[Chylous ascites in cirrhotic and non-cirrhotic patients]. / Ascitis quilosa en pacientes cirróticos y no cirróticos.

Chylous ascites is an accumulation of lymph in the abdominal cavity. The diagnosis is established when the concentration of triglycerides in plasma is greater than in ascitic fluid over a level of 200 mg/dl. The clinical and biochemical characteristics of 22 patients with chylous ascites (11 cirrhotics and 11 non cirrhotics) were studied in order to assess differences between patients with and without hepatic cirrhosis. The cirrhotic patients with chylous ascites showed lower protein (1.3 +/- 0.74 mg/dl, p = 0.002) and cholesterol concentration (46.0 +/- 45.2 mg/dl, p = 0.02) in ascitic fluid than non cirrhotic patients (3.1 +/- 1.09 mg/dl, and 100.85 +/- 41.7 mg/dl, respectively). In addition, the cellularity in the ascitic fluid was also lower in cirrhotic patients (209.09 +/- 113.96 cel/mm3) versus (831.8 +/- 945.08 cel/mm3; p < 0.05). Four patients (18.18%) presented high adenosine deaminase levels (ADA) in the ascitic fluid in the absence of tuberculous peritonitis. The authors conclude that the biochemical differences observed in the ascitic fluid of the cirrhotic patients with chylous ascites may be explained by a dilutional mechanism due to the combination of "clear" ascites secondary to portal hypertension and chylous ascites. Furthermore, chylous ascites could be the cause of an elevation in ADA in the absence of tuberculous peritonitis.

Small bowel bacterial overgrowth in patients with alcoholic cirrhosis.

A total of 89 patients with alcoholic cirrhosis and 40 healthy subjects were included in a study to assess the prevalence of intestinal bacterial overgrowth and to analyze its relationship with the severity of liver dysfunction, presence of ascites, and development of spontaneous bacterial peritonitis (SBP). Bacterial overgrowth was measured by means of a breath test after ingestion of glucose. Intestinal bacterial overgrowth was documented in 27 (30.3%) of the 89 patients with alcoholic cirrhosis and in none of the healthy subjects. The prevalence of intestinal bacterial overgrowth was significantly higher in cirrhotics with ascites (37.1%) than in those with no evidence of ascites (5.3%) and among patients with Pugh-Child class C (48.3%) than in patients with a class A (13.1%) or B (27%). Twelve (17.1%) of the 70 patients with ascites developed an episode of SBP. The prevalence of spontaneous bacterial peritonitis was significantly higher in patients who had intestinal bacterial overgrowth (30.7%) than in patients who did not (9.09%). We conclude that intestinal bacterial overgrowth occurs in approximately one third of patients with cirrhosis secondary to alcohol, particularly in patients with ascites and advanced liver dysfunction. Moreover, bacterial overgrowth may be a condition favoring infection of the ascitic fluid.

Small bowel bacterial overgrowth in patients with alcoholic cirrhosis.

A total of 89 patients with alcoholic cirrhosis and 40 healthy subjects were included in a study to assess the prevalence of intestinal bacterial overgrowth and to analyze its relationship with the severity of liver dysfunction, presence of ascites, and development of spontaneous bacterial peritonitis (SBP). Bacterial overgrowth was measured by means of a breath test after ingestion of glucose. Intestinal bacterial overgrowth was documented in 27 (30.3%) of the 89 patients with alcoholic cirrhosis and in none of the healthy subjects. The prevalence of intestinal bacterial overgrowth was significantly higher in cirrhotics with ascites (37.1%) than in those with no evidence of ascites (5.3%) and among patients with Pugh-Child class C (48.3%) than in patients with class A (13.1%) or B (27%). Twelve (17.1%) of the 70 patients with ascites developed an episode of SBP. The prevalence of spontaneous bacterial peritonitis was significantly higher in patients who had intestinal bacterial overgrowth (30.7%) than in patients who did not (9.09%). We conclude that intestinal bacterial overgrowth occurs in approximately one third of patients with cirrhosis secondary to alcohol, particularly in patients with ascites and advanced liver dysfunction. Moreover, bacterial overgrowth may be a condition favoring infection of the ascitic fluid.

Drinking habits and pain in chronic pancreatitis.

To study the role that continuous drinking plays in the pain of chronic pancreatitis, we have examined 67 patients with alcoholic chronic pancreatitis with pain and 29 patients without pain, and we report on their alcoholic habits. Drinking habits played a part 92 (67.6%) of 136 times in patients with pain; in 185 without pain, 86 (46.5%) had continued their drinking habit (p < 0.001). Advanced pancreatic exocrine insufficiency was seen in 27 patients; 11 of them had pain during follow-up, whereas 16 did not. The nondrinker rate was similar in patients with and without pain, whereas among 69 patients with better pancreatic exocrine function, 56 had pain episodes and 13 did not. Alcoholic consumers were significantly more in number in the pain group: 70.4% versus 35% of the no pain group (p < 0.002). Our study shows that drinking alcohol in patients with chronic pancreatitis increased the frequency of painful episodes when there was relatively good pancreatic function, whereas in severe pancreatic insufficiency drinking had less influence on the development of pain.

[Analysis of the DNA of the hepatitis B virus (HBV) in the serum and mononuclear cells of the peripheral blood in subjects with chronic infection by the HBV]. / Análisis del ADN del virus de la hepatitis B (VHB) en suero y células mononucleares de sangre periférica en sujetos con infección crónica por el VHB.

BACKGROUND: Viral replication is one of the determining factors of the natural history of infection by the hepatitis B virus (HBV). The clinical significance of the viremia and the DNA-HBV findings in mononuclear cells was therefore analyzed. METHODS: The epidemiologic history, liver function tests and the Knodell index were analyzed in 117 patients with chronic hepatitis B (CHB) and 33 healthy HBV carriers. The DNA-HBV was studied in serum and mononuclear cells by dot-blot and polymerase chain reaction (PCR). RESULTS: The DNA-HBV was detected by dot-blot in 62/117 subjects with and in CHB 3/33 healthy carriers. Viremis was determined by PCR in 107/117 patients with CHB and in 22/23 healthy carriers. Both aspartate aminotransferase (AST) as well as alanine aminotransferase (ALT) and the Knodell index were greater in the patients with positive DNA-HBV dot-blot. No significant differences were observed in the liver function tests and Knodell index with regard to the viremia detectable exclusively by PCR. In the mononuclear cells of peripheral blood, DNA-HBV was observed in 62% by dot-blot and in 95% by PCR. The presence of DNA-HBV by dot-blot in these cells was associated to greater disease activity. CONCLUSIONS: The activity of chronic hepatitis B was correlated with the presence of high viremic levels with no direct relation being observed between low grade viremia and disease aggressivity. The finding of DNA-HBV by dot-blot in mononuclear cells was associated with a greater activity of chronic hepatitis B, with these results being in agreement with the serologic data reported.

Correlation between hepatitis B viremia and the clinical and histological activity of chronic delta hepatitis.

To analyze the serological, clinical and histological significance of hepatitis B virus (HBV) replication among a group of patients with chronic delta hepatitis (CDH), we have studied the clinical and the histological activity in 49 patients with CDH. The HBV-DNA was analyzed by dot-blot and polymerase chain reaction (PCR). Concomitant infection with hepatitis C virus (HCV) was analyzed by reverse transcriptase (RT)-PCR, HDV replication by dot-blot, and human immunodeficiency virus (HIV) infection by enzyme-linked immunosorbent assay. The subjects were divided into three groups according to HBV-DNA status: group I: 14 patients HBV-DNA dot-blot positive; group II: 29 patients HBV-DNA positive only by PCR, and group III: 6 patients HBV-DNA negative by dot-blot and PCR. We have found HBV-DNA by dot-blot in 28.5% of patients, and by PCR in 87.7%. Also 22 patients were anti-HCV positive (86.3% had HCV-RNA by RT-PCR). The first group (HBV-DNA dot-blot positive) had significantly higher serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) than those in the second and third groups. Likewise, serum ALT and AST were significantly higher in the second group (HBV-DNA positive by PCR) than in those of the third group. Histological inflammatory activity was significantly higher in the group of patients with HBV-DNA detectable by dot-blot. The prevalence of serum HDV-RNA and IgM anti-HDV were similar in the three groups. These results were similar in the anti-HCV-positive and -negative patients. In conclusion, these data suggest that: (1) persistence of HBV replication is a major determinant of severe liver damage in chronic delta hepatitis, and (2) HCV and HIV infections do not influence the natural history of CDH.

[Influence of hepatitis C virus infection and human immunodeficiency on the natural history of chronic delta hepatitis]. / Influencia de la infección por los virus de la hepatitis C y de la inmunodeficiencia humana en la historia natural de la hepatitis crónica delta.

OBJECTIVES: To analyze the prevalence and clinical significance of HCV an HIV infections among a group of patients with chronic delta hepatitis. METHODS: We have studied the clinical and the histological activity and the serological profile the HBV DNA was analyzed by dot blot and PCR and the HDV RNA by dot blot) in 46 patients with chronic delta hepatitis. These results were correlated with HCV infection (assessed by ELISA-2, RIBA-2 and RT-PCR) and HIV infection (ELISA and immunoblot). RESULTS: HBV DNA and HDV RNA was detected by dot in 28.2% and 71.4% of patients respectively, and by PCR, 89.1% of patients had HBV DNA in their serum. Twenty two of 46 patients with chronic delta hepatitis were anti-HCV positives (with HCV RNA detectable in sera by RT-PCR in 19 cases). Anti-HIV positivity was detected in 19 of 46 patients. The mean aminotransferase level, histological activity and serological profile was similar in the anti-HCV positive and negative patients. Likewise, clinical and histological activity and serological profile was similar in the anti-HIV positive and negative patients. CONCLUSIONS: Concomitant infection with HCV or HIV does not seem to significantly modify the clinical course of chronic delta hepatitis. In addition, no significant serological difference has been noted in patients with chronic delta hepatitis with anti-HIV or anti-HCV antibodies.