Granulocitoaféresis en la enfermedad inflamatoria intestinal. Eficacia a 32 semanas con protocolo de inducción y sesiones de mantenimiento / Granulocytapheresis in inflammatory bowel disease. Efficacy of an induction plus maintenance sessions protocol at 32 weeks

Introducción: la granulocitoaféresis (GCAF) retira de la circulacióngranulocitos-monocitos activados, modificando el pool circulantee induciendo una reducción en la inflamación intestinal.Objetivo: valorar la eficacia de la GCAF en la enfermedad inflamatoriaintestinal (EII) mediante sesiones de inducción y mantenimiento.Material y método: análisis retrospectivo en pacientes conEII activa corticodependiente y corticorrefractaria. Aplicamos 5sesiones de inducción en colitis ulcerosa (CU) y 7 en enfermedadde Crohn (EC) y 1 sesión mensual hasta semana 32. Evaluamosindices clínicos de actividad y empleo de corticoides.Resultados: incluimos a 18 pacientes (10 CU, 8 EC), 10 deellos corticodependientes y 8 corticorrefractarios. Catorce pacienteseran refractarios y 4 intolerantes a inmunosupresores (IS). No completaronla inducción 2-CU (brotes graves) y 1-EC (secundarismos).Abandonaron el mantenimiento 1-CU y 3-EC. De aquellos quecompletaron inducción alcanzaron respuesta o remisión el 87,5%de las CU (2 y 5 pacientes), y el 71,4% de EC (1 y 4 pacientes) respectivamente.Estos resultados a 32 semanas eran del 75% en CU(3 y 3 pacientes) y del 42,8% en EC (1 y 2 pacientes) respectivamente.De los que completaron la inducción, suprimieron corticoidesel 14,2% de EC por el 62,5% de CU (25% de estas en remisióny 37,5% en respuesta). Registramos 2 secundarismos graves (tromboflebitisy síncope). Ninguna CU que completó inducción sufrió colectomíatras 97,6 (72-128) semanas de seguimiento.Conclusiones: tanto CU como EC responden bien a induccióncon GCAF pero mientras la CU mantiene tras 32 semanastasas similares de respuesta-remisión (87,5 vs. 75%) casi 1/3 delos pacientes con EC recaen tras alcanzar respuesta. La granulocitoaféresises una alternativa de tratamiento para inducir y mantenerremision en CU, ahorrando corticoides, pero en la EC se precisauna adecuada selección de pacientes y un esquema demantenimiento aún por definir

Introduction: granulocytapheresis (GCAP) eliminates activatedgranulocytes-monocytes from peripheral blood, thus modifyingthe circulating pool of leukocytes and reducing intestinal inflammation.Objective: tto evaluate the efficacy of GCAP in inflammatorybowel disease (IBD) using an induction and maintenance protocol.Material and method: a retrospective study including patientswith active corticosteroid-dependent or refractory IBD. Inductionincluded 5 sessions in ulcerative colitis (UC) and 7 sessionsin Crohn´s disease (CD); one monthly session was usedthereafter until week 32. Clinical activity indices and use of corticosteroidswere monitored.Results: eighteen patients were included (10 with UC, 8 withCD), 10 of them dependent on and 8 refractory to corticosteroids.Fourteen of them were refractory and a further 4 were intolerantto immunosuppressants (IS). Induction was not completedin 2 UC (severe relapses) and 1 CD (side-effects) patients. OneUC and 3 CD patients withdrew during maintenance. Among patientswho completed induction, response or remission wasachieved in 87.5% of UC cases (2 and 5 patients) and 71.4% ofCD cases (1 and 4 patients), respectively. At week 32 responseremissionrates reached 75% in CU (3 and 3 patients) and 42.8%in CD (1 and 2 patients) cases, respectively. Corticosteroid withdrawalwas possible in 14.2% of CD and in 62.5% of UC patients(25% in remission and 37.5% with response). There were twomajor side effects (thrombophlebitis and syncope). No colectomieswere performed for UC patients who completed GCAP inductionafter a mean follow-up of 97.6 weeks (range: 72-128).Conclusions: both UC and CD respond well to GCAP induction.At 32 weeks UC patients maintain similar response-remissionrates (87.5 vs. 75%), whereas almost one-third of CD patientsloose response. Granolocytapheresis is an alternative,steroid-sparing treatment modality to induce and maintain remissionin UC, while good patient selection and a maintenance protocolnot well defined yet are needed for CD (AU)

Intrahepatic arteriovenous fistula resulting from needle biopsy

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Hallazgos endoscópicos del tumor mucinoso de páncreas / Endoscopic signs of mucinous tumor of the pancreas

No disponible

Abdomen agudo en la enfermedad celiaca: yeyunoileítis ulcerativa / Acute abdomen in celiac disease: Ulcerative jejunoileitis

No disponible

[Granulocytapheresis in inflammatory bowel disease. Efficacy of an induction plus maintenance sessions protocol at 32 weeks]. / Granulocitoaféresis en la enfermedad inflamatoria intestinal. Eficacia a 32 semanas con protocolo de inducción y sesiones de mantenimiento.

INTRODUCTION: Granulocytapheresis (GCAP) eliminates activated granulocytes-monocytes from peripheral blood, thus modifying the circulating pool of leukocytes and reducing intestinal inflammation. OBJECTIVE: To evaluate the efficacy of GCAP in inflammatory bowel disease (IBD) using an induction and maintenance protocol. MATERIAL AND METHOD: A retrospective study including patients with active corticosteroid-dependent or refractory IBD. Induction included 5 sessions in ulcerative colitis (UC) and 7 sessions in Crohn's disease (CD); one monthly session was used thereafter until week 32. Clinical activity indices and use of corticosteroids were monitored. RESULTS: Eighteen patients were included (10 with UC, 8 with CD), 10 of them dependent on and 8 refractory to corticosteroids. Fourteen of them were refractory and a further 4 were intolerant to immunosuppressants (IS). Induction was not completed in 2 UC (severe relapses) and 1 CD (side-effects) patients. One UC and 3 CD patients withdrew during maintenance. Among patients who completed induction, response or remission was achieved in 87.5% of UC cases (2 and 5 patients) and 71.4% of CD cases (1 and 4 patients), respectively. At week 32 response-remission rates reached 75% in CU (3 and 3 patients) and 42.8% in CD (1 and 2 patients) cases, respectively. Corticosteroid withdrawal was possible in 14.2% of CD and in 62.5% of UC patients (25% in remission and 37.5% with response). There were two major side effects (thrombophlebitis and syncope). No colectomies were performed for UC patients who completed GCAP induction after a mean follow-up of 97.6 weeks (range: 72-128). CONCLUSIONS: both UC and CD respond well to GCAP induction. At 32 weeks UC patients maintain similar response-remission rates (87.5 vs. 75%), whereas almost one-third of CD patients lose response. Granolocytapheresis is an alternative, steroid-sparing treatment modality to induce and maintain remission in UC, while good patient selection and a maintenance protocol not well defined yet are needed for CD.

[Liver biopsy in patients with chronic hepatitis C virus infection: experience in a district hospital]. / Biopsia hepática en pacientes con infección crónica por el VHC: experiencia de un hospital comarcal.

INTRODUCTION: Liver biopsy is a highly useful tool in the evaluation of patients with chronic hepatitis C. However, the technique is not free of complications and presents a series of limitations (lack of representativity and interobserver variability in sample interpretation). Due to these limitations and the development of new noninvasive techniques, the role of liver biopsy is currently being reevaluated. MATERIAL AND METHOD: We performed a descriptive retrospective study of liver biopsies performed in patients with chronic hepatitis C virus (HCV) infection from January 2002 to January 2005. Age, gender, genotype, histology of the hepatic cylinder, and the percentage of patients who received treatment after liver biopsy was analyzed. The indications for biopsy in our patients and the reasons for nontreatment after biopsy were identified. We also analyzed whether the decision to start treatment was influenced by the histological grade of the lesion and whether there is any association between histological grade and transaminase levels. RESULTS: A total of 156 patients were included and 72% received treatment after biopsy. Transaminase levels were elevated in 86%. Alanine aminotransferase (ALT) levels were elevated in 92.30% of treated patients and in 66% of untreated patients. The most frequent cause of nontreatment after biopsy was fibrosis stage < 2. The histological results were as follows: G0 in 2%, G1 in 26.8%, G2 in 47.7%, G3 in 22.2% and G4 in 1.3%; stage of fibrosis was F0 in 7.2%, F1 in 30.1%, F2 in 37.9%, F3 in 19.6%, and F4 in 5.2%. Fibrosis was advanced (F >= 2) in 41% of the patients with normal ALT levels and was mild (< F2) in 33% of those with elevated ALT levels. CONCLUSION: Liver biopsy could be useful in patients with indication for treatment but a high risk of treatment-related adverse effects, as well as in those with normal transaminase levels, in whom the degree of fibrosis observed could influence the therapeutic approach.

Biopsia hepática en pacientes con infección crónica por el VHC: experiencia de un hospital comarcal / Liver biopsy in patients with chronic hepatitis C virus infection: experience in a district hospital

Introducción: La biopsia hepática es una herramienta muy importante en la evaluación de los pacientes con hepatitis crónica C. Es una técnica no exenta de complicaciones, y que presenta una serie de limitaciones (falta de representatividad del órgano y variablidad interobservador en la interpretación de la muestra). Por tanto, debido a sus limitaciones y al desarrollo de nuevas técnicas no invasivas, en la actualidad el papel de la biopsia hepática está siendo revaluado. Material y método: Estudio descriptivo y retrospectivo de las biopsias hepáticas realizadas en pacientes con infección crónica por el virus de la hepatitis C, durante enero de 2002 a enero de 2005. Se analizaron los siguientes aspectos: a) edad, sexo, genotipo, histología del cilindro hepático y porcentaje de pacientes que recibieron tratamiento tras la realización de la biopsia hepática; b) descripción de las indicaciones de la biopsia en nuestros pacientes, así como las causas de la ausencia de tratamiento después de realizada la biopsia; c) si la decisión de iniciar tratamiento se encontró influida por el grado de lesión histológica, y d) si existía correlación entre el grado de lesión histológica y los valores de transaminasas. Resultados: Se incluyó a 156 pacientes, de los que el 72% recibió tratamiento tras la realización de la biopsia. Las transaminasas se encontraban elevadas en el 86%. En el grupo de pacientes tratados, la alanina aminotransferasa (ALT) se encontraba elevada en el 92,30%, y en el grupo de pacientes no tratado, lo estaba en el 66%. La causa más frecuente de no tratamiento tras la realización de la biopsia fue la presencia de lesiones histológicas mínimas. El resultado histológico fue el siguiente: G0 en el 2%, G1 en el 26,8%, G2 en el 47,7%, G3 en el 22,2% y G4 en el 1,3%; con respecto al estadio de la fibrosis fue: F0 en el 7,2%, F1 en el 30,1%, F2 en el 37,9%, F3 en el 19,6% y F4 en el 5,2%. Los pacientes con ALT normal presentaban, en el 41%, lesiones >= F2, mientras que los del grupo de ALT elevada mostraban lesiones < 2 en el 33%. Conclusión: La biopsia hepática sería útil en los pacientes con indicación de tratamiento, pero con una elevada posibilidad de presentar efectos secundarios durante su duración, así como en los pacientes con transaminasas normales, donde el grado de fibrosis observado podría influir en la actitud terapéutica

Introduction: Liver biopsy is a highly useful tool in the evaluation of patients with chronic hepatitis C. However, the technique is not free of complications and presents a series of limitations (lack of representativity and interobserver variability in sample interpretation). Due to these limitations and the development of new noninvasive techniques, the role of liver biopsy is currently being reevaluated. Material and method: We performed a descriptive retrospective study of liver biopsies performed in patients with chronic hepatitis C virus (HCV) infection from January 2002 to January 2005. Age, gender, genotype, histology of the hepatic cylinder, and the percentage of patients who received treatment after liver biopsy was analyzed. The indications for biopsy in our patients and the reasons for nontreatment after biopsy were identified. We also analyzed whether the decision to start treatment was influenced by the histological grade of the lesion and whether there is any association between histological grade and transaminase levels. Results: A total of 156 patients were included and 72% received treatment after biopsy. Transaminase levels were elevated in 86%. Alanine aminotransferase (ALT) levels were elevated in 92.30% of treated patients and in 66% of untreated patients. The most frequent cause of nontreatment after biopsy was fibrosis stage = 2) in 41% of the patients with normal ALT levels and was mild (< F2) in 33% of those with elevated ALT levels. Conclusion: Liver biopsy could be useful in patients with indication for treatment but a high risk of treatment-related adverse effects, as well as in those with normal transaminase levels, in whom the degree of fibrosis observed could influence the therapeutic approach

Amiloidosis hepática masiva con fallo hepático fulminante / Massive hepatic amyloidosis with fatal hepatic failure

No disponible

[Crohn's disease and pregnancy. A descriptive and retrospective study]. / Enfermedad de Crohn y embarazo: un estudio descriptivo y retrospectivo.

OBJECTIVES: To determine the behavior of Crohn's disease during pregnancy, as well as the influence of this disease on the presence of low birthweight neonates. MATERIAL AND METHODS: A descriptive and retrospective study of all patients with Crohn's disease followed-up in the Hospital Costa del Sol was performed. A total of 124 pregnant women were included, classified in two groups: women who became pregnant before and those who became pregnant after Crohn's disease was diagnosed. In all patients, clinical and epidemiological data, disease activity during pregnancy and in the immediate postpartum period, type of assisted delivery, and neonatal birthweight were recorded. RESULTS: A total of 66.1% of pregnancies occurred before Crohn's disease was diagnosed, 31.5% occurred after diagnosis and 2.4% coincided with disease onset. No significant differences were found between women with and without a diagnosis of Crohn's disease in type of assisted delivery or low birthweight (p = 0.064; p = 0.643). All non-smoking patients remained in the quiescent phase and did not present disease recurrences during pregnancy. Among smokers, the disease remained inactive in 61.1%, while chronic activity or recurrences were observed in 38.9% (p = 0.003). CONCLUSIONS: The course of inflammatory bowel disease does not adversely affect pregnancy or the immediate postpartum period, nor does it increase the presence of low birthweight neonates or the number of cesarean deliveries performed.

Enfermedad de Crohn y embarazo: un estudio descriptivo y retrospectivo / Crohn’s disease and pregnancy. A descriptive and retrospective study

Objetivos: El objetivo del presente estudio fue determinar el comportamiento de la enfermedad de Crohn durante el embarazo, así como la influencia de esta enfermedad en la presencia del recién nacido de bajo peso. Material y métodos: Se ha realizado un estudio descriptivo y retrospectivo de todas las pacientes con enfermedad de Crohn a quienes se les ha efectuado un seguimiento en el Hospital Costa del Sol. Se incluyó a 124 pacientes gestantes, que se clasificaron en 2 grupos: con embarazos antes y después del diagnóstico de la enfermedad. En todas ellas se recogieron los siguientes datos: clinicoepidemiológicos, actividad de la enfermedad durante la gestación y posparto inmediato, así como el tipo de parto asistido y el peso del recién nacido. Resultados: El 66,1% de las gestaciones se produjo antes de conocer el diagnóstico de la enfermedad, el 31,5%, después del diagnóstico, y el 2,4%, coincidió con el inicio de la enfermedad. Al comparar el tipo de parto asistido y el bajo peso al nacimiento, en las gestantes con o sin diagnóstico de la enfermedad, no se encontraron diferencias estadísticamente significativas entre ambos grupos (p = 0,064; p = 0,643). El 100% de las pacientes no fumadoras permanecía en fase quiescente y no presentaba recaídas de la enfermedad durante el transcurso del embarazo, mientras que el 61,1% de las pacientes fumadoras mantenía inactiva la enfermedad, y el 38,9% presentaba recaídas o una actividad crónica (p = 0,003). Conclusiones: El curso de la enfermedad inflamatoria intestinal no afecta de forma adversa a la evolución de la gestación o posparto inmediato, así como tampoco a la mayor presencia de recién nacidos de bajo peso o de cesáreas practicadas

Objectives: To determine the behavior of Crohn's disease during pregnancy, as well as the influence of this disease on the presence of low birthweight neonates. Material and methods: A descriptive and retrospective study of all patients with Crohn's disease followed-up in the Hospital Costa del Sol was performed. A total of 124 pregnant women were included, classified in two groups: women who became pregnant before and those who became pregnant after Crohn's disease was diagnosed. In all patients, clinical and epidemiological data, disease activity during pregnancy and in the immediate postpartum period, type of assisted delivery, and neonatal birthweight were recorded. Results: A total of 66.1% of pregnancies occurred before Crohn's disease was diagnosed, 31.5% occurred after diagnosis and 2.4% coincided with disease onset. No significant differences were found between women with and without a diagnosis of Crohn's disease in type of assisted delivery or low birthweight (p = 0.064; p = 0.643). All non-smoking patients remained in the quiescent phase and did not present disease recurrences during pregnancy. Among smokers, the disease remained inactive in 61.1%, while chronic activity or recurrences were observed in 38.9% (p = 0.003). Conclusions: The course of inflammatory bowel disease does not adversely affect pregnancy or the immediate postpartum period, nor does it increase the presence of low birthweight neonates or the number of cesarean deliveries performed

Hemorragia digestiva baja grave activa por úlcera apendicular / Active lower gastrointestinal bleeding due to appendiceal ulcer

Presentamos un caso de hemorragia digestiva baja grave por úlcera apendicular asociada a la toma de ácido acetilsalicílico con cubierta entérica. La colonoscopia urgente pudo precisar la localización y las características de la lesión sangrante durante el episodio agudo y permitió un tratamiento eficaz mediante apendicectomía simple

We present a case of severe lower gastrointestinal bleeding due to appendiceal ulcer associated with intake of enteric coated aspirin. Urgent colonoscopy revealed the location and characteristics of the source of bleeding during the acute episode, allowing effective treatment through simple appendicectomy to be performed

Sarcoidosis pulmonar asociada a interferón pegilado en el tratamiento de la hepatitis C crónica / Pulmonary sarcoidosis associated with pegylated interferon in the treatment of chronic hepatitis C

El tratamiento con interferón pegilado se utiliza habitualmente en la hepatitis crónica por el virus de la hepatitis C asociado a ribavirina. Entre los efectos secundarios del interferón encontramos un cuadro seudogripal junto con manifestaciones respiratorias banales que son muy frecuentes. Entre los efectos inmunomoduladores se encuentra la posibilidad de inducir o exacerbar fenómenos autoinmunitarios como la sarcoidosis cutánea o sistémica. Presentamos un nuevo caso de sarcoidosis pulmonar inducida por interferón pegilado en una mujer de 35 años con hepatitis crónica por el virus de la hepatitis C que a los 4 meses de iniciar el tratamiento con interferón pegilado más ribavirina comenzó con clínica respiratoria que no tenía previamente e imagen radiológica de patrón micronodular en ambos campos pulmonares junto con adenopatías hiliares y mediastínicas. La biopsia transbronquial confirmó la presencia de granulomas sarcoideos. Tras el diagnóstico de sarcoidosis pulmonar se suspendió el tratamiento antiviral con desaparición posterior de la clínica respiratoria

Treatment with pegylated interferon is usually used in active chronic hepatitis C in association with ribavirin. The adverse effects of interferon include influenza-like syndrome and mild respiratory manifestations, which are highly frequent. Among the immunomodulatory effects is the possibility of inducing or exacerbating autoimmune phenomena such as cutaneous or systemic sarcoidosis. We present a new case of pulmonary sarcoidosis induced by pegylated interferon in a 35 year-old woman with chronic hepatitis C who developed respiratory symptoms 4 months after starting therapy with pegylated interferon associated with ribavirin. Radiological images showed a micronodular pattern in both pulmonary fields together with hilar and mediastinal adenopathies. Transbronchial biopsy confirmed the presence of sarcoidal granulomas. After the diagnosis of pulmonary sarcoidosis, antiviral therapy was suspended with subsequent resolution of the clinical symptoms

[Active lower gastrointestinal bleeding due to appendiceal ulcer]. / Hemorragia digestiva baja grave activa por úlcera apendicular.

We present a case of severe lower gastrointestinal bleeding due to appendiceal ulcer associated with intake of enteric coated aspirin. Urgent colonoscopy revealed the location and characteristics of the source of bleeding during the acute episode, allowing effective treatment through simple appendicectomy to be performed.

[Pulmonary sarcoidosis associated with pegylated interferon in the treatment of chronic hepatitis C]. / Sarcoidosis pulmonar asociada a interferón pegilado en el tratamiento de la hepatitis C crónica.

Treatment with pegylated interferon is usually used in active chronic hepatitis C in association with ribavirin. The adverse effects of interferon include influenza-like syndrome and mild respiratory manifestations, which are highly frequent. Among the immunomodulatory effects is the possibility of inducing or exacerbating autoimmune phenomena such as cutaneous or systemic sarcoidosis. We present a new case of pulmonary sarcoidosis induced by pegylated interferon in a 35 year-old woman with chronic hepatitis C who developed respiratory symptoms 4 months after starting therapy with pegylated interferon associated with ribavirin. Radiological images showed a micronodular pattern in both pulmonary fields together with hilar and mediastinal adenopathies. Transbronchial biopsy confirmed the presence of sarcoidal granulomas. After the diagnosis of pulmonary sarcoidosis, antiviral therapy was suspended with subsequent resolution of the clinical symptoms.