Enfermedad veno-oclusiva hepática, colitis ulcerosa idiopática y trombosis portal: comunicación de un caso clínico / Hepatic veno-occlusive disease, idiopathic ulcerative colitis and portal thrombosis. Report of one case

We report a previously healthy 29 years old man, presenting with a sudden episode of abdominal pain, mild jaundice, hepatomegaly and ascites. Magnetic resonance imaging study and liver biopsy were compatible with veno-occlusive disease. Incidentally, an ulcerative colitis and portal vein thrombosis were diagnosed. Anticoagulant treatment was started, with good clinical and radiological response. Veno-occlusive disease of the liver must be suspected In cases of liver failure and ascites associated to procoagulant conditions.

Daño hepático por fármacos: características clínicas e histológicas en 33 casos / Drug induced liver disease: clinical and pathological patterns in 33 cases

BACKGROUND: Drug induced liver disease (DILD) is common and of difficult diagnosis. AIM: To report the clinical, laboratory and pathological findings in 33 patients with DILD. PATIENTS AND METHODS: We revised 1,164 liver biopsies and 57 were selected as suspicious of DILD. In these, the scale proposed by Maria et al was applied to assess the possibility of hepatotoxicity reactions and 33 were selected. RESULTS: The 33 cases had a mean age of 48 +/- 18 years and 14 were male. Forty eight medications were involved, with an average of 1.4 drugs per patient. The main drugs were antimicrobials, antineoplastics-immunosuppressives and non-steroidal antiinflammatory drugs. The clinical presentations in order of frequency were cholestasis, hepatitis, asymptomatic, fulminant hepatitis and cirrhosis. The laboratory alterations observed in cases with hepatitis were 20 fold transaminase and bilirubin elevation. In cholestasis, moderate elevations of alkaline phosphatases and gamma glytamyl transferase were observed. Pathology showed hepatocellular damage, cholestasis and mixed damage, but also submassive necrosis and cirrhosis in one case. CONCLUSIONS: The present study confirms that DILD is frequently unpredictable and that it can cause a wide variety of clinical and pathological presentations, that can even evolve to chronicity.

Transmisión familiar del virus de la hepatitis C en un grupo de población chilena / Familial transmission of hepatitis C virus infection in Chilean subjects

BACKGROUND: Intravenous drug use, sexual promiscuity and a longer cohabitation period are considered risk factors for familial transmission of hepatitis C virus. The relative importance of this type of transmission is a subject of controversy. AIM: To study familial clustering of hepatitis C virus infection and its risk factors. MATERIAL AND METHODS: HCV positive patients (91 with chronic hepatitis, 88 with cirrhosis, nine with hepatic carcinoma and 29 hemophiliacs) were the index cases. HCV antibodies were measured by ELISA and the type of relationship with the index case was investigated in 317 family members. RESULTS: Positive anti HVC antibodies were detected in 12 of 243 family members of patients with chronic liver disease and in none of the family members of patients with hemophilia. Of these, five were couples of an index case with a long cohabitation period. Ten members had an index case with a severe liver disease (three with Child C cirrhosis and seven with liver carcinoma). CONCLUSIONS: Family transmission of HCV infection is uncommon in Chile. The association of severe liver disease and family transmission could be due to a higher viral load as responsible for transmission during the early periods of a long lasting disease.

Colecistectomía laparoscópica y clásica en pacientes con cirrosis hepática / Laparoscopic and classic cholecystectomy in patients with liver cirrhosis

BACKGROUND: The prevalence of gallstones is increased in patients with cirrhosis. However the presence of cirrhosis has been generally considered a relative contraindication to cholecystectomy. AIM: To investigate the complications and the outcomes of laparoscopic and open cholecystectomy in patients with cirrhosis. PATIENTS AND METHODS: Sixty seven patients with gallstones with well-documented cirrhosis undergoing cholecystectomy (laparoscopic cholecystectomy (LC) in 35 and open cholecystectomy (OC) in 32), were studied. The mean age was 57.7 + 10.3 years for LC and 58.9 + 11.6 years for OC. In the LC group, 26 were classified as Child-Pugh class A, 8 as Child's B class and 1 as Child's class C. In the OC group, 12 were classified as Child's class A, 15 as Child's B and 5 as Child's C. RESULTS: Complications occurred in 4 of 35 (12.3 per cent) LC patients (1 patients was Child A and 3 were B). In the OC group 14 of 32 patients had complications (4 Child A, 7 B and 3 C, 43.7 per cent p < 0.05 as compared with LC group). Three patients in the OC group died (9.4 per cent). Mean hospital stay was 2.8 + 1.9 and 13 + 12 days in LC and OC patients, respectively (p < 0.05). CONCLUSIONS: LC has a lower rate of complications than OC and is a reasonable option for Child's class A and B patients with cirrhosis and gallstones.