Lack of impact of hepatitis C virus coinfection in end-stage renal disease patients with hepatitis B virus infection.

INTRODUCTION: Hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection results in more severe forms of liver disease in nonuremic patients; however, the impact of HCV coinfection is not clearly known in end-stage renal disease (ESRD) patients with HBV infection. We sought to determine the impact of HCV coinfection in HBV-infected ESRD patients. PATIENTS AND METHODS: The HBsAg-positive ESRD patients evaluated between March 1999 and May 2003 were divided into two groups: group B, HBV infection alone, and group BC, HBV-HCV coinfection (anti-HCV-positive). Both groups were compared regarding epidemiological, laboratory, and histological findings. A liver biopsy was obtained in cases with evidence of viral replication and/or elevated alanine aminotransferase. RESULTS: One hundred patients (73% men) with mean age of 42 +/- 11 years (55 patients in group B and 45 in group BC) were studied. Comparison between groups showed a difference in time on hemodialysis and duration of infection, which were higher in group BC (P < .001 and P = .001, respectively) and in history of blood transfusion, which was also more frequent in group BC (P = .04). Liver biopsies, obtained from 15 patients in group B and 28 patients in group BC, showed no difference in frequency of septal fibrosis (60% in group B vs 48% in group BC, P = .46) or interface hepatitis (73% vs 71%, P = .99). CONCLUSIONS: HBV-HCV coinfection was related to a longer time on hemodialysis, longer duration of infection, and history of blood transfusion. Contrary to nonuremic patients, HCV coinfection was not associated with more severe forms of liver disease in ESRD patients.

[Hyperlipemic pancreatitis: clinical course]. / Pancreatite hiperlipêmica: aspectos clínico-evolutivos.

Acute pancreatitis is one of the complications associated with severe primary and secondary hypertriglyceridemia. The frequency of hypertriglyceridemia in patients with pancreatitis ranges from 4 to 53%. The elevation in serum triglycerides probably induces the release of free fatty acids, responsible for the pancreatic damage. During a three year study, nine patients with acute pancreatitis due to hypertriglyceridemia were followed up at the University Hospital of Federal University and at the "Hospital Monte Sinai" (Juiz de Fora, MG, Brazil). Suggestive clinical manifestations, especially superior abdominal pain, nausea, vomiting and ileus, were found in all the patients; however, only three showed elevated serum amylase levels. All had triglyceride levels above 1000 mg/dl (11.3 mmol/L). The evolution after clinical treatment was good in eight patients (two needed parenteral nutrition). The only death observed was due to shock and acute respiratory distress, refractory to clinical management. The maintenance treatment aimed at withdrawing the predisposing conditions and reduction of the triglyceride levels prevented recurrence of acute pancreatitis episodes during the 23 months of follow-up.

[Intestinal parasitosis and hepatic cirrhosis]. / Parasitoses intestinais e cirrose hepática.

The authors describe their experience, in a prospective survey, with the prevalence rates of intestinal parasites in patients with hepatic cirrhosis admitted to the Gastroenterology Unit of University Hospital of Federal University in Juiz de Fora, Brazil, whose fresh stools were examined by Hoffman-Pons-Janner, Baermann-Moraes and Willis methods. They compare the results of stool exams with two control groups and look for a relation with cirrhosis' etiology. A higher prevalence of some parasites was observed in cirrhosis than in people with other digestive diseases (group I). mainly for the Strongyloides stercoralis, found in 40.2%, chiefly in alcoholic cirrhosis. Oddly no one of the group I admitted in the same period had strongyloidiasis. Another group including all the people who had stool samples examined in the same period at the hospital had 1.91% of that helmintic infection (group II). A comparison is also made with the prevalence in schoolchildren between the ages of 7 and 14 studies eight years before (13.16%). Other parasites were also observed in different incidence between those with cirrhosis and the other groups and the results are presented. They conclude that hepatic cirrhosis must be included in the list of conditions which increases the risk of Strongyloides stercoralis infection.

PIP: In a prospective study conducted between July 1995 and June 1996 the prevalence of intestinal parasites is described in 35 (32 male, 3 female) patients with hepatic cirrhosis, aged 13-77 years, who had been admitted to the gastroenterology unit of the Federal University in Juiz de Fora, Brazil. The causes of cirrhosis were: alcohol (19 cases), hepatitis B virus (HBV) (3 cases), hepatitis C virus (HCV) (5 cases), HBV and HCV (2 cases), cryptogenetics (3 cases), Wilson's disease (1 case), biliary cirrhosis (1 case), and Gaucher's disease (1 case). Another 45 patients who were hospitalized during this period served as controls (Group I). Group II was comprised of 1411 persons who underwent parasitological tests during December 1995 and May 1996. Comparison was also made with 7371 tests performed in children aged 7-14 years who had been studied in 1988. Stools were examined by the Hoffman-Pons-Janner, Baermann-Moraes, and Willis methods. The results of stool exams were compared with those of the two control groups. A higher prevalence of some parasites was observed in cirrhosis patients than in patients with other digestive diseases (Group I). Of the 35 cirrhosis patients, 19 presented with positive parasite tests. Strongyloides stercoralis was found in 40.2%, chiefly in alcoholic cirrhosis patients, which was significant when compared to the other two control groups, but not significant when compared to the patients with nonalcoholic cirrhosis (4 cases of strongyloidiasis out of 16 patients). None of the 45 patients in Group I had strongyloidiasis. Group II (including all the people who had stool samples examined during the same period in the hospital) had a 1.91% rate of helminthic infection. A rate of 13.16% was found in the children's group.

[Hepatic puncture biopsy in the outpatient clinic]. / Biopsia hepática por puncão em ambulatório.

The authors present the results of a prospective study on percutaneous needle biopsy of the liver conducted at the Hepatology Outpatients' Ward of the Gastroenterology Unit of the University Hospital -" Universidade Federal de Juiz de Fora", MG, Brazil. In 16 months 61 biopsies were made in patients with chronic liver disease according to the technique described by menghini. The inclusion criteria were established by The Patient Care Committee of The American Gastroenterological Association. Abdominal ultrasound was done before and after the procedure. The patients stayed six hours under control (blood pressure and pulse rate) in the hospital. After 24 hours other clinical, laboratorial and ultrasonic control were performed. The main complication was local pain or in the right shoulder (32 patients--52.5%). Abdominal ultrasound after 24 hours revealed only one hematoma of the abdominal wall (1.8%). This study shows that the outpatient needle liver biopsy is a safe procedure with low complication rate when performed in a judicious way, by specialized personnel and under strict clinical control.