[Endoscopic management of foreign bodies in the digestive tract]. / Manejo endoscópico de los cuerpos extraños del tubo digestivo.

From 1983 to 1989, the Unidad de Endoscopias has attended 424 cases of foreign bodies located in the gastrointestinal tract, most of them in the esophagus. The mean age of the patients was 49 years. The commonest foreign bodies were food particles and the most common symptom was acute dysphagia. The most frequent localization of impaction was the cricopharyngeal sphincter (Killian's mouth). In 89% of the cases the foreign body could be removed endoscopically. The most common underlying pathology was hiatal hernia. There were severe complications related to the presence of the foreign body in 4.5% of the cases; one death was due to aorto-esophageal fistula. Foreign bodies, mainly impacted food particles (p less than 0.001), are most frequent in patients over 65, mainly females (p less than 0.01).

[Treatment with recombinant interferon alfa-2b of a patient with chronic hepatitis C and concomitant ulcerative colitis]. / Tratamiento con interferón alfa-2b recombinante de una paciente con hepatitis crónica C y brote de colitis ulcerosa concomitante.

The case of a patient ulcerative colitis involving an autoimmune base who was treated with recombinant alpha-2b interferon for presenting chronic active hepatitis in relation to virus C is reported. Such treatment was achieved in addition to improving the hepatic disease normalizing the transaminases control the outbreak of ulcerative colitis that the patient was presenting from some days before beginning the treatment. Various aspects are discussed related to the autoimmunity in the ulcerative colitis and in the chronic C hepatitis and the exarcebation of autoimmune phenomena which may lead to interferon therapeutic. As a basis for the above and the review of the literature, we concluded that the existence of ulcerative colitis does not contraindicate the use of alpha-2b interferon in patient with chronic hepatitis, although special control of the disease should be carried out during the treatment period.

[Mixed cryoglobulinemia associated with hepatitis C virus]. / Crioglobulinemia mixta asociada al virus de la hepatitis C.

We report six cases of essential mixed cryoglobulinemia associated with chronic liver disease and positive HCV markers, who showed several acute symptoms of vasculitis, arthralgias, neuropathy and glomerulonephritis. The presence in the serum and cryoprecipitates of anti HCV antibodies detected by the second-generation ELISA (ELISA 2) and the of HCV RNA by PCR in the serum in all six cases, suggest an important role for this virus in the pathogenesis of mixed cryoglobulinemia.

[Role of endoscopy in caustic gastroesophageal lesions]. / Papel de la endoscopia en las lesiones cáusticas gastroesofágicas.

From 1984 to 1989 we have examined endoscopically 191 patients who ingested, for different causes, some type of caustic substance. The mean age was 36.8 +/- 21 years. 57% were female and 43% males. The most common substance was lye (52%). The clinical symptoms consisted mainly of epigastric pain and odynophagia. The most prevalent lesion was oesophagitis, of variable degrees (58%). Complications related to the ingestion of the caustic appeared in 20% of the patients; three of them died. The most common sequela was oesophageal stenosis and secondly gastric stenosis. Males ingested acids more frequently than females (P less than 0.001). In 20% of the cases the ingestion of the caustic was for suicide while in children all the cases were accidents.

Rheumatologic and autoimmune manifestations in patients with chronic hepatitis C virus infection.

Hepatitis C virus (HCV) has been associated with several autoimmune and rheumatologic disorders. The aim of this study was to determine the incidence of these abnormalities in patients with chronic HCV. We studied 56 patients, 29 of whom (52%) had biochemical abnormalities that suggested immunological disorders. Cryoglobulinemia was detected in nine patients (22%), antinuclear antibodies in eleven (20%), rheumatoid factor in seven (19.27%) and hypocomplementemia in fourteen (29.16%). The most common clinical manifestations were: arthralgias (52%), myalgias (16%), xerostomia (28.5%) and xerophthalmia (14%). These results indicate the existence of a relationship between HCV and rheumatologic disorders. We conclude that HCV may play a role in the pathogenesis of these autoimmune phenomena, but more studies are required to define the extent of this role.

[Immunological differences between patients with cirrhosis and liver carcinoma]. / Diferencias inmunológicas entre pacientes con cirrosis y hepatocarcinoma.

Fifteen patients with liver cirrhosis and 15 with primary liver cancer were studied. The results of cellular immunity in these two groups and a third control group of 15 healthy subjects were compared. A significant decrease in OKT3 and OKT4 lymphocytes and response to different mytogenic stimuli were found, particularly in the hepatocarcinoma group. No significant differences were observed in OKT8, OKM1 or chemotaxis.

[Transjugular hepatic biopsy. Apropos the first 100 cases and a review of the literature]. / Biopsia hepática transyugular: a propósito de los cien primeros casos y revisión de la literatura.

Under certain conditions a percutaneous liver biopsy cannot be carried out. In many of these patients transjugular liver biopsy is the correct option. We present our first hundred biopsies: in 92 cases a liver specimen was obtained; in 80 cases (87%) the tissue specimen allowed the histopathologic diagnosis; in five cases perforation of the hepatic capsule was observed, without producing hemoperitoneum. The mortality in our series was nil. In our experience and the revision of the literature, we consider that transvenous (transjugular) needle biopsy is an efficient and reliable procedure.

[Ischemic hepatitis following liver biopsy in a patient with transplanted liver]. / Hepatitis isquémica tras biopsia hepática en paciente transplantada hepática.

We report a case of ischemic hepatitis following a percutaneous liver biopsy in a 51 year old female patient, who had had an orthotopic liver transplant 6 months before. The angiographic study demonstrated a marked stenosis in the hepatic artery at the anastomosis site and a small arterioportal fistula. We suggest that the percutaneous liver biopsy was partially responsible for the ischemic hepatitis, due to the development of a small arterioportal fistula in a previously damaged vascular area with hepatic artery stenosis.

Bacteremia following liver biopsy in transplant recipients with Roux-en-Y choledochojejunostomy.

Between 1990 and 1995, 666 percutaneous liver biopsies were performed in 196 patients at Gregorio Marañón General Hospital (mean 3.4 biopsies/patient); 533 biopsies (80.03%) were carried out in patients with choledochostomy biliary anastomosis and 133 (19.97%) in patients with choledochojejunostomy. Infectious complications, in the form of sepsis, occurred in two patients, who recovered favorably with antibiotic therapy. These two patients had undergone Roux-en-Y choledochojejunostomy (1.5%, not significant). Our findings suggest that the incidence of infectious complications after liver biopsy in transplant recipients is very low. Antibiotic prophylaxis at the time of liver biopsy in patients with Roux-en-Y choledochojejunostomy may decrease the frequency of infectious complications.

[Leishmaniasis in a patient with liver cirrhosis]. / Leishmaniasis en paciente con cirrosis hepática.

We present a 35 years-old man with fever related leishmania infection as the first complication of a previously undiagnosed cirrhosis. Diagnosis of leishmaniasis is often complicated. Clinical and therapeutical aspects are commented.

Acute pancreatitis associated with milk allergy.

We are reporting the case of a 23-yr-old patient who had recurring episodes of acute pancreatitis characterized by the typical abdominal pain, elevated serum levels of pancreatic enzymes, and enlargement of the pancreas and edema on sonogram. These episodes were accompanied by facial erythema with conjunctival injection, generalized pruritus, diarrhea, and eosinophilia, and they were induced by the consumption of milk. The serum levels of IgE specific to cow milk proteins and to beta-lactoglobulin were increased. We suggest that these episodes are caused by a milk allergy (milk), that has been described as an unusual cause of acute pancreatitis.