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Search Results: 1 - 10 of 17173 matches for " Federico; Domínguez-Mu?oz "
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Is safety infliximab during pregnancy in patients with inflammatory bowel disease?
Argüelles-Arias,Federico; Castro-Laria,Luisa; Barreiro-de-Acosta,Manuel; García-Sánchez,Ma Valle; Guerrero-Jiménez,Pedro; Gómez-García,Ma Rosa; Cordero-Ruiz,Patricia; Iglesias-Flores,Eva; Gómez-Camacho,Federico; Domínguez-Muoz,Enrique J.; Herrerías-Gutiérrez,Juan Manuel;
Revista Espa?ola de Enfermedades Digestivas , 2012, DOI: 10.4321/S1130-01082012000200003
Abstract: background: in most cases, inflammatory bowel disease (ibd) debuts at reproductive age. the data available in the literature show infliximab (ifx) to be a safe drug during pregnancy but there is very little evidence about the activity of the disease following drug withdrawal during pregnancy. aims: determine the drug′s safety in pregnant women in our setting and assess its effect on the foetus, drawing on the experience of several hospitals. secondly, observe the effect of treatment withdrawal on disease activity during pregnancy. material and methods: a retrospective study was conducted of women with ibd who had received ifx treatment during pregnancy in five hospitals in spain. disease activity was assessed using crohn′s disease activity index, while uc was assessed using the truelove-witts index in each trimester of pregnancy. gestational age, weight and diseases in the foetus were determined at birth. results: the study included 12 women with a mean age of 29 years; 4 had ulcerative colitis and 8 crohn′s disease, with mean disease duration of 7 years. all but one, who was diagnosed during pregnancy, was receiving ifx treatment at conception. six patients received uninterrupted treatment throughout the pregnancy, 2 requested voluntary interruption and in 3 cases treatment was interrupted in the third trimester as a precaution. they received a mean ifx dose of 400 mg every 8 weeks. of the 6 patients who received continuous treatment, in 50% disease was held in remission. the 6 remaining patients suspended treatment for different reasons, presenting disease recurrence in all but one case (83.3%). eight deliveries were vaginal and 4 by caesarean section. newborns presented no congenital anomalies, intrauterine growth retardation or low birth weight and there was only one premature delivery. conclusions: although cases included in the stduy are not significant, in our experience, ifx during pregnancy is a safe treatment for the mother and the foetus. in fact, in our
Indications, diagnostic tests and Helicobacter pylori eradication therapy: Recommendations by the 2nd Spanish Consensus Conference
Monés,J.; Gisbert,J. P.; Borda,F.; Domínguez-Muoz,E.; ,;
Revista Espa?ola de Enfermedades Digestivas , 2005, DOI: 10.4321/S1130-01082005000500007
Abstract: the results of the 2nd spanish consensus conference for appropriate practice regarding indications for eradication, diagnostic tests, and therapy regimens for helicobacter pylori infection are summarized. the conference was based on literature searches in medline, abstracts from three international meetings, and abstracts from national meetings. results were agreed upon and approved by the whole group. results are supplemented by evidence grades and recommendation levels according to the classification used in the clinical practice guidelines issued by cochrane collaboration. convincing indications (peptic ulcer, duodenal erosions with no history of asa or nsaids, malt lymphoma), and not so convincing indications (functional dyspepsia, patients receiving low-dose asa for platelet aggregation, gastrectomy stump in patients operated on for gastric cancer, first-degree relatives of patients with gastric cancer, lymphocytic gastritis, and ménétrier's disease) for h. pylori eradication are discussed. diagnostic recommendations for various clinical conditions (peptic ulcer, digestive hemorrhage secondary to ulcer, eradication control, patients currently or recently receiving antibiotic or antisecretory therapy), as well as diagnostic tests requiring biopsy collection (histology, urease fast test, and culture) when endoscopy is needed for clinical diagnosis, and non-invasive tests requiring no biopsy collection (13c-urea breath test, serologic tests, and fecal antigen tests) when endoscopy is not needed are also discussed. as regards treatment, first-choice therapies (triple therapy using a ppi and two antibiotics), therapy length, quadruple therapy, and a number of novel antibiotic options as "rescue" therapy are prioritized, the fact that prolonging ppi therapy following effective eradication is unnecessary for patients with duodenal ulcer but not for all gastric ulcers is documented, the fact that cultures and antibiograms are not needed for all eradicating therapies is
Indications, diagnostic tests and Helicobacter pylori eradication therapy: Recommendations by the 2nd Spanish Consensus Conference Indicaciones, métodos diagnósticos y tratamiento erradicador de Helicobacter pylori: Recomendaciones de la II Conferencia Espa ola de Consenso
J. Monés,J. P. Gisbert,F. Borda,E. Domínguez-Muoz
Revista Espa?ola de Enfermedades Digestivas , 2005,
Abstract: The results of the 2nd Spanish Consensus Conference for appropriate practice regarding indications for eradication, diagnostic tests, and therapy regimens for Helicobacter pylori infection are summarized. The Conference was based on literature searches in Medline, abstracts from three international meetings, and abstracts from national meetings. Results were agreed upon and approved by the whole group. Results are supplemented by evidence grades and recommendation levels according to the classification used in the Clinical Practice Guidelines issued by Cochrane Collaboration. Convincing indications (peptic ulcer, duodenal erosions with no history of ASA or NSAIDs, MALT lymphoma), and not so convincing indications (functional dyspepsia, patients receiving low-dose ASA for platelet aggregation, gastrectomy stump in patients operated on for gastric cancer, first-degree relatives of patients with gastric cancer, lymphocytic gastritis, and Ménétrier's disease) for H. pylori eradication are discussed. Diagnostic recommendations for various clinical conditions (peptic ulcer, digestive hemorrhage secondary to ulcer, eradication control, patients currently or recently receiving antibiotic or antisecretory therapy), as well as diagnostic tests requiring biopsy collection (histology, urease fast test, and culture) when endoscopy is needed for clinical diagnosis, and non-invasive tests requiring no biopsy collection (13C-urea breath test, serologic tests, and fecal antigen tests) when endoscopy is not needed are also discussed. As regards treatment, first-choice therapies (triple therapy using a PPI and two antibiotics), therapy length, quadruple therapy, and a number of novel antibiotic options as "rescue" therapy are prioritized, the fact that prolonging PPI therapy following effective eradication is unnecessary for patients with duodenal ulcer but not for all gastric ulcers is documented, the fact that cultures and antibiograms are not needed for all eradicating therapies is indicated, and finally the test and treat strategy is considered adequate, however only under certain circumstances. Se resumen los resultados de la II Conferencia Espa ola de Consenso para la práctica más idonea en cuanto a las indicaciones de erradicación, métodos diagnósticos y pautas de tratamiento de la infección por Helicobacter pylori. La conferencia se basó en la búsqueda bibliográfica con la base de datos de "Medline", los resumenes de tres congresos internacionales y de los congresos nacionales. Los resultados fueron consensuados y aprobados por todo el grupo. Los resultados se comp
Association of NOD2/CARD15 mutations with previous surgical procedures in Crohn's disease Asociación entre las mutaciones del gen NOD2/CARD15 con los antecedentes quirúrgicos por enfermedad de Crohn
M. Barreiro,C. Nú?ez,J. E. Domínguez-Muoz,A. Lorenzo
Revista Espa?ola de Enfermedades Digestivas , 2005,
Abstract: Objective: the aim of this study is to assess the importance of NOD2/CARD15 gene mutations as prognostic factors for surgical indications in Crohn's disease. Patients and experimental design: a total of 165 Crohn's disease patients were studied, considering previous surgery related to Crohn′s disease. We analyzed for previous surgery in global procedures as well as separately for the two main surgical indications: ileal resection and fistula treatment. The need for appendectomy was also studied. All patients were genotyped for the three CARD15 mutations, and association studies were developed using Chi-square statistics and Fisher's exact test whenever appropriate. Results: carriers of the G908R or 1007fs mutation needed surgery more frequently, both for ileal resection and fistula repair. In contrast, appendectomy was not associated with CARD15 mutations. Conclusions: as previously reported in this population, the R702W mutation does influence parameters of disease or need of surgery. The need for Crohn's disease-related surgery is higher in carriers of the G908R or 1007fs CARD15 mutation in the Galician population. Nevertheless, the frequency of these mutations does not allow their use to predict the course of disease. Objetivo: conocer la influencia de las principales mutaciones descritas en el gen NOD2/CARD15 en la cirugía asociada a la enfermedad de Crohn. Pacientes y dise o experimental: se estudió un total de 165 pacientes con enfermedad de Crohn, analizándose los antecedentes de cirugía de estos pacientes en relación con su enfermedad, se analizaron los antecedentes de cirugía en global e, individualmente, de las dos formas principales de cirugía, resección ileal y cirugía de las fístulas. Se estudió también la necesidad de apendicectomía. Todos los pacientes fueron genotipados para las tres mutaciones del gen CARD15 y se llevaron a cabo estudios de asociación mediante el empleo de test Chi cuadrado o test exacto de Fisher cuando este fue necesario. Resultados: individuos portadores de las mutaciones G908R o 1007fs requieren cirugía con mayor frecuencia, tanto sea esta considerada de forma global como en resección ileal y cirugía de fístulas individualmente. Por el contrario la apendicectomía no aparece asociada significativamente al gen CARD15. Conclusiones: la necesidad de cirugía asociada a enfermedad de Crohn, es mayor en pacientes que portan las mutaciones G908R o 1007fs del gen CARD15. Sin embargo, la mutación R702W parece no influir en población gallega. La influencia de esas dos mutaciones no es, sin embargo, suficiente como para que pue
Efficacy of adalimumab for the treatment of extraintestinal manifestations of Crohn's disease Eficacia del adalimumab en el tratamiento de las manifestaciones extraintestinales de la enfermedad de Crohn
Manuel Barreiro-de-Acosta,Aurelio Lorenzo,J. Enrique Domínguez-Muoz
Revista Espa?ola de Enfermedades Digestivas , 2012,
Abstract: Background and aims: Crohn's disease (CD) is commonly associated with inflammatory processes located in organs and systems others than the gut, which are known as extraintestinal manifestations (EIM) of the disease. The aim of this study was to assess the effectiveness of adalimumab (ADA) for the treatment of EIM in patients with CD. Methods: forty two consecutive CD patients with at least one EIM were prospectively included in a open-label study. Patients received ADA (160 mg at week zero, 80 mg at week two and 40 mg every other week) over six months and the effectiveness and safety of ADA for EIMs were assessed. The influence of gender, age, smoking habits, family history of inflammatory bowel disease, phenotype and previous anti-TNF treatment on EIM resolution was also investigated. Results: at month six, 76.2% of the patients showed remission or response in CD (33.3% remission and 42.9% any response). EIM showed a parallel course with CD in most cases, and showed remission or response in 66.7% of patients (38.1% remission and 28.5% any response). Patients with any response of their EIM condition were younger than those with no response (p = 0.04). No relationship was found between sex, tobacco, family history of IBD, phenotype and previous treatment with anti-TNF, and EIM resolution. Conclusions: adalimumab is effective in reducing EIM of CD. Age but not tobacco, CD phenotype and anti-TNF-na ve status appears to influence the response.
Metastasis of lobular breast carcinoma diagnosed by rectal macrobiopsies Metástasis de carcinoma lobular de mama diagnosticado por macrobiopsias rectales
F. Macías-García,M. Sobrino-Faya,J. E. Domínguez-Muoz
Revista Espa?ola de Enfermedades Digestivas , 2010,
Abstract:
Endoscopic ultrasound elastography
Julio Iglesias-Garcia;Bj?rn Lindkvist;J. Enrique Domínguez-Muoz;Jose Lari?o-Noia;
Endoscopic Ultrasound (EUS) , 2012, DOI: 10.7178/eus.01.003
Abstract: Endoscopic ultrasound (EUS) is a reference technique for diagnosing and staging several different diseases. EUS-guidedbiopsies and fine needle aspirations are used to improve diagnostic performance of cases where a definitive diagnosis cannotbe obtained through conventional EUS. However, EUS-guided tissue sampling requires experience and is associated with alow but not negligible risk of complications. EUS elastography is a non-invasive method that can be used in combination withconventional EUS and has the potential for improving the diagnostic accuracy and reducing the need for EUS-guided tissuesampling in several situations. Elastography measures tissue stiffness by evaluating changes in the EUS image before and afterthe application of slight pressure to the target tissue by the ultrasonography probe. Pathologic processes such as cancerizationand fibrosis alter tissue elasticity and therefore induce changes in elastographic appearance. Qualitative elastography depictstissue stiffness using different colors, whereas quantitative elastography renders numerical results expressed as a strain ratio orhue histogram mean. EUS elastography has been proven to differentiate between benign and malignant solid pancreatic masses,as well as between benign and malignant lymph nodes with a high accuracy. Studies have also demonstrated that the earlychanges of chronic pancreatitis can be distinguished from normal pancreatic tissues under EUS elastography. In this article, wereview the technical aspects and current clinical applications of qualitative and quantitative EUS elastography and emphasizethe potential additional indications that need to be evaluated in future clinical studies.
The role of endoscopic ultrasound (EUS) in relation to other imaging modalities in the differential diagnosis between mass forming chronic pancreatitis, autoimmune pancreatitis and ductal pancreatic adenocarcinoma Papel de la endoscopia en relación con otras modalidades de imagen en el diagnóstico diferencial entre pancreatitis crónica en forma de masa, pancreatitis autoinmune y adenocarcinoma pancreático
Julio Iglesias-García,Bj?rn Lindkvist,José Lari?o-Noia,J. Enrique Domínguez-Muoz
Revista Espa?ola de Enfermedades Digestivas , 2012,
Abstract: Differential diagnosis of solid pancreatic lesions remains as an important clinical challenge, mainly for the differentiation between mass forming chronic pancreatitis, autoimmune pancreatitis and pancreatic adenocarcinoma. Endoscopic ultrasound (EUS), computed tomography (CT) and magnetic resonance imaging (MRI) can all provide valuable and complementary information in this setting. Among them, EUS has the unique ability to obtain specimens for histopathological diagnosis and can therefore play a crucial role in the evaluation patients with inconclusive findings on initial examinations. Nowadays, new developed techniques associated to EUS, like elastography and contrast enhancement, have shown promising results for the differential diagnosis of these pancreatic lesions. El diagnóstico diferencial de las lesiones sólidas pancreáticas permanece como un reto clínico importante, sobre todo para la diferenciación entre la masa de conformación pancreatitis crónica, pancreatitis autoinmune y el adenocarcinoma de páncreas. Ecografía endoscópica (USE), la tomografía computarizada (TC) y la resonancia magnética (MRI) pueden proporcionar información valiosa y complementaria en este entorno. Entre ellos, la USE tiene la capacidad única de obtener muestras para diagnóstico histopatológico y por lo tanto, puede desempe ar un papel crucial en la evaluación de los pacientes con resultados poco concluyentes en los exámenes iniciales. Hoy en día, las nuevas técnicas desarrolladas asociadas a la USE, como la elastografía y realce de contraste, han mostrado resultados prometedores para el diagnóstico diferencial de las lesiones pancreáticas.
NOD2/CARD15: geographic differences in the Spanish population and clinical applications in Crohn's disease NOD2/CARD15: diferencias geográficas en la población espa ola y su aplicación clínica en la enfermedad de Crohn
M. Barreiro-de-Acosta,J. L. Mendoza,R. Lana,J. E. Domínguez-Muoz
Revista Espa?ola de Enfermedades Digestivas , 2010,
Abstract: Crohn's disease (CD) is a genetically complex disease in which both genetic susceptibility and environmental factors play key roles in the development of the disorder. NOD2/CARD15 mutations are associated with CD. NOD2 encodes for a protein that is an intracellular receptor for a bacterial product (muramyl dipeptide), though the exact functional consequences of these mutations remain the subject of debate. NOD2/CARD15 mutations are associated with ileal CD, with stricturing behavior, and possibly with a more complicated course of CD. NOD2/CARD15 mutations associated with CD have demonstrated heterogeneity across ethnicities and populations throughout the world, with regional variations across Europe and Spain. However, "NOD2/CARD15 testing" is not yet ready for use in the clinical setting. One of the reasons is that we know that these genetic variants increase the risk of disease only marginally, and many healthy individuals carry the risk alleles, At present it is not recommended to screen first-degree relatives, because we do not have the ability to prevent the disease at the present time. La enfermedad de Crohn (EC) es una enfermedad compleja desde el punto de vista de la genética puesto que para el desarrollo de la enfermedad se tiene que producir una interacción entre factores genéticos y ambientales. Las mutaciones del gen NOD2/CARD15 se han asociado con la susceptibilidad a padecer la EC. El gen NOD2/CARD15 codifica una proteína que actúa como un receptor intracelular de la proteína dipeptidomuramil que se encuentran en la pared de cubierta de algunas bacterias. Actualmente se desconoce cuál es el papel exacto de estas mutaciones en el funcionamiento de la proteína NOD2/CARD15. Estas mutaciones se han asociado con la localización en intestino delgado de la enfermedad, el comportamiento fibroestenosante y con un curso más grave de la enfermedad. Las tres mutaciones asociadas con la EC presentan una distribución desigual entre las diferentes razas y áreas geográficas del mundo, con variaciones a lo largo de Europa y Espa a. La determinación de las mutaciones del NOD2/CARD15 no se puede utilizar todavía en la práctica clínica. La principal razón es que estas variantes genéticas sólo incrementan el riesgo de una forma marginal y los podemos identificar en muchos sujetos sanos. Actualmente no se recomienda realizar estudios de despistaje en familiares de primer grado que padecen la EC porque no disponemos de ninguna medida preventiva para evitar la enfermedad.
ERCP in a low-volume hospital: Arguments "for" and "against" this type of practice CPRE en un hospital con bajo volumen: argumentos "a favor" y "en contra" de este tipo de práctica
Leopoldo López-Rosés,Sarbelio Rodríguez-Muoz,Enrique Vázquez-Sequeiros,J. Enrique Domínguez-Muoz
Revista Espa?ola de Enfermedades Digestivas , 2013,
Abstract:
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