Budesonide combined with ursodeoxycholic acid in primary biliary cirrhosis with advanced liver damage.

We describe two patients with primary biliary cirrhosis who rapidly suffered progressive liver failure and developed jaundice, despite having undergone correct therapy using ursodeoxycholic acid. Both cases showed an extraordinary clinical and biochemical response 2 months after budesonide was added to standard therapy, leading to recovery of normal liver function.

[Interferon, ribavirin and amantadine in prior nonresponders to interferon and ribavirin therapy with chronic hepatitis C (genotype 1)]. / Interferón, ribavirina y amantadina en pacientes con hepatitis C crónica (genotipo 1) sin respuesta al tratamiento previo con interferón y ribavirina.

OBJECTIVE: Despite advances in the treatment of chronic hepatitis C virus (HCV), the disease persists after treatment with interferon and ribavirin in a large percentage of patients and other therapeutic options are lacking. We investigated the efficacy of retreatment with antiviral therapy including amantadine. EXPERIMENTAL DESIGN: prospective and open pilot study. PATIENTS: Thirty-nine patients with chronic HCV, genotype 1, who were nonresponders to interferon and ribavirin were included. The patients were given repeat treatment with interferon-alpha 2A (9 MU/week), ribavirin (1,000-1,200 mg/day) and amantadine (200 mg/day) for 48 weeks. RESULTS: HCV-RNA was undetectable in 5 patients in week 48 (12.8%) and in only 2 patients after 24 weeks of follow-up (5.1% of sustained responses). In patients with basal viremia of < 8 105 U/ml the probability of response at the end of treatment and of sustained response was 26.3 and 10.5%, respectively; in patients with elevated viremias response was 0%. CONCLUSIONS: In patients with chronic HCV genotype 1 without response to interferon and ribavirin, triple antiviral therapy with interferon, ribavirin and amantadine is not useful.

Hydrogastric sonography in the preoperative staging of gastric cancer.

PURPOSE: Depth of wall invasion is the main prognostic factor in gastric cancer. We studied the utility of hydrogastric sonography in the evaluation of transmural infiltration by gastric cancer. METHODS: Thirty-seven patients with gastric adenocarcinoma were examined before surgery with a 5-MHz probe after the ingestion of 100-400 ml of water (mean, 330 ml). Sonographic results were compared with pathologic classifications obtained after surgery. RESULTS: Of the 37 tumors, 15 were found at surgery to be in the antrum, 10 were in the gastric body, 5 were proximal, and 7 were diffuse. After surgery, tumors were classified as follows: 2 (5%) T1, 4 (11%) T2, 15 (41%) T3, and 16 (43%) T4. Hydrogastric sonography correctly classified 30 (81%) of the 37 tumors. Sonography was correct for 2 (100%) of the 2 T1 tumors, 2 (50%) of the 4 T2 tumors, 13 (87%) of the 15 T3 tumors, and 13 (81%) of the 16 T4 tumors. Five sonographic errors were due to understaging and 4 to overstaging. With regard to tumor site, sonographic results were correct for 4 (57%) of the 7 diffuse tumors, 3 (60%) of the 5 proximal tumors, 9 (90%) of the 10 gastric body tumors, and 14 (93%) of the 15 antral tumors. CONCLUSIONS: Hydrogastric sonography is useful for preoperative evaluation of transmural infiltration by gastric cancers, particularly tumors in the antrum or gastric body.

Hidrocolonic ultrasonography in the detection of tumoral processes in the inferior gastrointestinal tract.

OBJECTIVES: To determine the value of hidrocolonic ultrasound in the detection of proliferative lesions in the colon and to compare it with other techniques of already proven value. MATERIAL AND METHODS: We performed a prospective blinded trial including 155 patients (82 males and 73 females) with ages ranging from 33 to 94 years (average of 58) and clinical and analytical criteria suggesting the existence of colonic proliferative lesions. Patients with rectal mass or those with deficient bowel preparation were excluded. Ultrasound findings were compared to those obtained by colonoscopy (133 cases) and by Barium RX studies (22 cases) and all diagnoses were always confirmed by histologic exams. RESULTS: 155 patients were studied. 50 of them had cancer and 46 of these 50 were diagnosed by Hidrocolonic Ultrasound (92%); 19 had polyps > 7 mm. and 15 of these (78.9%) were diagnosed by Hidrocolonic Ultrasound. Hidrocolonic Ultrasound failed to detect all the polyps < 7 mm. The overall sensitivity, specificity, positive predictive value and negative predictive value for identifying colon carcinoma were 92%, 98%, 95.8% and 96.2% respectively and for polyps > 7 mm were 78.9%, 100%, 100% and 97.1%, respectively. The mean time for examination was 14 minutes. Tolerance was good in 114 patients (73.5%), 29 showed a slight discomfort (18.7%) and 12 (7.7%) showed a great discomfort. There were no complications. CONCLUSIONS: Hidrocolonic ultrasound is an innocuous, fast, well tolerated technique for detecting colonic proliferative lesions > 7 mm H.U. can be considered as a useful complementary technique to other more expensive and invasive ones, such as barium RX studies and Colonoscopy.

[Usefulness of abdominal echography in the diagnosis of active Crohn's disease]. / Utilidad de la ecografía abdominal en el diagnóstico de la enfermedad de Crohn en actividad.

OBJECTIVE: The aim of this study was to evaluate the relevance of the ultrasonography in assessing activity in a series of patients with Crohn's disease. PATIENTS AND METHODS: A series of 24 patients with active (Crohn's disease activity index > 150) ileal or ileocolonic Crohn disease underwent abdominal ultrasonography. RESULTS: There was a significant correlation between bowel wall thickening and the Crohn's disease activity index: the higher the bowel wall thickening was the higher were the values of Crohn's disease activity index. Two or more ultrasound studies were performed in 10 patients with bowel wall > 4 mm during treatment, and a progressive normalization of bowel wall size was observed with new thickening when recurrence occurred. CONCLUSIONS: A bowel wall thickening (> or = 4 mm) was found in patients with active Crohn's disease. A patient with bowel wall thickness > 6 mm should make us suspect the presence of stenosis. Abdominal ultrasonography is an accurate method in the first assessment of Crohn's disease because its high correlation with the Crohn's disease activity index.

[Abdominal echography in patients with human immunodeficiency virus (HIV) infection. Diagnostic usefulness in the evaluation of associated medico-surgical pathology]. / Ecografía abdominal en el paciente con infeción por el virus de la inmunodeficiencia humana (VIH). Utilidad diagnóstica en la valoración de la patología médico-quirúrgica asociada.

BASIS: The abdominal manifestations in the patient with HIV infection are increasingly frequent. We have conducted the present study in order to determine the diagnostic usefulness of the abdominal echography in the clinical assessment of the patient. MATERIALS AND METHODS: We review the echographic findings of 112 patients carrying the HIV with or without the Acquired Immunodeficiency Syndrome (AIDS). Seventy eight patients were men and 34, women, with an average age of 30 years. The main risk group was parenterally drug addiction (72%). The stage of the HIV infection was IVC1 in 41% of the cases, II in 23%, III in 13% and IVC2 in 13%. The echographic exploration was performed using a real-time echography, with a probe of 3.5 Mhz, assessing according to conventional criteria the abdominal organs and their pathology, masses and free intraabdominal fluid. The echographic characteristics were first broadly assessed in the patients from the series and later on, according to the patient's pathology. (Infectious, acute abdominal, hepatic biochemical disorders, HIV carrier-associated pathology). RESULTS: In 33% of the cases, the echography was normal. Hepatomegaly was the most frequent echographic sign: 56 patients (50%), followed by splenomegaly in 43 patients (38.3%), standing out the affection of the biliary and/or vesicular ductus in 7 patients (6.2%). The echographic findings were not related to the HIV infection stage, nor with the presence of hepatic biochemical disorders. However, the presence of organomegaly (hepatosplenomegaly associated or not to retroperitoneal adenopathies) were more frequent in the group with infectious complication, 33.3% vs 19.6% (p < 0.01), that in the patients without associated infectious processes. In patients with medical or surgical acute abdominal pathology, the echography was diagnostic in 9 out of 10 patients. CONCLUSION: In the HIV patient, the echography allows an specific initial diagnostic assessment, being able in most of the patients with abdominal manifestations to diagnose the causal pathology.

[Cytomegalovirus colitis in a patient carrying the human immunodeficiency virus: the endoscopic image similar to pseudomembranous colitis]. / Colitis por citomegalovirus en un paciente portador del virus de la inmunodeficiencia humana: imagen endoscópica similar a una colitis pseudomembranosa.

Endoscopically detected ulcers and submucous haemorrhage are common findings related to cytomegalovirus infection. We report a case of cytomegalovirus colitis in a patient seropositive for human immunodeficiency virus. Endoscopic findings showed elevated, white-yellowish, small size plaques with an erythematous central depression, resembling those found in pseudomembranous colitis.

[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.