[Clinical, laboratory and liver histology of HBsAg-positive volunteer blood donors in Belo Horizonte, State of Minas Gerais, Brazil]. / Estudo clínico, laboratorial e da histologia hepática de candidatos a doadores de sangue HBsAg positivos em Belo Horizonte.

Two hundred and fifty two blood donors HBsAg positive (mean age = 32.6, 91, 7% male) were searched into a transversal study to determine their clinical, laboratorial and histological characteristics. It was also compared the positiviness and negativiness of the serologic markers HBeAg, anti-Hbe and IgM anti-HBc with the values of serum aminotransferases. Hepatomegaly and splenomegaly were detected in 9.9% (25/252) and in 2.4% (6/252) respectively. In 17.5% (44/251) and 28.3% (71/251) the AST and ALT were respectively, over 50 UI/I. The positive frequencies of the various serologic markers of hepatitis B virus in 120 patients were: anti-HBc total in 89.5% (102/114), HBeAg in 25.7% (28/109) anti-Hbe in 67.3% (66/98), IgM anti-HBc in 40.8% (49/120); anti-Delta in 0.0% (0.66). Thirty one patients were submitted to liver biopsy, due do clinical alteration and/or of the aminotransferases. The hystological findings were: normal liver in 16.1% (5/31), non specific hystological alterations in 22.6% (7/31), persistent chronic hepatitis in 22.6% (7/31), active chronic hepatitis in 6.5% (2/31), cirrhosis in 12.9% (4/31), alcoholic hepatitis in 3.2% (1/31), lobular chronic hepatitis in 3.2% (1/31) and alterations exclusively due to schistosomiasis in 12.9% (4/31). Schistosomiasis elements (granuloma and/or Symmers fibrosis) were also notived in 7 patients. The comparative analysis of positiveness and negativeness of the serologic markers with the aminotransferases ("t" test of Student) showed significative difference of the averages (p < 0.05) only in relation to the simultaneous positeveness and negativeness of the HBeAg and IgM anti-HBc (average of AST = 56.11 and ALT = 78.00 when HBeAg and IgM anti-HBc were positive; average of AST = 24.25 and ALT = 27.00 when HBeAg and IgM anti-HBc were negative). According to this study the conclusion are: 1) The presence of two markers (HBeAg and IgM anti-HBc) and not only one determinant of viral replication in asymptomatic HBsAg carriers can strongly indicate a significant biochemical activity suggestive of hepatocellular lesion. 2) The presence of HBeAg in 25.7% (28/109) clearly shows the high rate of carriers with a potential of infectivity. 3) The results of hepatic histology shows that the majority of our patients had either normal liver or mild histological alterations. It is important to notice that only the cases with elevated aminotransferases were submitted to liver biopsies. The alterations caused by schistosomiasis shows, as is well known, the high prevalence of the parasitism in our surroundings. 4) The clinical aspects of the patients studied did not show significant alterations. Risk factors to get the infection were low. The hematologic and biochemical parameters (except aminotransferases) were either normal or just slightly abnormal. It was not detected a statistically significant difference. 5) The co-infections by delta virus was null.

Late postoperative follow-up of patients submitted to subtotal splenectomy.

Subtotal splenectomy preserving the upper splenic pole vascularized only by the splenogastric vessels has been performed by us in 91 patients since 1984. This procedure was combined with central splenorenal shunt or portal variceal disconnection to treating schistosomatic portal hypertension (n = 67); it was combined with distal pancreatectomy to treat pancreatic cystadenoma (n = 1), and it was carried out for severe splenic trauma (n = 14), and to control severe Gaucher's disease (n = 4) and myeloid metaplasia due to myelofibrosis (n = 5). All patients are alive. In the present paper, we present the late postoperative follow up of 32 patients operated in a period that ranges from 1 to 12 years. All patients are satisfied with the operation. Increased counts of white blood cell (n = 10) and platelets (n = 7) were the only hematological alterations. Esophageal varices were present in 23 of 27 patients operated due to portal hypertension, but all of them were shorter than in the preoperative period. The ultrasound confirmed the presence of the splenic remnant (30 of 32) without significant size changes. Splenic scintigraphies were positive in 30 of 32 patients. Subtotal splenectomy seems to be a safe procedure that can be useful in portal hypertension, some metabolic and hematological diseases, and benign growth of the distal pancreas.

Diagnostic and pathogenetic implications of urinary coproporphyrin excretion in the Dubin-Johnson syndrome.

The Dubin-Johnson syndrome (DJS), a hereditary conjugated hyperbilirubinemia, is associated with an impairment of porphyrin metabolism. Total urinary coproporphyrin (CP) excretion and the urinary CP isomer I and III constellation were examined in 15 patients with DJS and 12 unaffected family members, and then compared with 50 unrelated control persons (55 +/- 15 nmol/24 h of total CP: 27 +/- 3% of isomer I; +/- SD). The patients with DJS excreted 80 +/- 7% (+/- SD) of CP isomer I (p less than 0.001). The isomer relation in two young children, 3 and 5 years old, shows an isomer reversal, with isomer I of about 95%. Studies done on four families from our patients with DJS indicate and confirm the autosomal recessive mode of inheritance. Total urinary CP was found to be elevated in subjects with DJS, reaching a mean value of 164 +/- 123 nmol/24 h (upper limit 120 nmol/24 h). Fecal CP isomers I and III were found to be in the usual physiological proportion to each other, but total fecal CP excretion had declined to the lower normal level (10 +/- nmol/g, n = 8). The pathogenetic mechanisms in DJS have not yet been fully worked out. Four possible explanations are currently under discussion: 1. an impaired hepatic excretory function: 2. a uroporphyrinogen III synthase defect; 3. an increase in porphobilinogen deaminase (uroporphyrinogen synthase) activity, or 4. a membrane-associated transport disorder with secondary metabolic changes of the isomer pool and enzyme activities.

[Histological analysis of the gastric mucosa, enterochromaffin cells and gastrin-producing cells in endoscopic biopsies of patients with achlorhydria]. / Análise histológica da mucosa gástrica, das células enterocromafins e das produtoras de gastrina em biopsias endoscópicas de pacientes com acloridria.

Twenty achlorhydric patients and five controls were submitted to gastric endoscopic biopsies in order to study the histological pattern of the gastric mucosa and the number of enterochromaffin (EC) and gastrin (G) cells of the antral mucosa. The histological changes of the oxyntic mucosa of achlorhydric patients were variable being the predominant pattern the severe chronic atrophic gastritis. The antral mucosa was normal in appearance or revealed mild degree of gastritis. In the most achlorhydric patients the antral EC cell number was decreased when compared to the controls and the G cell number were relatively numerous. The results of the present work are suggestive of an increased G:EC cell ratio in achlorhydric patients.

Aspectos endoscopicos, histopatologicos e secretorios no pos-operatorio tardio da vagotomia troncular, antrectomia parcial e gastroduodenostomia na pequena curvatura. / Endoscopic histopathologic and secretory aspects in the late postoperative period of truncal vagotomy, partial anthrectomy and gastroduodenostomy at the lesser curvature

Vinte e cinco pacientes em pos-operatorio tardio de vagotomia troncular, antrectomia parcial e gastroduodenostomia na pequena curvatura foram estudados atraves de esofagogastroduodenoscopia, gastroacidrograma e biopsia de mucosa gastrica. A nova modalidadde cirurgica e empregada no sentido de manter um reservatorio gastrico adequado, prevenir o esvaziamento rapido do estomago, aproveitar melhor a capacidade absortiva e hormonal do duodeno e buscar um nivel de acidez imcompativel com recidiva ulcerosa. Evitar-se-iam, assim, a sindrome de dumping, o emagrecimento ou a incapacidade de ganhar peso, a desnutricao, a anemia ferropriva ou por deficiencia de vitamina B12, a ma absorcao e a ulcera anastomotica. O controle tardio pode ser considerado satisfatorio. Foi observada esofagite de refluxo em um paciente. Em outro, o remanescente gastrico foi considerado pequeno. Em 5 pacientes (20%) observou-se gastrite endoscopicamente intensa, sem correspondencia clinica. Em 6 casos (24%) o nivel secretorio nao baixou a niveis ideais e em 6 pacientes (24%) a boca anastomotica era pequena, o que pode ser atribuido a defeitos tecnicos, ligados ao cirurgiao em aprendizado

[Gastric mucosal changes induced by the augmented Histalog test: endoscopic and histopathological study]. / Alteracões da mucosa gástrica provocadas pelo teste aumentado do Histalog: estudo endoscópico e histopatológico.

A prospective study of the effects of maximal doses of betazol hydrochloride ( Histalog ) on the endoscopic and histologic findings of the gastric mucosa of volunteers was made. Of the 11 patients examined, no alteration was seen on gastroscopic examination after Histalog in three, slight to moderate congestion of the mucosa in six and scattered oozing bleeding points in two. The study of the histologic findings revealed no statistical significant difference in the recurrence of erosion, hemorrhage and edema in the antrum and body gastric mucosa, before and after the administration of Histalog . It was concluded that maximal doses of Histalog cause no significant hemorrhage in the mucosa of the stomach and that the brown colour frequently seen in the gastric secretions of the final portions of a Histalog test is to be attributed to trauma to the mucosa by the nasogastric tube and to Histalog induced congestion of the mucosa.

Alteracoes da mucosa gastrica provocadas pelo teste aumentado do Histalog: estudo endoscopico e histopatologico. / Gastric mucosal changes induced by augmented Histalog test: endoscopic and histopathological study

Avaliou-se endoscopica e histologicamente, em 11 voluntarios, os efeitos sobre a mucosa gastrica, de doses maximas do cloridrato de betazol (Histalog).Gastroscopicamente, nao foram constatadas alteracoes em tres pacientes, enquanto seis mostraram congestao de ligeira a moderada da mucosa gastrica e em dois foram vistos sangramentos petequiais esparsos. No estudo das alteracoes histologicas verificadas na mucosa do corpo e antro gastricos, antes e apos a administracao do Histalog, nao se constatou diferenca estatisticamente significante na ocorrencia de erosoes, hemorragia e adenoma. Concluiu-se que doses maximas de Histalog nao causam hemorragia significante na mucosa gastrica e que a cor amarronzada do suco gastrico, aspirado nas ultimas porcoes de um teste aumentado de Histalog deve-se mais ao traumatismo da succao pela sonda nasogastrica, numa mucosa gastrica congesta pela acao do Histalo

Discromatopsia adquirida na cirrose hepatica. / Dyschromatopsia acquired in the course of hepatic cirrhosis

Os autores dosaram bilirrubina (direta e total), em 6 cirroticos. Encontraram niveis altos em todos. Testaram a vitamina A (baixa em 5 e normal em 1) e o caroteno normal em todos Aplicaram os testes cromaticos Ishihara, D15 desaturado, D28, 100 Hue e Anomaloscopio de Nagel tipo I. Em 2 pacientes foi evidenciada protanomalia em 1 e deuteranomalia, o que demonstra uma incidencia alta de discromatopsia adquirida na cirrose hepatica

Discromatopsia adquirida na cirrose hepatica. / Acquired dischromatopsia in hepatic cirrhosis

Os autores dosaram no sangue bilirrubina direta, e total em 18 pacientes com cirrose (alcoolica e nao alcoolica). Encontraram niveis altos em todos. Testaram os niveis sanguineos da vitamina A: acharam deficiente em 7, baixo em 10 e normal em 1. Os niveis sanguineos do caroteno foram baixo em 2 e normal em 16. Aplicaram os testes cromaticos:Ishihara, Panel D 15, D 15 desaturado, D 28, 100 Hue e Anomaloscopio de Nagel - modelo I. Em 6 pacientes evidenciaram tritanomalia, em 2 dentreanomalia e em 1 protanomalia. Concluiram que a patologia mais frequente foi a tritanomalia e que ha uma alta incidencia de discromatopsia adquirida na cirrose hepatica