[When is the best time to perform upper digestive endoscopy to detect the presence of esophageal varices in patients with cirrhosis?]. / 'Cuándo sería más rentable realizar una endoscopia digestiva alta para establecer la presencia de varices esofágicas en pacientes con cirrosis?

INTRODUCTION: Variceal hemorrhage occurs in 25 to 35% of cirrhotic patients and is associated with significant morbidity and mortality and elevated hospital costs. Endoscopic exploration of gastroesophageal varices (GEV) in cirrhotic patients increases costs and involves a certain degree of invasiveness and discomfort for patients. The association between the presence of GEV and spleen size, liver function and platelet count is controversial. The aim of this study was to determine the correlation between liver function, evaluated by Child-Pugh (Ch-P) classification, platelet count (PC) and spleen volume index (SVI) with the presence of GEV in patients with cirrhosis managed in the outpatient setting. PATIENTS AND METHOD: Sixty-eight patients were included. In all patients, a medical history was taken and biochemical tests, mode B and Doppler abdominal ultrasonography, and upper digestive video-endoscopy were performed. RESULTS: A total of 76.47% of the patients were men and 23.53% were women. The median age was 52.8 12.4 years. More than half (54.41%) of the patients were Ch-P grade A, 41.18% were grade B and 4.41% were grade C. The most frequent causes of cirrhosis were alcohol in 52.95% and hepatitis C virus in 17.65%. Esophageal varices (EV) were found in 85.29% of the patients. The median SVI was 50.5 9.2 and the median PC was 150 26 x 109/L. A correlation was found between the presence of EV, SVI >or= 45 and PC < or= 100 x 109/L (r = 0.327; p = 0.006). No correlation was found between the presence of EV and Ch-P grade A. In the multivariate analysis, only the presence of EV was associated with SVI >or= 45 (OR 7.4; 95% CI, 1.30-77.7; p = 0.02). CONCLUSION: The presence of EV in cirrhotic patients managed in the outpatient setting was correlated with SVI >or= 45 and PC

[Acute liver failure: clinical-epidemiological characteristics]. / Insuficiencia hepática aguda: características clínico-epidemiológicas.

In order to ascertain the clinical and epidemiological features of acute liver failure (ALF), we analyzed the clinical histories of 22 patients from La Plata city, with the diagnosis of ALF (prothrombin level or factor V below 50%) seen between November 1996 and November 2000. Age, sex, hepatic encephalopathy, reason for consultation, etiology, hepatic biochemical tests, serum creatinine, glycemia, digestive hemorrhage, course and treatment variables were analyzed. What is remarkable is the high frequency of the toxic etiology and of infection by HDV, as well as the high prevalence of ascites and the low incidence of hepatic encephalopathy. We think that the high survival rate we found is due to the early diagnosis and early referral of the patients to the intensive care unit and to centers with programs for liver transplantation.

[Acute liver failure by diphenylhydantoin]. / Insuficiencia hepática aguda por difenilhidantoina.

Diphenylhydantoin is a anticonvulsivant and antiarrhythmic drug. We reported a less frequent case of diphenylhydantoin associated acute hepatotoxicity in a 18-year old woman who immediately after child birth presented generalized tonic-clonic seizures secondary to arachnoid cyst in the left temporal-lobe. The patient developed a mononucleosis like coinciding with previous descriptions. Histological features observed in the liver biopsy specimen showed compatible changes with toxic acute liver failure (ALF). In the few cases published of ALF for Diphenylhydantoin is not specifically pointed out the absence of hepatic encephalopathy as it happened to our patient.

[Hepatocellular carcinoma: clinical and epidemiological characteristics]. / Carcinoma hepatocelular: características clinicoepidemiológicas.

We present 12 patients with CHC, 11 men and one woman, median age, 59.9 +/- 10.1 cared for in two hospitals from La Plata city. The median age, the predominance of men and presence of cirrhosis in the 75% are similar findings to European 41% of the patients, consulted of the CHC has increased in our environment. The fact that all the patients have been symptomatic at the moment of the consultation, that one of them had normal liver function tests and that only two of them had nodule of less than 5 cm of diameter, suggest advanced stage of the disease. At the same time, the median of survival of 8.3 +/- 9 (DS) months post-diagnosis and of 3.6 +/- 8 (DS) months post surgery. 90.9% had a risk factor to undergo CHC (alcohol, HBC, HCV). Because of one patient, the risk of hemodyalizer patients to have CHC is emphasized. Therefore, it is important to prevent and treat viral infections. In this study, the diagnosis of the echography was of 100% and the histologic corroboration was done by percutaneous biopsy with ultrasound or TC assessment. We observed that the levels of alpha-fetoprotein had a weak, negative correlation, not significative, with the diameters of the nodules. Although it is true that the size of the sample and the retrospective character of the investigation inhibits us to draw definitive conclusions, the behaviour of alfafetoprotein creates doubts about its value in the diagnosis and screening of the CHC.

[The prevalence of antibodies against hepatitis B abs c virus in odontology students]. / Prevalencia de anticuerpos contra los virus de hepatitis B y C en estudiantes de odontología.

UNLABELLED: It is accepted that the practice of odontology implies a risk of BBV and HCV transmission but the study of does not. This work tries to determine the prevalence of HBv Ac and HCV Ac (by ELISA) in odontology students and whether there is any relation to the year of study and/or the presence of other risk factors. 188 students in their last three years of studies were investigated, all the participants filled out a clinical epidemiological form. 89 women (47.3%) and 99 men (52.7%), x age was 24.8. 50 (26.7%) had other risk factors. 160 (85.1%) fulfilled biosecurity norms and 40 (21.2%) had a labour accident. RESULTS: None of the analyzed sera were positive for HCV Ac (0%) and 1 was positive for HbcAc. CONCLUSION: The prevalence of HBv Ac and HCV Ac is extremely low with no relation to the year of study or any other risk factors.

[Sexual transmission of Hepatitis C virus]. / Transmisiòn sexual del virus de Hepatitis C.

Fifty heterosexual partners out of 50 patients (index cases) without confirmed or probable risk factors of parenteral transmission by HCV were studied from 1/1997 to 1/2001. The index cases were HCV Ab (+) (EIA 3rd Abbott and PCR + by RT-nested PCR). The couples with probable or confirmed risk factors of parenteral transmission were strictly excluded. No case of HCV infection was found, suggesting that sexual via wouldn't be a direct transmission of HCV.

[Prevalence of hepatic involvement, alcoholism, hepatis B, C and HIV in patients with background history of drug use]. / Prevalencia de afectación hepática, alcoholismo, hepatitis B, C y HIV en pacientes con antecedente de consumo de drogas.

UNLABELLED: Drug addicts frequently have liver diseases for different reasons: alcohol abuse, the drugs themselves, but more often hepatitis B and C infections. AIDS is common in this population as well and could also affect the liver directly or in the form of hepatocellular or biliary damage. We conducted this study to determine the prevalence of liver diseases, alcoholism, hepatitis B and C infections, and HIV positivity in this population. We studied a cohort of 137 persons, all with a history of drug abuse, and investigated the quantity of alcohol intake, the kind of drug used, and he routes of drug administration. RESULTS: We found liver disease in 33.6%. The prevalence of alcoholism was 65.4%, of HCV 67.3%, and of HBV 17.3%. HDV was undetectable, whereas we found HIV at a frequency of 17.3%. HCV RNA was detected in 85.4% of HCV. The drug most often used was cocaine at 90.4%, followed by marihuana at 88.3%; LSD use occurred in 17.5%. We found parenteral drug use in 43.1%. We performed 22 liver biopsies, 21 associated with HCV, and detected histological changes consistent with chronic hepatitis in 17, with cirrhosis in 4, and with hepatocellularcarcinoma in 1.

[Anti HCV in hemodialyzed patients: reduction of the prevalence and association with epidemiological variables]. / Anti HCV en pacientes hemodializados: descenso de la prevalencia y asociación con variables epidemiológicas.

In order to establish the present prevalence of HCV in hemodialyzed patients (HD) from the city of La Plata, and to know the association between the prevalence and different variables, we have studied 217 hemodialyzed patients belonged to the Hemodialysis Unit of a Public Hospital and other 7 private Units. Serological reactivity to Anti HCV and Anti HBc IgG were investigated in all of them, as well as age, sex, number of transfusions, the time under dialysis treatment, the use of erythropoietin and hepatitis episodes were taken into account. We have found a prevalence of Anti HCV of 18.4% which was significantly superior to the blood donors' prevalence (P < 0.01) and significantly inferior to the one found in 1993 in HD patients of the same city (p = 0.002). We have found an association between the presence of Anti HCV and transfusions exposure, as well as more hemodialysis time. Our results may agree with the ones that suggest the aminotransferases are not good markers for hepatocellular injuries in Anti HCV (R) HD patients.

Disfunción hepática en el trasplante de celulas progenitoras hematopoyéticas: Impacto sobre la mortalidad / Liver dysfunction in recipients of hematopoietic stem cells: Impact on mortality

El compromiso hepático en receptores de transplante alogénico de células progenitoras hemotopoyéticas (TCPH) es una complicación muy frecuente y es responsable de la morbimortalidad precoz. La toxicidad por fármacos la enfermedad injerto versus huésped ( EICH) , la enfermedad venooclusiva (EVO) y las infecciones fúngicas, bacterianas y virales constituyen las principales etiologias. El objetivo de este estúdio retrospectivo fue estabelecer la prevalencia y etiología de la afectación hepática, evaluar el impacto en la mortalidad y analizar el valor predictivo de las transaminasas pré TCPH en la ocurrencia de EICH agudo, crônico y mortalidad. De un total de 236 pacientes transplantados, se evaluaron 82 sometidos a TCPH alogénico. El 88% de los pacientes tuvo afectación hepática: EICH agudo 40.2%, EICH crônico 15.9%, de causa indeterminada 9.8% sepsis 7.3%, toxicidad por fármacos 6.1%, EVO 3.7%, hepatitis aguda y recidiva de enfermedad 2.4%. La mortalidad evaluada al año fue 36.6%. La insuficiência hepática aguda (IHA) represento el 10% de las muertes. Las causas de IHA fueron: progresón de EICH agudo, recidiva de la enfermedad hematológica en el hígado, hepatitis herpética y EVO. El valor predictivo positivo de las transaminasas pré TCPH para EICH agudo, crônico y mortalidad fue 0.27, 0.14 y 0.43 respectivamente. No se hallaron diferencias significativas entre pacientes con pruebas bioquímicas hepáticas pré TCPH alteradas o normales en la ocurrencia de EICH agudo, crónico o mortalidad.

Disfunción hepática en el trasplante de celulas progenitoras hematopoyéticas: Impacto sobre la mortalidad / Liver dysfunction in recipients of hematopoietic stem cells: Impact on mortality

El compromiso hepático en receptores de transplante alogénico de células progenitoras hemotopoyéticas (TCPH) es una complicación muy frecuente y es responsable de la morbimortalidad precoz. La toxicidad por fármacos la enfermedad injerto versus huésped ( EICH) , la enfermedad venooclusiva (EVO) y las infecciones fúngicas, bacterianas y virales constituyen las principales etiologias. El objetivo de este estúdio retrospectivo fue estabelecer la prevalencia y etiología de la afectación hepática, evaluar el impacto en la mortalidad y analizar el valor predictivo de las transaminasas pré TCPH en la ocurrencia de EICH agudo, cr¶nico y mortalidad. De un total de 236 pacientes transplantados, se evaluaron 82 sometidos a TCPH alogénico. El 88% de los pacientes tuvo afectación hepática: EICH agudo 40.2%, EICH cr¶nico 15.9%, de causa indeterminada 9.8% sepsis 7.3%, toxicidad por fármacos 6.1%, EVO 3.7%, hepatitis aguda y recidiva de enfermedad 2.4%. La mortalidad evaluada al año fue 36.6%. La insuficiÛncia hepática aguda (IHA) represento el 10% de las muertes. Las causas de IHA fueron: progresón de EICH agudo, recidiva de la enfermedad hematológica en el hígado, hepatitis herpética y EVO. El valor predictivo positivo de las transaminasas pré TCPH para EICH agudo, cr¶nico y mortalidad fue 0.27, 0.14 y 0.43 respectivamente. No se hallaron diferencias significativas entre pacientes con pruebas bioquímicas hepáticas pré TCPH alteradas o normales en la ocurrencia de EICH agudo, crónico o mortalidad. (AU)

Prevalencia de afección hepática, alcoholismo, hepatitis B, C y HIV en pacientes con antecedentes de consum / Prevalence of hepatic involvement, alcoholism, hepatis B, C and HIV in patients with background history of drug use

Drug addicts frequently have liver diseases for different reasons: alcohol abuse, the drugs themselves, but more often hepatitis B and C infections. AIDS is common in this population as well and could also affect the liver directly or in the form of hepatocellular or biliary damage. We conducted this study to determine the prevalence of liver diseases, alcoholism, hepatitis B and C infections, and HIV positivity in this population. We studied a cohort of 137 persons, all with a history of drug abuse, and investigated the quantity of alcohol intake, the kind of drug used, and he routes of drug administration. RESULTS: We found liver disease in 33.6%. The prevalence of alcoholism was 65.4%, of HCV 67.3%, and of HBV 17.3%. HDV was undetectable, whereas we found HIV at a frequency of 17.3%. HCV RNA was detected in 85.4% of HCV. The drug most often used was cocaine at 90.4%, followed by marihuana at 88.3%; LSD use occurred in 17.5%. We found parenteral drug use in 43.1%. We performed 22 liver biopsies, 21 associated with HCV, and detected histological changes consistent with chronic hepatitis in 17, with cirrhosis in 4, and with hepatocellularcarcinoma in 1.(AU)

Insuficiencia hepática aguda: características clínico-epidemiológicas / Acute liver failure: clinical-epidemiological characteristics

Se analizaron las historias clínicas de 22 pacientes con IHA (Protrombina y/o factor V menor de 50 por ciento). La ictericia fue el motivo de consulta más frecuente (54.5 por ciento). Doce pacientes (54.5 por ciento) presentaron EH, sólo dos de los cuales la teníam en el momento del ingreso. Doce (54.5 por ciento) presentaron ascitis en algún momento de la evolución. Etiología desconocida en 6 (27.2 por ciento), fármacos 6 (27.2 por ciento), HBV 5 (22.7 por ciento) 2 de los cuales teníam además HDV y 3 (13.6 por ciento) autoimmune. Se halló una alta tasa de sobrevida.

Insuficiencia hepática aguda: características clínico-epidemiológicas / Acute liver failure: clinical-epidemiological characteristics

Se analizaron las historias clínicas de 22 pacientes con IHA (Protrombina y/o factor V menor de 50 por ciento). La ictericia fue el motivo de consulta más frecuente (54.5 por ciento). Doce pacientes (54.5 por ciento) presentaron EH, sólo dos de los cuales la teníam en el momento del ingreso. Doce (54.5 por ciento) presentaron ascitis en algún momento de la evolución. Etiología desconocida en 6 (27.2 por ciento), fármacos 6 (27.2 por ciento), HBV 5 (22.7 por ciento) 2 de los cuales teníam además HDV y 3 (13.6 por ciento) autoimmune. Se halló una alta tasa de sobrevida. (Au)

Insuficiencia hepática aguda: características clínico-epidemiológicas. / [Acute liver failure: clinical-epidemiological characteristics]

In order to ascertain the clinical and epidemiological features of acute liver failure (ALF), we analyzed the clinical histories of 22 patients from La Plata city, with the diagnosis of ALF (prothrombin level or factor V below 50

) seen between November 1996 and November 2000. Age, sex, hepatic encephalopathy, reason for consultation, etiology, hepatic biochemical tests, serum creatinine, glycemia, digestive hemorrhage, course and treatment variables were analyzed. What is remarkable is the high frequency of the toxic etiology and of infection by HDV, as well as the high prevalence of ascites and the low incidence of hepatic encephalopathy. We think that the high survival rate we found is due to the early diagnosis and early referral of the patients to the intensive care unit and to centers with programs for liver transplantation.

Prevalencia de anticuerpos contra los virus de hepatitis B y C en estudiantes de ondontología / The prevalence of antibodies against hepatitis B abs c virus in odontology

It is accepted that the practice of odontology implies a risk of BBV and HCV transmission but the study of does not. This work tries to determine the prevalence of HBv Ac and HCV Ac (by ELISA) in odontology students and whether there is any relation to the year of study and/or the presence of other risk factors. 188 students in their last three years of studies were investigated, all the participants filled out a clinical epidemiological form. 89 women (47.3%) and 99 men (52.7%), x age was 24.8. 50 (26.7%) had other risk factors. 160 (85.1%) fulfilled biosecurity norms and 40 (21.2%) had a labour accident. RESULTS: None of the analyzed sera were positive for HCV Ac (0%) and 1 was positive for HbcAc. CONCLUSION: The prevalence of HBv Ac and HCV Ac is extremely low with no relation to the year of study or any other risk factors

Insuficiencia hepática aguda por difenilhidantoina / Acute liver failure by diphenylhydantoin

Presentamos un caso poco frecuente de insuficiencia hepática aguda por difenilhidantoína en una joven de 18 años. La paciente fue tratada con dicho fármaco inmediatamente después de un parto normal por presentar convulsiones clónicas secundarias a un quiste aracnoideo del lóbulo temporal izquierdo. La paciente presentó un "tipo mononucleosis like" tal como ha sido descripto previamente. La enferma mejoró su función hepática estando en lista de espera para transplante ortotópico hepático y se recuperó totalmente hasta alcanzar el alta definitiva de dos meses después sin haber presentado manifestaciones de encefalopatía hepática en ningún momento de la evolución. La ausencia de encefalopatía hepática, tal como ocurrió en nuestra paciente, no fue señalada en ninguno de los pocos casos de insuficiencia hepática por difenilhidantoína comunicados previamente. Nos estimulan a poner en conocimiento de la comunidad médica un nuevo caso de insuficiencia hepática aguda por difenilhidantoína: 1) La ausencia de encefalopatía hepática (comunicada por primera vez en un caso de insuficiencia hepática aguda por difenilhidantoína. 2) La baja frecuencia de insuficiencia hepática aguda por difenilhidantoína. 3) La forma típica de presentación como "Síndrome Mononucleosis like" con la posibilidad que ella convella de confundir esta entidad con una infección por virus de Ebstein Bar.

Prevalencia de anticuerpos contra los virus de hepatitis B y C en estudiantes de ondontología / The prevalence of antibodies against hepatitis B abs c virus in odontology

It is accepted that the practice of odontology implies a risk of BBV and HCV transmission but the study of does not. This work tries to determine the prevalence of HBv Ac and HCV Ac (by ELISA) in odontology students and whether there is any relation to the year of study and/or the presence of other risk factors. 188 students in their last three years of studies were investigated, all the participants filled out a clinical epidemiological form. 89 women (47.3%) and 99 men (52.7%), x age was 24.8. 50 (26.7%) had other risk factors. 160 (85.1%) fulfilled biosecurity norms and 40 (21.2%) had a labour accident. RESULTS: None of the analyzed sera were positive for HCV Ac (0%) and 1 was positive for HbcAc. CONCLUSION: The prevalence of HBv Ac and HCV Ac is extremely low with no relation to the year of study or any other risk factors (AU)

Insuficiencia hepática aguda por difenilhidantoina / Acute liver failure by diphenylhydantoin

Presentamos un caso poco frecuente de insuficiencia hepática aguda por difenilhidantoína en una joven de 18 años. La paciente fue tratada con dicho fármaco inmediatamente después de un parto normal por presentar convulsiones clónicas secundarias a un quiste aracnoideo del lóbulo temporal izquierdo. La paciente presentó un "tipo mononucleosis like" tal como ha sido descripto previamente. La enferma mejoró su función hepática estando en lista de espera para transplante ortotópico hepático y se recuperó totalmente hasta alcanzar el alta definitiva de dos meses después sin haber presentado manifestaciones de encefalopatía hepática en ningún momento de la evolución. La ausencia de encefalopatía hepática, tal como ocurrió en nuestra paciente, no fue señalada en ninguno de los pocos casos de insuficiencia hepática por difenilhidantoína comunicados previamente. Nos estimulan a poner en conocimiento de la comunidad médica un nuevo caso de insuficiencia hepática aguda por difenilhidantoína: 1) La ausencia de encefalopatía hepática (comunicada por primera vez en un caso de insuficiencia hepática aguda por difenilhidantoína. 2) La baja frecuencia de insuficiencia hepática aguda por difenilhidantoína. 3) La forma típica de presentación como "Síndrome Mononucleosis like" con la posibilidad que ella convella de confundir esta entidad con una infección por virus de Ebstein Bar. (Au)

Carcinoma hepatocelular: caracteristicas clinicoepidemiologicas / Hepatocellular carcinoma: clinical and epidemiological characteristics

Presentamos una serie de 12 pacientes con diagnóstico histológico de Carcinoma Hepatocelular (CHC), once varones y una mujer con una edad media de 59.9 años + 10.1, asistidos en 2 centros de la ciudad de La Plata. La media de edad, el predominio de varones y la presencia de cirrosis en el 75 por ciento son hallazgos similares a los de series europeas. El 41 por ciento de los pacientes consultó en el último año del periodo de observación, sugiriendo que la ocurrencia del CHC ha aumentado en nuestro medio. El hecho que todos los pacientes hayan sido sintomáticos en el momento de la conculta, que 1 sólo tenía pruebas bioquímicas hepáticas normales y que únicamente 2 tenían nódulo < de 5 cm. de diámetro, sugieren el estadio avanzado de la enfermedad. Coincidentemente las medias de sobrevida fueron de 8.3 + 9 (DS) meses post-diagnóstico y de 3.6 + 8(DS) meses post-cirurgía. El 90.9 por ciento tenía algún factor de riesgo para proceder CHC (alcohol, HBV, HCV). A raíz de un paciente hace notar el riesgo que tienen los hemodialízados de podecer CHC y se destaca la importancia de la prevención y tratamiento de las infecciones virales en ese grupo. En esta experiencia el rédio diagnóstico de la ecografía fue el 100 por ciento y la corroboración histológica se concretó mediante punción percutanea guiada por ultrasonidos o por TAC, también exitosamente y sin conplicaciones, en el 100 por ciento de los casos. Observamos que los niveles de alpha fetoproteina tuvieron una correlación negativa débil, no significativa, con los diámetros de los nódulos. Si bien es cierto que el tamaño de la muestra y el carácter retrospectivo del estudio nos inhiben para sacar conclusiones definitivos, este comportamiento de la alpha fetoproteina genera dudas sobre su valor para el diagnóstico y el catastro del CHC. En conclusión. Nuestros pacientes con CHC son similares a los de los paises europeos. Supuestamente ha aumentado la ocurrencia de CHC en nuestro medio. Los CHC de esta serie se han diagnosticado en estadio muy avanzado. Es imprescindible hacer catastros sobre los pacientes de riesgo para contraer CHC. Los hemodializados son pacientes de alto riesgo para contraer CHC. El comportamiento de la alpha fetoproteina ha generado dudas respecto de su utilidad. La ecografía ha resultado de un extraordinario valor el diagnóstico. (AU)

Insuficiencia hepática aguda por difenilhidantoina. / [Acute liver failure by diphenylhydantoin]

Diphenylhydantoin is a anticonvulsivant and antiarrhythmic drug. We reported a less frequent case of diphenylhydantoin associated acute hepatotoxicity in a 18-year old woman who immediately after child birth presented generalized tonic-clonic seizures secondary to arachnoid cyst in the left temporal-lobe. The patient developed a mononucleosis like coinciding with previous descriptions. Histological features observed in the liver biopsy specimen showed compatible changes with toxic acute liver failure (ALF). In the few cases published of ALF for Diphenylhydantoin is not specifically pointed out the absence of hepatic encephalopathy as it happened to our patient.