[Ultrasound-guided biopsy of the pancreas: a multicenter study]. / Punción pancreática ecodirigida: estudio multicéntrico.

OBJECTIVE: Members of "Asociación de Ecografía Digestiva" decided to carry out a multicenter retrospective study on fine-needle aspiration biopsy for pancreatic space-occupying lesions under ultrasonographic guidance and via the percutaneous route in order to assess this technique s performance versus endoscopic ultrasound-guided biopsy. SUBJECTS: 10 hospitals for a total of 222 patients with suspiciously malignant, 8-120-mm pancreatic lesions were included in the study. RESULTS: The analysis of results shows a sensitivity of 89%, a specificity of 98%, a positive predictive value of 99%, and a negative predictive value of 74%, for an overall diagnostic accuracy of 91%. No major complications occurred. CONCLUSION: Percutaneous fine-needle aspiration for pancreatic lesions is highly cost-effective and has few and mild complications.

Fibrin-glue sealed liver biopsy in patients with a liver transplantation or in liver transplantation waiting list: preliminary results.

Liver biopsy is frequently necessary for candidate evaluation or histologic follow-up of transplanted livers. Although generally considered to be safe, it carries a risk of complications in up to 0.5% of cases; hemorrhage being the most important. It can present as an asymptomatic intra- or perihepatic hematoma or result in overt hemorrhage of variable intensity. Patients with deranged hemostasis or on antiaggregant therapy are at high-risk for hemorrhagic complications. Percutaneous liver biopsy may be contraindicated if hemostasis is profoundly disordered. Safety values are not well defined: arbitrary limits are 60% prothrombin activity and 60,000 platelets per mm3. Patients with more altered values are candidates for alternative techniques, such as transjugular biopsy. Another option is the so-called plugged percutaneous liver biopsy, which uses direct injection of a plugging material into the biopsy tract. Different materials have been used: Tissucol, absorbable gelatin sponge, or hemostasis coils. We communicate our experience with Tissucol (fibrin glue) plugging in 30 percutaneous liver biopsies on 16 patients after liver transplantation with prothrombin activity <60%, platelet count <60,000 per mm3, or both. Only two complications were observed. Plugged liver biopsy is an efficient and relatively safe procedure in patients with impaired hemostasis; it can be performed even when transjugular biopsy is not available.

[Is there any association between Helicobacter pylori infection and peptic esophagitis?]. / Existe alguna relación entre la infección por Helicobacter pylori y la esofagitis péptica?

BACKGROUND: To describe the prevalence of Helicobacter pylori infection in patients with reflux esophagitis, and compare it with that in patients with normal endoscopy. METHODS: Fifty-five patients with endoscopic peptic esophagitis and 55 symptomatic patients with normal endoscopy were studied. Age and sex distribution were similar in both groups. At endoscopy biopsy specimens were taken from gastric antrum and body (H & E, Gram stain and culture). RESULTS: H. pylori was found in 74.5% (95% CI = 62-84%) of patients with reflux esophagitis, and in 76.4% (CI = 64-86%) of cases with normal endoscopy (a non-significant difference). In patients with esophagitis and H. pylori infection normal histologic antral mucosa was observed in 7.3% of cases (CI = 2.5-19.4%). In patients with normal endoscopy the corresponding figure was 4.8% (CI = 1.3-15.8%) (a non-significant difference). At gastric body from infected patients the percentages of patients with normal histologic mucosa was 29.3% (n = 12) and 23.8% (n = 10), in both groups respectively. CONCLUSIONS: The prevalence of H. pylori infection in patients with reflux esophagitis was 74.5%, and no difference was observed when comparing with infection rate in patients with normal endoscopy (76.4%). Therefore, a non-significant association was found between this esophageal disorder and H. pylori infection.

[Immunologic changes in chronic post-transfusion positive hepatitis C and non-A non-B non-C hepatitis]. / Alteraciones inmunológicas en la hepatitis crónica postransfusional C positiva y no-A no-B no-C.

OBJECTIVES: To study some aspects of the immunological abnormalities of C and non-A non-B non-C posttransfusional chronic hepatitis through the spontaneous and mitogen-stimulated "in vitro" production of immunoglobulins by peripheral blood lymphocytes. EXPERIMENTAL DESIGN: Peripheral blood lymphocytes from non-A non-B posttransfusional chronic hepatitis patients and from healthy volunteers were cultured in presence and absence of Pokeweed mitogen and the secreted immunoglobulins (IgG, IgA and IgM) were measured by ELISA in the supernatants. The results in both groups were compared. PATIENTS: 23 posttransfusional chronic hepatitis patients, 11 males and 12 females with an average age of 46.73 +/- 11.2 yrs (range: 24-69 yrs), have been studied. The histological diagnosis was chronic active hepatitis (CAH) in 13 cases, CAH with bridge necrosis in 6 patients and CAH with associated cirrhosis in 4 cases. The control group was composed by 11 healthy volunteers, 5 male and 6 female, with an average age of 38.45 +/- 12.77 yrs (range: 26-65 yrs). No one of the control group was positive for anti-HCV antibodies while in the posttransfusional chronic hepatitis patients group, 19 were positive and 4 negative. RESULTS: No significant differences in the spontaneous production of immunoglobulins between both groups has been found, however, when peripheral blood lymphocytes were stimulated with Pokeweed mitogen, a statistically significant lower production of immunoglobulins was observed in chronic hepatitis patients when compared with the control group. In non-A non-B posttransfusional chronic hepatitis patients, no relation has been found between the immunoglobulins production and histological findings or anti-HCV antibody titles. CONCLUSIONS: In the chronic phase of C and non-A non-B non-C posttransfusional chronic hepatitis, stimulated immunoglobulin production is significantly decreased for each immunoglobulin compared with the control group. These results suggest a failure in T-B lymphocyte cooperation in these infections since 82.6% of our patients were positive for HCV serological markers.

Frequency and chronology of occurrence of anti-HCV in non-A non-B post-transfusional hepatitis.

OBJECTIVE: Studying the frequency and timing of the appearance of the virus C antibody. PATIENTS: We studied serum samples of 57 patients whom developed post-transfusional non-A non-B hepatitis. 34 males, and mean age was 47.56 +/- 13.45 years. Initially anti-HVC was detected by ELISA, and the test was repeated on the last negative sample and the first two positive ones of each patient. RIBA-I and 2nd generation ELISA were performed on these same samples. HCV polymerase chain reaction was performed in 5 seronegative patients by the other techniques. RESULTS: Fifty patients (87.5%) seroconverted to anti-HCV; 26 (52%) within 30 days after the onset of the disease (11 during incubation period); and, 24 (48%) seroconverted after the first month of the disease. Anti-HCV negative patients had lower transaminase levels. Twenty six (52%) of the 50 patients showing seroconversion developed a chronic hepatitis, while this occurred in two (28.5%) of the seven seronegative patients (this difference was not statistically significant). Determination of HCV-RNA by polymerase chain reaction, performed (eight years after the onset of the disease) in 4 of the five seronegative patients by ELISA and RIBA techniques, was negative. Nowadays one of them is anti-HCV and HCV-PCR positive and sustain normal transaminases values. CONCLUSIONS: 87.5% of post-transfusional non-A non-B hepatitis seroconverted during the follow-up. 26 (52%) showed this within 30 days after the onset of their disease; of this group, 11 became seropositive before their ALT values rose. Nowadays in all patients (except one) initially seronegative, in which polymerase chain reaction was performed, negative serology results persist. There were no clinical and evolution differences between the groups.

[Treatment of hepatic and intra-abdominal hydatidosis with mebendazole: prospective comparison of the cyclic and the continuous regimen]. / Tratamiento de la hidatidosis hepática e intraabdominal con mebendazol: comparación prospectiva de las pautas cíclica y contínua.

AIM: To communicate the results of two different schedules (cyclic and continuous) of mebendazole therapy for hepatic and intraabdominal hydatid disease. DESIGN: Prospective and randomized. PATIENTS: 26 cases of abdominal hydatid disease. RESULTS: No significant differences were registered between both groups. CONCLUSION: Cyclic mebendazole therapy does not improve the results of continuous treatment in abdominal hydatid disease.

[Toxic cholestatic hepatitis due to phenytoin]. / Hepatitis tóxica colestásica por fenitoína.

We report the case of a 51-years-old female who was prophylactically treated with diphenylhydantoin after surgery of an intracranial aneurysm. Twenty-four days after beginning the treatment, a general syndrome appeared, in addition to a diffuse cutaneous exanthema. Four days later, a cholestatic syndrome, compatible with "toxic cholestatic acute hepatitis", was developed. The suppression of the drug, was followed by rapid clinical improvement and gradual normalization of transaminases values, although biochemical cholestasis persisted for months.

[Collagenous colitis: an entity with diverse therapeutic options]. / Colitis colágena: una entidad con diversas opciones terapéuticas.

Collagenous colitis is a disorder which has been diagnosed with increasing frequency in the last few years, probably due to the routine obtention of colon biopsy specimens in the study of patients with chronic diarrhoea. Good responses have been reported with a number of therapies, although only a scarce number of clinical trials have been performed, partly because of the small number of patients studied. Two cases of collagenous colitis with different therapeutic approaches are here reported. All medical therapy options for this interesting disorder are reviewed.

Portal vein thrombosis due to Candida albicans associated with hepatic cirrhosis.

A case of portal vein thrombosis due to Candida albicans in a patient with alcoholic hepatic cirrhosis in the absence of hepatocarcinoma is described. Infection is a known cause of portal vein thrombosis but thrombosis by Candida albicans has not to our knowledge been previously reported.

Treatment of liver hydatid disease with mebendazole: a prospective study of thirteen cases.

We have prospectively studied the evolution of 13 patients with liver hydatid cysts treated with mebendazole. Two patients also had peritoneal hydatid disease in addition to liver cysts. One of the two also had a retrovesical cyst. Liver cysts disappeared in three patients. In one, the liver cyst reappeared and in another a new cyst was observed after treatment was stopped. Therapy was most effective in young patients, in small cysts, in one case of peritoneal hydatid disease and in one case of a retrovesical cyst. Side effects warranted interruption of therapy in three cases, although we cannot be sure that they were due to mebendazole treatment. We recommend long-term patient follow-up once the cyst can no longer be identified by ultrasound.

Randomised controlled trial of efficacy of albendazole in intra-abdominal hydatid disease.

The efficacy of albendazole in hydatid disease is still unclear, because there has been no study that assessed the status of the parasite after treatment. The significance of albendazole-induced echographic changes in the cyst therefore cannot be judged. We did a prospective, controlled, randomised, open study of albendazole in patients with liver hydatid disease, and assessed parasite viability after treatment. 18 patients received no albendazole treatment (controls), 18 received albendazole (10 mg/kg daily) for 1 month (group A), and 19 received the drug for about 3 months (group B). Echography was done before and during treatment; all patients underwent surgery on completion. Parasite (protoscolex viability and development of cysts in mice) and ultrastructure studies were done for all cysts removed. 8 (50%) of cysts in the control group, 13 (72%) in group A, and 16 (94%) in group B were non-viable (p = 0.015). Protoscolex and cyst viability were significantly (p = 0.039 and p = 0.018, respectively) lower in treated patients than in controls. Treatment was also significantly associated with total cyst membrane disintegration. 68% of cysts treated for 3 months showed echographic changes, and only 1 of 20 cysts showing echographic changes during treatment was judged viable. The efficacy of albendazole at a dose of 10 mg/kg daily for 3 months suggests that it is a suitable alternative to surgery in uncomplicated hydatid liver disease, as initial treatment.