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Paragangliomas are infrequent neuroendocrine tumours whose only criterion for malignancy is presence of metastases; thus, all paragangliomas show malignant potential. Actually, different risk factors have been analyzed to predict metastases but they remain unclear. To analyze clinical, histological, and genetic factors to predict the occurrence of metastasis. A multicentre retrospective observational analysis was performed between January 1990 and July 2019. Patients diagnosed with paraganglioma were selected. Clinical, histological, and genetic features were analyzed for the prediction of malignancy. A total of 83 patients diagnosed with paraganglioma were included, of which nine (10.8%) had malignant paraganglioma. Tumour size was greater in malignant tumours than in benign (6 cm vs. 4 cm, respectively; p = 0.027). The most frequent location of malignancy was the thorax-abdomen-pelvis area observed in six cases (p = 0.024). No differences were observed in histological differentiation, age, symptoms, and catecholaminergic production. The most frequent genetic mutation was SDHD followed by SDHB but no differences were observed between benign and malignant tumours. In the univariate analysis for predictive factors for malignancy, location, tumour size, and histological differentiation showed statistical significance (p = 0.025, p = 0.014, and p = 0.046, respectively); however, they were not confirmed as predictive factors for malignancy in the multivariate analysis. In this study, no risk factors for malignancy have been established; therefore, we recommend follow-up of all patients diagnosed with paraganglioma.

Background Participation rates in colorectal cancer screening are below recommended European targets. Aim To evaluate the effectiveness of an alert in primary care electronic medical records (EMRs) to increase individuals’ participation in an organised, population-based colorectal cancer screening programme when compared with usual care. Design and setting Cluster randomised controlled trial in primary care centres of Barcelona, Spain. Method Participants were males and females aged 50–69 years, who were invited to the first round of a screening programme based on the faecal immunochemical test (FIT) ( n = 41 042), and their primary care professional. The randomisation unit was the physician cluster ( n = 130) and patients were blinded to the study group. The control group followed usual care as per the colorectal cancer screening programme. In the intervention group, as well as usual care, an alert to health professionals (cluster level) to promote screening was introduced in the individual’s primary care EMR for 1 year. The main outcome was colorectal cancer screening participation at individual participant level. Results In total, 67 physicians and 21 619 patients (intervention group) and 63 physicians and 19 423 patients (control group) were randomised. In the intention-to-treat analysis screening participation was 44.1% and 42.2% respectively (odds ratio 1.08, 95% confidence interval [CI] = 0.97 to 1.20, P = 0.146). However, in the per-protocol analysis screening uptake in the intervention group showed a statistically significant increase, after adjusting for potential confounders (OR, 1.11; 95% CI = 1.02 to 1.22; P = 0.018). Conclusion The use of an alert in an individual’s primary care EMR is associated with a statistically significant increased uptake of an organised, FIT-based colorectal cancer screening programme in patients attending primary care centres.

Pivotal phase studies of telaprevir (TLV) and boceprevir (BOV) showed 10-56% rates of early treatment interruption. However, there have been no reports on the sustained virological response (SVR) rates of these patients.To assess the SVR rate in a large cohort of patients who discontinued triple therapy with TLV or BOV for reasons other than stopping rules and to identify variables predicting SVR.A survey was sent to 15 hospitals in Catalonia asking them to report all TLV/BOV treatments finished by 31 May 2014. Demographic, clinical, laboratory, liver fibrosis and therapeutic data were recorded for treatments with early discontinuation. Logistic regression analysis, ROC curves and prognostic assessment of the variables identified were calculated.Twelve hospitals responded to the survey, representing 467 treatments and 121 (21.2%) early discontinuations, 76 (62.8%) due to stopping rules and 45 (37.2%) for other reasons. Early discontinuation was more frequent with BOV [38.2% (50/131) versus 21.1% (71/336) p0.005], mainly due to stopping rules [78% (39/50) versus 52.1% (37/71); p=0.004]. SVR was achieved in 21/121 patients (17.4%), 19/71 (26.8%) treated with TLV and 2/50 (4.0%) treated with BOV. In patients discontinuing treatment for reasons other than stopping rules, SVR was achieved in 19/37 (55.9%) treated with TLV and in 2/11 (18.2%) treated with BOV. The SVR rate in patients treated with TLV who discontinued due to a severe adverse event was 61.5% (16/26). A logistic regression analysis was performed only with triple therapy with TLV and early discontinuation. The predictive variables of SVR were undetectable HCV-RNA at treatment week 4 and treatment length longer than 11 weeks. Treatment duration longer than 11 weeks showed the best accuracy (0.794), with a positive predictive value of 0.928.Early discontinuation of TLV-based triple therapy due to reasons other than stopping rules still have a significant SVR rate (55.9%). Undetectable HVC-RNA at week 4 of treatment and treatment duration longer than 11 weeks are predictive of SVR in this subset of patients.

Resumen Objetivo Valorar los recursos disponibles en los hospitales comarcales catalanes para la asistencia urgente de la hemorragia digestiva alta. Metodo Se analiza una encuesta enviada a 32 hospitales, sobre la existencia, composicion y recursos del turno de guardia (TDG) de endoscopia, referida al ano 2009. Resultados Respondieron 24 centros, que cubrian la asistencia de 3.954.000 habitantes. Tenian TDG 12 hospitales. No disponian de TDG en su centro de referencia 1.483.000 habitantes. Los centros con TDG tenian mas camas y cubrian mas poblacion. Los TDG estaban formados por 4,5 endoscopistas (rango 2-11), que cubrian 82,1 (33,2-182,5) guardias/ano. Diecisiete centros reportaban 1.571 episodios (51 por centro, rango 3-280, 39,68/100.000 hab.). Los centros con TDG reportaban mas casos (76 vs. 43, p = 0,047). Los que no disponen de TDG derivaron mas pacientes (147 vs . 17, p= 0,001). Los pacientes en urgencias estaban a cargo de medicina interna en 4 centros, de cirugia en 14 y repartidos entre ambos servicios en 6. Si ingresaban, quedaron a cargo de Digestivo solo en 6 hospitales. Los recursos mas utilizados eran la ligadura en la hemorragia varicosa y las terapias de inyeccion en la no varicosa. Un 21% de centros no realizaban tratamiento combinado. Conclusiones Una proporcion significativa de la poblacion no dispone de endoscopista de guardia en su centro de referencia. La constitucion de TDG en hospitales comarcales supone importantes cargas asistenciales. La coordinacion entre profesionales y centros permitiria la aplicacion eficiente de los recursos terapeuticos y el establecimiento de TDG en centros que no tienen.

Resumen Fundamento y objetivo Determinar la prevalencia de sujetos susceptibles al virus varicela-zoster (VVZ) en personal sanitario de 5 centros hospitalarios. Como objetivo secundario, describir la inmunogenicidad y reactogenicidad de la vacuna en los sujetos susceptibles. Sujetos y metodos Estudio multicentrico transversal analitico realizado en 5 centros hospitalarios de Cataluna. Se incluyeron 1.111 trabajadores sanitarios con edades entre 18-60 anos. Se estudio la prevalencia de anticuerpos (IgG) anti-VVZ, y se obtuvieron variables (demograficas, medicas, laborales y antecedentes de varicela) presuntamente relacionadas. Se vacuno a los susceptibles y se estudio la inmunogenicidad (determinacion de anticuerpos) y la reactogenicidad de 1 y 2 dosis de vacuna. La determinacion de anticuerpos anti-VVZ (IgG) se realizo mediante la tecnica de enzimoinmunoensayo. Los resultados negativos posvacunales se confirmaron mediante test de anticuerpos fluorescentes para la deteccion de la membrana del antigeno (FAMA). Resultados Cuarenta y dos sujetos (3,8%) resultaron susceptibles. La susceptibilidad al VVZ se asocio (p Conclusiones La susceptibilidad a la varicela del personal sanitario es baja. El antecedente declarado de padecimiento de varicela es un buen predictor de exposicion anterior al VVZ, ya que el 99% (687/696) de los que decian haber padecido la enfermedad eran inmunes. Esto permitiria obviar el cribado prevacunal en casi dos tercios de los sanitarios.

Resumen Se determinaron los valores de la FCF y las aceleraciones en fetos con restriccion en el crecimiento y desarrollo y se equipararon con un grupo testigo. El estudio fue abierto, prospectivo, comparativo y exploratorio. La muestra la integraron 40 pacientes, se dividio en 2 grupos: grupo 1 o problema: 20 pacientes embarazadas con diagnostico de RCF; grupo 2 o testigo: 20 pacientes con embarazo normal. Con ultrasonido se determino el diametro biparietal del feto. Se realizaron registros de FCF y contractilidad uterina. El estado fisico de los RN se valoro con la prueba de Apgar, se les peso y determino la talla. En los grupos problema y testigo se equipararon la FCF basal y la amplitud de las aceleraciones. En el primero, la FCF se incremento 5 latidos y la amplitud decrecio 3 latidos, las diferencias fueron altamente significativas. Se elaboraron diagramas de dispersion, se calculo la regresion a una recta utilizando los valores del diametro biparietal de fetos con restriccion en el crecimiento, la ecuacion fue y=0,547 x+64,38 y el coeficiente de correlacion de R 2 =0,3561. En el grupo con distribucion normal, la ecuacion de la recta fue y=2,0344 x+12,944 y el coeficiente de correlacion de R 2 =0,9981. Se equipararon las medias del diametro biparietal entre los grupos problema y testigo. La diferencia no fue significativa. Se calcularon las medias de la altura uterina y el perimetro abdominal, los valores fueron de 33,45 y 101,15. El estado fisico de los RN se valoro de acuerdo con la prueba de Apgar. En el 1. er min, 2 neonatos nacieron deprimidos con calificacion de 6;12, vigorosos con rango de 7–9 y en los 6 restantes no se aplico la prueba; en el 5.° min la calificacion fue de 7–9. Al confrontar los grupos problema y testigo, en primero el peso y la talla de los recien nacidos sufrieron un decremento de 243 g y de 2 c. p

Resumen Fundamento y objetivo identificar los posibles factores de riesgo (FR) de las exposiciones laborales percutaneas no prevenibles mediante las precauciones estandares. Pacientes y metodo estudio multicentrico de casos y controles. Se definio como caso el trabajador que habia experimentado una exposicion percutanea a pesar de haber seguido las precauciones estandares. Los controles fueron trabajadores del mismo hospital que hubieran realizado procedimientos similares al caso y que hubieran tenido un accidente biologico sin adoptar de forma correcta las precauciones estandares (control 1) o que no hubieran tenido una exposicion accidental en los ultimos 6 meses (control 2). Resultados se incluyeron 512 exposiciones (256 casos y 256 controles 1) y 256 controles 2. Respecto a los controles 1, se observo una asociacion entre ser medico (odds ratio ajustada [ORa]: 2,22; intervalo de confianza [IC] del 95%: 1,07–4,60) y trabajar en quirofano (ORa: 2,87; IC del 95%: 1,26–6,55). En relacion con los controles 2, se observo asociacion entre tener una edad inferior a 25 anos (ORa: 2,58; IC del 95%: 1,20–5,58), ser medico (ORa: 5,24; IC del 95%: 1,50–18,28), trabajar en quirofanos (ORa: 6; IC del 95%: 2,07–17,36), trabajar en servicios de urgencias, unidades de cuidados intensivos (UCI) y reanimacion (ORa: 3,48; IC del 95%: 1,37–8,85) y estar expuesto a iluminacion inadecuada (ORa: 1,67; IC del 95%: 1,02–2,82). La formacion en prevencion de riesgos laborales se mostro como un factor protector en los controles 1 (ORa: 0,61; IC del 95%: 0,39–0,97). Conclusiones a pesar de seguir de forma correcta las precauciones estandares, ser medico y trabajar en quirofanos, urgencias, UCI o reanimacion, la edad inferior a 25 anos, la visibilidad inadecuada y la poca formacion en prevencion son FR independientes de experimentar exposiciones accidentales percutaneas.

Introduccion La prevalencia de homocigosidad para C282Y en pacientes con hemocromatosis hereditaria (HH) originarios de algunos paises de la cuenca mediterranea puede ser sustancialmente inferior a la observada en el norte de Europa. Los datos referidos a Espana son contradictorios y basados en series pequenas de ambito regional. El objetivo de nuestro estudio es determinar la prevalencia de las 2 principales mutaciones del gen HFE en una serie de pacientes espanoles con HH, no relacionados y de diferente procedencia geografica. Pacientes y mEtodo Los criterios para el diagnostico de HH fueron: indice de saturacion de transferrina superior al 45% en 2 determinaciones y homocigosidad para C282Y y/o indice de hierro hepatico mayor de 1,9 de tejido hepatico seco en pacientes no cirroticos o superior a 4,1 en presencia de cirrosis. Se excluyeron los casos detectados en familiares. Se evaluaron los datos demograficos, la expresion clinica, los parametros del hierro y las mutaciones C282Y y H63D del gen HFE en un total de 222 pacientes. Resultados El 83,3% de los pacientes fueron homocigotos para C282Y y el 5% dobles heterocigotos (C282Y/H63D). No se observaron diferencias significativas en la expresion fenotipica ni en la frecuencia de homocigosidad para C282Y en los pacientes nacidos en el norte o en el sur de Espana. Conclusion El patron genotipico y la expresion fenotipica de la HH en Espana son muy similares a los observados en el norte de Europa. Por tanto, la heterogeneidad genetica descrita en algunas regiones del sur de Europa no puede considerarse una caracteristica comun a todos los paises de la cuenca mediterranea.

Fundamento Aunque el tratamiento con interferon (IFN) a las dosis estandar solo consigue unarespuesta persistente en el 5% de los pacientes con cirrosis debida al virus de la hepatitis C(CVHC), se ha planteado que podria disminuir el riesgo de complicaciones y la incidencia dehepatocarcinoma. Teniendo en cuenta los estudios cineticos del virus de la hepatitis C (VHC),la terapia de induccion con IFN podria aumentar las tasas de respuesta al tratamiento. Pacientes y metodo Cuarenta pacientes con CVHC compensada fueron distribuidos al azar pararecibir (grupo I = 19) o no (grupo II = 21) tratamiento con IFN (4,5 MU/dia durante 6 meses,seguidos de 4,5 MU/dias alternos durante 6 meses mas, solo si la ALT se habia normalizado). Resultados El tratamiento con IFN hubo de reducirse o interrumpirse por efectos adversos en11 (58%) y seis (31,5%) casos, respectivamente. La respuesta al final del tratamiento se observoen 4 pacientes del grupo I (21%), que fue persistente en dos (10,5%), y en ninguno delgrupo II (p = 0,04 y NS, respectivamente). La probabilidad global de presentar ascitis, hepatocarcinomay/o muerte o trasplante hepatico fue menor en el grupo I que en el II (el 6 frenteal 27% a los tres anos; p = 0,05). Conclusiones Aunque la terapia de induccion con IFN en la CVHC compensada se asocia a frecuentesefectos adversos e induce una respuesta persistente en una proporcion baja de pacientes,podria mejorar el pronostico a medio plazo de los pacientes.

Hybrid lesions comprise elements of different pathologies in one lesion. Hybrid lesions comprising central giant cell granulomas (CGCG) with fibro-osseous components are rare, with only six maxillomandibular cases reported in the literature. We report a case of a hybrid lesion in a 38-year-old woman who presented with a swelling in the mandibular parasymphysis, on the left side. Panoramic and occlusal radiographs and CT showed a mixed lesion with expansion of the buccal cortical plate that pointed to the diagnosis of ossifying fibroma (OF). Complete excision of the lesion was performed, and the anatomopathological examination showed features of both CGCG and a fibro-osseous lesion. Clinical, imaging and histopathological features indicate a hybrid lesion of CGCG and OF. The patient remains asymptomatic after 30 months of follow-up.

Limited information suggests the existence of a high prevalence of hepatitis B (HBV) and C virus (HCV) infection in inflammatory bowel disease (IBD). This knowledge is relevant because the viruses may reactivate under immunosuppressive therapy. The objectives of this study are to assess the prevalence of HBV and HCV infection in IBD, in a nationwide study, and to evaluate associated risk factors.This cross-sectional multicenter study included 2,076 IBD patients, consecutively recruited in 17 Spanish hospitals. Factors related to IBD (severity, invasive procedures, etc.) and to infection (transfusions, drug abuse, etc.) were registered. Independent risk factors for viral infection were evaluated using logistic regression analysis.Present and/or past HBV and HCV infection was found in 9.7% of patients of both ulcerative colitis (UC) and Crohn's disease (CD) (UC: HBsAg 0.8%, anti-HBc 8%, anti-HCV 1.3%; CD: HBsAg 0.6%, anti-HBc 7.1%, anti-HCV 2.3 %). Effective vaccination (anti-HBs, without anti-HBc) was present in 12% of patients. In multivariate analysis, age (odds ratio (OR) 1.04; 95% confidence interval (CI) 1.02-1.06; P=0.000), family history of hepatitis (OR 2.48; 95% CI 1.3-4.74; P=0.006) and moderate-to-severe IBD disease (OR 2.5; 95% CI 1.02-6.15; P=0.046) were significantly related to HBV, whereas transfusions (OR 2.66; 95% CI 1.2-5.87; P=0.015) and antibiotic use (OR 2.66; 95% CI 1.1-6.3; P=0.03) were significantly related to HCV. The significance for transfusions was lost if they were administered after 1991, when HCV markers became mandatory in blood banks.Prevalence of HBV and HCV infection in IBD is similar to that of the general population of reference and lower than that in previously published series. This fact, in addition to the lack of association with invasive procedures, suggests the existence of adequate preventive measures in centers attending to these patients. The low percentage of effective vaccination makes it mandatory to intensify B virus vaccination in IBD.

Introduccion Los inmunosupresores pueden aumentar la replicacion viral con exacerbacion de la hepatitis B (VHB) y C (VHC). Existe escasa informacion con respecto a la influencia del tratamiento inmunosupresor en pacientes con enfermedad inflamatoria intestinal (EII) e infeccion viral simultanea. En pacientes hematologicos sometidos a terapia antineoplasica, se demuestra reactivacion por el VHB que oscila del 14–78%, con un alto porcentaje de hepatitis fulminante (50% mortalidad), siendo la reactivacion por el VHC menos frecuente. Objetivo Evaluar la influencia del tratamiento inmunosupresor en la evolucion de la infeccion por el VHB y C en pacientes con EII. Metodos Estudio multicentrico retrospectivo que incluye todos los pacientes con EII e infeccion por el VHB y/o VHC actual o pasada y que hayan recibido tratamiento inmunosupresor en 18 hospitales espanoles. Se recopila informacion sobre el tipo y periodo de uso de los inmunosupresores utilizados y se evalua la funcion hepatica y marcadores virales pre, durante y postratamiento. Los datos se introducen en una base electronica ( www.repentina.com ), finalizando el reclutamiento el 31 marzo 2009. Resultados En el momento del envio del resumen, disponemos de datos de los marcadores virales de 77 pacientes; 43 de los cuales con serologia positiva para el VHB y 39 para el VHC. Cinco de estos tenian marcadores de ambas infecciones (antiHBc+AcVHC). En la tabla se muestra la evolucion de la infeccion de los pacientes HBsAg y RNA-VHC positivos, en relacion con la inmunosupresion. Casos Reactivacion No reactivacion Datos incompletos VHB (HBsAg) 13 53,8% (7/13) 46,1% (6/13) 0% (0/13) VHC (RNA) 23 8,7% (2/23) 52,2% (12/23) 39,1% (9/23) La reactivacion del VHB se observo en la mayoria de los casos con la utilizacion simultanea de 2 inmunosupresores (azatioprina+infliximab o esteroides), y se acompano de insuficiencia hepatica grave en 5 de 7 casos (71%). En 1 paciente con marcadores de infeccion pasada por VHB (antiHBc+antiHBs) y tratado con infliximab+azatioprina se detecto DNAVHB en dos ocasiones sin evidencia de reactivacion. Conclusiones 1) Igual como se ha descrito en otras situaciones de inmunosupresion, la reactivacion del VHB (HBsAg positivo) es mucho mas frecuente y grave que con el VHC. 2) La mayoria de las reactivaciones del VHB se producen con la administracion de 2 inmunosupresores simultaneos. 3) Los pacientes con marcadores de infeccion pasada por VHB deben ser controlados de forma estricta por la posibilidad de infeccion oculta.

BACKGROUND--There is some controversy concerning the efficacy of low dose alpha interferon therapy in chronic hepatitis C. AIMS--To evaluate the effectiveness of treatment with low doses of alpha interferon in chronic hepatitis C. PATIENTS--One hundred and forty one patients with anti-HCV positive chronic active hepatitis C from six hospitals were enrolled in the study. METHODS--Patients were randomised to treatment with 5 MU (group A) or 1.5 MU (group B) injections. The dose was reduced in responders from group A or increased in non-responders from group B to maintain treatment with the minimal effective dose. Patients were treated for 48 weeks and followed up for 24 additional weeks with no treatment. Normalisation of alanine aminotransferase (ALT) was used to evaluate response. RESULTS--A sustained response was seen in eight patients from group A (12%) and in 15 (21%) from group B. This difference was not statistically significant. Increasing the dose of interferon led to sustained response in only five of 58 patients (9%) from group B who did not respond to 1.5 MU injections. In contrast, 15 of 21 patients (71%) in whom ALT remained normal with 1.5 MU injections developed a sustained response. By multivariate analysis sustained response seemed associated with young age and was more frequent in patients with genotype 3 HCV infection. Sustained response was preceded by a rapid normalisation of ALT and was inversely related to the amount of alpha interferon necessary to maintain ALT at low values during treatment. CONCLUSIONS--Some patients with chronic hepatitis C are very sensitive to alpha interferon and can be successfully treated with low doses. Treatment with higher doses may be effective in a minority of patients who do not respond to low doses.

The factors influencing the histological evolution of alcoholic hepatitis without cirrhosis have been evaluated in 26 patients (14 males and 12 females) submitted to repeated liver biopsies over a mean period of 1.7 years (1-3). Drinking habits during follow-up were checked by inquiries to patients and relatives and by serial determination of ethanol in urine. At the end of the follow-up, 9 patients (34.6%) had progressed to cirrhosis, 5 (19.2%) still had alcoholic hepatitis and 12 (46.1%) had normal liver or only minimal changes. Nine patients continued drinking heavily, 4 reduced their daily intake markedly and 13 stopped drinking. Improvement of liver lesions was observed in 9 of the abstainers and in 3 non-abstainers that had markedly reduced their alcohol consumption. Among the 9 patients with persistent heavy alcohol consumption, 5 developed cirrhosis and 4 still showed alcoholic hepatitis in their last biopsy. Cirrhosis also developed over 1-2 years in 4 females who had stopped drinking, indicating a marked influence of sex on the course of alcoholic hepatitis. Progression of the disease to cirrhosis despite abstinence occurred in a high proportion of women (4/7) but not in men (0/6). These observations indicate that discontinuation of heavy alcohol consumption often results in improvement of liver lesion in patients with alcoholic hepatitis. However, the risk of progression to cirrhosis remains elevated in women.

The usefulness of a urine-alcohol determination in the evaluation of abstinence in alcoholic liver disease has been investigated in 181 patients. Alcohol was tested in morning urine samples collected on a follow-up visit in 103 patients, and the results were compared with those in 78 patients, where three samples were collected within the same week; one in the morning and two in the evening. Although the percentage of urine samples containing alcohol measured in a morning sample was similar to the patients' self-report (31% and 34%, respectively), urine analysis identified an additional 7% of patients who denied alcohol intake. Alternatively, serial urine-alcohol determinations were significantly more effective than patient reports (54% and 35.9%, respectively, P less than 0.01), particularly when urine was collected in the evenings. This difference was due mainly to the reluctance of women to admit drinking (7.4% of positive self reports vs 51% of women with alcohol positive urine samples, P less than 0.001). We conclude that serial measurements of alcohol in urine were useful tests which should be used to complement personal interview in the control of abstinence in patients with alcoholic liver disease.

Varicella pneumonia develops in 10-20% of cases of chickenpox occurring in adolescence or adult life.' Airflow obstruction, pleural effusion, and respiratory failure are less frequent. Although several haemorrhagic pleuropulmonary complications have been described in the course of chickenpox, haemothorax has been observed only once. We describe a new case of this association.

Background Colorectal cancer is an important public health problem in Spain. Over the last decade, several regions have carried out screening programmes, but population participation rates remain below recommended European goals. Reminders on electronic medical records have been identified as a low-cost and high-reach strategy to increase participation. Further knowledge is needed about their effect in a population-based screening programme. The main aim of this study is to evaluate the effectiveness of an electronic reminder to promote the participation in a population-based colorectal cancer screening programme. Secondary aims are to learn population’s reasons for refusing to take part in the screening programme and to find out the health professionals’ opinion about the official programme implementation and on the new computerised tool. Methods/Design This is a parallel randomised trial with a cross-sectional second stage. Participants: all the invited subjects to participate in the public colorectal cancer screening programme that includes men and women aged between 50–69, allocated to the eleven primary care centres of the study and all their health professionals. The randomisation unit will be the primary care physician. The intervention will consist of activating an electronic reminder, in the patient’s electronic medical record, in order to promote colorectal cancer screening, during a synchronous medical appointment, throughout the year that the intervention takes place. A comparison of the screening rates will then take place, using the faecal occult blood test of the patients from the control and the intervention groups. We will also take a questionnaire to know the opinions of the health professionals. The main outcome is the screening status at the end of the study. Data will be analysed with an intention-to-treat approach. Discussion We expect that the introduction of specific reminders in electronic medical records, as a tool to facilitate and encourage direct referral by physicians and nurse practitioners to perform colorectal cancer screening will mean an increase in participation of the target population. The introduction of this new software tool will have good acceptance and increase compliance with recommendations from health professionals. Trial registration Clinical Trials.gov identifier NCT01877018

To evaluate if serum procollagen type III peptide levels reflect the extent of liver fibrosis and hepatic collagen synthesis, we have studied 19 patients with histologically proven alcoholic hepatitis and 9 chronic alcoholics with normal liver histology or minimal steatosis. Serum procollagen peptide type III was measured at the time of liver biopsy, and determination of hepatic prolyl-hydroxylase activity, as an index of collagen synthesis, was performed in all liver samples. Hepatic prolyl-hydroxylase activity and serum procollagen peptide levels were significantly higher in patients with alcoholic hepatitis (959 +/- 115 cpm/mg and 33.2 +/- 5.3 ng/ml, respectively) than in alcoholics from the control group (537 +/- 62 cpm/mg and 10.9 +/- 1.5 ng/ml, respectively) (p less than 0.05 and p less than 0.01, respectively). All patients with alcoholic hepatitis had fibrosis (10 mild and 9 severe). Prolyl-hydroxylase activity and procollagen peptide levels were significantly higher in alcoholic hepatitis patients with severe fibrosis than in those with mild fibrosis (1208 +/- 154 cpm/mg vs. 734 +/- 138 cpm/mg, p less than 0.05 and 49.1 +/- 8.8 ng/ml vs. 20.4 +/- 2.6 ng/ml, p less than 0.01). Furthermore, a close correlation was found between the hepatic prolyl-hydroxylase activity and the serum level of procollagen peptide (r = 0.76, p less than 0.001). We conclude that the serum procollagen peptide level is a good marker of hepatic fibrogenesis in alcoholic hepatitis; thus, its serial measurement could be useful in identifying patients in progress to cirrhosis and in assessing the therapeutic efficiency of antifibrogenic drugs.

It has recently been shown that repeated large-volume paracentesis associated with intravenous albumin infusion is a rapid, effective, and safe therapy of ascites in cirrhosis. To investigate whether intravenous albumin infusion is necessary in the treatment of cirrhotics with large-volume paracentesis, 105 patients with tense ascites were randomly allocated into two groups. Fifty-two patients (group 1) were treated with paracentesis (4-6 L/day until disappearance of ascites) plus intravenous albumin infusion (40 g after each tap), and 53 (group 2) with paracentesis without albumin infusion. After disappearance of ascites, patients were discharged from the hospital with diuretics. Patients developing tense ascites during follow-up were treated according to their initial schedule. Paracentesis was effective in eliminating the ascites in 50 patients from group 1 and in 48 from group 2, with the duration of the hospital stay being approximately 11 days in both groups. Paracentesis plus intravenous albumin did not induce significant changes in standard renal function tests, plasma renin activity, and plasma aldosterone. In contrast, paracentesis without albumin was associated with a significant increase in blood urea nitrogen, a marked elevation in plasma renin activity and plasma aldosterone concentration, and a significant reduction in serum sodium concentration. One patient from group 1 and 11 from group 2 developed renal impairment or severe hyponatremia after treatment, or both (chi 2 = 9.19; p less than 0.01). The development of these complications could not be predicted by clinical and laboratory data before treatment. Although the probability of survival after entry into the study was similar in patients from both groups, a multivariate analysis identified the development of hyponatremia or renal impairment, or both, following the first paracentesis treatment and the occurrence of other complications during the first hospitalization (encephalopathy, gastrointestinal bleeding, and severe infection) as being the only independent predictors of mortality. These results indicate that intravenous albumin infusion is important in avoiding renal and electrolyte complications and activation of endogenous vasoactive systems in cirrhotics with ascites who are treated with repeated large-volume paracentesis. The development of such complications may impair survival in these patients.