[Obesity in the 21st century. Progress in etiopathogenesis and treatment]. / La obesidad en el siglo XXI. Avances en la etiopatogenia y tratamiento.

Obesity is complex in its etiology and treatment. Its global incidence is increasing significantly. Favoring weight-loss can only bring beneficial effects. Obesity is a chronic condition with multifactorial origin. The discovery of the ob gene and its product, the OB protein or Leptin, neuropeptide Y, and the alterations of the metabolism of lipogenic tissues that inhibit appetite are significant advances in the understanding of its etiopathogenesis and treatment. This new knowledge will change the philosophy of the management of obesity. Obesity responds poorly to nonsurgical therapies. Its treatment must be long-term in spite of the considerable social and biological pressure that favor the regaining of weight. Treatment of the obese patient must be performed by a multidisciplinary team, and should include a hypoenergetic diet, exercise program, behavioral modifications, and in some instances, family therapy. The treatment of obesity should be tailored for each individual. Drug use in the treatment of obesity is not a substitute for modifying the individual's diet and physical activity. Bariatric surgery is indicated only when the BMI is greater than 30 kg/m2. Physicians and patients must interact closely and assess possible risks that are involved in its treatment against real benefits. A good relation between practitioner and patient is essential.

Colonic lymphoma in ulcerative colitis.

Only rarely has lymphoma been associated with ulcerative colitis. We report a 25-year-old man with an 8-year history of ulcerative colitis, who developed diffuse large cell lymphoma (histiocytic) of the colon. We review 17 previously reported cases and discuss the risk of lymphoma, diagnostic clues, prognosis, and the evidence for a relationship between ulcerative colitis and lymphoma.

[Prevention of cholelithiasis with ascorbic acid. Experimental study in hamsters]. / Prevención de la colelitiasis con acido ascórbico. Estudio experimental en el hamster.

Cholesterol lithogenesis is the end result of hepatic microsomal enzymatic alterations which determine an increase in cholesterol synthesis (HMG CoA reductase) and a decrease in its transformation into bile salts (7 alpha hydroxylase). Therefore biliary cholesterol excretion is increased while bile salt excretion is diminished. Ascorbic Acid (A.A.) seems capable of reversing those enzymatic derrangements in scorbutic animals. Since hamsters are able to synthesize A.A., we evaluated its effect used in high doses during diet induced lithogenesis. Two groups of 6 weeks old, male hamsters, were fed with a lithogenic diet for 30 days. Group A received the usual amount of A.A. contained in the diet (0.25 mg/day/manster) while group B had supplementary A.A. added to drinking water (5 mg/day/hamster). Thirteen out of twenty of group A (65%) and 5 out of 20 of group B (25%) developed cholesterol calculi (p 0.05). Less stones were found in the gallbladders of hamsters fed with supplementary A.A. It is concluded that A.A. in this model, has an inhibitory effect on lithogenesis. The possible mechanism seems to be related to A.A. influence on the microsomal enzymes involved in lithogenesis. These findings, plus the lack of undesirable secondary effects of supplementary A.A. suggest a potential therapeutic role in human cholelithiasis.

Relief of malignant obstructive jaundice by percutaneous insertion of a permanent prosthesis in the biliary tree.

Twelve patients with malignant obstruction of the biliary tree were treated by dilating the lesion percutaneously and inserting an internal large-bore teflon prosthesis in place bridging the the stricture. All 12 patients had unresectable neoplasms. The procedure was devised because existing modes of palliation using surgical techniques are associated with significant mortality or mobidity. There are also many problems with nonsurgical catheter drainage. Decompression was achieved in all 12 patients as shown radiographically by passage of contrast into the duodenum. Disappearance of pruitus was achieved in seven of seven patients, and in 10 of 12 disappearance of jaundice (bilirubin, before prosthesis, 18.4 +/- 4.5 mg/dl [mean +/- 1 SD], bilirubin 1 month after prosthesis, 1.8 +/- 0.6 mg/dl [mean +/- 1 SD], P less than 0.001) with improvement of general clinical status was achieved. Percutaneous placement of a permanent biliary tract prosthesis is safe and effective for the palliative decompression of malignant biliary tract obstruction.

Disulfiram hepatitis.

A case of an adult with disulfiram-induced hepatitis is presented. An etiological role for the drug was proved when the patient underwent a provocative challenge and developed evidence of hepatocellular damage, reversible on withdrawal of the drug. Disulfiram-induced liver injury is difficult to detect in a population with a high incidence of alcohol-related hepatic disease. Liver chemistries should be screened before beginning disulfiram therapy and periodically during treatment.

Rapid diagnosis of obstructive jaundice due to pancreatic abscess with pancreaticobiliary fistula.

A case of pancreatic abscess with pancreaticobiliary fistula manifesting as obstructive jaundice of occult etiology is presented. Diagnosis was made preoperatively by skinny needle percutaneous transhepatic cholangiography. In addition, a communication between the biliary tree and the pancreatic abscess cavity was demonstrated in the absence of previous biliary surgery or primary biliary tract disease. We feel this is the procedure of choice for emergency visualization of the biliary tree in a jaundiced patient where a surgically approachable lesion is suspected.

Local gangrene: a complication of peripheral Pitressin therapy for bleeding esophageal varices.

Two patients developed local gangrene after subcutaneous infiltration of vasopressin (Pitressin, Parke, Davis & Company, Detroit, Mich.) utilized for the control of bleeding from esophageal varices. In the 1st patient, ischemic gangrene resulted in transmetatarsal amputation and also necessitated skin grafts on the forearm. The 2nd patient developed gangrene and clostridial sepsis and expired. The effects of systemically administered Pitressin are reviewed and suggestion to prevent local necrosis are presented.

Intrahepatic hematoma resulting in obstructive jaundice. An unusual complication of liver biopsy.

A patient who developed obstructive jaundice as a complication of a liver biopsy is presented. The jaundice was found to be attributable to obstruction of the biliary tree at the level of the bifurcation by an intrahepatic hematoma. The patient had a complete and spontaneous recovery.

Percutaneous aspiration liver biopsy using a large-caliber disposable needle: a preliminary report.

A modification of the aspiration liver biopsy technique using a large-caliber disposable needle is described in an 18-month experience. One hundred forty liver biopsies were performed, obtaining adequate tissue in 98% of the patients. Complications occurred in 12 patients and were limited to pain at the biopsy site, epigastrium, or right shoulder; one instance of tachycardia and three of transient hypotension occurred. Thirty patients studied prospectively with liver scans and hematologic parameters failed to disclose subclinical complications. While the number of patients biopsied is still too small to provide definite conclusions , it appears that this technique is safe, similar and has a very high yield of excellent specimens. In addition, the needle offers the advantage of being disposable and easy to use by a single operator.

Percutaneous transhepatic cholangiography with the "skinny" needle. A rapid, simple, and accurate method in the diagnosis of cholestasis.

One hundred thirty-one cases of cholestasis were evaluated by "skinny" needle percutaneous transhepatic cholangiography. The biliary tree was seen in 129 patients (98.5%). When the biliary tree was dilated, a success rate of 100% was obtained. In the 45 patients with nondilated ducts, visualization was achieved in 95.6%. There was no mortality, early operation, or transfusion requirement associated with the procedure. This form of cholangiography is a simple, reliable, and extremely high-yield technique for evaluating patients with cholestasis.

Myxedema ascites.

A 74-year-old man presented with mental obtundation and massive ascites without evidence of significant impairment of liver function. Thyroid function studies suggested hypothyroidism. Aspirated ascitic fluid had the characteristics of an exudate. Thyroid replacement therapy resulted in rapid clinical improvement with resolution of the ascites. Prompt recognition of myxedema ascites may prevent the inappropriate use of diuretic agents, therapeutic paracentesis, and sometimes unnecessary laparotomy.

Intrahepatic cholestasis after griseofulvin administration.

The occurrence of cholestatic jaundice in a patient receiving griseofulvin is described. The clinical manifestations, laboratory features, and pathological lesion of drug-induced hepatotoxicity are discussed. Complete recovery followed the discontinuation of drug administration. The potential hepatotoxicity of griseofulvin and the importance of close monitoring of liver function studies in patients receiving this drug are emphasized.