Influence of the transmission route and disease duration in the histopathology of chronic hepatitis C: a study of 101 patients.

OBJECTIVE: Different studies have demonstrated that factors such as transmission route, disease duration and age at the time of infection can influence the histological evolution of chronic hepatitis by the hepatitis C virus (HCV). The aim of this study was to determine if epidemiological factors such as disease duration and transmission route influence the severity of the histological lesions of patients with chronic hepatitis by HCV. DESIGN: A prospective study. METHODS: The hepatic biopsies of 101 patients diagnosed with chronic hepatitis by HCV were studied. The patients were divided into three groups according to transmission mode: (1) post-transfusional (n = 28), (2) associated with the use of drugs by parenteral route or intravenous drug use (n = 28), and (3) sporadic hepatitis (n = 45). RESULTS: We found more severe forms of hepatopathy in post-transfusional hepatitis and sporadic groups than in the intravenous drug user group of patients. The disease evolution time was significantly higher in patients diagnosed as having chronic active hepatitis with or without cirrhosis (13.8 +/- 9 years) than in patients with chronic persistent hepatitis (8 +/- 4 years), P < 0.01. We found a significant correlation between the evolution time of the infection by HCV and the Histology Activity Index (P < 0.01). The multivariate analysis showed that only the transmission route and the disease evolution time are predictive variables of Histology Activity Index in chronic hepatitis C. CONCLUSION: These results suggest that the post-transfusional and sporadic transmission routes and a greater evolution time of the disease are epidemiological variables that are associated with the presence of more severe histological lesions in chronic hepatitis C.

[Acute pancreatitis and sarcoidosis: a case report and review of the literature]. / Pancreatitis aguda y sarcoidosis: presentación de un caso y revisión de la literatura.

We describe a case of sarcoidosis that began as acute pancreatitis. Diagnosis was established by mediastinoscopy. Although involvement of the pancreas is rare and in general asymptomatic, we conclude that sarcoidosis should be included in the long list of factors that can trigger acute pancreatitis.

[Severe gastroesophageal lesions due to caustics: the role of nutritional support]. / Lesiones gastroesofágicas graves por cáusticos: papel del soporte nutricional.

AIM: Describe the clinical-nutritional state of patients with severe digestive lesions after the ingestion of caustic substances, as well as their nutritional support (NS). PATIENTS AND METHODS: We studied 5 patients diagnosed by means of early endoscopy, treated with artificial nutrition, 4 of whom used enteral nutrition. During the acute phase of the disease, an evaluation of the nutritional state (ENS) was done, by means of the following parameters: body mass index (BMI), creatinine/height index (CHI), visceral proteins, nitrogen content of 24 h urine, and plasma zinc level. The corrected Harris-Benedict equation was used to calculate the energy needs. RESULTS: The BMI did not experience significant changes. The CHI decreased in a large degree. The long life visceral protein did not change notably, and those of intermediate and short life increased. The losses of nitrogen were increased. We found hypozincemia in 4 of the cases. The mean Kcal provided was 2323 +/- 105. CONCLUSIONS: In the described patients, given their catabolic condition, and early ENS and NS should be done. If at all possible, the NS shall be enteral, with or without parenteral support. In our study we have found a cessation of the weight loss, a decrease of somatic protein with a short term re-filling of the visceral protein pol. The zinc levels should be monitored.

[Immunological and biochemical factors associated with spontaneous bacterial peritonitis]. / Factores inmunológicos y bioquímicos relacionados con la peritonitis bacteriana espontánea.

A prospective study (June 1988-December 1989) of all patients admitted with ascites due to cirrhosis was undertaken: Biochemical and immunological factors which may have significance in the development of spontaneous bacterial peritonitis were determined. Among 56 patients (44 males and 12 females) SBP developed in 16% of the group. No age differences were found and the etiology of the cirrhosis was mainly alcoholic. Patients with SBP had lower alpha-2 globulin concentrations: 0.43 +/- 0.12 vs. 0.60 +/- 0.18 g/dl (p less than 0.05) and a lower prothrombin time: 41 +/- 13% vs. 69.5 +/- 13 vs. 69.5 +/- 21% (p less than 0.001). Patients with SBP had also lower ascitic fluid total protein 0.99 +/- 0.4 vs. 1.64 +/- 1.1 g/dl (p less than 0.01) as well as lower alfa-2 globulin: 0.065 +/- 0.012 vs. 0.096 +/- 0.067 g/dl (p less than 0.05); beta globulin, 0.11 +/- 0.047 vs. 0.2 +/- 0.17 g/dl (p less than 0.05); gamma globulin, 0.32 +/- 0.1 vs. 0.52 +/- 0.4 g/dl (p less than 0.05); IgG, 275 +/- 157 vs. 477 +/- 335 g/dl (p less than 0.05); C3, 9.2 +/- 3.2 vs. 17 +/- 13 mg/dl (p less than 0.01) and C4, 2.83 +/- 1.5 vs. 4.66 +/- 3.9 mg/dl (p less than 0.05) than patients without this complication.

[Fibro-endoscopic therapy of intraesophageal foreign bodies]. / Terapéutica fibroendoscópica de los cuerpos extraños intraesofágicos.

We have studied by means of flexible endoscopy 298 patients with a suspicion of esophageal foreign body. Only a third of them were proven, prevailing in women older than 60 years. We verify the meaning of some symptoms (dysphagia, odynophagia, retrosternal pain, and pharyngeal parestesias) according to the presence or not of the foreign body, and we confirm its general tendency to locate in the proximal esophagus and Killian's ring becoming nailed or impacted in a high percentage (73.8%) of cases. The lesions caused by such foreign bodies were slight in general, and no special treatment was required. The incidence of serious complications was very low (0.97%). The success of treatment by flexible endoscopy was 92.3%, making this the best method for extracting the foreign bodies of the upper digestive tract.

[A psoas abscess in a patient with Crohn's disease]. / Absceso del psoas en un paciente con enfermedad de Crohn.

We report a case of Crohn's disease diagnosed 13 years ago, complicated by a psoas abscess. The main symptoms were flexion deformity of the hip, pain and fever. Diagnosis was made by CT-scan. Surgical and CT-guided percutaneous drainage was ineffective and the abscess relapsed. Surgical resection of the affected bowel with abscess drainage, provided patient's healing.

[Idiopathic portal hypertension, multiple focal nodular hepatic hyperplasia, the CREST syndrome and protein S deficiency]. / Hipertensión portal idiopática, hiperplasia nodular focal hepática múltiple, síndrome de CREST y déficit de proteína "S".

A 54 year old woman with idiopathic portal hypertension, CREST syndrome, protein "S" deficiency and multiple focal nodular hyperplasia is reported. The patient presented several episodes of upper digestive bleeding due to portal hypertension gastropathy and to esophageal varices. Treatment with propanolol and isosorbide 5-mononitrate failed to control recurrent bleeding and a portacaval shunt was performed. At operation, ten hepatic nodes were found, being diagnosed as focal nodular hyperplasia in the pathologic study. Congestive gastropathy, esophageal varices and splenomegaly disappeared after portacaval shunt and bleeding did not recur after a follow-up of twelve months. This results support the role of portal decompressive surgery in the bleeding due to portal hypertension gastropathy.

[Interstitial pneumopathy as extradigestive manifestation of ulcerative colitis]. / Neumopatía intersticial como manifestación extradigestiva de la colitis ulcerosa.

We report two cases of interstitial pulmonary disease in ulcerative colitis unrelated to sulfasalazine or 5-Aminosalicylate therapy. It is concluded that these two cases represent an extracolonic manifestation of ulcerative colitis.

[The usefulness of reactive protein C in managing patients with ulcerative colitis and Crohn's disease]. / Utilidad de la proteína C reactiva en el manejo de los pacientes con colitis ulcerosa y enfermedad de Crohn.

Serum concentrations of C-Reactive protein (CRP) were measured in 40 patients with inflammatory bowel disease (22 with ulcerative colitis and 18 with Crohn's disease). In the evaluation of disease activity, CRP was a more sensitive (98.6% vs 71.4%) and specific (95% vs 84.6%) activity index in Crohn's disease than in ulcerative colitis. The CRP concentrations were significantly higher in Crohn's disease (57.7 +/- 55.7 mg/dl) than in ulcerative colitis (16.3 +/- 18.8 mg/dl), particularly in severely affected patients (104.8 +/- 54.3 vs 29 +/- 24.2 mg/dl). The CRP levels correlated significantly with clinical activity indices. There was poor or no correlation between CRP levels and the endoscopic activity indices, the extent of inflammatory bowel disease, and the days of hospitalization. We conclude that the determination of CRP levels provide a simple objective index of inflammatory activity with may be useful in the assessment, management and study of inflammatory bowel disease.

[Acute recurring pancreatitis due to gastric duplication]. / Pancreatitis aguda recidivante por duplicación gástrica.

We report the case of a young female patient with a gastric duplication communicating with the pancreas, which manifested clinically as episodes of acute relapsing pancreatitis. We analyze the diagnostic procedures and treatment methods, and review similar cases reported in the literature.

[Acute hepatitis due to ingestion of Teucrium chamaedrys infusions]. / Hepatitis aguda por ingestión de infusiones con Teucrium chamaedrys.

Herbal remedies, used for many years for therapeutic purposes, have traditionally been considered safe and effective. Herbal medicine toxicity has been infrequently reported in Spain. We present two cases of acute hepatitis after ingestion of herbal infusions over a period of several months. Among the plants consumed was Teucrium chamaedrys (germander), which has been associated with several cases of hepatotoxicity, mainly in France. After ruling out other causes of hepatitis, we consider that Teucrium chamaedrys provoked the disease. One patient presented acute, cholestatic hepatitis and another presented mixed (hepatocellular and cholestatic) hepatitis. In both patients, the disease was resolved after discontinuing the intake of the herbal teas. We believe that herbal medicine toxicity may be increasing due to the growing consumption of these products. Finally, we emphasize the need to rule out the intake of herbal remedies in patients whose liver tests present abnormalities.

[Good's syndrome and chronic diarrhea]. / Síndrome de Good y diarrea crónica.

Good's syndrome is an infrequent disorder associated with humoral immunodeficiency and thymoma. Patients usually present severe or chronic infections. The most frequent are sinopulmonary infections sometimes associated with bronchiectasias. Another complication is chronic diarrhea, frequently associated with malabsorption, which can be due to a mucosal lesion, infection with gastrointestinal pathogens, or bacterial overgrowth. We describe a patient with Good's syndrome and chronic diarrhea due to bacterial overgrowth.

[Hepatitis C virus infection and porphyria cutanea tarda]. / Infección por el virus de la hepatitis C y porfiria cutánea tarda.

The prevalence of antibodies versus the hepatitis C virus (antiHCV) was studied in a group of 10 patients diagnosed with porphyria cutanea tarda (PCT) and the possible existence of subclinical forms of PCT was determined in 64 patients with chronic anti HCV positive liver diseases. The prevalence of anti HCV was found to be 40% in patients with PCT. In the group of patients with chronic anti HCV positive liver disease only one patient (1.5%) presented an increase in the urinary elimination of porphyrias in the absence of cutaneous lesions of photosensitivity. This study confirms the importance of the hepatitis C virus as a triggering agent of PCT. These results demonstrate the existence of a low prevalence of subclinical forms of PCT among patients with chronic anti HCV positive liver diseases.

[Alterations in iron metabolism in chronic anti-HCV positive hepatitis. The relationship with response to interferon treatment]. / Alteraciones del metabolismo del hierro en las hepatitis crónicas anti-VHC positivo. Relación con la respuesta al tratamiento con interferón.

A prospective study in which the existence of iron metabolism alterations (increase in the serum levels of iron and ferritin and the presence of iron in liver tissue) in a group of 53 patients diagnosed with chronic anti-HCV positive hepatitis was performed. The aim of the study was to determine whether these parameters influence the response to interferon treatment. Elevations were observed in the serum levels of iron and/or ferritin in 17 (32%) of the patients. Higher than normal values of serum iron or ferritin in pretreatment analyses were associated with worse therapeutic response. The basal serum levels of iron and ferritin were significantly higher in non responding patients. No relationship was found between the presence of iron in the hepatic parenchyma and response to interferon treatment.

[Sinusoidal portal hypertension secondary to nodular regenerative hyperplasia of the liver]. / Hipertensión portal sinusoidal secundaria a hiperplasia nodular regenerativa hepática.

Regenerative hepatic nodular hyperplasia is infrequent and generally appears in association with many other diseases, the most frequent being the Felty syndrome. It may cause portal hypertension and variceal bleeding. A histologic study is necessary for diagnosis since certain biologic data and the nodular appearance of the hepatic surface may be confused with hepatic cirrhosis from which it may basically be, apart from the histologic features, distinguished by its good prognosis due to the absence of liver failure. We present the case of a seropositive patient with regenerative hepatic nodular hyperplasia and rheumatoid arthritis with marked portal hypertension shown in the hemodynamic study performed by our department for presentation of a persistent elevation in transaminases and ultrasonography alterations suggesting hepatic cirrhosis.

[Malignant lymphoproliferative neoplasms and chronic hepatitis C virus infection]. / Neoplasias linfoproliferativas malignas e infección crónica por el virus del la hepatitis C.

It has been suggested that chronic hepatitis C virus (HCV) infection predisposes to the development of benign and malignant lymphoproliferative disorders. We present 2 cases of malignant lymphoproliferative neoplasias (a non-Hodgkin lymphoma [NHL] and a chronic lymphoid leukemia [CLL]) associated to chronic hepatitis C virus (HCV). The possible etiological role of HCV in the development of these tumors is discussed.

[The histological lesions of chronic hepatitis C as predicting factors of sustained response to the treatment with interferon]. / Las lesiones anátomo-patológicas de la hepatitis crónica C como factores predictivos de respuesta mantenida al tratamiento con interferón.

BACKGROUND: Although many studies have been implemented in order to determine the pre-treatment factors that can predict patients' response to interferon (IFN) therapy, it is not yet clear whether characteristic histologic abnormalities in chronic hepatitis C can predict such response. AIMS: The aim of this study were to evaluate, in patients with chronic hepatitis C, (i) the predictive value of histologic lesions for the sustained response to IFN therapy (ii) other pre-treatment (epidemiological and analytical) factors known to be predictive of response. PATIENTS AND METHODS: Sustained response was retrospectively evaluated in two hundred one patients who had been treated with IFN for at least 3 months in four different hospitals from Castilla y León. The following histological parameters were studied as predictors of response: histological diagnosis, Knodell index, grading and stage, characteristic histologic lesions of HCV infection. Epidemiological and analytical parameters were also evaluated. RESULTS: The rate of patient's sustained response to IFN treatment was 16%. None of the histological parameters was useful to predict this response. By univariate analysis, age, disease evolution time, mode of viral transmission, GGT, ferritin and viral genotype were associated with a sustained response. The most powerful, and only independent predictive factor, however, was the genotype (the response odds ratio was 8.6). CONCLUSIONS: Histological parameters do not predict the response to IFN treatment. Other factors (mainly the viral genotype) are associated with a higher response percentage, although no one is useful to decide which patients are going to respond.