[Ethanol and the gastrointestinal tract]. / Etanol e o trato gastrointestinal.

The effects of ethanol upon the gastrointestinal tract (mouth, pharynx, esophagus, stomach, duodenum, Oddi's sphincter, small bowel, colon and rectum) were reviewed. Several studies showed that the incidence of cancer in the mouth and pharynx is increased in alcoholics as a consequence of ethanol effects and probably those of other compounds found in liquors. The gastroesophageal reflux disease may be induced by alcohol since it reduces the pressure in the lower and the upper esophageal sphincter, as well as the extent of primary peristalsis. Several studies showed a strong correlation between esophageal cancer and alcohol abuse. The risk for developing this kind of tumour is significantly increased when alcohol abuse and smoking coexist. Alcoholism predisposes patients to Mallory-Weiss syndrome as well as to bleeding of esophageal varices Ethanol may affect gastric secretion, motility, and permeability. Some drugs acting upon the gastric alcohol-dehydrogenase are able to affect gastric absorption of ethanol. Eradication of Helicobacter pylori increases the activity of alcohol-dehydrogenase in the pyloric antrum. The effects of alcohol upon the gastric mucosa include caustic damage, retrograde diffusion of H+, and cytoprotection. This agent may cause an acute gastritis but it is probably not involved in chronic gastritis. Whether alcohol is a risk factor for ulcer or not is unknown. Some studies found an increased incidence of gastric cancer associated with consumption of beer, wine and vodka. Some authors reported a decreased pressure in Oddi's sphincter while others found it increased in association with the consumption of ethanol. The acute and the chronic consumption of alcohol may affect the structure of small bowel as well as the absorption of nutrients. Several studies reported a significant correlation between colorectal cancer and the chronic consumption of ethanol.

Colestase intra-hepática en situs inversus do fígado / Intrahepatic cholestasis with situs inversus of the liver

Em nossa pesquisa bibliográfica näo encontramos nenhum trabalho sobre colestase intra-hepática em situs inversus do fígado. OBJETIVO. Relatar um caso de seguimento por um de nós (MM) durante aproximadamente, 14 anos após o desaparecimento da mencionada colestase. MÉTODOS. Foram estudados aspectos clínicos, realizados diversos testes laboratoriais e efetuados três exames ultra-sonográficos e uma tomografia computadorizada. Tentou-se realizar colangiografias transparieto-hepática e endoscópica. RESULTADOS. Quatro dias após a paciente ter sido submetida à prótese aórtica (com circulaçäo extracorpórea) surgiu icterícia, urina escura e fezes claras. As bilirubinas, fosfatase alcalina, gamaglutamil transferase e colesterol séricos estavam muito elevados. Os exames ultra-sonográficos e a tomografia sem evidências de obstruçäo extra-hepática. Neste exame, em especial, ficou caracterizada a existência de situs inversus do estômago e fígado. Näo houve êxito na realizaçäo das colangiografias. Os dados clínicos e laboratoriais referentes à colestase normalizaron após quatro meses. Boa evoluçäo após 14 abos. CONCLUSAO. O diagnóstico diferencial entre colestase intra e extra-hepática em pacientes com situs inversus do fígado pode, realmente, ser dificil, exigindo associar dados clínicos e vários exames complementares, entre os quais a colangiopancreatografia endoscópica retrógrada. A realizaçäo desse exame pode, porém, ser difícil nos mencionados pacientes

[Intrahepatic cholestasis with situs inversus of the liver]. / Colestase intra-hepática em situs inversus do fígado.

Intrahepatic cholestasis with situs inversus of the liver has not been reported in the literature. PURPOSE--A follow-up case for approximately 14 years (by one of the authors, MM). METHODS--Clinical aspects were studied and several laboratory exams as well as three ultrasonography and one computerized tomography exams were performed. Percutaneous and endoscopic cholangiographies were attempted. RESULTS--Four days after the patient was submitted to a surgical replacement of the aortic valve (with extracorporeal circulation), she developed jaundice, severe pruritus, dark urine, and pale stools. Serum levels of bilirubin, alkaline phosphatase, gama-glutamil transferase, and cholesterol were very high. Ultrasonography and computerized tomography exams did not reveal any evidence of extrahepatic obstruction. The tomography exam confirmed the existence of situs inversus in the stomach and liver. We were not successful in performing the cholangiography exams. Clinical and laboratory data as to cholestasis returned to normal after 4 months with no recurrence or complication during the follow-up period (14 years). CONCLUSION--The differential diagnosis between intra and extra-hepatic cholestasis in patients with situs inversus of the liver may be difficult. Therefore it will be necessary to collect clinical data and various complementary exams such as endoscopic retrograde cholangiopancreatography which is very difficult to perform in these patients.

[Ultrasonography aspects of primary gallbladder neoplasms]. / Aspectos ultra-sonográficos do câncer primário da vesícula biliar.

Sixty six patients with primary gallbladder cancer were seen at the Hospital A. C. Camargo, São Paulo, Brazil, from January 1980 to December 1988 and who represent 0.14% of the total of 46,519 patients registered in the same period. Out of the 66 cases, 41 were submitted to an ultrasonographic exam. As to the other 25 patients, 20 had been submitted to a cholecystectomy at another hospital. This exam was not done in the other 5 patients for several reasons. The gallbladder cancer diagnosis was based on data obtained from surgery and confirmed by anatomopathological exam. Regarding the 20 cases operated on at another hospital there was a slide review performed at the Department of Pathologic Anatomy at the Hospital A. C. Camargo. The main ultrasonographic aspects in the 30 cases in which there was a correct diagnosis, were the following: solid mass in the gallbladder lumen in 13 cases (43.33%); solid tumour in the gallbladder area in 7 cases (23.33%); a tumour contiguous to the gallbladder reaching other organs in 6 cases (20.00%); an alteration of the gallbladder shape in 3 cases (10.00%) and an accentuated thickening of the gallbladder wall with inaccurate limits in one case (3.33%). In the sub-group in which the ultrasonographic exam was performed, cholelithiasis was observed in 31 (75.60%) of the 41 cases. There was a correct diagnosis in 18 (58.06%) of the 31 cases with cholelithiasis and in 8 (80.00%) of the 10 without cholelithiasis; not a significant difference. As to the ultrasonographic aspects of the false negative cases, in 9 (81.81%) of the 11 cases the images suggested cholelithiasis. Among these 9 cases there were 2 with an enlarged gallbladder, one case of escleroatrophic gallbladder and one case with thickened walls. The diagnosis of the other 2 cases were biliary mud in one and a probable cholelithiasis in another.

Substâncias hepatotóxicas em pingas nacionais / Hepatotoxic substances in national brandy

O objetivo do trabalho foi observar se há em pingas nacionais substâncias tóxicas, além do etanol, em níveis considerados de risco para dano, principalmente hepático. Foram determinadas em amostras de 8 pingas as concentraçöes de ferro, cobre, zinco (método por absorçäo atômica) e etanol, acetaldeído, n-propanol, acetato de etila, isobutanol e álcool isoamílico (método cromatografia em fase gasosa e espectrometria de massas). Os níveis de ferro estavam acima dos limites permissíveis em duas pingas, amostras números 1 e 8 (respectivamente 0,57mg/L e 0,38mg/L). Esses níveis podem ser considerados prejudiciais se essas bebidas forem consumidas em quantidades elevadas durante longos períodos e, especialmente, se houver, como alguns autores admitem, efeito sinérgico entre etanol e ferro. Os resultados obtidos justificam prosseguir esse estudo preliminar

[Hepatotoxic substances in Brazilian rum]. / Substâncias hepatotóxicas em pingas nacionais.

The purpose of this study was to investigate whether Brazilian "pingas" (liquor distilled from sugar cane) contain toxic agents other than ethanol at levels which might risk consumers health, especially regarding liver damage. We have studied 8 different "pingas" in which the levels of iron, copper and zinc were measured through an atomic absorption method, and the levels of ethanol, acetaldehyde, n-propanol, ethyl acetate, isobutane, and isoamylic alcohol were measured through gas chromatography and mass spectrometry. Iron levels were higher than those allowed in two liquors, samples 1 and 8 (respectively 0.57 mg/L and 0.38 mg/L). Such levels may be considered deleterious to health if these liquors are consumed in great amounts and during large periods, especially if a synergistic interaction between alcohol and iron exists, as accepted by some authors. Our findings warrant that further studies be performed.

Iron, copper and alpha 1-antitrypsin deficiency in the liver of cirrhotic and schistosomotic patients.

While a number of studies investigated iron and copper storage or alpha 1-antitrypsin (A1AT) deficiency in the liver of patients with cirrhosis, we did not find any similar study in schistosomotic patients reported in literature. We investigated the storage of both metals and the A1AT deficiency in the liver of 72 cirrhotic and 27 schistosomotic patients (5 with the hepatointestinal and 22 with the hepatoesplenic form of the disease). Forty-four patients with cirrhosis were also alcoholic, and 28 were not. Iron storage was detected in 23 patients with cirrhosis (31.9%); among these 16 (36.3%) were alcoholic and 7 (25.0%) non-alcoholic (the difference was not statistically significant). Thirteen (56.5%), 5 (21.7%) and 5 (21.7%) patients presented I-grade, II-grade, and III-grade iron storage, respectively. Copperstorage was detected in 24 cirrhotic patients (33.3%), 15 being alcoholic (34.0%) in contrast with 9 non-alcoholic patients (32.1%), a statistically non-significant difference. A1AT deficiency was observed in 2 patients with cirrhosis (2.8%), one with history of alcoholism. HBsAg and HBcAg in hepatic tissue were detected in 5 cirrhotic patients (6.9%), three of them with a history of alcoholism. Iron and copper storage and A1AT deficiency were observed in 3 patients with cirrhosis (12.5%), while iron storage and A1AT deficiency were found in 2 additional patients with cirrhosis (2.8%). The authors underline that neither iron nor copper storage nor A1AT deficiency was found in any schistosomotic patient. The authors discuss the possible importance of these data.

Serum type III procollagen peptides in patients with hepatointestinal and compensated hepatoesplenic schistosomiasis forms.

The Serum Type III Procollagen Peptides (SIIIPP) were determined in 35 individuals: 25 untreated schistosomotics: 16 with hepatointestinal (HI) and 9 with the compensated hepatosplenic (CHE) forms and a control group (C) consisted of 10 healthy volunteers. Kits of radioimmunoassay were performed for SIIIPP dosage. It was searched whether there was relationship between the SIIIPP and the serum levels of alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT), alkaline phosphatase (AP) and gamma glutamyltranspeptidase (GGTP). The mean values of SIIIPP in the forms of HI (13.0 ng/ml) and CHE (17.0 ng/ml) were significantly higher than controls (9.0 ng/ml) (p less than 0.05). No significant difference was observed in SIIIP values between the HI and CHE patient groups, and between SIIIPP and ALAT, ASAT, AP and GGTP serum levels.

[Wilson's disease: a report of 4 cases. Follow-up study of a patient for 33 years]. / Doença de Wilson: relato de quatro casos. Estudo evolutivo de um paciente durante 33 anos+.

Wilson's disease is a rare disorder with relatively few studies about long term evolutional aspects. The aim was to relate 4 cases emphasizing their polymorphic clinical and laboratorial aspects and the evolutional study of one of them for 33 years and whose treatment enabled the disappearance of the symptoms and the signals of the disease.

Sulfated glycosaminoglycan composition of human gastric mucosa: effect of aging, chronic superficial gastritis and adenocarcinoma.

The sulfated glycosaminoglycan (SGAG) composition of gastric mucosa from 24 patients with chronic superficial gastritis, 2 patients with adenocarcinoma and 36 normal subjects is reported. The mucosa was obtained by endoscopic biopsy and after histopathological examination the SGAG were extracted and characterized. Three different SGAG were isolated: chondroitin 4,6-sulfate, dermatan sulfate and heparan sulfate. Their relative concentrations for the different groups were submitted to analysis of variance by Scheffe's method. Different SGAG compositions were observed in two gastric regions (antrum and body), in chronic superficial gastritis, in adenocarcinoma and in two age groups (less than 40 years and greater than 40 years). These and other results suggest that these macromolecules might be involved in the processes of cell division and aging.