J. M. Segura Cabral

Púrpura trombocitopénica idiopática como manifestación extraintestinal de la enfermedad de Crohn

Resumen La purpura trombocitopenica idiopatica es una manifestacion extraintestinal poco frecuente de la enfermedad inflamatoria intestinal, y sobre todo es rara en la enfermedad de Crohn, donde presenta ciertas peculiaridades respecto a su clinica habitual, de tal manera que ocurre con mas frecuencia cuando la enfermedad de Crohn es de predominio colonico, suele aparecer un tiempo despues del diagnostico de esta y, ademas, complica el curso clinico de ambas enfermedades. En este trabajo se presenta un caso de enfermedad de Crohn asociada a purpura trombocitopenica idiopatica, en una mujer de 14 anos en la que la purpura trombocitopenica idiopatica se inicio de forma simultanea a la enfermedad de Crohn, con mala evolucion clinica y resistencia a los tratamientos habituales de ambas enfermedades.

Ecografía hepática: lesiones focales y enfermedades difusas

Liver ultrasound is frequently used as a first-line technique for the detection and characterization of the most common liver lesions, especially those incidentally found focal liver lesions, and for monitoring of chronic liver diseases. Ultrasound is not only used in the Bmode, but also with Doppler and, more recently, contrast-enhanced ultrasound. It is mainly used in the diagnosis of diffuse liver diseases, such as steatosis or cirrhosis. This article presents a practical approach for diagnosis workup, in which the different characteristics of the main focal liver lesions and diffuse liver diseases are reviewed.

Anatomía ecográfica abdominal normal. Sistemática de exploración

To carry out an abdominal ultrasound examination with the highest degree of accuracy and thoroughness, it is essential to have a good knowledge of the anatomy and the normal measurements of the different organs. In this way, we can determine their normal condition and identify the pathology and its location more easily. It is very important to adopt a correct examination procedure, systematically sweeping the scan in the same direction and not leaving any organ unexamined. We suggest a procedure consisting of longitudinal, cross-sectional and oblique scans to view all the abdominal organs, starting the examination in the epigastric region, scanning first the right upper quadrant, then the left upper quadrant, both iliac fossa, and lastly the hypogastric region.

Chronic hepatitis C treatment in a cystic fibrosis patient in the pulmonary pre-transplant stage

The standard treatment of chronic hepatitis C, pegylated interferon and ribavirin (pegI/R), has many limitations in both effectiveness and secondary effects, which makes it unsuitable or even contraindicated for some patients. In hepatitis C virus-infected cystic fibrosis patients this treatment could increase respiratory infections with subsequent pulmonary function deterioration. On the contrary, hepatitis C virus (HCV) infection may make lung transplant (LT) unfeasible. We present the case of a cystic fibrosis-young man diagnosed with HCV infection during LT assessment who was treated with pegI/R. In spite of the lung function worsening and respiratory infections, he managed to complete treatment and even sustained virological response (SVR). At present he is on LT waiting list.

Amiloidosis globular focal localizada en colon: Un diagnóstico inusual

Globular amyloidosis is a very infrequent amyloidosis subtype, characterized by the deposition of rounded bodies of protein, occasionally perivascular instead of the usual linear deposits. The most frequently affected organ is the liver, although other organs can also been involved. To date, only eight cases (1-3) of globular amyloidosis of the gastrointestinal tract have been described. Clinical meaning of this morphologic variation of amyloidosis is unknown.

Complicacion inusual de las arañas vasculares: diátesis hemorrágica con control del sangrado con terapia antihormonal (tamoxifeno)

Las arañas vasculares son lesiones cutáneas que se presentan en la cirrosis hepática observándose con mayor frecuencia en el territorio de la vena cava inferior (1). Su presencia se relaciona con la existencia de insuficiencia hepatocelular, que alteraría el metabolismo estrogénico, induciendo la formación de estas lesiones. Se describen con mayor frecuencia asociadas a la cirrosis de origen etílico, en la que los cambios hormonales son más marcados (2). Sin embargo, estudios recientes relacionan su formación con la activación de los procesos de angiogénesis y un mayor grado de hipertensión portal. También se ha relacionado el aumento del número de estas lesiones y su tamaño, con mayor riesgo de sangrado por varices esofágicas (3). Estas lesiones suelen presentar un curso clínico silente; no hemos encontrado en la literatura la complicación con diátesis hemorrágica. Presentamos el caso de una paciente con sangrado por lesiones angiomatosas en tórax con curso tórpido que precisó la resección quirúrgica; destacamos la respuesta terapéutica (control del sangrado) con tamoxifeno. Caso clínico

Ecografía de la vesícula y la vía biliar

The cystic nature of the gallbladder and bile duct when dilated, and the advantages of ultrasound as a quick, reproducible, convenient, cheap and low risk technique, with a high sensitivity and specificity, make it the most eligible technique in biliary pathology studies. Ultrasound has become a valuable tool for doctors studying biliary pathology and its complications, from abnormal liver function results, right upper quadrant pain, or jaundice, to cholelithiasis, cholecystitis, or suspicion of biliary tumors.

P367 Compliance to the scheduled treatment with infliximab. Experience in a tertiary care hospital

Background: Scheduled infliximab infusions are effective inducing and maintaining remission in IBD. Compliance with the schedule is important to avoid infusional reactions and loss of response. The aim of this report is to assess the compliance to this treatment in our Unit. Methods: All infliximab infusions received in the IBD Day Care Centre of our hospital since its opening in March 2007 were recorded. Treatment schedule consists in an induction phase 0, 2, 6 weeks and maintenance every 8 weeks. Treatment intensification was prescribed following medical criteria. Infusion delay was defined when the interval between two maintenance doses exceeded 63 days (9 weeks) or when infusion was delayed more than 5 days from calculated date in the induction phase. Intervals when treatment was stopped due to pregnancy, “drug holidays” by medical criteria, etc were excluded. We define “non-adherent patient” when at least three doses and 25% of the total are delayed. Results: 128 patients received 1508 infliximab infusions in our hospital from March 2007 to October 2011. Mean number of infusions was 11.78 (SD 8.9). 60 patients (46.9%) were male and 68 (53.1%) female. The indication was Crohn’s disease in 98 patients (76.5%) and ulcerative colitis in 30 (23.4%). Age at start of the therapy was 39 years (SD 14.6 range 15 77). 74 patients (57.81%) had some dose delayed, being 1.73 the mean number of infusion delayed (SD 2.4). Mean delay was 11.97 days (SD 16.4 median 7 days). Only 19 (14.84%) patients had at least one interval between doses greater than 12 weeks. 13 patients were defined as non-adherent (10,15%) 8 male (53.3%) and 5 female. The type of disease was Crohn in 9 cases (69.2%) and ulcerative colitis in 4 (30.8%). Differences between adherent (AP) and non-adherent patients (NAP) were analyzed: there is no difference in gender or type of disease. Statistically significant differences were found in mean age at start of the therapy (39.44 SD 14.6 AP vs 25.67 SD 5.6 NAP, p < 0.001), number of doses received 11.78 SD 8.9 AP vs 19.15 SD 7.9, NAP p < 0.001), and time on therapy (202.25 SD 9.6 AP vs 99.3 SD 94.9 NAP, p < 0.001). There is no difference in treatment intensification need between both groups; 24 of 115 patients (20.8%) in adherent vs 3 of 13 (23%) in non-adherent (p =NS). Conclusions: Our patients have a good scheduled doses compliance on infliximab therapy in our Unit, even after years of treatment. Risk factors for poor compliance are young patients and need of prolonged therapy. P368 Routine practice of iron infusion therapy in IBD T. Iqbal1 *, G. Rogler2, C. Hoffman3, J. Stein4. 1University Hospital Birmingham, Gastroenterology, Birmingham, United Kingdom, 2University Hospital Zurich, Klinik fur Gastroenterologie und Hepatologie Department fur Innere Medizin, Zurich, Switzerland, 3Vifor Pharma Ltd., Glattbrugg, Switzerland, 4Interdisciplinary Crohn Colitis Centre Rhein Main, Frankfurt, Germany