Aqueous extract of Chrysobalanus icaco leaves, in lower doses, prevent fat gain in obese high-fat fed mice.

ETHNOPHARMACOLOGICAL RELEVANCE: Due to the rise in obesity, the necessity for resources and treatments that could reduce the morbidity and mortality associated to this pandemia has emerged. The development of new anti-obesity drugs through herbal sources has been increasing in the past decades which are being used not only as medicine but also as food supplements. Previous studies with the aqueous extract of Chrysobalanus icaco L (AECI) have demonstrated activity on lowering blood glucose levels and body weight. AIM OF THE STUDY: Investigate C. icaco effects in overall adiposity and glycemic homeostasis. MATERIAL AND METHODS: C57BL/6J mice were randomly assigned to standard chow (SC) or high-fat diet (HFD) and treated with AECI in 0.35mg/mL or 0.7mg/mL concentrations ad libitum. Food intake, feed efficiency, metabolic efficiency, body, fat pads and gastrocnemius weight, adiposity index, serum lipids, fecal lipid excretion, locomotor activity in the open field test and insulin and glucose tolerance tests were analyzed and compared. The major components of the extract were demonstrated through HPLC and its antioxidant activity analyzed through DPPH and lipid peroxidation. RESULTS: The AECI in the 0.35mg/mL concentration did not affect food intake or body weight. However, it promoted lower adipose tissue gain, TG levels, and fecal lipid excretion, increased locomotor activity and lean mass weight, and normalized insulin sensitivity and glucose tolerance. Moreover, AECI showed the presence of myricetin 3-O-glucuronide, rutin, quercitrin and myricitrin and demonstrated high-antioxidant activity. CONCLUSIONS: AECI in lower concentrations can prevent fat storage or enhance fat utilization through the increase of locomotor activity. Also, this reinforces its ability to maintain glucose homeostasis through the normalization of insulin sensitivity and glucose tolerance despite the high-fat diet intake. These activities could be associated to the extract's polyphenol content.

Use of the splenic artery for arterial reconstruction in living donor liver transplantation.

BACKGROUND: The present study sought to evaluate the possibility of using the splenic artery for arterialization of a living donor liver graft. PATIENTS AND METHODS: In the period between August 2004 and April 2006, we performed 31 adult-to-adult living donor liver transplantations. In 27 patients (group A), the right or left hepatic artery was used to arterialize the graft, whereas in the other four cases (group B), we used the recipient splenic artery. RESULTS: The Model for End-stage Liver Disease (MELD) score of the patients averaged 17 (17.2 and 15.2 for groups A and B, respectively) ranging between 7 and 28. We did not observe pancreatitis, splenic infarction, or other complications related to ligation of the splenic artery. Two cases (6.4%) of arterial complication were observed, both in group A patients. CONCLUSION: The use of the splenic artery is a safe, practical alternative for arterial reconstruction in living donor liver transplantation procedures, when the hepatic artery is not adequate or in cases of portal hypertension with splenomegaly.

Liver transplantation from deceased donors serologically positive for Chagas disease.

The high mortality rates among patients waiting for liver transplantation has motivated the use of "marginal livers", among which are included livers from deceased donors serologically positive for Chagas disease (CD). The present work describes the outcome of orthotopic liver transplantation in six patients with severe liver disease (Child Pugh C), with livers from donors serologically positive for CD. Transplantations were performed from November 2000 to January 2005, and the patients received prophylactic treatment with benznidazole for 60 days, as a recommended by the Brazilian Consensus in Chagas Disease. The transplantation procedures presented no technical problems, and all the patients were discharged from hospital. Five of them did not present side effects demanding interruption of the prophylactic treatment. Four of the patients were clinically well over 1 year after transplantation (mean follow-up of 42.1 months), with negative serological results for CD. Two patients died, one of them 6 months post surgery of sepsis due to biliary complication and other one due to pulmonary (tuberculosis) complications. They were both serologically negative for CD. These results suggest that liver transplantation from CD donors, followed by benznidazole prophylactic treatment, is an important therapeutic alternative for severe liver disease.

Appropriateness of emergency department visits in a Portuguese university hospital.

STUDY OBJECTIVE: There are no studies in Portugal supporting a common claim that most emergency department visits are inappropriate. The aim of this study was to determine the prevalence of and to evaluate factors associated with an appropriate ED visit in a major public hospital. METHODS: A cross-sectional prospective study was performed at a public university hospital ED. Data for demographic variables, duration of complaint, transfer from other medical sources, and previous medical care for the same complaints were collected by interviewing all patients who arrived at the ED within a consecutive period of at least 24 hours. Data for diagnostic tests, treatment performed, and final patient destination were collected by triage records review. An appropriate ED visit was defined by explicit criteria: interhospital transfer, patient death at the ED, hospitalization, and diagnostic tests or treatments performed. RESULTS: The study included 5,818 adult patients. The prevalence of an appropriate ED visit, by use of our criteria, was 68.7%. Sex was an effect modifier. According to this study, determinants of an appropriate visit for men and women were age 60 years or older and complaints of 24 hours or less and in women but not in men, retired from work and with arrival between midnight and 8 AM. CONCLUSIONS: In a university hospital in Oporto, the majority of ED visits were appropriate according to explicit criteria. Some variables may be associated with appropriateness of ED visits. A duration of the complaint 24 hours or less along with an arrival between midnight and 8 AM in women and age 60 years or older in men were the most important determinants.

[Primary sclerosing cholangitis in children and adolescents]. / Colangite esclerosante primária em crianças e adolescentes.

Primary sclerosing cholangitis is a disease usually with a poor prognosis with a mean survival of 10-12 years, starting from the time of diagnosis. Among the different populations studied, males predominate in a ratio 2:1 with ages ranging from 20-78 (mean 42 years). This article describes four patients with this syndrome, a child of eight and three adolescents, thirteen and fourteen years old. It is possibly of autoimmune etiology, characterized by stenosis, dilatation and fibrosis involving the intrahepatic and extrahepatic biliary tree. We analyzed laboratory assays, clinical, immunological, laboratory assays, histological and cholangiographic aspects. In conclusion, in this age group perhaps of the small population sample there was no sex predominance, and 50% progressed without jaundice and without hepatomegaly. The serum levels of gamma glutamyltransferases and especially alkaline phosphatase were elevated compared to aminotransferases without increase of the serum auto antibodies. Only one patients displayed the typical histological appearance of primary sclerosing cholangitis. The diagnosis in al was confirmed by typical cholangiographic signs, restricted only to the intrahepatic biliary tree, identified in all those included in this study.

[Diffuse primary malignant mesothelioma in abdominal cavity]. / Mesotelioma maligno primário difuso em cavidade abdominal.

Two cases of diffuse malignant mesothelioma of abdominal cavity were analysed. These tumors arise from the peritoneum and are also found in the parietal and visceral pleura, pericardium and in vaginal tunic. All of them, infra or supra-diaphragmatic, are associated with asbestos exposure in at least 80% of cases. It is difficult to explain how inhaled asbestos induces peritoneal neoplasms. This aspects become very important in the diagnostic, basically why it is done at laparotomy or laparoscopy. When was proceed the biopsy of the lesions, and occasionally by identification of malignant mesothelial cells in ascitic fluid. In this two cases exposed considerations about the advanced phase of diagnostic are made, the diagnostic was performed in the majority of the collected cells, showing the advanced stage of the disease. At that time of diagnosis we observed poor evolution. We call attention to the importance of precancer diagnosis, the best chance to treatment options, always based on surgical resections, radiation or chemotherapy alone or combined. If the radical surgery is not possible, this patients must be treated by chemotherapy or radiotherapy, defined after complete staging of the disease.

[Treatment of hemorrhagic congestive gastropathy with TIPS implantation. Pilot study]. / Tratamento da gastropatia congestiva hemorrágica através do implante do TIPS. Estudo piloto.

Minimally invasive percutaneous procedures has an important place in internal medicine. In this concept is included a transjugular intrahepatic portosystemic shunts (TIPS). In this pilot study we describe the indication of this therapeutic modality in three cirrhotic patients with hemorrhagic congestive gastropathy unresponsive to infusion of drugs that reduce the portal pressure. All of them were treated by TIPS and control of gastric bleeding occurred in all. One of these showed partial stenosis of the wallstent, treated by prosthesis dilatation. Another developed portosystemic encephalopathy controlled by usual therapeutic measures in the other we implanted two TIPS to obtain a low pressure level of the hepatic-portal gradient. They had no further necessity of blood transfusion, with better hemodynamic conditions and biochemical tests with reduction of the values of the GHP. We conclude that TIPS may be useful to treat hemorrhagic congestive gastropathy acting like a bridge for subsequent elective liver transplantation under good clinical and hemodynamic conditions.

[Frantz tumor--report of 2 cases. Therapeutic approach and prognosis]. / Tumor de Frantz--relato de dois casos. Medidas terapêuticas e prognóstico.

The authors report two rare pancreatic tumor cases (Frantz's tumor), which were in different evolutionary stages, emphasizing the complexity of a precise anatomopathologic diagnosis and an aggressive surgical approach, whenever possible because the excellent prognosis. They also discuss the clinical manifestation and histological origin, as well as the prognosis factors and a new approach for the liver metastasis.

[Reversal of hepatorenal syndrome after liver transplantation. Considerations about 3 patients]. / Reversão da síndrome hepatorrenal após transplante de fígado. Considerações sobre três pacientes.

Hepatorenal syndrome was observed in 25% of the patients with end stage liver disease. In this situation they stayed longer time in intensive unit treatment, hemodialysis. This evolution was observed in 67% of them with this complication after surgery. In this report we describe three patients with hepatorenal syndrome reversible after liver transplant. We define the form of management of these patients after surgery, regard treatment with cyclosporine A, only 72 h after surgery, without administration of aminoglycosides and amphoterycin. This good evaluation also depends of absence of arterial hypotension or infection episodes during and after surgery. It also depends of the good conditions of the implanted liver.

[Arterial hypertension in a patient with cardiac tamponade]. / Hipertensão arterial num doente com tamponamento cardíaco.

An elevated arterial pressure in cardiac tamponade, although not unusual might postpone the diagnosis of pericardial disease. We reported a case of cardiac tamponade, due to neoplastic infiltration of the pericardium, in which the diagnosis was first suspected by the presence of pulsus paradoxus. The patient presented cardiac tamponade and arterial hypertension simultaneously.

[Hepatic functional changes induced by the combined use of isoniazid, pyrazinamide and rifampicin in the treatment of pulmonary tuberculosis]. / Alterações funcionais hepáticas induzidas pelo uso concomitante de isoniazida, pirazinamida e rifampicina no tratamento da tuberculose pulmonar.

Antituberculosis therapy commonly used for pulmonary tuberculosis in Brazil include isoniazid (440 mg), rifampicin (600 mg) both for six months plus pyrazinamide (2 g) together in the first two months. Such therapy may induce acute or chronic liver damage in some individuals. The purpose of this study is to evaluate 1096 patients treated with antituberculous drugs, being 773 males and 323 females. Clinical and laboratory signs of hepatic cell injury was present in 66 patients. Serum bilirubin and transaminase levels were evaluated in 21 (31.81%) and 45 (68.19%) respectively, with a female preponderance. Early return to normal values occurred more frequently among alcoholic drinkers and non-cigarette smokers. Liver injury was characterized as being mild and moderate and the type of injury associated was represented by pure cholestasis and hepatocanalicular lesions. Probably, rifampicin is the drug responsible for this kind of evolution aggravating the hepatotoxicity induces by isoniazid and pyrazinamide.

[Transjugular intrahepatic portosystemic shunts (TIPS) as a bridge for liver transplantation]. / Anastomose portossistêmica intra-hepática (TIPS) como ponte para o transplante de fígado.

Transjugular intrahepatic portosystemic shunts (TIPS) represents a new surgical technique minimally invasive utilized in the treatment of portal hypertension. Such technique avoid the risks of general anesthesia, and major surgery like portocava anastomosis, reducing the hepatic-portal gradient, and help bleeding esophagogastric varices, hemorrhagic congestive gastropathy and refractary ascites. Certainly diminishes the intensity of intraperitoneal colorectal circulation and the necessity of blood transfusion during surgery for liver transplantation. In this report we reported the first case in Brazil of the implant of TIPS like preparation for liver transplantation in cirrhotic alcoholic patient. We made consideration about techniques aspects and surgery evolution. This new interesting technique applied for this type of patients is indicated as a bridge for candidates for liver transplantation.

[Ultrasonically guided needle biopsy in malignant focal solid nodules of the liver]. / Biopsia percutânea guiada por ultra-som em lesões nodulares sólidas focais malignas do fígado.

In the most of the cases, the diagnosis of focal solid hepatic lesions are performed by ultrasonography, computed tomography, magnetic resonance and hepatic angiography imagig. However, the distinction between benign and malignant neoplasias, sometimes is made after liver biopsy. This report is about 32 of these lesions, diagnosed after guided liver biopsy by ultrasonography. The efficacy of this propedeutic method, minimally invasive, is defined emphasizing that there are no mortality and low levels of morbidity.

Cholelithiasis in cirrhotic patients. (Analysis of cholelithiasis among patients with liver cirrhosis in São Paulo, Brazil).

During the past 20 years, several authors have reported increased prevalence of cholelithiasis in liver cirrhosis. This biliary disease has been implicated with the deterioration of liver function, liver disease of alcoholic origin or even the presence of hypersplenism in this patient population. This study analyzes the incidence and possible factors which are responsible for promoting cholelithiasis in cirrhosis. The study included 110 cirrhotic patients of a private center specialized in treating liver diseases. The incidence of cholelithiasis was 27.3% (25.3% in males and 33.3% in females). There was no correlation between liver function defined by Child's classification or through the laboratory examinations (AST, ALT, AP, GGT, PT, Alb, TB, DB, PA) and the presence of gallstones. No evidence was found that the etiology of cirrhosis or the presence/absence of hypersplenism affected the prevalence of cholelithiasis in this population. In conclusion, an increased prevalence of cholelithiasis was verified in this population of cirrhotics but the pathogenesis is still obscure.

[Hepatic hemangioma. Analysis of 103 cases. Clinical considerations and imaging methods]. / Hemangiomas hepáticos. Análise de 103 casos. Considerações clínicas e dos métodos de imagem.

Hemangiomas are the most common benign vascular tumor found in the liver. In this study, 103 cases of hepatic hemangiomas were analysed in a retrospective manner. Image aspects such as those seen in ultrassonography, computed tomography, nuclear magnetic resonance and arteriography are discussed. The incidence was higher amongst the female sex, between individuals from 40 to 60 years old, which presented predominantly without symptoms (66%) and localized mainly in the right hepatic lobe (74%). The meaning of those aspects, when adopted, permits the clinicians to differentiate benign from malignant nodular lesions in the liver.

Laparoscopic cholecystectomy in cirrhotic patients.

Cholecystectomy in cirrhotic patients is commonly followed by high morbidity and mortality. In our study, laparoscopic cholecystectomy was performed in 12 cirrhotic patients (eight Child A and four Child B) in an effort to obtain lower complication and mortality rates. The mean age of the group was 51.8 years; seven of the 12 patients were men. Four patients had liver disease from virus B, five from virus C, one because of alcohol, and two had cryptogenic liver cirrhosis. The average operative time was 157 min. Intraoperative cholangiography could be performed in eight cases. No mortality or need to perform laparotomy occurred. Only one patient required blood transfusion (8.3%). Postoperative complications occurred in four patients, but these were easily controlled and included renal failure, diabetic impairment, hematoma with ascitic leakage through the wound, and wound abscess, one case each. No postoperative liver failure was observed. All patients walked and were refed in the first 24 h after surgery. They were dismissed in an average period of 2.5 days. Our primary view demonstrated that laparoscopic cholecystectomy was safe and well tolerated by selected cirrhotic patients (Child A and B) with clear indication for surgery.