Search

Introduction: Knowledge of acute hepatitis C infection (AHC) is important to design effective prevention and treatment strategies. The aim of this study was to determine the clinical and epidemiological features and outcomes of patients diagnosed with AHC., Methods: A retrospective clinical-epidemiological study was carried out in adult patients diagnosed with AHC between 2000 and 2008 in our hospital., Results: Sixteen patients were diagnosed. The most probable source of transmission was intravenous drug abuse in four patients, a percutaneous injury in three healthcare workers, a medical procedure in three patients and sexual contact in two patients. The source of infection was unknown in four patients. Diagnosis was based on acute clinical symptoms in eight patients, follow-up of healthcare injury in three patients and was fortuitous in five patients. Nine patients showed severe symptoms, while seven patients were asymptomatic or had mild symptoms. The four patients who received treatment were cured. Of the 12 patients that did not receive treatment, the disease became chronic in 58.3%. Progression to chronic disease was more frequent in patients without jaundice than in those with jaundice (85.7% vs 16.7%)., Conclusions: Because medical procedures are still a risk factor for hepatitis C infection, active surveillance is required as well as compliance with prevention measures against parenteral transmission. The percentage of patients with jaundice who progress to chronic disease is low and consequently the start of treatment in these patients could be delayed according to their clinical course.

Objective: To investigate the prevalence of hepatitis B virus (HBV) genotypes in Spanish hepatitis B carriers, and to study the differences in epidemiological characteristics, e antigen (HBeAg) seroconversion, serum DNA viral levels (VL) and liver function alterations., Methods: This study included 108 patients. Genotyping was carried out in 84 with the INNO-LiPA HBV genotyping assay (Innogenetics)., Results: There were 41 women and 67 men, with a mean age of 44.1 years. The source of transmission was family contact in 26 patients (24.1%); transfusions in 10 (9.3%); sexual promiscuity in 9 (8.3%), intravenous drug use in 3 (2.8%), health care accident in 2 (1.8%); and unknown causes in 58 (53.7%). Forty patients had chronic hepatitis and 68 (63%) were healthy carriers. The time of evolution of the infection was known in only in 45 patients, and was over 10 years in 42 of them. One hundred patients (92.6%) were HbeAg-negative and 90 (83.3%) had detectable viral DNA. Genotype A was present in 46 (54.8%), D in 20 (23.8%), F in 2 (2,4%), C in 1 (1.2%), A-G coinfection in 7 (8.3%), A-D in 4 (4.8%), D-G in 2 (2,4%), A-C in 1 (1.2%), and A-D-G in 1 (1.2%). There were no significant differences between genotypes. A trend towards an association was found between VL

Objective: To analyse the prevalence of HCV genotypes among patients from Gran Canaria and the relation with the routes of viral transmission, date of primoinfection and severity of hepatic lesion., Patients and Methods: 179 patients were studied. In 61 patients the date of exposure was determinate. Liver biopsies were obtained in 139 patients. Genotypes were determinate by reverse hybridisation using InnoLiPA genotyping kit (Innogenetics)., Results: The distribution of genotypes was: 1b, 114 (63.7%), 1a, 30 (16.7%); 1, 17 (9.5%); 3a, 7 (3.9%); 4c/4d, 6 (3.3%); 2, 1 (0.5%); 2a/2c, 2 (1.1%), 3, 1 (0.5%) and 4f, 1 (0.5%). We did not find any case of coinfection with a second genotype. In univariable analysis, we found statistically differences in sex (78.9% of women infected with genotype 1b compared with 55.1% of men, p < 0.01 and 31.6% of men infected with 1a, 3a and 4c/4d compared with 15.7% of women, p < 0.01) and age (median age in genotype 1b 45 +/- 12 years vs 36 +/- 9 years in the other genotypes, p < 0.01). HCV subtypes 1a and 3a were predominant in patients IVDA (47.6% and 23.85% respectively) and 1b in blood transfusion receptors (71.2%) (p < 0.01). In 40.2% of the patients, the sources of infection were unknown. In the multivariable logistical regression analysis we found the only factor influencing the genotypes distribution was the transmission mechanism (p < 0.001) and sex and age are relationated with the transmission mode. The media infection duration in patients infected with 1b was 22 +/- 11 years vs 9 +/- 6 years in the other genotypes. We found differences in the liver histologic findings and the age of the patient, but not in the different genotypes., Conclusions: Our study reflects the higher frequency of HCV subtype 1b in our area and a different prevalence of genotypes in relation to mode of transmission. Our results suggest that in our media the liver damage seems to be directly influenced by the age of the patient, but not influenced by HCV genotype.

The aortoduodeonal fistula is a rare condition and has high mortality. We report five retrospective cases of digestive hemorrhage due to an aortoduodenal fistula (4 secondary and 1 primary) between 1986 and 1990. Three of them died. Attention is called to the importance of clinical suspicion and the main diagnostic methods in early diagnosis such as oral endoscopy. We also enhance the importance of emergency surgery for survival.

A case report of a man 58 years old with a history of surgical treatment for an aortic-abdominal aneurysm by an aortobifemoral bifurcated vascular graft is presented. The patient was admitted on Urgencies with digestive hemorrhage and he was submitted to an emergent surgical procedure. Surgical findings were a secondary aortoduodenal fistula and an aortic abdominal aneurysm located between renal arteries and the bifurcated prosthesis. Duodenal fistula was then closed and aortic aneurysm removed, interposing an straight Dacron prosthesis. Fifteen days after procedure, patient was discharged and a suitable duodenal and aortic restauration was demonstrated by duodenal transit and angiography. Two months latter, patient is asymptomatic. Relevant details in regard to diagnosis and treatment of such relatively rare affection are commented.