[The role of the abdominal ultrasonography and percutaneous liver biopsy in the differential diagnosis of neonatal cholestasis]. / Valor da ultra-sonografia abdominal e da biopsia hepática percutânea no diagnóstico diferencial da colestase neonatal.

Neonatal cholestasis still presents a diagnostic challenge, both from the anatomic and etiologic point of view. Distinguishing intrahepatic from extrahepatic causes of cholestasis is of paramount importance since the latter may be treated by surgery but prognosis depends on the age at which operation is performed. Many tests have been proposed to help in differentiating these two entities, among which liver biopsy is the most frequently employed, and ultrasonography one of the most recently included. Our purpose is to present our experience with these two methods in the differential diagnosis of intra and extrahepatic causes of cholestasis. From January 1989 to July 1993, 35 patients with neonatal cholestasis were evaluated through a protocol which included liver biopsy and ultrasonography. The latter was performed after a 4 hour fast and was considered indicative of extrahepatic cholestasis when the gallbladder was not visualized, was hypoplastic or non-functioning, or if a cystic structure was seen at the extrahepatic biliary tree. Sensitivity, specificity, and accuracy were determined for these two tests. Seventeen patients were found to have extrahepatic cholestasis (all with biliary atresia) and 18 intrahepatic cholestasis, on the basis of clinical evolution or operative findings. Sensitivity was 100% for ultrasonography and 76% for liver biopsy in diagnosing extrahepatic cholestasis. Accuracy was 83% for ultrasonography and 86% for biopsy, rising to 96% when both tests were considered together. Based on these findings we strongly recommend ultrasonography with definite criteria as the initial investigation tool in the management of neonatal cholestasis, associated with liver biopsy.

Alcalose metabolica causada por antibioticos. / Metabolic alkalosis caused by antibiotics

Os autores apresentam quatro pacientes que desenvolveram alcalose metabolica e hipopotassemia durante o uso de antibioticos.O antibiotico mais associado com essas alteracoes foi a carbenicilina. Discutem-se os provaveis mecanismos implicados nessas alteracoes metabolicas

Insulina endovenosa continua no tratamento da cetoacidose diabetica. / Continuous endovenous insulin in the treatment of diabetic ketoacidosis

Estudou-se o tratamento da cetoacidose diabetica com insulina endovenosa continua Discutem-se os resultados sobre a dose de insulina usada, a evolucao da glicemia e o uso de bicarbonato.O disturbio foi controlado com bem menores quantidades de insulina que os esquemas classicos. Nao se encontraram alteracoes metabolicas. O metodo mostrou-se pratico, eficaz e seguro

[Intrahepatic cholangiodysplasia in 2 brothers. Concept of the entity]. / Colangiodisplasia intrahepática em dois irmãos. Conceituação da entidade.

The histopathologic aspects of the intrahepatic dysplasic bile ducts (cholangiodysplasia) found in two brothers, one of them asymptomatic, are discussed. This entity is characterized by interlobular bile ducts proliferation and portal fibrosis, without cholestasis but with chronic active cholangitis. The differential diagnosis and the probable genesis of the cholangiodysplasias are discussed.

Apgar score and blood coagulation factors.

Blood coagulation tests were performed in 93 newborn infants with different Apgar score at the 1st and 5th minutes of life. The laboratorial determinations were periodically performed at 0, 24 and 48 hours of life. The following tests were performed: bleeding time, whole blood clotting time, prothrombin time, kaolin-cephalin clotting time, thrombin time, dosage of factors I, V, VIII and X, clot retraction, platelet count, englobulin lysis time and the tourniquet test. Immediately after birth, the mean values of the blood coagulation factors were significantly different among the groups, with the exception of the whole blood clotting time and the platelet count. Those differences were due to the presence of the more depressed neonates. Although these results could indicate some degree of hepatic damage, it was apparent that an activation of the blood coagulation mechanisms took place, leading to a consumption coagulopathy. The infants who died (10) presented clinical and laboratorial data suggestive of disseminated intravascular coagulation (DIC). Necroscopic findings of microthrombosis in the liver and in the central nervous system were diagnosed in two infants.