Basiliximab en el tratamiento del rechazo celular agudo resistentea los corticoides postrasplante hepático / Basiliximab in the treatment of acute steroid-resistant rejection after liver transplantation

Se presenta el caso de un receptor de un trasplante hepático con la indicación de cirrosis hepática alcohólica y carcinoma hepatocelular en estadio inicial que presentó un rechazo celular agudo resistente a los corticoides demostrado por biopsia a los 3 meses del trasplante. Tras la ausencia de mejora analítica o histológica con 6-metil-prednisolona intravenosa y la conversión del régimen inmunosupresor a tacrolimus y micofenolato mofetil, se administraron 2 dosis de basiliximab intravenoso separadas por 4 días, asistiendo a la normalización clínica, analítica e histológica. No se detectaron episodios adversos relacionados con el tratamiento con basiliximab. El basiliximab puede representar una opción terapéutica en el rechazo celular agudo resistente a los corticoides tras el trasplante hepático, sin que se hayan observado infecciones, neoplasias ni otros efectos adversos potencialmente relacionados en este caso (AU)

We present the case of a liver transplant recipient with alcoholic liver cirrhosis and early-stage hepatocellular carcinoma who developed biopsy-proven acute steroid-resistant rejection 3 months after liver transplantation. After the failure of immunosuppressive therapy with intravenous boluses of 6-methyl-prednisolone and switching of the immunosuppressive regimen to tacrolimus plus mycophenolate mofetil, two doses of intravenous basiliximab were administered four days apart. Clinical, analytical, and biopsy-proven histological response was complete. No basiliximab-related adverse events were detected. Basiliximab may represent an alternative in liver transplantation immune suppression to treat acute steroid-resistant rejection, without increasing the incidence of infections, neoplasms, or other adverse events, as shown by this case (AU)

[Basiliximab in the treatment of acute steroid-resistant rejection after liver transplantation]. / Basiliximab en el tratamiento del rechazo celular agudo resistente a los corticoides postrasplante hepático.

We present the case of a liver transplant recipient with alcoholic liver cirrhosis and early-stage hepatocellular carcinoma who developed biopsy-proven acute steroid-resistant rejection 3 months after liver transplantation. After the failure of immunosuppressive therapy with intravenous boluses of 6-methyl-prednisolone and switching of the immunosuppressive regimen to tacrolimus plus mycophenolate mofetil, two doses of intravenous basiliximab were administered four days apart. Clinical, analytical, and biopsy-proven histological response was complete. No basiliximab-related adverse events were detected. Basiliximab may represent an alternative in liver transplantation immunosuppression to treat acute steroid-resistant rejection, without increasing the incidence of infections, neoplasms, or other adverse events, as shown by this case.

Efficacy of intravenous iron in treating iron deficiency anaemia in patients with inflammatory bowel disease. Are there predictors of response?

INTRODUCTION: In inflammatory bowel disease (IBD) iron deficiency anaemia (IDA) is a very common disorder. Until recently,oral iron has been the mainstay therapy, nevertheless it has been associated with intolerance and noncompliance. Therefore, the goal of our study was to evaluate the efficacy of intravenous iron in IDA in IBD patients and the secondary aim was to investigate whether other potencial factors could influence in the response to the treatment. DESIGN: An open-label, prospective, consecutive, single centre study. MATERIAL AND METHODS: We performed our study in patients with ulcerative colitis (UC) or Crohn´s disease (CD) with severe anaemia or intolerance with oral iron. All of them received intravenous sacarose iron and did biochemistry profile with hemoglobin (Hb). Moreover, the correlation with other variables was studied: age,sex, smoking habit, IBD type, previous surgery and type of surgery and other treatments. Response was defined as Hb increase of ≥ 2 g/dL or normalization of the levels. RESULTS: Fifty-four patients were included into the study, 34(63%) with UC y 20 (37%) with CD, 18 (33.3%) men and 36 wo-men (66.6%) and the average was 48 +/- 14 years. The total proportion of responders was 52% (SD +/- 05); 43% of the patients reached Hb ≥ 2 g/dl and y 9% of them normalized Hb. Only the utilization of 5-ASA was associated with low response to iron treatment (p < 0.05). CONCLUSIONS: Our study suggests that response to intravenous iron is achievable in the majority of patients with IBD and severe IDA or intolerance treatment with oral iron. Moreover, the patients with consumption of 5-ASA could had less response to the treatment.

Eficacia del hierro intravenoso en el tratamiento de la anemia ferropénica en pacientes con enfermedad inflamatoria intestinal. ¿Existen factores predictivos de respuesta? / Efficacy of intravenous iron in treating iron deficiency anaemia in patients with inflammatory bowel disease. Are there predictors of response?

Introducción: la anemia por déficit de hierro es un problema frecuente en la enfermedad inflamatoria intestinal (EII). Un número no despreciable de pacientes no responde o presenta intolerancia al hierro oral. El objetivo de nuestro estudio es evaluar la efica - cia del hierro sacarosa intravenoso (Venofer®) en los pacientes con EII así como los potenciales factores que pueden influir en la respuesta al mismo. Diseño: estudio abierto, unicéntrico y con una inclusión consecutiva de casos. Material y métodos: se incluyeron pacientes con colitis ulcerosa (CU) y enfermedad de Crohn (EC) con anemia grave o anemia moderada con intolerancia al hierro oral. A todos los pacientes se les administró hierro sacarosa intravenoso y se les realizó una analítica que incluía hemoglobina (Hb). Además fueron estratificados según edad, sexo, hábito tabáquico, localización, patrón de la enfermedad, cirugías previas, tipos de cirugías, otras manifestaciones extraintestinales y tratamientos concomitantes. Se consideró como respuesta al tratamiento un aumento de la Hb igual o mayor de 2 g/dl o la normalización de la misma. Resultados: se incluyeron 54 pacientes, 34 (63%) con CU y 20 (37%) con EC, 18 (33,3%) hombres y 36 mujeres (66,6%), con edad media de 48 ± 14 años. El porcentaje total de respondedores se situó en el 52% (DE ± 0,5); un 43% experimentó un incremento de la Hb >= 2 g/dl y un 9% normalizó las cifras de Hb. En cuanto a los demás factores analizados tan solo se observó una disminución de respuesta al tratamiento en los pacientes que recibieron5-ASA (p < 0,05). Conclusiones: el tratamiento con hierro sacarosa intravenoso podría ser eficaz en los pacientes con EII con anemia grave o intolerancia al hierro oral. La utilización de salicilatos podría influir en la respuesta al tratamiento(AU)

Introduction: in inflammatory bowel disease (IBD) iron deficiency anaemia (IDA) is a very common disorder. Until recently, oral iron has been the mainstay therapy, nevertheless it has been associated with intolerance and noncompliance. Therefore, the goal of our study was to evaluate the efficacy of intravenous iron in IDA in IBD patients and the secondary aim was to investigate whether other potencial factors could influence in the response to the treatment. Design: an open-label, prospective, consecutive, single centre study. Material and methods: we performed our study in patients with ulcerative colitis (UC) or Crohn’s disease (CD) with severe anaemia or intolerance with oral iron. All of them received intravenous sacarose iron and did biochemistry profile with hemoglobine (Hb). Moreover, the correlation with other variables was studied: age, sex, smoking habit, IBD type, previous surgery and type of surgery and other treatments. Response was defined as Hb increase of >= 2 g/dL or normalization of the levels. Results: fifty-four patients were included into the study, 34 (63%) with UC y 20 (37%) with CD, 18 (33.3%) men and 36 women (66.6%) and the average was 48 ± 14 years. The total proportion of responders was 52% (SD ± 05); 43% of the patients reached Hb >= 2 g/dl and y 9% of them normalized Hb. Only the utilization of 5-ASA was associated with low response to iron treatment (p < 0.05). Conclusions: our study suggests that response to intravenous iron is achievable in the majority of patients with IBD and severe IDA or intolerance treatment with oral iron. Moreover, the patients with consumption of 5-ASA could had less response to the treatment(AU)

Trombosis portal / Portal vein thrombosis

La trombosis del eje esplenoportal no asociada a cirrosis hepática o a enfermedad tumoral es la segunda causa de hipertensión portal en el mundo occidental. Hasta en un 60% de los casos es posible identificar un trastorno protrombótico sistémico subyacente como factor etiológico. Los factores locales son los causantes de un tercio de los casos, y no es infrecuente la coexistencia de varias entidades. Por eso, en estos pacientes es de vital importancia el diagnóstico etiológico. El inicio de una anticoagulación precoz en la fase aguda de la trombosis venosa portal (TVP) incidirá de manera significativa en la probabilidad de recanalización y, por tanto, en el pronóstico de estos pacientes. En la fase crónica de la TVP (o cavernomatosis portal), la sintomatología y la morbilidad vienen dadas por las complicaciones de la hipertensión portal desarrolladas. Hasta la fecha, la anticoagulación en estos casos se reserva a los pacientes en los que se haya demostrado un trastorno protrombótico subyacente (AU)

Thrombosis of the splenoportal axis not associated with liver cirrhosis or tumoral disease is the second cause of portal hypertension in the western world. In up to 60% of cases, an underlying systemic prothrombotic disorder can be identified as an etiological factor. One third of cases are caused by local factors and the coexistence of several entities is not unusual. Therefore, an etiologic diagnosis is essential in these patients. Early anticoagulation therapy in the acute phase of thrombosis of the splenoportal axis significantly affects the probability of recanalization and consequently the prognosis of these patients. In the chronic phase of splenoportal thrombosis (or portal cavernoma), the symptoms are caused by the complications of established portal hypertension. To date, anticoagulation therapy is limited to patients in whom an underlying prothrombotic disorder has been demonstrated (AU)

[Portal vein thrombosis]. / Trombosis portal.

Thrombosis of the splenoportal axis not associated with liver cirrhosis or tumoral disease is the second cause of portal hypertension in the western world. In up to 60% of cases, an underlying systemic prothrombotic disorder can be identified as an etiological factor. One third of cases are caused by local factors and the coexistence of several entities is not unusual. Therefore, an etiologic diagnosis is essential in these patients. Early anticoagulation therapy in the acute phase of thrombosis of the splenoportal axis significantly affects the probability of recanalization and consequently the prognosis of these patients. In the chronic phase of splenoportal thrombosis (or portal cavernoma), the symptoms are caused by the complications of established portal hypertension. To date, anticoagulation therapy is limited to patients in whom an underlying prothrombotic disorder has been demonstrated.

[Intraductal papillary mucinous tumor: diagnostic and therapeutic approach]. / Tumor papilar, mucinoso e intraductal: abordaje diagnóstico y terapéutico.

Primary cystic pancreatic neoplasms are rare tumors, with an approximate prevalence of 10% of cystic pancreatic lesions. Most of these lesions correspond to mucinous cystic neoplasm, serous cystoadenoma and intraductal papillary mucinous tumor (IPMT). IPMT is characterized by diffuse dilatation of the main pancreatic duct and/or side branches with inner defects related to mucin or tumor, or mucin extrusion from a patent ampulla. IPMT has a low potential for malignancy, with a low growth rate, a low rate of metastatic spread and postsurgical recurrence. Over the last few years, major advances have been made in the diagnostic and therapeutic management of this tumor.

Tumor papilar, mucinoso e intraductal: abordaje diagnóstico y terapéutico / Intraductal papillary mucinous tumor: diagnostic and therapeutic approach

Las neoplasias quísticas primarias del páncreas son unos tumores raros, con una prevalencia aproximada del 10% de las lesiones quísticas del páncreas. La gran mayoría de estas lesiones están constituidas por tres entidades: el cistoadenoma mucinoso, el cistoadenoma seroso y el tumor papilar mucinoso intraductal (TPMI). El TPMI se caracteriza por una dilatación difusa del conducto pancreático principal y/o sus colaterales, con defectos de repleción correspondientes a globos de mucina o tumor, y salida de mucina a través de una papila patulosa. Posee un bajo potencial maligno, una baja tasa de crecimiento, de extensión metastásica y de recurrencia posquirúrgica. En los últimos años se ha producido un importante avance en su manejo, tanto diagnóstico como terapéutico

Primary cystic pancreatic neoplasms are rare tumors, with an approximate prevalence of 10% of cystic pancreatic lesions. Most of these lesions correspond to mucinous cystic neoplasm, serous cystoadenoma and intraductal papillary mucinous tumor (IPMT). IPMT is characterized by diffuse dilatation of the main pancreatic duct and/or side branches with inner defects related to mucin or tumor, or mucin extrusion from a patent ampulla. IPMT has a low potential for malignancy, with a low growth rate, a low rate of metastatic spread and postsurgical recurrence. Over the last few years, major advances have been made in the diagnostic and therapeutic management of this tumor (AU)