Effectiveness of argon plasma coagulation in the treatment of chronic actinic proc.

INTRODUCTION: There are two kinds of actinic proctitis--one is acute and self-limited, and lasts about 3 months; the other is chronic and develops months to years after radiation therapy. The incidence of chronic actinic proctitis is about 5-20% of radiated prostate tumors. OBJECTIVE: To evaluate the effectiveness of argon plasma coagulation in the treatment of chronic actinic proctitis. MATERIAL AND METHOD: A retrospective search of patients with the diagnosis of actinic proctitis. The number of argon plasma coagulation therapies needed to achieve the symptom resolution was analyzed. RESULTS: We found 22 patients with a diagnosis of actinic proctitis. Nineteen were males (86.7%) and three (13.6%) were females. Nineteen patients (86.4%) had a diagnosis of prostate adenocarcinoma, one had a diagnosis of squamous-cell cervix carcinoma (4.5%), and two had a diagnosis of endometrial carcinoma (9.1%). The mean number of coagulation sessions needed for symptom resolution was 2.58 (absolute range 1-7) with a median of 2 sessions. CONCLUSION: Multiple treatments are described in the literature. None of them have shown promising results. Our results suggest that argon plasma coagulation is effective in the treatment of this condition, and achieves a rapid and sustained response with few sessions and a good safety profile.

Efectividad de la fulguración con argón plasma en el tratamiento de la proctitis actínica crónica / Effectiveness of argon plasma coagulation in the treatment of chronic actinic proctitis

Introducción: existen 2 tipos de proctitis actínica, una aguda autolimitada, que dura aproximadamente 3 meses y otra crónica que aparece a los meses o años de la radioterapia. La incidencia de proctitis actínica crónica es del 5-20% de los tumores prostáticos irradiados. Objetivo: evaluar la efectividad de la fulguración con argón plasma en el tratamiento de este tipo de proctitis. Material y método: estudio retrospectivo. Realizamos una búsqueda retrospectiva de aquellos pacientes diagnosticados de proctitis actínica entre 2004 y 2007. Analizamos el número de sesiones de fulguración con plasma de argón que fueron necesarias para la resolución de la sintomatología. Resultados: hemos hallado 22 pacientes con el diagnóstico de proctitis actínica. Diecinueve de los pacientes eran varones (86,4%) y tres mujeres (13,6%). De todos los pacientes 19 fueron diagnosticados de adenocarcinoma prostático (86,4%), una fue diagnosticada de carcinoma epidermoide de cérvix uterino (4,5%) y dos fueron diagnosticadas de adenocarcinoma de endometrio (9,1%). La media de sesiones de fulguración con plasma de argón necesarias para resolución de la clínica presentada fue de 2,58 (rango entre 1 y 7 sesiones) y con un mediana de 2 sesiones. Conclusión: en la literatura hay descritos múltiples tratamientos para la proctitis actínica. No obstante, ninguno de ellos ha presentado resultados demasiado prometedores. Nuestros resultados sugieren que la fulguración con plasma de argón es efectiva en el tratamiento de esta patología, consiguiendo una resolución rápida y mantenida de la sintomatología con pocas sesiones, además de presentar un buen perfil de seguridad(AU)

Introduction: there are two kinds of actinic proctitis - one is acute and self-limited, and lasts about 3 months; the other is chronic and develops months to years after radiation therapy. The incidence of chronic actinic proctitis is about 5-20% of radiated prostate tumors. Objective: to evaluate the effectiveness of argon plasma coagulation in the treatment of chronic actinic proctitis. Material and method: a retrospective search of patients with the diagnosis of actinic proctitis. The number of argon plasma coagulation therapies needed to achieve the symptom resolution was analyzed. Results: we found 22 patients with a diagnosis of actinic proctitis. Nineteen were males (86.7%) and three (13.6%) were females. Nineteen patients (86.4%) had a diagnosis of prostate adenocarcinoma, one had a diagnosis of squamous-cell cervix carcinoma (4.5%), and two had a diagnosis of endometrial carcinoma (9.1%). The mean number of coagulation sessions needed for symptom resolution was 2.58 (absolute range 1-7) with a median of 2 sessions. Conclusion: multiple treatments are described in the literature. None of them have shown promising results. Our results suggest that argon plasma coagulation is effective in the treatment of this condition, and achieves a rapid and sustained response with few sessions and a good safety profile(AU)

[Intravenous 3-day Helicobacter pylori eradication therapy is highly effective in patients with bleeding peptic ulcer]. / Alta eficacia erradicadora de la infección por Helicobacter pylori de una pauta terapéutica intravenosa de 3 días de duración en pacientes con úlcera péptica sangrante.

AIMS: To evaluate the efficacy of 3-day intravenous Helicobacter pylori eradication therapy in patients with bleeding peptic ulcer associated with H. pylori infection. MATERIAL AND METHOD: We studied 53 patients admitted to hospital with bleeding of the upper gastrointestinal tract due to peptic ulcer and positive urease test over a 12-month period. After endoscopic diagnosis, intravenous pantoprazole (40 mg/12 hours), metronidazole (500 mg/8 hours) and amoxicillin-clavulanic acid (1,000 mg/200 mg/8 hours) was administered for 72 hours. The efficacy of eradication therapy was evaluated by 13C-urea breath test at least 2 months after the end of treatment. RESULTS: Fifty-one patients were included. Of these, 40 had duodenal ulcer and 11 had gastric ulcer. H. pylori eradication was achieved in 87.5% of those with duodenal ulcers and in 63.6% of those with gastric ulcers (p = 0.066). No adverse reactions or episodes of bleeding recurrence were found and none of the patients withdrew from treatment. CONCLUSIONS: The ultra-short course eradication therapy used in this study is highly effective. Its efficacy is similar to that of oral treatment and it avoids certain problems such as adverse effects and adherence to treatment.

Prevalence of hepatitis A virus antibodies in patients with chronic liver diseases.

OBJECTIVE: The age of persons with hepatitis A virus (HAV) infection in the general population has risen; these persons are at increased risk of clinically severe disease, especially patients with chronic liver disease. The aim of the present study was to analyze the prevalence of total antibodies against HAV in patients with chronic liver disease. METHODS: In a prospective study carried out between September 1998 and June 1999, 180 patients seen in the chronic liver disease outpatient department were studied. The prevalence of total anti-HAV antibodies was determined by age group, etiology and degree of histological damage, and according to the antecedents of risk for parenteral infection. A nonconditional logistic regression model was fitted with anti-HAV positivity as the dependent variable. RESULTS: Mean age was 44.1 years, with an anti-HAV prevalence of 77.2% (varying from 42.9% in the 21-25-year-old group to more than 83% in patients > 56-years old). Differences across groups regarding other categories (histological damage, etiology and history of parenteral or drug use) were not statistically significant, but the probability of anti-HAV positivity increased with age and a history of drug addiction. CONCLUSIONS: The prevalence of total anti-HAV antibodies is high among patients with chronic liver disease. We therefore recommend this test before vaccination against HAV, until current recommendations on universal childhood vaccination are implemented, in order to prevent hepatitis A epidemics in the general population.

Prevalencia de anticuerpos antivirus de la hepatitis A en pacientes con hepatopatías crónicas / Prevalence of hepatitis A virus antibodies in patients with chronic liver diseases

OBJETIVO: la edad de infección por el virus de la hepatitis A (VHA) ha aumentado en la población, con un mayor riesgo de gravedad clínica, sobre todo en pacientes con hepatopatía crónica. Se pretende conocer la prevalencia de anticuerpos totales frente al VHA en pacientes con hepatopatía crónica. PACIENTES Y MÉTODOS: se estudió de forma prospectiva a 180 pacientes atendidos consecutivamente en nuestra consulta de Hepatopatías Crónicas desde septiembre de 1998 hasta junio de 1999. Se determinó la prevalencia de anticuerpos totales anti-VHA por grupos de edad, etiologías, grado de afectación histológica y antecedentes de riesgo de infección por vía parenteral. Finalmente se ajustó un modelo de regresión logística no condicional con variable dependiente la presencia de anti-VHA. RESULTADOS: la edad media fue de 44,1 años, con una prevalencia de anti-VHA del 77,2 por ciento (desde el 42,9 por ciento entre 21-25 años hasta más del 83 por ciento a partir de 56 años). No existieron diferencias estadísticamente significativas según la afectación histológica, etiología o antecedentes de riesgo parenteral o de drogadicción, pero la probabilidad de tener anti-VHA aumentaba con la edad y con el antecedente UDVP. CONCLUSIONES: los pacientes con hepatopatía crónica presentan una alta prevalencia de anticuerpos totales anti-VHA, En consecuencia, en estos pacientes recomendamos su determinación previamente a la vacunación frente al VHA hasta que se introduzcan las recomendaciones actuales de vacunación generalizada de la población infantil para evitar epidemias de hepatitis A en la población general (AU)

Portal vein thrombosis associated to prothrombin G20210A mutation and protein C deficiency.

We describe a patient with left branch portal vein thrombosis involving two thrombophilic alterations, the prothrombin G20210A mutation and protein C deficiency. In spite of not being under anticoagulant treatment, the thrombus in the portal vein underwent complete and spontaneous lysis. No other risk factors were detected and no family history related to thrombosis was found.

[Percutaneous intrahepatic portosystemic shunt: its effects on hypersplenism]. / Derivación percutánea portosistémica intrahepática: efectos sobre el hiperesplenismo.

The aim of this study was to verify the early effects that the transjugular intrahepatic portosystemic shunt (TIPS) produces on thrombocytopenia and its possible relationship to portal pressure and the size of the spleen. A TIPS was placed in 24 cirrhotic patients (11 women and 13 men) with a mean age of 57.6 +/- 12.3 years. Prior to the test the platelets count, the size of the spleen and the portocaval gradient were determined. The same parameters were evaluated one day and one month afterwards. A significant increase was observed in then number of platelets following the placement of the prosthesis (87.6 +/- 55.2 vs 97 +/- 66.8 x 10(9)/l) (p < 0.05) which was maintained in the monthly control without achieving statistical significance (99.5 +/- 60.8 x 10(9)/l). A significant decrease was also observed in the size of the spleen from 156.7 +/- 28.7 mm during the previous control to 144.5 +/- 19.9 mm in the monthly control (p < 0.05). The portocaval gradient was significantly reduced following the procedure with the values being 23.25 +/- 3.86 mmHg prior to the TIPS, 10.29 +/- 3.84 mmHg in the immediate control and 10.37 +/- 4.81 mmHg at the one month control. A statistically significant correlation was observed between the size of the spleen and the number of platelets in both the previous control (r = 0.7264; p < 0.001) and in the monthly control (r = 0.5764; p < 0.05), between the size of the spleen and the portocaval gradient prior to the test (r = 0.5285; p < 0.05) and at one month (r = 0.7185; p < 0.01) and between the portocaval gradient and the number of platelets before the prosthesis (r = 0.5060; p < 0.05). TIPS may improve the thrombocytopenia in correlation with the decrease in portal pressure.