Clinical and genetic factors involved in Porto-sinusoidal vascular disorder after oxaliplatin exposure.

BACKGROUND AND AIMS: Oxaliplatin (OX) has been described as a potential etiologic agent for porto-sinusoidal vascular disorder (PSVD). Our aim was to describe the natural history of PSVD due to OX in colon cancer (CRC) and identify risk factors for its development. METHODS: We made a multicenter retrospective case-control (ratio 1:3) study with patients diagnosed of PSVD-OX. Baseline data, end of treatment, years of follow-up and diagnosis of PSVD were collected and compared to controls (without PSVD). Besides, 16 different SNPs were selected from bibliography and analyzed by genotyping in the case group to identify potential genetic risk factors. RESULTS: 41 cases were identified, with a median time to PSVD diagnosis after the end of OX of 34 months. Spleen diameter was the strongest predictor of PSVD during treatment (OR 43.94 (14.48-133.336); p < 0.0001). Additionally, thrombocytopenia (<150 × 10^9) at one year was a significant disease risk marker (OR 9.35; 95% CI: 3.71-23.58; p = 0.001). We could not establish any significant association between the selected SNPs and PSVD diagnosis. CONCLUSION: The increase of spleen diameter is the strongest predictor of PSVD in patients treated with OX for CRC. These patients could be candidates for a specific follow-up of portal hypertension-related complications.

Enfermedades vasculares del hígado. Guías Clínicas de la Sociedad Catalana de Digestología y de la Asociación Española para el Estudio del Hígado / Vascular diseases of the liver. Clinical Guidelines from the Catalan Society of Digestology and the Spanish Association for the Study of the Liver

Las enfermedades vasculares hepáticas, a pesar de su relativamente baja prevalencia, representan un problema de salud importante en el campo de las enfermedades hepáticas. Una característica común a muchas de estas enfermedades es que pueden causar hipertensión portal, con la elevada morbimortalidad que ello conlleva. Con frecuencia estas enfermedades se diagnostican en pacientes jóvenes y el retraso en su diagnóstico y/o un tratamiento inadecuado pueden reducir de forma importante la esperanza de vida. El presente artículo revisa la evidencia actual en el síndrome de Budd-Chiari, la trombosis venosa portal en pacientes no cirróticos, la hipertensión portal idiopática, el síndrome de obstrucción sinusoidal, las malformaciones vasculares hepáticas en la telangiectasia hemorrágica hereditaria, la trombosis portal en la cirrosis, otras patologías vasculares menos frecuentes como las fístulas arterioportales, así como un apartado sobre el diagnóstico por imagen de las enfermedades vasculares hepáticas y su tratamiento desde el punto de vista hematológico (estudio de la diátesis trombótica y tratamiento anticoagulante). Las recomendaciones se han realizado de acuerdo a los estudios publicados extraídos de Pubmed. La calidad de la evidencia y la intensidad de las recomendaciones fueron graduadas de acuerdo al sistema Grading of Recommendations Assessment Development and Evaluation (GRADE). Cuando no existían evidencias suficientes, las recomendaciones se basaron en la opinión del comité que redactó la guía.

Despite their relatively low prevalence, vascular diseases of the liver represent a significant health problem in the field of liver disease. A common characteristic shared by many such diseases is their propensity to cause portal hypertension together with increased morbidity and mortality. These diseases are often diagnosed in young patients and their delayed diagnosis and/or inappropriate treatment can greatly reduce life expectancy. This article reviews the current body of evidence concerning Budd-Chiari syndrome, non-cirrhotic portal vein thrombosis, idiopathic portal hypertension, sinusoidal obstruction syndrome, hepatic vascular malformations in hereditary haemorrhagic telangiectasia, cirrhotic portal vein thrombosis and other rarer vascular diseases including arterioportal fistulas. It also includes a section on the diagnostic imaging of vascular diseases of the liver and their treatment from a haematological standpoint (study of thrombotic diathesis and anticoagulation therapy). All recommendations are based on published studies extracted from PubMed. The quality of evidence and strength of recommendations were rated in accordance with the GRADE system (Grading of Recommendations, Assessment Development and Evaluation). In the absence of sufficient evidence, recommendations were based on the opinion of the committee that produced the guide.

[Prevalence of immunity to hepatitis viruses in pregnant women from the health area of Gijón (Spain)]. / Prevalencia de inmunidad frente a los virus de la hepatitis en gestantes del Area Sanitaria de Gijón.

INTRODUCTION: The objective of the study is to determine the prevalence of hepatitis B or C chronic infection, and hepatitis A or E immunity among pregnant women from Gijón, as well as their clinical and epidemiological antecedents. PATIENTS AND METHOD: HBsAg and anti-HCV were determined in 2287 pregnant women consecutively attended in the Cabueñes Hospital, Gijón. Ninety nine of them, non-European or Gipsy, were also tested for anti-HAV IgG and anti-HEV IgG as were a sample of 325 and 365 respectively of the remaining 2188. Several clinical and epidemiological parameters were checked in all of them. RESULTS: Hepatitis B virus: 10.8% (246/2287) were previously vaccinated. Among the 2043 non vaccinated, 0.8% (17 cases) were HBsAg+. None of them had HBV replication and in 59% (10/17) the HBV infection was unknown. Hepatitis C virus: 1.44% (33/2287) women were anti-VHC+, 1.26% (29/2287) anti-VHC and PCR+. In 28% of them (8/29) no parenteral risk factor was identified. Again, the infection was unknown in 58% (17/29) previously unknown. Hepatitis A virus: excluding non-European and Gipsy women, with a rate of immunity against HAV in younger than 29 years-old of 57% (12/21) and 89% (16/18), respectively, the anti-HAV IgG was positive in 17% (22/128) of the women younger than 29 years-old, 28% (60/214) between 29 and 36 years-old, and in 56% (13/23) of those older than 36 years-old. Hepatitis E virus: anti-HEC IgG was found in 2% (2/99) non European or Gipsy pregnant women and in 0.6% of the rest (2/325). CONCLUSIONS: a). Vaccination rate against hepatitis B virus is still low among pregnant women in Gijón; b). most of HBsAg+ or anti-VHC+ ignore it and many of them have not an evident risk factor; c). susceptibility to hepatitis A infection is high, with progress towards adult age, and d). remember the possibility of infection by hepatitis E virus.

[Epidemiology of chronic inflammatory bowel disease in Gijón, Asturias]. / Epidemiología de la enfermedad inflamatoria intestinal crónica en Gijón. Asturias.

AIMS: To determine several aspects of the epidemiology of chronic inflammatory bowel disease (IBD), including distribution of the various forms of IBD, sex, age at diagnosis considering lag-time to diagnosis, criteria used in the diagnosis, the relationship between educational level and activity, familial aggregation, phenotype (site and clinical type), number of admissions and mean hospital stay/year, surgical requirements and mortality. PATIENTS AND METHODS: We carried out a retrospective (1954-1993) and prospective (1994-97) descriptive epidemiologic population study, in the fifth health district of Gijón in Asturias (Spain), with 225,798 inhabitants. A total of 595 patients diagnosed with chronic IBD according to the diagnostic criteria described by Lennard-Jones and Truelove for Crohn's disease (CD) and ulcerative colitis (UC) and according to Ashley B. Price's criteria for indeterminate colitis (IC) were studied. In all patients a complete clinical follow-up was performed. RESULTS: During the study period, we diagnosed 595 patients with IBD [305 patients with UC (51.3%), 272 (45.7%) patients with CD and 18 (3%) with IC]. Sex distribution was 287 females (48.2%) and 308 males (51.8%), with a male/female ratio of 1.07. Mean age at presentation was 38.79 +/- 17.44 years (UC: 43.37 +/- 17.55; CD: 33.98 +/- 16.16; IC: 33.73 +/- 13.48), p = 0.000. Age at onset prior to diagnosis was as follows: UC: 42.03; CD: 30.47; IC: 30.99 (p = 0.000). Diagnostic criteria used in UC was symptomatic in 99.01% (p = ns), endoscopic in 95.04% (p = 0.000), and pathologic in 87.21% (p = 0.000); in CD diagnostic criteria used was radiologic in 85.29% (p = 0.000). A total of 29.1% of patients with UC and 66.7% of those with CD had higher education (p = 0.0005). Family history was found in 9.8%. Anatomical site was as follows: in UC: rectum 21%, 28.2% rectum and sigmoid, 22.3% left colitis, 4.2% distal to hepatic flexure and 24% pancolitis; in CD: 32.72% terminal ileum, 19.11% colon, 37.13% ileo-colon, 11.02% extensive intestinal and 3.67% gastro-duodenal. A total of 8.37% of patients with UC and 14.51% of those with CD had been hospitalized during the previous 4 years; mean hospital stay was 1.63 days in UC and 2.27 days in CD. The mean surgical requirements were 0.54 +/- 1.08 (31.59%); UC: 0.11 +/- 0.36 (10.2%); CD: 1.04 +/- 1.38 (56.25%), p = 0.000. The mortality rate was 48.73 deaths/1,000 inhabitants (UC: T = 65.57; CD: T = 33.08; IC:T= 0) p = ns. The standardized mortality ratio was 4.83 (UC: 6.51; CD: 3.28). CONCLUSIONS: We highlight the uniformity of the distribution of IBD in relation to types of disease and sex. Patients with CD had a higher level of education. Genetic components play an important role in these diseases and familial aggregation was high, especially in CD. Complicated situations are infrequent in this group of patients. Morbidity was higher in patients with CD as reflected by surgical requirements and hospital stay. Mortality was lower in CD than in UC.

[Incidence and prevalence of inflammatory bowel disease in Gijon, Asturias, Spain]. / Incidencia y prevalencia de la enfermedad inflamatoria intestinal en Gijón (Asturias).

AIM: To determine the incidence and prevalence of inflammatory bowel disease in our area and to compare our results with those of other series from Spain and other parts of the world. PATIENTS AND METHODS: Descriptive epidemiologic population study, retrospective (1954-1993) and prospective (1994-1997) in health district V of Gijón in Asturias (Spain) with 225,798 inhabitants. Diagnostic criteria used were those described by Lennard-Jones and Truelove for Crohn's disease and ulcerative colitis and those described by Ashley B. Price for indeterminate colitis. Annual incidence was expressed per 100,000 inhabitants. Prevalence was calculated excluding cured patients: proctocolectomized in ulcerative colitis (10 cases) and deaths (29 cases). RESULTS: During the period studied, 595 patients were diagnosed with bowel disease (305 patients with ulcerative colitis, 272 with Crohn's disease and 18 with indeterminate colitis). Mean annual incidence (1954-1997) was 6.128 (95% CI: 2.90-9.36). In the 4-year prospective study the incidence was 15.49 (95% CI: 11.19-21.79), 9.36 for ulcerative colitis, 6.08 for Crohn's disease and 0.77 for indeterminate colitis (UC/CD: 1.58). Prevalence was 246.23 (95% CI: 225.6-226.70, 212.79 for ulcerative colitis, 116.47 for Crohn's disease and 7.97 for indeterminate colitis. CONCLUSIONS: Incidence and prevalence obtained in our environment were higher than those described in other areas of Spain and were similar to those found in areas of Europe and other parts of the world with a higher incidence. Incidence and prevalence have increased since 1980, probably due to the widespread use of endoscopy as a diagnostic technique. Rates were higher in the prospective study than in the retrospective one.

Mortality and causes of death in patients with chronic inflammatory bowel disease in Gijón, Asturias (Spain).

OBJECTIVE: to review mortality, survival, influence of age at diagnosis and at death, cause of death, and relation with the extent of chronic inflammatory bowel disease, in a city in northern Spain. METHOD: descriptive retrospective epidemiological study of 516 patients diagnosed in Gijón (Asturias) between 1954 and 1997. RESULTS: of the 26 patients who died (5.03%), 18 had ulcerative colitis, 8 had Crohn's disease, and none had indeterminate colitis. Mortality was higher than in the general population, with a standard mortality ratio (SMR) of 5 (95% confidence interval 1.6-11.6). We found no differences in sex ratio (p = 0.63). Mean duration of the disease was 10 +/- 8 years in surviving patients, and 6 +/- 6 years in patients who died (p = 0.02). Duration was longer in Crohn's disease than in ulcerative colitis (p = 0.014). Mean age at diagnosis for chronic inflammatory bowel disease was 37.5 +/- 17 years in patients who survived, and 58 +/- 18 years in patients who died (p = 0.0005). Mean age at death was 64 +/- 20 years. In Crohn's disease, the most frequent cause of death was the primary disease (50%), followed by tumors of different origin (37.5%). In ulcerative colitis the primary disease was also the most frequent cause of death (38.%), followed by thromboembolic disease (22.2%) and tumors (22.2%). CONCLUSIONS: mortality among patients with chronic inflammatory bowel disease is higher than in the general population in our setting, decreases as duration of the disease increases, and is higher in patients diagnosed at older ages. Fewer than half the deaths were due to the primary disease; many patients with Crohn's disease died from tumors or thromboembolic disease.

Serological markers of hepatitis A, B and C in first year student nurses.

OBJECTIVE: To know the prevalence of serological markers of hepatitis A, B and C virus in first year student nurses. SETTING: A transversal study of prevalence. SUBJECTS AND METHODS: 81 first year student nurses, mean age 20.6 years (18-37, S.D. 3.8), with demographic, epidemiologic and clinical variables, performing liver enzymes, anti-HAV IgG, anti-HBcore and anti-HCV. RESULTS: The anti-HAV IgG was positive in 9 students (11.1%), with a prevalence of 6.7% between 17 and 19 years (C.I.95% 1.7 to 19.3%), 8.7% between 20 and 22 years (C.I.95% 1.5 to 29.5%), 20% between 23 and 25 years (C.I.95% 10.5 to 70.1%), and 37.5% (C.I.95% 10.2 to 74.1) in those over 25 years (p < 0.001). No other significative variables existed according to age-group. Regarding hepatitis B virus, of the 65 not previously vaccinated, only 1 (1.5%, C.I.95% 0.08 to 9.4%) was immunized, and there were no cases of HBsAg positive. The anti-VHC was positive in one case (1.2%, C.I.95% 0.06 to 7.6%), RIBA indeterminate and with normal ALT. Only one student (1.2%) showed increased transaminase values, attributed to liver steatosis. None of the students had suffered any episode of acute clinic hepatitis. CONCLUSIONS: The anti-HAV IgG prevalence in first year student nurses in our area is very low, and it is not necessary to carry out prevacunal screening. The low prevalence of anti-Hbcore also rejects a similar screening with respect to HBV. There were no HBsAg or anti-HCV positive cases, but it should not be the cause of forgetting to take the universal precautions or giving a false sensation of security.

[The prevalence of hepatitis A, B and C viral markers in the population of Gijón between 26 and 65 years old]. / Prevalencia de marcadores frente a los virus A, B y C de la hepatitis en la población de Gijón entre 26 y 65 años de edad.

The aim of this study was to know the prevalence of hepatitis A, B and C markers in an adult population in Gijón, Spain. A randomized, transversal sample according to the census was made in a population between 26 and 65 years of age in Gijón, analyzing demographic, epidemiologic and clinical variables, liver function tests, anti-HAV IgG, anti-HBcore and anti-HCV. Of the 476 individuals included a census error was detected in 26 (5.5%) and 340 (71.4%) were studied. Of these anti-HAV IgG was positive in 210 (61.8%) with prevalences of 17.9% from 26 to 30 years (CI: 95%, 11.1%-27.4%), 54.7% from 31 to 35 years (CI: 95%, 41.8%-67%), 73.6% from 36 to 40 years (CI: 95%, 59.4%-84.3%) and 93% (CI: 95%, 86.7%-96.5%) above 40 years of age (p < 0.001). No other significant variables were found adjusted by age groups. With regard to HBV, of the 331 unvaccinated cases, 35 (10.6, CI 95%, 7.6%-14.5%) presented immune markers and 4 (1.2% CI: 95%, 0.4%-3.3%) HBsAg positivity, with all having normal ALT and no viral replication. Anti-HCV was positive in 1.7% (CI: 95%, 0.7-3.9%), being significantly related to IVDA or tattoos. Hypertransaminasemias were detected in 18 (5.3%) being attributed to virus C (27.8%), alcoholism (27.8%) or obesity (44.4%). History of clinical manifestations of acute hepatitis was collected in 9.7% of the cases with no memory of the episode in 84.3% of the anti-HAV IgG positive cases, 79.5% of the anti-HBcore positive cases and 83.3% of the anti-HCV positive cases. The current curve of prevalence of anti-HAV IgG in the Gijón population varies in the decade from 30 to 40 years in age ranging from values discarding prevaccination screening under the age of 30 to levels of minimum susceptibility to infection above the age of 40. The low prevalence of anti-HBcore underestimates its use as prevaccination screening versus HBV in the population of Gijón. The prevalences of HBsAg or anti-HCV thereby make this area a zone of intermediate endemicity, with around 3% of the population being chronically infected by one of these viruses.

[The prevalence of markers for the hepatitis A and B viruses in the population of Gijón between 6 and 25 years old]. / Prevalencia de marcadores frente a los virus A y B de la hepatitis en población de Gijón entre 6 y 25 años de edad.

BACKGROUND: The aim of this study was to know the prevalence of previous infection markers for hepatitis A and B viruses in a pediatric-juvenile population from Gijón, Spain. PATIENTS AND METHODS: A representative (according to the census) transversal randomized sample of a population from 6 to 25 years in age from Gijón, Spain, was included in the study analyzing demographic, epidemiologic and clinical variables, liver tests, anti-HAV IgG and anti-HBc. RESULTS: Of the 630 individuals selected a demographic error was detected in 28 (4.4%) and 453 subjects were studied (71.9%) in whom the anti-HAV IgG was positive in 37 cases (8.75% of prevalence adjusted for age), with 4.4% (12/271) (CI 95% 2.3%-7.6%) for the younger cases and 13.7% (25/182) (CI 95% 9.1%-19.6%) in the group ranging from 18 to 25 years in age (p < 0.001). No anti-HAV IgG positive case was detected in the population under the age of 10 years. Among the young adults the prevalence of anti-HAV IgG positive cases was higher in those born in the south of Spain (2/6, 33.3%) (CI 95% 4.3%-77.7%) with respect to those from the northern regions of Spain (9/259, 3.5%) (CI 95% 1.6%-6.4%). (p = 0.02). With respect to HBV markers, of the 433 unvaccinated cases, 6 (1.4%) presented markers of past infection and 2 (0.46%) HBsAg positivity. Both had normal serum ALT without viral replication. Six cases of hypertransaminasemia levels (1.3%) were detected all being related with obesity or alcoholism. All the cases with previous acute clinical hepatitis were found to be anti-HAV IgG positive and anti-HBc negative. CONCLUSIONS: The current prevalence of anti-HAV IgG in the population from 6 to 25 years from Gijón, Spain is very low and given the high degree of susceptibility (86%) for HAV infection in the young adult population (18-25 years) the implementation of vaccination programs is recommended even without previous serologic screening. The low prevalence of anti-Hbc would also undervalue its use as prevaccination screening against HB in this geographical area.

Epidemiology of hepatitis D virus infection: changes in the last 14 years.

To calculate the prevalence of hepatitis D virus (HDV) superinfection, antibody to HDV (anti-HD) was tested on admission in 696 hepatitis B virus (HBV) chronic carriers diagnosed between 1979 and 1992. Anti-HD was positive in 67 patients (9.6%), and it was more frequently detected in i.v. drug abusers (IVDA) (59/74, 79.7%) than in non-IVDA (8/622, 1.3%) (p = 0.0001). The prevalence of anti-HD was higher in HBV chronic carriers diagnosed between 1979 and 1985 (33/219, 15.1%) than in those diagnosed from 1986 to 1992 (34/477, 7.1%) (p < 0.001). However, these figures were not different when IVDA were analyzed alone; 29/34 (85%) and 30/40 (75%) (p = 0.4) IVDA diagnosed in both time frames were anti-HD-positive. Four hundred and thirty anti-HD-negative HBV carriers were prospectively followed, and serial determinations of anti-HD were made. Seroconversion to anti-HD was observed in only six patients (1.4%), and again the rate of seroconversion was higher in IVDA (5/10, 50%) than in non-IVDA (1/420, 0.2%) (p < 0.0001). These findings show that IVDA HBV chronic carriers are still an extremely high risk group for HDV superinfection in Spain and that this virus has little penetrance in other epidemiological categories of HBV carriers.

[The prevalence of anti-HCV positivity among blood donors in Asturias. A clinical-epidemiologic study]. / Prevalencia de la positividad del anti-VHC entre donantes de sangre en Asturias. Un estudio clinicoepidemiológico.

BACKGROUND: The aim of this study was to know the prevalence, epidemiology, clinical manifestations and analytical changes present in anti-HCV positive blood donors detected in Asturias. METHODS: A prospective analysis of the incidence and prevalence of anti-HCV positivity in the blood donations carried out in Asturias from October 1989 to October 1991 was performed, as was a clinical and analytical study of the anti-HCV positive cases who attended a clinic specifically created for the same. RESULTS: The prevalence of the anti-HCV was 0.87% of the donors (372/42,789) and 0.50% of the donations (372/73,831) being higher among new donors (1.77%, 165/9,322). Of the 288 cases studied (77.4%), only 51 (17.7%) had been transfused and 105 (36.5%) lacked the previous parenteral risk factor. Only 31 (10.8%) presented symptoms or signs of liver disease and the positivity of the anti-HBc was not associated to any relevant analytical change. The existence of previous major surgery or transfusion was variable with the independent predictive value versus a negative anti-HCV control group. The mean follow up was 12.4 +/- 7.3 months (6-30 months) with an increase in aminotransferases (ALT) being detected in 108 cases (52.7%). A good correlation was found between this data, an ELISA-2 score greater than 5 and RIBA-2 positivity: of the 177 cases in whom RIBA-2 was determined this was found to be positive in 109 (61.6%); 84 cases (77.1%) had an increase in ALT and 100 (91.8%) an ELISA-2 score greater than 5. CONCLUSIONS: In Asturias the prevalence of anti-HCV positivity among blood donors is almost 1% and is greater if new donors are considered, being confirmed by RIBA-2 in 61% of the cases. The subjects are usually asymptomatic and up to one third of the same lack any known risk factor, while almost half have hypertransaminasemia during follow up.

[Acute ++indomethacin-induced hepatitis in a female patient with asymptomatic primary biliary cirrhosis]. / Hepatitis aguda por indometacina en una enferma con cirrosis biliar primaria asintomática.

We present an infrequent case of acute hepatitis by indomethacin, in a patient with a primary biliary cirrhosis, previously not diagnosed and asymptomatic, in who during in the follow-up, with a persistent analytical pattern of disociated cholestasis, a liver biopsy was indicated, with the final diagnosis of chronic non-suppurative destructive cholangitis.

[Campylobacter fetus, an infrequent microbe, as a cause of spontaneous bacterial peritonitis in cirrhosis]. / Campylobacter fetus, un germen infrecuente, causante de peritonitis bacteriana espontánea del cirrótico.

Campylobacter fetus has been implicated in the etiology of sepsis and bacteriemias in immunosupressed subjects. In a few cases, it has also been reported to be responsible for spontaneous bacterial peritonitis in cirrhotic patients. We describe the clinical picture of a woman with terminal liver cirrhosis who had bacteriemia and spontaneous bacterial peritonitis caused by this agent. We argue about the history of cleansing enemas and their probable role in the development of the infection. We stress the excellent response to the antibiotic treatment.

[Ascitic peritonitis due to Candida albicans]. / Peritonitis del líquido ascítico por Candida albicans.

We report a case of spontaneous peritonitis due to Candida albicans, in a diabetic patient with alcoholic liver cirrhosis, ascites, gastrointestinal bleeding from esophageal varices, sepsis, renal failure and encephalopathy. These factors, added to prolonged antibiotic therapy and instrumental manipulations, could have resulted in the colonization by Candida, usually described in secondary peritonitis, but perhaps underdiagnosed in cirrhotic patients with spontaneous peritonitis and severe multiorgan failure.

Epidemiological, clinical and biological characteristics of acute non-A, non-B hepatitis with and without hepatitis C virus infection.

Serially collected serum samples from 81 patients with acute non-A, non-B hepatitis were tested for the presence of antibodies to hepatitis C virus (anti-HCV) by a second-generation enzyme immunoassay (EIA) test. Anti-HCV was detected in 56 cases (69%) during the first month, in 61 cases (75%) at 3 months and in 63 cases (78%) at 6 months. In those 18 patients showing anti-HCV negative results in the three determinations, hepatitis C virus (HCV) RNA was tested using a nested polymerase chain reaction (PCR) in the first serum sample and was detected in only one case. Anti-HCV or HCV-RNA positive episodes were considered as acute hepatitis C, while those negative for both markers were classified as acute non-A, non-B, non-C hepatitis. On comparing acute hepatitis C with the non-A, non-B, non-C episodes, no significant differences were found in the presence of jaundice, mean maximum alanine-aminotransferase (ALT) levels and positivity of markers of past hepatitis B virus (HBV) infection. However, patients with hepatitis C were significantly younger than those with non-A, non-B, non-C hepatitis (p = 0.002). Male sex (78.1% vs. 35.3%; p = 0.001), history of parenteral exposure (90.6% vs. 11.8%; p = 0.0001), and progression to chronicity (73.4% vs. 5.9%; p = 0.0001) were significantly more frequent in the HCV-related group. Although other possibilities cannot be excluded, these results suggest that there might be a different infectious agent implicated in the etiology of acute non-A, non-B, non-C hepatitis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Usefulness of endoscopic hemostasis in Dieulafoy's vascular disease]. / Utilidad de la hemostasia endoscópica en la enfermedad vascular de Dieulafoy.

We report three cases of "Dieulafoy's gastric erosion" or "Exulceratio simplex", which is rarely recognized but is not an uncommon cause of upper gastrointestinal hemorrhage, usually very dangerous, as it's an arterial bleeding. In all cases an emergency endoscopy was performed, and treatment with combination of local sclerosis and vessel's electrocoagulation was successful. We insist in the potential benefits of endoscopic treatment in all these occasions, if it's possible, since even exact diagnosis of the bleeding site is very difficult in some patients.

[Ulcerative colitis with Coombs+ autoimmune hemolytic anemia. A report of a case with favorable response to medical treatment]. / Colitis ulcerosa con anemia hemolítica autoinmune Coombs+. Descripción de un caso con respuesta favorable al tratamiento médico.

We report the case of a patient with ulcerative colitis and autoimmune hemolytic anemia, that improved with steroid therapy, and during the follow-up showed analytical changes of iron deficiency anemia and anemia of chronic disorders. We discuss the possible etiologies of the anemia in patients with ulcerative colitis, and the treatments suggested for the associated Coombs-positive hemolytic anemia in these cases, stressing the good response to steroids in our patient.