Tratamiento de mantenimiento en las vasculitis asociadas a anticuerpos contra citoplasma de neutrófilos (ANCA) / Maintainance treatment of anti-neutrophil cytoplasm associated antibodies (ANCA)

Las vasculitis asociadas a ANCA son enfermedades raras y complejas con compromiso sistémico. El desarrollo de grupos colaborativos en Europa y los Estados Unidos de América ha facilitado la realización de estudios clínicos aleatorizados para garantizar la seguridad en el tratamiento de mantenimiento de estas enfermedades. Aunque la ciclofosfamida continúa vigente para la fase de inducción, sus efectos adversos a largo plazo han propiciado el estudio de otras drogas inmunosupresoras en la fase demantenimiento. Aquí revisamos estos estudios con especial atención a los que se refieren a la combinación de medicamentos inmunosupresores y a la duración del tratamiento (AU)

ANCA-associated vasculitides are rare and complex systemic diseases. Collaborative studies in both Europe and the United States of America have been particularly important in the development of randomized clinical trials that have studied the safety of maintenance therapy for these diseases. Although cyclophosphamide continues to be the main drug utilized during induction therapy, its long-term side effects have given rise to the study of other immunosuppressive drugs for the maintenance phase. We herein review these studies with particular attention to combination therapy and the duration of treatment (AU)

[Maintainance treatment of anti-neutrophil cytoplasm associated antibodies (ANCA)]. / Tratamiento de mantenimiento en las vasculitis asociadas a anticuerpos contra citoplasma de neutrófilos (ANCA).

ANCA-associated vasculitides are rare and complex systemic diseases. Collaborative studies in both Europe and the United States of America have been particularly important in the development of randomized clinical trials that have studied the safety of maintenance therapy for these diseases. Although cyclophosphamide continues to be the main drug utilized during induction therapy, its long-term side effects have given rise to the study of other immunosuppressive drugs for the maintenance phase. We herein review these studies with particular attention to combination therapy and the duration of treatment.

[Usefulness of endoscopic cholangiography and sphincterotomy in patients with biliary lithiasis]. / Utilidad de la colangiografía y esfinterotomía endoscópica como adyuvante de la colecistectomía laparoscópica en enfermos con litiasis biliar.

BACKGROUND: With the popularity of laparoscopic cholecystectomy (LC), the algorithm of endoscopic retrograde cholangiography (ERC) with biliary sphincterotomy followed by laparoscopic cholecystectomy has proven to be an effective treatment in choledocholithiasis in symptomatic gallstone disease. However, its use as a standard approach remains controversial. OBJECTIVES: 1. To determine the diagnostic and therapeutic usefulness of ERC with biliary sphincterotomy in patients with LC. 2. To evaluate clinical, biochemical and ultrasonographic factors which can be used as predictors of choledocholithiasis in symptomatic gallstone disease. MATERIAL AND METHODS: It is a retrospective study which included patients with: 1. symptomatic cholelithiasis with presurgical clinical, biochemical and ultrasonographic suspicion of choledocholithiasis; 2. patients with acute biliary pancreatitis subjected to ERC before LC; 3. patients subjected to ERC under suspicion of residual choledocholitiasis or complicated LC. The clinical laboratorial, ultrasonographic, ERC and surgical variables were analyzed. RESULTS: From January 1997 to December 2001, 805 LC were performed, 91 patients were included in the final analysis. Jaundice was found at arrival in 54 patients (59%), 15 (16%) had cholangitis and 32 (35%) had pancreatitis. The ultrasonographic features found common bile duct dilation in 34 patients (38%) and choledocholithiasis in seven (7.8%). Presurgical ERC was performed in 73 patients (80.2%) and post surgically in 18 (19.8%), no intraoperative cholangiogram was performed during surgery. In the presurgical ERC, choledocholithiasis was found in 37 patients (51%) and post surgically in 8 (44%). Five biliary leaks were diagnosed during post surgical ERC, or which the cystic duct fistula was the most common. The duration of hospital stay ranged between 1 to 53 days (medium 4.8 days) after LC. The multivariate analysis showed that the best predictors of choledocholithiasis were cholangitis (OR 15.9, IC 95% 1.8-135.1 and p = 9.01) and elevated alanine aminotransferase (OR 4.7, IC 95% 1.5-15.3 and p = 0.009). CONCLUSIONS: The ERC with biliary sphincterotomy and stones extraction is a useful and safe treatment of choledocholithiasis associated with symptomatic gallstone disease before or after LC. The best predictors of choledocholithiasis in ERC were cholangitis and elevation of alanine aminotransferase at arrival. It is convenient to perform ERC with biliary sphincterotomy before LC in patients with evidence of choledocholithiasis.