Percutaneous liver biopsy--2 decades of experience in a public hospital in the South of Brazil.

INTRODUCTION: Liver biopsy is a complementary method for diagnosis, staging and therapeutic guidance in liver diseases, where chronic viral hepatitis are the most acknowledged causes for the indication of histopathological study. The objective is to assess the patients' profile as well as the indication and results of percutaneous liver biopsies in a tertiary hospital. MATERIAL AND METHODS: A descriptive, cross-section study was carried out through the review of medical charts (retrospective cohort) of patients submitted to blind percutaneous liver biopsies (PLB) at a hospital in Porto Alegre, South Brazil, from October 1993 to December 2011. RESULTS: 1,955 PLB were carried out, the mean patients' age was 44.8 years old, and 1,127 (57.65%) were men. Chronic hepatitis C was the main indication (60.5%), followed by HCV-HIV coinfection (12.2%) and chronic hepatitis B (3.5%). Seven cases (0.3%) had complications, without deaths. CONCLUSION: PLB is a safe method and continues to be an important option to assist patients with chronic liver disease.

Manifestações gastrintestinais e diagnóstico de intoxicação por chumbo: relato de dois casos / Gastrintestinal manifestations and diagnosis of lead intoxication: report of two cases

O chumbo é um metal utilizado amplamente na indústria automotiva, bem como na produção de soldas, tintas, cerâmicas e na manufatura de baterias. Pode ser absorvido pelo corpo humano, principalmente por via respiratória, através de vapores. Quando em contato com hemácias, liga-se avidamente e se distribui por todo organismo, causando a doença ocupacional, chamada saturnismo. O principal sistema afetado é o sistema nervoso central, com sintomas de encefalopatia de variados graus. Assim, trabalhadores que manipulam essa substância devem utilizar proteção adequada. No presente trabalho, são relatados dois casos de intoxicação aguda pelo chumbo, associadas à exposição ocupacional.

Lead is a metal that is widely used in the automotive industry as well as in the production of solders, paints, ceramics and in the manufacturing of batteries. It can be absorbed by the human body, mainly by the respiratory route, through vapors. When in contact with red blood cells, lead binds avidly and is distributed throughout the body, causing the occupational disease called lead poisoning. The main system affected is the central nervous system with symptoms of encephalopathy, in varying degrees. Thus, workers who handle this substance should use adequate protection. In this paper we report two cases of acute poisoning by lead associated with occupational exposure.

Whipple's disease: rare disorder and late diagnosis / Doença de Whipple: patologia rara e de diagnóstico tardio

Whipple's disease is a rare systemic infectious disorder caused by the bacterium Tropheryma whipplei. We report the case of a 61-year-old male patient who presented to emergency room complaining of asthenia, arthralgia, anorexia, articular complaints intermittent diarrhea, and a 10-kg weight loss in one year. Laboratory tests showed the following results: Hb = 7.5 g/dL, albumin = 2.5 mg/dL, weight = 50.3 kg (BMI 17.4 kg/m²). Upper gastrointestinal endoscopy revealed areas of focal enanthema in the duodenum. An endoscopic biopsy was suggestive of Whipple's disease. Diagnosis was confirmed based on a positive serum polymerase chain reaction. Treatment was initiated with intravenous ceftriaxone followed by oral trimethoprim-sulfamethoxazole. After one year of treatment, the patient was asymptomatic, with Hb = 13.5 g/dL, serum albumin = 5.3 mg/dL, and weight = 70 kg (BMI 24.2 kg/m²). Whipple's disease should be considered a differential diagnosis in patients with prolonged constitutional and/or gastrointestinal symptoms. Appropriate antibiotic treatment improves the quality of life of patients.

Doença de Whipple é uma rara infecção sistêmica causada pelo Tropheryma whipplei. Caracteriza-se por fase prolongada de sintomas inespecíficos, levando longo período até o seu diagnóstico. Sem tratamento, pode ser grave e fatal, mas com antibioticoterapia tem ótima resposta clínica e laboratorial. Relatamos o caso de paciente masculino, 61 anos, internado por astenia, anorexia, diarréia intermitente e perda de 10 kg em um ano. Apresentava-se com hemoglobina (Hb) 7,5 g/dL, albumina de 2,5 mg/dL, peso 50,3 kg (IMC 17,4). Endoscopia digestiva alta com áreas de enantema focal da mucosa duodenal e biópsia compatível com doença de Whipple. O diagnóstico foi confirmado com PCR sérica positiva, sendo instituído tratamento com ceftriaxone seguido de sulfametoxazol-trimetropim. Após um ano de tratamento, encontrava-se assintomático, com Hb 13,5 g/dL, albumina sérica de 5,3 mg/dL e peso de 70 kg. Doença de Whipple deve fazer parte da lista de diagnósticos diferenciais em pacientes com sintomas constitucionais e/ou com queixas gastrointestinais com evolução prolongada. O tratamento antibiótico pode curar a infecção, recuperando a qualidade de vida do paciente.

Whipple's disease: rare disorder and late diagnosis.

Whipple's disease is a rare systemic infectious disorder caused by the bacterium Tropheryma whipplei. We report the case of a 61-year-old male patient who presented to emergency room complaining of asthenia, arthralgia, anorexia, articular complaints intermittent diarrhea, and a 10-kg weight loss in one year. Laboratory tests showed the following results: Hb = 7.5 g/dL, albumin = 2.5 mg/dL, weight = 50.3 kg (BMI 17.4 kg/m²). Upper gastrointestinal endoscopy revealed areas of focal enanthema in the duodenum. An endoscopic biopsy was suggestive of Whipple's disease. Diagnosis was confirmed based on a positive serum polymerase chain reaction. Treatment was initiated with intravenous ceftriaxone followed by oral trimethoprim-sulfamethoxazole. After one year of treatment, the patient was asymptomatic, with Hb = 13.5 g/dL, serum albumin = 5.3 mg/dL, and weight = 70 kg (BMI 24.2 kg/m²). Whipple's disease should be considered a differential diagnosis in patients with prolonged constitutional and/or gastrointestinal symptoms. Appropriate antibiotic treatment improves the quality of life of patients.

Cisto de colédoco com apresentação em idade adulta / Choledochal cyst presenting in adulthood

Cistos biliares são ectasias ductais congênitas envolvendo um segmento ou toda árvore biliar intra- e/ou extra-hepática, comuns na infância, mas de diagnóstico raro na idade adulta. O objetivo do presente trabalho é de relatar o caso de um paciente adulto diagnosticado com cisto gigante de colédoco durante investigação para dor abdominal (AU)

Biliary cysts are congenital ductal ectasias involving a segment or the entire intra- and/or extrahepatic biliary tree, common in childhood, but of uncommon diagnosis in adulthood. The aim of this study is to report the case of an adult patient diagnosed with giant choledochal cyst during investigation for abdominal pain (AU)

Sensitivity to microcystins: a comparative study in human cell lines with and without multidrug resistance phenotype.

Multidrug resistance (MDR) is an obstacle in cancer treatment. An understanding of how tumoral cells react to oxidants can help us elucidate the cellular mechanism involved in resistance. Microcystins are cyanobacteria hepatotoxins known to generate oxidative stress. The aim of this study was to compare the sensitivity to microcystins of human tumoral cell lines with (Lucena) and without (K562) MDR phenotype. Endpoints analyzed were effective microcystins concentration to 50% of exposed cells (EC50), antioxidant enzyme activity, lipid peroxidation, DNA damage, reactive oxygen species (ROS) concentration, and tubulin content. Lucena were more resistant and showed lower DNA damage than K562 cells (P<0.05). Although microcystins did not alter catalase activity, a higher mean value was observed in Lucena than in K562 cells. Lucena cells also showed lower ROS concentration and higher tubulin content. The higher metabolism associated with the MDR phenotype should increase ROS concentration and make for an improved antioxidant defense against the toxic effects of microcystins.