Transferrina carbohidrato deficiente, gammaglutamil transferasa y volumen corpuscular medio en la evaluación de la ingesta alcohólica reciente de bebedores excesivos / Carbohydrate deficient transferrin for the assessment of recent alcohol intake in excessive drinkers

Background: There are no reliable markers to detect heavy drinking or as a tool to control abstinence compliance in alcoholic treatments. The Mean Corpuscular Volume (MCV), and the gammaglutamyl transpeptidase (GGT), are widely used although their predictive value is somewhat limited due to their low specificity. On the other hand, the Carbohydrate-deficient transferrin (CDT) described in the eighties is highly specific and would be of value in early detection of problem drinking. Aim: To compare the sensitivity and specificity of CDT, GGT, and MCV in order to evaluate their single and combined use as markers for detection of heavy drinking behaviour. Patients and Methods : CDT, GGT, and MCV values were determined in blood samples from (a) alcoholics (drinking more than 100 9 alcohol/day; n=47) and (b) healthy volunteers, teetotalers from the Church of Saints of Later Days (n=34). At the time of sampling alcoholics were presently drinking or had been abstinents for no more than six weeks. ROC curves were used to determine the best cut-off point for each marker. Results: Sensitivity was found to be similar for all three markers. Specificity was found higher for GGT (90.9 percent) and CDT (91.0 percent). The combined use of MCV, GGT and CDT, that is, when at least one of the markers is altered, was shown to detect 83 percent of the patients. No correlation was observed between the markers and the level of alcohol intake. Conclusions: CDT could be of value as a marker to detect heavy drinking when used with GGT and MCV values combined. CDT is particularly higher in drinking alcoholics and remains significantly high for at least six weeks after they stop drinking

Hepatotoxicidad por amoxicilina/ácido clavulánico: caso clínico / Hepatotoxixity associated to the use of amoxicillin clavulanic acid

We report a 72 years old diabetic male that, after the use of combined amoxicillin-clavulanic acid, developed pruritus and jaundice. Liver function tests showed serum total bilirubin of 4.3 mg/dL aspartate aminotransferase 140 U/l (normal <35 U/L), alanine aminotransferase 470 U/L (normal <40) and alkaline phosphatases of 400 U/L (normal <100). Serology for hepatitis A, B and C viruses was negative, ERCP showed a normal biliary tree and liver biopsy disclosed a cholestatic hepatitis. Ursodeoxycholic was started to relieve pruritus. Liver function tests improved shortly thereafter, suggesting that this drug may be useful in the treatment of drug induced cholestasis

Colestasia y embarazo: nuevos conceptos / Cholestasis and pregnacy: new concepts

La patogenia de la Colestasia Gravídica es desconocida. Sin embargo, hay hechos que sugieren que la elevada frecuencia de la CG en Chile es el resultado de la confluencia de una suceptibilidad genética muy difundida en su población y probablemente ligada a su ancestro mapuche, con la acción de factores ambientales también difundidos. El prurito característico, que aparece generalmente en las últimas semanas del embarazo, es la manifestación clínica fundamental. No existe una clara explicación de cómo se genera este síntoma. No existe un marcador específico. La coexistencia de ictericia en algunos casos y las frecuentes alteraciones de laboratorio que muestran compromiso hepático, llevaron a concluir que la alteración básica es la colestasia; sin embargo, los marcadores de colestasia no siempre están presentes. Como consecuencia del desconocimiento tanto de la etiología como de la patogenia de sus manifestaciones, no tenemos una clara definición de la enfermedad.

Disolución de cálculos vesiculares een una población de mujeres adultas: ensayo de terapia con lovastatina / Gallstone dissolution in an adult female population: essay with lovastatine therapy

There are no chilean reports on gallstone dissolution using oral medications. To measure the proportion of asymptomatic adult women elegible for gallstone dissolution therapy and to test the effectiveness and tolerance of lovastatin for this purpose, three hundred fifty six women working at health care onstitutions were subjected to gallbladder ultrasound examination. Non pregnant women with radiolucent gallstone of less than 2 cm were invited to receive lovastatin 20 mg od and were followed during 6 months. Twenty two women had gallstones and 8 eligible women receive lovastatin therapy. No reduction in stone size was observed in these women. Less than half of asymptomatic women with gallstones are elegible for oral therapy. Lovastatin did not reduce gallstone size after 6 months of therapy

Neoplasias hepáticas en enfermos con glucogenosis: problemas diagnósticos y terapéuticos / Hepatic neoplasm in patients with glycogenosis: diagnostic and therapeutical problems

In a family composed by 8 brothers, 5 had a type I glycogen storage disease and tnhree presented with liver tumors complicated with hemorrhage or malignant transformation, during the followup. The periodic yltrasonographic control allowed the early diagnosis of these neoplasms. We described the clinical picture and treatment of 2 patients. Metabolic alterations were corrected during the preoperative period with parenteral nutrition. Resection was succesful in both cases. It is concluded that a close follow up and early treatment of these lesions is effective and avoids complications. In patients with multiple lesions and severe metabolic alterations, liver transplantation is the treatment of choice

Pronóstico vital en insuficiencia hepática aguda grave: valor de los índices cuantitativos de evaluación / Life prognosis in severe acute hepatic failure: value of assessment quantitative index

The aim of this study was to assess the predictive value for mortality of admission and daily APACHE II score, mortality due to multiple organ failure and the organ failure score in patients with acute hepatic failure. We retrospectively studied 15 such patients admitted to an intensive care unit. Thirteen patients died (87 percent) and their admission APACHE II score was 22ñ7.5 compared to 21ñ8.5 in survovors. Daily APACHE II score, mortality due to multiple organ failure and multiple organ failure score had a 100 percent sensitivity to predict mortality and a 69.2, 76.9 and 76.9 percent specificity respectively. The predictive accuracies of multiple organ failure and multiple organ failure score were 80 percent and significantly better than the accuracy of admission APACHE II score (53 percent). We conclude that these prognostic scores can be useful in the assessment of patients with acute hepatic failure