Hepatie crônica por virus C. Parte 2. Tratamento / Chronic hepatitis by C virus. Part 2. Treatment

Säo revistos aspectos relativos às drogas utilizadas, suas dosagens, tempo de duraçäo dos tratamentos, as diferentes respostas terapêuticas obtidas, segundo os vários tipos de doença e de doentes estudados, assim como os fatores que podem modificar os resultados obtidos.

Hepatite crônica por vírus C. Parte 1: considerações gerais / Chronic hepatitis by C virus. Part 1: general considerations

Hepatitis C virus was identified in 1989 as the main causative agent of non-A, non-B and was followed by the recognition of a high prevalence of hepatitis C virus infection after transfusion of infected blood or blood products and in association with intravenous drug abuse. The availability of sensitive and reliable techniques to screen blood for hepatitis C virus has reduced the incidence of post-transfusion hepatitis. True healthy carriers of hepatitis C virus did not exist. Approximately 95 per cent of hepatitis C virus infected individuals can be identified by third generation anti-hepatitis C virus testing. Retrospective studies of iatrogenic hepatitis C virus infection are the main source of the natural history of the disease. The distribution of different hepatitis C virus genotypes varies according to the geographic region. In South America, Europe, The United States and Japan hepatitis C virus genotypes 1, 2 and 3 account for the majority of the infections, being (sub)type 1b the most prevalent. Epidemiological parameters (age, risk factors and duration of infection) may be associated with hepatitis C virus genotypes (intravenous drug abuse with types 1-a and 3-a and 1-b with post-transfusion hepatitic C). Subtype 1-b, lead to a more severe course of viral infection, with ultrastructural alterations of the mitochondria, and greater impairment of the process of oxidative phosphorylation. No increased production of free radicals may influence the evolution of the liver disease by an enhancement of the cytopathic effect of hepatitis C virus. The clinical significance of intrahepatic hepatitis C virus level in patients with chronic hepatitis C virus infection is not determined by host factors (age of patient, mode or duration of infection) or by virus factors (hepatitis C virus genotypes) and, repeatedly negative RT-PCR for hepatitis C virus RNA in serum does not indicate absence of hepatitis C virus from the liver. The association between autoimmunity and hepatitis C virus is questioned. Markers of its does occur with high frequency in these patients. Modulation of immune responses to hepatitis C virus envelope E2 protein following injection of plasmid DNA, has been used for induction of specific response to hepatitis C virus. The spectrum of such responses could likely be broadened by combining plasmids, delivery routes, and other forms of encoded immunogens (peptide vaccines...

Carcinoma hepatocelular. Parte 2: tratamento / Hepatocelular carcinoma. part 2: treatment

Recent improvements on the therapeutical management of hepatocellular carcinoma are revised with special attention to evaluate the role of surgery for the disease. Considering that definitive surgical intervention is not feasible in most cases because of extreme tumor extension, multiplicity of tumor foci, and associated advanced liver cirrhosis at the time of diagnosis, others forms of treatment are listed, such as transcatheterarterial chemoembolization, percutaneous ethanol and acetic acid injections, and chemotherapy only to a small portion of patients with no indication for standard treatments. The emerging role of retinoic acid metabolism blocking agents, was examined and may offer a significant new potential treatment for cancer, inclusive the possibility of combining other anticancer drugs with exogenous retinoids or modulation of endogenous retinoids as a real opportunity to advance our ability to treat or prevent human cancer effectively Octreotide, nitrosamine and other drugs are analyzed and is concluded that improves survival and is a valuable alternative in the treatment of inoperable hepatocellular carcinoma. The potential role of intersticial laser coagulation for patients with irresectable hepatic tumors was investigated, and in terms of experience, it has now been developed sufficiently to study its effect on these patients survival. The homeostatic control of angiogenesis and its influences on the tumor growth and for migration of metastatic cells, was focused in this concise review, given that hepatocytes are the source of much of the precursor pool, regulation of angiogenesis may be regarded as a new liver function with important consequences for tissue repair and cancer. Early hepatocellular carcinoma and its recognition in routine clinical practice contributes to improved patients survival. Recombinant-Interferon-alpha therapy surely prevents, the development of cirrhosis or hepatocellular carcinoma in about one-third of patients, with chronic hepatitis C, with sustained response. Finally, in individuals with life-threatening liver disease, such as those with cirrhosis and hepatocellular carcinoma, the liver transplantation, must be considered, besides controversial, however, with increasing experience the results of the procedure in these patients have improved, and may offer a better long-term survival than liver resection

Hemocromatose Hereditária / Heredidary Hemochromatosis

O propósito deste trabalho é analisar as causas näo reconhecidas de sobrecarga secundária de ferro, sua hereditariedade, as lesöes hepáticas associadas e outras características clínicas, como as sindromes de sobrecarga de ferro näo HLA ligadas (anemias por eritropoiese ineficiente, várias hapatopatias, ingestäo excessiva de medicamentos a base de ferro), uso parenteral de ferro, sobrecarga neonatal de ferro, ingestäo de cervejas feitas em casa, entre outras. Breve revisäo de certos aspectos diagnósticos e terapêuticos. Algoritmo para avaliaçäo dos pacientes. Diagnóstico precoce e tratamento adequado säo muito importantes e podem prevenir significante morbimortalidade associada ao desenvolvimento das complicaçöes dos órgäos-alvo. Esse diagnóstico precoce é hoje perfeitamente possível com a aplicaçäo dos C282Y testes genéticos. Levantamento populacional em massa pode tornar-se realidade para a identificaçäo desses pacientes antes da ocorrência de lesöes teciduais ou morbidade frustra.(au)

Normal neuronal features of the human gallblader and structural changes in cholelithiasic patients

Foi realizado estudo histológico de dez vesículas biliares, obtidas cinco de indivíduos normais e cinco de portadores de colelitíase. Células nervosas foram contadas separadamente no colo, corpo e fundo. Em vesículas de indivíduos normais o número maior de células nervosas foi encontrado na regiäo do colo (23,48ñ 10,14 por mm2) e menor no corpo (7,7 ñ 8,45) por mm2) e fundo (5,6 ñ 3,66 mm2). Em vesículas biliares com litíase, o número maior de células nervosas foi também encontrado no colo (5,83 ñ 4,92 por mm2) e menor no corpo (2,63 ñ 1,56 por mm2) e fundo (1,03 ñ 0,71 por mm2)

Tratamento näo cirúrgico da litíase biliar / Non-surgical treatment of the biliary lithiasis

Revendo a literatura, procurou-se atualizar o tratamento näo cirúrgico da colelitiase e da coledocolitíase, frente as drogas existentes, tais como ácidos queno e ursodeoxicólicos, compostos terapênicos (Rowachol), metil-butil-éter terceário (MTBE), litotripsia extracorpórea, no primeiro caso e, nas coledocolitíases o uso de fármacos por via oral, esfincterotomia endoscópica com ou sem dissoluçäo e/ou extraçäo de cálculos, a disoluçäo com entubaçäo transhepática percutânea, a infusäo de solventes por sonda nasobiliar, a infusäo de solventes pelo dreno em T e a litotripsia extracorpórea ou endoscópica, respectivamente

Colecistograma ultra-sonográfico com ceruletide intramuscular / Ultrasonographic cholecystogran with intramuscular ceruletide

Foram estudados 13 pacientes, com idades de 19 a 30 anos (média 24,4), sete do sexo feminino e seis do masculino, sem afecçäo orgânica digestiva alta demonstrável, submetidos a exame ultra-sonográfico da vesícula biliar em jejum e 20 minutos após 300 ng/kg de ceruletide IM, sem administraçäo prévia de contraste iodado. Os cálculos volumétricos demonstraram resposta motora vesícular com esvaziamento de 67,27% + ou - 18,65, aos 20 minutos, em relaçäo aos volumes vesiculares de jejum de 18,00 ml + ou - 4,99. Näo foram detectados sinais de lesöes orgânicas e de esforço anormal de contraçäo vesicular à ultra-sonografia ou efeitos colaterais decorrentes da aplicaçäo intramuscular de ceruletide

Pamoato de pirantel no tratamento da ascaridiase. / Pyrantel pamoate in the treatment of ascaridiasis

Em um grupo homogeneo de pacientes ("comunidade fechada" de uma fazenda do interior do Estado de Sao Paulo), observou-se 53 pacientes com Ascaris lumbricoides dentre 152 examinados. O exame parasitologico foi feito pelo metodo de Kato de Miura e, a contagem de ovos, pelo metodo de Kartz e col. O pamoato de pirantel foi administrado na dose de 10mg por kg, em uma unica tomada, sem qualquer preparo anterior. Os exames de controle foram realizados ao 7, 14 e 21 dias. Observou-se cura em 49 dos 53 individuos (92,4%). Os autores sugerem que as dificuldades socio-economicas e educacionais, impossiveis de solucao a curto ou medio prazo, implicam no tratamento periodico de grupos populacionais como o estudado, com drogas reconhecidamente eficazes como e o caso do pamoato de pirante