[The role of liver biopsy in the study of patients with fever of unknown origin (author's transl)]. / La biopsia hepática en el estudio de una fiebre de origen desconocido.

Of 25 patients undergoing percutaneous liver biopsy during the study of fever of unknown origin, the histologic examination provided useful diagnostic information in the nine cases (36 %). The liver biopsy had no diagnostic utility in the remaining 16 patients, half of whom had spontaneous resolution of the fever without a diagnosis being established. Liver enlargement or altered liver function tests were more frequent in the group of patients with a diagnostic liver biopsy, but they had no predictive value as it regards finding morphological changes of diagnostic interest. It is concluded that liver biopsy is an useful procedure in the study of patients with fever of unknown origin.

Serum procollagen type III peptide as a marker of hepatic fibrogenesis in alcoholic hepatitis.

To evaluate if serum procollagen type III peptide levels reflect the extent of liver fibrosis and hepatic collagen synthesis, we have studied 19 patients with histologically proven alcoholic hepatitis and 9 chronic alcoholics with normal liver histology or minimal steatosis. Serum procollagen peptide type III was measured at the time of liver biopsy, and determination of hepatic prolyl-hydroxylase activity, as an index of collagen synthesis, was performed in all liver samples. Hepatic prolyl-hydroxylase activity and serum procollagen peptide levels were significantly higher in patients with alcoholic hepatitis (959 +/- 115 cpm/mg and 33.2 +/- 5.3 ng/ml, respectively) than in alcoholics from the control group (537 +/- 62 cpm/mg and 10.9 +/- 1.5 ng/ml, respectively) (p less than 0.05 and p less than 0.01, respectively). All patients with alcoholic hepatitis had fibrosis (10 mild and 9 severe). Prolyl-hydroxylase activity and procollagen peptide levels were significantly higher in alcoholic hepatitis patients with severe fibrosis than in those with mild fibrosis (1208 +/- 154 cpm/mg vs. 734 +/- 138 cpm/mg, p less than 0.05 and 49.1 +/- 8.8 ng/ml vs. 20.4 +/- 2.6 ng/ml, p less than 0.01). Furthermore, a close correlation was found between the hepatic prolyl-hydroxylase activity and the serum level of procollagen peptide (r = 0.76, p less than 0.001). We conclude that the serum procollagen peptide level is a good marker of hepatic fibrogenesis in alcoholic hepatitis; thus, its serial measurement could be useful in identifying patients in progress to cirrhosis and in assessing the therapeutic efficiency of antifibrogenic drugs.

[Gynecomastia and Leydig cell tumor, clinically occult]. / Ginecomastía y tumor de células de Leydig, clínicamente oculto.

OBJECTIVES: An uncommon case of clinically occult Leydig cell tumor of the testis is described. The literature is reviewed with special reference to the difficulty encountered in making the diagnosis. METHODS/RESULTS: The clinical data of a patient with occult Leydig cell tumor of the testis, whose only remarkable feature was a long history of gynecomastia, are presented. CONCLUSIONS: A hormonal study and scrotal ultrasound evaluation are essential in the diagnosis of this tumor type and should be performed even in the absence of testicular anomalies on palpation.