Primary Sclerosing Cholangitis: Gender Effects in Valencia's Low-Prevalence Region

BACKGROUND AND AIMS

Recent studies point out to epidemiological changes in primary sclerosing cholangitis (PSC). Our aims were to determine in PSC patients followed in several centers in a Mediterranean geographic area: (i) changes in baseline features and (ii) effect of gender on clinical course.

METHODS

Retrospective multicenter study of PSC patients treated in 8 hospitals in a Mediterranean area between 2000 and 2021. Charts were reviewed compiling demographic, clinical, radiological, and histological variables.

RESULTS

Cohort of 112 PSC patients included, 42% women, 70% diagnosed after 2010. Women were increasingly diagnosed in recent cohorts. The median time from diagnosis to the combined endpoint liver transplantation (Lt) and/or death was 6.9 years. Asthenia at diagnosis (p = 0.009) was associated with lower transplant-free survival, while diagnosis before 2005 was associated with greater LT-free survival (p < 0.001). By Cox regression, LT-free survival was not influenced by age, sex, or cirrhosis at the time of diagnosis. Women were found to have less jaundice at diagnosis (2 vs 14%; p = 0.013), higher prevalence of ANA antibodies (43.9 vs 15.7%; p = 0.003), and lower GGT levels at diagnosis (GGT 123 vs 209U/L; p = 0.014) than men.

CONCLUSION

In an area traditionally considered to have low prevalence, the prevalence of affected women surpasses expectations based on existing literature. There appear to be gender-related variations in the presentation of the condition, highlighting the need for confirmation through larger-scale studies.

Predictors of rehospitalization in Psychotic Patients after their first hospitalization

Introduction

It is important to determine those clinical factors that imply a greater risk of rehospitalization in psychotic patients

Objectives

To determine the rate and predictors of rehospitalization in psychotic patients after their first hospitalization

Methods

We include all Psychotic patients admitted for first time in their life in our Psychiatric Unit between 2009 and 2019 (N=359) , including all diagnosed according DSM-IV of Schizophrenia or other Psychotic disorders -Multiple clinical, sociodemographic and biological variables of the basal hospitalization were recorded With the SPSS program we compared the variables between patients who needed any hospitalization in the follow-up until 31th December 2019 and those who do not. We use the Chi square ( qualitative variables) and the Student T ( quantitative variables)

Results

109 psychotic inpatients had at least one rehospitalizations (30,4%). The qualitative variables significantly associated with rehospitalization were : cannabis in urine at admission (P<0.03), and treatment with risperidone (P<0.014). Instead treatment with long acting paliperidone was associated with absence of rehospitalization (P<0.005) .The quantitative variables relationed significantly with multiple rehospitalization were : lower age (P<0,015) lower HDL cholesterol levels (P<0.02) and higher years of follow-up after discharge (P<0.000)

Conclusions

1-More of 30% of psychotic patients need rehospitalization after their first hospitalization in a mean of follow up of 5,8 years 2-Lower age, longer follow-up period and treatment with risperidone are significantly associated with rehospitalization , instead treatment with long acting paliperidone are significantly associated with absence of rehospitalization

Disclosure

No significant relationships.

Completed suicide in bipolar i patients after their first hospitalisation

Introduction

Bipolar disorder is a mental disorder that has one of the greatest risk of completed suicide (CS)

Objectives

Determine the rate and the risk factors of CS in a cohort of Bipolar I patients followed after their first hospitalization

Methods

We choose all Bipolar I patients (DSM-IV) who were first time hospitalized in our Psychiatric unit between 1996 and 2016. We reviewed the charts of first hospitalization and recorded multiple baseline variables. In the follow-up we updated the database recording all patients who CS. We compared the different baseline variables between Bipolar patients who CS and the rest.

Results

Of a total of 254 bipolar I patients 9 (3,5%) CS in the mean of 13 years of follow up (rate 40 times higher than General Population). The average age at CS was 41.1 years (range between 26 and 71 years old) so there was a 9 years gap on average between the first psychiatric hospitalization and suicide. CS was characterized by a violent act (8 out of 9 cases, 89 %). When we compared BP patients who CS with the rest, only history of suicide in first-degree relatives was detected as a risk factor significantly associated (P<0.01) with CS. Conversely baseline treatment with anticonvulsants (mainly valproate) was detected as a significantly (P<0.004) protective factor of CS.

Conclusions

1-Bipolar I patients after first hospitalization completed suicide 40 times higher than general population almost always by violent method 2-History of CS in first-degree relatives is predictor of completed suicide

Disclosure

No significant relationships.

Completed suicide in bipolar ii patients after their first hospitalization

Introduction

Bipolar disorder, especially Bipolar II subtype, is a mental disorder that has one of the greatest risk of completed suicide (CS).

Objectives

Determine the rate and the risk factors of CS in a cohort of Bipolar II patients followed after their first hospitalization

Methods

We choose all Bipolar II patients (DSM-IV) who were hospitalized for first time in our Psychiatric unit between 1996 and 2016. We reviewed the charts of first hospitalization and recorded multiple baseline variables. In the follow-up we updated the database recording all patients who CS. We compared the different baseline variables between Bipolar II patients who CS and the rest

Results

Of a total of 59 bipolar II patients 6 (10 %) CS in the mean of 13 years of follow up (rate 120 times higher than General Population). The average age at CS was 45.3 years (range between 33 and 57 years old) so there was a 2 years gap on average between the first psychiatric hospitalization and suicide. CS was characterized by a violent act (5 out of 6 cases, 83 %). When we compared BP II patients who CS with the rest, only history of previous violent suicide attempt was detected as a risk factor significantly associated (P<0.04) with CS.

Conclusions

Bipolar II patients CS early after their first hospitalization and at very high rate (120 times than GP) almost always by violent method. History of previous violent suicide attempt is predictor of completed suicide

Disclosure

No significant relationships.

De novo assembly of the Brown trout (Salmo trutta m. fario) brain and muscle transcriptome: transcript annotation, tissue differential expression profile and SNP discovery

OBJECTIVES

The Brown trout is a salmonid species with a high commercial value in Europe. Life history and spawning behaviour include resident (Salmo trutta m. fario) and migratory (Salmo trutta m. trutta) ecotypes. The main objective is to apply RNA-seq technology in order to obtain a reference transcriptome of two key tissues, brain and muscle, of the riverine trout Salmo trutta m. fario. Having a reference transcriptome of the resident form will complement genomic resources of salmonid species.

DATA DESCRIPTION

We generate two cDNA libraries from pooled RNA samples, isolated from muscle and brain tissues of adult individuals of Salmo trutta m. fario, which were sequenced by Illumina technology. Raw reads were subjected to de-novo transcriptome assembly using Trinity, and coding regions were predicted by TransDecoder. A final set of 35,049 non-redundant ORF unigenes were annotated. Tissue differential expression analysis was evaluated by Cuffdiff. A False Discovery Rate (FDR) ≤ 0.01 was considered for significant differential expression, allowing to identify key differentially expressed unigenes. Finally, we have identified SNP variants that will be useful tools for population genomic studies.

Angular flux creep contributions in YBa2Cu3O7-δ nanocomposites from electrical transport measurements

The shape of the electric-field—current-density (E-J) curve is determined by flux pinning and also by dynamics of vortices. Here, we propose a novel methodology to study the normalized flux creep rate S in YBa₂Cu₃O_7−δ measured from E-J curves obtained by electrical transport measurements that provides a fast and versatile way to foresee the flux magnetic relaxation in films and disentangle angular flux creep contributions by the scaling of the isotropic contribution of S. After a detailed comparison of various pristine and nanocomposite films with differentiated nanostructures, we focus on the roles that intrinsic pinning and stacking faults (YBa₂Cu₄O₈-intergrowths) play when the magnetic field is applied parallel to the superconducting CuO₂ planes. This study reveals that the emerging intergrowths provide advanced pinning properties that additionally reduce the thermal activated flux magnetic relaxation. For this purpose, creep analysis becomes a very appropriate tool to elucidate the dominance of the different pinning sites at different regions of the magnetic-field—temperature diagram.

Untangling surface oxygen exchange effects in YBa2Cu3O6+x thin films by electrical conductivity relaxation

The kinetics of oxygen incorporation (in-diffusion process) and excorporation (out-diffusion process), in YBa₂Cu₃O_6+x (YBCO) epitaxial thin films prepared using the chemical solution deposition (CSD) methodology by the trifluoroacetate route, was investigated by electrical conductivity relaxation measurements. We show that the oxygenation kinetics of YBCO films is limited by the surface exchange process of oxygen molecules prior to bulk diffusion into the films. The analysis of the temperature and oxygen partial pressure influence on the oxygenation kinetics has drawn a consistent picture of the oxygen surface exchange process enabling us to define the most likely rate determining step. We have also established a strategy to accelerate the oxygenation kinetics at low temperatures based on the catalytic influence of Ag coatings thus allowing us to decrease the oxygenation temperature in the YBCO thin films.

Effects of afforestation on runoff and sediment load in an upland Mediterranean catchment

This paper assesses annual and seasonal trends in runoff and sediment load resulting from climate variability and afforestation in an upland Mediterranean basin, the Ribera Salada (NE Iberian Peninsula). We implemented a hydrological and sediment transport distributed model (TETIS) with a daily time-step, using continuous discharge and sediment transport data collected at a monitoring station during the period 2009-2013. Once calibrated and validated, the model was used to simulate the hydrosedimentary response of the basin for the period 1971-2014 using historical climate and land use data. Simulated series were further used to (i) detect sediment transport and hydrologic trends at different temporal scales (annual, seasonal); (ii) assess changes in the contribution of extreme events (i.e. low and high flows) and (ii) assess the relative effect of forest expansion and climate variability on trends observed by applying a scenario of constant land use. The non-parametric Mann-Kendall test indicated upward trends for temperature and decreasing trends (although non-significant) for precipitation. Downward trends occurred for annual runoff, and less significantly for sediment yield. Reductions in runoff were less intense when afforestation was not considered in the model, while trends in sediment yield were reversed. Results also indicated that an increase in the river's torrential behaviour may have occurred throughout the studied period, with low and high flow events gaining importance with respect to the annual contribution, although its magnitude was reduced over time.

Information resources used by patients with inflammatory bowel disease: Satisfaction, expectations and information gaps

BACKGROUND AND PURPOSE

Information received by IBD patients about their disease is of particular importance. The objective of the study was to determine the information resources these patients used, together with their perceived information gaps and expected preferences.

PATIENTS AND METHODS

A prospective, observational, cross-sectional study conducted on IBD patients attending 13 Spanish hospitals during 2008. Patients completed a semi-structured 52-question survey.

RESULTS

Survey was adequately completed by 379 of 385 patients (98%), of whom 57% had Crohn's disease and 43% ulcerative colitis. Mean patient age was 37.9 years (range, 16-76 years). Gastroenterologists were the most commonly used resource (98%), followed by the Internet (60%), and general practitioners (50%). More than 90% reported good to excellent satisfaction with gastroenterologists, nurses, and patients' associations. Only 56% considered their information needs to be covered. The Internet was mostly used by young patients and those with a high education level. In the future, 85% of the patients would like to receive information from the gastroenterologists, and 92% by face-to-face interviews. Patients mainly want additional information on treatment (medical and surgical), clinical manifestations, cancer, and mortality risks. They also think that they are poorly informed about their social and work rights, risks of cancer and death, and research trials.

CONCLUSIONS

Patients with IBD use and prefer gastroenterologists as the main source of information, but only half of them consider their information needs to be covered.

Nanoscale strain-induced pair suppression as a vortex-pinning mechanism in high-temperature superconductors

Boosting large-scale superconductor applications require nanostructured conductors with artificial pinning centres immobilizing quantized vortices at high temperature and magnetic fields. Here we demonstrate a highly effective mechanism of artificial pinning centres in solution-derived high-temperature superconductor nanocomposites through generation of nanostrained regions where Cooper pair formation is suppressed. The nanostrained regions identified from transmission electron microscopy devise a very high concentration of partial dislocations associated with intergrowths generated between the randomly oriented nanodots and the epitaxial YBa(2)Cu(3)O(7) matrix. Consequently, an outstanding vortex-pinning enhancement correlated to the nanostrain is demonstrated for four types of randomly oriented nanodot, and a unique evolution towards an isotropic vortex-pinning behaviour, even in the effective anisotropy, is achieved as the nanostrain turns isotropic. We suggest a new vortex-pinning mechanism based on the bond-contraction pairing model, where pair formation is quenched under tensile strain, forming new and effective core-pinning regions.

Worse recent efficacy of antiviral therapy in liver transplant recipients with recurrent hepatitis C: impact of donor age and baseline cirrhosis

We hypothesized that antiviral efficacy [sustained virologic response (SVR)] has improved in recent years in the transplant setting. Our aim was to assess whether the efficacy of pegylated interferon (PegIFN)-ribavirin (Rbv) has improved over time. One hundred seven liver transplant patients [74% men, 55.5 years old (range: 37.5-69.5), 86% genotype 1a or 1b] were treated with PegIFN-Rbv for 355 (16-623) days at 20.1 (1.7-132.6) months after transplantation. Tacrolimus was used in 61%. Sixty-seven percent had baseline F3-F4 (cirrhosis: 20.5%). Donor age was 49 (12-78) years. SVR was achieved in 39 (36.5%) patients, with worse results achieved in recent years (2001-2003: n = 27, 46.5%; 2004: n = 23, 43.5%; 2005: n = 21, 35%; 2006 to January 2007: n = 36, 24%; P = 0.043). Variables associated with SVR in the univariate analysis included donor age, baseline viremia and cirrhosis, bilirubin levels, rapid virologic response and early virologic response (EVR), premature discontinuation of PegIFN or Rbv, and accumulated Rbv dose. In the multivariate analysis, the variables in the model were EVR [odds ratio (OR): 0.08, 95% confidence interval (CI): 0.016-0.414, P = 0.002] and donor age (OR: 1.039, 95% CI: 1.008-1.071, P = 0.01). Variables that had changed over time included donor age, baseline viremia, disease severity (cirrhosis, baseline bilirubin, and leukocyte and platelet counts), interval between transplantation and therapy, and use of growth factors. In the multivariate analysis, variables independently changing were donor age (OR: 1.041, 95% CI: 1.013-1.071, P = 0.004), duration from transplantation to antiviral therapy (OR: 1.001, 95% CI: 1.000-1.001, P = 0.013), and baseline leukocyte count (OR: 1.000, 95% CI: 1.000-1.000, P = 0.034). In conclusion, the efficacy of antiviral therapy with PegIFN-Rbv has worsened over time, at least in our center. The increase in donor age and greater proportion of patients treated at advanced stages of disease are potential causes.

Vortex breaking and cutting in type II superconductors

In technological superconductors, the Lorentz force on the flux vortices is opposed by inhomogeneous pinning and so the critical current may be controlled by a combination of vortex entanglement, cutting, and cross-joining. To understand the roles of these processes we report measurements of structures in which a weak pinning layer is sandwiched between two strongly pinning leads. Quantitative modeling of the results demonstrates that in such systems the critical current is limited by the deformation of individual vortices and not by subsequent cross-joining processes.

Clinical benefits of antiviral therapy in patients with recurrent hepatitis C following liver transplantation

Pegylated interferon (pegIFN) and ribavirin eradicates hepatitis C virus (HCV) in one third of liver recipients with recurrent disease. Side effects are frequent and potentially life threatening. Our aim was to define the long-term benefits of antiviral therapy in recurrent HCV. Eighty-nine (89) recipients (genotype 1: 86.5%) were treated with IFN (n = 31) or pegIFN (n = 58) plus ribavirin and 75 untreated contemporaneous disease-matched controls. The major end point was survival from transplantation. Survival, progression to cirrhosis and clinical decompensation since start of therapy were compared between sustained virologic responders (SVRs) and nonresponders (NRs). Results revealed 44 patients died during the follow-up (20% treated vs. 35% controls; p = 0.05). Patient survival was higher in treated compared to controls (7 years: 74% vs. 62%; p = 0.04). Among treated patients, an SVR was achieved in 37% (IFN 16% vs. peg-IFN 48%; p = 0.03). About 2/33 SVRs and 16/56 NRs died (p = 0.01) due to HCV-disease (56%), IFN-induced rejection (11%), both causes (11%) or others (22%). Five-year survival was greater in SVRs than in NRs (93% vs. 69%, p = 0.032). In patients without baseline cirrhosis, progression to cirrhosis occurred more frequently in NRs (27/42 vs. 6/16; p = 0.06). The 5-year risk of graft decompensation was higher in NRs (33% vs. 16%; p = 0.04). Antiviral therapy is associated with improved long-term outcome in recurrent HCV.

Hysteretic vortex pinning in superconductor-ferromagnet nanocomposites

This Letter reports the observation of hysteresis in the vortex pinning in a superconductor-ferromagnetic epitaxial nanocomposite consisting of fcc Gd particles incorporated in a Nb matrix. We show that this hysteretic pinning is associated with magnetic reversal losses in the Gd particles and is fundamentally different in origin to pinning interactions previously observed for ferromagnetic particles or other microstructural features.

Crossover between channeling and pinning at twin boundaries in YBa2Cu3O7 thin films

The critical current (Jc) of highly twinned YBa2Cu3O7 films has been measured as a function of temperature, magnetic field, and angle. For much of the parameter space we observe a strong suppression of Jc for fields in the twin boundary (TB) directions; this is quantitatively modeled as flux-cutting-mediated vortex channeling. For certain temperatures and fields a crossover occurs to a regime in which channeling is blocked and the TBs act as planar pinning centers so that TB pinning enhances the overall Jc. In this regime, intrinsic pinning along the TBs is comparable to that between the twins.

Efficacy, predictors of response, and potential risks associated with antiviral therapy in liver transplant recipients with recurrent hepatitis C

There are unresolved issues regarding sustained virological response (SVR), tolerance and risk of rejection following antiviral therapy in liver transplantation (LT). The aim of our study was to determine efficacy, rejection risk and factors associated with SVR. HCV-infected LT patients with at least 6 months of follow-up following end-of-therapy (EOT) received combination therapy of ribavirin (Rbvr) + standard (n = 31)/pegIFN (n = 36) between 1999 and 2004 (95% genotype 1). An EOT and SVR was obtained in 46% and 33%, respectively. Type of antiviral therapy, use of erythropoietin, compliance, and early virologic response (EVR) were predictive of SVR, but only the latter remained in the multivariate analysis. Premature discontinuation, not impacted by the use of erythropoietin or GCSF, occurred in 40% patients. None of the variables predicted rejection (acute n = 2, chronic n = 4). A SVR occurred in 3/4 patients with chronic rejection. In conclusion, the efficacy of pegIFN-Rbvr is similar to the non-transplant population. An EVR at 3 months is useful to predict lack of response. The type of calcineurin inhibitor and history of prior non-response to IFN before LT do not influence the outcome of therapy. Severe rejection may lead to graft loss, a complication difficult to predict.

Recurrent hepatitis C genotype 1b following liver transplantation: treatment with combination interferon-ribavirin therapy

BACKGROUND

Recurrent hepatitis C is very common leading to graft cirrhosis in a significant proportion of patients. Preliminary reports of combination therapy with interferon-ribavirin have been promising but generally applied to selected patients with chronic mild disease. Little is known, however, about the efficacy and risk of adverse effects when it is used in general clinical practice.

AIMS

To analyse the efficacy (biochemical, virological and histological response) and tolerance of combination therapy in patients with recurrent hepatitis C genotype 1b.

METHODS

Twenty-four patients (mean age 54 years; range 37-67 years; 75% male) with recurrent hepatitis C virus (histology at baseline: acute hepatitis (n = 3); chronic hepatitis (n = 21) with F3 or 4 in 77%) were treated with 12 months interferon (1.5-3 MU thrice weekly) + ribavirin (600-1200 mg daily) followed by 6 months ribavirin (58%), at a median of 427 days (56-2812) after transplantation.

RESULTS

Seven patients (29%) discontinued therapy due to side effects, mainly anaemia, at a median of 3 months since initiation. Dose modifications were required in 88% of those completing the whole course of therapy. Overall, the sustained virological and biochemical response was 12.5%. This rate was slightly higher (18%) if only the 17 patients who finished the whole course of therapy were analysed. Histological improvement was achieved in 31.5% of treated patients.

CONCLUSIONS

Combination therapy has a very limited efficacy in the liver transplant setting, although some benefit may be achieved, even in those with advanced graft fibrosis. Tolerance, however, remains a matter of concern.

Severe recurrent hepatitis C after liver retransplantation for hepatitis C virus-related graft cirrhosis

An increase in the number of hepatitis C virus (HCV)-infected transplant recipients at need for repeated liver transplantation is anticipated. To date, there is a certain reluctance to accept these patients because of an increased organ shortage, early reports suggesting a poor outcome, and uncertainty regarding the natural history of recurrent hepatitis C in the second graft. The aim of this study is to determine the outcome of patients undergoing retransplantation for HCV-related graft cirrhosis. Of 49 transplant recipients with HCV-related allograft cirrhosis, 31 patients developed decompensation with criteria for retransplantation. Thirteen patients were denied this option. Of the 18 patients accepted, 6 patients died while on the waiting list (5 patients died of graft cirrhosis at a median of 3.2 months of listing), and 12 patients have undergone retransplantation (median, 10 months since HCV cirrhosis). After retransplantation, 8 patients (67%) died at a median of 8 months, and 4 patients (33%) remain alive after 1.9 years of follow-up. Causes and times of death from retransplantation were: surgical complications, n = 3 (perioperative period); HCV cirrhosis of the second graft, n = 2 (at 9 and 54 months); fibrosing cholestatic hepatitis, n = 1 (at 2 years); lymphoproliferative disorder, n = 1 (at 7 months); and endocarditis, n = 1 (at 3.5 years, with underlying cirrhosis). Of the 4 patients alive, fibrosis stages in the last biopsy specimens are stage 1 (n = 1), stage 3 (n = 1), and stage 4 or cirrhosis (n = 1; one patient has not undergone biopsy), despite antiviral therapy. The outcome of retransplantation for HCV cirrhosis of the first graft is very poor because of multiple complications. The severity of recurrent HCV disease in the second graft seems to be related to that observed in the first graft.

[Endoscopic treatment of pancreatitis and its complications]

OBJECTIVES

To study the long- and short-term safety and efficacy of endoscopic treatment of pancreatitis and its complications in our environment.

PATIENTS AND METHODS

We performed a retrospective analysis of 43 patients with chronic pancreatitis, acute pancreatitis complicated with pseudocyst, and pancreatic fistula diagnosed by endoscopic retrograde cholangiopancreatography who were suitable for endoscopic treatment.

RESULTS

Endoscopic treatment was attempted in 35 patients. The indication for treatment was pain in 17 patients (48.5%), jaundice in 7 (20%), pseudocyst in 10 (28.5%) and suspected external fistula in 1 (3%). The technique was successfully performed in 28 (80%). Of the patients with pain, pancreatic prosthesis was inserted in 13 and extracorporeal lithotripsy was applied in 6. Sixty-five percent of the patients improved. Of the 7 patients with jaundice, all had secondary stenosis of the biliary tract. Treatment was applied in 2, who showed partial improvement. Of the 15 patients with pseudocyst, endoscopic treatment was indicated in 10; the technique was successfully performed in 8 and complete resolution was achieved in 7 (87.5%). The patient with external fistula was treated with transpapillary prosthesis and complete resolution of disruption of Wirsung's duct was achieved. Overall improvement in successfully treated patients was: complete in 19 (68%), partial in 3 (18%), no improvement in 4 (14%) and 2 patients were lost to treatment. There were 4 short-term complications. There were 4 deaths and one was related to the technique.

CONCLUSIONS

Endoscopic treatment of chronic pain in chronic pancreatitis, pseudocysts and fistulas was effective in our environment with a low rate of complications.

[Endoscopic treatment combined with extracorporeal shock wave lithotripsy of difficult bile duct stones]

OBJECTIVES

The aim of this study was to determine the safety and effectiveness of extracorporeal shock wave lithotripsy (ESWL) in difficult bile duct stones resistant to endoscopic extraction.

PATIENTS AND METHOD

From January 1997 to February 2002, combined treatment with endoscopy and ESWL was used in 19 patients who had undergone unsuccessful endoscopic bile duct stone extraction after sphincterotomy. The procedure was carried out using analgesic and sedative drugs or deep sedation, prophylactic antibiotic therapy, and monitoring of vital signs. Bile duct stone localization was performed by contrast injection through nasobiliary drainage and fluoroscopy. After each ESWL session, lavage was performed through drainage and stone fragments were extracted endoscopically.

RESULTS

The 19 patients presented high surgical risk due to advanced aged and/or concomitant diseases. All presented jaundice and pain and nine (47.3%) presented associated cholangitis. Thirty ESWL sessions were performed (1.57 sessions per patient), with a mean of 2,120 shock waves per session. In 16 of the 19 patients (84.2%), combined treatment with ESWL and subsequent instrumental endoscopic extraction achieved complete clearance of the biliary tract. The treatment failed in 3 patients who were referred for surgical treatment. No early or late complications were observed, except in one patient who presented a self-limiting febrile syndrome.

CONCLUSIONS

Therapeutic endoscopy combined with ESWL is safe and effective in patients with difficult bile duct stones. It represents a therapeutic alternative in patients at high surgical risk.

Spanish family with Machado-Joseph disease: neurophysiological features and neuropathy study

OBJECTIVES

We have carried out electrophysiological studies and sural nerve biopsy evaluation in a Spanish family with genetically proven Machado-Joseph disease (SCA3/MJD) phenotype III.

PATIENTS AND METHODS

Two symptomatic and other two asymptomatic members of the family were clinically examined. Electrophysiological evaluation included multimodal evoked potentials, quantitative electromyography and nerve conduction studies, and central motor conduction time. We also report neuropathological findings in the sural nerve biopsy in the proband.

RESULTS

Analysis of the SCA3/MJD CAG trinucleotide repeat at the ataxin 3 gene in the DNA of the proband and one of his daughters demonstrated an expanded allele of 63 CAG repeat units. Ataxic pursuit was primary disturbed in MJD, followed by gaze evoked nystagmus, hypermetric saccades and glissades. Limitation of vertical and horizontal gaze, impaired sinusoidal vestibulo-ocular reflex and vestibulo-ocular reflex-fixation-suppression, and active and passive optokinetic nistagmus loss appeared at later stages. Evoked potential studies showed multimodal abnormalities. Electrophysiological and sural nerve biopsy findings correspond well to a pattern of both anterior horn and root ganglion cell distal dominant degeneration. Central motor conduction time was normal in our patients up to advanced stages of the disease.

CONCLUSIONS

Electrophysiological and neuropathological studies suggested widespread peripheral and central affection in MJD. Repeated application of electrophysiological techniques may prove useful for monitoring disease progress.

[Eosinophilic gastroenteritis]

Eosinophilic gastroenteritis is a rare clinicopathogenic entity of an unknown aetiology in which a variety of digestive symptoms are associated to the eosinophilic infiltration in the intestinal wall. The clinical features depend on the site of eosinophilic infiltration, and the association with peripheral eosinophilia is very frequent. The radiologic findings were not specific and the diagnostic is based on the endoscopic and/or peroral gastrointestinal biopsy. The response to steroid therapy is spectacular. The etiology is unknown but we review the recent literature.

[Primary intestinal T lymphoma]

Primary gastrointestinal lymphoma comprises a group of distinctive clinicopathological entities. They may be of B or T-cell type. Intestinal T-cell lymphomas are much less common and include the entity: lymphomas T enteropathy-associated T-cell lymphoma, the most common, and T-cell lymphoma without features of enteropathy. The morphologic and immunologic findings suggest that derived from mucosal T lymphocytes population. Clinically, the patients were usually males with constitutional symptoms and acute perforation and/or obstruction of the small bowel. Their prognosis are very poor and tumor are very aggressive.

[Approximation of the dynamics of microbial contamination of the Segre River in Lérida]

The water rivers contains a basal autochthonus population of micro-organisms which is local and temporal and it is modified by the incoming sewage. In this paper a simple model is applied to estimate the faecal bacterial load poured from the town of Lérida to the Segre River and the downstream assimilation capacity of this river. In spite of the inherent limitations and imprecision due to sampling operations and calculations, the numerical results are related to other published results. The evolution of faecal bacterial population downstream of Lérida does not follow the theoretical model without a growth coefficient. The showed data on faecal pollution (bacteriological and viral detectors) are the only ones which have been published on the final section, the most disturbed, of the Segre River.