[The prophylaxis and treatment of c virus liver disease in the liver transplantation setting. Narrative review]. / Profilaxis y tratamiento de la hepatopatía por virus C en el entorno del trasplante hepático. Revisión narrativa.

OBJECTIVE: To review the use of antiviral therapy as prophylaxis or treatment of virus C liver disease in the liver transplantation setting. METHOD: A search was made of the literature in PubMed with the strategy liver transplantation AND hepatitis C AND (interferon OR peginterferon OR ribavirin) from 1966 to June 2007 and a manual search of the journals Gastroenterología y Hepatología, Journal of Hepatology and Hepatology between 2001 and June 2007, to identify publications and communications to congresses relating to the subject. The studies identified were selected and evaluated. RESULTS: A total of 48 articles were chosen for review. Hepatitis C virus is one of the main indications for liver transplantation. Post-transplant re-infection is immediate and almost universal, and results, in many cases, in a recurrent liver disease that reduces the patients survival. Four basic therapeutic strategies have been studied: pre-transplant anti-viral treatment, prophylaxis, early or preventative treatment and treatment of acute or chronic recurrent hepatitis C. CONCLUSIONS: Currently, the hepatitis C treatment in the liver transplantation setting is based on the use of peginterferon associated with ribavirin as pre-transplant treatment in selected patients or as treatment of recurrent post-transplant hepatitis C, achieving sustained virological responses of around 20% and 35% respectively. The main limitation of these treatments is the high frequency of the adverse effects and interruptions to treatment, meaning it is important to carry out strict follow-up of the treatment safety.

Profilaxis y tratamiento de la hepatopatía por virus C en el entorno del trasplante hepático. Revisión narrativa / The prophylaxis and treatment of C virus liver disease in the liver transplantation setting. Narrative review

Objetivo: Revisar la utilización de terapia antiviral como profilaxis otratamiento de la hepatopatía por virus C en el entorno del trasplantehepático.Método: Se realizó una búsqueda bibliográfica en PubMed con laestrategia “liver transplantation” AND “hepatitis C” AND (“interferon”OR “peginterferon” OR “ribavirin”) desde 1966 hasta junio2007 y una búsqueda manual en las revistas Gastroenterología yHepatología, Journal of Hepatology y Hepatology desde 2001 hastajunio 2007, para identificar publicaciones y comunicaciones a congresosrelacionadas con el tema. Se seleccionaron y evaluaron losestudios identificados.Resultados: Se seleccionaron 84 trabajos para realizar la revisión.La hepatopatía por virus C es una de las principales indicaciones detrasplante hepático. La re-infección post-trasplante es inmediata ycasi universal, y deriva, en muchos casos, en una hepatopatía recurrenteque disminuye la supervivencia del paciente. Se han estudiadocuatro estrategias terapéuticas básicas: tratamiento antiviral pretrasplante,profiláctico, anticipado o preventivo y tratamiento de lahepatitis C aguda y crónica recurrente.Conclusiones: Actualmente el tratamiento de la hepatitis C en elentorno del trasplante hepático se basa en la utilización de peginterferónasociado a ribavirina como tratamiento pre-trasplante enpacientes seleccionados o como tratamiento de la hepatitis C recurrentepost-trasplante, alcanzándose respuestas virológicas sostenidasen torno al 20% y 35% respectivamente. La principallimitación de estos tratamientos es la alta frecuencia de efectosadversos y suspensiones de tratamiento, por lo que es muy importanterealizar un seguimiento estricto de la seguridad del tratamiento

Objective: To review the use of antiviral therapy as prophylaxis ortreatment of virus C liver disease in the liver transplantation setting.Method: A search was made of the literature in PubMed with thestrategy “liver transplantation” AND “hepatitis C” AND (“interferon”OR “peginterferon” OR “ribavirin”) from 1966 to June 2007 and amanual search of the journals Gastroenterología y Hepatología,Journal of Hepatology and Hepatology between 2001 and June2007, to identify publications and communications to congressesrelating to the subject. The studies identified were selected and evaluated.Results: A total of 48 articles were chosen for review. Hepatitis C virusis one of the main indications for liver transplantation. Post-transplantre-infection is immediate and almost universal, and results, inmany cases, in a recurrent liver disease that reduces the patient’s survival.Four basic therapeutic strategies have been studied: pre-transplantanti-viral treatment, prophylaxis, early or preventative treatmentand treatment of acute or chronic recurrent hepatitis C.Conclusions: Currently, the hepatitis C treatment in the liver transplantationsetting is based on the use of peginterferon associatedwith ribavirin as pre-transplant treatment in selected patients or astreatment of recurrent post-transplant hepatitis C, achieving sustainedvirological responses of around 20% and 35% respectively. Themain limitation of these treatments is the high frequency of the adverseeffects and interruptions to treatment, meaning it is importantto carry out strict follow-up of the treatment safety

Liver transplantation in patients with hepatocellular carcinoma: factors implicated in tumor relapse.

INTRODUCTION: Liver segmental resection and liver transplantation are both treatments intended for healing liver cancer. An adequate selection of patients eligible for transplantation is crucial, since organs available for transplants are usually scarce. For this reason, awareness of the prognostic factors of relapse is of great importance. We present a comprehensive review of our series in order to better understand these prognostic factors. MATERIAL AND METHODS: We revised the cases of patients with hepatocellular carcinoma who underwent liver transplantation during the period 1994-2000, and present a detailed analysis of a series of variables which may be probably implicated in the appearance of relapse and which have an effect on survival. RESULTS: After a mean follow-up of 33 months, the mortality rate was 27.5% and relapse occurred in 18.75% of cases. No history of alcohol abuse, the number and size of the nodules, the presence of macro and microscopic vascular invasion, and pTNM stage T4 were all factors associated with a significantly increased risk of relapse (p<0.05). These factors and positive HCV were associated to decreased survival. After a multivariate analysis, the size of the nodules and the presence of macroscopic vascular invasion were considered the only independent risk factors for tumor relapse and post-transplantation relapse and mortality, respectively. CONCLUSIONS: Macroscopic vascular invasion and tumor nodules larger than 5 cm are both independent risk factors of tumor relapse after transplantation. Nevertheless, only macroscopic vascular invasion seems to have a significant effect on survival.

Indication and results of endoscopic management of sigmoid volvulus.

INTRODUCTIONS: sigmoid volvulus is a relatively common cause of intestinal obstruction, particularly in the elderly and in patients with debilitating conditions. As the risks associated with surgical treatment of the sigmoid volvulus are in many cases too high, conservative (endoscopic) management is an option to be considered. MATERIAL AND METHODS: all emergency lower gastrointestinal endoscopies performed between January 1, 1996 and December 31, 2001 were review and, among these, the cases of diagnosis of sigmoid volvulus were selected. The results of the endoscopic management, percentage of recurrence, mortality rate, complications, surgical procedures etc were evaluated in the select cases. RESULTS: lower gastrointestinal endoscopy was diagnostic in all cases. Endoscopic management showed and overall efficacy of 87.5%. recurrence appeared in approximately 57% of the cases. Successful treatment was accomplished for the first episode in 25% of the cases. In case of recurrence, endoscopic management could be performed again with similar efficacy and safety. CONCLUSIONS: endoscopic reduction is a safe and successful technique for the management of emergency sigmoid volvulus, provided vascular compromise in the intestinal wall is ruled out. As recurrence is frequent, elective definitive surgery could be a treatment to consider. Endoscopic management could be the only choice treatment in the case of patients not it for surgery due to the very important risks associated with it their cases.

Diferencias entre carcinomas infrecuentes y adenocarcinomas habituales de la vesícula biliar / Differences between uncommon carcinomas and usual gallbladder adenocarcinomas

No disponible

[The endoscopic polypectomy of colonic polyps with invasive adenocarcinoma. A series of 19 cases]. / Polipectomía endoscópica de pólipos de colon con adenocarcinoma invasor. Una serie de 19 casos.

We review the endoscopic polypectomies done at the "Juan Canalejo" Hospital in the last 6 years (1984-1989). Out of a 509 adenomatous polyps, 19 showed invasive adenocarcinoma seen in 18 patients (there were two carcinomatous polyps in one single patient), 11 men and 7 women. The median age was 67 years and all of them were located in the left side of the colon or the rectum. The average size was 3 cm and the most frequent histologic type was villoglandular (58%) followed by the villous (26%) and adenomatous (16%). The endoscopic resection was curative in all but one patient that presented vascular invasion in the resected polyp.