Intestinal flora, probiotics, and cirrhosis.

Intestinal microflora constitutes a symbiotic ecosystem in permanent equilibrium, composed mainly of anaerobic bacteria. However, such equilibrium may be altered by daily conditions as drug use or pathologies interfering with intestinal physiology, generating an unfavorable environment for the organism. Besides, there are factors which may cause alterations in the intestinal wall, creating the conditions for translocation or permeation of substances or bacteria. In cirrhotic patients, there are many conditions that combine to alter the amount and populations of intestinal bacteria, as well as the functional capacity of the intestinal wall to prevent the permeation of substances and bacteria. Nowadays, numerous complications associated with cirrhosis have been identified, where such mechanisms could play an important role. There is evidence that some probiotic microorganisms could restore the microbiologic and immunologic equilibrium in the intestinal wall in cirrhotic patients and help in the treatment of complications due to cirrhosis. This article has the objective to review the interactions between intestinal flora, gut permeability, and the actual role of probiotics in the field of cirrhotic patients.

[Bone marrow infiltration as an early sign of gastric cancer]. / Infiltración a médula ósea como manifestación temprana de carcinoma gástrico.

The symptomatic infiltration to bone marrow by gastric carcinoma is an extremely infrequent condition even so as an early manifestation. Very few reports exist in the worldwide literature about it. In this paper we report a case of a 47 years woman who was attended in our Institute because of the presence of thrombocytopenia, anaemia, fever involuntary weight loss and linfadenopathy, and also dyspepsia. Through her diagnostic evaluation the diagnosis of an occult gastric cancer was established. The aim of this report is to present the clinical, radiological and pathological characteristics of this unusual presentation of gastric cancer; and also we present a brief literature review of the cases that had been reported and their clinical implication.

[Autoimmune hepatitis and primary sclerosing cholangitis: dependent or independent association?]. / Hepatitis autoinmune y colangitis esclerosante primaria: asociación dependiente o independiente?

BACKGROUND AND OBJECTIVE: The diagnosis of an autoimmune liver disease is based on clinical, biochemical, immunological and histological criteria particular to each disease, such as autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). Hepatic overlap syndromes (OS) are defined by the presence of a well established autoimmune liver disease, primarily AIH plus two or more characteristics associated with another liver disease (PBC or PSC); however the association of HAI and PSC is considered rare in adult population, and only 43 cases have been reported in the literature. The aim of this study is to review and reappraise the characteristics of this rare association, and to discuss current concepts on OS. METHODS: We describe the clinical presentation, evolution, radiologic studies, histological characteristics and therapeutic options in a Mexican woman with OS (HAI-PSC). We also include an updated review of the literature. RESULTS: Overlap ofAIH and PSC has been described in a number of repqrts during the last decade, and is assumed to exist in a considerable part of mainly young patients with autoimmune liver diseases. Sequential appearance of AIH and PSC has been described in children, but also may be observed in adults. This association has been reported between 1.4%-8%, probably because differences in age of the study populations, range of autoantibodies taken into consideration, and degree of completeness of analyzed data. CONCLUSIONS: HAI-PSC is a rare disease, more common in children, and its outcome and evolution seem to be similar of AIH alone. Ursodesoxycholic acid in combination with an immunosuppressive regimen may be an adequate medical treatment for most patients with this association, and liver transplantation should be considered in late stage disease.

[Minimal hepatic encephalopathy: characteristics, diagnosis and clinical implications]. / Encefalopatía hepática mínima: características, diagnóstico e implicaciones clínicas.

The term minimal hepatic encephalopathy (MHE) refers to the subtle changes in cognitive function, electrophysiological parameters, cerebral neurochemical/neurotransmitter homeostasis, cerebral blood flow, metabolism, and fluid homeostasis that can be observed in patients with cirrhosis who have no clinical evidence of hepatic encephalopathy; the prevalence is as high as 84% in patients with hepatic cirrhosis. This cirrhosis complication is generally not perceived by physician, and diagnosis can only be made by neuropsychological tests and other especial measurements like evoked potentials and image studies like positron emission tomography. Diagnosis of minimal hepatic encephalopathy may have prognostic and therapeutic implications in cirrhotic patients. The present review pretends to explore the clinic, therapeutic, diagnosis and prognostic aspects of this complication.

[Renal hemodynamics and its correlation with the Child-Pugh stage in cirrhotic patients and their controls]. / Hemodinámica renal y su correlación con el estadio de Child-Pugh en pacientes cirróticos y controles sanos.

INTRODUCTION: Portal hypertension is associated with splanchnic vasodilatation and baroreceptors activation with secondary renal vasoconstriction. OBJECTIVE: To measure the pulsatility and resistance index in the renal arteries: Segmentaries and arcuates of both kidneys in cirrhotic patients Child-Pugh A, B, C classes and compared them with healthy controls. PATIENTS AND METHODS: Thirty patients with cirrhosis were included: Ten patients Child A, 10 were Child B and 10 Child C class and 10 healthy patients, we measured the resistance index (RI = [systolic peak velocity-minimum diastolic velocity]/systolic peak velocity) and the pulsatility index (PI = [systolic peak velocity-minimum diastolic velocity]/medium velocity) with Doppler spectral analysis. RESULTS: The RI in controls had an average of 0.55 +/- 0.11. In child A: 0.79 +/- 0.114, in Child B 0.77 +/- 0.104 and in Child C 0.85 +/- 0.037. For the pulsatility index the values were: 0.98 +/- 0.21, 1.4 +/- 0.105, 1.72 +/- 0.206, and 2.04 +/- 0.346, respectively. The resistances and pulsatility index were higher in patients with cirrhosis at the time to be compared with healthy controls, which represent a diminishment in blood flow. At the time to compare each one of the Child stages with controls, both index resulted higher in cirrhotic patients, but when we compared the cirrhotic patients between them, only difference for RI in child B vs. C was evident. The differences in PI were evident between each one of the Child classes. DISCUSSION: The present study proved that a non invasive method like Doppler ultrasound is useful in the evaluation of the renal hemodynamic changes in cirrhotic patients with a good correlation between Child class and IP.

Biliary stricture caused by portal biliopathy: case report and literature review.

Portal biliopathy is a rare condition that is usually not diagnosed and only in few cases causes symptoms. Those symptoms are caused by vascular obstruction of the biliary tree in patients with portal hypertension. We report a case of a 29 years man who presented with history of intermittent jaundice, persistent elevation of hepatic function test and hematemesis as a manifestation of portal hypertension without liver damage. We present the clinical, radiological and pathological characteristics and literature review of the cases that had been reported, their diagnoses, treatment and clinical implication.