Scielo RSS http://scielo.isciii.es/rss.php?pid=1130-010820150010&lang=en vol. 107 num. 10 lang. en http://scielo.isciii.es/img/en/fbpelogp.gif http://scielo.isciii.es http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015001000001&lng=en&nrm=iso&tlng=en http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015001000002&lng=en&nrm=iso&tlng=en Background: Current guidelines address the initiation of treatment to prevent postoperative recurrence (PR) after ileo-cecal resection in Crohn's disease (CD), but appropriate management of postoperative CD patients who are already receiving treatment to prevent PR is yet to be defined. Usefulness of endoscopic monitoring in this scenario remains uncertain. Aims: To evaluate the usefulness of endoscopy-based management of postoperative CD patients who are already under pharmacological prevention of PR. Methods: Retrospective review of clinical outcome of all CD patients with ileo-cecal resection who underwent postoperative colonoscopy between 2004 and 2013 at our centre. Postoperative endoscopic findings were classified as no endoscopic recurrence (Rutgeerts i0-i1) or endoscopic recurrence (Rutgeerts i2-i4). Patients with endoscopic recurrence were classified as "endoscopy-based management (EBM)" if treatment step-up after endoscopy, or "non EBM (N-EBM)". Clinical recurrence was considered if re-operation, CD related hospitalization or treatment change. Time until clinical recurrence or the end of the follow up was considered. Results: One hundred sixty six patients initially identified. One hundred twenty nine (77%) under pharmacological prevention of PR at the time of colonoscopy were analyzed: 34% were receiving aminosalicylates, 50% thiopurines, 11% anti-TNF, 5% combo. Colonoscopy showed endoscopic recurrence in 57% of patients; those with N-EBM were more likely to have clinical recurrence than patients with EBM along the follow up (p = 0.01). Conclussions: Endoscopic monitoring could be useful in postoperative CD patients also in patients already receiving pharmacological treatment to prevent PR. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015001000003&lng=en&nrm=iso&tlng=en Background and aim: A simeprevir (SMV)-based regimen has shown promising results in treating chronic hepatitis C virus (HCV) infection. This meta-analysis aimed to assess the efficacy and safety of simeprevir for treating HCV genotype 1 infection. Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched, along with the reference lists of retrieved articles. The meta-analysis only included randomized controlled trials (RCTs) that compared the efficacy and safety of addition of SMV to peginterferon (PegIFN) and ribavirin (RBV) (triple regimen) with PegIFN/RBV alone (dual regimen) in treating chronic HCV genotype 1 infection. Results: A total of seven RCTs involving 2,301 patients were included. The triple regimen had a higher pooled sustained virologic response (SVR) rate [odds ratio (OR) = 4.57; 95% confidence interval (CI): 3.34-6.27; p < 0.001)] and lower pooled relapse rate [relative risk (RR) = 0.41; 95% CI: 0.33-0.50; p < 0.001] than the dual regimen had. The pooled incidence of adverse events (AEs) was comparable between the two regimens (RR = 1.01; 95% CI: 0.99-1.03; p = 0.339), whereas the incidence of serious AEs in the triple regimen was lower (RR = 0.7; 95% CI: 0.50-0.98; p < 0.05). Conclusions: The meta-analysis demonstrates that the addition of SMV to pegIFN and RBV is effective and well-tolerated in treating chronic HCV genotype 1 infection, with a low incidence of AEs. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015001000004&lng=en&nrm=iso&tlng=en Background: Although colorectal carcinogenesis has been intensively studied, the published investigations do not provide a consistent description of how different carbohydrate determinants of colorectal epithelium are modified in colorectal cancer (CRC). Objective: This study is an attempt to characterize the terminal fucosylation steps responsible for the synthesis of mono-(Leª/Le x) and difucosylated (Le b/Le y) Lewis antigens in healthy and tumour CRC tissue. Methods: An immunohistochemical study of Lewis antigens' expression was undertaken, along with screening of the fucosyltransferase (FT) activities involved in their synthesis, on healthy and tumour samples from 18 patients undergoing CRC. Results: Analysis of α(1,2/3/4)FT activities involved in the sequential fucosylation of cores 1 and 2 showed significant increases in tumour tissue. Expressed as μU/mg and control vs. tumour activity (p from Wilcoxon's test), the FT activities for Leª/Le b synthesis were: lacto-N-biose α(1,2)/α(1,4)FT, 65.4 ± 19.0 vs. 186 ± 35.1 (p < 0.005); lacto-N-fucopentaose 1 α(1,4)FT, 64.9 ± 11.9 vs. 125.4 ± 20.7 (p < 0.005); Leª α(1,2)FT, 56.2 ± 7.2 vs. 130.5 ± 15.6 (p < 0.001). Similarly, for Le x/Le y synthesis were: N-acetyllactosamine α(1,2)-/α(1,3)FT, 53.4 ± 12.2 vs. 108.1 ± 18.9 (p < 0.001); 2'-Fucosyl-N-acetyllactosamine α(1,3)FT, 61.3 ± 10.7 vs. 126.4 ± 22.9 (p < 0.001); 2'-Fucosyllactose α(1,3)FT, 38.9 ± 10.9 vs. 143.6 ± 28.9 (p < 0.001); 2'-Methyllactose α(1,3)FT, 30.9 ± 4.8 vs. 66.1 ± 8.1 (p < 0.005); and Le x α(1,2)FT, 54.3 ± 11.9 vs. 88.2 ± 14.4 (p < 0.001). Immunohistochemical Le y expression was increased (p < 0.01 according to Wilcoxon's test) in tumour tissue, with 84.6% of specimens being positive: 7.7% weak, 15.4% moderate and 61.5% high intensity. Conclusions: Results suggest the activation of the biosynthesis pathways of mono-and difucosylated Lewis histo-blood antigens in tumour tissue from CRC patients, leading to the overexpression of Le y, probably at the expense of Le x. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015001000005&lng=en&nrm=iso&tlng=en Objective: The use of fully covered metal stents (FCMS) for the treatment of benign conditions is increasing. The aim of our study was to assess the efficacy of FCMS in the management of post-operative leaks after gastric or esophageal surgery. Material and methods: During a three year period (2011-2013), patients who underwent a surgery related with esophageal or gastric cancer and developed a postoperative anastomotic leak treated with FCMS were prospectively included. Results: Fourteen patients were included (11 men, 3 women), with median age of 65 years. Placement of at least one stent was achieved in 13 patients (93% of cases), with initial closure of the leak in 12 of these 13 cases (92.3%). A final success (after removal of the stent) could be demonstrated in 9 cases (69.2%, intention to treat analysis); stent failed only in one case (7.7%) and there were 3 patients (23.1%) not evaluated because death before stent retrieval (not related with the endoscopic procedure). One stent were used in 9 cases (69.2%), and two in 4 (30.8%). Migration was observed in two cases (15.3%). There were no major complications related with the use of stents. There were no complications related with retrieval. Conclusions: The placement of FCMS to achieve the leak closure after esophageal or gastric surgery is an effective and probably safe alternative feasible with minor risks. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015001000006&lng=en&nrm=iso&tlng=en Background: Ulcerative colitis (UC) has a recognized phenotypic heterogeneity. Some studies suggest that age at diagnosis may influence features and natural history of the disease. Aim: This study aimed to compare patients', disease's and treatment's features between Portuguese patients diagnosed before and after the age of 40-years-old. Methods: Retrospective single-center study that included 310 patients with UC, divided in two groups: Those diagnosed before the age of 40-years-old (early onset UC) and those diagnosed later than that (late onset UC). In each group features of the patients (gender, family history, smoking), of the disease (duration, extension, severity, clinical course, hospitalization, extraintestinal manifestations), and of treatment (oral aminosalicylates, systemic steroids or immunomodulators) were analyzed. Statistical analysis was performed using SPSSv22.0. Univariate and multivariate analyses were performed to assess factors associated with early and late onset UC. Results: From the analyzed patients, 207 had UC diagnosed before the age of 40 years old (43.5% men; mean age at diagnosis 29.4 ± 6.9 years) and 103 were diagnosed after that age (61.2% men; mean age at diagnosis 51.8 ± 8.1 years). In the group diagnosed before 40 years old, female gender (p = 0.003), severe disease (p = 0.002), chronic intermittent clinical course (p = 0.026), and hospitalizations (p = 0.001) were significantly more frequent. The use of oral aminosalicylates (p = 0.032), systemic steroids (p = 0.003) and immunomodulators (p = 0.012) were also more common in the early onset UC group. No differences between groups were found in family history, smoking, disease's extension, extraintestinal manifestations, and use of biological agents. Multivariate analysis pointed early onset UC to be significantly associated with female gender (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.08-2.91; p = 0.024), chronic intermittent symptoms (OR, 2.34; 95% CI, 1.17-4.70; p = 0.016), and need of hospitalization (OR, 2.89; 95% CI, 1.46-5.72; p = 0.002). Conclusions: When diagnosed before the age of 40-years-old, UC preferably affects women and manifests as a more severe disease, with more frequent hospitalizations and chronic intermittent symptoms. These facts might have implications in planning timely and individualized future therapeutic strategies. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015001000007&lng=en&nrm=iso&tlng=en Eosinophilic esophagitis is a chronic immunoallergic inflammatory disease of the esophagus that represents a major cause of digestive morbidity among the pediatric and young adult populations. Despite the fact that key symptoms in adults include dysphagia and food impaction, many patients lack structural changes in the esophagus to account for their complaints, which suggests the presence of underlying motor disorders and esophageal distensibility impairment. In the last few years the esophageal motility of these patients has been studied using various approaches, most particularly high-resolution manometry, ambulatory manometry, and impedance planimetry. This review focuses on the most relevant findings and scientific evidence regarding esophageal motor disorders in eosinophilic esophagitis.<hr/>La esofagitis eosinofílica es una enfermedad inflamatoria crónica del esófago con una base inmunoalérgica que representa una de las principales causas de morbilidad digestiva en la población pediátrica y adulta joven. A pesar de que sus síntomas principales en adultos son la disfagia y las impactaciones alimentarias, gran parte de los pacientes no presentan alteraciones estructurales esofágicas que justifiquen estos síntomas, lo que sugiere la presencia de trastornos motores y alteraciones de la distensibilidad esofágica subyacentes. En los últimos años se ha estudiado la motilidad esofágica de estos pacientes mediante diferentes métodos, entre los que destacan la manometría de alta resolución, la manometría ambulatoria y la planimetría por impedancia. Esta revisión recoge los hallazgos más relevantes y la evidencia científica más destacada acerca de las alteraciones motoras esofágicas en la esofagitis eosinofílica. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015001000008&lng=en&nrm=iso&tlng=en Eosinophilic esophagitis is a chronic immunoallergic inflammatory disease of the esophagus that represents a major cause of digestive morbidity among the pediatric and young adult populations. Despite the fact that key symptoms in adults include dysphagia and food impaction, many patients lack structural changes in the esophagus to account for their complaints, which suggests the presence of underlying motor disorders and esophageal distensibility impairment. In the last few years the esophageal motility of these patients has been studied using various approaches, most particularly high-resolution manometry, ambulatory manometry, and impedance planimetry. This review focuses on the most relevant findings and scientific evidence regarding esophageal motor disorders in eosinophilic esophagitis.<hr/>La esofagitis eosinofílica es una enfermedad inflamatoria crónica del esófago con una base inmunoalérgica que representa una de las principales causas de morbilidad digestiva en la población pediátrica y adulta joven. A pesar de que sus síntomas principales en adultos son la disfagia y las impactaciones alimentarias, gran parte de los pacientes no presentan alteraciones estructurales esofágicas que justifiquen estos síntomas, lo que sugiere la presencia de trastornos motores y alteraciones de la distensibilidad esofágica subyacentes. En los últimos años se ha estudiado la motilidad esofágica de estos pacientes mediante diferentes métodos, entre los que destacan la manometría de alta resolución, la manometría ambulatoria y la planimetría por impedancia. Esta revisión recoge los hallazgos más relevantes y la evidencia científica más destacada acerca de las alteraciones motoras esofágicas en la esofagitis eosinofílica. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015001000009&lng=en&nrm=iso&tlng=en Eosinophilic esophagitis is a chronic immunoallergic inflammatory disease of the esophagus that represents a major cause of digestive morbidity among the pediatric and young adult populations. Despite the fact that key symptoms in adults include dysphagia and food impaction, many patients lack structural changes in the esophagus to account for their complaints, which suggests the presence of underlying motor disorders and esophageal distensibility impairment. In the last few years the esophageal motility of these patients has been studied using various approaches, most particularly high-resolution manometry, ambulatory manometry, and impedance planimetry. This review focuses on the most relevant findings and scientific evidence regarding esophageal motor disorders in eosinophilic esophagitis.<hr/>La esofagitis eosinofílica es una enfermedad inflamatoria crónica del esófago con una base inmunoalérgica que representa una de las principales causas de morbilidad digestiva en la población pediátrica y adulta joven. A pesar de que sus síntomas principales en adultos son la disfagia y las impactaciones alimentarias, gran parte de los pacientes no presentan alteraciones estructurales esofágicas que justifiquen estos síntomas, lo que sugiere la presencia de trastornos motores y alteraciones de la distensibilidad esofágica subyacentes. En los últimos años se ha estudiado la motilidad esofágica de estos pacientes mediante diferentes métodos, entre los que destacan la manometría de alta resolución, la manometría ambulatoria y la planimetría por impedancia. Esta revisión recoge los hallazgos más relevantes y la evidencia científica más destacada acerca de las alteraciones motoras esofágicas en la esofagitis eosinofílica. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015001000010&lng=en&nrm=iso&tlng=en Solitary fibrous tumor (SFT) is a rare mesenchymal tumor. Given its origin, it can appear in almost any location. In the literature, only 50 cases of SFT in the liver parenchyma have been reported. Despite its rarity, this entity should be included in the differential diagnosis of liver masses. We report the first case with imaging data from five years prior to diagnosis, which was treated by right portal embolization and arterial tumor embolization, and subsequent liver resection. We also present an exhaustive review of the cases described to date.<hr/>El tumor fibroso solitario (TFS) es una neoplasia mesenquimal infrecuente. Dado su origen, puede aparecer en prácticamente cualquier localización. En la literatura sólo hay 50 casos descritos de TFS localizado en el parénquima hepático. A pesar de su rareza, debe ser considerada dentro del diagnóstico diferencial de una masa hepática. Presentamos el primer caso con seguimiento por imagen desde 5 años antes del diagnóstico, tratado mediante embolización portal derecha y embolización arterial tumoral con posterior resección hepática, así como una revisión exhaustiva de los casos descritos hasta la actualidad. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015001000011&lng=en&nrm=iso&tlng=en Solitary fibrous tumor (SFT) is a rare mesenchymal tumor. Given its origin, it can appear in almost any location. In the literature, only 50 cases of SFT in the liver parenchyma have been reported. Despite its rarity, this entity should be included in the differential diagnosis of liver masses. We report the first case with imaging data from five years prior to diagnosis, which was treated by right portal embolization and arterial tumor embolization, and subsequent liver resection. We also present an exhaustive review of the cases described to date.<hr/>El tumor fibroso solitario (TFS) es una neoplasia mesenquimal infrecuente. Dado su origen, puede aparecer en prácticamente cualquier localización. En la literatura sólo hay 50 casos descritos de TFS localizado en el parénquima hepático. A pesar de su rareza, debe ser considerada dentro del diagnóstico diferencial de una masa hepática. Presentamos el primer caso con seguimiento por imagen desde 5 años antes del diagnóstico, tratado mediante embolización portal derecha y embolización arterial tumoral con posterior resección hepática, así como una revisión exhaustiva de los casos descritos hasta la actualidad. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015001000012&lng=en&nrm=iso&tlng=en Solitary fibrous tumor (SFT) is a rare mesenchymal tumor. Given its origin, it can appear in almost any location. In the literature, only 50 cases of SFT in the liver parenchyma have been reported. Despite its rarity, this entity should be included in the differential diagnosis of liver masses. We report the first case with imaging data from five years prior to diagnosis, which was treated by right portal embolization and arterial tumor embolization, and subsequent liver resection. We also present an exhaustive review of the cases described to date.<hr/>El tumor fibroso solitario (TFS) es una neoplasia mesenquimal infrecuente. Dado su origen, puede aparecer en prácticamente cualquier localización. En la literatura sólo hay 50 casos descritos de TFS localizado en el parénquima hepático. A pesar de su rareza, debe ser considerada dentro del diagnóstico diferencial de una masa hepática. Presentamos el primer caso con seguimiento por imagen desde 5 años antes del diagnóstico, tratado mediante embolización portal derecha y embolización arterial tumoral con posterior resección hepática, así como una revisión exhaustiva de los casos descritos hasta la actualidad. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015001000013&lng=en&nrm=iso&tlng=en Solitary fibrous tumor (SFT) is a rare mesenchymal tumor. Given its origin, it can appear in almost any location. In the literature, only 50 cases of SFT in the liver parenchyma have been reported. Despite its rarity, this entity should be included in the differential diagnosis of liver masses. We report the first case with imaging data from five years prior to diagnosis, which was treated by right portal embolization and arterial tumor embolization, and subsequent liver resection. We also present an exhaustive review of the cases described to date.<hr/>El tumor fibroso solitario (TFS) es una neoplasia mesenquimal infrecuente. Dado su origen, puede aparecer en prácticamente cualquier localización. En la literatura sólo hay 50 casos descritos de TFS localizado en el parénquima hepático. A pesar de su rareza, debe ser considerada dentro del diagnóstico diferencial de una masa hepática. Presentamos el primer caso con seguimiento por imagen desde 5 años antes del diagnóstico, tratado mediante embolización portal derecha y embolización arterial tumoral con posterior resección hepática, así como una revisión exhaustiva de los casos descritos hasta la actualidad. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015001000014&lng=en&nrm=iso&tlng=en Solitary fibrous tumor (SFT) is a rare mesenchymal tumor. Given its origin, it can appear in almost any location. In the literature, only 50 cases of SFT in the liver parenchyma have been reported. Despite its rarity, this entity should be included in the differential diagnosis of liver masses. We report the first case with imaging data from five years prior to diagnosis, which was treated by right portal embolization and arterial tumor embolization, and subsequent liver resection. We also present an exhaustive review of the cases described to date.<hr/>El tumor fibroso solitario (TFS) es una neoplasia mesenquimal infrecuente. Dado su origen, puede aparecer en prácticamente cualquier localización. En la literatura sólo hay 50 casos descritos de TFS localizado en el parénquima hepático. A pesar de su rareza, debe ser considerada dentro del diagnóstico diferencial de una masa hepática. Presentamos el primer caso con seguimiento por imagen desde 5 años antes del diagnóstico, tratado mediante embolización portal derecha y embolización arterial tumoral con posterior resección hepática, así como una revisión exhaustiva de los casos descritos hasta la actualidad. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015001000015&lng=en&nrm=iso&tlng=en Solitary fibrous tumor (SFT) is a rare mesenchymal tumor. Given its origin, it can appear in almost any location. In the literature, only 50 cases of SFT in the liver parenchyma have been reported. Despite its rarity, this entity should be included in the differential diagnosis of liver masses. We report the first case with imaging data from five years prior to diagnosis, which was treated by right portal embolization and arterial tumor embolization, and subsequent liver resection. We also present an exhaustive review of the cases described to date.<hr/>El tumor fibroso solitario (TFS) es una neoplasia mesenquimal infrecuente. Dado su origen, puede aparecer en prácticamente cualquier localización. En la literatura sólo hay 50 casos descritos de TFS localizado en el parénquima hepático. A pesar de su rareza, debe ser considerada dentro del diagnóstico diferencial de una masa hepática. Presentamos el primer caso con seguimiento por imagen desde 5 años antes del diagnóstico, tratado mediante embolización portal derecha y embolización arterial tumoral con posterior resección hepática, así como una revisión exhaustiva de los casos descritos hasta la actualidad. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015001000016&lng=en&nrm=iso&tlng=en Solitary fibrous tumor (SFT) is a rare mesenchymal tumor. Given its origin, it can appear in almost any location. In the literature, only 50 cases of SFT in the liver parenchyma have been reported. Despite its rarity, this entity should be included in the differential diagnosis of liver masses. We report the first case with imaging data from five years prior to diagnosis, which was treated by right portal embolization and arterial tumor embolization, and subsequent liver resection. We also present an exhaustive review of the cases described to date.<hr/>El tumor fibroso solitario (TFS) es una neoplasia mesenquimal infrecuente. Dado su origen, puede aparecer en prácticamente cualquier localización. En la literatura sólo hay 50 casos descritos de TFS localizado en el parénquima hepático. A pesar de su rareza, debe ser considerada dentro del diagnóstico diferencial de una masa hepática. Presentamos el primer caso con seguimiento por imagen desde 5 años antes del diagnóstico, tratado mediante embolización portal derecha y embolización arterial tumoral con posterior resección hepática, así como una revisión exhaustiva de los casos descritos hasta la actualidad. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015001000017&lng=en&nrm=iso&tlng=en Solitary fibrous tumor (SFT) is a rare mesenchymal tumor. Given its origin, it can appear in almost any location. In the literature, only 50 cases of SFT in the liver parenchyma have been reported. Despite its rarity, this entity should be included in the differential diagnosis of liver masses. We report the first case with imaging data from five years prior to diagnosis, which was treated by right portal embolization and arterial tumor embolization, and subsequent liver resection. We also present an exhaustive review of the cases described to date.<hr/>El tumor fibroso solitario (TFS) es una neoplasia mesenquimal infrecuente. Dado su origen, puede aparecer en prácticamente cualquier localización. En la literatura sólo hay 50 casos descritos de TFS localizado en el parénquima hepático. A pesar de su rareza, debe ser considerada dentro del diagnóstico diferencial de una masa hepática. Presentamos el primer caso con seguimiento por imagen desde 5 años antes del diagnóstico, tratado mediante embolización portal derecha y embolización arterial tumoral con posterior resección hepática, así como una revisión exhaustiva de los casos descritos hasta la actualidad. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015001000018&lng=en&nrm=iso&tlng=en Solitary fibrous tumor (SFT) is a rare mesenchymal tumor. Given its origin, it can appear in almost any location. In the literature, only 50 cases of SFT in the liver parenchyma have been reported. Despite its rarity, this entity should be included in the differential diagnosis of liver masses. We report the first case with imaging data from five years prior to diagnosis, which was treated by right portal embolization and arterial tumor embolization, and subsequent liver resection. We also present an exhaustive review of the cases described to date.<hr/>El tumor fibroso solitario (TFS) es una neoplasia mesenquimal infrecuente. Dado su origen, puede aparecer en prácticamente cualquier localización. En la literatura sólo hay 50 casos descritos de TFS localizado en el parénquima hepático. A pesar de su rareza, debe ser considerada dentro del diagnóstico diferencial de una masa hepática. Presentamos el primer caso con seguimiento por imagen desde 5 años antes del diagnóstico, tratado mediante embolización portal derecha y embolización arterial tumoral con posterior resección hepática, así como una revisión exhaustiva de los casos descritos hasta la actualidad.