[Non alcoholic steatohepatitis]. / Esteatohepatitis no alcohólica.

A prospective study of 21 patients with the diagnosis of non-alcoholic steatohepatitis (NASH) was carried out. All patients had hepatomegaly and in 10 (48%) image studies were consistent with steatosis and/or fibrosis. Biochemically, there was increase of AST, ALT and cholesterol in 48%, of GGT in 52% and of alkaline phosphatase in 38%. 18 patients were obese, 2 of them diabetic, 2 others had a history of exposure to drugs (amiodarone and isopropilic alcohol) and the last one presented hypothyroidism. Liver biopsies were studied using a semiquantitative scale to evaluate the degree of steatosis, inflammation and fibrosis in a scale from 1 to 3. Results showed a medium score of 2.6 for steatosis, 1.5 for inflammation and 1.8 for fibrosis. Four patients had cirrhosis and Mallory bodies were found in 11 cases (52%). NASH is an oligosymptomatic disease that can be found in different clinical conditions, mainly obesity, and is more frequent in women. It is histologically indistinguishable from alcoholic steatohepatitis. It is frequently underdiagnosed clinically and must be taken into account as a possible cause of cryptogenetic cirrhosis.

[Reproducibility of nuclear grade in breast neoplasm. A multicenter experience]. / Reproducibilidad del grado nuclear en el cáncer de mama. Una experiencia multicéntrica.

Nuclear grade is considered a valuable prognostic factor in mammary carcinomas. Since the histological diagnosis of most of these tumors is made by "non expert" pathologists, it was considered interesting to find out the reproducibility of general pathologists to define the nuclear grade. In order to do this, a series of 15 mammary carcinomas, 10 of them randomly selected and 5 because they were considered difficult to classify for nuclear grade, were examined separately by 10 general pathologists. In a first round of observation, each one of them graded the cases according to their own criteria as used routinely, and for a second round they followed a written guide. An analysis of variance was applied to the data and no significant differences were found between observers, neither in the randomly selected cases nor in the total series. The written guide, surprisingly, instead of lowering the differences, increased them. Analysis of the individual performance of observers showed two of them having a great variation between both rounds of observation, and this was considered to influence the results of the whole group. Interobserver performance to discriminate high grade tumors (G3) from the rest, showed a good correlation in all the participants. These results allow us to conclude that in this series, examined by general pathologists, an acceptable reproducibility was observed, specially when high risk tumors were being identified.

[Hepatic lesion caused by halogenated anesthetics]. / Lesión hepática por anestésicos halogenados.

Two patients has been presented to whom general anaesthesia consecutive with halogenated anesthetics has been administrated. In one of the observations the first anaesthesia was administrated with enfluorane and halothane was for the others. The two patients inured with jaundice and in one of them accompanied with hepatic insufficiency; both of them had favourable evolution. The histology of one of them show us a lesion compatible with injury caused by halogenated anaesthesia. In one of the patients appears evidences of hypersensitivity. It is request the possibility that the enfluorane could be acting as a sensibilisant drug of the hepatic injury produced by the halothane. This experience suggest us the danger already described of the consecutive use at short intervals of halogenated anesthetics. So long as fat patients are more sensible to the toxic action of these anesthetics it is suggested prevent in their cases.

Lesión hepática por anestésicos halogenados. / [Hepatic lesion caused by halogenated anesthetics]

Two patients has been presented to whom general anaesthesia consecutive with halogenated anesthetics has been administrated. In one of the observations the first anaesthesia was administrated with enfluorane and halothane was for the others. The two patients inured with jaundice and in one of them accompanied with hepatic insufficiency; both of them had favourable evolution. The histology of one of them show us a lesion compatible with injury caused by halogenated anaesthesia. In one of the patients appears evidences of hypersensitivity. It is request the possibility that the enfluorane could be acting as a sensibilisant drug of the hepatic injury produced by the halothane. This experience suggest us the danger already described of the consecutive use at short intervals of halogenated anesthetics. So long as fat patients are more sensible to the toxic action of these anesthetics it is suggested prevent in their cases.

Esteatohepatitis no alcohólica. / [Non alcoholic steatohepatitis]

A prospective study of 21 patients with the diagnosis of non-alcoholic steatohepatitis (NASH) was carried out. All patients had hepatomegaly and in 10 (48

) image studies were consistent with steatosis and/or fibrosis. Biochemically, there was increase of AST, ALT and cholesterol in 48

, of GGT in 52

and of alkaline phosphatase in 38

. 18 patients were obese, 2 of them diabetic, 2 others had a history of exposure to drugs (amiodarone and isopropilic alcohol) and the last one presented hypothyroidism. Liver biopsies were studied using a semiquantitative scale to evaluate the degree of steatosis, inflammation and fibrosis in a scale from 1 to 3. Results showed a medium score of 2.6 for steatosis, 1.5 for inflammation and 1.8 for fibrosis. Four patients had cirrhosis and Mallory bodies were found in 11 cases (52

). NASH is an oligosymptomatic disease that can be found in different clinical conditions, mainly obesity, and is more frequent in women. It is histologically indistinguishable from alcoholic steatohepatitis. It is frequently underdiagnosed clinically and must be taken into account as a possible cause of cryptogenetic cirrhosis.