[Glucose-6-phosphate dehydrogenase deficiency: report of 2 cases]. / Deficiencia de glucosa 6 fosfato deshidrogenasa: presentación de 2 casos.

Glucose 6 phosphate dehydrogenase (G6PD) is an enzyme related to the metabolism of glutation, an antioxidant agent. Its deficiency causes hemolisis, generally well tolerated. However there are some factors including, exercise, infections and oxidants drugs that stimulate the hemolisis of the older red blood cells. We report two patients with G6PD deficiency, that were initially diagnosed as acute viral hepatitis. Although this pathology is not frequent it should be recognized, for the implication of giving profilactic antimalaric drugs in endemic areas. The diagnosis should be suspected in patients with unconjugated jaundice, always investigating the previous ingestion of oxidants drugs.

[Ultrasonography as diagnostic method in abdominal trauma and wounds]. / La ultrasonografía como método diagnóstico en traumatismos y heridas abdominales.

Abdominal trauma is a public health problem. Early diagnosis of this lesion is directly related to the survival of these patients. Ultrasonography is a good method for the study of the traumatized patient. Abdominal ultrasonography was performed in 35 patients seen at the Central Military Hospital of Caracas during the years 1987-1988. Free liquid in the abdominal cavity and parenchymatous hematomas were the most frequent findings followed by retroperitoneal hematomas. Abdominal ultrasonography performed by trained and experienced personnel can be of great help in the management of patients with abdominal trauma. Correlation between ultrasonography, surgical findings and the clinical follow up was 100%. We recommended this method for the initial evaluation of these patients.

[Hepatitis caused by virus C. Risk factors]. / Hepatitis por virus C. Factores de riesgo.

To establish the risk factors to hepatitis C virus (HCV) infection, we studied 120 patients divided in 2 groups: A first group of 40 patients with HCV infection, 24 (60%) with past medical history of blood transfusion, 14 (35%) of them also had hemodialysis and 3 Kidney transplant. 10 patients (25%) had mayor surgery without transfusion, 3 had frequent visits to the dentist and 3 month baby whose mother was HCV positive. In 4 patients we found no risk factors. A second group of 80 patients who visit our clinic for the first time, 2 were found positive for HCV (1.6%). 13 of them had blood transfusion, one was HCV+ (OR: 5.5, P = 0.73). 41 had history of mayor surgery, one HCV+ (OR: 0.95, P = 1.000). The risk factors related to HCV infection in our population were blood transfusion, hemodialysis and mayor surgery. The use of EV drugs, tatoos, sexual behavior, interfamiliar or vertical transmission were not risk factor in our population.

[Cytologic diagnosis of abdominal lesions with fine needle aspiration guided by ultrasound]. / Diagnóstico citológico de lesiones abdominales mediante punción aspiración con aguja fina guiada por ultrasonografía.

The purpose of this work was to analyse the advantages and disadvantages of puncture-aspiration with fine needle, guided by ultrasonography, trying to determine its usefulness in our hospitals and its reliability in the diagnosis of intraabdominal lesions of different locations. 29 punctures were practiced on 19 patients, 9 women and 10 men of ages comprised between 34 and 94 years, with lesions in different organs of the abdominal cavity diagnosed by ultrasonography with real time equipment and lineal 3.5 and 5 MHz transducers. After cleaning and antisepsis a Chiba needle is introduced under ultrasonographic vision, up to the location of the lesion, the guide is removed and under a negative pressure, the sample is taken, which is later dried into the air and coloured using the May-Grünwald-Giemsa Technique. Only in one case it was not possible to obtain adequate material for the cytological study. There were 11 positive cases for malignity and 7 negative, one of which was a false negative. The sensibility of the method was of 91.6% with a specificity of 100% and a reliability of 89.4%. We definitely believe that the method is practical, very easy to carry out in our hospitals with a minimum amount of risk, and most of all, dependable to clarify certain diagnoses.

[Ultrasonographic changes in the gallbladder wall in non-gallbladder diseases]. / Alteraciones ultrasonográficas de la pared vesicular en patologías no vesiculares.

Alterations of the gallbladder wall is a well known sonographic sign of acute cholecystitis. But thickening of the gallbladder wall is also found in patients without intrinsic gallbladder disease. We present our experience on this regard in patients with cirrhosis, acute viral hepatitis, infectious mononucleosis, halothane hepatitis, fulminant hepatic failure, malaria due to plasmodium falciparum, heart failure, severe malnutrition due to gastric obstruction, septicemia, pyogenic hepatic abscess, amoebic hepatic abscess and in a 14 years old patient with fracture of the skull-acute anemia-shock. Most of these diseases affected the liver directly or indirectly. Knowledge of these alterations of the gallbladder wall in these circumstances are important in order to avoid a the erroneous diagnosis of acute cholecystitis.

[Antibodies against hepatitis C virus. Experience with a second generation test]. / Anticuerpos contra el virus de la hepatitis C. Experiencias con una prueba de segunda generación.

A second generation recombinant immunoblot assay to detect antibodies against Hepatitis C virus (RIBA II, Ortho Diagnostic Systems) was applied to 30 serum samples repeatedly reactive to ELISA anti-HCV c100-3, 11 from hemodialysis patients, 11 from patients with chronic hepatitis and 8 from patients with cirrhosis. The assay detects individual antibodies directed to 4 antigenic components of the C virus, 2 antigens, c100 and 5-1-1 contained in the original ELISA assay and 2 new antigens, c33c and c22-3 the latter structural in nature. From the total of 30 samples, 23 (77%) were reactive, 4 (13%) indeterminate and 3 (10%) non reactive to the RIBA II assay. Much variation was observed regarding the response to each individual antigen. c22-3 was the most frequently reactive with the highest intensity. RIBA II assay confirmed a high percentage of the reactive results with the ELISA c-100-3, serum samples that were non reactive to RIBA showed a low optical density with ELISA. c22-3 was the most sensitive antigenic component.

[Malignant thymoma with myasthenia gravis and hepatic metastasis. Report of a case and review of the literature]. / Timoma maligno con miastenia gravis y metástasis hepáticas. Presentación de un caso y revisión de la literatura.

This paper reports a case of an histological non aggressive thymoma with myasthenic symptoms as the first clinical manifestation. Three years after its complete surgical resection liver metastases appeared without evidence of intrathoracic neoplastic disease. The extrathoracic metastases are uncommon and the thymomatous myasthenia gravis is present in 25 to 50% of cases. We reviewed the literature and analyzed its clinical pathological characteristics and therapeutics approach.

[Antibodies against hepatitis C virus in patients with liver diseases and in risk subjects. Preliminary report]. / Anticuerpos contra el virus de la hepatitis C en pacientes con hepatopatías y en sujetos a riesgo. Comunicación preliminar.

The recent discovery of an antigenic component of the causative agent of Non-A, Non-B hepatitis, has led to the characterization of this virus--Hepatitis C Virus (HCV)--and to the identification of an antibody present in infected subjects (anti-HCV) detected by means of the C-100 antigen derived from a nonstructural region of the viral genome. Using a commercial Kit (Ortho Diagnostic Inc.), the incidence of anti-HCV antibody was studied in the Military Hospital "Dr. Carlos Arvelo" of Caracas, Venezuela with the following results: Health personnel (doctors, nurses, laboratory staff): 102 persons studied, 2 positives (1.96%); 16 patients in chronic hemodialysis: 6 positives (33%); 20 subjects with antibodies against HIV virus, confirmed by Western Blot: 7 positives (35.4%). Of 10 patients with Surface Antigen negative Chronic Hepatitis, 7 (70%) positive for anti-HCV, of 25 patients with cirrhosis: 12 positive (48%), 2 patients with hepatocarcinoma 1 positive (50%). There was also a high incidence of total anti-core antibodies in the patients studied. The results suggest that the hepatitis C virus could be playing an important role as a causative factor of liver diseases in our Country.