[Hepatobiliary clearance of glycocholic acid in Gilbert's disease]. / Aclaramiento hepatobiliar de ácido glico-cólico en la enfermedad de Gilbert.

AIM: To research the behaviour of one biliary acid (glyco-cholic) i.v. injected in patients with Gilbert's disease and in healthy controls, so that contribute to the knowledge of the pathophysiological correlate between bilirubin and biliary acids. PATIENTS AND METHODS: We include 15 patients with Gilbert's disease and 7 healthy voluntary ones. We injected i.v. glycocholic acid and obtained the clearance curve (CG-RIA Abbot method). We evaluated the possible biostatistically significant differences between the obtained values of both groups though the non-parametric method of Mann-Whitney. RESULTS: The clearance curve of both groups had a similar profile; biostatisticaly there are not significant differences between the serum values of glyco-cholic acid in both groups. CONCLUSIONS: The clearance of the glyco-cholic acid in patients with Gilbert's disease had a similar behaviour as in healthy controls, without biostatisticaly significant differences between both groups.

[Heterozygotic alpha-1 antitrypsin deficiency. A case report]. / Déficit heterozigótico de alfa-1-antitripsina. Presentación de un caso.

The clinical, analytical (including phenotypical) and histologic (optical and ultrastructural) data of a 34-years-old male patient attended for evaluation of moderate hypertransaminasemia discovered following a company screening examination. The existence of an alpha-1-antitrypsin heterozygotic deficit (MZ) was detected with flattening of the alpha wave in the proteinogram and a decreased serum level of this glycoprotein. Morpho-pathologically no PAS positive globules were optically found on liver biopsy although dilatation of the rough RE was observed with deposition in the medium electrodensity material, the significance of which is discussed on the basis of the patient's phenotype. It is suggested that serum studies of alpha-1-antitrypsin should be included in the routine evaluation of chronic liver diseases.

[The correlation of the isotopic liver/spleen ratio with the tissue damage in chronic diffuse hepatopathies]. / Correlación del cociente hígado/bazo isotópico con el daño hístico en hepatopatías crónicas difusas.

The purpose of the study was to determine whether a correlation between the radioisotopic "spleen-to-liver" ratio and the hepatic damage (according to Knodell's Index) exists in patients with chronic liver disease, in order to ascertain whether hepatic biopsy should be performed under visual (laparoscopic) control or not (blind liver biopsy). Thirty patients with inflammatory chronic hepatic disease were studied (9 chronic persistent hepatitis, 14 active chronic hepatitis and 7 hepatic cirrhosis). An inverse correlation was found between Knodell's Index and the "spleen-to-liver" ratio with moderate statistical significance (r = -0.46). In conclusion, the isotopic "spleen-to-liver" ratio correlates moderately well with the degree of hepatic damage and consequently it can only be used as orientation about the preferable way for obtaining a liver biopsy (laparoscopically or not).

[Viral replication, histologic damage and enzymatic activity in chronic hepatopathies caused by B virus]. / Replicación viral, daño histológico y movimiento enzimático en hepatopatías crónicas por virus B.

The future of patients with chronic hepatitis (HC) due to B virus depends above all on the tendency of the interaction between viral activity and immune response. Viral activity (replication) (RV) can be expressed in these patients by two variants: a) "complete" or "early", associated with the presence in serum of HBsAg, HBeAg, and significant DNA polymerase activity, and b) "incomplete" or "late", in which anti-HBe is found in serum and there are scant or no histopathologic changes ("healthy carriers" in some cases). In prolonged infections viral replication declines gradually, although viral capsid protein continues to be synthesized and DNA-HBV is integrated into the genome. Viral replication per se does not condition the histologic damage (DH) expressive of liver cirrhosis with HBV (HCB). Other publications take a different view of this problem. The increase in viral replication often is proportional to a rise in serum GPT (an expression of histologic damage), but viral replication is not always associated with a progressive disease course. The immune defense leads to cytolysis and subsequent elimination of the HB virus. Some patients with high HBsAg levels have little active forms of liver cirrhosis; the DNA-HBV integrated would be capable of producing HBsAg but not HBcAg. It is precisely this that induces the response of cytotoxic T lymphocytes at the level of the hepatocyte surface. The presence in serum of anti-HBe IgM would be related to the expression of HBcAg on the hepatocyte membrane and/or the liberation of HBcAg particles by lysed hepatocytes. The relationship between the degree of histologic damage and serum aminotransferase levels is better established.

[Viral replication, histologic damage and enzymatic activity in chronic hepatopathies caused by B virus. Analysis of 21 patients]. / Replicación viral, daño histológico y movimiento enzimático en hepatopatías crónicas por virus B. Análisis de 21 pacientes.

In 21 patients from the out-patient clinic of the Internal Medicine Department of our hospital with chronic hepatitis (HC) due to B virus (HBV) and anti-HBC (IgG) serology but not HBsAg, a study was made of the possible correlation between viral replication levels (RV) --as expressed by DNA polymerase values (DNAp)-- and, respectively, histologic changes and serum enzyme movements (GPT, GOT). Our study parted from the diverse criteria cited in the literature concerning the role assigned to viral replication per se and/or immune response per se in the genesis of histologic damage (DH). All patients exhibited signs of moderate clinical and enzymatic activity. The levels of viral replication in the group studies were significant (compared to a control group), which supports the thesis that a certain degree of viral replication, although very attenuated, persists in these patients and is the basis of the continued histological damage that eventually leads to liver cirrhosis (CH) and its derivatives, often with little clinical translation. As regards histologic damage, the correlation with DNAp is reciprocal and of moderate significance, supporting the criterion that the multiform expression of histologic damage in liver cirrhosis due to HBV (HCB) (cellular necrosis, intracellular degenerative phenomena, inflammatory cellular infiltrate, fibrosis) is, at the very least, unproportional to the degree of viral replication and can even be reciprocal. Only the severity of the overall hepatic process remains a function of immune response.(ABSTRACT TRUNCATED AT 250 WORDS)

[Determination of copper in hepatic tissue for the diagnosis of Wilson's disease]. / Determinación de cobre en tejido hepático para el diagnóstico de la enfermedad de Wilson.

Three young patients had clinical data compatible with Wilson's disease (WD); all of them had high serum levels of ceruloplasmin without Kayser-Fleischer rings (K-F), the urinary copper level being very low, not supporting the Wilson's disease diagnosis. This reason was why we decided to detect the amount of copper in the liver tissue, which was very high in all patients, confirming the disease. We would comment that WD of abdominal type does not usually have the K-F rings, which made the diagnosis difficult. An algorithm is proposed to be applied in each case were WD is suspected.