Improvements in the Effectiveness of Early Detection in Colorectal Cancer with Open-Label Randomised Study.

INTRODUCTION: The general objective of this research is to improve the quality of colorectal cancer screening (CRC) by assessing, as an indicator of effectiveness, the ability of colonoscopy to detect more advanced adenomas in the exposed group than in the control group. MATERIAL AND METHODS: The present work is designed as an open-label randomized study on cancer screening, using two groups based on their exposure to the protocol: an exposed to intervention group (EIG, 167), and a control group (CG, 167), without the intervention of the protocol and by 1:1 matching. RESULTS: In 167 patients in the GEI, 449 polyps are visualized and 274 are adenomas (80.58%), of which 100 (36.49%) are advanced adenomas. In the CG (n = 174), there are 321 polyps and 152 adenomas (82.60%). The variables significantly associated by logistic regression to the detection of adenomas are the male sex with an OR of 2.52. The variable time to withdrawal, ≥9 min, is significant at 99% confidence (p = 0.002/OR 34.67) and the fractional dose is significant at 99% (p = 0.009, OR 7.81). CONCLUSION: Based on the observations made, our study suggests that the intervention in collaboration between primary care and hospital care is effective from a preventive point of view and achieves the objective of effectiveness and quality of the PCCR.

Cáncer de esófago: particularidades anatómicas, estadificación y técnicas de imagen / Esophageal cancer: anatomic particularities, staging, and imaging techniques

El cáncer de esófago es un tumor de comportamiento agresivo, que suele diagnosticarse en etapas avanzadas. La ausencia de serosa permite su rápida propagación a estructuras vecinas del mediastino, y una extensa red de drenaje linfático facilita la diseminación tumoral incluso en estadios precoces. La actual clasificación TNM, armonizada con la del cáncer gástrico, proporciona nuevas definiciones en la clasificación anatómica, añade características no anatómicas del tumor e incluye los tumores de la unión esofagogástrica. La mayor precisión en la determinación del estadio clínico inicial se obtiene con la combinación de ecoendoscopia, TC, PET-TC y RM, que desempeñan un papel esencial en la elección, la planificación y la evaluación del tratamiento. En este artículo repasamos algunas particularidades que explican el comportamiento de este tumor, revisamos la estadificación TNM actual y presentamos las distintas pruebas de imagen de que disponemos en la actualidad para su evaluación, incluyendo un algoritmo de diagnóstico (AU)

Cancer of the esophagus is a tumor with aggressive behavior that is usually diagnosed in advanced stages. The absence of serosa allows it to spread quickly to neighboring mediastinal structures, and an extensive lymphatic drainage network facilitates tumor spread even in early stages. The current TNM classification, harmonized with the classification for gastric cancer, provides new definitions for the anatomic classification, adds non-anatomic characteristics of the tumor, and includes tumors of the gastroesophageal junction. Combining endoscopic ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging provides greater accuracy in determining the initial clinical stage, and these imaging techniques play an essential role in the selection, planning, and evaluation of treatment. In this article, we review some particularities that explain the behavior of this tumor and we describe the current TNM staging system; furthermore, we discuss the different imaging tests available for its evaluation and include a diagnostic algorithm (AU)

Esophageal cancer: anatomic particularities, staging, and imaging techniques. / Cáncer de esófago: particularidades anatómicas, estadificación y técnicas de imagen.

Cancer of the esophagus is a tumor with aggressive behavior that is usually diagnosed in advanced stages. The absence of serosa allows it to spread quickly to neighboring mediastinal structures, and an extensive lymphatic drainage network facilitates tumor spread even in early stages. The current TNM classification, harmonized with the classification for gastric cancer, provides new definitions for the anatomic classification, adds non-anatomic characteristics of the tumor, and includes tumors of the gastroesophageal junction. Combining endoscopic ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging provides greater accuracy in determining the initial clinical stage, and these imaging techniques play an essential role in the selection, planning, and evaluation of treatment. In this article, we review some particularities that explain the behavior of this tumor and we describe the current TNM staging system; furthermore, we discuss the different imaging tests available for its evaluation and include a diagnostic algorithm.

Colestasis intrahepática por amoxicilina-clavulánico / Intrahepatic cholestasis caused by amoxicilin-clavulanic acid

No disponible

[Treatment of chronic hepatitis C virus infection in human immunodeficiency virus (HIV) infected patients]. / Tratamiento de la infección crónica por VHC en pacientes coinfectados por el VIH.

Treatment of chronic hepatitis C Virus (HCV) infection in human immunodeficiency virus (HIV) infected patients has become a topic of great importance, since the complications of chronic hepatitis are the first one cause of mortality among HIV patients. The aim of this study is to review the biological and epidemiological data in HIV-HCV coinfection, to establish treatment guidelines taking in consideration drugs' adverse effects and interactions, and to report the results of the main studies carried out. The treatment currently accepted includes pegylate interferon andribavirin, which have improved prior treatments, but the response rate depends on HCV genotype.

Tratamiento de la infección crónica por VHC en pacientes coinfectados por el VIH / Treatment of chronic hepatitis C virus infection in human immunodeficiency virus (HIV) infected patients

El tratamiento de la infección por el virus de la hepatitis C (VHC) en los pacientes coinfectados por el virus de la inmunodeficiencia humana (VIH) se ha convertido en un tema de gran importancia, ya que las complicacionesde la hepatopatía son actualmente la primera causa de mortalidad entre el colectivo con infección por el VIH. El objetivo de este trabajo es revisar los datos biológicos y epidemiológicos de la coinfección, y sobre todo las pautas de tratamiento a seguir, valorando las complicaciones producidas por los fármacos utilizados y sus interacciones, e informar de los resultados de los principales estudios realizados. La pauta de tratamiento actualmente aceptada incluye interferón pegilado y ribavirina. Con estos fármacos han mejorado los resultados respecto a pautas previas, aunque la respuesta es variable según el genotipo- VHC que presente el paciente

Treatment of chronic hepatitis C Virus (HCV) infection in human immunodeficiency virus (HIV) infected patients has become a topic of great importance, since the complications of chronic hepatitis are the first one cause of mortality among HIV patients. The aim of this study is to review the biological and epidemiological data in HIV-HCV coinfection, to establish treatment guidelines taking in consideration drugs adverse effects and interations, and to report the results of the main studies carried out. The treatment currently accepted includes pegylate interferon and ribavirin, wich have improved prior treatments, but the respouse rate depends on HCV genotype

[Lamivudine for the treatment of patients with chronic hepatitis with negative hepatitis B AgHbe]. / Lamivudina en el tratamiento de la hepatopatía crónica por virus hepatitis B AgHbe minus.

INTRODUCTION: It is estimated that chronic hepatitis B affects to than 350 million people around the world. Patients with AgHB- minus account, in some areas, for between 50-80% of the total of the population with chronic hepatitis B. Spontaneous clearance is rare within these patients, the response to interferon is low and the probability of developing cirrhosis and hepatocarcinoma is higher than in the wild type. AIM: To analyze the response to lamivudine treatment in patients with chronic hepatitis B which are AgHB negative. RESULTS: Seven of the 9 patients which were treated in our department for more than 3 months were AgHB negative. Six of them responded to the treatment in an average time of 3.5 months (range 1-6 months). There were two patients that relapsed at 18 and 24 months and they were treated with adefovir. Four patients remained DNA negative and had normal aminotransferases values after an average treatment time of 25 months. CONCLUSION: In our series, the majority of the patients (77.7%) were AgHB negative at the beginning of treatment. The efficacy of the treatment with lamivudine in these cases is high (85.7%) and with an early response (average 3.5 months). One third of patients treated relapsed after one and a half years of treatment.

Lamivudina en el tratamiento de la hepatopatía crónica por virus hepatitis B AgHbe minus / Lamivudine for the treatment of patients with hepatitis B AGHBE Minus

Introducción: Se estima que la hepatopatía crónica por virus de la hepatitis B afecta a más de 350 millones de personas en todo el mundo. Los pacientes AgHbe minus representan en algunas áreas entre el 50-80% del total. En estos pacientes la remisión espontánea es rara, la respuesta a interferón menor y la probabilidad de evolución a cirrosis y hepatocarcinoma mayor que en la cepa salvaje. Objetivo: Analizar la respuesta al tratamiento con Lamivudina en pacientes con hepatopatía crónica VHB AgHBe negativos. Resultados: De los nueve pacientes tratados en nuestro servicio durante más de 3meses, 7 eran AgHbe negativos. De ellos 6 pacientes respondieron al tratamiento, en un tiempo medio de 3,5 meses (rango 1-6). Se han producido dos recidivas a los 18 y 24 meses que han sido tratadas con Adefovir. Cuatro pacientes persisten con ADN negativo y transaminasas normales tras un tiempo medio de tratamiento de 25 meses.Conclusiones: En nuestra serie, la mayoría de los pacientes (77,7%) eran AgHbe negativos al inicio del tratamiento. La eficacia del tratamiento con Lamivudina en ellos es alta (85,7%) y precoz (media de 3,5 meses). En un tercio de los pacientes tratados se produce recidiva viral, al menos tras 1 año y medio de tratamiento

Introduction: It is estimated that chronic hepatitis B affects to than 350 million people around the world. Patients with eAgHB- minus account, in some areas, for between 50-80% of the total of the population with chronic hepatitis B. Spontaneous clearance is rare within these patients, the response to interferon is low and the probability of developing cirrhosis and hepatocarcinoma is higher than in the wild type. Aim: To analyze the response to lamivudine treatment in patients with chronic hepatitis B which are eAgHB negative. Results: Seven of the 9 patients which were treated in our departmentfor more than 3 months were eAgHB negative. Six of them responded to the treatment in an average time of 3.5 months (range 1-6 months). There were two patients that relapsed at 18 and 24 months and they were treated withadefovir. Four patients remained DNA negative and had normal aminotransferases values after an average treatment time of 25 months. Conclusion: In our series, the majority of the patients (77.7%) were eAgHB negative at the beginning of treatment. The efficacy of the treatment with lamivudine in these cases is high (85.7%) and with an early response (average 3,5 months). One third of patients treated relapsed after one and a half years of treatment