[Ultrasound-guided biopsy of the pancreas: a multicenter study]. / Punción pancreática ecodirigida: estudio multicéntrico.

OBJECTIVE: Members of "Asociación de Ecografía Digestiva" decided to carry out a multicenter retrospective study on fine-needle aspiration biopsy for pancreatic space-occupying lesions under ultrasonographic guidance and via the percutaneous route in order to assess this technique s performance versus endoscopic ultrasound-guided biopsy. SUBJECTS: 10 hospitals for a total of 222 patients with suspiciously malignant, 8-120-mm pancreatic lesions were included in the study. RESULTS: The analysis of results shows a sensitivity of 89%, a specificity of 98%, a positive predictive value of 99%, and a negative predictive value of 74%, for an overall diagnostic accuracy of 91%. No major complications occurred. CONCLUSION: Percutaneous fine-needle aspiration for pancreatic lesions is highly cost-effective and has few and mild complications.

Encefalopatía hepática secundaria a la existencia de un shunt portosistémico tratada satisfactoriamente mediante radiología intervencionista / Hepatic encephalopathy secondary to porto-systemic shunt satisfactorily treated with interventionist radiology

La encefalopatía hepática es un estado reversible de alteraciónen la función cognitiva, que puede ocurrir en pacientes con enfermedadhepática aguda o crónica o shunts porto-sistémicos, en elque puede aparecer cualquiera de los signos neurológicos o psiquiátricosconocidos. Las sustancias nitrogenadas procedentes dela digestión intestinal alcanzan el cerebro sin la depuración que suponesu paso por el hígado, debido a las derivaciones porto-sistémicas,y dan lugar a los signos característicos de la encefalopatíahepática. A continuación presentamos dos casos clínicos de pacientescon shunt porto-sistémicos, diagnosticados de encefalopatíahepática crónica recurrente refractaria al tratamiento médicoconvencional, tratados satisfactoriamente con embolización de dichoshunt mediante técnicas de radiología intervencionista

Hepatic encephalopathy is a reversible state of altered cognitionthat may occur in patients with acute or chronic liver diseaseor porto-systemic shunt, and in which known neurological or psychiatricsigns may develop. Nitrogenated substances from intestinaldigestion reach the brain without being cleared by their passagethrough the liver due to the presence of porto-systemicshunt. We report two cases of patients with porto-systemic shuntdiagnosed with recurrent chronic hepatic encephalopathy refractoryto conventional medical treatment. They were satisfactorilytreated with shunt embolization using interventionist radiologytechniques

[A prospective study about the usefulness of ultrasonographic monitoring after invasive liver procedures--liver biopsy and fine-needle aspiration (FNA)]. / Estudio prospectivo sobre la utilidad de la ecografía de control tras la realización de pruebas invasivas hepáticas: biopsia hepática y punción aspiración con aguja fina (PAAF).

OBJECTIVE: To determine the need to perform ultrasound scans to all patients after liver biopsy or fine-needle aspiration (FNA) in order to detect complications with or without symptoms. MATERIAL AND METHODS: After liver biopsy or FNA using a regular protocol the patient is observed for 24 hours at the hospital, and all patients undergo an abdominal sonography at that time even in the absence of evident complications. RESULTS: 298 liver biopsies and 98 FNAs were performed. There were complications in 37 patients (9.34%): 36 (9.09%) were minor complications such as pain, vasovagal episodes, or small bleeding, and 1 (0.25%) was a major complication with severe hemorrhage. Only 1 out of all 396 procedures had a complication detected by ultrasounds (intrahepatic hematoma) while the patient was asymptomatic. CONCLUSIONS: The low incidence of complications occurring without symptoms, and their favorable course suggest that routine ultrasonography is not necessary after these techniques, and that it should be only performed when a complication is suspected.

Estudio prospectivo sobre la utilidad de la ecografía de control tras la realización de pruebas invasivas hepáticas: biopsia hepática y punción aspiración con aguja fina (PAAF) / A prospective study about the usefulness of ultrasonographic monitoring after invasive liver procedures –liver biopsy and fine-needle aspiration (FNA)

Objetivo: establecer si es necesario realizar una ecografía de control a todos los pacientes sometidos a una biopsia hepática o una punción aspiración con aguja fina, para detectar posibles complicaciones con o sin repercusión clínica. Material y métodos: tras la realización de una biopsia hepática o una punción aspiración con aguja fina según el protocolo habitual, se mantiene al paciente en observación durante 24 horas, realizándose en ese momento una ecografía a todos los pacientes aunque no presenten datos clínicos de complicación. Resultados: se llevaron a cabo 298 biopsias hepáticas y 98 punciones mediante aguja fina. Presentaron complicaciones un total de 37 pacientes (9,34%), de las cuales 36 (9,09%) fueron complicaciones menores en forma de dolor, síncope vasovagal o hemorragia leve y 1 (0,25%) complicación mayor en forma de hemorragia grave. De las 396 exploraciones tan sólo uno de los casos presentó una complicación detectada en la ecografía (hematoma intraparenquimatoso) encontrándose asintomático. Conclusiones: la baja incidencia de complicaciones, que cursan de forma asintomática, y la buena evolución de las mismas hacen poco rentable la realización de ecografía de control tras la realización de dichas técnicas diagnósticas, siendo necesaria tan sólo en el caso de sospecha clínica de complicación

Objective: to determine the need to perform ultrasound scans to all patients after liver biopsy or fine-needle aspiration (FNA) in order to detect complications with or without symptoms. Material and methods: after liver biopsy or FNA using a regular protocol the patient is observed for 24 hours at the hospital, and all patients undergo an abdominal sonography at that time even in the absence of evident complications. Results: 298 liver biopsies and 98 FNAs were performed. There were complications in 37 patients (9.34%): 36 (9.09%) were minor complications such as pain, vasovagal episodes, or small bleeding, and 1 (0.25%) was a major complication with severe hemorrhage. Only 1 out of all 396 procedures had a complication detected by ultrasounds (intrahepatic hematoma) while the patient was asymptomatic. Conclusions: the low incidence of complications occurring without symptoms, and their favorable course suggest that routine ultrasonography is not necessary after these techniques, and that it should be only performed when a complication is suspected

[Hepatic encephalopathy secondary to porto-systemic shunt satisfactorily treated with interventionist radiology]. / Encefalopatía hepática secundaria a la existencia de un shunt portosistémico tratada satisfactoriamente mediante radiología intervencionista.

Hepatic encephalopathy is a reversible state of altered cognition that may occur in patients with acute or chronic liver disease or porto-systemic shunt, and in which known neurological or psychiatric signs may develop. Nitrogenated substances from intestinal digestion reach the brain without being cleared by their passage through the liver due to the presence of porto-systemic shunt. We report two cases of patients with porto-systemic shunt diagnosed with recurrent chronic hepatic encephalopathy refractory to conventional medical treatment. They were satisfactorily treated with shunt embolization using interventionist radiology techniques.

Toxicidad hepática por flutamida / Liver toxicity associated with flutamide

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Fibrin-glue sealed liver biopsy in patients with a liver transplantation or in liver transplantation waiting list: preliminary results.

Liver biopsy is frequently necessary for candidate evaluation or histologic follow-up of transplanted livers. Although generally considered to be safe, it carries a risk of complications in up to 0.5% of cases; hemorrhage being the most important. It can present as an asymptomatic intra- or perihepatic hematoma or result in overt hemorrhage of variable intensity. Patients with deranged hemostasis or on antiaggregant therapy are at high-risk for hemorrhagic complications. Percutaneous liver biopsy may be contraindicated if hemostasis is profoundly disordered. Safety values are not well defined: arbitrary limits are 60% prothrombin activity and 60,000 platelets per mm3. Patients with more altered values are candidates for alternative techniques, such as transjugular biopsy. Another option is the so-called plugged percutaneous liver biopsy, which uses direct injection of a plugging material into the biopsy tract. Different materials have been used: Tissucol, absorbable gelatin sponge, or hemostasis coils. We communicate our experience with Tissucol (fibrin glue) plugging in 30 percutaneous liver biopsies on 16 patients after liver transplantation with prothrombin activity <60%, platelet count <60,000 per mm3, or both. Only two complications were observed. Plugged liver biopsy is an efficient and relatively safe procedure in patients with impaired hemostasis; it can be performed even when transjugular biopsy is not available.

La biopsia hepática ciega en la medicina actual / Blind liver biopsy in current medicine

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[Collagenous colitis: an entity with diverse therapeutic options]. / Colitis colágena: una entidad con diversas opciones terapéuticas.

Collagenous colitis is a disorder which has been diagnosed with increasing frequency in the last few years, probably due to the routine obtention of colon biopsy specimens in the study of patients with chronic diarrhoea. Good responses have been reported with a number of therapies, although only a scarce number of clinical trials have been performed, partly because of the small number of patients studied. Two cases of collagenous colitis with different therapeutic approaches are here reported. All medical therapy options for this interesting disorder are reviewed.

[Is there any association between Helicobacter pylori infection and peptic esophagitis?]. / Existe alguna relación entre la infección por Helicobacter pylori y la esofagitis péptica?

BACKGROUND: To describe the prevalence of Helicobacter pylori infection in patients with reflux esophagitis, and compare it with that in patients with normal endoscopy. METHODS: Fifty-five patients with endoscopic peptic esophagitis and 55 symptomatic patients with normal endoscopy were studied. Age and sex distribution were similar in both groups. At endoscopy biopsy specimens were taken from gastric antrum and body (H & E, Gram stain and culture). RESULTS: H. pylori was found in 74.5% (95% CI = 62-84%) of patients with reflux esophagitis, and in 76.4% (CI = 64-86%) of cases with normal endoscopy (a non-significant difference). In patients with esophagitis and H. pylori infection normal histologic antral mucosa was observed in 7.3% of cases (CI = 2.5-19.4%). In patients with normal endoscopy the corresponding figure was 4.8% (CI = 1.3-15.8%) (a non-significant difference). At gastric body from infected patients the percentages of patients with normal histologic mucosa was 29.3% (n = 12) and 23.8% (n = 10), in both groups respectively. CONCLUSIONS: The prevalence of H. pylori infection in patients with reflux esophagitis was 74.5%, and no difference was observed when comparing with infection rate in patients with normal endoscopy (76.4%). Therefore, a non-significant association was found between this esophageal disorder and H. pylori infection.

[Toxic cholestatic hepatitis due to phenytoin]. / Hepatitis tóxica colestásica por fenitoína.

We report the case of a 51-years-old female who was prophylactically treated with diphenylhydantoin after surgery of an intracranial aneurysm. Twenty-four days after beginning the treatment, a general syndrome appeared, in addition to a diffuse cutaneous exanthema. Four days later, a cholestatic syndrome, compatible with "toxic cholestatic acute hepatitis", was developed. The suppression of the drug, was followed by rapid clinical improvement and gradual normalization of transaminases values, although biochemical cholestasis persisted for months.

[Immunologic changes in chronic post-transfusion positive hepatitis C and non-A non-B non-C hepatitis]. / Alteraciones inmunológicas en la hepatitis crónica postransfusional C positiva y no-A no-B no-C.

OBJECTIVES: To study some aspects of the immunological abnormalities of C and non-A non-B non-C posttransfusional chronic hepatitis through the spontaneous and mitogen-stimulated "in vitro" production of immunoglobulins by peripheral blood lymphocytes. EXPERIMENTAL DESIGN: Peripheral blood lymphocytes from non-A non-B posttransfusional chronic hepatitis patients and from healthy volunteers were cultured in presence and absence of Pokeweed mitogen and the secreted immunoglobulins (IgG, IgA and IgM) were measured by ELISA in the supernatants. The results in both groups were compared. PATIENTS: 23 posttransfusional chronic hepatitis patients, 11 males and 12 females with an average age of 46.73 +/- 11.2 yrs (range: 24-69 yrs), have been studied. The histological diagnosis was chronic active hepatitis (CAH) in 13 cases, CAH with bridge necrosis in 6 patients and CAH with associated cirrhosis in 4 cases. The control group was composed by 11 healthy volunteers, 5 male and 6 female, with an average age of 38.45 +/- 12.77 yrs (range: 26-65 yrs). No one of the control group was positive for anti-HCV antibodies while in the posttransfusional chronic hepatitis patients group, 19 were positive and 4 negative. RESULTS: No significant differences in the spontaneous production of immunoglobulins between both groups has been found, however, when peripheral blood lymphocytes were stimulated with Pokeweed mitogen, a statistically significant lower production of immunoglobulins was observed in chronic hepatitis patients when compared with the control group. In non-A non-B posttransfusional chronic hepatitis patients, no relation has been found between the immunoglobulins production and histological findings or anti-HCV antibody titles. CONCLUSIONS: In the chronic phase of C and non-A non-B non-C posttransfusional chronic hepatitis, stimulated immunoglobulin production is significantly decreased for each immunoglobulin compared with the control group. These results suggest a failure in T-B lymphocyte cooperation in these infections since 82.6% of our patients were positive for HCV serological markers.

[Treatment of hepatic and intra-abdominal hydatidosis with mebendazole: prospective comparison of the cyclic and the continuous regimen]. / Tratamiento de la hidatidosis hepática e intraabdominal con mebendazol: comparación prospectiva de las pautas cíclica y contínua.

AIM: To communicate the results of two different schedules (cyclic and continuous) of mebendazole therapy for hepatic and intraabdominal hydatid disease. DESIGN: Prospective and randomized. PATIENTS: 26 cases of abdominal hydatid disease. RESULTS: No significant differences were registered between both groups. CONCLUSION: Cyclic mebendazole therapy does not improve the results of continuous treatment in abdominal hydatid disease.

Randomised controlled trial of efficacy of albendazole in intra-abdominal hydatid disease.

The efficacy of albendazole in hydatid disease is still unclear, because there has been no study that assessed the status of the parasite after treatment. The significance of albendazole-induced echographic changes in the cyst therefore cannot be judged. We did a prospective, controlled, randomised, open study of albendazole in patients with liver hydatid disease, and assessed parasite viability after treatment. 18 patients received no albendazole treatment (controls), 18 received albendazole (10 mg/kg daily) for 1 month (group A), and 19 received the drug for about 3 months (group B). Echography was done before and during treatment; all patients underwent surgery on completion. Parasite (protoscolex viability and development of cysts in mice) and ultrastructure studies were done for all cysts removed. 8 (50%) of cysts in the control group, 13 (72%) in group A, and 16 (94%) in group B were non-viable (p = 0.015). Protoscolex and cyst viability were significantly (p = 0.039 and p = 0.018, respectively) lower in treated patients than in controls. Treatment was also significantly associated with total cyst membrane disintegration. 68% of cysts treated for 3 months showed echographic changes, and only 1 of 20 cysts showing echographic changes during treatment was judged viable. The efficacy of albendazole at a dose of 10 mg/kg daily for 3 months suggests that it is a suitable alternative to surgery in uncomplicated hydatid liver disease, as initial treatment.