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Infections are one of the leading causes of morbidity and mortality in solid organ transplant recipients because of treatment with immunosuppressive agents. Infections due to nontuberculous mycobacteria (NTM) are infrequent but may be a major cause of morbidity. Treatment is associated with therapeutic limitations due to drug interactions with immunosuppressive agents and enhanced toxicity. Treatment of NTM infection most commonly involves surgery, reducing the doses of immunosuppressive medications and/or therapy with antimycobacterial medications The American Thoracic Society recommends isoniazid, rifampicin, and ethambutol. The current duration for treatment of pulmonary disease caused by Mycobacterium kansasii is 18 months. We describe the case of an immunosuppressed liver transplant recipient with poor outcome due to acute cholangitis who also developed concomitant infection with an uncommon organism, M. kansasii, in the late posttransplantation period.

Fundamento y objetivo Debido a la mayor morbimortalidad de la hepatitis aguda por el virus de la hepatitis A (VHA) cuando ocurre en pacientes con infeccion cronica por el virus de la hepatitis C (VHC), interesa conocer la prevalencia de inmunizacion frente al VHA en estos pacientes. Pacientes y metodo Se determinaron los anticuerpos de tipo inmunoglobulina G (IgG) frente al VHA (IgG anti-VHA) en 313 pacientes con infeccion cronica por el VHC (anti-VHC) y en 313 individuos anti-VHC negativo. Resultados La prevalencia de IgG anti-VHA encontrada fue identica en ambos grupos: un 81,2%. Sin embargo, entre los menores de 41 anos esta prevalencia era mayor en los anti-VHC positivo que en los individuos del grupo control. La adiccion a drogas por via parenteral y los tatuajes fueron mas frecuentes en el primer grupo. La presencia de IgG anti-VHA se asocio con la edad y con la procedencia del medio rural en ambos grupos. Conclusiones La prevalencia de IgG anti-VHA aumenta con la edad y es mas elevada entre los individuos de procedencia rural. Tambien podria ser mayor entre los pacientes jovenes anti-VHC positivo, en comparacion con los controles de edad similar. Este hallazgo puede deberse a las peores condiciones higienicas probablemente asociadas con ciertas practicas mas communes entre estos individuos, como la adiccion a drogas por via parenteral y los tatuajes.

Fundamento y objetivo: Es conocido el papel que desempenan los mediadores inmunologicos proinflamatorios en la patogenia de algunas alteraciones de organos distantes en la pancreatitis aguda (PA). El objetivo de este estudio ha sido evaluar la relacion entre dichos mediadores y la afectacion hepatica, renal y pulmonar en pacientes con PA. Pacientes y metodo: En 34 pacientes con PA se valoraron el dia del ingreso, parametros bioquimicos de funcion hepatica, creatinina y presion parcial de oxigeno (PO2) arterial, y se establecieron puntos de corte. Se determinaron el receptor soluble tipo I del factor de necrosis tumoral (sTNFRI), el receptor antagonista de la interleucina (IL) 1 (IL-1Ra), la IL-6, el receptor soluble de la IL-6 (sIL-6R), la IL-18 y la molecula de adherencia intercelular-1 (ICAM-1) los dias 1, 2, 3 y 7, y se compararon entre los pacientes con los parametros en el momento del ingreso (bioquimicos y PO2) superiores o inferiores a un punto de corte establecido. Resultados: Se encontraron valores significativamente mas elevados y mantenidos de sTNFRI, IL-18 e ICAM-1, y de IL-6 solo el primer dia, en los pacientes con algun parametro de funcion hepatica superior al punto de corte. sTNFRI, IL-1Ra e ICAM-1 presentaban al inicio valores significativamente superiores en los pacientes en relacion con la creatinina, y de estos e IL-6 en los que presentaban PO2 inferior a 60 mmHg. Conclusiones: sTNFRI, IL-6, IL-18 e ICAM-1 se comportaron como marcadores tempranos de lesion hepatica; sTNFRI, IL-1Ra e ICAM-1, de disfuncion renal, y estos e IL-6, de afectacion pulmonar.

Nina de 3 anos con antecedentes de broncoespasmos severos, que acude a urgencias por crisis asmatica grave. Presenta regular estado general, gran trabajo respiratorio, sibilancias audibles sin fonendo e hipoventilacion generalizada. Se administra oxigenoterapia, salbutamol, bromuro de ipratropio, corticoterapia oral e intravenosa (iv) y sulfato de magnesio iv. Se realiza una radiografia de torax (fig. 1). Debido a la no mejoria ingresa en la Unidad de Cuidados Intensivos Pediatricos anadiendose oxigenoterapia de alto flujo, seguida de ventilacion no invasiva y antibioterapia iv. Finalmente, requiere el inicio de ventilacion mecanica invasiva para su estabilizacion. Dada la mala respuesta al tratamiento, se revisa el diagnostico de presuncion. Asi tras analizar la radiografia ya citada (fig. 2) se indica fibrobroncoscopia, primero flexible y posteriormente rigida, en la que se extraen 2 piedras de 4mm de diametro en ambos lobulos inferiores. La aspiracion de cuerpo extrano (ACE) es una patologia frecuente y potencialmente grave (mortalidad del 0,9%)1. Su diagnostico es complejo, sobre todo si no se refiere un episodio de aspiracion o existe una enfermedad de base que asocie clinica respiratoria2. La localizacion habitual es el bronquio derecho, siendo excepcional la bilateralidad (2% de los casos), que origina en ocasiones una

Eltrombopag is an oral thrombopoietin-receptor agonist. This study evaluated the efficacy of eltrombopag for increasing platelet counts and reducing the need for platelet transfusions in patients with thrombocytopenia and chronic liver disease who are undergoing an elective invasive procedure.We randomly assigned 292 patients with chronic liver disease of diverse causes and platelet counts of less than 50,000 per cubic millimeter to receive eltrombopag, at a dose of 75 mg daily, or placebo for 14 days before a planned elective invasive procedure that was performed within 5 days after the last dose. The primary end point was the avoidance of a platelet transfusion before, during, and up to 7 days after the procedure. A key secondary end point was the occurrence of bleeding (World Health Organization [WHO] grade 2 or higher) during this period.A platelet transfusion was avoided in 104 of 145 patients who received eltrombopag (72%) and in 28 of 147 who received placebo (19%) (P0.001). No significant difference between the eltrombopag and placebo groups was observed in bleeding episodes of WHO grade 2 or higher, which were reported in 17% and 23% of patients, respectively. Thrombotic events of the portal venous system were observed in 6 patients who received eltrombopag, as compared with 1 who received placebo, resulting in the early termination of the study. The incidence and severity of other adverse events were similar in the eltrombopag and placebo groups.Eltrombopag reduced the need for platelet transfusions in patients with chronic liver disease who were undergoing elective invasive procedures, but it was associated with an increased incidence of portal-vein thrombosis, as compared with placebo. (Funded by GlaxoSmithKline; ELEVATE ClinicalTrials.gov number, NCT00678587.).

Objetivos Este proyecto experimental ha sido disenado para evaluar: a) la capacidad de la oxitetraciclina para inducir esteatosis en el higado de rata cuando es administrada durante un periodo prolongado; b) evaluar si las ratas hembras son mas susceptibles a este farmaco, y c) estudiar las posibles alteraciones ultraestructurales y su relacion con los mecanismos de la esteatosis. MeTodos Sesenta y dos ratas Wistar (31 machos y 31 hembras) fueron distribuidas en 6 grupos, dos grupos control y cuatro grupos experimentales. El estudio duro 3 meses. Se obtuvo sangre y tejido hepatico bajo anestesia para el estudio morfologico (microscopia optica [MO] y microscopia electronica [ME]). Resultados La esteatosis fue de tipo microvesicular con una distribucion periportal. Aparecio en los grupos tratados, con un grado significativamente mayor en las hembras (p = 0,004). No se observo ninguna relacion con la dosis. El estudio ultraestructural revelo una dilatacion de los microsomas en todos los grupos experimentales, sin diferencias en cuanto al sexo. No se constato una proliferacion de los peroxisomas ni la aparicion alteraciones mitocondriales. Conclusiones La oxitetraciclina produce predominantemente esteatosis hepatica microvesicular, apareciendo fundamentalmente en hembras. Como posible mecanismo de esta esteatosis inducida por oxitetraciclina postulamos un descenso en las funciones mitocondrial, microsomal y peroxisomal como resultado de una inhibicion en la sintesis proteica de estos compartimientos celulares.

Introduction: care overload, aging of population, and increased chronic diseases lead to increased referrals from primary care, which may sometimes overload the health system. Thus, different interventions have been carried out attempting to improve these aspects. Objectives: to assess the most frequent causes of consultation of general physicians, both in joint consultations and clinical sessions held jointly with specialist consultant in primary care, in the urban and rural setting, and the influence on referrals to first consultations of gastroenterology. Material and methods: a mainly training type of intervention was carried out, consisting of regular meetings in both urban and rural primary care center, to perform joint consultations and clinical sessions on patients and topics related to the specialty of gastroenterology. The intervention period (divided in two subperiods) was compared with a control period. Results: most reasons for consultation were those corresponding to lower gastrointestinal tract, followed by liver disease and upper gastrointestinal tract. Significant differences were only found in distribution of diagnoses between the two centers in joint consultations. There was a relative (percent) decrease in referrals at the global level in both subperiods, only significant in the first (51.45 %), as well as in rural setting (45.24 %). Conclusion: common consultations motifs were similar in urban and rural settings, with some relevance of lower gastrointestinal tract disease. Most of them can be solved at primary care, with the help of consultant specialist. There is impact on referrals to the outpatient first consultations of gastroenterology, mainly in rural setting.

Introduction Liver biopsy remains the gold standard to evaluate fibrosis. However, it is invasive and uncomfortable as well as associated with complications. Transient elastography (FibroScan) is a simple and noninvasive method to assess liver fibrosis by measuring liver stiffness in kilopascals. Body mass index (BMI) greater than 28 is associated with high rates of invalid tests. Liver transplant patients show increased rates of obesity. We do not yet have many data about the usefulness of FibroScan in liver transplantation. Aims To analyze the applicability of FibroScan to assess fibrosis in liver transplantation and study the association between obesity and valid tests. Material and Methods We prospectively assessed the performance of transient elastography in 29 liver transplant patients from February to May 2008. We prospectively studied the success rate, the elasticity (stiffness) in kilopascals, and the BMI. Results The BMI was greater than 30 kg/m 2 in four patients; 25 to 30 kg/m 2 in eight; and 17 had BMI 2 . The overall success of FibroScan was 24/29 (82.7%). However, among patients with BMI > 30 kg/m 2 , it was 2/4 (50%), whereas for BMI 2 it climbed to 100%. The average duration of the procedure was 211.52 seconds for BMI 2 ; 236 seconds for BMI between 25 and 30 kg/m 2 ; and 361 seconds in patients with a BMI > 30 kg/m 2 —differences that were statistically significant. Conclusions FibroScan seemed to be a promising approach to assess liver fibrosis.BMI is a limiting factor toward achieving a valid test; FibroScan had limited usefulness in obese patients.

Given the appearance of pancreatitis attributed to tetracycline, as described in the literature, we have investigated its effect on the enzymatic content of pancreas and duodenal fluid and on pancreatic ultrastructure. We have evaluated possible differences between sexes and the relation of our findings with those described in the initial phases of acute pancreatitis, in the context of the acinar hypothesis.With 128 Wistar rats (63 male and 65 female), 3 groups were established: control (group I) experimental animals treated with oxytetracycline intramuscularly, 15 and 30 mg/kg/d (groups II and III, respectively). Before sacrifice, half of the rats in each group were stimulated with cholecystokinin. Blood, pancreatic tissue (for enzyme dosage and morphological study), and duodenal fluid were extracted following anesthesia.The stimulated males of group III presented lower amylase levels in pancreatic tissue and duodenal fluid (P0.003). Just the opposite occurred in female rats. A similar tendency was observed with other enzymes (lipase and trypsin). Zymogen granule counts, appearance of immature granules, and dilation of ergastoplasm were more frequent in the stimulated animals.Oxytetracycline seems to induce morphofunctional changes in rat pancreas, which differ according to sex. In the female, enzyme accumulation that could predispose intracellular activation seems to exist, as well as the ultrastructural findings described in initial phases of acute experimental pancreatitis. This agrees with the greater frequency of pancreatitis in women undergoing tetracycline treatment described in the literature. In contrast, for males the findings were more compatible with decrease of protein synthesis. This would make them less susceptible to crinophagy phenomena and, thus, to acute pancreatitis in the context of the acinar or lysosome hypothesis.

Arterioportal shunt in the liver is a rare vascular disorder that may be due to congenital vascular malformation (hereditary hemorrhagic telangiectasia), trauma, iatrogenic causes (after a hepatic biopsy) or neoplasm. Initial treatment consists of transcatheter arterial embolization with different kinds of materials. We present the case of a 64-year-old woman with signs of portal hypertension and severe diarrhea. Doppler ultrasonography, computed tomography and angiography revealed arterioportal fistulae between the hepatic artery and right portal vein. Transcatheter arterial embolization with n-butyl-2-cyanoacrylate surgical glue (Glubran) was successfully performed. After 2 years of follow-up, the patient remains asymptomatic. Transcatheter arterial embolization with Glubran should be considered as a therapeutic option in arterioportal shunts and could be a definitive therapy.

Introduction: care overload, aging of population, and increased chronic diseases lead to increased referrals from primary care, which may sometimes overload the health system. Thus, different interventions have been carried out attempting to improve these aspects. Objectives: to assess the most frequent causes of consultation of general physicians, both in joint consultations and clinical sessions held jointly with specialist consultant in primary care, in the urban and rural setting, and the influence on referrals to first consultations of gastroenterology. Material and methods: a mainly training type of intervention was carried out, consisting of regular meetings in both urban and rural primary care center, to perform joint consultations and clinical sessions on patients and topics related to the specialty of gastroenterology. The intervention period (divided in two subperiods) was compared with a control period. Results: most reasons for consultation were those corresponding to lower gastrointestinal tract, followed by liver disease and upper gastrointestinal tract. Significant differences were only found in distribution of diagnoses between the two centers in joint consultations. There was a relative (percent) decrease in referrals at the global level in both subperiods, only significant in the first (51.45%), as well as in rural setting (45.24%). Conclusion: common consultations motifs were similar in urban and rural settings, with some relevance of lower gastrointestinal tract disease. Most of them can be solved at primary care, with the help of consultant specialist. There is impact on referrals to the outpatient first consultations of gastroenterology, mainly in rural setting. Introducción: la presión asistencial, el envejecimiento poblacional y el aumento de enfermedades crónicas incrementan las derivaciones desde atención primaria, pudiendo sobrecargar el sistema sanitario. Se han efectuado diversas intervenciones que intentan mejorar estos aspectos. Objetivos: valorar motivos de consulta más frecuentes de los médicos generales, tanto en consultas compartidas como en sesiones clínicas realizadas conjuntamente con un especialista consultor en atención primaria, en medios urbano y rural, y su repercusión sobre las derivaciones a primeras consultas de gastroenterología. Material y métodos: se efectúa una intervención de tipo fundamentalmente formativo, consistente en reuniones periódicas en dos centros de atención primaria (urbano y rural), con consultas compartidas y sesiones clínicas en relación con pacientes y temas de gastroenterología. El periodo de intervención (dividido en dos subperiodos) se comparó con un periodo control. Resultados: los problemas más comentados corresponden al tracto digestivo inferior, seguido de patología hepática y del tracto digestivo superior. Se encontraron diferencias significativas en la distribución de diagnósticos entre los dos centros en las consultas compartidas. Se detectó un descenso relativo o porcentual de las derivaciones a nivel global en ambos subperiodos, significativo solo en el primero (51,45%), así como a nivel rural (45,24%). Conclusión: los motivos de consulta habituales fueron similares en los medios urbano y rural, con cierto predominio del tracto digestivo inferior. La mayoría pueden ser resueltos desde atención primaria, con el apoyo del consultor especialista. Hay repercusión en las derivaciones a las consultas externas de la especialidad, sobre todo a nivel rural.

El sistema de distribución de competencias establecido por la Ley 40/2010, de 29 de diciembre, de Almacenamiento Geológico de Dióxido de Carbono, que se caracteriza porque el Estado se atribuye competencias ejecutivas importantes, resulta complejo y difícil de justificar en los títulos constitucionales. El conflicto competencial ya ha sido planteado por tres CC. AA. (Aragón, Cataluña y Galicia) ante el Tribunal Constitucional y, sin perjuicio de la resolución que eventualmente recaiga, a simple vista no es fácil entender por qué el Estado se atribuye la competencia para otorgar las concesiones que la Ley regula, cuando tanto en materia de medio ambiente como de minas carece de competencias de ejecución. Además, el análisis de las competencias en juego manifiesta una problemática más amplia que la citada Ley suscita que tiene que ver con las dificultades de coordinación que pueden advertirse y que, sin duda, determinarán una pérdida de eficacia administrativa.

Cavernous hemangioma is the most frequent benign hepatic tumor. These tumors are usually small, solitary or multiple, and asymptomatic but they can be large. In the majority of cases, these tumors are sporadic. We describe a family in which six members from three successive generations presented cavernous hepatic hemangiomas. One of the women, who was taking oral contraceptives, presented a giant cavernous hemangioma causing pain in the right hypochondriac region and biochemical abnormalities while the remaining cases were asymptomatic. We found only one study in the literature that reports familial cavernous hepatic hemangioma; a further two studies describe hepatic hemangiomas in members of families with angiomas in other sites. We believe that description of a new family with this disease is of interest. The findings could support autosomal dominant inheritance as the mode of transmission of these tumors, as well as the existence of proliferative factors in these tumors.

Mucormycosis, although an infrequent fungal infection, has a high mortality in patients undergoing orthotopic liver transplantation. We present two cases of cutaneous Absidia mucormycosis in two successive patients undergoing liver transplantation in our hospital. In our literature search, we encountered only one published case of Absidia infection in liver transplantation.

Grabación de vídeos docentes para el aprendizaje de las técnicas de exploración física normal, Departamento de Medicina, Dermatología y Toxicología

Grabación de vídeos docentes para el aprendizaje de las técnicas de exploración física normal, Departamento de Medicina, Dermatología y Toxicología

Grabación de vídeos docentes para el aprendizaje de las técnicas de exploración física normal, Departamento de Medicina, Dermatología y Toxicología

Whipple's disease is a rare systemic disease of infectious etiology. Its clinical presentation is highly variable. The most common symptoms are diarrhea, weight loss, abdominal pain and joint manifestations. Non-digestive manifestations frequently precede digestive symptoms by several years. For all these reasons, diagnosis is difficult. Definitive diagnosis is established by the finding of PAS-positive macrophages in the lamina propria of the thin intestine. It is important to start appropriate antibiotic therapy early, as this improves the prognosis. We present the case of a male patient in whom the first manifestations of the disease were constipation and upper gastrointestinal hemorrhage, two forms of clinical presentation that have rarely been described in the literature on Whipple's disease.

Gastrointestinal amyloidosis may occur as part of the systemic manifestations of primary amyloidosis or in a localized form. The symptoms and signs that may occur are numerous and nonspecific, hampering clinical suspicion when this disease has not already been diagnosed. Gastric ulcers presenting as massive bleeding are an uncommon manifestation of this disease. We report the case of a patient with primary amyloidosis who developed massive gastrointestinal bleeding complicated by an amyloid gastric ulcer. Emergency surgery was required to control the bleeding.

Introduccion y objetivos: La puncion-aspiracion con aguja fina guiada por ecoendoscopia (USE-PAAF) tiene un valor limitado en el diagnostico histologico de las lesiones submucosas (LSM). El empleo de agujas Tru-Cut presenta limitaciones, por lo que se necesitan alternativas. Describimos un nuevo abordaje diagnostico de las LSM mediante biopsia con pinza tras incision con esfinterotomo de aguja (IEA-BP) guiada por USE. Material, pacientes y metodos: Estudio retrospectivo sobre 8 casos de LSM del tracto digestivo superior (Tabla 1). Las LSM se caracterizaron en tandem mediante USE radial (USEr) y sectorial (USEs) con Doppler pulsado para descartar vascularizacion superficial. Se uso un esfinterotomo de aguja a traves del ecoendoscopio en modo endocut a 30–60W. Se realizo una incision lineal de 6 a 12mm sobre la zona de maxima convexidad, introduciendose una pinza de biopsia convencional y tomandose de 3 a 5 muestras para formol. En 5 casos se realizo simultaneamente PAAF (22G/19G, n=4/1), de 2 a 4 pases, procesados para citologia en medio liquido. La incision se cerro profilacticamente con clips en 3 casos. Resultados: IEA-BP diagnostica en 7/8 casos (sensibilidad 87.5%) sin artefactos por electrocoagulacion. En 3/4 GIST gastricos se pudo realizar IHQ y en uno, determinar el indice mitotico (IM). En 5, se realizaron de forma sucesiva IEA-BP y PAAF que aporto resultados concluyentes unicamente en 2 casos de GIST gastricos (40%) con muestra suficiente para IHQ en uno. Un caso con ambas tecnicas negativas. No hubo complicaciones. Confirmacion quirurgica en el caso 4. Conclusiones: La IEA-BP parece una tecnica sencilla, eficaz y segura para el diagnostico histologico y valoracion del potencial maligno de las LSM del tracto digestivo superior. Puede constituir una alternativa fiable a la PAAF convencional al obtenerse muestras de mayor tamano que aumentan el rendimiento diagnostico

Background Biliary complications, a major source of morbidity after orthotopic liver transplantation (OLT), are increasingly being treated by endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic management has been shown to be superior to percutaneous therapy and surgery. Covered self-expandable metal stents (CSEMSs) may be an alternative to the current endoscopic standard treatment with periodic plastic stent replacement. Objective To assess the safety and efficacy of temporary CSEMS insertion for biliary complications after OLT. Methods From November 2001 to December 2009, the 242 OLT performed in 226 patients included 67 cases that developed post-OLT leaks or strictures (29.6%), excluding ischemic biliary complications. CSEMSs were used in 22 patients (33%), 18 male and 4 female, with an overall median age of 55 years (range, 29–69). In-house OLT patients underwent an index ERCP at 26 days (range, 8–784) after OLT. Their records were reviewed to determine ERCP findings, technical success, and clinical outcomes. Results ERCP with sphincterotomy was performed in all 22 patients, revealing 18 with biliary strictures alone (82%), 3 with strictures and leaks (14%), and 1 with strictures and choledocholithiasis (4%). All strictures were anastomotic. All patients had 1–2 plastic stents inserted across the anastomosis (11 had prior balloon dilation); stones were successfully removed, for an initial technical success rate of 100% (22/22). CSEMSs, were placed at the second ERCP in 14 patients, at the third in 7, and at the fourth in 1. With a median follow-up of 12.5 months (range, 3–25) after CSEMS removal, 21/22 patients (95.5%) remain stricture free and one relapsed, requiring repeat CSEMS insertion. Four patients experienced pain after CSEMS insertion. At CSEMS removal, migration was noted in 5 cases, into either the distal duodenum (n = 4) or the proximal biliary tree (n = 1), and embedding was seen in 1 case. There were no serious complications; no patients needed hepatojejunostomy. Conclusions ERCP is a safe first-line approach for post-OLT biliary complications. It was highly successful in a population with anastomotic leaks and strictures. The therapeutic role of ERCP to manage biliary complications after OLT in the long term is not well known. In our experience, the high rate (close to 95%) of efficacy and its relative safety allowed us to use CSEMS to manage refractory biliary post-OLT strictures. CSEMS insertion may preclude most post-OLT hepatojejunostomies.

Gene expression profiling in the first weeks of treatment of patients with chronic hepatitis C may contribute to better evaluate the response to interferon-based therapy. The objective of this study was to evaluate the gene expression profiles of early responders and non-responders before, and after 12 weeks of treatment with peginterferon alfa and ribavirin.Gene expression profiles were analysed in 12 patients with chronic hepatitis C, and scheduled for treatment with peginterferon alpha and ribavirin.Of the 12 patients studied, six showed a complete early virological response, while six failed to control viremia. In early responders, treatment with peginterferon and ribavirin induced an increased expression of a larger number of interferon-induced genes (ISG15, IFI6, IFI44L, IFI27, MX1, OASL, IRF7, IFIT3, IFITM1, EIF2AK2, HERC5 and APOBEC3) than in non-responders (ISG15, IFI44L, IFI27, IRF7, USP18) in the first twelve weeks of treatment (P0.05). In both groups, there were changes in the levels of certain genes poorly described in the treatment of hepatitis C so far.The gene expression profiles described in this study provide a new insight to understanding the pathogenesis of the disease and treatment effect. The more marked effect of the treatment on the expression of interferon-response genes observed in early responders could explain their better control of viral load.

Gastrointestinal endoscopy is a safe, efficient technique with minimal complications, and a useful diagnostic tool for the pediatric population. Under ideal conditions endoscopies for children should be performed by experienced pediatric endoscopists. In this study we report our experience with pediatric endoscopy at the general adult endoscopy unit in our hospital. Our goal is to quantify the number of endoscopies performed in children, as well as their indications and findings, the type of sedation or anesthesia used, and the time waiting for the test to occur. Our experience demonstrates that endoscopists in a general adult gastroenterology department, working together with pediatricians, may perform a relevant number of endoscopies in children in a fast, safe, effective manner.

Gastrointestinal endoscopy is a safe, efficient technique with minimal complications, and a useful diagnostic tool for the pediatric population. Under ideal conditions endoscopies for children should be performed by experienced pediatric endoscopists. In this study we report our experience with pediatric endoscopy at the general adult endoscopy unit in our hospital. Our goal is to quantify the number of endoscopies performed in children, as well as their indications and findings, the type of sedation or anesthesia used, and the time waiting for the test to occur. Our experience demonstrates that endoscopists in a general adult gastroenterology department, working together with pediatricians, may perform a relevant number of endoscopies in children in a fast, safe, effective manner. La endoscopia gastrointestinal es una técnica segura y eficiente con mínimas complicaciones, así como una útil herramienta diagnóstica en la población pediátrica. En condiciones ideales, las endoscopias en niños deberían ser realizadas por endoscopistas pediátricos experimentados. En este estudio reportamos nuestra experiencia en la realización de endoscopias pediátricas en la Unidad de Endoscopias general de adultos de nuestro hospital. El objetivo es cuantificar la cantidad de endoscopias realizadas en niños, así como las indicaciones y hallazgos de las mismas, el tipo de sedación o anestesia empleado y el tiempo de espera para la realización de la prueba. Nuestra experiencia demuestra que los endoscopistas de un servicio de gastroenterología general de adultos, en colaboración con pediatras, pueden realizar un número importante de endoscopias a niños, de forma rápida, segura y eficaz.

although the vaccination against hepatitis A (VAH) and hepatitis B (VBH) is recommended in patients with HCV, the most cost-effective strategy has not been established. Our objective was to compare the cost-effectiveness of universal strategy (vaccination all patients) with selective strategy (vaccination only patients against virus they lack immunity to) in patients with HCV.we compared the direct medical costs of the two vaccination strategies against both viruses in 313 patients with HC. Serological markers for HAV (anti-HAV) and HBV (HbsAg, anti HBs, anti HBc) were determined in the 313 patients and the costs of the vaccines and the blood tests necessary to determinate the immunity state in our care system were considered.the prevalence of anti-HAV was 81,2% and of anti-HBc was 24,6%. The prevalence of anti-HAV increases with age. HAV vaccination with universal strategy has a cost of 19.806,64 euro and with selective one of 9.899,62 euro. HBV vaccination with universal strategy rose to 18.780 euro and to 20.385,57 euro with selective one (employing anti-HBc). Costs were analysed in different groups of age and several hepatitis HBV risk factors.the selective vaccination strategy against HAV was most cost-effective in our patients with HCV. However, when the prevalence of the anti-HAV decreased to less than 20% universal strategy will be the best option. Difference of cost-effective between the two vaccination strategies against HBV was small, on behalf of universal one, so in groups with higher anti-HBc prevalence, like parenteral drugs users and tattoos, the selective strategy could be the best option.