[Hepatocellular carcinoma. Part 1. General considerations and diagnosis]. / Carcinoma hepatocelular. Parte 1. Considerações gerais e diagnóstico.

Several aspects are revised on the subject hepatocellular carcinoma related to its incidence/prevalence, risk and prognostic factors, cellular proliferation, pathological aspects, progression of chronic hepatitis B and C to cirrhosis and hepatocellular carcinoma, natural course of hepatocellular carcinoma, some clinical data, morphological diagnosis with special emphasis on radiological findings as ultrasound, dynamic computed tomography and magnetic resonance imaging, color-power Doppler, tissue and contrast harmonic.

[Hepatocellular carcinoma. Part 2. Treatment]. / Carcinoma hepatocelular. Parte 2. Tratamento.

Recent improvements on the therapeutical management of hepatocellular carcinoma are revised with special attention to evaluate the role of surgery for the disease. Considering that definitive surgical intervention is not feasible in most cases because of extreme tumor extension, multiplicity of tumor foci, and associated advanced liver cirrhosis at the time of diagnosis, others forms of treatment are listed, such as transcatheterarterial chemoembolization, percutaneous ethanol and acetic acid injections, and chemotherapy only to a small portion of patients with no indication for standard treatments. The emerging role of retinoic acid metabolism blocking agents, was examined and may offer a significant new potential treatment for cancer, inclusive the possibility of combining other anticancer drugs with exogenous retinoids or modulation of endogenous retinoids as a real opportunity to advance our ability to treat or prevent human cancer effectively Octreotide, nitrosamine and other drugs are analyzed and is concluded that improves survival and is a valuable alternative in the treatment of inoperable hepatocellular carcinoma. The potential role of intersticial laser coagulation for patients with irresectable hepatic tumors was investigated, and in terms of experience, it has now been developed sufficiently to study its effect on these patients survival. The homeostatic control of angiogenesis and its influences on the tumor growth and for migration of metastatic cells, was focused in this concise review, given that hepatocytes are the source of much of the precursor pool, regulation of angiogenesis may be regarded as a new liver function with important consequences for tissue repair and cancer. Early hepatocellular carcinoma and its recognition in routine clinical practice contributes to improved patients survival. Recombinant-Interferon-alpha therapy surely prevents, the development of cirrhosis or hepatocellular carcinoma in about one-third of patients, with chronic hepatitis C, with sustained response. Finally, in individuals with life-threatening liver disease, such as those with cirrhosis and hepatocellular carcinoma, the liver transplantation, must be considered, besides controversial, however, with increasing experience the results of the procedure in these patients have improved, and may offer a better long-term survival than liver resection.

[Chronic viral hepatitis C. Part 1. General considerations]. / Hepatite crônica por vírus C. Parte 1. Considerações gerais.

Hepatitis C virus was identified in 1989 as the main causative agent of non-A, non-B and was followed by the recognition of a high prevalence of hepatitis C virus infection after transfusion of infected blood or blood products and in association with intravenous drug abuse. The availability of sensitive and reliable techniques to screen blood for hepatitis C virus has reduced the incidence of post-transfusion hepatitis. True healthy carriers of hepatitis C virus did not exist. Approximately 95% of hepatitis C virus infected individuals can be identified by third generation anti-hepatitis C virus testing. Retrospective studies of iatrogenic hepatitis C virus infection are the main source of the natural history of the disease. The distribution of different hepatitis C virus genotypes varies according to the geographic region. In South America, Europe, The United States and Japan hepatitis C virus genotypes 1, 2 and 3 account for the majority of the infections, being (sub)type 1b the most prevalent. Epidemiological parameters (age, risk factors and duration of infection) may be associated with hepatitis C virus genotypes (intravenous drug abuse with types 1-a and 3-a and 1-b with post-transfusion hepatitic C). Subtype 1-b, lead to a more severe course of viral infection, with ultrastructural alterations of the mitochondria, and greater impairment of the process of oxidative phosphorylation. No increased production of free radicals may influence the evolution of the liver disease by an enhancement of the cytopathic effect of hepatitis C virus. The clinical significance of intrahepatic hepatitis C virus level in patients with chronic hepatitis C virus infection is not determined by host factors (age of patient, mode or duration of infection) or by virus factors (hepatitis C virus genotypes) and, repeatedly negative RT-PCR for hepatitis C virus RNA in serum does not indicate absence of hepatitis C virus from the liver. The association between autoimmunity and hepatitis C virus is questioned. Markers of its does occur with high frequency in these patients. Modulation of immune responses to hepatitis C virus envelope E2 protein following injection of plasmid DNA, has been used for induction of specific response to hepatitis C virus. The spectrum of such responses could likely be broadened by combining plasmids, delivery routes, and other forms of encoded immunogens (peptide vaccines). These may be important to the development of a vaccine against the high mutable hepatitis C virus. The pathogenic role of novel DNA virus (TTV) is under spotlight. As with hepatitis G, however, the association of TTV with disease is far from clear.

[Chronic hepatitis by C virus. Part 2. Treatment]. / Hepatite crônica por virus C. Parte 2. Tratamento.

Several aspects are revised on the subject related to drugs used, their doses, duration of treatment, different responses obtained, according different types of diseases and patients studied, as the factors able to modify the results obtained.

Disfuncoes do esfincter de Oddi / Oddi's sphincter dysfunction

Desde a primeira descricao de uma estrutura esfincteriana no ducto biliar terminal, em 1681, por Glisson, inumeras publicacoes contribuiram para melhor compreensao da funcao do esfincter de Oddi. Estudos manometricos do esfincter de Oddi abriram novas perspectivas para redefinicao de velhos conceitos como a discinesia biliar e a sindrome pos-colecistectomia, e permitiram uma avaliacao mais racional dos resultados obtidos apos esfincterotomia. Os autores realizaram revisao da literatura no que se refere aos aspectos fisiologicos, farmacologicos, diagnosticos e terapeuticos das disfuncoes do esfincter de Oddi.

[Oddi's sphincter dysfunction]. / Disfunções do esfíncter de oddi.

Since the first description by Glisson in 1681 many papers about the sphincter of Oddi have been published contributing to the understanding of its physiology. Sphincter manometry has brought to light new facts that allow a better understanding of old concepts such as the biliary dyskinesia and the post-cholecystectomy syndrome as well as a more rational evaluation of the clinical results of the sphincterectomy. A review of the physiologic, pharmacologic, diagnostic and therapeutic aspects of the dysfunction of the sphincter of Oddi is presented.

Normal neuronal features of the human gallbladder and structural changes in cholelithiasis patients.

Report on a histological study of ten gallbladders, of which five were from normal subjects and five from patients with cholelithiasis. In normal controls a higher number of nerve cells was found in the neck (23.45 +/- 10.14 per mm2) and a lesser one in the body (7.70 +/- 8.45 per mm2) and fundus (5.60 +/- 3.66 per mm2). In the lithiasic gallbladder wall the higher number of the nerve cells was present in the neck (5.83 +/- 4.92 per mm2), and a lowest one in the body (2.63 +/- 1.56 per mm2) and fundus (1.03 +/- 0.71 per mm2).

[Non-surgical treatment of biliary lithiasis]. / Tratamento não cirúrgico da litíase biliar.

The usefulness of the treatment of the biliary lithiasis with chenodeoxycholic and ursodeoxycholic acids is discussed, including the selection of patients, optimal doses, adverse effects and recurrence of stones. New treatment with methyl tertiary butyl ether and extracorporeal shock wave lithotripsy (ESWL) is evaluated. Endoscopic procedures, eventually combined with ESWL, represent the preferred treatment for patients with bile duct stones.