One year of Lamivudine therapy for portuguese patients with chronic hepatitis B.

OBJECTIVE: To assess the efficacy of lamivudine treatment on hepatitis B e antigen (HBeAg) and/or hepatitis B surface antigen (HBsAg) seroconversion, on other virological and serological markers of response including hepatitis B virus (HBV) DNA and serum aminotransferases, and the safety of lamivudine treatment in hepatitis B patients. PATIENTS: This phase III open-label study evaluated the virological and biochemical response to lamivudine in 70 Portuguese patients with HBeAg positive chronic hepatitis B. Patients were treated with lamivudine 100mg once daily for 12 months. METHODS: Antiviral activity was assessed by measuring alanine aminotransferase (ALT)/aspartate aminotransferase (AST) levels at all protocol visits, and hepatitis B serology and HBV DNA were performed at baseline and at month 12 visits. Evaluation of safety and tolerance was based on clinical adverse events and laboratory analyses. RESULTS: The primary endpoint was virological response at month 12, defined as loss of detectable HBeAg from serum with a reduction of HBV DNA to undetectable levels, and this was observed in 19/69 (27.5%) of patients. Almost half of the patients were HBV DNA negative by this time. Mean ALT values decreased steadily during treatment and by 12 months 61% of patients had values within the normal range. HBeAg seroconversion (HBeAg negative, HBeAb positive) was achieved in 27.9% of patients by 12 months, although all patients remained HBsAg positive. CONCLUSION: Lamivudine was well tolerated and the incidence of adverse events was similar to those reported in previous studies. Lamivudine treatment resulted in virological and biochemical improvements in HBeAg positive chronic hepatitis B patients, with HBeAg seroconversion in one-third of patients.

[Heart failure due to a postlaminectomy arteriovenous fistula]. / Insuficiência cardíaca por fístula arteriovenosa pós-laminectomia.

The authors report a case of congestive heart failure as a consequence of traumatic postlumbar laminectomy arteriovenous fistula. A 49 years old female with the diagnosis of atrial septal defect was admitted at the hospital, complaining of dyspnea and peripheral edema. A hemodynamic study was performed and an arteriovenous fistula was detected between the iliac artery and vein, and arterial septal defect was excluded. Surgery for fistula closure was performed with great clinical improvement.

[Coexistence of hepatic and pancreatic disease in the chronic alcoholic. Unusual or frequent situation?]. / Coexistência de doença hepática e pancreática no alcoólico crónico. Situação rara ou frequente?

In all that has been written there is still some controversy about the importance of the simultaneous pathologycal involvement (functional and/or morphologic) of the pancreas and liver on the same alcoholic patient. Thus, and with the intention of reaching an agreement on the matter, we studied on one hand, on a functional basis, the exocrine pancreas in a group of alcoholic cirrhotics (n = 75) and, on the other, we analysed on a triple perspective--clinical, biological and anatomic-pathological--the pathological involvement of the liver in a series of cases (n = 20) with chronic calcifying pancreatitis. In such case, we verified that, essentially, the secretory capacity of the pancreas had diminished in 17.3% of the cirrhotic cases, while on the other hand, the clinical-laboratorial and anatomic-pathological analysis of liver on pancreatic patients showed clinical-biological suspicion of alcoholic hepatic disease, serious lesions considered pre-cirrhotic and established cirrhosis, respectively in 56.2%, 12.5% and 6.2% of the cases. We conclude that, although the idea of rarity in associating hepatic cirrhosis with chronic pancreatitis, came through on the clinical-symptomatological observation plan, certain investigations of functional and/or histopathological nature, run by us on alcoholic patients, proved to suffer from these affections, permitted us to indicate that the coexistence of pathological involvement of these two organs should not be underestimated.