Hepatic fascioliasis: case report and review.

A well documented case of hepatic fascioliasis (HF), successfully treated with triclabendazole, is reported. Predominant clinical manifestations were fever, marked eosinophilia and abdominal pain. Triclabendazole was given as two single oral doses of 10 mg/kg each. Neither side effects nor clinical or parasitological relapses were seen after three months of follow up. Based on this experience and few other similar reports in the literature, triclabendazole might be a valid therapeutical alternative in the treatment of human fascioliasis.

Liver disease in cystic fibrosis.

Because of improved survival in the past two decades, liver disease has assumed greater importance in patients with cystic fibrosis. Clinical detection has been difficult thus far. In recent years, advances in our understanding of pathogenesis as well as increasing experience in therapeutic modalities have been accomplished. For these reasons, it is relevant to review this topic.

[Hemobilia. Its clinical presentation and diagnosis]. / Hemobilia. Presentación clínica y diagnóstico.

Hemobilia is a rare cause of upper GI bleeding that must be suspect in order to make an early and precise diagnosis, that permits to decrease the high rate of mortality. We present our experience in three cases and analyze the clinical manifestations, diagnostic methods and follow-up.

[Accessory spleen: compensating hypertrophy after of splenectomy. A case report]. / Bazo accesorio: hipertrofia compensadora post esplenectomía. Presentación de un caso.

The prevalence of accessory spleens has been reported to be about 7.1% in infants. When these patients undergo splenectomy without removal of the accessory spleen, the latter develop hypertrophy later in life and can reach the size of a normal spleen, with clinical manifestations similar to the ones before surgery. We report the case, of fourteen-old boy, who had splenectomy 7 year ago, for refractory and recurrent thrombocytopenia, who had splenectomy at age 7 years because of persistent thrombocytopaenia, resistant to non-surgical treatment, and who was found by conventional ultrasound study, doppler duplex color and selective angiography to have a hypertrophied spleen with sings of portal thrombosis and portal hypertension.

[Metabolic markers of chronic liver disease]. / Marcadores metabólicos de enfermedad hepática crónica.

The association between chronic liver disease and plasmatic lipids and glucidic metabolism was studied. The liver was evaluated with biochemical variables, ultrasound and upper gastrointestinal endoscopy. 12 chronic liver diseases patients and 10 normal were studied. 83.3% of patients showed lipidic abnormalities, 66.6% on the cholesterol levels and 41.7%, reduced HDL. When patients received 100 gr of glucose the response was abnormal in 83.3%. These results were compared with other "liver function test". 75% had abnormal bilirubin, 58.3% abnormal albumin, prothrombin time 58.3%, aminotransferases 75%. Esophageal verices were found in 75% of cases and ultrasound abnormalities in 91.6% (27.3% cirrhosis, 54.4% diffuse abnormal patter and 18.2% splenomegaly). These findings show that lipidic and glucidic metabolism, and ultrasound, in chronic liver diseases are the more frequent abnormalities.

[Biliary cystadenoma. Report of a case]. / Cistoadenoma biliar. Reporte de un caso.

Biliary Cystadenoma are rare benign neoplasms that occurs mainly in young women. Clinical features includes abdominal pain and biliary obstruction. The diagnosis is for clinical features and radiologic method, but require the pathological report. The treatment is surgical. We report a 30 years old woman, with biliary obstruction and radiological findings of a neoplasm located in the left hepatic duct, that was surgically removed. The pathological report was a biliary cystadenoma. We discuss the clinical radiological and pathological tindings.

[Intrahepatic lithiasis]. / Litiasis intrahepatica.

The intrahepactic lithisis is unusual in the Occidental hemisphere. The prevalence in Venezuela in unknown. We study all the edoscipic retrograde cholangiography carried for lithiasic pathology, in the Servicio de Gastroenterología, Hospital Universitario de Caracas, since January 1993 until April 1995. Over 342 patients, 9 were intrahepatic lithisis (1.16%). Seven cases of Caracas and two refered of the rest of the country. The sex was female in seven patients and males in two. The age range was 15 to 67 years old. The clinic feature much frequent was abdominal pain. The diagnosis was ultrasound and endoscopic retrograde cholangiography. The treatment was endoscopic with sphincterotomy and removal stones and surgical with resection in two cases, and choledocotomy in the other four cases.

[Complications of laparoscopic cholecystectomy]. / Complicaciones de la colecistectomía laparoscópica.

The laparoscopy cholecistectomy is a surgical procedure described in 1987, and it has had an important apogee and it's had substitute to open procedure. Between its advantages is notable, the postoperatory evolution without pain, paralytic ileus and the short time of hospitalization besides the patient can go away the same day in some cases. In Venezuela, the procedure has been received with enthusiasm by the surgeons with prefer this procedure however, there are complications derived in part for the lack of experience in the first cases, but occur non related of the experience. The quantization of the complications is not simple to realize for different reasons. We present twelve complications, two belong to patients intervened in the Hospital Universitario de Caracas and ten belong to patient transferred from other center. The complications were: pseudoaneurism of hepatic artery, hematoma of the wall, cutting of common bile duct, section the right bile duct, abscess of vesicular bed in two cases, retropneumoperitoneum, ascites by biliary fistula and four biloma. The treatment varied in every case and the utilization of radiologic technique with percutaneous drainage were useful in five cases. We conclude: first, this technique is not free of complications. Second, the percutaneous drainage (abscess, biloma), endoscopic procedure (biliary prosthesis) in fistulaes and arteriographics (arterial embolization), are useful in some cases, and could prevent the surgical reintervention.

[Endoscopic retrograde cholangiopancreatography in hepatic fascioliasis]. / Colangiopancreatografia retrógrada endoscópica en fasciolasis hepática.

We present a 60 years old female with a history of upper right quadrant pain, fever and eosinophily. We made the diagnosis of fasciolasis on clinical, parasitology studies and radiological findings. In the endoscopic retrograde cholangiopancreatography (ERCP) we found the bile duct of normal caliber, but with many filling defects. Fasciola eggs were found in the bile. This is the first case with endoscopic retrograde cholanglopancreatography and the fourth case of fasciolasis in Venezuela.

Schistosomiasis mansoni in low transmission areas: abdominal ultrasound.

In endemic areas with low prevalence and low intensity of infection, the diagnosis of hepatic pathology due to the Schistosoma mansoni infection is very difficult. In order to establish the hepatic morbidity, a double-blind study was achieved in Venezuelan endemic areas, with one group of patients with schistosomiasis and the other one of non-infected people, that were evaluated clinically and by abdominal ultrasound using the Cairo classification. Schistosomiasis diagnosis was established based on parasitologic and serological tests. The increase of the hepatic size at midclavicular and midsternal lines (in hepatometry) and the hard liver consistency were the clinical parameters able to differentiate infected persons from non infected ones, as well as the presence of left lobe hepatomegaly detected by abdominal ultrasound. The periportal thickening, especially the mild form, was frequent in all age groups in both infected and uninfected patients. There was not correlation between the intensity of infection and ultrasound under the current circumstances. Our data suggest that in Venezuela, a low endemic area of transmission of schistosomiasis, the hepatic morbidity is mild and uncommon. The Cairo classification seems to overestimate the prevalence of periportal pathology. The specificity of the method must be improved, especially for the recognition of precocious pathology. Other causes of hepatopathies must be investigated.

[Epidemiology of viral hepatitis in Venezuela: preliminary results of phase 1. Prevalence in the metropolitan area]. / Epidemiología de la hepatitis viral en Venezuela: resultados preliminares de la etapa 1. Prevalencia en el área metropolitana.

Two different areas of metropolitan zone in Venezuela were studied in relationship to the immunological condition associated with A, B, C and D viral hepatitis in 557 healthy subjects. We performed clinical history with personal information, that was subsequently correlated with results of the hepatitis markers. General results show prevalence different from previous reports: Anti-HAV: 90.84%, HBsAg: 1.62%, Anti-HBc: 10.6%, Anti-HCV: 0.36% y Anti HDV: 0%.

Schistosomiasis mansoni in low transmission areas. Abdominal ultrasound

In endemic areas with low prevalence and low intensity of infection, the diagnosis of hepatic pathology due to the Schistosoma mansoni infection is very difficult. In order to establish the hepatic morbidity, a double-blind study was achieved in Venezuelan endemic areas, with one group of patients with schistosomiasis and the other one of non-infected people, that were evaluated clinically and by abdominal ultrasound using the Cairo classification. Schistosomiasis diagnosis was established based on parasitologic and serological tests. The increase of the hepatic size at midclavicular and midsternal lines (in hepatometry) and the hard liver consistency were the clinical parameters able to differentiate infected persons from non infected ones, as well as the presence of left lobe hepatomegaly detected by abdominal ultrasound. The periportal thickening, especially the mild form, was frequent in all age groups in both infected and uninfected patients. There was not correlation between the intensity of infection and ultrasound under the current circumstances. Our data suggest that in Venezuela, a low endemic area of transmission of schistosomiasis, the hepatic morbidity is mild and uncommon. The Cairo classification seems to overestimate the prevalence of periportal pathology. The specificity of the method must be improved, especially for the recognition of precocious pathology. Other causes of hepatopathies must be investigated

Timoma y anemia hemolítica: presentación de un caso / Thymoma and hemolytic anemia: presentation of a case

Presentamos un paciente masculino, blanco, de 53 años, conocido diabético. Consultó a nuestro hospital por anemia, ictericia, hepato-esplenomegalia y pérdida de 10 kgrs. en los últimos 2 meses. Las radiografías de tórax mostraron una masa en mediastino anterior e inferior de 8x11 cms. Las pruebas de laboratorio rebelaron reticulocitosis, elevada sedimentación globular, hiperbilirrubinemia indirecta, Coombs fuertemente positivo, complemento C3 y C4 normales y ANA negativo. El tratamiento inicial con prednisona mejoró sus cifras hematológicas y se practicó toracotomía. Después de la remoción del tumor que resultó ser un timoma lifo-epitelial, el paciente se recuperó totalmente desde el punto de vista hematológico, con negativización del Coombs. Hacemos enfásis en la rara asociación de timoma con anemia hemolítica, (menos del 1// en las grandes series) y que el tratamiento definitivo de esta condición es la cirugía

Evaluación de la infección de helicobacter pylori en distintas patologías de las vías digestivas superiores y su asociación con el oncogen K-ras 12 / Evaluate the infection of helicobacter pylori in the different pathologies from the gastroduodenal tract and its association with the oncogen K-ras 12

El objetivo del presente trabajo fue evaluar la infección de helicobacter pylori en las diferentes patologías de las vías digestivas superiores y su asociación con el oncogen K-ras 12. Se estudiaron 62 pacientes a quienes se les practicó endoscopia digestiva superior y se tomaron 3 biopsia de la región del antro. Una biopsia fue empleada para el estudio histológico, otra para el cultivo y una biopsia para la determinación de mutaciones puntuales en dicho oncogen. Los resultados mostraron una alta incidencia de la infección por helicobacter pylori en pacientes con gastritis crónica activa (GCAc) (61 por ciento), el 11 por ciento fue observado en gastritis crónica atrófica (GCAt), metaplasia intestinal (MI), y cambios displásicos (CD); el 6 por ciento se observó en cáncer gástrico. En relación a la presencia de alteraciones en el codon 12 del gen K-ras, se detectaron mutaciones puntuales simples y combinadas en el mismo tejido en relación a las diferentes patologías gástricas. En GCAc se evidenció el mayor número de mutaciones. Sin embargo en la medida que progresan las etapas hacia cáncer gástrico disminuye el número de mutaciones Estas características pueden que podrían ser definidas como marcadores tumorales y determinante para el eventual desarrollo de lesiones neoplásicas