Chronic hepatitis C treatment in a cystic fibrosis patient in the pulmonary pre-transplant stage.

The standard treatment of chronic hepatitis C, pegylated interferon and ribavirin (pegI/R), has many limitations in both effectiveness and secondary effects, which makes it unsuitable or even contraindicated for some patients. In hepatitis C virus-infected cystic fibrosis patients this treatment could increase respiratory infections with subsequent pulmonary function deterioration. On the contrary, hepatitis C virus (HCV) infection may make lung transplant (LT) unfeasible. We present the case of a cystic fibrosis-young man diagnosed with HCV infection during LT assessment who was treated with pegI/R. In spite of the lung function worsening and respiratory infections, he managed to complete treatment and even sustained virological response (SVR). At present he is on LT waiting list.

[Gastric adenocarcinoma in young adults; comparative study with older patients]. / Adenocarcinoma gástrico en adultos jóvenes; estudio comparativo con pacientes mayores.

BACKGROUND: Gastric adenocarcinoma (GA) has been considered a disease of elderly age and has been rarely reported in patients younger than 35 years of age. The aim of thisΩ demographic, clinicopathological and prognosis of gastric cancer in young patients and to compare their features with the behavior in elder adults. METHODS: Between 1993 and 2008, 1536 patients with GA were enrolled in a retrospective database. Clinical and pathologic features of thirty patients aged 35 years or less (young group) were compared with those of 458 aged 75 years or more (elder group). RESULTS: Mean patient age was 31 and 80-years old in the young and elder groups, respectively, with a predominance of females in the last group (61%). Lauren diffuse type carcinoma was more frequent in people younger than 35 years (70%) than in older patients (17.4%). Main symptoms were dyspepsia (40%) and hemorrhage (20%). The most common T stage in young and elder patients was T3 (52.9% and 56.7% respectively). Surgical resection was performed in 68% of cases and the rest received only systemic chemotherapy. CONCLUSION: Gastric adenocarcinoma is rare in young patients and most cases presented at advanced clinical stage similar to elderly patients, so the prognosis in both age groups is poor. For this reason is important to be aware of alarm symptoms and risk factors in order to perform an early endoscopic diagnosis and a treatment with curative intent.

[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.

[Ultrasound of the urinary system]. / Ecografía del aparato urinario.

Ultrasound techniques are able to provide a fairly complete examination of the urinary system, achieving a high sensitivity in relevant-pathology detection, especially in the kidney, bladder and prostate. Early detection of pathologies such as tumors or urinary tract obstructions, sometimes even before their clinical manifestation, has improved their management and prognosis in many cases. This, added to its low cost and harmlessness, makes ultrasound ideal for early approaches and follow-up of a wide number of urinary system pathologies. In this article, the ultrasound characteristics of the main urinary system pathologies that can be diagnosed by this technique, are reviewed.

[Ultrasound of gallbladder and bile duct]. / Ecografía de la vesícula y la vía biliar.

The cystic nature of the gallbladder and bile duct when dilated, and the advantages of ultrasound as a quick, reproducible, convenient, cheap and low risk technique, with a high sensitivity and specificity, make it the most eligible technique in biliary pathology studies. Ultrasound has become a valuable tool for doctors studying biliary pathology and its complications, from abnormal liver function results, right upper quadrant pain, or jaundice, to cholelithiasis, cholecystitis, or suspicion of biliary tumors.

[Liver ultrasound: focal lesions and diffuse diseases]. / Ecografía hepática: lesiones focales y enfermedades difusas.

Liver ultrasound is frequently used as a first-line technique for the detection and characterization of the most common liver lesions, especially those incidentally found focal liver lesions, and for monitoring of chronic liver diseases. Ultrasound is not only used in the Bmode, but also with Doppler and, more recently, contrast-enhanced ultrasound. It is mainly used in the diagnosis of diffuse liver diseases, such as steatosis or cirrhosis. This article presents a practical approach for diagnosis workup, in which the different characteristics of the main focal liver lesions and diffuse liver diseases are reviewed.

[Ultrasound of spleen and retroperitoneum]. / Ecografía de bazo y retroperitoneo.

Ultrasound provides data of extremely great value when studying spleen pathology, being diagnostic in splenomegaly and splenic trauma, as well as offering a good approach to the diagnosis of both benign and malignant focal pathology, particularly lymphoma. However, for the evaluation of adrenal and retroperitoneal diseases, other techniques such as CT or MRI are more suitable, even though ultrasound is still an excellent screening and monitoring method, as well as being useful in non-invasive therapeutic approaches.

[Pancreatic ultrasonography]. / Ecografía pancreática.

Despite the recent technological advances in imaging, abdominal ultrasonography continues to be the first diagnostic test indicated in patients with a suspicion of pancreatic disease, due to its safety, accessibility and low cost. It is an essential technique in the study of inflammatory processes, since it not only assesses changes in pancreatic parenchyma, but also gives an indication of the origin (bile or alcoholic). It is also essential in the detection and tracing of possible complications as well as being used as a guide in diagnostic and therapeutic punctures. It is also the first technique used in the study of pancreatic tumors, detecting them with a sensitivity of around 70% and a specificity of 90%.

[Focal hepatic lesions. Their diagnosis by fine-needle (25 G) aspiration puncture]. / Lesiones focales hepáticas. Diagnóstico por punción aspiración con aguja fina (25 G).

151 patients with focal lesions of the liver underwent percutaneous fine-needle aspiration biopsy under ultrasonographic control. We used 25 G needles, the thinnest available. Aspiration biopsy was performed on malignant disease in 122 cases, and on benign disease in 29 cases. There were 3 false negatives diagnosis and 2 minor complications. The overall accuracy of the cytologic evaluations was 91.2%, with a sensitivity of 89.1% and specificity of 100%. Guided percutaneous fine-needle aspiration biopsy is recommended for a morphological diagnosis of focal liver lesions, because of its simplicity, safety and high degree of correct diagnosis.

[Adenosquamous carcinoma of the pancreas: diagnosis with ultrasonography-guided percutaneous needle biopsy]. / Carcinoma adenoescamoso de páncreas: diagnóstico por punción citológica percutánea bajo control ecográfico.

Pancreatic adenosquamous carcinoma is an unusual histologic subtype of nonendocrine cancer of the pancreas. Diagnosis is usually made after surgery or necropsy. We report a case of adenosquamous cell carcinoma of the pancreas diagnosed by ultrasonically guided fine-needle aspiration biopsy.

[Hepatocellular carcinoma: is spontaneous regression possible?]. / Carcinoma hepatocelular: es posible la regresión espontánea?

We present the case of a patient with liver cirrhosis secondary to hepatitis C who developed a large (6 cms) hepatocellular carcinoma, diagnosed by raised alphafetoprotein (AFP) levels (> 10000 ng/ml) and imaging techniques (ultrasonography and abdominal CT with and without contrast). During follow-up there was normalization of the AFP levels and disappearance of the lesion on U.S. and CT. Spontaneous regression is exceptional in hepatocellular carcinoma. We describe the characteristics of our case and of the 10 patients described in the literature.

[Ultrasonographic aspects of cystic papillary tumor of the pancreas. Apropos of 2 cases]. / Aspectos ecográficos del tumor papilar quístico del páncreas. A propósito de 2 casos.

Cystic papillary pancreatic tumor is an infrequent neoplasm of unknown origin which is presented almost exclusively in young women. It is characterized by an anodyne clinical symptomatology with it frequently treated as an accidental finding. Ultrasonography and computerized axial tomography have a priority role in the study of this entity but the definitive diagnosis is based on the histologic findings. The treatment of choice is surgical removal and although it is a malignant tumor, good evolution is observed with recurrence not being expected. Two new cases of cystic papillary tumor are presented comparing the ultrasonographic appearance of the same with other pancreatic cystic neoplasms. Although the ultrasonographic findings are not characteristic they may be suggestive of papillary tumor.

[The usefulness of hydrogastric ultrasonography in the detection of neoplastic lesions of the gastric wall]. / Utilidad de la ecografía hidrogástrica en la detección de lesiones neoformativas de la pared gástrica.

Forty patients endoscopically diagnosed of different gastric neoplastic lesions were explored by hydrogastric ultrasonography to evaluate the usefulness of this method in the detection of such lesions and to analyze the characteristics of the ultrasonographic images and their correlation with the anatomopathologic findings. The sensitivity of the detection of the lesions was 87.5% being close to 100% in those located in the antrum, showing the body and fundus more difficulties due to gas and the costal ribcage. A clear correlation was observed between the ultrasonographic images and the anatomographic findings. It was concluded that this may be a complementary technique to gastroscopy in the diagnosis of sumucosal lesions and extrinsic compressions of the gastric wall. The infiltration of the wall may be delimited in neoplastic lesions and thus may contribute to correct T stratification of the tumor, although this should be confirmed in further studies.

[Color duplex Doppler ultrasonography in the evaluation of the risk of esophageal varices bleeding in cirrhotic patients]. / Ultrasonografía Doppler dúplex color en la valoración del riesgo de sangrado por varices esofágicas en pacientes cirróticos.

The risk of variceal bleeding (VB) in patients with cirrhosis and esophageal varices may be determined by the portal pressure gradient. The value of Color Duplex Doppler Ultrasonography (CDDU) in the identification of patients at risk for variceal bleeding has been discussed in the literature. In patients with esophageal varices at risk for bleeding, CDDU did not detect patients who presented variceal bleeding during a mean follow-up of 7 months. However, patients with a low Congestion Index (< 0.05) and a mean upper portal vein velocity of > 9 were at lower risk for variceal bleeding. The Congestion Index was higher in patients with bleeding during the follow-up (0.09 vs. 0.057 (p = 0.03) and the mean portal vein velocity was lower in these patients (10.7 vs. 14).

[Idiopathic thrombocytopenic purpura as an extraintestinal manifestation of Crohn's disease]. / Púrpura trombocitopénica idiopática como manifestación extraintestinal de la enfermedad de Crohn.

Idiopathic thrombocytopenic purpura is an infrequent extraintestinal manifestation of inflammatory bowel disease. It is particularly rare in association with Crohn's disease. In these cases it presents certain peculiarities with respect to its normal clinical features, occurring more frequently when Crohn's disease is mainly colonic and usually appearing after the diagnosis of Crohn's disease has been made. Moreover, it usually complicates the clinical course of both diseases. We present a case of idiopathic thrombocytopenic purpura in a 14-year-old girl in whom the two diseases first presented simultaneously. The clinical course was poor and both diseases were refractory to habitual treatment.