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.

Tratamiento de hepatitis crónica C en un paciente con fibrosis quística en situación de pretrasplante pulmonar / Chronic hepatitis C treatment in a cystic fibrosis patient in the pulmonary pre-transplant stage

El tratamiento estándar de la hepatitis crónica C, interferón pegilado (INF-peg) y ribavirina (RBV), puede ser inadecuado o incluso estar contraindicado en algunos pacientes debido a sus limitaciones en cuanto a eficacia y efectos adversos. En pacientes con fibrosis quística infectados por el virus de la hepatitis C (VHC) el tratamiento antiviral podría aumentar las infecciones respiratorias con el consiguiente empeoramiento de la función pulmonar. Por contra, la infección por VHC podría desestimar a estos pacientes para un necesario trasplante pulmonar. Presentamos el caso de un varón con fibrosis quística diagnosticado de infección VHC durante su evaluación previa al trasplante pulmonar. El paciente fue tratado con INF-peg y RBV. A pesar del empeoramiento en la función pulmonar y numerosas infecciones respiratorias intercurrentes, logró completar el tratamiento y obtener respuesta viral sostenida, encontrándose actualmente en lista de espera(AU)

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 fibrosisyoung 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(AU)

[The retained antrum, its endoscopic diagnosis and clinical significance]. / Antro retenido, diagnóstico endoscópico y significación clínica.

A 65-year-old man was admitted to our hospital with gastrointestinal bleeding. Seventeen years previously, he had a Billroth II procedure for a bleeding duodenal ulcer. A gastroscopy performed on admission showed a stomal ulcer with signs of recent haemorrhage. In the proximal end of the afferent loop, we saw retained gastric mucosa. Histological evaluation confirmed the existence of antrum gastric mucosa. Other diagnostic test for retained gastric antrum were normal. The different approaches in the diagnosis of retained gastric antrum, the importance of our findings and the clinic implications are discussed. We conclude that endoscopic management may be the first diagnostic method in the assessment of retained gastric antrum, and it's possible to find gastric mucosa in the proximal end of the afferent loop (antrum retained), without clinic manifestations.

[Colonic tuberculosis. Endoscopic diagnosis]. / Tuberculosis colónica. Diagnóstico endoscópico.

We present a patient with acute and severe abdominal pain, fever and mild tenderness elicited on deep palpation in the right lower quadrant. X-ray films of the chest and abdomen were normal. The ultrasonographic study, barium enema examination and colonoscopic study avoided a diagnostic laparotomy. A purified protein skin test (PPD) and the cultures on Lowestein medium were negative. The final diagnosis was ulcero-hipertrophic tuberculosis of the ascending colon, and was confirmed by the finding of positive acid fast facilli and granulomas with Langerhans cells in the colonic biopsy material. The colonic lesions disapplared at the end of the antituberculous treatment.