Usefulness of urinary galactose for diagnosis of hypolactasia.
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Adult↗
Biomedical subjects
J M Pajares
Publications and source records attributed to J M Pajares.
Hepatitis C virus infection in Spanish volunteer blood donors: HCV RNA analysis and liver disease.
OBJECTIVE: To evaluate in a large group of volunteer blood donors the prevalence of antibodies to hepatitis C virus (anti-HCV) and the relation of transaminase (ALT) levels and viraemia to liver damage. DESIGN: A prospective study. SETTING: Transfusion Centre of the Autonomous Community of Madrid and the Liver Unit of the Princesa University Hospital. PATIENTS: From a population of 55,587 volunteer blood donors, 160 seropositive cases were further evaluated for virological and histological assessment. METHODS: Anti-HCV was tested by ELISA-2 and RIBA-2 assays. HCV RNA was analysed by nested PCR. Liver biopsies were obtained in 35 volunteer blood donors with abnormal ALT levels. RESULTS: The prevalence of anti-HCV detected by ELISA-2 was 0.93%. Serum ALT was abnormal in 61 of the 160 volunteers (38.1%). Of these, RIBA-2 was positive in 96.7% and HCV RNA was detectable in 96.1%. Serum ALT was normal in the remaining 99, 70.7% being RIBA-2 negative and 98.3% HCV RNA negative. The majority of biopsies (85.6%) showed chronic hepatitis. CONCLUSION: This study demonstrates that in blood donors screening for anti-HCV, a positive ELISA-2 test, when associated with abnormal ALT levels, is effective in recognizing subjects with active infection detected by HCV RNA and liver disease. Concerning ELISA-2 positive volunteer blood donors with normal ALT, long-term studies are warranted to elucidate whether they are really infected by HCV.
Adolescent↗
Tonsillectomy and inflammatory bowel disease location.
OBJECTIVE: Epidemiological studies have found an increased frequency of childhood infections and tonsillectomies in patients with inflammatory bowel disease (IBD). The aim of our study was to test whether particular clinical patterns of IBD could be associated with previous tonsillectomy. METHODS: Two hundred and twenty consecutive IBD patients (100 with Crohn's disease (CD) and 120 with ulcerative colitis (UC)) were prospectively assessed and classified into groups according to disease location. In those with a positive history of tonsillectomy, an ear, nose and throat (ENT) examination was carried out to confirm the diagnosis. RESULTS: Eighty-two IBD patients (37%) underwent tonsillectomy in childhood: 47 out of 100 CD patients (47%), and 35 out of 120 UC patients (29%). Disease location in CD patients affected the ileum in 28, and 21 of them were tonsillectomized (tonsillectomy rate of 75%). Thirty-six patients had an ileocolonic location, and 14 of them had had a tonsillectomy (39%). With disease confined to the colon, only 9 out of 29 patients (31%) had undergone previous tonsillectomy. The higher prevalence of tonsillectomy in patients with CD ileitis was statistically significant (P = 0.0034). No significant differences between groups of UC patients according to the extent of the disease were found. CONCLUSION: The ileum is the most prevalent location of disease in CD patients with previous tonsillectomy.
Adult↗
Antimicrobial therapy for Helicobacter pylori infection versus long-term maintenance antisecretion treatment in the prevention of recurrent hemorrhage from peptic ulcer: prospective nonrandomized trial on 125 patients.
OBJECTIVE: Our objective was to assess the effectiveness of therapy for Helicobacter pylori (HP) on the prevention of recurrent bleeding in patients with recent upper gastrointestinal hemorrhage from peptic ulcers. METHODS: We performed a prospective follow-up study without randomization on 125 consecutive patients (83 males and 42 females) who had presented with their first major episode of upper gastrointestinal hemorrhage from peptic ulcer (22 gastric and 103 duodenal ulcers). All 125 patients were HP-positive. During the acute phase of bleeding, all patients were treated with standard supportive measures. After the acute bleeding phase, patients were allocated to two treatment groups: 1) antimicrobial therapy-84 patients received one of the following three regimens: 1) amoxicillin 500 mg t.i.d. for 10 days + omeprazole 20 mg b.i.d. for 30 days; 2) clarythromycin 500 mg t.i.d. for 12 days + omeprazole 20 mg b.i.d. for 30 days; or 3) amoxicillin 500 mg t.i.d. for 10 days + metronidazole 500 mg t.i.d. for 10 days + colloidal bismuth subcitrate 240 mg b.i.d. for 30 days. For long-term antisecretion maintenance treatment, 41 patients were allocated to either omeprazole 20 mg once a day or ranitidine 150 mg once a day, for 1 yr. RESULTS: During the follow-up period, peptic ulcers recurred in six patients in the antibiotic group (7.14%) and 13 patients in the maintenance group (31.7%) (p < 0.001). The fraction of patients without recurrent bleeding was greater in the antibiotic group than in the maintenance group. Two patients in the antibiotic group (2.3%) and five in the maintenance group (12.1%) had recurrent hemorrhages (p < 0.1). CONCLUSION: Cure of HP infection reduces the recurrence of peptic ulcer and of rebleeding from ulcer disease more effectively than does long-term maintenance therapy.
Amoxicillin↗
[Crohn's disease of the duodenum complicated by sclerosing cholangitis and pancreatitis].
We describe the case of a 27 year-old man with Crohn's Disease of the duodenum associated with pancreatitis and cholestatic syndrome secondary to sclerosing cholangitis. Pancreatitis resolved along with the clinical improvement of Crohn's Disease. This case supports the concept of an association between duodenal Crohn's Disease, sclerosing cholangitis and pancreatitis.
Acute Disease↗
Prevalence of Helicobacter pylori infection-associated histologic chronic gastritis in the Spanish population.
The aim of this study was to investigate the prevalence of Helicobacter pylori infection-associated chronic gastritis in an unselected Spanish population. Between November 1990 and May 1991, consecutive patients referred for upper gastrointestinal endoscopy due to severe upper abdominal complaints were studied. Only patients with chronic gastritis were included. Four biopsy specimens were taken (two for histologic examination, one for a rapid urease test, and one for culture of H. pylori). A total of 3094 patients from 17 Spanish Autonomic Communities 1817 men (58.7%) and 1277 women (41.3%) were studied by endoscopy. The mean age of the patients overall was 51.4 years. Of these 3094 patients, 1642 had symptomatic chronic gastritis. The prevalence of H. pylori infection in chronic gastritis patients in Spain was 85% (pooled data of the three methods above), and there was at a close correlation between severity of gastritis and H. pylori infection.
Biopsy↗
Significant increase in eradication rates of Helicobacter pylori infection with two consecutive dual therapies (omeprazole and amoxycillin or omeprazole and clarithromycin). A randomized study in 450 Spanish patients.
Helicobacter pylori infection is associated with peptic ulcer disease and chronic gastritis, and eradication of the microorganism markedly reduces the recurrence of peptic ulcer. However, a major problem is the choice of a treatment that is effective, has high eradication rate, and is well tolerated by patients. We evaluated the eradication of H. pylori infection in patients with chronic gastritis (CG), duodenal ulcer (DU), and gastric ulcer (GU) after two dual therapies (omeprazole with either amoxycillin or clarithromycin). Of 450 patients initially included in the study, 207 had CG, 187 DU and 56 GU, and all presented with H. pylori infection. Diagnosis was made from endoscope examination, biopsy samples, rapid urease test and 13C-urea breath test (UBT). H. pylori infection was considered to be present when two of the tests had positive results. All patients were randomized to one of two regimens: (A) omeprazole (20 mg b.i.d.) plus amoxycillin (750 mg t.i.d.) or (B) omeprazole (40 mg b.i.d.) plus clarithromycin (500 mg t.i.d.). The duration of each of the regimens was 2 weeks. Fifty-eight patients who showed H. pylori infection after the first treatment (27 with CG, 24 with DU, and 7 with GU) were allocated to a second therapy. H. pylori eradication was assessed by UBT, 6 weeks after the end of the therapies; positive values were those higher than 5 delta units. A second consecutive dual therapy of omeprazole plus an antibiotic (amoxycillin or clarithromycin) not used in the first therapy improved on the eradication rates obtained with the first regimen. The overall eradication rates were also higher, but no significant differences were found between amoxycillin and clarithromycin. The best results were obtained in those patients with GU.
Adult↗
[Immunologic response in Helicobacter pylori gastric infection].
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Antibodies, Bacterial↗
[Breath test in the diagnosis of Helicobacter pylori infection: concordance with histological methods and correlation with anatomopathological lesions of the gastric mucosa].
PURPOSE: To study the concordance between 13C-urea breath test and histology in the diagnosis of Helicobacter pylori infection, and to evaluate whether there is a correlation between breath test values and histologic lesions of the gastric mucosa. METHODS: Sixty-nine patients with duodenal ulcer were prospectively studied. An endoscopy with biopsy samples (H&E stain) taken from the antrum and body was performed, and a 13C-urea breath test (measuring 13C difference: delta 13CO2) was also done. Both procedures were repeated one month after completing therapy ["classic" triple therapy (n = 28), and omeprazole+amoxycillin (n = 41)]. Eradication was defined as the absence of H. pylori both by histological and breath test methods. RESULTS: At the beginning of the study, 94.2% of patients (n = 65) were H. pylori positive by histological methods, and 98.6% (n = 68) were positive by the breath test (ratio of positive agreement = 0.96). Kappa for H. pylori diagnosis after therapy was 0.83 (95% CI: 0.69-0.96). A correlation between delta 13CO2 and histologic lesions was observed, both in the antrum at before treatment (Spearman coef = 0.34; p = 0.007) and after therapy in both the gastric antrum (0.63; p < 0.001) and body (0.35; p = 0.005). A significant difference was observed when comparing mean delta 13CO2 in patients with different degrees of histologic gastritis, both before treatment (antrum: W Kruskal-Wallis = 6; p < 0.05) and after therapy (antrum: W = 17; p < 0.001; body: W = 10; p < 0.05). CONCLUSION: A high concordance was observed between the 13C-urea breath test and histology in the diagnosis of H. pylori infection. A correlation exists between breath test values and histologic lesions of the gastric mucosa.
Adult↗
[Chronic gastritis and Helicobacter pylori in patients with non-ulcerous dyspepsia. Role and significance of age].
Patients with recurrent upper abdominal complaints and without peptic ulcer or definite evidence of organic disease have been labelled as suffering from nonulcer dyspepsia and included in the study. A total of 125 patients were studied and upper gastrointestinal endoscopy performed. Histology, urease rapid test and ELISA serology were done in order to detect Helicobacter pylori infection. Age groups were done. The most frequent endoscopic and histological finding was chronic gastritis in all age groups of patients. In patients under 30 years old, the highest rate of normal endoscopy was found. Chronic gastritis was associated with Helicobacter pylori infection in 89.8% of all patients. The highest rate of chronic gastritis non associated with Helicobacter pylori infection was found in the age group of patients younger than 30 years old. Other factors as biliary reflux, gastroduodenal dismotility, decreased pain tolerance or stress have been proposed to be the etiology of chronic gastritis in young patients.
Adolescent↗
[Usefulness of the breath test with urea-13C in the diagnosis of Helicobacter pylori infection].
BACKGROUND: Many diagnostic methods of variable diagnostic profitability are available to detect infection by Helicobacter pylori. The aim of this study was to evaluate the usefulness of the European method of the breath test with urea-13C and compare the results with common histologic methods, the rapid urease test and serology. METHODS: Thirty-six patients who attended the Endoscopy Unit for recurrent symptomatology of the upper digestive tract were included in the study. A patient was considered to present infection by Helicobacter pylori on positivity of 2 of the usual methods: histology, rapid urease test and serology. RESULTS: The breath test with urea-13C was positive in 25 patients (13CO2 > 5 per 1,000) and negative in 10 patients with 100% specificity and 96% sensitivity. The specificity of the rapid urease test, histology and serologic tests were 90, 90 and 80%, respectively with 92, 88, and 88% sensitivity, respectively. CONCLUSIONS: The European method of the breath test with urea-13C is simple, non invasive and achieves the greatest profitability in the determination of Helicobacter pylori.
Adolescent↗
Incidence and prevalence of ulcerative colitis and Crohn's disease in urban and rural areas of Spain from 1981 to 1988.
We retrospectively investigated the annual incidence and prevalence of inflammatory bowel disease (IBD) from 1981 to 1988 in an urban and a rural area of central Spain. Two hundred and eighty-one patients presented with IBD; 193 ulcerative colitis (UC) and 88 Crohn's disease (CD) (prevalence 43.4/100,000 and 19.8/100,000, respectively). Of these patients, 168 were diagnosed for the first time during the study period. One hundred and eleven UC and 57 CD (incidence 3.16/100,000 and 1.61/100,000 respectively). Within the urban area, the UC incidence was 3.15/100,000 and the CD 1.87/100,000. In the rural area, the incidence for the UC was 3.25/100,000 and 0.86/100,000 for the CD. No sex differences were found. The incidence rates have increased significantly (p < 0.05) for CD in the study period. However, for UC rates did not change. During 1986-1988, the patient's age at the time of diagnosis was significantly lower than that of 1981-1983 (p < 0.05).
Adult↗
[Is the carbohydrate antigen Ca 19.9 useful in the diagnosis of pancreatic carcinoma?].
OBJECTIVE: To determine the sensitivity and specificity of the tumor marker Ca 19.9 in subjects with suspected pancreatic cancer. MATERIAL AND METHODS: Levels of Ca 19.9 antigen were measured by enzymeimmunoassay during a 3 year period to 72 patients investigated for suspected pancreatic cancer. RESULTS: A threshold of 100 U/ml resulted in sensitivity of 94.7%, specificity of 39.6%, positive predictive value of 36% and negative predictive value of 95.4%. CONCLUSION: Levels of Ca 19.9 antigen > 100 U/ml are suggestive of malignancy in patients investigated for suspected pancreatic cancer.
CA-19-9 Antigen↗
Down-regulation of intercellular adhesion molecule 1 on hepatocytes in viral chronic hepatitis treated with interferon alfa-2b.
BACKGROUND: Intercellular adhesion molecule 1 and lymphocyte function-associated antigen 3 are expressed markedly on hepatocytes in viral chronic hepatitis. The aim of this study was to determine whether treatment induces changes in the intrahepatic expression of adhesion molecules. METHODS: The expression patterns of these molecules were studied in liver tissue from 12 patients with chronic hepatitis B and from 14 patients with chronic hepatitis C before and after treatment with interferon alfa-2b. Immunoperoxidase staining was performed in frozen liver biopsy sections. RESULTS: Partial or complete responses to therapy were achieved in 7 (58%) of 12 patients with chronic hepatitis B and in 10 (71%) of 14 patients with chronic hepatitis C. In the first biopsy specimen, hepatocytes showed a marked expression of intercellular adhesion molecule 1. In the second biopsy specimen obtained from responders, hepatocytes showed no reactivity in 4 patients with chronic hepatitis B and in 5 with chronic hepatitis C. However, its expression did not significantly change among nonresponders. A similar pattern of reactivity for lymphocyte function-associated antigen 3 was observed. CONCLUSIONS: Beneficial effect of interferon alfa-2b appears to be associated with a down-regulation of adhesion molecules on hepatocytes, suggesting that this novel immunomodulatory action of interferon could be important to induce a therapeutic response in viral chronic hepatitis.
Adolescent↗
[Tissue expression of antigenic recognition and intercellular adhesion molecules in chronic viral hepatitis].
OBJECTIVE: To analyze the expression of different HLA class I antigens and cell adhesion molecules on frozen liver sections from patients with chronic active hepatitis, types B and C. EXPERIMENTAL DESIGN: Liver biopsy samples were divided into two parts, one for routine histological examination and another, after snap-freezing and storing at -80 degrees C, for immunohistochemical analysis. To carry out immunoperoxidase and immunofluorescence stainings, a panel of monoclonal antibodies specific for HLA class I light (beta 2-microglobulin) and heavy chain determinants, and for adhesion molecules such as intercellular adhesion molecule-1 and lymphocyte function associate antigen-3 was used. PATIENTS: Immunohistochemistry was performed in frozen liver biopsy sections from 25 patients with viral chronic active hepatitis, 10 type B and 15 type C. As controls, normal liver samples and liver specimens from patients with cholestasis or steatosis were also studied. RESULTS: HLA class I light and heavy chain determinants were expressed on hepatocytes, biliary duct epithelium, sinusoidal lining cells and lymphocytes from patients and controls; however, the beta 2-microglobulin conformational epitope was undetectable on hepatocytes from normal livers or with cholestasis or steatosis, but clearly positive on hepatocytes from patients with hepatitis. In addition, in liver sections from controls no adhesion molecules positivity was detected on hepatocytes; by contrast, hepatocytes from patients with hepatitis showed markedly enhanced membranous reactivity for both adhesion molecules in areas of piecemeal and lobular necrosis. CONCLUSIONS: Virus B and C infections could induce an increased hepatocellular expression of HLA-class I determinants, including the conformational epitope adequate for antigen presentation, and cell-cell adhesion molecules. These findings underline the role of cell mediated immune reactions in the pathogenesis of hepatic injury in viral chronic hepatitis.
Adolescent↗
A study of the lactic dehydrogenase isoenzyme patterns in the adenoma--carcinoma sequence of the colon.
In order to determine whether the LDH isoenzyme pattern, measuring the percentages of LDH4-5 (M monomer), might be a marker in the adenoma-carcinoma sequence, 103 adenomas, 8 adenomas with proven malignant degeneration and 27 adenocarcinomas of the large intestine, as well as 12 biopsy samples of colonic mucosa from normal controls, were studied histologically and histochemically. The proportion of M polypeptide was significantly increased in adenomas of larger size (diameter > 2 cm), in adenomas with a larger villous component, and in those with severe dysplasia. The largest proportion of M polypeptide was found in villous adenomas and colloid adenocarcinomas, and might reflect a common origin. These results suggest that the histochemical study of the LDH isoenzymogram might be a useful marker for detecting early malignant degeneration in adenomas of the colon.
Adenocarcinoma↗
[Effectiveness of endoscopic sclerotherapy in the treatment of bleeding esophageal varices].
92 patients to whom urgent endoscopy and sclerotherapy of esophageal varices was performed are studied retrospectively. After the bleeding episode, elective sclerosis sessions were performed to eradicate varices, to prevent hemorrhagic complications and post-sclerotic stenosis somatostatin, H2 antagonists and sucralfate were administered. The Total number of sessions was 331, with a mean of 3.6 per patient (range 1-10). Immediate hemostasis was achieved in 93% of patients, with an early relapse in 10.4% of them. Hemorrhagic relapse two years following therapy was 35.8%. Mortality was 41%; 8% of the decreased patients belonged to Child's A functional grade, 24% belonged to B; and 68% to C. There was a 44% of complications, but only one death was due to the technique. No patient developed symptomatic stenosis neither hemorrhage secondary to esophageal ulceration. We conclude that endoscopic sclerotherapy is one of the principal therapeutic options in the hemorrhage due to esophageal varices, although new studies are necessary to define the role of somatostatin and H2 antagonists in the prophylaxis of complications.
Adult↗
Treatment of peptic ulcer disease: is Helicobacter pylori a consideration?
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Anti-Bacterial Agents↗