The Mexican consensus on nonalcoholic fatty liver disease. / Consenso mexicano de la enfermedad por hígado graso no alcohólico.

Nonalcoholic fatty liver disease (NAFLD) affects nearly one third of the population worldwide. Mexico is one of the countries whose population has several risk factors for the disease and its prevalence could surpass 50%. If immediate action is not taken to counteract what is now considered a national health problem, the medium-term panorama will be very bleak. This serious situation prompted the Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Hepatología to produce the Mexican Consensus on Fatty Liver Disease. It is an up-to-date and detailed review of the epidemiology, pathophysiology, clinical forms, diagnosis, and treatment of the disease, whose aim is to provide the Mexican physician with a useful tool for the prevention and management of nonalcoholic fatty liver disease.

Ulcerative colitis in husband and wife. First report in Mexico.

The prevalence of inflammatory bowel disease in Mexico is low. The occurrence in familial cases has been attributed to genetic influences. We described the first report of inflammatory bowel diseases in one pairs of husband-wife in Mexico. According with characteristics of this case, we can speculate that the environmental and infectious etiology might play some role in the development of IBD.

[IL-6 and TNF-α gene expression in the rectal mucosal of patients with chronic idiopathic ulcerative colitis and controls]. / Expresion del gen de IL-6 y TNF-α en la mucosa rectal de pacientes con colitis ulcerosa crónica idiopática y controles.

BACKGROUND: It has been reported that pro-inflammatory cytokines levels like IL-6 and TNF-α can determine the degree of inflammation of ulcerative colitis (UC). AIMS: To measure the gene expression of IL-6 and TNF-á in patients with UC and controls and to correlate with histological activity. PATIENTS AND METHODS: We studied 36 patients with UC, 13 healthy controls and 11 with inflammation. After total ribonucleic acid (RNA) extraction, complementary deoxyribonucleic acid (DNA) was synthesized by polymerase chain reaction (PCR) and relative expression was determined through real-time PCR for IL-6 and TNF-á. Statistical analysis was performed using the Kruskal-Wallis test and Spearman correlation. RESULTS: The expression of IL-6 increases in patients with active UC compared to controls (p = 0.004) as well as UC patients in remission (p = 0.014). There was no significant difference between patients with active UC and controls with inflammation. (p = 0.446). Gene expression of TNF-α was higher in biopsies from patients with UC activity compred with control subjects (p = 0.004), as well as those in remission (p = 0.001). The expression of IL-6 correlated significantly (p = 0.02) with histological activity. CONCLUSIONS: The gene expression of IL-6 and TNF-α is increased in active UC. Interleukin 6 is better marker of bowel inflammation because its expression correlates with histological activity.

[The prevalence of hepatitis B and C in blood donors in a 3rd-level hospital of Mexico City]. / Prevalencia de hepatitis B y C en donadores de sangre en un hospital de tercer nivel de la ciudad de México.

OBJECTIVE: To investigate the prevalence of the hepatitis C virus (HCV) and B virus (HBV) in blood donors attending Médica Sur Hospital. MATERIAL AND METHODS: A total of 9,099 blood donors were tested for hepatitis B and C viruses from 1994 to 1998. A questionnaire was used to collect data and HCV and HBV were detected in serum. We obtained percentages and assessed statistical significance using the chi 2 test. RESULTS: The prevalence of HCV and HBV carriers was 0.47 and 0.11 per cent. The main risk factors were dental procedures (11.6% for HCV and 20%, for HBV), and unsafe sexual practices (20%) for HBV. CONCLUSIONS: These results indicate a low prevalence of HCV and HBV infection in this population.

Case report of multiple myeloma and hypothyroidism in primary biliary cirrhosis.

A 71-year-old female with primary biliary cirrhosis, multiple myeloma and hypothyroidism is reported. The liver biopsy showed stage II-III histologic damage according to Scheuer's classification and the multiple myeloma was IgG-lambda type, stage II-A at the time of diagnosis. Another three cases of primary biliary cirrhosis associated with multiple myeloma were found in the literature. As a group, the four cases had mild or moderate liver damage, extensive bone lesions and three of four cases had multiple myeloma IgG-lambda type. Although this association could be incidental, there is evidence that implies a pathogenic relationship. This information is summarized in this report.

In vitro and in vivo lactose and lactulose effects on colonic fermentation and portal-systemic encephalopathy parameters.

Lactose intolerance occurs in the majority of human groups, excluding people from Northern Europe. Because its effect is similar to that of lactulose, lactose seems to be an alternative treatment for patients with portal-systemic encephalopathy (PSE) and lactase deficiency. The mechanism of action of lactose is similar to that of lactulose. In vivo, lactose improves PSE parameters and causes acidic diarrhea. We performed in vitro studies in a fecal incubation system to investigate the biochemical and bacteriological effects induced by different substances customarily used for the treatment of patients with PSE (lactose, lactulose and Neomycin). In vitro experiments showed that lactose and lactulose decreased aerobic flora counts and reduced the pH of fecal incubation. Both disaccharides reduced the ammonia concentration in the incubation system.

[Nutrition of patients with liver diseases. (lst of 2 parts)]. / Nutrición en pacientes con enfermedades hepáticas. (Primera de dos partes).

Diet may be modified and can alter the hepatic function or contributes to maintain it on excellent state. The objective of this paper was to review the recently advances on the clinical aspects of nutrition in chronic liver diseases and the underlying rationale for specific nutritional therapies focusing in the works in Mexico. Original papers in english and spanish informed on Medline until 1994 were included. We also review the national literature about nutrition aspects on liver diseases.

[Physiology of gallbladder motility and its clinical importance]. / Fisiología de la motilidad vesicular y su importancia clínica.

The role of gallbladder motility (GBM) in gastrointestinal diseases has been frequently ignored. Recently however, the introduction of new diagnostic methods and data on the normal physiology of gallbladder emptying and refilling have placed this interesting area of gastrointestinal motility where it justly deserves. In this way it has been possible to recognize and further study the pathophysiologic mechanisms involved in some clinical situations with a higher-than expected frequency of gallstones (GS). It has also been possible to identify with more clarity the role GBM has in the chain of events that lead to GS development and thus, to plan prevention or therapeutic strategies. The discovery of new drugs with effects on GBM have also permitted to further advance in the knowledge of normal physiologic mechanisms and to have access to possible future treatments. Also pathologic entities have been clearly defined, such as chronic acalculous cholecystitis. In this review we present recent knowledge on normal GBM physiology and its clinical applications as well consequences of its dysfunction.

[Laboratory studies and special tests for assessing gallbladder and bile duct function]. / Estudios de laboratorio y pruebas especiales para valorar la función de la vesícula y los conductos biliares.

We review the pathogenesis of cholesterol gallstones, which occur in five steps: 1) metabolic; 2) chemical; 3) nucleation, 4) growing and maturation of gallstones; 5) clinical. It is emphasized that in the third step it could occur an arenous precipitate formed by cholesterol crystals, calcium bilirrubinate granules, calcium phosphate, or fatty acids anions and calcium, and mucin, called "biliary sludge", which has been associated with cholecystitis and pancreatitis. We describe the gallbladder motor abnormalities that occur during the lithogenesis and the diagnostic approach through scintigraphy and real time ultrasound. We review the pancreatobiliary dyskinesia, a condition associated with the postcholecystectomy syndrome. This later condition can result from anatomic stenosis or dyskinetic dysfunction of the sphincter of Oddi. Likewise, it is pointed out that at the present time, the manometric evaluation of the sphincter of Oddi is the gold standard in the diagnostic approach of this condition.

[Knowledge, application, and diffusion of results of clinical research: the case of porto-systemic encephalopathy]. / Conocimiento, aplicación y difusión de los resultados de la investigación clínica: el caso de la encefalopatía portosistémica.

The objectives of this survey were to evaluate the medical knowledge, acceptance and application of research results, and to identify the main sources of information in our environment. Portal-systemic encephalopathy (PSE) was the specific health problem addressed. Three hundred seventy-seven attendants to the National Mexican Gastroenterology Week (december 14-19, 1991) were surveyed. The results point out: 1) Gaps in PSE knowledge, since 30% or more incorrect answers were obtained for some PSE manifestations and therapeutic measures; 2) A persistent use of measures with doubtful efficacy, which is exemplified by the regular use of neomycin by (80%) of the respondents, 3) frequent influence of the availability of therapeutic measures (68%), as the satisfaction with therapeutic response (66%) on PSE treatment patterns, and 4) important role of continuing education courses and/or scientific meetings (> 66%) and medical journals (> 57%) as sources of information.

[Extracorporeal shockwave biliary lithotripsy. Physical basis and clinical application]. / Litotripsia biliar con ondas de choque extracorpóreas. Fundamentos físicos y aplicación clínica.

Extracorporeal shock waves lithotripsy is a new procedure discovered and applied in the present decade to treat urinary and biliary stones. Shock waves are acoustic waves similar to sonic waves which follow the acoustic laws and therefore the shock waves can be refracted or reflected depending on the medium interface. Due to the high water content, the human body can be crossed by shock waves which eventually may be focused on the target stone. There are several commercially available shock waves generators, i.e. the spark gap emisors which were the first ones, and the piezoceramic and electromagnetic emisors. To focus the shock waves on a biliary stone the machines are provided with fluoroscopic or ultrasound devices or with both in the most advanced machines. Using an electromagnetic emisor (Lithostar plus) our group has treated 78 patients with biliary stones without analgesia or anesthesia. Total stone fragmentation was achieved in 85% of the cases. In patients with cholesterol gallstones who undergo lithotripsy, an adjuvant treatment with oral cholesterol solvent is mandatory. Extracorporeal biliary lithotripsy is free of mortality, and the morbidity is less than 5%.

[Epidemiology of gallstone disease in Mexico]. / Características de la litiasis biliar en México.

Prevalence of gallstone disease in autopsies from Mexico is 14.3%, 8.4% in men and 20.4% in women respectively. Frequency of cholelithiasis has increased remarkably from 12.2% in 1950 to 15.8% in 1980 (p < 0.05). Population of low socioeconomic status is apparently more affected. Obesity is the clinical association more frequently found in the population studied. Cholesterol gallstones showed the highest frequency. Economic cost of this disease is high. We conclude that gallstone disease is a public health problem for our country.