[Spanish scientific publications on hepatitis C virus. A Medline study (1980-2002)]. / Producción científica española relacionada con el virus de la hepatitis C. Un estudio a través de MedLine (1980-2002).

BACKGROUND: To analyze the scientific publications on hepatitis C virus infection from Spanish hospitals between 1980 and 2002. METHOD: Articles published from January 1980 to December 2002 and contained in the Medline database were selected using the following key words: "Hepatitis C" [MeSH] AND ((Spain [AD] OR Espana [AD] OR Spanien [AD] OR Espagne [AD] OR Espanha [AD]) OR (Spanish [LA]) OR Spain)). Geographical and institutional distribution, national or international publication, subject matter of the article, and date of publication were recorded. Bibliometric indicators of output and impact were estimated. RESULTS: A total of 1.051 articles were studied, of which 346 were excluded. The number of articles published increased from 0 in 1980 to 121 in 1998 and decreased to 36 in 2002. More articles were published in international journals than in Spanish journals (59.2% versus 40.8%). The main topic was epidemiology (28.6%) in the first decade and treatment (20.2%) in the second. Original articles were the most common type of article (80.5%). The centers with the greatest output were Hospital Clinic in Barcelona (11.6%), Vall d'Hebron Hospital (8.9%) in Barcelona and Fundación Jiménez Díaz in Madrid (8.9%). The mean impact factor increased linearly from 0 in 1980 to 3 in 2002. CONCLUSIONS: The number and impact factor of scientific publications on hepatitis C virus by Spanish authors has grown significantly during the last 2 decades.

Geographic differences and the role of cagA gene in gastroduodenal diseases associated with Helicobacter pylori infection.

Helicobacter pylori (H. pylori) is the major causal agent of gastritis, peptic ulcer and gastric cancer. Several bacterium genes seem to be involved in the pathogenicity mechanism. One of them, the cagA gene, has been extensively studied and characterized. In this article we have carried out a study of characteristics and genetic variability of cagA gene in different geographic areas of the world. At the same time, we have summarized several studies that evaluate possible relation of cagA with gastroduodenal diseases associated by H. pylori infection. In our study we found that the presence of the cagA gene has been confirmed in more than 60% H. pylori strains distributed throughout the world. The prevalence of cagA genotype is of 65.4% in gastritis patients, 84.2% in patients with peptic ulcer and 86.5% in those with gastric cancer. It shows a high genetic variability of cagA associated with gastroduodenal diseases that could serve as a virulence marker in H. pylori infected subjects. However, the high prevalence of H. pylori cagA positive strains in some geographic areas does not confirm the strong association between cagA and virulence of strains as described in other countries. Nowadays, cagA gene is considered as a marker for the presence of cag pathogenicity island (cag-PAI) in H. pylori genoma. This region contains several genes that has been involved with the production of cytokines that results in an increased inflammation of host gastric mucosa, but its function is unknown. Probably, others bacterium factors, such as susceptibility host and environmental cofactors could influence in the risk of developing different gastroduodenal diseases associated with H. pylori infection.

[Mesenteric fibromatosis as the cause of a single abdominal mass]. / Fibromatosis mesentérica como causa de masa abdominal única.

We present a mesenteric desmoid tumor in a man without associated diseases. Characteristics of this tumor are reviewed and the need to perform total exeresis of the mass for diagnosis is emphasized. Although surgery is the treatment of choice, alternative treatments are recommended when surgery cannot be performed, has been incomplete, or in cases of repeated recurrence.

Noninvasive antigen-based assay for assessing Helicobacter pylori eradication: a European multicenter study. The European Helicobacter pylori HpSA Study Group.

OBJECTIVE: In a recently published multicenter study involving 501 patients undergoing esophagogastroduodenoscopy (EGD) throughout Europe, we showed the high accuracy of a recently developed simple test (HpSA) to detect Helicobacter pylori (H. pylori) antigens in stools of untreated patients. The aim of this study was to assess the diagnostic usefulness of HpSA compared with 13C UBT shortly after H. pylori eradication treatment. METHODS: Of the 501 patients enrolled in the validation study, 279 were found to be H. pylori-positive. These patients were given H. pylori eradicating regimen and asked to return for follow-up EGD with biopsies, 13C UBT and HpSA testing 4 wk after therapy. Follow-up results were available for 235 patients. Of these, 162 consented to all testing and 73 consented only to 13C UBT and HpSA testing. We assessed sensitivity and specificity of both HpSA and 13C UBT compared with biopsy-based methods in the 162 patients, who accepted follow-up EGD. We also assessed sensitivity and specificity of HpSA compared with 13C UBT, arbitrarily chosen as the gold standard, in the whole population of 235 patients. RESULTS: Sensitivity and specificity in 162 patients who consented to a second EGD were 93.8% (CI: 85.4-100%) and 96.9% (CI: 93.9-99.9%) for HpSA, and 90.6% (CI: 80.5-100%) and 99.2% (CI: 97.7-100%) for UBT. Using EGD-based methods as the gold standard, 130 of the 162 treated patients' H. pylori infection were eradicated (125 HpSA-negative, one borderline, and four false-positive; 129 13C UBT-negative, one false-positive), and 32 remained H. pylori-infected (30 HpSA-positive, two false-negative, 29 13C UBT-positive, three false negative). The overall eradication rate was 80.2%. The sensitivity and specificity of HpSA relative to UBT as the gold standard in the overall population (n = 235) were 95.6% (CI: 89.6-100%) and 94.7% (CI: 91.5-97.9%), respectively. CONCLUSIONS: HpSA has proven to be a useful method in posttreatment eradication testing for H. pylori. Its ease of use, speed, and noninvasive nature make HpSA testing an ideal method for post-treatment monitoring where a second EGD may not be justified.

High-dose intravenous cyclosporine in steroid refractory attacks of inflammatory bowel disease.

BACKGROUND/AIMS: To determin whether cyclosporine is effective in inducing remission in patients with severe active inflammatory bowel disease, refractory to steroids. METHODOLOGY: Twenty-three patients with severe and steroid-refractory inflammatory bowel disease (15 ulcerative colitis and 8 Crohn's disease) were included. The Mayo Clinic Score and the CDAI were used to evaluate activity. Cyclosporine (4 mg/kg/day) was administered for a maximum of ten and a minimum of 7 days. RESULTS: Ten of the 15 ulcerative colitis patients achieved remission with a mean response lag time to onset improvement of 8 days. Seven of these patients remained stable with mesalazine 4 months after cyclosporine treatment. Two patients relapsed and underwent colectomy on the 50th and 200th day after treatment. Five patients presented no response and required urgent colectomy. Six of the 8 Crohn's disease patients achieved remission with a mean response lag time to onset improvement of 7 days. The 6 patients remained stable with mesalazine four months after cyclosporine treatment. The other 2 developed reversible renal failure and had to be released from the study. CONCLUSIONS: Intravenous high dose cyclosporine is effective and can be used as a rapid onset treatment for acute steroid refractory IBD.

Diagnosis of Helicobacter pylori: invasive methods.

The methods which require endoscopy for the examination of the gastric mucosa are called invasive (direct) methods. Several tests can be performed on the gastric mucosa obtained by endoscopy: Rapid urease test, histology, smear (cytology), culture and polymerase chain reaction. A combination of at least two tests with high sensitivity and specificity is recommended for clinical trials, and, when possible, for clinical management of patients. In clinical practice the invasive methods should be carried out only in those patients to be treated with eradication regimes. All invasive methods rely on gastric biopsy samples. Therefore, the specimens should be taken under optimal conditions. Several factors guide the site and the number of biopsy specimens for identification of Helicobacter pylori infection. In pre-treatment diagnosis, the biopsies should be taken from the distal antrum (2 cm from the pylorus). The number required depends on the diagnostic method used: in Helicobacter pylori eradicated patients the same number of biopsies for histology and culture should be taken from the antrum and corpus. The sensitivity and specificity of the Rapid urease test varies from 80-90% the results are known very quickly and the cost is very low. The maximal accuracy of histology is obtained with: an optimal specimen processing, an adequate staining and an experienced observer. This method of biopsy processing facilitates the identification of Helicobacter pylori which is commonly located on the superficial and foveolar epithelium. Sensitivity depends on the observer's experience and the extent of biopsy sampling. In general, the histological method has a sensitivity and specificity of 90-95%. In patients treated by proton pump inhibitors, antibiotics or bismuth salts two-four weeks prior to biopsy, the bacteria may be restricted to the corpus or fundus. Culture is strictly indicated in patients after failure of two or more eradication regimens to test for susceptibility and resistence. Specificity is 100% and sensitivity depends on the experience and interest of the microbiologist. The indication of polymerase chain reaction is only for research, specially, in molecular epidemiology and for fingerprinting.

[Acute pancreatitis in Caroli's syndrome]. / Pancreatitis aguda en un síndrome de Caroli.

Caroli's syndrome is included in the fibropolycystic abnormalities of the bile ducts. The disease is usually manifested by episodes of cholangitis. We report a case which presented as acute pancreatitis in the adulthood. The diagnosis was obtained by ultrasonography, CT scan, ERCP and liver biopsy. A choledochojejunostomy was performed with poor outcome and the patient is in the waiting list for liver transplantation.

[Survey on Helicobacter pylori and peptic ulcer in Spain]. / Encuesta sobre Helicobacter pylori y úlcera péptica en España.

OBJECTIVE: The goal of this study is to determine, through a national survey, the degree of acceptance among gastroenterologists of the relationship between Helicobacter pylori and peptic ulcer, and how they manage their patients according to this association. STUDY DESIGN: An observational study through a self-administered questionnaire. PARTICIPANTS: The questionnaire was distributed to 690 gastroenterologists from all over Spain. The questionnaire was answered by 687 specialists. RESULTS: Most (98.1%) Spanish specialists accept the relationship, 1.5% are reluctant, and 0.3% are irresolute. Eradication treatments are prescribed by 96.4% of the gastroenterologists, mainly omeprazole+amoxicillin, in 1994, though only 40.8% of gastroenterologists always prescribe it for H. pylori positive peptic ulcer. A control of the effectiveness of the treatment is undertaken by 84.3% of gastroenterologists. CONCLUSIONS: The relationship between H. pylori and ulcer is accepted by Spanish gastroenterologists, as well as eradication therapy.