Iatrogenic rectal perforation due to application of topical treatment in a patient with ulcerative colitis: a rare complication.

Rectal perforations due to topical treatments (enemas or foams) are unusual complications and they have been mostly reported in the use of barium enemas or in elderly patients with constipation. Very little has been reported about perforations secondary to topical treatment in patients with ulcerative colitis. We present the case of a patient with ulcerative colitis who suffered a rectal perforation complicated with a superinfected collection after the application of topical mesalazine foam.

Erradicación completa del esófago de Barrett mediante técnicas endoscópicas: ¿remisión o curación? / No disponible

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Complete Barrett's esophagus eradication by endoscopic techniques: remission or cure?

The prevalence of Barrett's esophagus has been estimated to be 1 % to 2 % of all patients referred for upper gastrointestinal endoscopy, and up to 15% amongst patients with chronic gastroesophageal reflux symptoms.

[Metastatic Crohn's disease]. / Enfermedad de Crohn metastásica.

Metastatic Crohn's disease is a granulomatous cutaneous lesion that appears in patients with Crohn's disease and is located in any skin area, separated from the lesions in the gastrointestinal tract. This entity is characterized by its heterogeneous behavior, both in its localization and clinical expression and in its effect on patients' quality of life. Histology is essential for diagnosis and shows non-caseating granulomas. There are no treatment guidelines and various therapeutic strategies have been employed, with variable response. In most patients, treatment with biological agents is highly effective. We describe three cases of metastatic Crohn's disease with the aim of analyzing the characteristics of this entity, which should always be included in the differential diagnosis of skin lesions in patients with Crohn's disease. A literature review is also provided.

[Value of contrast-enhanced ultrasound in the diagnosis of hepatocarcinoma in focal lesions detected in patients with liver disease]. / Valor de los contrastes ecográficos en el diagnóstico de hepatocarcinoma en lesiones ocupantes de espacio detectadas en pacientes con hepatopatía.

OBJECTIVE: To assess the value of contrast-enhanced ultrasound in the detection of arterial hypervascularity as a diagnostic criterion of hepatocellular carcinoma (HCC) in patients with focal lesions and liver disease. PATIENTS AND METHODS: This prospective study included patients with chronic liver disease and focal liver lesions on ultrasound (US) examination. SonoVue was used as contrast agent. We employed a US imaging technique with contrast-specific software operating at a low mechanical index (< 0.14) (Hitachi EUB 6500). The contrast enhancement pattern was analyzed during the arterial phase and classified as diffuse (homogeneous or heterogeneous), peripheral, adjacent parenchyma-like enhancement, and absent. The diagnostic procedure was completed by combined study with computed tomography, magnetic resonance imaging, histologic data and clinical features. RESULTS: A total of 23 nodules in 22 patients were included in the study (one patient had two different US lesions). The final diagnosis was hepatocellular carcinoma (HCC) in 12 patients, benign lesions in nine, metastases in one and cholangiocarcinoma in one. In the 10 patients with diffuse contrast enhancement, the lesion was malignant and in the eight patients with diffuse homogeneous enhancement, the lesion was a HCC. Seventy-five percent of the patients with HCC had a diffuse enhancement pattern during the arterial phase. This pattern involved malignancy with 71.4% sensitivity, 100% specificity, 100% positive predictive value, 69.2% negative predictive value, and 82.6% accuracy. The diffuse homogeneous pattern involved HCC with 66.7% sensitivity, 100% specificity, 100% positive predictive value, 73.3% negative predictive value and 82.6% accuracy. CONCLUSIONS: Contrast-enhanced US with SonoVue allows the vascularity of focal liver lesions to be assessed. In our study, 75% of patients with HCC showed arterial hypervascularity. A diffuse homogeneous enhancement pattern during the arterial phase was highly specific to HCC. In cirrhotic patients, this arterial pattern could avoid the need for further investigations, although clinical staging should be completed with another diagnostic test.

Valor de los contrastes ecográficos en el diagnóstico de hepatocarcinoma en lesiones ocupantes de espacio detectadas en pacientes con hepatopatía / Value of contrast-enhanced ultrasound in the diagnosis of hepatocarcinoma in focal lesions detected in patients with liver disease

Objetivo: Determinar la utilidad de la ecografía con contraste en la detección de hipervascularización arterial como criterio diagnóstico de carcinoma hepatocelular (CHC) en lesiones ocupantes de espacio (LOE) de pacientes con hepatopatía. Pacientes y métodos: Estudio prospectivo en el que se incluyen pacientes con hepatopatía crónica a los que se detectó alguna LOE mediante ecografía. Como potenciador se administró un contraste de segunda generación (SonoVue®). Se utilizó un ecógrafo Hitachi EUB 6500 con un programa específico para potenciadores, y se empleó un índice mecánico inferior a 0,14. Se analizó el patrón de captación en fase arterial, clasificándose en patrón difuso (homogéneo o heterogéneo), periférico, captación similar al parénquima circundante y ausencia de captación. El diagnóstico definitivo se confirmó mediante el estudio combinado de tomografía computarizada, resonancia magnética y análisis histológico, junto con la evolución clínica. Resultados: Se incluyen 23 lesiones en 22 pacientes (uno presentó 2 lesiones de características ecográficas diferentes). El diagnóstico final fue: CHC en 12 casos, lesiones benignas en 9, metástasis en uno y colangiocarcinoma en otro caso. Todos los casos que presentaron un patrón difuso con el contraste tenían una lesión maligna, y los 8 casos con patrón difuso homogéneo tenían un CHC. El 75% de los pacientes con CHC presentó una hipervascularización arterial con un patrón difuso tras el contraste. Este patrón difuso presentó una sensibilidad del 71,4%, especificidad del 100%, valor predictivo positivo (VPP) del 100%, valor predictivo negativo (VPN) del 69,2% y exactitud del 82,6% para el diagnóstico de malignidad. El patrón difuso homogéneo presentó una sensibilidad del 66,7%, una especificidad del 100%, un VPP del 100%, un VPN del 73,3% y una exactitud del 82,6% para el diagnóstico de CHC. Conclusiones: La utilización de la ecografía con contraste de segunda generación facilita una caracterización vascular inmediata de la lesión. En nuestro estudio se detecta una hipervascularización arterial en el 75% de los pacientes con CHC. Un patrón de realce difuso homogéneo es muy específico de CHC. Creemos que la detección de este tipo de patrón en un paciente con cirrosis haría innecesaria la utilización de más pruebas de imagen para el diagnóstico, si bien el estudio de extensión debe completarse con otra técnica

Objective: To assess the value of contrast-enhanced ultrasound in the detection of arterial hypervascularity as a diagnostic criterion of hepatocellular carcinoma (HCC) in patients with focal lesions and liver disease. Patients and methods: This prospective study included patients with chronic liver disease and focal liver lesions on ultrasound (US) examination. SonoVue® was used as contrast agent. We employed a US imaging technique with contrast-specific software operating at a low mechanical index (< 0.14) (Hitachi EUB 6500). The contrast enhancement pattern was analyzed during the arterial phase and classified as diffuse (homogeneous or heterogeneous), peripheral, adjacent parenchyma-like enhancement, and absent. The diagnostic procedure was completed by combined study with computed tomography, magnetic resonance imaging, histologic data and clinical features. Results: A total of 23 nodules in 22 patients were included in the study (one patient had two different US lesions). The final diagnosis was hepatocellular carcinoma (HCC) in 12 patients, benign lesions in nine, metastases in one and cholangiocarcinoma in one. In the 10 patients with diffuse contrast enhancement, the lesion was malignant and in the eight patients with diffuse homogeneous enhancement, the lesion was a HCC. Seventy-five percent of the patients with HCC had a diffuse enhancement pattern during the arterial phase. This pattern involved malignancy with 71.4% sensitivity, 100% specificity, 100% positive predictive value, 69.2% negative predictive value, and 82.6% accuracy. The diffuse homogeneous pattern involved HCC with 66.7% sensitivity, 100% specificity, 100% positive predictive value, 73.3% negative predictive value and 82.6% accuracy. Conclusions: Contrast-enhanced US with SonoVue® allows the vascularity of focal liver lesions to be assessed. In our study, 75% of patients with HCC showed arterial hypervascularity. A diffuse homogeneous enhancement pattern during the arterial phase was highly specific to HCC. In cirrhotic patients, this arterial pattern could avoid the need for further investigations, although clinical staging should be completed with another diagnostic test

Frequency of CARD15 polymorphisms in patients with Crohn's disease from Toledo, Spain: genotype-phenotype correlation.

Crohn's disease (CD) presents a complex multifactorial etiology with genetic and environmental factors contributing to the disorder. Epidemiological studies have shown that three major CARD15 polymorphisms, R702W, G908R, and 1007fs, are associated with CD. We studied the frequencies of these three polymorphisms in patients from Toledo, Spain, and compared them with the frequencies found in studies of other populations. A total of 183 patients with CD and 172 healthy controls from Toledo, Spain, were included in this study. All of these individuals were genotyped for the three CARD15 polymorphisms R702W, G908R, and 1007fs. Frequencies were analyzed to identify any genotype-phenotype associations. The control population exhibited frequencies of CARD15 polymorphisms similar to the results of previous studies, 3.4%, 1.1%, and 2.0% for the R702W, G908R, and 1007fs polymorphisms, respectively, whereas CD patients had allele frequencies of 7.6%, 3.0%, and 4.6%, respectively. Significant associations were found between the presence of R702W and patients carrying two susceptibility variants with early age of onset and stricturing pattern.

Clinical features of patients with negative results from traditional diagnostic work-up and Crohn's disease findings from capsule endoscopy.

INTRODUCTION: Capsule endoscopy (CE) can detect Crohn's disease in patients with suggestive symptoms but with negative results from the traditional diagnostic work-up (ileocolonoscopy and small bowel follow-through). The objective of this study was to determine which clinical features predict the diagnosis of Crohn's disease by CE in this subgroup of patients. MATERIAL AND METHODS: Twenty-three patients (7 men, 16 women; mean age: 40+/-15 y) with negative results from conventional imaging techniques were prospectively included in the study because of suspicion of Crohn's disease (long-standing abdominal pain and/or diarrhea and at least one of the following symptoms: anemia, weight loss, long-standing fever, perianal disease, extraintestinal manifestations typical of inflammatory bowel disease, elevated inflammatory parameters, or family history of inflammatory bowel disease). RESULTS: CE diagnosed Crohn's disease in 6 patients (26%). Crohn's disease diagnosis was more frequent in patients with a combination of anemia and elevated inflammatory parameters than in patients without this combination (57% vs. 12.5%; P=0.04). The only statistically significant association between an inflammatory parameter and Crohn's disease was an increased platelet count. CONCLUSIONS: CE is a useful tool for the diagnosis of subtle small bowel Crohn's disease. The diagnostic yield of CE in patients with suspicion of Crohn's disease but negative results from the traditional diagnostic work-up is significantly higher in patients with anemia and increased platelet count than in patients without this combination of clinical features.