Hepatitis herpética en paciente hematológico / No disponible

No disponible

Síndrome de Reye en paciente pediátrico / Reye's syndrome in a pediatric patient

No disponible

[Lamivudine for the treatment of patients with chronic hepatitis with negative hepatitis B AgHbe]. / Lamivudina en el tratamiento de la hepatopatía crónica por virus hepatitis B AgHbe minus.

INTRODUCTION: It is estimated that chronic hepatitis B affects to than 350 million people around the world. Patients with AgHB- minus account, in some areas, for between 50-80% of the total of the population with chronic hepatitis B. Spontaneous clearance is rare within these patients, the response to interferon is low and the probability of developing cirrhosis and hepatocarcinoma is higher than in the wild type. AIM: To analyze the response to lamivudine treatment in patients with chronic hepatitis B which are AgHB negative. RESULTS: Seven of the 9 patients which were treated in our department for more than 3 months were AgHB negative. Six of them responded to the treatment in an average time of 3.5 months (range 1-6 months). There were two patients that relapsed at 18 and 24 months and they were treated with adefovir. Four patients remained DNA negative and had normal aminotransferases values after an average treatment time of 25 months. CONCLUSION: In our series, the majority of the patients (77.7%) were AgHB negative at the beginning of treatment. The efficacy of the treatment with lamivudine in these cases is high (85.7%) and with an early response (average 3.5 months). One third of patients treated relapsed after one and a half years of treatment.

Lamivudina en el tratamiento de la hepatopatía crónica por virus hepatitis B AgHbe minus / Lamivudine for the treatment of patients with hepatitis B AGHBE Minus

Introducción: Se estima que la hepatopatía crónica por virus de la hepatitis B afecta a más de 350 millones de personas en todo el mundo. Los pacientes AgHbe minus representan en algunas áreas entre el 50-80% del total. En estos pacientes la remisión espontánea es rara, la respuesta a interferón menor y la probabilidad de evolución a cirrosis y hepatocarcinoma mayor que en la cepa salvaje. Objetivo: Analizar la respuesta al tratamiento con Lamivudina en pacientes con hepatopatía crónica VHB AgHBe negativos. Resultados: De los nueve pacientes tratados en nuestro servicio durante más de 3meses, 7 eran AgHbe negativos. De ellos 6 pacientes respondieron al tratamiento, en un tiempo medio de 3,5 meses (rango 1-6). Se han producido dos recidivas a los 18 y 24 meses que han sido tratadas con Adefovir. Cuatro pacientes persisten con ADN negativo y transaminasas normales tras un tiempo medio de tratamiento de 25 meses.Conclusiones: En nuestra serie, la mayoría de los pacientes (77,7%) eran AgHbe negativos al inicio del tratamiento. La eficacia del tratamiento con Lamivudina en ellos es alta (85,7%) y precoz (media de 3,5 meses). En un tercio de los pacientes tratados se produce recidiva viral, al menos tras 1 año y medio de tratamiento

Introduction: It is estimated that chronic hepatitis B affects to than 350 million people around the world. Patients with eAgHB- minus account, in some areas, for between 50-80% of the total of the population with chronic hepatitis B. Spontaneous clearance is rare within these patients, the response to interferon is low and the probability of developing cirrhosis and hepatocarcinoma is higher than in the wild type. Aim: To analyze the response to lamivudine treatment in patients with chronic hepatitis B which are eAgHB negative. Results: Seven of the 9 patients which were treated in our departmentfor more than 3 months were eAgHB negative. Six of them responded to the treatment in an average time of 3.5 months (range 1-6 months). There were two patients that relapsed at 18 and 24 months and they were treated withadefovir. Four patients remained DNA negative and had normal aminotransferases values after an average treatment time of 25 months. Conclusion: In our series, the majority of the patients (77.7%) were eAgHB negative at the beginning of treatment. The efficacy of the treatment with lamivudine in these cases is high (85.7%) and with an early response (average 3,5 months). One third of patients treated relapsed after one and a half years of treatment

[The histological lesions of chronic hepatitis C as predicting factors of sustained response to the treatment with interferon]. / Las lesiones anátomo-patológicas de la hepatitis crónica C como factores predictivos de respuesta mantenida al tratamiento con interferón.

BACKGROUND: Although many studies have been implemented in order to determine the pre-treatment factors that can predict patients' response to interferon (IFN) therapy, it is not yet clear whether characteristic histologic abnormalities in chronic hepatitis C can predict such response. AIMS: The aim of this study were to evaluate, in patients with chronic hepatitis C, (i) the predictive value of histologic lesions for the sustained response to IFN therapy (ii) other pre-treatment (epidemiological and analytical) factors known to be predictive of response. PATIENTS AND METHODS: Sustained response was retrospectively evaluated in two hundred one patients who had been treated with IFN for at least 3 months in four different hospitals from Castilla y León. The following histological parameters were studied as predictors of response: histological diagnosis, Knodell index, grading and stage, characteristic histologic lesions of HCV infection. Epidemiological and analytical parameters were also evaluated. RESULTS: The rate of patient's sustained response to IFN treatment was 16%. None of the histological parameters was useful to predict this response. By univariate analysis, age, disease evolution time, mode of viral transmission, GGT, ferritin and viral genotype were associated with a sustained response. The most powerful, and only independent predictive factor, however, was the genotype (the response odds ratio was 8.6). CONCLUSIONS: Histological parameters do not predict the response to IFN treatment. Other factors (mainly the viral genotype) are associated with a higher response percentage, although no one is useful to decide which patients are going to respond.

Las lesiones anátomo-patológicas de la hepatitis crónica C como factores predictivos de respuesta mantenida al trata miento con interferón / The histological lesions of chronic hepatitis C as predicting factors of sustained response to the treatment with interferon

Introducción: Aunque se han realizado múltiples estudios para conocer los factores pre-tratamiento que pueden predecir la respuesta al tratamiento con interferón (IFN), se desconoce si las lesiones histológicas características de la hepatitis crónica C (HCC) sirven para predecir dicha respuesta. Objetivos: Valorar si los parámetros histológicos pueden predecir la respuesta mantenida al tratamiento con IFN en los pacientes con HCC, y estudiar otros parámetros (epidemiológicos y analíticos) ya descritos como factores predictivos de respuesta. Métodos: Se estudiaron de forma retrospectiva 201 pacientes, tratados con IFN durante al menos 3 meses en cuatro hospitales de Castilla y León. La variable dependiente analizada fue la respuesta mantenida al tratamiento. Como factores predictivos de respuesta se estudiaron las siguientes variables histológicas: diagnóstico histológico, índice de Knodell total y por apartados, grado y estadio, y lesiones características de la HCC. Además, se analizaron parámetros epidemiológicos y analíticos. Resultados: El 16 por ciento de los pacientes presentó una respuesta mantenida. Ninguno de los parámetros histológicos sirvió para predecir dicha respuesta. Demostraron ser factores predictivos en el análisis bivariante la edad, el tiempo de evolución de la HCC, la vía de transmisión, la GGT, la ferritina y el genotipo viral. El factor predictivo más importante fue el genotipo viral, y el único asociado independientemente a la respuesta mantenida ("odds ratio" de respuesta al tratamiento de 8,6). Conclusiones: Los parámetros histológicos no predicen la respuesta al tratamiento con IFN. Otros factores, fundamentalmente el genotipo viral, se asocian a un mayor porcentaje de respuestas, aunque ninguno sirve para decidir con exactitud qué pacientes responderán. (AU)

Enterocolitis necrotizante por Aspergillus en paciente imnunodeprimido / Necrotizing enterocolitis for Aspergillus in patient with immunodepression

No disponible

[Waist/hip ratio and vascular risk factors in obese and not obese individuals]. / Indice cintura/cadera y factores de riesgo vascular en sujetos obesos y no obesos.

Three groups of men and three groups of women were studied, each one of the three corresponding to obese individuals, overweight and not overweight according to the ratio of corporal mass > or = 30, 25-29.9 and < 25 respectively. In each group two subgroups were made following the waist/hip ratio (< 1 and > or = 1 for men and < 0.8 and > or = 0.8 for women). In each subgroup arterial pressure, basal glucemia, cholesterol and plasmic triglycerides, lipoproteins and insulinemia after a higher than normal oral intake of glucose were determined, comparing results according to waist/hip ratio. Practically all the parameters studied showed greater levels of risk in subjects of both sexes with high waist/hip ratio, both in obese individuals and not obese individuals. This shows the possibility that high waist/hip ratio in associated with risk factors in individuals who are not obese, and this association is considered as a "metabolic lipopathy" present in the intraabdominal visceral adipocyte. The measurement of waist/hip ratio must be recommended in all patients and in medical examinations.

[Etiology of isolated general malaise]. / Etiología del malestar general aislado.

Isolated general malaise (IGM) is defined as an imprecise sensation of feeling bad, without any other signs or symptoms that suggest even a diagnostic orientation. 137 patients who demanded medical help for IGM were selected and divided into three groups, according to their evolution: IGM of banal or benign cause; IGM of easy or attainable diagnosis; and IGM of difficult or prolonged diagnosis. The 37 patients of the latter group were integrated under the title of Unexplained General Malaise Syndrome (UGMS). The criteria of these syndromes are defined. The patients with UGMS were studied in order to make a diagnosis of its unknown disease, which was achieved in all cases except two. The non-specific symptoms that the patients with UGMS manifest and their relation to final diagnosis are described. When the final diagnosis was made, the number of diagnostic tests used, the time of hospitalisation and the derived economic cost was estimated in each case compared to the corresponding mean data, obtained. Depression as the most frequent aetiology detected in the patients with UGMS, should be the first consideration made in any evaluation.

[Deep cystic enteritis in Peutz-Jeghers syndrome (pseudoinfiltrating lesions in a patient with enteric polyps)]. / Enteritis quística profunda en síndrome de Peutz-Jeghers (lesiones pseudoinfiltrantes en paciente con pólipos entéricos).

We report a case of enteritis cystica profunda observed in a patient who, owing to both his personal and familial history, had been diagnosed and suffering from Peutz-Jeghers syndrome. The patient was operated because of a clinical picture of intestinal invagination. Together with hamartomatous polyps, anatomopathological study of the segment of the small intestine removed revealed the presence of lesions typical of Enteritis cystica profunda consisting in the presence of benign encysted glands and pools of mucous in the deep layers of the intestinal wall. The main characteristics of this interesting and rare entity are briefly commented.

[Clinical-endoscopic-histologic correlations in gastric pathology. II]. / Correlaciones clínico-endoscópicas-histológicas en patología gástrica II.

Some authors do not accept as valid the clinical diagnosis of gastritis, due to the latter being mainly an anatomical-pathological term. Others, however, argue that such diagnosis may be establish through a correct anamnesis. A cross-sectional study of a hundred and fifty patients undergoing fibrosgastroscopy with antral biopsy and anamnesis, as well as clinical exploration in accordance with specific protocols, has been conducted. We have concluded that there does not exist as symptomatology associated to a concrete pathology, despite the presence of certain symptoms as, for example, the pain, that may be related with certain pathologies (14/20 of those developing H.H.E.D., 22/34 of those developing UB and 7/10 of those developing neoplasia). We also inferred that many of the patients (46/50) with endoscopic and histological normal findings (20/23), present as many as or more symptoms than those with pathological findings. This symptomatology may be due to a somatic disorder that could be hiding the process.

[Clinical-endoscopic-histological correlations in gastric pathology. I]. / Correlaciones clínico-endoscópicas-histológicas en patología gástrica. I.

We have conducted a blind cross-selectional study with 150 consecutive patients undergoing fibrogastroscopy and biopsy of the antral mucosa. The endoscopic sensitivity for the diagnosis of the several types of gastritis, is low (63%), although this technique is highly sensitive for other types of pathology. Consequently, we conclude that, in all endoscopic explorations, at least one biopsy of the antral mucosa must be done, given the anatomopathological definition of gastritis. In addition, the clinical use of this term should be restricted to the histologically demonstrated cases.

[Primary duodenal adenocarcinoma; apropos of a case]. / Adenocarcinoma duodenal primario; a propósito de un caso.

Primary duodenal adenocarcinoma is an infrequent malignant tumor that usually affects persons 60 to 70 years-old. Its clinical manifestations are nonspecific. The diagnosis is suspected on the basis of gastroduodenal contrast radiography and it is generally confirmed by endoscopic biopsy. It is slow to metastasize, so early diagnosis can lead to curative surgical treatment. We present a case seen late, of rapid and fatal course. Statistical data are provided and we comment on some aspects of the classification, clinical manifestations, diagnosis and treatment of these tumors.

[Morgagni's diaphragmatic hernia. Report of 2 cases]. / Hernia diafragmática de Morgagni. Aportación de dos casos.

We present two cases of Morgagni hernia complicated by the clinical picture of intestinal sub-occlusion and gastric strangulation, respectively. Photographs are offered and it is emphasized that plain film radiology followed by barium studies suffices for its diagnosis. An interesting aspect examined in the discussion is the surgical procedure; we used the subxiphoid approach in our cases with excellent results.

[Double gastric neoplasia (lymphoma/adenocarcinoma) associated with alpha-1 antitrypsin deficiency. Presentation of a case and review of the literature]. / Doble neoplasia gástrica (linfoma/adenocarcinoma) asociada a déficit de alfa-1 antitripsina. Presentación de un caso y revisión de la literatura.

A case of simultaneous double gastric primary neoplasia, lymphoma and adenocarcinoma, is presented. This association having been described in only 11 cases, our case also possessing a deficit of alpha-1-antitrypsin, the implication of which has not been clarified. We review the literature on the variety of gastric neoplasia associations, highlighting the unknown pathogenic aspects.