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G Castellano Tortajada

Publications and source records attributed to G Castellano Tortajada.

15 recordsLinked to original sources
PubMed2002

Chronic viral hepatitis: liver biopsy, yes or no?

LB increases costs and has--although minimal--potential risks; however, LB is: a) the gold standard to get to know lesion severity (grade and stage); b) the only method for the diagnosis of an F3 stage, which progresses to liver cirrhosis in approximately 10 years; c) the only method for the certain diagnosis of compensated liver cirrhosis, which requires early diagnosis programs for oesophageal varices and hepatocarcinoma; and d) the only method for the certain diagnosis of lesions predicting a good therapeutic response. On all these grounds--save for exceptions (contraindications, clinical and/or ultrasonographic cirrhosis)--liver biopsy should be carried out in the initial study of all patients. In non-responders to anti-viral therapy liver biopsy should be repeated once or twice with 5-10-year intervals to ascertain fibrosis growth rate and, according to this, plan a most appropriate follow-up. Assuming hepatitis progresses rapidly in all HIV co-infected patients, anti-viral therapy could be administered with no previous LB; such biopsy would be performed in non-responders to decide their course of therapy.

Biopsy↗
PubMed1991

[Non alcoholic steatohepatitis. Mid-term clinical and histologic course in 10 patients].

BACKGROUND: The progressive character of the hepatic lesions in nonalcoholic steatohepatitis (NASH) has not been well established. In the present study, the clinical and histological course of this condition was evaluated at medium term. METHODS: Then patients (6 females and 4 males) with NASH, in a non-cirrhotic stage at the time of diagnosis, were followed up during 58 +/- 7 months (range 24 to 88 months). RESULTS: Nine patients were obese, but a significant reduction of body weight was found at the end of the study (p = 0.0072). Other clinical, physical or laboratory changes were not found, although in two cases hepatic biochemical tests were within normal limits when the follow-up biopsy was performed. Changes in the characteristic hepatic features were also absent, although fat infiltrates disappeared in three cases. Six patients had increased fibrosis and a progression of the hepatic architectural distortion; four reached the stage of cirrhosis. The evolution of the hepatic lesion correlated with the interval between diagnostic and follow-up biopsies (r = 0.69; p less than 0.05) and with the reduction in body weight (r = 0.64; p less than 0.05). CONCLUSIONS: In most cases, NASH results in a progressive hepatic distortion with can end in cirrhosis, although the change is slow and silent.

Adult↗
PubMed1990

[The prognostic factors and evolution of the quality of life in primary biliary cirrhosis].

The prognostic factors and the evolution of the quality of life were evaluated in 38 patients with primary biliary cirrhosis (94.7% females, mean age 52.6 +/- 2.0 years) followed up for more than 36 months (mean 65.3 +/- 3.7 months). Karnofsky's index significantly declined during follow up (p less than 0.05) in a parallel fashion to modified Child's hepatic functional class (p less than 0.05) and to the days of hospital readmission (p less than 0.05). Eleven patients (28.9%) died, and the median survival was 88.7 months. The comparison of the actuarial curves showed the following to be significant poor prognostic factors at the time of diagnosis: a) clinical: more than one associated autoimmune disease, weight loss of more than 10% of the ideal weight, jaundice, upper gastrointestinal hemorrhage associated with portal hypertension, portal-systemic encephalopathy and a modified Child's hepatic functional class of 9 or more; b) biochemical: serum albumin lower than 3.5 g/dl and bilirubin higher than 2 mg/dl; c) histological: Total histological activity index of 10 or more and erosive necrosis index of 2 or more (Knodell et al.), lobular granulomas, and stage IV (Ludwig et al). A significant correlation was found (p less than 0.001) between the R index of the Mayo Clinic and the mean survival time of our patients. As a temporary policy, we indicate hepatic transplant when R is 9.2 or higher (life expectancy lower than 24 months), awaiting our own probabilistic prognostic model with the inclusion of quality of life criteria.

Adult↗
PubMed1990

[Epidemiology of primary biliary cirrhosis in southern Madrid].

This study reports the epidemiologic features of primary biliary cirrhosis in patients admitted to the 12 de Octubre Hospital in Madrid between 1974 and 1988. Among the 54 patients recruited, 45 lived in the hospital surroundings. Ninety-three percent were women with a mean age of 53.7 +/- 15.1 years (range 25 to 76 years). The maximal incidence of the disorder occurred in patients above 60 years. At the time of diagnosis 37.8% were asymptomatic and the mean time to symptoms was 20.1 +/- 18.1 months. The year incidence was maximal in 1982, being the mean year rate of 7.45 +/- 4.9 cases/10(6) inhabitants. This rate was lower in women above 25 years (13.9 +/- 8 cases/10(6) inh/yr). A comparable incidence has been reported in Catalonia and Asturias but it was higher in Navarre. During the study period the prevalence of the illness has increased. By december 1988 the mean incidence for the whole group was 45.5 cases/10(6) inh/yr, whereas it reached 134.1 cases/10(6) ihn/yr in women above 25 years. Environmental, genetic or personal factors contributing to the development of the illness have not been encountered. There was, however, a relationship between the mortality and morbidity rates with the severity of the symptoms and with the degree of histological damage.

Adult↗
PubMed1990

[Esophageal tuberculosis. Presentation of a case and review of the literature].

We describe the case of a 63-year-old woman who had recently developed dysphagia. Oral endoscopy revealed an ulcerated fungating lesion in the middle third of the esophagus. The histologic examination showed granulomas with caseous central necrosis, and the culture in a Lowenstein medium produced M. tuberculosis. There were mediastinic adenopathies, but no other organic involvement with this mycobacterium was demonstrated. We review the other 21 cases reported in the English and Spanish literature over the past ten years.

Esophageal Diseases↗