[Ultrasonography in the differential diagnosis of obstructive jaundice: comparison with endoscopic retrograde cholangiopancreatography]. / Ultrasonido en el diagnóstico diferencial de ictericia obstructiva: comparación con la pancreatocolangiografía retrógada endoscópica.

A retrospective study comparing ultrasound (US) and endoscopic retrograde cholangiopancreatography (ERCP) as practiced on 42 jaundiced patients. Obstruction of the bile ducts was demonstrated in 21 by US and in 33 by ERCP, this latter method was taken as the gold standard for comparison, and thus the sensibility of US for detecting obstructive jaundice was 64% and specificity was 89%. Choledocolithiasis and papillary stenosis were the most frequent etiologies, diagnosed in 26 cases by ERCP and in 14 cases by US. Of the 36 patients with gallbladder, US demonstrated gallstones in 28 cases (78%) and ERCP in 18 (50%). We conclude from this study that US has a high sensibility and specificity in patients in whom obstructive jaundice is suspected.

[Value of liver biopsy in the diagnosis of cholestatic jaundice]. / Valor de la biopsia hepática en el diagnóstico de la ictericia colestática.

50 patients with cholestatic jaundice were studied with liver biopsy and fine needle transhepatic cholangiography. In 36 cases there was obstruction of the extrahepatic bile ducts. Rest of the cases had normal bile ducts. These findings were compared with those of the liver biopsy. When there is portal inflammation, bile pigment intracellular, cholangitis and bile plugs associated there was obstruction in 99 per cent of cases. A concluded that cholangiography should precede biopsy in cholestatic jaundice.

[Prevention of hepatitis B]. / Prevención de la hepatitis B.

This article reviews the prevention of hepatitis B virus infection with emphasis on immunoprophylaxis in its 2 forms, passive by the use of immunoglobulins and active by the use of vaccines, plasmatic and recombinant. Both have been shown to be safe, with few secondary effects an highly effective. Response to the vaccine depends on age and immunological status, there are few contraindications. In Venezuela pre-exposure vaccination is recommended taking into account the prevalence of B virus infection, which is high in certain indigenous groups, homosexuals, drug addicts and patients in hemodialysis and intermediate in health workers and pregnant women of low socioeconomic status. Post-exposure vaccination is recommended in sexual contacts of persons infected acutely or chronically with the virus, in newborns of surface antigen positive mothers and in case of accidental percutaneous exposure.

[Non-surgical drainage of intra-abdominal abscesses]. / Drenaje no quirúrgico de los abscesos intra-abdominales.

UNLABELLED: Intra-abdominal abscesses were treated by percutaneous needle drainage. Diagnosis was based, in 100% of the cases, on clinical findings, flat abdomen X-rays and ultrasound. 71% had previous abdominal surgery and 17% had abdominal trauma. The abscesses were located as follows: 29% in the liver, 24% in right sub-diaphragmatic area, 41% had several locations and 6% was pyogenic collection in de common biliary duct. The average duration of drainage was 9 days. Fifteen out of the 17 procedures were successful (88%). Predominant germs obtained in cultures of the drained material were E. Coli and P. Aeruginosa. CONCLUSION: the above experience demonstrate that percutaneous drainage in intra-abdominal abscesses is a secure and effective procedure with high rate of success and low of morbidity and mortality. It must be considered as treatment of choice.

[Longitudinal follow-up study of 64 children chronically infected with hepatitis B virus, treated and not treated with interferon]. / Seguimiento longitudinal de 64 niños crónicamente infectados por virus B, tratados y no tratados con Interferon.

With the purpose of knowing the spectrum of the disease we studied the outcome of 64 children chronically infected by Hepatitis B Virus (HBV): 38 treated with Interferon (INF) and 26 without treatment. The period of infection was no less than 8 months, the average age was 4.7 years, 39 boys, 25 girls, and the observation period was 5 years, 3 moths (range 6 months-14 years). We divided them in 2 groups: a) 40 patients AgeBH positive from which 26 received treatment. b) 24 patients AgeBH negative from which 12 received treatment. We used 5,000,000 U. of interferon per M2 3 times a week for 16 weeks. The results do not show statistically difference that might favor the use of INF in order to reach seroconversion neither of Age nor Ags. Meanwhile the age is significant in Ags seroconversion. This might lead us to the question if seroconversion is due to the natural course of the disease once the body gets rid of the virus, or to interferon treatment. During the study period only one case turned to cirrhosis (1.7%) and none to Hepato carcinoma.

[Prevalence of the antibody of hepatitis C virus in HBsAg negative patients with chronic liver diseases: children, prostitutes, and homosexuals]. / Prevalencia del anticuerpo del virus C en pacientes con enfermedades crónicas hepáticas AgsHB negativos: niños; prostitutas y homosexuales.

We present the results of the determination of hepatitis C virus antibody, recently discovered on a group of 34 patients with chronic liver disease, divided in: a) 23 patients with cirrhosis. b) 8 with protracted hepatitis. c) 2 with steatosis of unknown origin++. d) One patients with hepatocellular carcinoma. Another group examined was integrated by persons of promiscuous sexual activity (15 prostitutes and 14 homosexuals). Finally we included 20 children chronically infected with VB. In the 23 patients with cirrhosis, the VB markers (HBsAg and anti-core were negative in 18 and 5 were only anti-core positive; anti-HCV was positive in 3 of the 18 VB negative (16.6%) and in one of the 5 with anti-core positive (20%), that represents a total of 4 cases anti-HCV positive (17.3%). 5 of the 8 patients with protracted hepatitis were virus B and A negative and 4 of them were anti-HCV positive (80%), 3 of which had parenteral infection. The 15 prostitutes and the 14 homosexuals were negative for the anti-HCV, as well as the 20 children chronically VB infected. Our result of the determination of anti-HCV in cryptogenetic cirrhosis (17.3%) is similar that reported in USA (> 20%) and very much lower than of the Italian group (80%). Meanwhile we found a high incidence in protracted hepatitis (80%) with parenteral infection.

[Endoscopic sclerotherapy of esophageal varices with 80% alcohol. Experience with 46 cases]. / Escleroterapia endoscópica de las várices esofágicas con alcohol al 80%. Experiencia en 46 casos.

We are presenting the results obtained by endoscopic sclerotherapy with 80% alcohol in fifty-five patients with upper GI bleeding caused by esophageal varices, with or without active bleeding at the moment of the endoscopic study. We obtained control of bleeding in 83.64% with a recurrence of bleeding of 16.36% during the first 15 days. At the same period of time we obtained a 16.36% mortality rate. In the forty six patients that concluded sclerotherapy, decrease in size of the varices occurred in 89.79% and eradication was obtained in 6.11% of the patients. We observed three types of complications: esophageal ulcers in 100% of the cases which healed in a period of three weeks. Retrosternal pain of short duration, in 45.65%, this pain appears when the sclerosant substance is injected. Esophageal stenosis in 5.45% which were treated with dilatations. Our conclusion is that 80% alcohol is an effective and safe sclerosant substance in the management of acute bleeding of esophageal varices and in the prevention of the immediate recurrence, but has the disadvantage of a great number of local complications.

[The effectiveness of endoscopic retrograde cholangiopancreatography in the etiological diagnosis of postcholecystectomy syndrome]. / Effectividad de la colangiopancreatografía retrograda endoscopica en el diagnostico etiologico del sindrome post-colecistectomía.

A retrospective study of 249 with symptoms and signs of postcholecystectomy syndrome was made to evaluate the usefulness of endoscopic retrograde cholangiopancreatography (ER CP) in its etiological diagnosis. From 1693 ERCP evaluated, 1108 were checked and from these 249 patients showed symptoms and signs after the cholecystectomy. So they were selected to practice a diagnostic ERCP. 204 patients were females and its principal symptom was jaundice. Lesions found in most of the cases were: stones in the bile ducts (45.78%), benign biliary stenosis (8.3%), stenosis of vater's papilla (7.22%) and biliary fistula (7.22%). It can be conclude that biliary stones is the most frequent pathology in those patients with clinical suspicion of biliary-pancreatic organicity and that ERCP is the principal method of diagnosis in these patients.

[Abdominal tuberculosis]. / Tuberculosis abdominal.

20 cases of abdominal tuberculosis (TB) were evaluated; from these, 10% with intestinal TB without peritoneal involvement and 90% presenting TB of peritoneal localization. 80% of the patients showed clinical manifestation in other organs. Pleura-lung alterations were found in 83% of the cases after X-ray chest examination. The diagnosis of abdominal TB was based on finding of caseating tuberculoid granuloma (65%), anti-TB therapeutic response (30%) and positive observation of acid-fast bacillus in sputum (5%). The conclusions from this review are that: 1) Patients with chronic illness, negative cultures and clinical evidence of infectious etiology are highly suspicious; 2) Analysis of pathologic specimens was the most accurate diagnostic method; 3) when abdominal TB is suspected a stepwise methodology must be followed to confirm diagnosis; 4) Anti-TB therapy must be started as soon as diagnosis is confirmed.

[The relationship between intestinal metaplasia and gastric carcinoma: a study of 722 biopsies]. / Relación entre metaplasia intestinal y carcinoma gástrico: estudio de 722 biopsias.

Intestinal metaplasia has been shown by many investigators to be a premalignant state. Considering this fact, 722 gastric biopsies were studied, a 24% of association was found between gastric carcinoma and intestinal metaplasia and 27% of the cases with metaplasia were found in "apparently normal" or with benign stomach lesions. The group most affected was males over 61 years. Control endoscopy and biopsy was practiced in 17 patients with previously diagnosed intestinal metaplasia and in 11.7% gastric carcinoma with metaplasia was found. Therefore, it cannot be concluded that intestinal metaplasia is a premalignant condition, but its frequent association with gastric adenocarcinoma advises periodical examination by endoscopy in every patient over 40 years in which it is determined by biopsy.

[Chronic infection due to hepatitis B virus in patients less than 16 years of age: therapeutic approach by means of interferon alfa-2b]. / Infección crónica por virus B en pacientes menores de 16 años de edad: abordaje terapéutico mediante interferón alfa 2b.

Twenty children with chronic Hepatitis B virus infection where treated with alfa interferon 2b and compared with a group of 24 non treated patients with similar age and sex distribution. Both treated and untreated patients, all Hepatitis B surface antigen positive for a minimum of 6 months, were divided in 2 groups according to HBeAg status: positive and negative. The treatment was ambulatory at a dose of 5.000.000 U per square meter of body surface, administered 3 times a week during 16 weeks. Tolerance of the drug was good with secondary reactions only at the beginning of the treatment. The only change in laboratory tests was the normalization of aminotransferases in HBeAg positive children. There was no significant difference between the treated and untreated group of HBeAg positive patients regarding the rate of HBeAg seroconversion. There was a striking difference in negativization of HBsAg in HBeAg negative patients: 8% in the treated group and 81% in the untreated group, this is explained by important epidemiological differences between both groups.