Subject(s)
Hepatitis/microbiology , Syphilis , Hepatitis/diagnosis , Humans , Male , Syphilis/diagnosisSubject(s)
Humans , Male , Adult , Hepatitis/complications , Hepatitis/diagnosis , Syphilis/complications , Syphilis/diagnosis , Asthenia/complications , Asthenia/diagnosis , Jaundice/complications , Enzyme-Linked Immunosorbent Assay/methods , Penicillin G Benzathine/therapeutic use , Hepatitis/drug therapy , Hepatitis/physiopathology , Syphilis/drug therapy , Syphilis/physiopathology , Diagnosis, Differential , Risk Factors , Treponema pallidum/isolation & purification , Treponema pallidum/pathogenicityABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Hematoma/chemically induced , Anticoagulants/adverse effects , Duodenal Ulcer/chemically induced , Hematoma/diagnosisABSTRACT
No disponible
Subject(s)
Male , Middle Aged , Humans , Adenocarcinoma, Mucinous/diagnosis , Endoscopy, Digestive System/methods , Pancreatic Neoplasms/diagnosis , Diagnosis, DifferentialSubject(s)
Hypertension, Portal/etiology , Liver/pathology , Portal System/pathology , Biopsy , Child , Esophageal and Gastric Varices/complications , Humans , Male , Pancytopenia/complications , Prognosis , Sclerosis , Splenomegaly/diagnosis , Splenomegaly/diagnostic imaging , Ultrasonography, DopplerABSTRACT
INTRODUCTION: Liver biopsy is a highly useful tool in the evaluation of patients with chronic hepatitis C. However, the technique is not free of complications and presents a series of limitations (lack of representativity and interobserver variability in sample interpretation). Due to these limitations and the development of new noninvasive techniques, the role of liver biopsy is currently being reevaluated. MATERIAL AND METHOD: We performed a descriptive retrospective study of liver biopsies performed in patients with chronic hepatitis C virus (HCV) infection from January 2002 to January 2005. Age, gender, genotype, histology of the hepatic cylinder, and the percentage of patients who received treatment after liver biopsy was analyzed. The indications for biopsy in our patients and the reasons for nontreatment after biopsy were identified. We also analyzed whether the decision to start treatment was influenced by the histological grade of the lesion and whether there is any association between histological grade and transaminase levels. RESULTS: A total of 156 patients were included and 72% received treatment after biopsy. Transaminase levels were elevated in 86%. Alanine aminotransferase (ALT) levels were elevated in 92.30% of treated patients and in 66% of untreated patients. The most frequent cause of nontreatment after biopsy was fibrosis stage < 2. The histological results were as follows: G0 in 2%, G1 in 26.8%, G2 in 47.7%, G3 in 22.2% and G4 in 1.3%; stage of fibrosis was F0 in 7.2%, F1 in 30.1%, F2 in 37.9%, F3 in 19.6%, and F4 in 5.2%. Fibrosis was advanced (F >= 2) in 41% of the patients with normal ALT levels and was mild (< F2) in 33% of those with elevated ALT levels. CONCLUSION: Liver biopsy could be useful in patients with indication for treatment but a high risk of treatment-related adverse effects, as well as in those with normal transaminase levels, in whom the degree of fibrosis observed could influence the therapeutic approach.
Subject(s)
Hepatitis C, Chronic/pathology , Liver/pathology , Adult , Biopsy, Needle , Female , Hepacivirus/isolation & purification , Hepatitis C, Chronic/virology , Hospitals, District , Humans , Liver/virology , Liver Function Tests , Male , Middle Aged , Retrospective StudiesABSTRACT
Introducción: La biopsia hepática es una herramienta muy importante en la evaluación de los pacientes con hepatitis crónica C. Es una técnica no exenta de complicaciones, y que presenta una serie de limitaciones (falta de representatividad del órgano y variablidad interobservador en la interpretación de la muestra). Por tanto, debido a sus limitaciones y al desarrollo de nuevas técnicas no invasivas, en la actualidad el papel de la biopsia hepática está siendo revaluado. Material y método: Estudio descriptivo y retrospectivo de las biopsias hepáticas realizadas en pacientes con infección crónica por el virus de la hepatitis C, durante enero de 2002 a enero de 2005. Se analizaron los siguientes aspectos: a) edad, sexo, genotipo, histología del cilindro hepático y porcentaje de pacientes que recibieron tratamiento tras la realización de la biopsia hepática; b) descripción de las indicaciones de la biopsia en nuestros pacientes, así como las causas de la ausencia de tratamiento después de realizada la biopsia; c) si la decisión de iniciar tratamiento se encontró influida por el grado de lesión histológica, y d) si existía correlación entre el grado de lesión histológica y los valores de transaminasas. Resultados: Se incluyó a 156 pacientes, de los que el 72% recibió tratamiento tras la realización de la biopsia. Las transaminasas se encontraban elevadas en el 86%. En el grupo de pacientes tratados, la alanina aminotransferasa (ALT) se encontraba elevada en el 92,30%, y en el grupo de pacientes no tratado, lo estaba en el 66%. La causa más frecuente de no tratamiento tras la realización de la biopsia fue la presencia de lesiones histológicas mínimas. El resultado histológico fue el siguiente: G0 en el 2%, G1 en el 26,8%, G2 en el 47,7%, G3 en el 22,2% y G4 en el 1,3%; con respecto al estadio de la fibrosis fue: F0 en el 7,2%, F1 en el 30,1%, F2 en el 37,9%, F3 en el 19,6% y F4 en el 5,2%. Los pacientes con ALT normal presentaban, en el 41%, lesiones >= F2, mientras que los del grupo de ALT elevada mostraban lesiones < 2 en el 33%. Conclusión: La biopsia hepática sería útil en los pacientes con indicación de tratamiento, pero con una elevada posibilidad de presentar efectos secundarios durante su duración, así como en los pacientes con transaminasas normales, donde el grado de fibrosis observado podría influir en la actitud terapéutica
Introduction: Liver biopsy is a highly useful tool in the evaluation of patients with chronic hepatitis C. However, the technique is not free of complications and presents a series of limitations (lack of representativity and interobserver variability in sample interpretation). Due to these limitations and the development of new noninvasive techniques, the role of liver biopsy is currently being reevaluated. Material and method: We performed a descriptive retrospective study of liver biopsies performed in patients with chronic hepatitis C virus (HCV) infection from January 2002 to January 2005. Age, gender, genotype, histology of the hepatic cylinder, and the percentage of patients who received treatment after liver biopsy was analyzed. The indications for biopsy in our patients and the reasons for nontreatment after biopsy were identified. We also analyzed whether the decision to start treatment was influenced by the histological grade of the lesion and whether there is any association between histological grade and transaminase levels. Results: A total of 156 patients were included and 72% received treatment after biopsy. Transaminase levels were elevated in 86%. Alanine aminotransferase (ALT) levels were elevated in 92.30% of treated patients and in 66% of untreated patients. The most frequent cause of nontreatment after biopsy was fibrosis stage = 2) in 41% of the patients with normal ALT levels and was mild (< F2) in 33% of those with elevated ALT levels. Conclusion: Liver biopsy could be useful in patients with indication for treatment but a high risk of treatment-related adverse effects, as well as in those with normal transaminase levels, in whom the degree of fibrosis observed could influence the therapeutic approach
Subject(s)
Animals , Male , Female , Adult , Middle Aged , Humans , Hepatitis C, Chronic/pathology , Liver/pathology , Biopsy, Needle , Hepacivirus/isolation & purification , Hepatitis C, Chronic/virology , Hospitals, District , Liver/virology , Retrospective Studies , Liver Function TestsABSTRACT
El tratamiento con interferón pegilado se utiliza habitualmente en la hepatitis crónica por el virus de la hepatitis C asociado a ribavirina. Entre los efectos secundarios del interferón encontramos un cuadro seudogripal junto con manifestaciones respiratorias banales que son muy frecuentes. Entre los efectos inmunomoduladores se encuentra la posibilidad de inducir o exacerbar fenómenos autoinmunitarios como la sarcoidosis cutánea o sistémica. Presentamos un nuevo caso de sarcoidosis pulmonar inducida por interferón pegilado en una mujer de 35 años con hepatitis crónica por el virus de la hepatitis C que a los 4 meses de iniciar el tratamiento con interferón pegilado más ribavirina comenzó con clínica respiratoria que no tenía previamente e imagen radiológica de patrón micronodular en ambos campos pulmonares junto con adenopatías hiliares y mediastínicas. La biopsia transbronquial confirmó la presencia de granulomas sarcoideos. Tras el diagnóstico de sarcoidosis pulmonar se suspendió el tratamiento antiviral con desaparición posterior de la clínica respiratoria
Treatment with pegylated interferon is usually used in active chronic hepatitis C in association with ribavirin. The adverse effects of interferon include influenza-like syndrome and mild respiratory manifestations, which are highly frequent. Among the immunomodulatory effects is the possibility of inducing or exacerbating autoimmune phenomena such as cutaneous or systemic sarcoidosis. We present a new case of pulmonary sarcoidosis induced by pegylated interferon in a 35 year-old woman with chronic hepatitis C who developed respiratory symptoms 4 months after starting therapy with pegylated interferon associated with ribavirin. Radiological images showed a micronodular pattern in both pulmonary fields together with hilar and mediastinal adenopathies. Transbronchial biopsy confirmed the presence of sarcoidal granulomas. After the diagnosis of pulmonary sarcoidosis, antiviral therapy was suspended with subsequent resolution of the clinical symptoms
Subject(s)
Female , Adult , Humans , Antiviral Agents/adverse effects , Hepatitis C, Chronic/drug therapy , Interferon-alpha/adverse effects , Polyethylene Glycols/adverse effects , Sarcoidosis, Pulmonary/chemically induced , Antiviral Agents/administration & dosage , Antiviral Agents/therapeutic use , Hepatitis C, Chronic/complications , Interferon-alpha/administration & dosage , Interferon-alpha/pharmacology , Interferon-alpha/therapeutic use , Polyethylene Glycols/administration & dosage , Polyethylene Glycols/therapeutic use , Ribavirin/administration & dosage , Ribavirin/therapeutic use , Sarcoidosis, Pulmonary , Th1 Cells , Th1 Cells/immunology , Tomography, X-Ray ComputedABSTRACT
Treatment with pegylated interferon is usually used in active chronic hepatitis C in association with ribavirin. The adverse effects of interferon include influenza-like syndrome and mild respiratory manifestations, which are highly frequent. Among the immunomodulatory effects is the possibility of inducing or exacerbating autoimmune phenomena such as cutaneous or systemic sarcoidosis. We present a new case of pulmonary sarcoidosis induced by pegylated interferon in a 35 year-old woman with chronic hepatitis C who developed respiratory symptoms 4 months after starting therapy with pegylated interferon associated with ribavirin. Radiological images showed a micronodular pattern in both pulmonary fields together with hilar and mediastinal adenopathies. Transbronchial biopsy confirmed the presence of sarcoidal granulomas. After the diagnosis of pulmonary sarcoidosis, antiviral therapy was suspended with subsequent resolution of the clinical symptoms.
