Consumo de cannabis e invaginaciones intestinales. ¿Una asociación casual? / Cannabis intake and intussusception: an accidental association?

La mayoría de las invaginaciones intestinales en adultos tienen una causa orgánica y su tratamiento es quirúrgico. En algunos casos, no se encuentra lesión asociada a la invaginación y se puede optar por un manejo conservador. En nuestra práctica clínica hemos objetivado la presencia de invaginaciones intestinales en ausencia de lesión estructural asociada al consumo crónico de cannabis con buena evolución tras manejo conservador. Se describen tres casos de invaginaciones recurrentes en consumidores de cannabis, sugiriendo una relación entre el consumo de cannabis y la incidencia de invaginaciones intestinales (AU)

Most intussusception cases in adults have an organic cause and their treatment is surgical. In some cases, there is no injury associated with intussusception and we can opt for conservative management. In our clinical practice we have shown the presence of intussusceptions in the absence of structural damage associated with chronic cannabis with a good course after conservative management. We describe three cases of recurrent intussusception in cannabis users, suggesting a relationship between cannabis use and the incidence of intussusception (AU)

Cannabis intake and intussusception: an accidental association?

Most intussusception cases in adults have an organic cause and their treatment is surgical. In some cases, there is no injury associated with intussusception and we can opt for conservative management. In our clinical practice we have shown the presence of intussusceptions in the absence of structural damage associated with chronic cannabis with a good course after conservative management. We describe three cases of recurrent intussusception in cannabis users, suggesting a relationship between cannabis use and the incidence of intussusception.

Resultados en la práctica clínica del tratamiento de la hepatitis crónica por virus B con tenofovir y entecavir / Results in clinical practice of treatment of chronic hepatitis b virus with tenofovirand entecavir

Actualmente hay pocos datos sobre los resultados obtenidos con tenofovir y entecavir en la práctica clínica. Objetivo: Valorar la respuesta viral y la seguridad de tenofovir y entecavir en un periodo de 5 años. Material y métodos: Estudio observacional en donde se incluyó a todos los pacientes con hepatitis crónica por virus B que iniciaron tratamiento con tenofovir o entecavir desde enero de 2008 hasta diciembre de 2012. Resultados: De un total de 70 pacientes: 42 (60%) en tratamiento con entecavir y 28 (40%) con tenofovir. Un 75,7% eran hombres, con una edad media de 53 (DE 14) años. Un 70% eran caucásicos. Se realizó biopsia hepática en 46 pacientes (F0 8,7%; F1 6,5%; F2 26,1%; F3 43,5% y F4 15,2%). El 51,4% eran naïve. Del grupo de pacientes previamente tratados, un 17,6% había recibido interferón; un 26,4% interferón inicialmente y luego análogos; y un 55,8% otros análogos de los nucleósidos o de los nucleótidos. El tiempo de seguimiento fue de 36 (DE 12) meses. El DNA del VHB inicial medio era de 31.570.006 UI/mL (rango 24-1.100.000.000 UI/mL).Todos ellos, excepto 3, presentaron un DNA indetectable al año del tratamiento. De los 10 con HBeAg+, 2 de ellos presentaron seroconversión. Los valores de creatinina y la estimación del filtrado glomerular (EFG) fueron de 0,9 (DE 0,3) mg/dL y de 93,92 ml/min/1,73 m² (DE 21,92) al inicio y creatinina 0,93 (DE 0,27) mg/dL y EFG 91,7392 ml/min/1,73 m² (DE 21,38) al año de seguimiento. Conclusiones: Entecavir y tenofovir son eficaces y seguros en la práctica clínica en pacientes con hepatitis crónica por virus B.

The current first line treatment for chronic hepatitis B virus is with entecavir andtenofovir. However, there are few data regarding the results obtained from these treatmentsin clinical practice. Objective: To assess viral response and safety of treatment with entecavir and tenofovir in a5-year follow-up. Material and methods: Observational study on patients with chronic hepatitis B virus who begantreatment with tenofovir or entecavir between January 2008 and December 2012. Results: Seventy patients were included; 42 (60%) were treated with entecavir and 28 (40%)with tenofovir. Of these, 75.7% were men, with an average age of 53 (SD ± 14) years, and mostwere white (70%). A liver biopsy was performed on 46 patients (F0 8.7%; F1 6.5%; F2 26.1%;F3 43.5% and F4 15.2%). Of all the patients, 51.4% were treatment naïve, and of the groupof previously treated patients, 17.6% had received interferon; 26.4% had received interferonfollowed by one or more analogues; and 55.8% had received other nucleoside or nucleotideanalogues.The time of follow-up was 36 (SD ± 12) months. The average initial DNA was 31,570,006UI/mL (range 24-1,100,000,000 UI/mL). All except 3 presented undetectable DNA after oneyear of treatment. Ten patients were HBeAg-positive at the beginning of the treatment and 2seroconverted. At the beginning of the treatment, creatinine was 0.9 (SD ± 0.3) mg/dL and theestimated glomerular filtration rate (eGFR) was 93.92 ml/min/1.73 m²(DE 21.92); both keepingstable after a year of treatment (creatinine levels 0.93 SD ± 0.27 mg/dL, eGFR 91.7392 SD± 21.38 ml/min/1.73 m²). Conclusions: Entecavir and tenofovir are safe and effective in clinical practice for the treatmentof chronic hepatitis B virus, both in treatment-naïve patients and in those previously treated.

Hemospray treatment is effective for lower gastrointestinal bleeding.

Acute lower gastrointestinal bleeding (LGIB) is diverse in origin and can be substantial, requiring urgent hemostasis. Hemospray is a promising novel hemostatic agent for upper gastrointestinal bleeding (UGIB). It has been claimed in a small series that the use of Hemospray is also feasible in LGIB. We aimed to expand our knowledge of the application of Hemospray for the treatment of LGIB in a wider range of conditions to further define the optimal patient population for this new therapeutic modality. We analyzed the outcomes of nine unselected consecutive patients with active LGIB treated with Hemospray in two major hospitals in Europe. Initial hemostasis was achieved after Hemospray application in all patients. Rebleeding occurred in two patients (22%) who were on acetyl salicylic acid and presented with spurting bleeds. These preliminary data show that Hemospray can be effective in the management of LGIB, but suggest cautious use for patients on antithrombotic therapy and spurting bleeds.

Hepatotoxicidad de rizatriptán. Descripción de un caso clínico / Rizatriptan-induced liver toxicity. Report of a case

Los triptanes son un grupo farmacológico con reconocida eficacia en el tratamiento agudo de la cefalea migrañosa, del que el primer componente fue el sumatriptán, y surgieron posteriormente diferentes derivados. Hasta la actualidad, solo ha sido reportado un caso de toxicidad hepática con zolmitriptán. Presentamos un cuadro de hepatotoxicidad relacionado con otro fármaco de este grupo, el rizatriptán (AU)

Triptans are a class of drugs with proven efficacy in the acute treatment of migraine headache. The first component of these drugs was sumatriptan, with various derivatives subsequently emerging. Until now, there has only been one reported case of liver toxicity with zolmitriptan. We now present a case of hepatotoxicity related to another drug in this group: rizatriptan (AU)

[Rizatriptan-induced liver toxicity. Report of a case]. / Hepatotoxicidad de rizatriptán. Descripción de un caso clínico.

Triptans are a class of drugs with proven efficacy in the acute treatment of migraine headache. The first component of these drugs was sumatriptan, with various derivatives subsequently emerging. Until now, there has only been one reported case of liver toxicity with zolmitriptan. We now present a case of hepatotoxicity related to another drug in this group: rizatriptan.