Efectos del bypass gástrico en el esófago de Barrett de pacientes con obesidad mórbida / Effects of gastric bypass for morbid obesity on Barrett esophagus

Background: Besides the weight reducing effects of gastric bypass, it is also a good antireflux procedure since there is no acid production by the gastric pouch and there is no duodenal reflux due to the presence of a Roux en Y. Aim: To describe the effect of gastric bypass on Barrett esophagus among patients with morbid obesity. Material and Methods: Among 896 patients subjected to gastric bypass, 14 patient with a Barrett esophagus diagnosed with endoscopy and biopsy, were followed. A new endoscopy was performed one to 30 months after the surgical procedure. Results: Short (< = 30 mm) and long segment (> = 31 mm) Barrett esophagi were present in eight and six patients, respectively. Gastroesophageal reflux symptoms relieved in 70 percent of these cases in a mean lapse of 6.5 months. There was regression from intestinal metaplasia to car-dial mucosa in six patients (75 percent) with short-segment, and in one patient (16 percent) with long-segment Barrett esophagus. Conclusions: Gastric bypass in patients with morbid obesity and Barrett esophagus is a very good antireflux operation. This was proved by the disappearance of symptoms in almost all patients and by the regression of the intestinal metaplasia which is time and length dependent.

Antecedentes: El bypass gástrico en obesos mórbidos, además de ser una alternativa de cirugía bariátrica, es un buen procedimiento antirreflujo dado que no hay producción de ácido en el reservorio gástrico y no existe reflujo duodenal debido a la Y de Roux. Objetivo: Describir el efecto que tiene el bypass gástrico sobre el esófago de Barrett (EB) de pacientes obesos mórbidos, además discutir nuevos mecanismos fisiopatológicos implicados. Población: De 896 obesos mórbidos operados mediante bypass gástrico resectivo abierto, se siguieron a los 14 pacientes diagnosticados con EB mediante endoscopia e histología. Resultados: De los 14 pacientes con diagnóstico de esófago de Barrett, ocho pacientes presentaban EB corto (< 30 mm) y seis EB largo (> 31 mm). Los síntomas de pirosis y/o regurgitación presentes se resolvieron en un 70 por ciento de los casos en una media de 6,5 meses. Hubo una regresión de la metaplasia intestinal a mucosa cardial normal en seis pacientes (75 por ciento) con EB corto y en un paciente (16 por ciento) con EB largo. Conclusiones: El bypass gástrico es una muy buena alternativa quirúrgica antirreflujo en obesos mórbidos con EB, demostrado por la desaparición de los síntomas en la mayoría de los pacientes y la regresión de la metaplasia intestinal en la mitad de ellos, dependiendo del tiempo y de la longitud. Lo anterior, postulamos, que no sería debido solamente a que no hay producción de ácido en el reservorio gástrico y a que no existe reflujo duodenal, sino que habrían otros mecanismos fisiopatológicos implicados.

Espectro clínico de la hepatotoxicidad por nitrofurantoína en serie clínica de 12 pacientes / Clinical spectrum of nitrofurantoin hepatotoxicity in a series of 12 patients

Nitrofurantoin, commonly used for prolonged periods, can produce different patterns of liver damage. Patients: 12 women, mean age 55 years (range 17-72), with recurrent urinary infections, treated with nitrofurantoin for long periods of time (2 months to 15 years), who presented with secondary liver disease. Results: 7 had acute hepatitis (3 fulminant), 3 chronic hepatitis, and 2 cirrhosis. All acute cases had consistent liver biopsies, and 2 were treated with steroids and azathioprine for 2 and 7 months, with liver tests normalization. Two fulminant cases were transplanted (submassive hepatic necrosis on explanted livers) and 1 was successfully treated with steroids and mycofenolate. The 3 cases of chronic hepatitis also had confirmatory biopsies and 1 received steroids and azathioprine, with full recovery. The other 2 responded to the drug withdrawal and the 2 cirrhotic patients had only symptomatic treatment. All patients were negative for hepatitis virus, 7 (58 percent had positive anti-nuclear and/or anti-smooth muscle antibodies and 4 (33 percent) had elevated IgG levels. Conclusions: Nitrofurantoin may cause severe acute liver disease, even requiring liver transplantation. Nitrofurantoin can also cause chronic liver disease, have markers of autoimmunity and respond to immunosuppressive therapy. These data confirmed that nitrofurantoin can induce liver diseases, probably due to immunological mechanisms.

La nitrofurantoína, comúnmente utilizada por períodos prolongados, puede producir daño hepático, con diferentes formas de presentación y evolución. Pacientes: 12 mujeres, edad promedio 55 años (rango 17 a 72), con infecciones urinarias recurrentes, usuarias de nitrofurantoína por períodos prolongados (2 meses a 15 años), que presentaron daño hepático asociado a la droga. Resultados: 7 casos de hepatitis aguda (3 fulminantes), 3 casos de hepatitis crónica y 2 casos de cirrosis. Todos los casos de hepatitis agudas tenían biopsia hepática compatible y 2 fueron tratadas con corticoides y azatioprina por 2 y 7 meses, con normalización de los exámenes. De las 3 pacientes con hepatitis fulminante, 2 fueron trasplantadas (necrosis submasiva en el hígado explantado) y 1 fue tratada con corticoides y micofenolato, con buena respuesta. Los 3 casos de hepatitis crónica tenían confirmación histológica y 1 se trató con corticoides y azatioprina, con excelente evolución. Las otras pacientes respondieron favorablemente sólo a la suspensión del fármaco. Los 2 casos con cirrosis han recibido tratamiento sintomático. Todas las pacientes fueron negativas para los virus hepatitis, 7/12 (58 por ciento) tenían anticuerpos antinucleares y/o antimúsculo liso positivos y 4/12 (33 por ciento) IgG elevada. Conclusión: La nitrofurantoína puede provocar una severa enfermedad hepática aguda, requiriendo incluso trasplante hepático. Además, puede producir hepatitis crónica y cirrosis, tener marcadores de autoinmunidad y buena respuesta a la terapia inmunosupresora habitual. Lo anterior confirma su capacidad de inducir un daño hepático, probablemente por mecanismos inmunológicos.

Esofagitis eosinofílica: presentación de 4 casos y revisión de la literatura / Eosinophilic esophagitis: report of four cases

Eosinophilic esophagitis is and uncommon disorder with an increasing incidence. We report four cases with ages ranging from 25 to 70 years. Disphagia of different intensity was present in all of them, the diagnosis was suggested by the endoscopic aspect and confirmed by histophatological finding of and increased eosinophilic infiltrate. A good response to treatment was observed in all the patients. This diagnosis should be considered in patients presenting with dysphagia or food impactation, mainly when stricture or narrowing are absent.

La esofagitis eosinofílica es una enfermedad poco frecuente con una incidencia en aumento. Se presentan 4 casos con un rango de edad entre 25 a 70 años. Todos presentaron disfagia de diferente intensidad, el diagnóstico se sospechó por el aspecto endoscópico y fue confirmado por el hallazgo histopatológico de un denso infiltrado eosinófilo. Una buena respuesta al tratamiento se observó en todos ellos. Este diagnóstico debe considerarse en presencia de disfagia o impactación de un bolo alimentario en ausencia de estrechez del lumen esofágico.

Alteraciones de la tolerancia a la glucosa y frecuencia de síndrome metabólico en pacientes con enfermedad por hígado graso no alcohólico / Glucose tolerance alterations and frequency of metabolic syndrome among patients with non alcoholic fatty liver disease

Background: Non alcoholic fatty liver disease (NAFLD) is associated to diabetes mellitus, obesity, disturbances in serum lipid levels, insulin resistance and metabolic syndrome. Aim: To assess glucose tolerance and the presence of metabolic syndrome among patients with biopsy proven NAFLD. Patients and methods: Serum lipid levels, hepatic function tests were measured and an oral glucose tolerance test was performed in 46 patients (mean age 45±12 years, 36 females) without history of diabetes mellitus and with steatosis in a liver biopsy. Results: Mean body mass index of the sample was 37±12 kg/m². Seventeen percent had pure steatosis, 78 percent had steatohepatitis with or without fibrosis and 50 percent had fibrosis in the liver biopsy. Glucose intolerance and diabetes was found in 57 percent and 15 percent of cases, respectively. The presence of steatohepatitis was higher in diabetics, compared with subjects with glucose intolerance or a normal glucose response (43, 38 and 8 percent, respectively, p <0.0001). Ninety three percent had a metabolic syndrome and the proportion of biopsies with fibrosis was higher among subjects with more than three diagnostic criteria for metabolic syndrome compared with those with three or less criteria (59 and 46 percent, respectively, p <0.05). Conclusions: Glucose intolerance, diabetes and metabolic syndrome are common among patients with NAFLD, even when they are not obese.

Cirrosis biliar primaria: experiencia de trece años en dos centros de referencia / Primary biliary cirrhosis: a thirteen years experience

Background: Primary biliary cirrhosis (PBC) is a chronic cholestatic disease, which can progress to hepatic failure. Aim: To study the clinical presentation, pathological features, treatment and outcome of a group of patients with PBC. Material and methods: Retrospective review of medical records of 115 patients (110 females, age range 30-76 years) with PBC. Clinical presentation, pathological stage, treatment, outcome and eventual use of liver transplantation, were recorded. Result: Seventy eight percent of patients were symptomatic at presentation (itching in 69% and malaise in 62%). Antimitochondrial antibodies were positive in 56%. No clinical or laboratory differences were observed between symptomatic patients or those with positive antimitochondrial antibodies and the rest of the study group. Sjögren syndrome was present in 38%, hypothyroidism in 13%, scleroderma in 7% and rheumatoid arthritis in 5%. Initially, 61% had fibrosis and/or cirrhosis, and ursodeoxycholic acid was indicated in 94% of the patients. Fifteen patients underwent liver transplantation due to upper digestive bleeding or itching. Survival has been 67% at 36 months after transplantation. In one transplanted liver, PBC recurred. Conclusions: An early diagnosis and treatment of a progressive disease such as PBC will reduce the incidence of complications and the use of costly treatments.

Infección por Citomegalovirus en paciente con colitis ulcerosa sin tratamiento inmunosupresor / Cytomegalovirus infection in patient with ulcerative colitis without immunosuppressant treatment

La asociación de infección por Citomegalovirus (CMV) y colitis ulcerosa (CU) está bien documentada. Sin embargo, en pacientes inmunocompetentes está asociación parece ser infrecuente. Se presenta el caso clínico de un paciente con diagnóstico reciente de CU sin tratamiento inmunosupresor previo, quien evolucionó con una crisis de CU refractaria a tratamiento convencional. Las biopsias de duodeno y colon mostraron la presencia de inflamación aguda y crónica, y cuerpos de inclusión intranuclear compatibles por inmunohistología con infección por CMV. Concluimos que el paciente presentaba infección por CMV durante esta primera crisis de CU. Se inició tratamiento con ganciclovir, con lo que evolucionó favorablemente. Parece importante considerar la infección por CMV en pacientes con CU refractaria a tratamiento convencional incluso cuando no han recibido tratamiento inmunosupresor.

Efecto del bypass en la esofagitis erosiva en pacientes con obesidad mórbida / Effects of gastric bypass on erosive esophagitis in obese subjects

Background: Obesity is an important risk for pathological gastroesophageal reflux. Aim: To assess the effects of gastric bypass on obese subjects with erosive esophagitis. Patients and methods: Sixty two morbid obese subjects (aged 16 to 70 years, 41 females) with erosive esophagitis at the moment of surgery were studied. These patients were subjected to a gastric bypass with gastric resection. They were followed with upper gastrointestinal endoscopy every one year, looking for the presence of erosions or ulcers in the distal esophagus. Results: The mean follow up period was 21 months. Prior to surgery all patients had heartburn or regurgitation and at two years after surgery, 97% were asymptomatic. Esophagitis was found in 97 and 6.5% before and after surgery, respectively. Two patients had an esophageal ulcer, that healed on follow up endoscopy. There was a 72% reduction of overweight on late follow up. Conclusions: Gastric bypass is effective to control pathological gastroesophageal reflux in patients with morbid obesity.

Hepatitis crónica por virus C: factores asociados a la severidad del daño histológico / Factors associated with the severity of liver damage in chronic hepatitis C

Background: Twenty percent of patients with chronic hepatitis C evolve to cirrhosis in 10 to 20 years. The degree of steatosis and hepatic iron stores in liver biopsy increase the risk. Age, high body mass index, diabetes mellitus and alcohol consumption are factors associated to the severity of liver damage. Aim: To study the association of steatosis and increased iron stores in the liver biopsy and age, overweight, alcohol consumption and diabetes with the severity of liver damage in patients with hepatitis C virus infection. Patients and methods: Retrospective study of 84 liver biopsies of patients with chronic infection with hepatitis C virus were studied. The pathological appearance was classified as stage I when chronic hepatitis with mild activity without fibrosis was observed; as stage II when moderate chronic hepatitis with mild fibrosis was observed and as stage III when there was a moderate chronic hepatitis with fibrosis or cirrhosis. The amount of steatosis and iron deposition in the biopsy were also assessed. Results: Forty one percent of patients were in stage I, 32% in stage II and 27% in stage III. Patients in stage I were younger than those in stages II and III (40.7 and 52.2 years respectively, p <0,001). No association between the severity of liver damage and the degree of steatosis, hemosiderosis, body mass index or alcohol intake, was observed. The frecuency of diabetes mellitus increased along with pathological staging (3, 15 and 30% in stages I, II and III, respectively, p <0,05). Conclusions: This study confirms that severity of chronic hepatitis C is associated with age and the presence of diabetes mellitus.

Enfermedad Celíaca del adulto: experiencia clínica / Adult celiac disease: clinical experience

Background: The prevalence of celiac disease (CD) is unknown in Chile. We have recently noted a rise in the number of cases diagnosed among adults. Aim: To describe the clinical characteristics of a group of adult celiac patients. Patients and methods: Clinical data of patients older than 15 years with positive antitransglutaminase or antiendomysial autoantibodies and a duodenal biopsy characteristic of CD were retrospectively reviewed. Age at diagnosis, symptoms and signs and laboratory, endoscopic and histological findings, were analyzed. Results: Thirty seven patients (28 women), were studied. Median age at diagnosis was 41 years (range 15-69). Main symptoms and signs were diarrhea (78%), weight loss (38%) and abdominal pain (38%). Anemia was found in 49%, elevation of ESR in 57%, elevation of alkaline phosphatases in 54%, elevation of aspartate aminotransferase in 38% and a rise in alanine aminotransferase in 27%. Antiendomysial antibodies were positive in 17/22 (77%) and antitransglutaminase in 19/22 (86%) patients. Endoscopic findings were suggestive of CD in 47% of cases and duodenal biopsy showed intestinal villi atrophy in 34 (92%) patients. The three patients with normal histology had positive serology and a good response to gluten free diet. Conclusions: CD should be considered in the differential diagnosis of patients with unespecific digestive symptons, even when they present late in adult life. Serologic markers are a good diagnostic tool. A normal duodenal pathology does not exclude the diagnosis, if other diagnostic features are present.

Colangitis esclerosante primaria: revisión de 12 años en dos centros de referencia / Primary sclerosing cholangitis: A twelve-year experience

Background:Primary sclerosing cholangitis (PSC) is a chronic cholestatic disorder characterized by progressive inflammation and fibrosis of the biliary tract, evolving to cirrhosis. It is commonly associated with inflammatory bowel disease (IBD). Aim: To communicate the clinical characteristics of patient with PSC seen in two reference centers. Patients and methods: Review of medical records of patients with PSC confirmed by liver biopsies. The clinical picture, laboratory abnormalities, imaging studies and treatment were recorded. Results: Thirty three patients (aged 16 to 73 years, 64% female) were identified. They corresponded to 1.7% of liver biopsies done between 1991-2003. Clinical presentation was a cholestatic picture in 40%, right upper abdominal pain in 36%, a dysenteric syndrome in 9% and varied symptoms in 15%. Laboratory tests showed cholestasis in 94% and positive anti ANCA, SMA, ANA and AMA antibodies in 28, 18, 15 and 9% of cases, respectively. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiography were diagnostic in 43 and 58% of patients, respectively. There was an association with ulcerative colitis in 12% of cases. Liver biopsies showed grade I PSC in 76% and grade II-III in 6% of patients. It also showed a concomitant chronic hepatitis and primary biliary cirrhosis in 12 and 6% of cases, respectively. Treatment consisted on ursodeoxycholic acid (UDCA) in 45%, UDCA plus 5-aminosalicylic acid derivatives in 12% and UDCA plus immunosuppresors in 12% of patients. Two patients had to be transplanted. Conclusions: PSC is an uncommon cause of chronic liver disease. It is suspected in cholestatic patients and confirmed with a liver biopsy. It can be associated with other autoimmune hepatic and extrahepatic diseases.

Hepatocarcinoma con invasión cardiovascular: comunicación de 5 casos y revisión de la literatura / Hepatocellular carcinoma with cardiovascular invasion: Report of five cases

The diagnosis of hepatocellular carcinoma in cirrhotic patients has increased, mainly due to early detection using newer imaging techniques. The therapeutic approach depends on the tumor staging and the liver function. Cardiac involvement has a very bad prognosis. We report three males aged 59, 75 and 76 years and two females, aged 64 and 79 years. All had cirrhosis of diverse aetiologies with hepatocellular carcinoma and tumoral invasion of the inferior vena cava and right atrium. Three patients died during hospital stay and two were discharged for conservative management at home. This rare complication has to be considered in cirrhosis.

Hepatitis crónica y cirrosis por virus C pre y post trasplante hepático en una niña de 9 años: report of one case / Chronic hepatitis and cirrhosis caused by C virus before and after liver transplantation

We report a girl with a chronic hepatitis caused by C virus diagnosed at the age of nine, unsuccessfully treated with interferon and ribavirine. Two years later, she was subjected to a liver transplantation. She maintained elevated viral loads with a normal pathological study of the liver until 22 months after transplantation. She was treated again with combined antiviral therapy, for 6 months, without response and experienced a progressive deterioration liver function, dying three years after transplantation.

Correlación entre síntomas de reflujo gastroesofágico y resultados de la pHmetría de 24 horas en pacientes con estudio endoscópico normal o levemente alterado / Relationship between gastroesophageal reflux symptoms and 24 h esophageal pH measurement in patients with normal or minimally abnormal upper endoscopies

Background:Heartburn and regurgitation are considered highly specific symptoms of gastroesophageal reflux. A considerable number of patients with these symptoms do not have endoscopic signs of esophagitis. Aim: To study the relationship between gastroesophageal reflux symptoms and 24 h esophageal pH mesurement in patients with normal or near normal endoscopic findings. Patients and methods: One hundred eighty six patients with persistent reflux symptoms and absence of severe endoscopic esophagitis were studied. Pathological studies of esophageal biopsies, manometry and 24 h esophageal pH measurements were performed in all. Results: Abnormal acid reflux was found in 131 patients (70 percent). No differences in the frequency of symptoms, gender or pathologic findings were observed between patients with or without abnormal acid reflux. However, a higher frequency of esophageal erosions and a lower resting pressure of the inferior sphincter of the esophagus was observed in patients with abnormal acid reflux. Conclusions: Thirty percent of patients with heartburn and regurgitation did not have abnormal acid reflux. Therefore, these symptoms are not specific for gastroesophageal reflux (Rev Méd Chile 2004; 132: 19-25).

Tumores de intestino delgado: experiencia de 11 años en un centro de referencia / Small intestine tumors: 11 years of experience in a reference center

Introducción: Los tumores primarios de intestino delgado (TID) son de baja frecuencia y su diagnóstico habitualmente es tardío, debido a su relativa inaccesibilidad a métodos diagnósticos. Objetivo: Precisar las formas de presentación, métodos diagnósticose histología de estos tumores en nuestro centro. Métodos: Se revisaron las fichas clínicas de los pacientes con diagnóstico de tumor intestinal desde enero de 1990 a diciembre del año 2000, consignándose los datos requeridos en los casos en que estaban claramente expuestos. Resultados: Se encontraron 30 casos con TID, siendo 16 mujeres (53,3 por ciento) y la edad media de 62 años (32 a 91 años). La biopsia intestinal fue compatiblecon tumor maligno en 26 de ellos (87 por ciento ) y en 4 con lesión benigna. Los síntomas más frecuentes fueron dolor en 20 casos (67 por ciento), astenia, anorexia y baja de peso en 18 pacientes (60 por ciento), obstrucción intestinal en 14 (47 por ciento), hemorragia en 9 (30 por ciento) y diarrea crónica en 5 (17 por ciento). Los exámenes diagnósticos fueron la endoscopia alta incluyendoenteroscopía (40 por ciento), TAC abdóminopélvico (17 por ciento), cirugía en 13 por ciento y en menor grado otros exámenes. La ubicación de las lesiones en orden de frecuencia fue duodenal (17/30), ileal (10/30) y yeyunal (3/30). El diagnóstico histológico fue adenocarcinomaen 12 casos (46 por ciento de tumores malignos), carcinoide en 7 (27 por ciento), linfoma en 2 (8 por ciento), sarcoma en 2 y hubo tres tumores primarios de estómago, páncreas y colon sigmoides diseminados a intestino delgado. Las 4 lesiones benignas consistieron en un adenoma velloso duodenal, un hamartoma yeyunal, y dos lesiones inflamatorias inespecíficas. Conclusión: Los TID más frecuentes en nuestro trabajo son el adenocarcinoma y el carcinoide. Se requiere un alto índice de sospecha en caso de dolor abdominal de causa no aclarada, baja de peso, obstrucción intestinal, anemia y masa palpable abdominal, siendo la endoscopia un eficiente método diagnóstico de estas lesiones.

Tumores neuroendocrinos gástricos: presentación clínica, endoscópica y alternativas de tratamiento / Clinical and endoscopic presentation of gastric neuroendocrine tumors

Background: Gastric neuroendocrine tumors correspond to less than 1 percent of all gastric tumors. These tumors can be of three types. Seventy five percent are type I and are associated to chronic atrophic gastritis type A (CAG- A). Half of them are associated with pernicious anemia. Type II tumors are associated with Zollinger Ellison syndrome and type I multiple endocrine neoplasia. Type III are sporadic tumors. Aim: To report the clinical, endoscopical features and response to the treatment of gastric neuroendocrine tumors. Patients and methods: A retrospective study of eleven patients (seven male, aged 38 to 72 years old) with a pathological diagnosis of gastric neuroendocrine tumor. Their clinical presentation, associated diseases, treatment and follow up were reviewed. Results: Epigastric pain was present in eight patients, weight loss in three, epigastric pain and weight loss in one and post prandial abdominal pain in two. At endoscopy, multiple polyps in the fundus were observed in six, verrucose gastritis in one, polyps in the antrum in one, two subcardial polyps in 1, a fundus ulcer in one and a Bormann III type lesion in one. Chronic atrophic gastritis was diagnosed in seven patients and pernicious anemia in five. Serum gastrin levels were determined in 4 patients and were high in all. Four subjects were treated with endoscopic polipectomy only. A partial or total gastrectomy was done in seven patients. No complications or mortality occurred during the follow up. Conclusions: Abdominal pain is a common presentation of patients with gastric neuroendocrine neoplasia. Polyps predominantly in the fundus are the most common endoscopic finding. Surgical treatment or endoscopical polypectomy, depending of the extension of the disease, yield satisfactory results

Obesidad: factor de riesgo para esteatohepatitis y fibrosis hepática / Obesity as a risk factor for steatohepatitis and hepatic fibrosis

Background: Nonalcoholic fatty liver (NAFL) has been recognized as a cause of chronic liver disease. Its main risk factor is obesity. Aim: To describe the clinical and liver pathological findings in a group of patients who underwent surgery as obesity treatment. Patients and Methods: Sixty eight patients with severe or morbid obesity were subjected to surgery as obesity treatment. Each patient was evaluated with a complete clinical and laboratory medical assessment. A wedge of liver was excised during surgery. Liver biopsies were analyzed without knowledge of clinical and laboratory findings. The presence of steatosis, inflammation (portal or lobular), fibrosis and cirrhosis were recorded in the pathological analysis. Age and body mass index (BMI) were correlated with pathological data. Significance was set at a p value of less than 0.05. Results: Ninety one percent of patients had steatosis, 45 percent inflammation and 47 percent fibrosis. One patient had cirrhosis (1,4 percent). There was a statistically significant association between BMI and moderate or severe steatosis (p <0.03). There was also an association between BMI and portal (p=0.017) and lobular inflammation (p=0.034). A BMI over 40 kg/m2 (morbid obesity) was significantly associated with the presence of fibrosis (p=0.032). Moreover, the presence of moderate or severe steatosis was a risk factor for the development of hepatic fibrosis (p=0.026). Conclusions: Obesity is a major and independent risk factor for steatohepatitis and fibrosis. The degree of steatosis in the liver biopsy, is a risk factor for the development of fibrosis

Evolución de hepatitis autoinmune a colangitis esclerosante primaria: 3 casos clínicos / Autoimmune hepatitis evolved to primary sclerosing cholangitis: 3 cases

Se presentan tres pacientes de sexo femenino, de 32, 38 y 24 años de edad, con el diagnóstico inicial de hepatitis autoinmune, que tuvieron buena respuesta a terapia inmunosupresora con prednisona y azatioprina. Durante su evolución (entre 5 y 13 años), presentaron elevación de fosfatasas alacalinas y GGT, con estudio histológico que evidenció fibrosis concéntrica periductal e inflamación linfoplasmocitaria, y colangioresonancia con estrecheces y dilataciones del árbol biliar, compatibles con colangitis esclerosante primaria. Estos casos confirman la evolutividad de hepatitis autoinmune a colangitis esclerosante primaria, a pesar de la terapia inmunosupresora. Lo anterior refuerza una patogenia común y hace necesario definir criterios diagnósticos y tratamiento en estudios prospectivos prolongados

Hígado graso agudo del embarazo: estudio retrospectivo clínico-patológico de 10 casos / Acute fatty liver of pregnancy: retrospective clinical-pathological study in 10 cases

Se estudiaron retrospectivamente 10 casos de Hígado Graso Agudo del Embarazo (HGAE) entre los años 1990 y 2001. Se describen los hallazgos clínicos y de laboratorio de la enfermedad, analizando su asociación con el síndrome hipertensivo del embarazo (SHE) y estableciendo el rol diagnóstico de la biopsia hépatica percutánea de esta patología. Se propone que el desenlace en falla hepática aguda podría gatillarse por eventos precipitantes compartidos por un mismo espectro de enfermedades (HGAE y SHE). Se concluye que el estudio anatomopatológico hépatico es discutido como pilar diagnóstico y se ofrece una aproximación actual al enfrentamiento de esta entidad

Mesenteritis retráctil: comunicación de cuatro casos / Retractile mesenteritis: report of 4 cases

Retractile mesenteritis is a rare condition in which the inflammation proces of the mesentery is the characteristic pathological. The histologic changes are variable proportions of fat necrosis, chronic inflammation and fibrosis. The clinical presentation of this process is diverse, also the natural history is variable, ranging from a benign to fatal disease. We reviewed 4 cases of retractile mesenteritis and evaluated the clinical manifestations. There was no gender predominance. The patients aged range was 63-69 years (average 65) Patients more often presented with abdiminal mass (cases n: 1 and n: 4), and chronic diarrhea (cases n: 1 and 3). The etiology is unknown, the treatment is empirical, including corticosteroids, colchicine, immunosuppressive drugs and oral progesterone