Recurrent drug-induced liver injury with cetirizine and amoxicillin-clavulanate potassium

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Results of hepatitis C virus treatment in patients on hemodialysis: data from published meta-analyses in 2008.

Reports on the outcome of treatment for hepatitis C virus (HCV) infection in dialysis patients are limited by small patient series, nonrandomized study designs, and few case-control studies. We reviewed 2 meta-analyses (Meta-1 and Meta-2) published in 2008, which analyzed sustained viral responses (SVR), adverse effects, and reasons for discontinuing treatment. Meta-1 analyzed the results obtained in 645 patients and Meta-2 the results in 459 patients (19 studies were duplicated). The overall SVR was 40%; the SVR in genotype 1 was 33%, with pegylated interferon providing few additional benefits over conventional interferon. Adverse events were reported in <50% of cases compiled in the meta-analyses. A high percentage of anemia was documented, although the use of erythropoietin, intravenous iron administration, or transfusions was not generally reported. A typical flu-like syndrome occurred in 41% of patients, requiring withdrawal of antiviral treatment in 11%. Severe adverse events were divided into the following groups: hormonal (thyroid): bone pain; cytopenia; gastrointestinal; immunological (prior graft rejection); central nervous system; cardiovascular; and infectious problems. The authors of the meta-analyses pointed out bias in the selection of candidates for treatment, limitations related to the number and type of adverse effects and their clinical evaluation, and in the cases of discontinuation of treatment or loss to follow-up. Additional studies reporting individual patient data are needed because the paucity of controlled studies limits generalization of the results to the population of dialysis patients.

Estudio del estado bucodental del paciente trasplantado hepático

Desde que se realizó en España el primer trasplante hepático en el año 1984 los avances en la técnica quirúrgica y en los fármacos inmunosupresores empleados han producido un aumento en el número de pacientes trasplantados. El objetivo del presente estudio fue valorar el estado bucodental de los pacientes trasplantados hepáticos. Se realizó un estudio descriptivo transversal de una muestra de pacientes que habían sido sometidos a un trasplante hepático en el Hospital Príncipes de España de la Ciudad Sanitaria y Universitaria de Bellvitge (L`Hospitalet de Llobregat - Barcelona). Los datos recogidos fueron los de filiación, los de la historia médica general, los de la historia bucodental y los de la exploración intrabucal. En total fueron examinados 53 individuos, 28 hombres y 25 mujeres, con una edad media de 57,6 años. El tiempo medio del trasplante fue de 3 años y 9 meses. La causa más frecuente del trasplante hepático fue la cirrosis hepática por el virus de la hepatitis C (49,1%). Los inmunosupresores más utilizados fueron la ciclosporina y el tacrolimus. El índice CAOD de la muestra fue de 11,2. En cuanto a la patología periodontal, el 22% de los pacientes dentados presentaban agrandamiento gingival, la mitad de los dentados tenían recesiones gingivales y el 34% presentaban algún tipo de movilidad dentaria. A la exploración de la mucosa bucal, la patología más prevalente fue la lengua fisurada (39,6%), la lengua saburral (28,3%) y la xerostomía (18,9%). La patología bucodental de estos pacientes está relacionada con el uso de fármacos inmunosupresores y de otros factores tales como la falta de medidas preventivas. Los datos de este estudio demuestran que sería necesario instaurar tratamientos preventivos en este grupo de población.(AU)

[Transcultural adaptation of the Liver Disease Quality of Life instrument (LDQOL 1.0) for its use in the Spanish population]. / Adaptación transcultural del cuestionario específico de calidad de vida para hepatopatías crónicas (LDQOL 1.0) para su uso en la población española.

Instruments of health-related quality of life (HRQOL) help us to interpret the results of treatments and health interventions. In Spain there is no HRQOL instrument specifically designed for use in patients with liver disease or to measure the effect of interventions such as liver transplantation. The Liver Disease Quality of Life (LDQOL 1.0) questionnaire is an American instrument developed for use in these patients. The aim of this study was to produce an appropriate version of this questionnaire for use in Spain. Cultural adaptation was performed in 3 phases: a) modification for use in Spain of a Hispanic version of this questionnaire supplied by the original authors; b) back-translation to English of a new version of the questionnaire and comparison with the original version in English, and c) a pilot test in a small sample of patients. In the first phase consisting of revision of the Hispanic version, the changes were mainly linguistic due to cultural and idiomatic differences. The validated Spanish version of the SF-36 was directly incorporated and items that could be of interest to local investigators were added. Few changes were made in the second phase of the process: changes involved an item on the appearance of feces and another item on taking naps. In the final phase, various changes suggested by the patients were introduced. Before applying the new version of the LDQOL 1.0 in clinical studies in Spain, its psychometric properties (its reliability, validity and sensitivity to change) must be verified in a subsequent validation study.

Mortalidad en el trasplante hepático: causas y período de máxima incidencia / Mortality in liver transplantation. Causes and period of maximum incidence

Objetivos. Describir y cuantificar las causas de muerte de nuestros pacientes e identificar su incidencia en los diversos períodos postrasplante. Pacientes y métodos. Durante el período de estudio, se realizaron 441 trasplantes hepáticos en 381 pacientes. Definimos como causa predisponente de fallecimiento aquella que pone al paciente en situación de riesgo de muerte, y causa inmediata la que precipita el fallecimiento. Definimos 3 períodos: mortalidad postoperatoria, temprana y tardía. Resultados. La mortalidad fue de 112 pacientes (29 por ciento). Los pacientes que fallecieron en período de mortalidad postoperatoria, temprana y tardía fueron 32 (30 por ciento), 13 (12 por ciento) y 65 (58 por ciento), respectivamente. Los tumores de novo (15 por ciento) y la recidiva viral (14 por ciento) fueron las causas predisponentes globales más frecuentes. Las infecciones (24 por ciento) y las complicaciones médicas (12 por ciento) fueron las causas inmediatas principales. En el período postoperatorio y temprano las causas más frecuentes fueron las complicaciones médicas y el rechazo ductopénico (4 por ciento), respectivamente; en cambio, en el período de mortalidad tardía lo fueron los tumores de novo (13 por ciento) y la recurrencia de hepatopatía por virus de la hepatitis C (13 por ciento). Conclusiones. La diferenciación entre causa predisponente e inmediata define con precisión la frecuencia de cada una de ellas. Los tumores de novo y la recurrencia de hepatopatía por virus de la hepatitis C son las causas más frecuentes de muerte global y tardía (AU)

Oral premedication with midazolam in paediatric anaesthesia. Effects on sedation and gastric contents.

The aim of this study was to assess oral premedication with midazolam in paediatric anaesthesia. Sedation, quality of induction, recovery time, acceptance and effects on gastric contents were analysed. This prospective, double blind, at random and controlled study was performed in 107 children, aged between three and ten years. They were divided into: group 1 (control, n = 29), group 2 (placebo) receiving 5 ml of water in the preoperative stage (n = 40), and group 3 (midazolam) with 0.75 mg.kg-1 midazolam by mouth (n = 38). Two children refused to take medication. In children aged five years or more (n = 48) of groups 2 and 3, acceptance of premedication was evaluated. The midazolam group showed a better level of sedation as compared with the placebo (P < 0.05). The recovery time was similar for the two groups. There were no statistically significant differences in gastric pH or residual volume among the three groups. It is concluded that midazolam given by mouth is an efficient and safe drug for premedication in paediatric anaesthesia.

[Autoimmune hemolytic anemia, infrequent complication of ulcerative colitis]. / Anemia hemolítica autoinmune, complicación poco frecuente de la colitis ulcerosa.

Autoimmune hemolytic anemia is a rare complication of ulcerative colitis. A retrospective review of the cases of ulcerative colitis treated at our hospital between January 1984 and August 1993 showed that, among 210 patients, three presented autoimmune hemolytic anemia with a positive direct Coomb's test. They were two men and one woman suffering from a moderately active ulcerative colitis that affected the left colon. The hemolysis was diagnosed before the onset of colitis in two cases and after it in the other. In the only patient treated with sulphasalazine, this drug was stopped without improvement. All the patients were treated with steroids, with resolution of the anemia in one of them. Healing was achieved with splenectomy in the other two. Colectomy was not necessary in any case. After suppression of sulphasalazine and treatment with steroids, the next therapeutic option in patients with ulcerative colitis and autoimmune hemolytic anemia should be splenectomy, whereas colectomy should be only used with unresponsive patients, as well as with those affected by severe ulcerative colitis refractory to steroids. In patients presenting with ulcerative colitis and anemia, the possibility of autoimmune hemolytic anemia has to be considered since--in spite of being rare--it is responsive to proper treatment.

[Palliative treatment of carcinomatous ascites with peritoneovenous shunt]. / Tratamiento paliativo de la ascitis carcinomatosa con shunt peritoneovenoso.

Carcinomatous ascites (CA) is not an uncommon manifestation of a metastatic neoplasia. The aim of this study was to evaluate the utility of peritoneovenous shunt (PVS) in patients with CA refractory to conventional management. Twelve patients in whom a PVS was placed with palliative intention were studied. One patient died in the postoperative period. Permanent control of the ascites was achieved in 7 (63.6%) of the remaining patients. PVS obstruction occurred in 4 patients (36.4%) and no other complications related to the shunt were seen. Results were better in CA of gynecological origin but without reaching significant statistical differences. We conclude that PVS can be useful for palliation of CA with a low complication rate.

[Laboratory studies on the subjective evaluation of motor vehicle seats]. / Laboruntersuchungen zur subjektiven Bewertung von Fahrzeugsitzen.

Operator seats (Models 050 and 500, Möve) were examined with vertical sinusoidal whole-body vibration (WBV) in the frequency range from 1 to 40 Hz (1.5 and 3.0 ms-2 rms) and with simulated stochastic vibration of combines for the harvest of sugarcane. Six male subjects volunteered for the experiments. The subjective assessments of operator seats by cross-modality matching, paired comparisons, and questionnaires were compared with data of a hard experimental seat. Transmitted WBV and subjective evaluation correlated partially only. Suggestions are derived for the improvement of the seats tested.

[Laboratory studies of vibration transmission in motor vehicle seats]. / Laboruntersuchungen zur Schwingungsausbreitung an Fahrzeugsitzen.

Operator seats (Models 050 and 500, Möve) were examined with vertical sinusoidal whole-body vibration (WBV) in the frequency range from 1 to 40 Hz (1.5 and 3.0 ms-2rms) and with simulated stochastic vibration of combines for the harvest of sugarcane. Six male subjects volunteered for the experiments. The WBV transmitted from the seat mounting base to the seat cushion and head were compared with data of a hard experimental seat. Interindividual differences cannot be explained by different body masses only. The iolation and main resonance of the two operator seats differed. Additional resonant peaks occurred above 6 Hz. They can cause unfavourable conditions at certain applications. The operator seats tested are probably suited for the reduction of WBV exposure on combines for the harvest of sugarcane.