Intestinal pneumatosis: a rare and misdiagnosed entity

Intestinal pneumatosis is a rare entity, usually found incidentally, and in most cases asymptomatic. We present the case of an 84-year-old man who underwent colonoscopy for adenomatous polyps surveillance and presented typical endoscopic images of intestinal pneumatosis. Some of the most important aspects of the disease are highlighted and even if the endoscopic image is quite impressive, conservative management is the treatment of choice. (AU)

Intestinal pneumatosis: a rare and misdiagnosed entity.

Intestinal pneumatosis is a rare entity, usually found incidentally, and in most cases asymptomatic. We present the case of an 84-year-old man who underwent colonoscopy for adenomatous polyps surveillance and presented typical endoscopic images of intestinal pneumatosis. Some of the most important aspects of the disease are highlighted and even if the endoscopic image is quite impressive, conservative management is the treatment of choice.

Schwann cell hamartoma as an incidental finding in a colonoscopy / Hamartoma de células de Schwann como hallazgo incidental en una colonoscopia

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Adenocarcinoma de colon sobre adenoma serrado tradicional / No disponible

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Colonic adenocarcinoma arising from traditional serrated adenoma.

We report the case of a 59-year-old male who underwent a screening colonoscopy after a positive fecal occult blood test. Several polyps were removed during the colonoscopy: two pedunculated tubular adenomas of 7 mm, a tubular adenoma with high-grade dysplasia of 25 mm and a pedunculated polyp of 20 mm in the descending colon. Histopathological analysis of the pedunculated polyp revealed a well-differentiated adenocarcinoma (G1) with a mucinous component that invaded the submucosa (T1). The resection margins were less than 1 mm, lymphovascular invasion was present and high budding (10 or more) with an invasive component of 8 mm.

Transarterial chemoembolisation in intermediate-stage hepatocellular carcinoma. Survey on clinical practice in hospitals in the Madrid Region.

BACKGROUND: Transarterial chemoembolisation (TACE), having demonstrated survival benefits, is the treatmentof choice in intermediate-stage hepatocellular carcinoma, although there is great heterogeneity in its clinical application. MATERIAL AND METHODS: A survey was sent to the Madrid Regional hospitals to assess applicability, indications and treatment protocols. The assessment was made overall and according to the type of hospital (groups A vs. B and C). RESULTS: Seventeen out of 22 hospitals responded (8/8 group A, 9/ 14 group B-C). All do/indicate transarterial chemoembolisation, 13/17 at their own facilities. Eight of the 17 hospitals have multidisciplinary groups (5/8 A, 3/9 B-C). Nine hospitals perform > 20 procedures/year (7 group A), and 6 from group B-C request/perform < 10/year. It is performed on an "on-demand" basis in 12/17. In 5 hospitals, all the procedures use drug-eluting beads loaded with doxorubicin. The average number of procedures per patient is 2. The mean time from diagnosis of hepatocellular carcinoma to transarterial chemoembolisation is ≤ 2 months in 16 hospitals. In 11/17 hospitals, response is assessed by computed tomography. Radiological response is measured without specific criteria in 12/17 and the other five hospitals (4 group A) assessed using standardised criteria. CONCLUSION: Uniformity among the Madrid Regional hospitals was found in the indication and treatment regimen. The use of DEB-TACE has become the preferred form of TACE in clinical practice. The differentiating factors for the more specialised hospitals are a larger volume of procedures, decision-making by multidisciplinary committees and assessment of radiological response more likely to be standardised.

Diagnostic incidence of the presence of positive HBsAg: epidemiologic, clinical, and virological characteristics.

OBJECTIVE: To analyze the epidemiological, clinical, and virological characteristics of patients newly diagnosed with active hepatitis B virus (HBV) infection based on the presence of positive hepatitis B surface antigen (HBsAg) in the digestive diseases department of a district hospital. PATIENTS AND METHODS: We performed a 3-year prospective study in patients newly diagnosed with HBV infection. We analyzed epidemiological, clinical, and virological characteristics, complete HBV markers, quantification of HBV DNA, and infection by hepatitis delta virus. We performed genotyping and resistance testing in patients with a high viral load. Results were obtained for patientswho required liver biopsy. RESULTS: We diagnosed 213 patients (18.8/10,000 inhabitants/year). Men accounted for 61%, and 59% were aged 20 to 40 years. Immigrants accounted for 53% of the population: 46% were from Rumania and 37% from Sub-Saharan African countries. At diagnosis, 2.3% had acute hepatitis (all with jaundice) and 3.3% had cirrhosis with portal hypertension. With the exception of cases of acute hepatitis, positive HBeAg was observed in 9%. Serum transaminase levels were normal in 62.2% of patients, HBV DNA was > 2,000 IU/mL in 33.8%, and delta virus was present in 3.3%. Genotyping and resistance testing were performed in 70 patients: the most common genotype was D, followed by A. Resistance was detected at baseline in only 2 cases: to adefovir in one case and to entecavir in another. Among the 36 biopsies performed, 32.4% showed inflammatory activity > or = 2, and 23.5% had fibrosis > or = 2 according to the METAVIR scoring system. According to clinical practice, specific treatment for HBV infection was necessary (any reason) in 17.4% of those diagnosed (3 patients per 100,000 inhabitants/year). CONCLUSIONS: Despite prevention and vaccination, HBV infection is a health problem that most commonly affects the immigrant population and men. Serum transaminase levels are normal in 62.2% of patients. The most frequent genotype is D, followed by A, and baseline resistance is scarce.

Incidencia diagnóstica de AgHBs positivo. Características epidemiológicas, clínicas y virológicas / Diagnostic incidence of the presence of positive HBsAg: epidemiologic, clinical, and virological characteristics

Objetivo: analizar las características epidemiológicas, clínicas y virológicas de los pacientes que han sido nuevos diagnósticos de infección activa por VHB, por la presencia de AgHBs positivo, en el servicio de Aparato Digestivo de un hospital de área. Pacientes y métodos: se trata de un estudio prospectivo realizado durante 3 años, en pacientes de nuevo diagnóstico de infección por VHB, donde se han analizado las características epidemiológicas, clínicas, marcadores completos de VHB, cuantificación de DNAVHB e infección por virus Delta. En los pacientes con alta carga viral se han estudiado genotipos y resistencias. En los pacientes con indicación de biopsias hepáticas sus resultados. Resultados: se han diagnosticado 213 pacientes, 18,8/10.000 habitantes y año. El 61% son varones, el 59% con edad comprendida entre 20 y 40 años. El 53% corresponde a población inmigrante, 46% procedentes de Rumanía y 37% de países subsaharianos. En el momento del diagnóstico, el 2,3% tenían una hepatitis aguda, todos los casos con ictericia, y el 3,3% una cirrosis hepática con hipertensión portal. El AgHBe positivo, descontando los cuadros de hepatitis aguda, estaba presente en el 9%. Las transaminasas eran normales en el 62,2%, el DNA-VHB en el 33,8% es superior a 2.000 UI/ml y la asociación del virus Delta está presente en el 3,3%. En 70 pacientes se analiza el genotipo y resistencias, siendo el más frecuente el D, seguido del A; solo se han detectado dos resistencias basales, una a adefovir y otro a entecavir. En las 36 biopsias hepáticas realizadas, el 32,4% tenían una actividad inflamatoria mayor o igual a 2, y el 23,5% una fibrosis igual o superior a 2, valorada según la clasificación de METAVIR. El 17,4% de los diagnosticados ha precisado tratamiento específico para el VHB según práctica clínica por algún motivo, lo que ha supuesto iniciar tratamiento a unos 3 pacientes por cada 100.000 habitantes y año. Conclusión: a pesar de la prevención y vacunación, la infección por VHB es un problema de salud, afecta de forma más frecuente a población inmigrante, varones y cursa en el 62,2% con transaminasas normales. El genotipo más frecuente es el D seguido del A y las resistencias basales son escasas(AU)

Objective: to analyze the epidemiological, clinical, and virological characteristics of patients newly diagnosed with active hepatitis B virus (HBV) infection based on the presence of positive hepati - tis B surface antigen (HBsAg) in the digestive diseases department of a district hospital. Patients and methods: we performed a 3-year prospective study in patients newly diagnosed with HBV infection. We analyzed epidemiological, clinical, and virological characteristics, complete HBV markers, quantification of HBV DNA, and infection by hepatitis delta virus. We performed genotyping and resistance testing in patients with a high viral load. Results were obtained for patients who required liver biopsy. Results: we diagnosed 213 patients (18.8/10,000 inhabitants/ year). Men accounted for 61%, and 59% were aged 20 to 40 years. Immigrants accounted for 53% of the population: 46% were from Rumania and 37% from Sub-Saharan African countries. At diagnosis, 2.3% had acute hepatitis (all with jaundice) and 3.3% had cirrhosis with portal hypertension. With the exception of cases of acute hepatitis, positive HBeAg was observed in 9%. Serum transaminase levels were normal in 62.2% of patients, HBV DNA was > 2,000 IU/mL in 33.8%, and delta virus was present in 3.3%. Genotyping and resistance testing were performed in 70 patients: the most common genotype was D, followed by A. Resistance was detected at baseline in only 2 cases: to adefovir in one case and to entecavir in another. Among the 36 biopsies performed, 32.4% showed inflammatory activity >= 2, and 23.5% had fibrosis >= 2 according to the METAVIR scoring system. According to clinical practice, specific treatment for HBV infection was necessary (any reason) in 17.4% of those diagnosed (3 patients per 100,000 inhabitants/year). Conclusions: despite prevention and vaccination, HBV infection is a health problem that most commonly affects the immigrant population and men. Serum transaminase levels are normal in 62.2% of patients. The most frequent genotype is D, followed by A, and baseline resistance is scarce(AU)