Test inmunológico para hemorragia oculta: correlación con hallazgos colonoscópicos / Immunological testing for fecal occult blood: correlation with colonoscopic findings

El hallazgo de sangre oculta en deposiciones permite sospechar la presencia de lesiones del tubo digestivo como cáncer colorrectal y pólipos precancerosos, existiendo estudios con rendimiento variable para este método. Objetivo: Correlacionar los resultados de un examen inmunológico para hemoglobina humana (Actim Fecal BloodR=AFB) con la colonoscopía. Métodos: Se realizó AFB en 94 pacientes que fueron sometidos concomitantemente a colonoscopía por diversas causas y sin evidencias de sangrado macroscópico, antecedentes de enfermedad inflamatoria intestinal o pólipos de colon, correlacionando sus resultados con el test. Resultados: AFB fue positivo en 32 pacientes (34 por ciento): en los 3 enfermos con cáncer colorrectal, en 4 casos con enfermedad inflamatoria intestinal, en 6 de los 9 pacientes con pólipos mayores a 1 cm, (sensibilidad de 67 por ciento para la detección de estas lesiones con mayor riesgo neoplásico), y en 4 de 15 pacientes con pólipos más pequeños. Hubo 7 casos con AFB positivo y colonoscopía normal, arrojando una especificidad de 76 por ciento. Conclusión: El test estudiado tiene una sensibilidad y especificidad aceptable para las lesiones descritas, y pudiera aplicarse principalmente en grupos con mayor riesgo de estas neoplasias.

Detection of minute amounts of blood in faeces has been used with variable results as a screening test in early diagnosis of colorectal cancer and premalignant polyps. Aims: To compare the results of a specific antibody against human hemoglobin (Actim fecal bloodR) with colonoscopic findings. Methods: The test was performed in 94 consecutive patients before colonoscopy. Overt gastrointestinal bleeding, previously known inflammatory bowel disease or colorectal polyps were excluded. Results: Actim fecal bloodR was positivein 32 of 94 patients (34%): in all of three colorectal cancer, in 6 of 9 polyps greater than 1 cm (67% sensibility for lesions with major neoplasic risk)), but only 4 of 15 minor polyps. On the other hand, 7 positive results were obtained in 29 patients with normal colonoscopy, i.e. the specificity of the test was 76%. Conclusion: The immunologic test studied had an acceptable specificity and a good sensibility for the screening of colorectal cancer and major colorectal polyps

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.

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.

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