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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.

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BACKGROUND: Although many studies have been implemented in order to determine the pre-treatment factors that can predict patients' response to interferon (IFN) therapy, it is not yet clear whether characteristic histologic abnormalities in chronic hepatitis C can predict such response. AIMS: The aim of this study were to evaluate, in patients with chronic hepatitis C, (i) the predictive value of histologic lesions for the sustained response to IFN therapy (ii) other pre-treatment (epidemiological and analytical) factors known to be predictive of response. PATIENTS AND METHODS: Sustained response was retrospectively evaluated in two hundred one patients who had been treated with IFN for at least 3 months in four different hospitals from Castilla y León. The following histological parameters were studied as predictors of response: histological diagnosis, Knodell index, grading and stage, characteristic histologic lesions of HCV infection. Epidemiological and analytical parameters were also evaluated. RESULTS: The rate of patient's sustained response to IFN treatment was 16%. None of the histological parameters was useful to predict this response. By univariate analysis, age, disease evolution time, mode of viral transmission, GGT, ferritin and viral genotype were associated with a sustained response. The most powerful, and only independent predictive factor, however, was the genotype (the response odds ratio was 8.6). CONCLUSIONS: Histological parameters do not predict the response to IFN treatment. Other factors (mainly the viral genotype) are associated with a higher response percentage, although no one is useful to decide which patients are going to respond.

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Introducción: Aunque se han realizado múltiples estudios para conocer los factores pre-tratamiento que pueden predecir la respuesta al tratamiento con interferón (IFN), se desconoce si las lesiones histológicas características de la hepatitis crónica C (HCC) sirven para predecir dicha respuesta. Objetivos: Valorar si los parámetros histológicos pueden predecir la respuesta mantenida al tratamiento con IFN en los pacientes con HCC, y estudiar otros parámetros (epidemiológicos y analíticos) ya descritos como factores predictivos de respuesta. Métodos: Se estudiaron de forma retrospectiva 201 pacientes, tratados con IFN durante al menos 3 meses en cuatro hospitales de Castilla y León. La variable dependiente analizada fue la respuesta mantenida al tratamiento. Como factores predictivos de respuesta se estudiaron las siguientes variables histológicas: diagnóstico histológico, índice de Knodell total y por apartados, grado y estadio, y lesiones características de la HCC. Además, se analizaron parámetros epidemiológicos y analíticos. Resultados: El 16 por ciento de los pacientes presentó una respuesta mantenida. Ninguno de los parámetros histológicos sirvió para predecir dicha respuesta. Demostraron ser factores predictivos en el análisis bivariante la edad, el tiempo de evolución de la HCC, la vía de transmisión, la GGT, la ferritina y el genotipo viral. El factor predictivo más importante fue el genotipo viral, y el único asociado independientemente a la respuesta mantenida ("odds ratio" de respuesta al tratamiento de 8,6). Conclusiones: Los parámetros histológicos no predicen la respuesta al tratamiento con IFN. Otros factores, fundamentalmente el genotipo viral, se asocian a un mayor porcentaje de respuestas, aunque ninguno sirve para decidir con exactitud qué pacientes responderán. (AU)

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Eosinophilic enteritis is an uncommon disorder of unknown etiology in which the digestive symptoms are associated with eosinophilic infiltration of the different layers of the intestinal wall. Clinical symptoms depend on the layers involved and are usually characterized by peripheral eosinophilia. Radiological findings depend on the layers involved. Definitive diagnosis is based on clinical and histopathological findings. Treatment of choice is currently with corticoids and prognosis is benign with relapses. The pathogenesis remains unclear. We report a patient who presented with intestinal obstruction and describe the follow-up.

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AIM: The possible induction of functional or morphologic changes in the exocrine pancreas of the rat by oral calcium overload was studied to determine the possible relationship to predisposition of acute pancreatitis over the acinar theory. MATERIALS AND METHODS: Oral chloride calcium (0.45 and 0.25 g/kg body weight/day) plus cholelecalciferol (300,000 UI/kg i.m.) were administered to male Wistar rats over 1 to 3 months. Half of each group, including a control were submitted to cholinergic stimulation with carbamylcholin. After anesthesia, blood and pancreatic tissue and duodenal fluid were extracted for enzymatic and ultrastructural studies. RESULTS: In the rats treated with high doses of calcium for 1 month greater tissue concentrations of amylase, lipase and trypsin were observed. Moreover, there was a greater trend to the presence of dilated ergastoplasm. In the rats treated with high doses over 3 months a lower enzyme concentration was observed in the animals not stimulated that in the control group. On stimulation with carbamylcholin, higher concentrations of enzymes were observed in tissue than in those not stimulated. This was accompanied by a lower number of exocytosis in this experimental group that in the control. CONCLUSIONS: A possible increase in the calcium concentration in the acinar cell may lead to dysfunction in the secretory mechanisms favoring the intracellular accumulation of digestive enzymes, predisposing intracellular activation, in the context of the acinar or lysosomal hypothesis of acute pancreatitis.

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We have made a prospective study in alcoholic patients, with and without hepatic cirrhosis, in order to evaluate the presence of modifications in the composition of pancreatic juice (JPP) and in the pancreatogram that allows us to diagnose the existence of chronic pancreatitis associated with alcoholic cirrhosis (CE). The patients where 23 chronic alcoholics, 13 of them with CE and the other 10 with no hepatic injury (AC). In all, an endoscopic retrograde cholangiopancreatography (CPRE) was made and after having obtained a pancreatogram a intravenous infusion of secretin and cholecystokinin was performed. The total volume, the concentrations and the out-puts of bicarbonate, amylase, lipase and total proteins were measured in the pancreatic juice collected during 12 minutes. The pancreatogram was normal in the 92.3% of CE and in all the AC. Patients with CE had similar values of all the evaluated parameters to AC patients. In conclusion, there seems to be a good correlation between the pancreatogram and the analytic study of JPP, because the JPP has no qualitative and quantitative anomalies when the Wirsung duct is normal. In our opinion the study of JPP is not useful in the diagnostic of chronic pancreatitis associated with alcoholic hepatic cirrhosis.

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The objective was to evaluate the effect of biliary salt depletion on morphology and function of the exocrine pancreas. Cholestyramine (15 g/day) was given during fifteen days to male Wistar rats in order to evaluate changes in pancreas weight as well as in enzymatic content of pancreatic tissue and duodenal juice (amylase, lipase and trypsinogen); in duodenal juice, bile salt concentration was also measured; Moreover ultrastructure of the exocrine pancreas was studied. Our results show an increase in pancreas weight in rats treated with cholestyramine, with a significant increase of amylase (p < 0.05) and trypsinogen in pancreatic tissue (p < 0.01), and of lipase in duodenal juice (p < 0.05). Ultrastructural changes were absent. It is concluded that cholestyramine, probably through a bile salt depletion, stimulates pancreatic function and growth, as well as lipase secretion.

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AIMS: To assess the level of immunity in a healthy population to the hepatitis A virus (HAV), according to age groups and in an urban health area. DESIGN: Transversal random prospective study of a sample of the population found by letters. SITE. Primary Care Centre covering the population of an urban health area in Valladolid. PATIENTS OR OTHER PARTICIPANTS: Random sample of 726 people with an adjustment as to sex and age according to the area's average, in line with the full census of the above area. The sample was 95% trustworthy, with a 3% margin of error. People with serious illness at the time of the study were excluded. MEASUREMENTS AND MAIN FINDINGS: We carried out a social-health count. We established the anti-HAV titer after its detection by enzyme immunoanalysis (HAVAB EIA Abbott); the titers were inferred from the absorbances relating then to that of a a "pool" of serums with very high titers. 69.9% (standardised rate) gave positive. The highest titers were presented in people between 31 and 50 (29.7 +/- 47.0), with significant differences both for lower (17.0 +/- 15.7) and higher (15.7 +/- 19.8) age groups (p. 0.001 for both). CONCLUSIONS: The highest anti-HAV titers corresponded to people in the middle age-group, with a subsequent dropping-off. This could suggest a greater susceptibility to HAV infection in the older person.

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In order to assess the experimental level of enzymatic content in exocrine pancreas of cirrhotic rats, cirrhosis was induced with administration of thioacetamide (50 mg/kg) during ten weeks to male Wistar rats with an initial average weight of 350 g. Contents of amylase, lipase and trypsinogen were determined in pancreatic tissues and amylase, lipase and biliary salts in duodenal juice obtained by cannulation and perfusion with physiologic serum. A higher presence of trypsinogen and amylase was detected in pancreatic tissues, and of lipase in the duodenal juice, with a trend, although insignificant, towards a decrease in biliary salts among the cirrhotic group. No changes were observed in the morphologic study. The hypothesis that a deficit of biliary salts in experimental cirrhosis could be responsible of the enzymatic increase in the pancreatic tissue and, in particular, of the selective excretion of lipase, is discussed.

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