). The most frequently isolated organism in AF in group P was Escherichia coli (42.9%).ConclusionsOptimizing the diagnostic procedure in cirrhotic patients with ascites significantly increases diagnostic microbiologic performance(AU)

Estudio descriptivo de la experiencia sobre carcinoma hepatocelular en hígado no cirrótico / Descriptive study of hepatocellular carcinoma in noncirrhotic liver

Introducción y objetivoEl carcinoma hepatocelular (CHC) es la sexta causa de cáncer. En el mundo occidental su incidencia está en aumento y la gran mayoría asientan sobre una cirrosis hepática. El objetivo del estudio fue evaluar las características del CHC en pacientes sin cirrosis.MétodosSe realizó una revisión retrospectiva de 469 pacientes con diagnóstico de CHC durante el periodo de enero de 2003 a diciembre de 2007. Se seleccionaron aquellos pacientes que cumplían criterios histológicos, o la conjunción de criterios clínicos, analíticos, radiológicos y/o de hemodinámica hepática, de ausencia de cirrosis hepática.ResultadosSe identificaron 29 pacientes con diagnóstico de CHC sobre hígado no cirrótico (6,2%). El 86,2% eran varones y con una mediana de edad de 61,6 (23 - 82) años. La enfermedad hepática fue hepatopatía crónica con fibrosis leve-moderada en el 68,9%. El 62,1% de los pacientes se encontraban asintomáticos al diagnóstico. El CHC era un nódulo único en el 86,2%, y la mediana del nódulo mayor fue 46 (20 - 150) mm. Se evidenció invasión vascular macroscópica en dos pacientes y metástasis óseas en otros dos. Se realizó tratamiento activo en 25 pacientes: 15 resección quirúrgica, 6 radiofrecuencia y 4 quimioembolización transarterial. La supervivencia acumulada a 1, 2 y 3 años, fue del 84,3; 67,2 y 50,1%, respectivamente.ConclusionesEl CHC sobre hígado no cirrótico es una patología poco frecuente, siendo tumores de gran tamaño al diagnóstico. A pesar de ello, se pueden aplicar tratamientos con intención curativa y alcanzar una supervivencia superior a la esperable en pacientes con cirrosis(AU)

Introduction and objectiveHepatocellular carcinoma (HCC) is the sixth leading cause of cancer. In western countries its impact is steadily growing and most of these tumors arise in cirrhotic liver. The aim of this study was to evaluate the incidence and characteristics of HCC developing in noncirrhotic patients. Methods: We conducted a retrospective review of 469 patients diagnosed with HCC between January 2003 and December 2007. Patients who met the histological criteria, or a combination of clinical, laboratory, imaging and hemodynamic criteria for the absence of cirrhosis were included.ResultsWe identified 29 patients with a diagnosis of HCC in non-cirrhotic liver (6.2%). Most (86.2%) were men and the median age was 61.6 (23 - 82) years. The most frequent histology of the liver was mild-moderate liver fibrosis (68.9%) and 62.1% of the patients were asymptomatic at diagnosis. HCC was a solitary nodule in 86.2%, and the median size of the main nodule was 46 (20 - 150) mm. Macroscopic vascular invasion was demonstrated in two patients and bone metastases in a further two patients. Active treatment was provided in 25 patients, consisting of tumoral resection in 15, radiofrequency ablation in six and transarterial chemoembolization in four. The overall cumulative survival at 1, 2 and 3years was 84.3%, 67.2% and 50.1%, respectively.ConclusionHCC arising in non-cirrhotic liver is uncommon and there is wide tumor extension at diagnosis. Nevertheless, in most patients, treatment with curative intent can be applied, achieving better survival than that expected patients with cirrhosis(AU)

[Descriptive study of hepatocellular carcinoma in noncirrhotic liver]. / Estudio descriptivo de la experiencia sobre carcinoma hepatocelular en hígado no cirrótico.

INTRODUCTION AND OBJECTIVE: Hepatocellular carcinoma (HCC) is the sixth leading cause of cancer. In western countries its impact is steadily growing and most of these tumors arise in cirrhotic liver. The aim of this study was to evaluate the incidence and characteristics of HCC developing in noncirrhotic patients. METHODS: We conducted a retrospective review of 469 patients diagnosed with HCC between January 2003 and December 2007. Patients who met the histological criteria, or a combination of clinical, laboratory, imaging and hemodynamic criteria for the absence of cirrhosis were included. RESULTS: We identified 29 patients with a diagnosis of HCC in non-cirrhotic liver (6.2%). Most (86.2%) were men and the median age was 61.6 (23 - 82) years. The most frequent histology of the liver was mild-moderate liver fibrosis (68.9%) and 62.1% of the patients were asymptomatic at diagnosis. HCC was a solitary nodule in 86.2%, and the median size of the main nodule was 46 (20 - 150) mm. Macroscopic vascular invasion was demonstrated in two patients and bone metastases in a further two patients. Active treatment was provided in 25 patients, consisting of tumoral resection in 15, radiofrequency ablation in six and transarterial chemoembolization in four. The overall cumulative survival at 1, 2 and 3 years was 84.3%, 67.2% and 50.1%, respectively. CONCLUSION: HCC arising in non-cirrhotic liver is uncommon and there is wide tumor extension at diagnosis. Nevertheless, in most patients, treatment with curative intent can be applied, achieving better survival than that expected patients with cirrhosis.

[Optimization of ascitic fluid culture in spontaneous bacterial peritonitis]. / Optimización del cultivo de líquido ascítico en el contexto clínico de la peritonitis bacteriana espontánea.

INTRODUCTION AND AIMS: Spontaneous bacterial peritonitis (SBP) is ascitic fluid (AF) infection in the absence of an intraperitoneal source of infection in patients with liver disease and portal hypertension. The aim of this study was to evaluate the yield of microbiological cultures to optimize their collection and systematic implementation in routine clinical practice. METHODS: We analyzed two cohorts: the first consisted of retrospective data from the clinical records of 156 consecutive episodes of SBP from January 2003 to December 2005 (group R), and the second was composed of data collected prospectively from October 2007 to October 2008, consisting of 79 episodes (group P), with systematic inoculation of 10 cc of AF in each blood culture bottle. RESULTS: No significant differences were demonstrated in baseline epidemiological or clinical characteristics among episodes, except the more frequent presence of alcoholic liver disease and the incidence of tense ascites, paralytic ileus and kidney failure at diagnosis in group P. Microbiological isolation in AF was achieved in 12.2% of the episodes in group R compared with 53.2% in group P (p = 0.001) and 8.5 and 26.6% (p = 0.001) in blood culture, respectively. Microbiological isolation was achieved in 65.8% of episodes in group P versus 19.2% in group R (OR 8; 95% CI: 4.4-14.9; p = 0.001). The most frequently isolated organism in AF in group P was Escherichia coli (42.9%). CONCLUSIONS: Optimizing the diagnostic procedure in cirrhotic patients with ascites significantly increases diagnostic microbiologic performance.

Peritonitis bacteriana espontánea en pacientes con cirrosis mayores de 65 años / Spontaneous bacterial peritonitis in cirrhotic patients over 65 years

Fundamento y objetivo: Estudiar los episodios de peritonitis bacteriana espontánea (PBE) en pacientes cirróticos mayores de 65 años y comparar sus características y su evolución clínica dentro de una cohorte de pacientes cirróticos con PBE. Material y métodos: Se realizó un estudio observacional y retrospectivo sobre todas las altas hospitalarias con diagnóstico de PBE en el período de enero de 2003 a diciembre de 2005, con un total de 158 episodios. Se valoró el episodio de PBE desde su diagnóstico hasta la muerte o el fin de seguimiento por otras causas del paciente. Se dividió la cohorte en 2 grupos, según edad superior a 65 años (grupo 1: 73 episodios) o edad inferior o igual a 65 años (grupo 2: 86 episodios). Se realizó un estudio descriptivo y comparativo de ambos grupos y posteriormente se realizó un análisis de supervivencia mediante curvas de Kaplan-Meier (comparadas mediante el test log-rank) y valoración de los factores predictivos independientes mediante regresión de Cox en la cohorte global. Resultados: En el grupo 1 el 74% de los pacientes eran varones y la edad media (desviación estándar) fue de 72,8 (5,6) años, y la distribución según la clasificación de Child-Pugh fue del 8,2 (A), del 68,5 (B) y del 23,3% (C). La etiología de la cirrosis fue vírica en el 65,8% de los casos. Comparado con el grupo 2, se observó mayor frecuencia de insuficiencia renal al ingreso, prevalencia de hepatocarcinoma y etiología vírica, mientras que las cifras de bilirrubina eran superiores en el grupo 2. La mortalidad intrahospitalaria fue del 23,3%. Se observó una supervivencia a los 3 y a los 6 meses del 69,5 y del 54,8% y en el grupo 2 del 80,3 y del 78,4%, respectivamente (p=0,001). La edad superior a 65 años, la existencia de hepatocarcinoma y la presión arterial media superior a 75mmHg al ingreso fueron factores predictivos independientes de mortalidad (AU)

Aims: Our aim was to study the episodes of spontaneous bacterial peritonitis (SBP) in cirrhotic patients older than 65 years. Their clinical characteristics were compared with a cohort of cirrhotic patients with SBP. Methods: We conducted a retrospective study on all hospital discharged patients diagnosed with SBP in the period from January 2003 to December 2005, obtaining a total of 158 episodes. Two groups of patients were created: those over 65 (group 1: 73 episodes) and those aged }65 years (group 2: 86 episodes). A descriptive study, an analysis of survival by Kaplan Meier curves (compared with log-rank test) and a Cox regression analysis was conducted comparing the two groups. Results: In Group 1, males were 74%, the average age was 72.4 (SD 4.2) years, and the Child-Pugh distribution was 8.2% (A), 68.5% (B) and 23.3% (C).The most usual etiology of cirrhosis was viral (65.8%). In comparison with group 2, there was a superior frequency of renal impairment at admission, hepatocellular carcinoma and a viral etiology. Yet the bilirubin levels were higher in group 2. In-hospital mortality rate was 23.3%. The survival at 3 and 6 months was of 69.5% and 54.8%, while in group 2 it was 80.3% and 78.4% respectively (p=0001). An age> 65 years, the existence of hepatocellular carcinoma and a Mean Arterial Pressure <75mm Hg at admission, in the overall cohort, were independent predictors of mortality. Conclusion: An age above 65 years is an independent predictor of mortality following the development of an episode of spontaneous bacterial peritonitis in cirrhotic patients (AU)

[Spontaneous bacterial peritonitis in cirrhotic patients over 65 years]. / Peritonitis bacteriana espontánea en pacientes con cirrosis mayores de 65 años.

AIMS: Our aim was to study the episodes of spontaneous bacterial peritonitis (SBP) in cirrhotic patients older than 65 years. Their clinical characteristics were compared with a cohort of cirrhotic patients with SBP. METHODS: We conducted a retrospective study on all hospital discharged patients diagnosed with SBP in the period from January 2003 to December 2005, obtaining a total of 158 episodes. Two groups of patients were created: those over 65 (group 1: 73 episodes) and those aged 65 years (group 2: 86 episodes). A descriptive study, an analysis of survival by Kaplan Meier curves (compared with log-rank test) and a Cox regression analysis was conducted comparing the two groups. RESULTS: In Group 1, males were 74%, the average age was 72.4 (SD 4.2) years, and the Child-Pugh distribution was 8.2% (A), 68.5% (B) and 23.3% (C).The most usual etiology of cirrhosis was viral (65.8%). In comparison with group 2, there was a superior frequency of renal impairment at admission, hepatocellular carcinoma and a viral etiology. Yet the bilirubin levels were higher in group 2. In-hospital mortality rate was 23.3%. The survival at 3 and 6 months was of 69.5% and 54.8%, while in group 2 it was 80.3% and 78.4% respectively (p=0001). An age> 65 years, the existence of hepatocellular carcinoma and a Mean Arterial Pressure <75 mm Hg at admission, in the overall cohort, were independent predictors of mortality. CONCLUSION: An age above 65 years is an independent predictor of mortality following the development of an episode of spontaneous bacterial peritonitis in cirrhotic patients.

[Upper gastrointestinal bleeding secondary to a jejunal stromal tumor in a patient with neurofibromatosis type 1]. / Hemorragia digestiva alta, secundaria a un tumor estromal yeyunal, en un paciente con neurofibromatosis tipo 1.

Neurofibromatosis type 1 (NF1) is a multisystemic disease with an autosomal dominant pattern of inheritance, complete penetrance and variable expressivity. This disease affects one in every 3,000 individuals and one out of every 200 patients with mental retardation. Gastrointestinal bleeding secondary to gastrointestinal mesenchymal tumors is one of the many complications associated with NF1. We report the case of a patient with NF1 admitted to hospital for severe gastrointestinal hemorrhage secondary to a jejunal gastrointestinal stromal tumor (GIST) with favorable outcome after surgical removal.

Hemorragia digestiva alta, secundaria a un tumor estromal yeyunal, en un paciente con neurofibromatosis tipo 1 / Upper gastrointestinal bleeding secondary to a jejunal stromal tumor in a patient with neurofibromatosis type 1

La neurofibromatosis tipo 1 (NF1) es una enfermedad multisistémica de herencia autosómica dominante, con penetrancia completa y expresividad variable. Afecta a uno de cada 3.000 individuos y se presenta en uno de cada 200 pacientes con retraso mental. Dentro de las múltiples complicaciones que asocia se encuentra la hemorragia digestiva secundaria a tumores mesenquimales gastrointestinales. Presentamos el caso de un paciente con NF1, ingresado por una hemorragia digestiva grave secundaria a un tumor yeyunal del estroma gastrointestinal (GIST), que presentó una buena evolución tras su exéresis quirúrgica (AU)

Neurofibromatosis type 1 (NF1) is a multisystemic disease with an autosomal dominant pattern of inheritance, complete penetrance and variable expressivity. This disease affects one in every 3,000 individuals and one out of every 200 patients with mental retardation. Gastrointestinal bleeding secondary to gastrointestinal mesenchymal tumors is one of the many complications associated with NF1. We report the case of a patient with NF1 admitted to hospital for severe gastrointestinal hemorrhage secondary to a jejunal gastrointestinal stromal tumor (GIST) with favorable outcome after surgical removal (AU)

[Prognostic value of a spontaneous bacterial peritonitis episode in cirrhotic patients in clinical practice]. / Valor pronóstico de un episodio de peritonitis bacteriana espontánea en pacientes cirróticos en la práctica clínica.

OBJECTIVES: To assess survival and predictive factors of mortality after an episode of spontaneous bacterial peritonitis (SBP) in cirrhotic patients and to analyze the diagnostic and therapeutic measures used. METHODS: We retrospectively reviewed the medical records of 158 consecutive episodes of SBP treated between January 2003 and December 2005. Survival was studied by Kaplan-Meier curves, compared by the log-rank test. Independent predictive factors of mortality were obtained by a Cox regression model, while independent predictive factors of in-hospital mortality were obtained by logistic regression analysis. RESULTS: A total of 80.4% of the SBP episodes occurred in men and the mean age was 61.23 +/- 12.49 years. The most frequent etiology of cirrhosis was viral (51.3%), followed by alcoholic (39.9%). The distribution of Child-Pugh classification was 5.7% (A), 63.3% (B) and 31% (C). Overall 3-year survival in the sample was 43.3%. Four variables were identified as independent predictive factors of in-hospital and 3-month mortality: renal impairment, hepatic encephalopathy, diagnosis of hepatocellular carcinoma (HCC) and mean arterial pressure (MAP) < 75 mmHg. At the end of the monitoring period, the results of the analysis were as follows: diagnosis of HCC, MAP < 75 mmHg, and age > 65 years. Microbiological detection was achieved in 21% of the episodes. The most frequent microorganisms detected were Escherichia coli in ascitic fluid and Staphylococcus aureus in blood cultures. CONCLUSIONS: SBP has a poor short- and long-term prognosis in cirrhotic patients. Independent predictive factors of short-term survival are renal impairment, hepatic encephalopathy, MAP < 75 mmHg, and the presence of HCC.

Valor pronóstico de un episodio de peritonitis bacteriana espontánea en pacientes cirróticos en la práctica clínica / Prognostic value of a spontaneous bacterial peritonitis episode in cirrhotic patients in clinical practice

OBJETIVOS: Evaluar la supervivencia y los factores pronósticotras el diagnóstico de un episodio de peritonitis bacterianaespontánea (PBE) en pacientes cirróticos y las medidasdiagnosticadas y terapéuticas utilizadas.MÉTODOS: Se revisaron de manera retrospectiva los datos de158 episodios de PBE consecutivos durante el período deenero de 2003 a diciembre de 2005. Se procedió a un análisisde supervivencia mediante curvas de Kaplan-Meier, su comparaciónmediante el test de rangos logarítmicos, y valoraciónde los factores predictivos independientes mediante regresiónde Cox, y de mortalidad intrahospitalaria medianteregresión logística.RESULTADOS: El 80,4% de los episodios de PBE se produjoen varones, y la edad media fue de 61,23 ± 12,49 años. Laetiología de la cirrosis más prevalente fue viral (51,3%) seguidadel origen etílico (39,9%), y la distribución según laclasificación de Child-Pugh fue del 5,7% (A), 63,3% (B) y31% (C). La supervivencia global de la cohorte a los 3 añosdel seguimiento fue del 43,3%. Se determinaron como factoresindependientes asociados a mortalidad, tanto intrahospitalariacomo a los 3 meses tras la PBE el deterioro de funciónrenal, la presencia de encefalopatía hepática, laexistencia de carcinoma hepatocelular (CHC) y una presiónarterial media (PAM) < 75 mmHg, y a largo plazo la edad> 65 años, la existencia de CHC y la PAM < 75 mmHg. Seconsiguió el aislamiento microbiológico en el 20,3% de losepisodios. El microorganismo más frecuentemente aisladoen el líquido ascítico fue Escherichia coli y en hemocultivosStaphylococcus aureus.CONCLUSIONES: La PBE es un evento pronóstico importanteen la cirrosis hepática, y los factores independientes de mortalidada corto plazo son el deterioro de función renal, lapresencia de encefalopatía hepática, la existencia de CHC yPAM < 75 mmHg

OBJECTIVES: To assess survival and predictive factors ofmortality after an episode of spontaneous bacterial peritonitis(SBP) in cirrhotic patients and to analyze the diagnosticand therapeutic measures used.METHODS: We retrospectively reviewed the medical recordsof 158 consecutive episodes of SBP treated between January2003 and December 2005. Survival was studied by Kaplan-Meier curves, compared by the log-rank test. Independentpredictive factors of mortality were obtained by a Cox regressionmodel, while independent predictive factors of inhospitalmortality were obtained by logistic regressionanalysis.RESULTS: A total of 80.4% of the SBP episodes occurred inmen and the mean age was 61.23 ± 12.49 years. The mostfrequent etiology of cirrhosis was viral (51.3%), followed byalcoholic (39.9%). The distribution of Child-Pugh classificationwas 5.7% (A), 63.3% (B) and 31% (C). Overall 3-yearsurvival in the sample was 43.3%. Four variables were identifiedas independent predictive factors of in-hospital and 3-month mortality: renal impairment, hepatic encephalopathy,diagnosis of hepatocellular carcinoma (HCC) andmean arterial pressure (MAP) < 75 mmHg. At the end of themonitoring period, the results of the analysis were as follows:diagnosis of HCC, MAP < 75 mmHg, and age > 65 years.Microbiological detection was achieved in 21% of theepisodes. The most frequent microorganisms detected wereEscherichia coli in ascitic fluid and Staphylococcus aureus inblood cultures.CONCLUSIONS: SBP has a poor short- and long-term prognosisin cirrhotic patients. Independent predictive factors ofshort-term survival are renal impairment, hepatic encephalopathy,MAP < 75 mmHg, and the presence of HCC (AU)