[Current indications for proton pump inhibitors].
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Biomedical subjects
Publications and source records attributed to J Berenguer Lapuerta.
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Hepatitis C virus (HCV) infection has been linked with some extrahepatic immunologic abnormalities. Cryoglobulinemia is one of the most frequently reported. Nevertheless, there are only a few reports of cryoglobulinemia in the setting of liver transplantation. More studies are needed to clarify the frequency of post-OLT cryoglobulinemia in patients with HCV-related cirrhosis and its impact on OLT outcome. A case of a patient who underwent liver transplantation because of HCV end-stage liver disease and in whom cryoglobulinemia appeared 3 years after transplantation is reported. Treatment with cyclophosphamide and steroids was attempted but patient died of septicemia 3 years after liver transplantation.
The blue rubber bleb nevus syndrome is a rare entity characterized by the presence of cavernous hemangiomas in the skin and gastrointestinal tract with frequent digestive hemorrhages. Different therapeutic modalities exist: medical treatment, surgical resection; and most recently, endoscopic therapy has been described. We present a patient with blue rubber bleb nevus syndrome treated with combined endoscopic therapy: sclerosis and band ligation.
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Toxic hepatitis is an infrequent secondary effect of amoxycillin-clavulanic acid with fewer than 30 well documented cases in the literature. Presentation is usually that of acute cholestasis several weeks after the initiation of treatment with this antibiotic. A new case of hepatic toxicity by amoxycillin-clavulanic acid is reported in a 47-years-old male who had taken this drug for a diarrhea syndrome. A brief review of the literature is made with special emphasis on the anatomopathologic aspects.
OBJECTIVE: To evaluate if the clinical presentation and the response to pneumatic dilation is different in patients with achalasia with an apparent normal lower esophageal sphincter relaxation. DESIGN: Prospective study to compare clinical, radiographic and manometric characteristics and the response to pneumatic dilation according to the ability of the lower esophageal sphincter to relax normally. PATIENTS: One hundred and fifty seven consecutive patients with achalasia were included. Relaxation of the lower esophageal sphincter was abnormal in 130 patients and apparently normal in 27. The response to pneumatic dilation was evaluated in 116 patients, 94 with abnormal function of the lower esophageal sphincter and 22 with normal function. RESULTS: Clinical findings, esophageal diameter and basal pressure of the lower esophageal sphincter were similar in both groups. The efficacy of the dilation, the number of dilations and the rate of complications were also similar. CONCLUSIONS: Patients with achalasia and an apparent normal lower esophageal sphincter relaxation are not different from patients with typical achalasia and present a similar response to pneumatic dilation.
Treatment of the benign obstruction of the main bile duct remains controversial. A questionnaire, containing the different aspects of the treatment, was mailed in order to learn the general opinion about its management in our country; 140 specialists were surveyed with the following results: 35% gave valid answers. Most of those surveyed (85%) use antibiotic prophylaxis, preferably (79%) pre and postoperatively. Ultrasonography is used in 100% of the cases, and the second most common examination is endoscopic retrograde colangiopan-creatography. Among the intraopreoperative examinations, colangiography is the most used (100%), followed by choledochoscopy. A majority (90.4%) of those surveyed employ the T-tube and 67.5% prefer choledochoduodenostomy if an internal bile drainage must be performed. In obstructive jaundice, only 27.5% recommend preoperative percutaneous drainage. Endoscopic sphinterotomy is the elective technique for suppurative cholangitis and for patients with choledocholitiasis and previous cholecystectomy.
The current debate involving Helicobacter pylori (H.p.) and its potential role as an etiological factor for some digestive diseases, as well as the recent discussion through different mass media of this bacterium, including the American N.I.H. Consensus, have lead to the discussion of the H.p. problem, in order to clarify its real importance in acid-related diseases. Thus we want, as gastroenterologists, to give an overview of the current status, so as to facilitate the general practitioner work when confronted with gastrointestinal diseases, particularly related to H.p. Our purpose is to provide a critical and objective view regarding the implications of H.p. infection, and explain when treatment is needed and how this treatment should be accomplished.
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The prognosis of 189 patients with upper gastrointestinal bleeding was studied with the assistance of a computer. The safety of the prognosis given by the doctor was partially improved with the computer. However, when both judgements were simultaneously considered, the best results were obtained. A scoring-system constructed with simple clinical data proved useful to obtain prognostic judgements with high sensitivity and specificity. It is concluded that the reliability of the prognosis given in patients with upper gastrointestinal bleeding can be improved with objective methods. The improvement is maximal if objective information is evaluated together with clinical information.
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