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Differential diagnosis of uterine vascular anomalies:Uterine pseudoaneurysm as a cause of massive hemorrhage

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World Journal of clinical Cases 2025年第9期13卷 60-64页

作者： Teresa Gastañaga-Holguera Isabel Campo Gesto Laura Gómez-Irwin Marta Calvo Urrutia Department of Obstetrics and Gynecology San Carlos Clinical HospitalMadrid 28040Spain Department of Gastroenterology University Hospital of CrucesBaracaldo 48903BizkaiaSpain

In this article,we comment on the paper by Kakinuma et al published *** focus specifically on the diagnosis of uterine pseudoaneurysm,but we also review other uterine vascular anomalies that may be the cause of life-threating hemorrhage and the different causes of uterine *** artery pseudoaneurysm is a complication of both surgical gynecological and nontraumatic *** hemorrhage is the consequence of the rupture of the *** artery pseudoaneurysm can develop after obstetric or gynecological procedures,being the most frequent after cesarean or vaginal deliveries,curettage and even during ***,there are several cases described unrelated to pregnancy,such as after conization,hysteroscopic surgery or laparoscopic *** is the clinical manifestation and it can be life-threatening so suspicion of this vascular lesion is essential for early diagnosis and ***,there are other uterine vascular anomalies that may be the cause of severe hemorrhage,which must be taken into account in the differential *** tomography angiography and embolization is supposed to be the first therapeutic option in most of them.

关键词： Uterine artery pseudoaneurysm Vascular anomaly Uterine vascular malformation Massive hemorrhage Postpartum hemorrhage Angiography Uterine embolization Transarterial embolization

High prevalence of viable Mycobacterium avium subspecies paratuberculosis in Crohn's disease

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World Journal of Gastroenterology 2010年第36期16卷 4558-4563页

作者： Juan L Mendoza Amparo san-Pedro Esther Culebras Raquel Cíes Carlos Taxonera Raquel Lana Elena Urcelay Fernando de la Torre Juan J Picazo Manuel Díaz-Rubio Department of Gastroenterology Hospital Clinico San Carlos28040 MadridSpain Department of clinical Microbiology Hospital Clinico San Carlos28040 MadridSpain Department of Internal Medicine Hospital Clinico San Carlos28040 MadridSpain Department of Immunology Hospital Clinico San Carlos28040 MadridSpain

AIM:To examine the detection rate of viable Mycobacterium avium subspecies paratuberculosis(MAP) in patients with inflammatory bowel disease [Crohn's disease(CD) and ulcerative colitis(UC)].METHODS:Thirty patients with CD(15 with at least one nOD2/CARD15 mutation),29 with UC,and 10 with no inflammatory bowel disease(IBD).were tested for MAP by polymerase chain reaction(specific IS900 fragment) and blood ***:MAP DnA was detected in all original blood samples and 8-wk blood cultures(CD,UC and non-IBD).Positive MAP DnA status was confirmed by dot blot *** 69 cultures were negative by acid-fast Ziehl-neelsen *** MAP,in spheroplast form,was isolated from the 18-mo blood cultures of all 30 CD patients,one UC patient,and none of the non-IBD *** association was found between positive MAP cultures and use of immunosuppressive drugs or CDassociated single nucleotide ***:MAP is widely present in our area and MAP DnA can be recovered from the blood of CD,UC and non-IBD ***,MAP spheroplasts were only found in CD patients.

关键词： Mycobacterium avium subspecies paratuberculosis Crohn’s disease Ulcerative colitis Inflammatory bowel disease Polymerase chain reaction Genetic susceptibility

Hepatitis C virus nS5A region mutation in chronic hepatitis C genotype 1 patients who are non-responders to two or more treatments and its relationship with response to a new treatment

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World Journal of Gastroenterology 2017年第25期23卷 4538-4547页

作者： Paloma Munoz de Rueda José Manuel Fuentes RodríguezRosa Quiles Pérez Ana Gila Medina Ana Belén Martínálvarez Jorge Casado Ruíz ángeles Ruíz Extremera Javier Salmerón Research Support Unit San Cecilio University Hospital of Granada Instituto de Investigación Biosanitaria CIBERehd Instituto de Salud Carlos III Unit for clinical Management of Digestive Diseases San Cecilio University Hospital of Granada Granada University

To determine the number of mutations in the nS5A region of the hepatitis C virus (HCV) and its relationship to the response to antiviral therapy in patients with chronic hepatitis C genotype 1 who are non-responders to two or more treatments. METHODSSequences within HCV nS5A [PKR binding domain (PKRBD) and the interferon-sensitivity-determining region (ISDR)] were analysed via direct sequencing in a selected cohort of 72 patients, with a total of 201 treatments [interferon-alpha (IFn-α), n = 49; IFn-α + ribavirin (RBV), n = 75; pegylated (peg) IFn-α + RBV, n = 47; first-generation direct-acting antivirals (DAAs), n = 13; and second-generation DAAs, n = 17]. Of these, 48/201 achieved a sustained virological response (SVR) and 153/201 achieved no virological response (nVR). RESULTSFor both regions, treatments resulting in SVR were associated with more baseline mutations than were treatments resulting in nVR (SVR vs nVR; PKRBD: 5.82 ± 3 vs 4.86 ± 2 mutations, P = 0.045; ISDR: 2.65 ± 2 vs 1.51 ± 1.7 mutations, P = 0.005). A decrease or no change in the number of mutations over time between treatments in the PKRBD or ISDR, as shown by sequencing, was associated with patients who usually failed to respond to treatment (PKRBD, P = 0.02; ISDR, P = 0.001). Moreover, patients showing a post-treatment baseline viral load > 600000 IU/mL and increased ISDR mutations with respect to the previous treatment were 9.21 times more likely to achieve SVR (P = 0.001). COnCLUSIOnThe obtained results show that among patients who have shown no response to two or more antiviral treatments, the likelihood of achieving SVR increases with the genetic variability in the ISDR region (≥ 2 mutations or number of substitutions from the HCV-J and HCV-1 prototype), especially when the viral load is greater than 600000 IU/mL.

关键词： Interferon-based therapy Interferon-free therapy Chronic hepatitis C nS5A region Sustained virological response number of mutations

nerve Fibres Detection in Paired Eutopic and Ectopic Endometria from Women with Endometriosis: Correlation with nerve Growth Factor Expression

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Open Journal of Obstetrics and Gynecology 2015年第7期5卷 417-426页

作者： Sebastián Venegas Edward Parada M. Angélica Boric Hugo Sovino Ariel Fuentes Fernando Gabler Reinaldo González-Ramos M. Cecilia Johnson Institute of Maternal and Child Research Faculty of Medicine University of Chile Santiago Chile Medical Technology School Faculty of Medicine University of Chile Santiago Chile san borja arriarán clinical hospital Santiago Chile Department of Pathology Faculty of Medicine University of Chile Santiago Chile

Endometriosis, disorder characterized by the presence of endometrium outside the uterus cavity, is associated with chronic pelvic pain. nerve growth factor (nGF) participates in development, repair and survival of neurons. We evaluated nGF and nerve fibres in eutopic and ectopic endometria from women with endometriosis and in normal endometrium from control patients without endometriosis. In endometrium collected during surgery for endometriosis (paired eutopic and ectopic endometria, proliferative n = 6 and secretory n = 7 phases) or during tubal ligation or hysterectomy for no endometrial disease (control, proliferative n = 6 and secretory n = 6 phases), nGF and neurofilament (nF) of nerve fibres were studied by immunohistochemistry measuring integrated optical density (IOD). Cytoplasmic nGF was detected in glands and stroma in all control, eutopic and ectopic endometrial samples;no statistical differences were found throughout the menstrual cycle. However, total (gland plus stroma) nGF IOD was higher in eutopic than in ectopic endometria during the secretory phase. nF was detected only in ectopic endometrium being eutopic and control endometria negative to this antibody, and no differences were observed between proliferative and secretory phases. negative and significant correlation was found between nGF and nF expression in ectopic endometria only during the secretory phase. In conclusion, our results show a significant negative correlation between nGF and myelinated nerve fibres in secretory ectopic endometria. nGF expression was not significantly modified throughout the menstrual cycle in control and in endometriosis, even higher in eutopic than in ectopic tissues;the nGF secretion from lesions to pelvic cavity cannot be ruled out, and could explain the negative correlation observed. Although nF and nGF are not useful as diagnostic markers for endometriosis, their expression may be related to endometrial physiology and pathophysiology of the disease.

关键词： nGF nerves Fibres Eutopic Endometrium Ectopic Endometrium Endometriosis

Small extrachromosomal circular DnA in amyotrophic lateral sclerosis matter

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neural Regeneration Research 2025年第5期20卷 1411-1413页

作者： Marcos J.Arauzo-Bravo Daniela Gerovska Matthias Schwab Alexandra Kretz Computational Biology and Systems Biomedicine Biodonostia Health Research InstituteSan SebastianSpain Basque Foundation for Science IKERBASQUEBilbaoSpainMax Planck Institute for Molecular BiomedicineComputational Biology and Bioinformatics GroupMünsterNorth Rhine-WestphaliaGermany Department of Cell Biology and Histology Faculty of Medicine and NursingUniversity of Basque Country(UPV/EHU)LeioaSpain Department of neurology Jena University HospitalJenaThuringiaGermany

Comprehensive studies identify motor neuron spectrum disorders including amyotrophic lateral sclerosis(ALS)as globally rising fatal disorders with the highest prevalence in aging populations,influenced by ethnicity and ancestry(GBD 2016 Motor neuron Disease Colla borators,2018).While~10% of diagnoses involve a family history(fALS),most cases are considered sporadic(sALS).However,population-based studies suggest that even cases without a common index mutation impart heritability(Ryan et al.,2019),indicating a crucial role of rare and as yet unknown genetic denominators.

关键词： amyotrophic sclerosis

Advantages of early cholecystectomy in clinical practice of a terciary care center

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Hepatobiliary & Pancreatic Diseases International 2013年第1期12卷 87-93页

作者： Marta Barceló Dulce María Cruz-santamaría Cristina Alba-López María José Devesa-Medina Manuel Díaz-Rubio Enrique Rey Health Research Institute San Carlos Clinical HospitalDepartment of MedicineSchool of MedicineComplutense University

BACKGROUnD:Despite a number of studies show the superiority of early over delayed cholecystectomy in the treatment of acute cholecystitis,there is still controversy over the time for *** study aimed to assess the use of early versus delayed cholecystectomy for the treatment of acute cholecystitis in terms of complications,conversion to open surgery and mean hospital ***:We collected patients with acute cholecystitis treated at a referral center for a year,and retrospectively analyzed the chosen therapeutic approach,the percentage of conversion of early cholecystectomy to open surgery,appearance of surgical complications,and mean hospital ***:The study included 117 patients,44 women and 73 men,who had a mean age of 67.36±15.74 *** cholecystectomy was chosen in 31(26.5%) and delayed cholecystectomy in 74 patients(63.2%).Of the 74 patients,28(37.8%) required emergency performance of delayed cholecystectomy,and 19(25.7%) had not undergone surgery by the end of the *** no differences were observed between early and delayed cholecystectomy in terms of surgical complications and conversion to open surgery,mean hospital stay was nevertheless significantly shorter in the early versus the delayed cholecystectomy group(8.32±4.98 vs 15.96±8.89 days).COnCLUSIOn:Under the routine working conditions of a hospital that is neither specially dedicated to the surgical treatment of acute cholecystitis nor provided with specific management guidelines,early cholecystectomy can reduce the hospital stay without increase of the conversion rate or complications.

关键词： acute cholecystitis cholecystectomy complications

Inflammatory bowel disease and celiac disease:Overlaps and differences

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World Journal of Gastroenterology 2014年第17期20卷 4846-4856页

作者： Virginia Pascual Romina Dieli-Crimi natalia López-Palacios Andrés Bodas Luz María Medrano Concepción nú?ez UGC de Inmunología Hospital Clínico San CarlosInstituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)28040 MadridSpain Servicio de Digestivo Hospital Clínico San CarlosInstituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)28040 MadridSpain Servicio de Pediatría Hospital Clínico San CarlosInstituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)28040 MadridSpain

Recent findings demonstrate the common genetic basis for many immune-mediated diseases, and consequently, the partially shared pathogenesis. We collected these findings and reviewed the extension of these overlaps to other disease characteristics. Two autoimmune diseases were selected that also share the specific target organ, the bowel. The etiology and immunopathogenesis of both conditions characterized by chronic intestinal inflammation, inflammatory bowel disease (IBD) and celiac disease (CeD), are not completely understood. Both are complex diseases with genetics and environment contributing to dysregulation of innate and adaptive immune responses, leading to chronic inflammation and disease. CeD constitutes a particular disease because the main environmental and genetic triggers are largely known. IBD comprises two main clinical forms, Crohn’s disease and ulcerative colitis, which most likely involve a complex interplay between some components of the commensal microbiota and other environmental factors in their origin. These multifactorial diseases encompass a broad spectrum of clinical phenotypes and ages of onset, although the clinical presentation often differs depending on childhood or adult onset, with greater heterogeneity commonly observed in adults.

关键词： Disease susceptibility Gene-environment interaction Immune system Inflammation Microbiota Inflammatory bowel disease

Anemia and inflammatory bowel diseases

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World Journal of Gastroenterology 2009年第37期15卷 4659-4665页

作者： Fernando Gomollón Javier P Gisbert Gastroenterology Unit Clinical Universitary Hospital "Lozano Blesa" CIBEREHD Avenida San Juan Bosco 15 Zaragoza 50009 Spain Gastroenterology Unit Universitary Hospital "La Princesa" CIBEREHD C/Diego de León 62 Madrid 28006 Spain

Too often anemia is considered a rare or unimportant manifestation in inflammatory bowel disease (IBD). However, over the last 10 years a number of studies have been conducted and the most relevant conclusions obtained are: (1) anemia is quite common in IBD; (2) although in many cases anemia parallels the clinical activity of the disease, many patients in remission have anemia, and iron, vitamin B12 and/or folic acid deficiency; (3) anemia, and also iron def iciency without anemia, have important consequences in the clinical status and quality of life of the patient; (4) oral iron can lead to gastrointestinal intolerance and failure of treatment; (5) intravenous iron is an effective and safe way to treat iron deficiency; (6) erythropoietin is needed in a significant number of cases to achieve normal hemoglobin levels. Thus, the clinician caring for IBD patients should have a comprehensive knowledge of anemia, and apply recently published guidelines in clinical practice.

关键词： Anemia Inflammatory bowel diseases Ferritin Iron

Anemia and digestive diseases: An update for the clinician

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World Journal of Gastroenterology 2009年第37期15卷 4615-4616页

作者： Fernando Gomollón Javier P Gisbert Digestive Diseases Service Clinical University Hospital CIBEREHD IACS Avenida San Juan Bosco 15 Zaragoza 50009 Spain Digestive Diseases Service University Hospital "La Princesa" CIBEREHD C/ Diego León 62 Madrid 28006 Spain

Anemia and iron deficiency are so common in digestive diseases that often are underestimated and undertreated. Our goal is to review from classif ication to treatment of the diverse types of anemias in different digestive diseases to update our knowledge on diagnosis and treatment. With the goal of improving the prognosis and quality of life of digestive diseases patients, we will review current transfusion, intravenous iron, and erythropoietin roles in the treatment of anemia.

关键词： Anemia Iron deficiency Inflammatory bowel disease Crohn's disease Ulcerative colitis