[Carbohydrate deficient transferrin, gammaglutamyl transferase and mean corpuscular volume in the evaluation of recent alcohol intake in excessive drinkers]. / Transferrina carbohidrato-deficiente, gammaglutamil transferasa y volumen corpuscular medio en la evaluación de la ingesta alcohólica reciente de bebedores excesivos.

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 abstinent 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%) and CDT (91.0%). The combined use of MCV, GGT and CDT, that is, when at least one of the markers is altered, was shown to detect 83% 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.

[Hepatotoxicity by amoxicillin/clavulanic acid: case report]. / Hepatotoxicidad por amoxicilina/ácido clavulánico: caso clínico.

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.

[Gallstone dissolution in an adult female population: trial with lovastatin therapy]. / Disolución de cálculos vesiculares en una población de mujeres adultas: ensayo de terapia con lovastatina.

BACKGROUND: There are no chilean reports on gallstone dissolution using oral medications. AIM: To measure the proportion of asymptomatic adult women eligible for gallstone dissolution therapy and to test the effectiveness and tolerance of lovastatin for this purpose. SUBJECTS AND METHODS: Three hundred fifty six women working at health care institutions were subjected to a gallbladder ultrasound examination. Non pregnant women with radiolucent gallstones of less than 2 cm phi were invited to receive lovastatin 20 mg od and were followed during six months. RESULTS: Twenty two women had gallstones and eight eligible women received lovastatin therapy. No reduction in stone size was observed in these women. CONCLUSIONS: Less than half of asymptomatic women with gallstones are eligible for oral dissolution therapy. Lovastatin did not reduce gallstone size after six months of therapy.

Exploring the genetic role of the HLA-DPB1 locus in Chileans with intrahepatic cholestasis of pregnancy.

BACKGROUND/AIMS: Intrahepatic cholestasis of pregnancy is a rare disease of unknown etiology, with a strikingly higher prevalence in Chile than in most other countries. Although several studies suggest that a genetic predisposition is involved in the pathogenesis, no genetic disease-marker has so far been identified. Using a recently developed HLA-genotyping technique, we performed an association study with a highly polymorphic HLA class II gene in patients with recurrent intrahepatic cholestasis of pregnancy and normal control patients. METHODS: Genomic DNA was extracted from 26 unrelated patients with recurrent ICP and 30 unrelated multiparous women without a personal or family history of this disease among a Chilean population. The polymorphic second exon of the HLA-DPB1 gene was amplified by the polymerase chain reaction and hybridized with 25 sequence-specific oligonucleotide probes to assign the HLA-DPB1 alleles on the basis of known sequence variations. RESULTS: Out of more than 50 HLA-DPB1 alleles presently known, 13 were represented in the analyzed groups. Patients with ICP had a higher frequency of the allele DPB*0402 when compared to controls (69% vs 43%). This difference failed to reach statistical significance (x2 = 2.81, corrected p > 0.5). No significant differences were observed between the frequencies of other detected HLA-DPB1 alleles in the analyzed groups. CONCLUSION: In this study, we observed a high frequency of the allele HLA-DPB1*0402 among Chilean patients with recurrent ICP, but no association of the disease with HLA-DPB1 alleles. Therefore, HLA-DPB1 alleles do not play a major role in determining susceptibility or resistance to intrahepatic cholestasis of pregnancy.

[Liver neoplasms in patients with glycogen storage disease. Diagnostic and therapeutic problems]. / Neoplasias hepáticas en enfermos con glucogenosis. Problemas diagnósticos y terapéuticos.

In a family composed by eight brothers, five had a type I glycogen storage disease and three presented with liver tumors complicated with hemorrhage or malignant transformation, during the follow up. The periodic ultrasonographic control allowed the early diagnosis of these neoplasms. We describe the clinical picture and treatment of two patients. Metabolic alterations were corrected during the preoperative period with parenteral nutrition. Resection was successful 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.

[Gallbladder polyps. 2d Consensus Workshop of the Chilean Hepatology Association]. / Pólipos vesiculares. Segundo taller de consenso de la asociatión chilena de hepatología.

During a workshop, hepatologists analyzed and gave recommendations about gallbladder polyps. They arrived to the following agreements: gallbladder polyps of less than 10 mm should be followed with ultrasonography at 3, 6 and 12 months if there is no enlargement. If there is enlargement, a cholecystectomy should be performed. Polyps larger than 10 mm should be subjected to cholecystectomy.

[Association of cholesterolosis and cholelithiasis: pathogenic implications and effects of the natural history of cholelithiasis]. / Asociación de colesterolosis y litíasis de la vesícula biliar: implicancia patogénica y efecto sobre la historia natural de la colelitiasis.

We studied 793 patients subjected to cholecystectomy to determine a) the relative frequency of cholesterolosis and cholelithiasis, b) the effects of their association on the natural history of biliary disease, c) the characteristics of gallstones associated to cholesterolosis and d) factors potentially associated to their pathogenesis. The gallbladders of all patients were examined and in 289 subjects a preoperative clinical history was taken. We observed that cholesterolosis is associated to earlier clinical manifestations of biliary disease and cholecystectomy, to a greater frequency of single calculus and to a higher weight/height index. It is concluded that there are relationships between the pathogenesis of cholesterolosis and cholelithiasis and that their association favors the development of clinical manifestations.

[Multiple organ failure syndrome in fulminant hepatic failure]. / Síndrome de falla orgánica múltiple en el curso de la insuficiencia hepática fulminante.

BACKGROUND: in fulminant hepatic failure, different organs systems become involved and a multiple systems organic failure may ensure. AIM: to perform a retrospective analysis of patients with fulminant hepatic failure admitted to UC Hospital Intensive Care Unit. PATIENTS AND METHODS: the charts of fourteen patients (8 male) were analyzed. Multiple systems organic failure was defined as the presence of 2 or more organic dysfunctions. The evolution and mortality of these patients was analyzed. RESULTS: patient's ages ranged from 30 to 74 years. The etiology of hepatic failure was B hepatitis in 4, non A non B hepatitis in 5, acute fatty liver of pregnancy in 3 and use of halothane and HIN in 2. ICU stay ranged from 1 to 44 days and 2 patients survived (one with drug induced liver failure and one with acute fatty live of pregnancy). Mean prothrombin time was 19 +/- 9.5%, total bilirrubin was 24 +/- 8.9 mg/dl and 12 patients reached grade IV encephalopathy. Mean admission APACHE II score was 21.5 +/- 6. Twelve patients developed multiple systems organic failure, that appeared 1.5 days after or was already present at ICU admission; it lasted a mean of 2.5 days and all these 12 patients died. Neurologic involvement occurred in 13 patients, renal in 10, cardiovascular in 9, respiratory in 5 and hematological involvement in 1. CONCLUSIONS: multiple systems organic failure is frequent in fulminant hepatic failure and is associated with a high mortality.

[Cholecystectomy in young women from the south-oriental area of Santiago: comparison between 2 periods]. / Colecistectomía en mujeres jovenes del area suroriente de Santiago: comparación entre dos períodos.

The aim of this study was to know if cholecystectomy rates have decreased in young women, considering that these rates have decreased in the last years in the general chilean population. The frequency of previous cholecystectomy was compared in 1582 women aged 23.9 +/- 5.8 years admitted to a maternity for delivery between 1985 and 1986 and 4943 women aged 24.6 +/- 5.9 years admitted between 1989 and 1990 for the same reason. There was a reduction in cholecystectomy frequency from 4.7 to 2.5% specially among women 21 to 35 years old. Cholecystectomy was performed at a mean age of 23 years in both groups and 42.6% of the procedures were done before the first pregnancy. An unexpected finding was a lower body weight among women studied in the second period (62.5 +/- 9.1 vs 67.7 +/- 8.4 k).

[Symptomatic lithiasic biliary disease. Comparison between men and women undergoing cholecystectomy]. / Enfermedad biliar litiasica sintomatica. Comparacion entre hombres y mujeres sometidos a colecistectomia.

A prospective survey was carried out in 205 males and 667 females who had their gallbladder removed for gallstone disease during 1989 at a general hospital in Chile. Females had a greater prevalence of disease with an earlier appearance of symptoms leading to surgery at a younger age. In contrast, males developed a more aggressive form of the disease, with a shorter interval from appearance of symptoms and surgery.

[Diabetes mellitus in chronic alcoholic liver damage]. / Diabetes mellitus en el daño hepatico cronico alcoholico.

We performed an oral glucose tolerance test and measured serum insulin levels in 38 patients with chronic alcoholic liver damage. A diabetic curve was obtained in 34% of subjects both obese and non obese. Insulin levels were elevated in comparison with normal subjects in all patients. The Turner index [(serum insulin x 100)/(blood sugar--30]) was lower than normal at all points of the GTT, suggesting a decreased insulin secretion in relation to serum glucose level. Blood glucose level at 120 min was correlated to age, serum bilirubin and prothrombin time. Thus, chronic liver damage is a risk factor for diabetes mellitus. The alteration of carbohydrate metabolism is correlated to the severity of liver disfunction. The initial pathogenic factor may be hyperinsulinism and resistance to insulin, followed by decreased secretion of the hormone.