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Vázquez-Sequeiros E, de Miquel DB, Olcina JRF, Martín JAG, García M, Lucas DJ, Garrido E, González C, Blanco AP, Arnau MR, Buenadicha A, Vicente VM, de Argila CM, Milicua JM. Training model for teaching endoscopic submucosal dissection of gastric tumors. Rev Esp Enferm Dig 2009; 101:546-52. [PMID: 19785494 DOI: 10.4321/s1130-01082009000800005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The elevated risk of complications and technical complexity of endoscopic submucosal dissection (ESD) has limited its implementation in our medical system. OBJECTIVE To design and evaluate a training program for learning the ESD technique. METHODS Four endoscopists with no experience with ESD underwent a 4-step training program: 1) review of the existing literature, didactic material, and theoretical aspects of ESD; 2) ESD training in an ex-vivo animal model; 3) ESD training in an in-vivo animal model (supervised by ESD expert); and 4) ESD performance in a patient. A standard gastroscope and an ESD knife (IT, Flex or Hook-knife Olympus) were employed. The classical ESD technique was performed: rising of the lesion, circumferential incision, and submucosal dissection. RESULTS Ex-vivo animal model: 6 x swine stomach/esophagus -cost < 100 euro; 6 x ESD: antrum (n = 2), body (n = 3) and fundus/cardia (n = 1)-; size of resected specimen: 4-10 cm; ESD duration: 105-240 minutes; therapeutic success: 100%; complications: perforation (1/6: 16%) sealed with clips. In-vivo animal model: 6 ESD (antrum/body of stomach: 4; esophagus: 2); size: 2-5 cm; duration: 40-165 minutes; success: 100%; complications: 0%. PATIENT ESD of a gastric lesion located in the antrum/body; size: 3 cm; duration 210 minutes; a complete resection was achieved; no complications. CONCLUSIONS The results of the present study support the usefulness of this model for learning ESD in our system.
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Affiliation(s)
- E Vázquez-Sequeiros
- Service of Gastroenterology, University Hospital Ramón y Cajal, Madrid, Spain.
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Alexandru S, Ortiz A, Baldovi S, Milicua JM, Ruiz-Escribano E, Egido J, Plaza JJ. Severe everolimus-associated pneumonitis in a renal transplant recipient. Nephrol Dial Transplant 2008; 23:3353-5. [DOI: 10.1093/ndt/gfn401] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Crespo L, Graus J, García-Hoz F, Bárcena R, Gil Grande L, Moreira VF, Milicua JM, Sánchez J, Blázquez J. [Hepatic encephalopathy secondary to porto-systemic shunt satisfactorily treated with interventionist radiology]. Rev Esp Enferm Dig 2008; 99:667-70. [PMID: 18271668 DOI: 10.4321/s1130-01082007001100010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hepatic encephalopathy is a reversible state of altered cognition that may occur in patients with acute or chronic liver disease or porto-systemic shunt, and in which known neurological or psychiatric signs may develop. Nitrogenated substances from intestinal digestion reach the brain without being cleared by their passage through the liver due to the presence of porto-systemic shunt. We report two cases of patients with porto-systemic shunt diagnosed with recurrent chronic hepatic encephalopathy refractory to conventional medical treatment. They were satisfactorily treated with shunt embolization using interventionist radiology techniques.
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Affiliation(s)
- L Crespo
- Servicios de Gastroenterología, Hospital Universitario Ramón y Cajal, Carretera de Colmenar, Madrid.
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Boixeda D, Bermejo F, Martín-De-Argila C, López-Sanromán A, Defarges V, Hernández-Ranz F, Milicua JM, García-Plaza A. Efficacy of quadruple therapy with pantoprazole, bismuth, tetracycline and metronidazole as rescue treatment for Helicobacter pylori infection. Aliment Pharmacol Ther 2002; 16:1457-60. [PMID: 12182745 DOI: 10.1046/j.1365-2036.2002.01304.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM To study the efficacy of a 7-day quadruple regimen combining pantoprazole, bismuth, tetracycline and metronidazole as rescue treatment for Helicobacter pylori infection after failure of standard triple therapy. METHODS A prospective study was made of 140 patients infected with H. pylori and diagnosed with peptic ulcer or non-ulcer dyspepsia in whom triple therapy with proton pump inhibitor, clarithromycin and amoxicillin had failed. The patients were treated with quadruple therapy including pantoprazole, 40 mg twice daily, colloidal bismuth subcitrate, 120 mg four times daily, tetracycline, 500 mg four times daily, and metronidazole, 500 mg three times daily, for 7 days. Two months after completion of therapy, a 13C-urea breath test was performed to confirm eradication. RESULTS With quadruple therapy, the H. pylori eradication rates were 82% (95% confidence interval (CI), 75-88%) by 'intention-to-treat' and 85% (95% CI, 79-91%) by 'per protocol'. No major side-effects were observed. No differences in eradication success were observed in relation to underlying disease (peptic ulcer: 85% (95% CI, 76-91%) vs. non-ulcer dyspepsia: 83% (95% CI, 68-93%)) or smoking habits (smokers: 86% (95% CI, 75-93%) vs. non-smokers: 83% (95% CI, 71-91%)). CONCLUSION Quadruple therapy with pantoprazole, bismuth, tetracycline and metronidazole for 7 days is an effective H. pylori eradication treatment for patients in whom standard triple therapy has failed.
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Affiliation(s)
- D Boixeda
- Department of Gastroenterology, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain
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Abstract
We report a case of acute cholestatic hepatitis in an immunocompetent young male with cytomegalovirus (CMV) primoinfection episode. The severity of the clinical symptoms led to a high-dose treatment with parenteral ganciclovir, with an immediate response and total resolution of symptoms. Therapeutic options are discussed, particularly the use of ganciclovir, even in immunocompetent patients when the severity of the symptoms could demand it.
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Affiliation(s)
- C Serna-Higuera
- Department of Gastroenterology, Ramón y Cajal Hospital, Faculty of Medicine, Alcalá de Henares University, Madrid, Spain
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de la Serna-Higuera C, González-García M, Milicua JM, Muñoz V. [Cytomegalovirus granulomatous hepatitis in an immunocompetent patient]. Gastroenterol Hepatol 1999; 22:230-1. [PMID: 10396104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
A case of granulomatous hepatitis induced by cytomegalovirus in a 34-year-old immunocompetent male with no other history of interest is presented. The clinical severity of the picture with progressive cholestasis, evening fever peaks and the development of echographic signs of portal hypertension led to treatment with high doses of intravenous ganciclovir. Rapid clinical improvement was observed with normalization of the analytical parameters after 15 days of treatment. The pathologic, clinical and therapeutic aspects of the liver infection by cytomegalovirus in an immunocompetent patient are discussed.
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Affiliation(s)
- C de la Serna-Higuera
- Servicio de Gastroenterología, Hospital Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá de Henares, Madrid
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Bárcena Marugán R, Nash R, Pascasio JM, Sáez de Santa-María J, Avilés J, García Hoz F, Moreira VF, Cano A, Milicua JM, Graus J. [Prevalence of hepatitis C virus antibody in chronic HBsAg-negative non alcoholic hepatopathy]. Rev Esp Enferm Dig 1992; 81:117-20. [PMID: 1314634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The presence of antibody to hepatitis C virus was determined in 316 HBsAg-negative patients with non-alcoholic chronic hepatitis who did not receive any blood transfusion once the diagnosis was made. A titre of antinuclear antibodies of 1/40 or lower was found in 18 patients. Persistent chronic hepatitis was present in 21 patients, active chronic hepatitis in 145, hepatic cirrhosis in 128, and hepatocarcinoma in 22 patients. One hundred and three patients had previously received blood transfusion, 76 had undergone previous surgery without transfusion, a clinical episode of hepatitis could be traced in 14, 13 patients were drug addicts (all of them HIV negative), 1 patient had received multiples injections, another had been treated with acupuncture, and 108 patients were free of any of the above. Anti-HCV was present in 76.6% of patients; a significantly higher proportion (87.4%) was found among patients who had received blood transfusion than in patients with previous surgery (72.4%) (p = 0.012), clinical hepatitis (57.1%), or without previous hepatic disease (70.3%) (p = 0.003). The incidence of anti-HCV was lower among cirrhotics (70.3%) than in patients with active chronic hepatitis (84.1%) (p = 0.006); in contrast, previous blood transfusion was significantly higher (p = 0.001) among the latter (40.7%) than in cirrhotics (21.9%). The incidence of anti-HCV was similar among patients with (78.6%) and without (75.8%) type B infection. Our results suggest that infection with virus C may account for a high proportion of non-alcoholic non-B chronic hepatitis.
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Affiliation(s)
- R Bárcena Marugán
- Servicio de Gastroenterología y de Microbiología del Hospital Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá
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Abstract
Sanded nuclei are nuclei with eosinophilic inclusions identified by light microscopy in cases of chronic hepatitis B virus infection. In hematoxylin and eosin-stained sections, these inclusions have an almost homogeneous, finely granular texture giving a sandy appearance. They have been related to excess hepatitis B core antigen formation. We have studied liver biopsies from two HBsAg positive immunosuppressed patients with numerous sanded nuclei, morphologically identical to those previously described in hepatitis B. Immunohistochemically, sanded nuclei showed a strong nuclear positivity for delta antigen, but were negative for hepatitis B core antigen. Hepatitis B core particles were not demonstrable by electron microscopy. To our knowledge, this is the first time that sanded nuclei have been related to hepatitis delta virus (HDV) infection.
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Affiliation(s)
- A Moreno
- Hospital Ramón y Cajal, Madrid, Spain
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Pascual J, Sureda A, Gil L, Milicua JM, Martín MA, Barcena R, Boixeda D. [Spontaneous bacterial peritonitis: clinical, microbiological and clinical course study of 89 episodes]. Enferm Infecc Microbiol Clin 1989; 7:471-7. [PMID: 2490477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We have retrospectively studied 89 episodes of spontaneous bacterial peritonitis (SBP) attended at our service with the purpose of analyzing clinical features, microbiologic data and possible etiopathogenic factors, treatment and course. The most frequent symptoms were ascites, abdominal pain and fever. Only 3.3% of episodes were asymptomatic. Twenty-four episodes (26.96%) resulted in death of the patient and only the presence of septic shock and prothrombin time lower than 35% statistically correlated with a higher mortality (100% and 53.8%, respectively, p less than 0.01) of the possible factors analyzed. The culture of ascitic fluid (AF) was positive in 52.8% of the episodes and there were no clinical or time course differences between these cases and those who presented negative culture. The isolated microorganisms were the usual ones in this condition, outstanding 37.5% of gram-positive cocci in monomicrobial SBP. Treatment was initiated within the first 12 hours from admittance in 76.4% of cases, between 12 and 72 hours in 12.3% and after 72 hours in 11.2%. Cefotaxime was given to 47.1% of episodes and 52.9% of patients received ampicillin or cefoxitin plus aminoglycoside; the mortality was lower with the first schedule (11.9% versus 40.4%, p less than 0.01).
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Moreira VF, Meroño E, Simón MA, del Olmo L, Aviles J, Milicua JM, Barcena R, González JA. [Endoscopic sphincterotomy in malignant periampullar neoplasms. Review of the literature]. Rev Esp Enferm Apar Dig 1985; 68:21-7. [PMID: 3901160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Martín del Yerro JL, Landín L, Bouza C, Díaz JM, López de la Morena JC, Liste D, Moreno A, Milicua JM. [Acute liver failure and Wilson's disease]. Rev Clin Esp 1985; 177:38-40. [PMID: 4035036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Bárcena R, Fernández Seara JJ, Boixeda D, Milicua JM, Domínguez Rodríguez A, Moreira VF, González Martín JA, Pascasio JM, Gil Grande LA, García Plaza A. [Acute viral hepatitis, type A: clinical features and course in adolescents and adults in our environment]. Rev Esp Enferm Apar Dig 1985; 67:316-20. [PMID: 4001526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Barcena R, Suarez-Garcia E, Gil LA, Moreira VF, Garcia-Hoz F, Milicua JM, Boixeda de Miquel D, Ruiz del Arbol L, Pascasio JM, Garcia-Plaza A. Posttransfusion non-A, non-B hepatitis. A prospective study. Liver 1985; 5:71-6. [PMID: 3923288 DOI: 10.1111/j.1600-0676.1985.tb00217.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We have prospectively studied the clinical data, prognostic factors and chronic liver sequelae in 68 patients who developed posttransfusion non-A, non-B hepatitis. The mean incubation period was 5.9 weeks with a range from 2.1 to 12 weeks; 63.5% of the patients were asymptomatic and 60.6% anicteric. The chronicity rate (elevated ALT values for a period of more than 6 months) was 67.6%. The chronicity rate of symptomatic hepatitis (95.5%) was significantly higher than that of asymptomatic hepatitis (54.5%) (P less than 0.01). Monophasic hepatitis, characterized by a rapid elevation in serum ALT followed by a rapid decline with no further fluctuations, had a chronicity rate (42.5%) significantly lower than polyphasic hepatitis (86.6%) (P less than 0.05) and plateau type hepatitis (94.4%) (P less than 0.01). Results of 35 liver biopsies carried out among 46 patients with elevated ALT after 6 months were as follows: chronic active hepatitis, 15 cases; prolonged acute hepatitis, 12 cases; chronic persistent hepatitis, 6 cases; posthepatitis liver changes, 1 case; and secondary hemosiderosis, 1 case.
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Domínguez A, Milicua JM, Larraona JL, Bárcena R, Fernández Rodríguez CM, Gil Grande LA. [Viral hepatitis B transmitted by acupuncture: presentation of 5 cases]. Med Clin (Barc) 1985; 84:317-9. [PMID: 3884928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Fernández Rodríguez C, Boixeda D, Gil Grande LA, Simón MA, Barcena R, Milicua JM, Porrero JL, Moreno J. [Inflammatory intestinal pseudotumor: an unusual cause of chronic anemia]. Rev Esp Enferm Apar Dig 1984; 66:435-8. [PMID: 6334873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Aguilera D, Milicua JM, Gonzalez-Palacios JF, Moreira VF, Pascasio JM, Barba M, Diaz Gonzalez M. [Menetrier's disease. Current status. Presentation of a new case]. Rev Esp Enferm Apar Dig 1983; 64:243-249. [PMID: 6647979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Milicua JM, Devesa M, Boixeda D, Domínguez A, García Hoz F, Meroño E, Hernández Ranz F, Morales V. [Rare presenting manifestations of colorectal carcinoma: bone and brain metastasis]. Rev Esp Enferm Apar Dig 1981; 59:611-6. [PMID: 7291672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Milicua JM, Faro MV, Moreno A, García Sagredo JM, Domínguez A, Capela I, Ocio G. [Alpha 1-antitrypsin deficiency: report of a new familial case]. Rev Esp Enferm Apar Dig 1981; 59:497-502. [PMID: 6973811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Moreira VF, Milicua JM, García Sánchez A, Hernández Ranz F, Boixeda de Miquel D, Gil Grande L, Martinez Molina E. [Ulcerative colitis, pericholangitis and cancer of the appendix]. Rev Clin Esp 1979; 154:237-41. [PMID: 534310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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