Motivation for change and barriers to treatment among young cannabis users.

BACKGROUND/AIMS: Despite cannabis use among adolescents has shown to be related to psychosocial and mental health problems, the demand from adolescents for professional help is very low, and determinants of motivation for change among nonclinical populations remain unknown. The purpose of this study was to assess motivation for change among young cannabis users and to identify determinants of intention to change and self-change, as well as perceived barriers to seeking professional help. METHODS: 261 cannabis users aged 16-21 participated in a computerized survey in Spain. RESULTS: Data from this cross-sectional study indicated that few users intend to stop taking the drug. Determining factors of intention to change were the following: having more drug-related problems, paranoid symptomatology and greater concern about the consequences of use. Self-change was facilitated by lower use of cannabis, and could be hindered by tobacco smoking and cannabis dependence. Lack of awareness of the problems and the desire to solve one's problems alone constitute the main barriers to seeking professional help. CONCLUSIONS: Adolescent cannabis users show low motivation for change though experiencing more problems associated with its use emerges as a determinant of increased motivation. Several barriers impede this motivation from turning into treatment demand.

Tratamiento de la adicción a la cocaína mediante terapia de incentivos / Treatment of cocaine addiction with vouchers treatment

El Programa de Reforzamiento Comunitario (CRA) más Terapia de Incentivos es un tratamiento psicológico para el abordaje de la adicción a la cocaína que integra un programa de entrenamiento en habilidades (CRA) y un componente de manejo de contingencias, en el que los pacientes reciben incentivos a cambio de resultados negativos en analíticas de orina. Este programa cuenta con amplia evidencia científica, pero la mayoría de estudios empíricos se han realizado en contextos experimentales en Estados Unidos. Durante los últimos años se han llevado a cabo estudios controlados para evaluar la adaptabilidad y la eficacia del programa en contextos comunitarios en España. El objetivo de este trabajo es describir los principales hallazgos de la aplicación del programa CRA más incentivos en España. Estos resultados respaldan el uso de este programa específico para la adicción a la cocaína en dispositivos asistenciales en España, debido a su adaptabilidad y eficacia. No obstante, se requieren estudios de seguimiento más largos y con un número mayor de participantes (AU)

The Community Reinforcement Approach (CRA) plus Vouchers program is a psychological treatment for cocaine addiction consisting of a program of skills training (CRA) and a contingency management procedure in which patients earn incentives for negative cocaine urinalysis. This program has demonstrated its efficacy, but most of clinical trials were conducted in experimental settings in USA. In recent years, several controlled trials have been conducted in order to assess the adaptability and efficacy of CRA + Vouchers program in community settings in Spain. The aim of this study is to describe main findings of CRA + Vouchers research in our country. These results support the implementation of CRA plus vouchers treatment for cocaine addiction in clinical settings in Spain due to its adaptability and efficacy. However, further follow-up studies with larger samples sizes are required (AU)

Intrahepatic arteriovenous fistula resulting from needle biopsy

No disponible

Hallazgos endoscópicos del tumor mucinoso de páncreas / Endoscopic signs of mucinous tumor of the pancreas

No disponible

Abdomen agudo en la enfermedad celiaca: yeyunoileítis ulcerativa / Acute abdomen in celiac disease: Ulcerative jejunoileitis

No disponible

Esclerosis hepatoportal, una causa infrecuente de hipertensión portal / Hepatoportal sclerosis, an unfrequent cause of portal hypertension

No disponible

[Liver biopsy in patients with chronic hepatitis C virus infection: experience in a district hospital]. / Biopsia hepática en pacientes con infección crónica por el VHC: experiencia de un hospital comarcal.

INTRODUCTION: Liver biopsy is a highly useful tool in the evaluation of patients with chronic hepatitis C. However, the technique is not free of complications and presents a series of limitations (lack of representativity and interobserver variability in sample interpretation). Due to these limitations and the development of new noninvasive techniques, the role of liver biopsy is currently being reevaluated. MATERIAL AND METHOD: We performed a descriptive retrospective study of liver biopsies performed in patients with chronic hepatitis C virus (HCV) infection from January 2002 to January 2005. Age, gender, genotype, histology of the hepatic cylinder, and the percentage of patients who received treatment after liver biopsy was analyzed. The indications for biopsy in our patients and the reasons for nontreatment after biopsy were identified. We also analyzed whether the decision to start treatment was influenced by the histological grade of the lesion and whether there is any association between histological grade and transaminase levels. RESULTS: A total of 156 patients were included and 72% received treatment after biopsy. Transaminase levels were elevated in 86%. Alanine aminotransferase (ALT) levels were elevated in 92.30% of treated patients and in 66% of untreated patients. The most frequent cause of nontreatment after biopsy was fibrosis stage < 2. The histological results were as follows: G0 in 2%, G1 in 26.8%, G2 in 47.7%, G3 in 22.2% and G4 in 1.3%; stage of fibrosis was F0 in 7.2%, F1 in 30.1%, F2 in 37.9%, F3 in 19.6%, and F4 in 5.2%. Fibrosis was advanced (F >= 2) in 41% of the patients with normal ALT levels and was mild (< F2) in 33% of those with elevated ALT levels. CONCLUSION: Liver biopsy could be useful in patients with indication for treatment but a high risk of treatment-related adverse effects, as well as in those with normal transaminase levels, in whom the degree of fibrosis observed could influence the therapeutic approach.

Síndrome de Bouveret resuelto mediante litotricia mecánica endoscópica / Successful treatment of Bouveret’s syndrome with endoscopic mecanical lithotripsy

No disponible

Biopsia hepática en pacientes con infección crónica por el VHC: experiencia de un hospital comarcal / Liver biopsy in patients with chronic hepatitis C virus infection: experience in a district hospital

Introducción: La biopsia hepática es una herramienta muy importante en la evaluación de los pacientes con hepatitis crónica C. Es una técnica no exenta de complicaciones, y que presenta una serie de limitaciones (falta de representatividad del órgano y variablidad interobservador en la interpretación de la muestra). Por tanto, debido a sus limitaciones y al desarrollo de nuevas técnicas no invasivas, en la actualidad el papel de la biopsia hepática está siendo revaluado. Material y método: Estudio descriptivo y retrospectivo de las biopsias hepáticas realizadas en pacientes con infección crónica por el virus de la hepatitis C, durante enero de 2002 a enero de 2005. Se analizaron los siguientes aspectos: a) edad, sexo, genotipo, histología del cilindro hepático y porcentaje de pacientes que recibieron tratamiento tras la realización de la biopsia hepática; b) descripción de las indicaciones de la biopsia en nuestros pacientes, así como las causas de la ausencia de tratamiento después de realizada la biopsia; c) si la decisión de iniciar tratamiento se encontró influida por el grado de lesión histológica, y d) si existía correlación entre el grado de lesión histológica y los valores de transaminasas. Resultados: Se incluyó a 156 pacientes, de los que el 72% recibió tratamiento tras la realización de la biopsia. Las transaminasas se encontraban elevadas en el 86%. En el grupo de pacientes tratados, la alanina aminotransferasa (ALT) se encontraba elevada en el 92,30%, y en el grupo de pacientes no tratado, lo estaba en el 66%. La causa más frecuente de no tratamiento tras la realización de la biopsia fue la presencia de lesiones histológicas mínimas. El resultado histológico fue el siguiente: G0 en el 2%, G1 en el 26,8%, G2 en el 47,7%, G3 en el 22,2% y G4 en el 1,3%; con respecto al estadio de la fibrosis fue: F0 en el 7,2%, F1 en el 30,1%, F2 en el 37,9%, F3 en el 19,6% y F4 en el 5,2%. Los pacientes con ALT normal presentaban, en el 41%, lesiones >= F2, mientras que los del grupo de ALT elevada mostraban lesiones < 2 en el 33%. Conclusión: La biopsia hepática sería útil en los pacientes con indicación de tratamiento, pero con una elevada posibilidad de presentar efectos secundarios durante su duración, así como en los pacientes con transaminasas normales, donde el grado de fibrosis observado podría influir en la actitud terapéutica

Introduction: Liver biopsy is a highly useful tool in the evaluation of patients with chronic hepatitis C. However, the technique is not free of complications and presents a series of limitations (lack of representativity and interobserver variability in sample interpretation). Due to these limitations and the development of new noninvasive techniques, the role of liver biopsy is currently being reevaluated. Material and method: We performed a descriptive retrospective study of liver biopsies performed in patients with chronic hepatitis C virus (HCV) infection from January 2002 to January 2005. Age, gender, genotype, histology of the hepatic cylinder, and the percentage of patients who received treatment after liver biopsy was analyzed. The indications for biopsy in our patients and the reasons for nontreatment after biopsy were identified. We also analyzed whether the decision to start treatment was influenced by the histological grade of the lesion and whether there is any association between histological grade and transaminase levels. Results: A total of 156 patients were included and 72% received treatment after biopsy. Transaminase levels were elevated in 86%. Alanine aminotransferase (ALT) levels were elevated in 92.30% of treated patients and in 66% of untreated patients. The most frequent cause of nontreatment after biopsy was fibrosis stage = 2) in 41% of the patients with normal ALT levels and was mild (< F2) in 33% of those with elevated ALT levels. Conclusion: Liver biopsy could be useful in patients with indication for treatment but a high risk of treatment-related adverse effects, as well as in those with normal transaminase levels, in whom the degree of fibrosis observed could influence the therapeutic approach

Amiloidosis hepática masiva con fallo hepático fulminante / Massive hepatic amyloidosis with fatal hepatic failure

No disponible

[Crohn's disease and pregnancy. A descriptive and retrospective study]. / Enfermedad de Crohn y embarazo: un estudio descriptivo y retrospectivo.

OBJECTIVES: To determine the behavior of Crohn's disease during pregnancy, as well as the influence of this disease on the presence of low birthweight neonates. MATERIAL AND METHODS: A descriptive and retrospective study of all patients with Crohn's disease followed-up in the Hospital Costa del Sol was performed. A total of 124 pregnant women were included, classified in two groups: women who became pregnant before and those who became pregnant after Crohn's disease was diagnosed. In all patients, clinical and epidemiological data, disease activity during pregnancy and in the immediate postpartum period, type of assisted delivery, and neonatal birthweight were recorded. RESULTS: A total of 66.1% of pregnancies occurred before Crohn's disease was diagnosed, 31.5% occurred after diagnosis and 2.4% coincided with disease onset. No significant differences were found between women with and without a diagnosis of Crohn's disease in type of assisted delivery or low birthweight (p = 0.064; p = 0.643). All non-smoking patients remained in the quiescent phase and did not present disease recurrences during pregnancy. Among smokers, the disease remained inactive in 61.1%, while chronic activity or recurrences were observed in 38.9% (p = 0.003). CONCLUSIONS: The course of inflammatory bowel disease does not adversely affect pregnancy or the immediate postpartum period, nor does it increase the presence of low birthweight neonates or the number of cesarean deliveries performed.