Hematemesis With Gastric Laceration After Tattooing a Polyp With Purified Carbon: A Review of the Literature.

Endoscopic tattooing is a simple and effective technique for marking small lesions, so they can be localized during surgery or in later endoscopies. Various agents can be used such as India ink or a solution of purified carbon particles. The number of complications from tattooing is relatively small, but not rare. The majority of the literature on the subject refers to complications in the colon. We present a case of gastric bleeding secondary to a laceration following tattooing with purified carbon, and a literature review.

Hepatitis E seroprevalence in inflammatory bowel disease / Seroprevalencia de la hepatitis E en la enfermedad inflamatoria intestinal

BACKGROUND AND AIMS: Several cases of chronic infection by hepatitis E virus (HEV) in immunocompromised patients have been described recently. Patients with inflammatory bowel disease (IBD) are frequently immunocompromised because of the disease itself or due to therapy. Our aims were to determine HEV seroprevalence in patients with IBD and to detect possible chronic forms. Methods: We prospectively selected a random sample of 87 patients from our local IBD clinic database at the Gastroenterology Service, Hospital Ramón y Cajal, in Madrid, Spain. Patients completed an oral epidemiologic interview. Anti-HEV IgG and IgM antibodies and HEV-RNA were determined. Medical records were reviewed, focusing on drug exposure. Results: We included 87 patients, with a mean age of 44.7 years (SD 16) and a mean of 10.4 years (SD 8.4) with IBD. Fifty-seven percent were diagnosed with Crohn's disease, 41.4% with ulcerative colitis and 1.1% with unclassified IBD. A total of 41.4% had received systemic glucocorticoids for more than 3 months, 32.2% had been treated with thiopurines, 16.1% with biological drugs, and 3.4% with methotrexate. Anti HEV-IgM was determined in 75 patients and IgG in 80, and were positive in 2.7% and 1.3%, respectively. HEV-RNA was analyzed in a random subset of 46 patients, and all determinations were negative. Therefore, no case of chronic HEV infection was detected. Conclusions: We found a low HEV seroprevalence of just 1.14% in patients with IBD, similar to that in the general population. This could be due to the lower degree of immunosuppression in this group, or to different dietary habits

INTRODUCCIÓN Y OBJETIVOS: Recientemente se han descrito varios casos de infección crónica por el virus de la hepatitis E (VHE) en pacientes inmunodeprimidos. Los pacientes con enfermedad inflamatoria intestinal (EII) suelen estar inmunodeprimidos debido a la enfermedad en sí o debido a los tratamientos recibidos. Nuestro objetivo fue determinar la seroprevalencia de VHE en pacientes con EII y detectar posibles formas crónicas. MÉTODOS: Analizamos de forma retrospectiva una muestra aleatorea de 87 pacientes de nuestra base de datos de la consulta de EII en el Servicio de Gastroenterología del Hospital Ramón y Cajal, en Madrid, España. Los pacientes respondieron una encuesta epidemiológica oral y se determinaron anticuerpos IgG e IgM frente al VHE, así como RNA de VHE. Se revisaron las historias médicas, haciendo especial hincapié en los tratamientos recibidos. RESULTADOS: Incluimos 87 pacientes con una edad media de 44,7 años (D.E.16) y una media de 10,4 (D.E. 8,4) años de enfermedad. El 57% tenían una enfermedad de Crohn, 41,4% colitis ulcerosa y 1,1% colitis indeterminada. El 41,4% de ellos habían recibido corticoides sistémicos durante más de 3 meses, el 32,3% habían sido tratados con tiopurinas, el 16,1% con fármacos biológicos y el 3,4% con metotrexato. Se determinó la IgM frente a VHE en 75 pacientes y la IgG en 80, resultando positivos en 2,7% y 1,3% respectivamente. El RNA de VHE se analizó en un subgrupo aleatorio de 46 pacientes, y todas las determinaciones fueron negativas, así que no se detectó ningún caso de infección crónica por VHE. CONCLUSIONES: Encontramos una baja seroprevalencia de tan sólo 1,14% en los pacientes con EII, dato similar al de la población general. Esto podría explicarse por un menor grado de inmunosupresión en este grupo, o a diferentes hábitos dietéticos

Colonic Metastases From Lung Carcinoma: A Case Report and Review of the Literature.

Lung cancer is the most frequent cause of cancer death in the world. Although about 50% of lung cancers have distant metastases at the time of diagnosis, gastrointestinal metastasis has rarely been described. The most common metastatic site is the small bowel, whereas, colonic metastases are very rare. This report presents a clinical case of a 68-year-old male with a previous diagnosis of non-microcytic lung carcinoma (T4, N2, M1), stage IV, who presented rectorrhagia at the emergency. Colonoscopy showed many ulcerated tumors along the colon and histology proved that these lesions were metastases of primitive lung carcinoma. Gut metastasis from the lung is uncommon but we have to be aware of it in patients who present gastrointestinal symptoms.

Hepatitis crónica E / Chronic hepatitis E

El virus de la hepatitis E es un virus ARN del que hay descritos 4 genotipos. Los genotipos 1 y 2 sólo afectan a humanos produciendo cuadros de hepatitis aguda epidémica en regiones endémicas (Asia y África), mientras que los genotipos 3 y 4 son considerados una zoonosis, produciendo cuadros de hepatitis aguda episódica en regiones no endémicas (América y Europa). Sin embargo, en los últimos 3 años han aparecido casos de hepatitis crónica E principalmente en individuos inmunodeprimidos. Por ello realizamos una revisión de los datos hasta ahora conocidos sobre la hepatitis crónica E en cuanto a evolución y tratamiento (AU)

The hepatitis E virus is an RNA virus with 4 genotypes. Genotypes 1 and 2 only affect humans and produce epidemic acute hepatitis in endemic regions (Asia and Africa). Genotypes 3 and 4 are considered a zoonosis and produce episodic acute hepatitis in non-endemic areas (America and Europe). However, in the last 3years there have been cases of chronic HEV hepatitis, mainly in immunosuppressed patients. Here we review the known data of chronic hepatitis E in terms of evolution and treatment (AU)

[Chronic hepatitis E]. / Hepatitis crónica E.

The hepatitis E virus is an RNA virus with 4 genotypes. Genotypes 1 and 2 only affect humans and produce epidemic acute hepatitis in endemic regions (Asia and Africa). Genotypes 3 and 4 are considered a zoonosis and produce episodic acute hepatitis in non-endemic areas (America and Europe). However, in the last 3 years there have been cases of chronic HEV hepatitis, mainly in immunosuppressed patients. Here we review the known data of chronic hepatitis E in terms of evolution and treatment.

Colangiopatía asociada a la hipertensión portal / Cholangiopathy associated with portal hypertension

La colangiopatía portal es el conjunto de alteraciones que pueden aparecer en la vesícula y en la vía biliar en relación con la existencia de una trombosis crónica de la vena porta y el desarrollo de circulación colateral. La obstrucción crónica de la vena porta es una causa frecuente de hemorragia digestiva por varices esofágicas, pero su posible repercusión sobre la vía biliar es menos conocida. Presentamos el caso clínico de un varón con un cuadro de ictericia secundaria a colangiopatía portal, analizando posteriormente la patogenia de esta entidad, los métodos diagnósticos y las diferentes posibilidades terapéuticas disponibles (AU)

Portal cholangiopathy encompasses a group of abnormalities of the biliary system and gallbladder that occur secondary to chronic portal vein thrombosis and collateral venous circulation. Chronic obstruction of the portal vein is a frequent cause of gastrointestinal variceal bleeding, but data on biliary tract abnormalities are limited. We report the case of a male patient with obstructive jaundice secondary to portal cholangiopathy. We describe the pathogenesis of this entity, and the various diagnostic and therapeutic options available

Hepatitis crónica E en paciente inmunocompetente / Chronic hepatitis E in an immunocompetent patient

El virus de la hepatitis E (VHE) es un virus de la familia Hepeviridae, del que hay descritos 4 genotipos diferentes. Los genotipos 1 y 2 suelen causar hepatitis agudas que cursan como brotes epidémicos en las regiones endémicas de Asia y África. Los genotipos 3 y 4 causan casos de hepatitis aguda esporádicos en Europa y Norteamérica, donde se empieza a considerar una zoonosis. Habitualmente, el cuadro clínico se resuelve de manera espontánea, pero en los últimos años se están detectando casos que evolucionan a hepatopatía crónica principalmente en pacientes inmunodeprimidos (trasplante de órgano sólido, linfomas, virus de la inmunodeficiencia humana [VIH], inmunodeficiencias primarias, pacientes en tratamiento con corticoides e inmunosupresores, etc.). Presentamos a continuación el caso de un varón sano inmunocompetente que presentó un cuadro de hepatitis aguda por VHE, que en el plazo de año y medio evolucionó a hepatopatía crónica, con fibrosis grado III/IV en la biopsia hepática (AU)

Hepatitis E virus (HEV) is a Herpesvirus, with four different genotypes. Genotypes 1 and 2 often cause acute hepatitis, which presents as outbreaks in endemic regions of Asia and Africa. Genotypes 3 and 4 cause sporadic cases of acute hepatitis in Europe and North America, where it is considered a zoonosis. Symptoms usually resolve spontaneously, but in recent years cases have been detected that progress to chronic liver disease mainly in immunocompromised patients (patients with solid organ transplants, lymphoma, human immunodeficiency virus, primary immunodeficiencies, and those under treatment with corticosteroids and immunosuppressive agents..). We report the case of a healthy, immunocompetent man who developed an episode of acute HEV hepatitis, which progressed to chronic liver disease with fibrosis grade III/IV in the liver biopsy within a year and half (AU)

[Chronic hepatitis E in an immunocompetent patient]. / Hepatitis crónica E en paciente inmunocompetente.

Hepatitis E virus (HEV) is a Herpesvirus, with four different genotypes. Genotypes 1 and 2 often cause acute hepatitis, which presents as outbreaks in endemic regions of Asia and Africa. Genotypes 3 and 4 cause sporadic cases of acute hepatitis in Europe and North America, where it is considered a zoonosis. Symptoms usually resolve spontaneously, but in recent years cases have been detected that progress to chronic liver disease mainly in immunocompromised patients (patients with solid organ transplants, lymphoma, human immunodeficiency virus, primary immunodeficiencies, and those under treatment with corticosteroids and immunosuppressive agents..). We report the case of a healthy, immunocompetent man who developed an episode of acute HEV hepatitis, which progressed to chronic liver disease with fibrosis grade III/IV in the liver biopsy within a year and half.

[Environmental scanning electron microscopy for biofilm detection in tonsils]. / Microscopia electrónica de barrido ambiental para la detección de biopelículas en las amígdalas.

INTRODUCTION AND OBJECTIVE: To describe an environmental scanning electron microscopic method for the study of biofilms in clinical samples. A comparison with standard scanning electron microscopy is performed. PATIENTS AND METHOD: Nine patients with a past history of recurrent tonsillitis underwent tonsillectomy. Samples from each patient were obtained for both conventional and environmental scanning electron microscopy. The tonsils removed from 2 patients with sleep apnoea syndrome were used as controls. RESULTS: Eight of nine tonsils had biofilms on their surface. Scanning electron microscopy showed accumulations of bacteria covered by fibrillar structures resulting from the sample dehydration process. Environmental scanning electron microscopy provided a view of bacteria embedded in a homogeneous, amorphous substance that was preserved during the examination. CONCLUSIONS: Environmental scanning electron microscopy permits the imaging of wet systems at different degrees of dehydration. It therefore allows researchers to observe biofilms in their natural hydrated state.

Microscopia electrónica de barrido ambiental para la detección de biopelículas en las amígdalas / Environmental scanning electron microscopy for biofilm detection in tonsils

Introducción y objetivo: Describir un método ambiental con microscopio electrónico de barrido para el estudio de biopelículas en muestras clínicas. Se realiza una comparación con la microscopia electrónica de barrido convencional. Pacientes y método: Se intervino de amigdalectomía a 9 pacientes con antecedentes de amigdalitis de repetición. Se obtuvieron muestras de cada uno para microscopia electrónica de barrido tanto convencional como ambiental. Como controles se empleó las amígdalas extirpadas de 2 pacientes intervenidos por síndrome de apnea del sueño. Resultados: De las 9 amígdalas, 8 mostraron biopelículas en su superficie. La microscopia electrónica de barrido convencional mostró acumulaciones de bacterias cubiertas de estructuras fibrilares, originadas en el procedimiento de deshidratación de las muestras. La técnica ambiental proporcionó una imagen de las bacterias sumergidas en una sustancia homogénea y amorfa, que se pudo conservar durante el examen microscópico. Conclusiones: La microscopia electrónica de barrido en su modalidad ambiental permite la observación de muestras húmedas en diferentes grados de deshidratación. Por lo tanto, permite al investigador la observación de las biopelículas en su estado natural de hidratación

Introduction and objective: To describe an environmental scanning electron microscopic method for the study of biofilms in clinical samples. A comparison with standard scanning electron microscopy is performed. Patients and method: Nine patients with a past history of recurrent tonsillitis underwent tonsillectomy. Samples from each patient were obtained for both conventional and environmental scanning electron microscopy. The tonsils removed from 2 patients with sleep apnoea syndrome were used as controls. Results: Eight of nine tonsils had biofilms on their surface. Scanning electron microscopy showed accumulations of bacteria covered by fibrillar structures resulting from the sample dehydration process. Environmental scanning electron microscopy provided a view of bacteria embedded in a homogeneous, amorphous substance that was preserved during the examination. Conclusions: Environmental scanning electron microscopy permits the imaging of wet systems at different degrees of dehydration. It therefore allows researchers to observe biofilms in their natural hydrated state