Dolor abdominal y síndrome de secreción inadecuada de hormona antidiurética (SIADH) en un paciente diagnosticado de porfiria aguda intermitente / No disponible

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Divertículo de Zenker: diagnóstico mediante radiografía simple / Zenker's diverticulum: diagnosis by plain radiographic examination

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[HFE gene mutations, hepatic iron content, and histological severity in hepatitis C virus-induced chronic hepatitis].

OBJECTIVE: To study whether any relationship exists between the C282Y and H63D mutations of the HFE gene, iron liver content, and the severity of histological damage in patients with hepatitis C virus (HCV)-induced chronic hepatitis. MATERIAL AND METHODS: In 72 patients diagnosed with HCV-chronic infection, naïve for antiviral therapy, and undergoing liver biopsy, the Knodell index was established, a morphometric evaluation of hepatic hemosiderin deposits was performed by using a semiautomatic method of image analysis, and mutations of the HFE gene were identified through a polymerase chain reaction on leukocyte genomic DNA by using specific restriction enzymes. The control group for the distribution of HFE genetic variants was composed of 181 healthy individuals with the same ethnic and geographical (white Spaniards) origin. RESULTS: (Cases/controls): 1. Genotype distribution: a) mutation C282Y: no homozygotes, 6/23 heterozygotes, 66/158 without the mutation (not significant, n.s.); b) mutation H63D: 2/5 homozygotes, 26/52 heterozygotes, 44/124 without the mutation (n.s.). compound heterozygotes 2/6. 2. Allele frequencies: a) mutation C282Y: 0.042/0.064 (n.s.); b) mutation H63D: 0.208/0.171 (n.s.). Four C282Y heterozygous patients had stainable liver iron (p=0.015 vs patients without mutations). Sixty-six patients were not carriers of the C282Y mutation; among them, 26.9% of 26 carriers and 15% of 40 non-carriers of the H63D mutation had liver stainable iron (n.s.). Knodell index score, gender, age at diagnosis, mode of transmission, and serum and liver iron values were not related to the HFE genotype. CONCLUSIONS: our results suggest that the C282Y mutation, but not the H63D mutation, of the HFE gene is frequently associated with stainable iron in the liver in HCV-related chronic hepatitis. The HFE genotype is not related to the histological severity of the disease.

Interferon-alpha induced transient thyroid dysfunction in hepatitis C.

We report the case of thyroid dysfunction that developed in a 36-year-old female patient who required combination therapy with interferon and ribavirine for chronic hepatitis C. Firstly, she suffered a hyperthyroidism followed by a hypothyroidism stage requiring thyroxine replacement therapy. Nevertheless, combination treatment was not discontinued, reaching a sustained biochemical and virological response. The pathogenesis of autoimmune diseases in patients with Hepatitis C virus infection and interferon therapy is not clear, but usually these disorders are reversible and only require supervision and treatment if clinical or laboratory abnormalities are present.

Alteración transitoria de la función tiroidea en la hepatitis C inducida por interferón-alfa / Interferon-alpha induced transient thyroid dysfunction in hepatitis C

Describimos un caso de alteración de la función tiroidea que se presentó en una mujer de 36 años que requirió tratamiento combinado con interferón y ribavirina para su hepatitis crónica C. En primer lugar, presentó un hipertiroidismo seguido por un hipotiroidismo que requirió tratamiento con tiroxina. Sin embargo, el tratamiento combinado no fue suspendido, alcanzando una respuesta mantenida bioquímica y virológica. La patogenia de las enfermedades autoinmunes en pacientes con infección por el virus C de la hepatitis tratados con interferón no está clara, pero generalmente estos trastornos son reversibles y sólo requiere supervisión y tratamiento si se presentaran anormalidades clínicas o bioquímicas (AU)

Factores predictivos de la eficacia del tratamiento con interferón de la hepatitis crónica C / Predicting factors in the efficacy of interferon treatment in chronic hepatitis C

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Hepatitis G virus infection in Spanish patients with hepatocellular carcinoma.

AIMS/BACKGROUND: To establish the rate of infection with a newly discovered Flaviviridae family member hepatitis G virus (HGV) -- in Spanish patients with hepatocellular carcinoma (HCC), chronic alcoholic liver disease (CALD) with cirrhosis, or hepatitis C virus (HCV)-induced chronic hepatitis (CH). METHODS: The presence of HGV-RNA was assessed in sera of 117 patients divided in three groups: group 1: 40 patients with HCC (35 men, mean age 62.7 years, SD 10.9 years); group 2: 41 patients with chronic alcoholic liver disease (CALD) (36 men, mean age 52.5 years, SD 9.8 years); group 3: 36 patients with HCV-induced CH (27 men, mean age 35.8 years, SD 8.5 years). Serum samples were tested for HGV-RNA by specific reverse transcriptase-polymerase chain reaction (RT-PCR). Serological markers of hepatitis B virus (HBV) and HCV were investigated in all patients and were negative in CALD patients, as a prerequisite for their inclusion in the study. All patients in group 1 were also tested for HBV-DNA. RESULTS: Rates of HGV-RNA positivity were, respectively, 47%, 10% and 28% in groups 1, 2 and 3. Differences were significant between groups 1 and 2 (p=0.00017) and groups 2 and 3 (p= 0.042), but not between groups 1 and 3 (p=0.079). CONCLUSIONS: HGV infection is common in HCC patients, but usually in association with HCV, indicating that both agents share common routes of infection. HGV was the only hepatitis virus detected in 12% of HCC patients, but its possible role in the pathogenesis of HCC remains unclear.

Transduodenopancreatic interposition mesocaval shunt using an internal jugular vein autograft.

In 26 interposition mesocaval shunts using an internal jugular vein autograft which has been performed since 1970, four patients had important abnormalities in the superior mesenteric vein, making impossible the usual subduodenal position of the jugular vein graft. In these four patients, a small pancreatectomy was performed between the transverse portion of the duodenum and the right aspect of the superior mesenteric vein, placing the interposition mesocaval shunt in a transduodenopancreatic position. No patient has had any bleeding after the operation nor have esophageal varices been found at the time of the last examination. During this period, all patients showed a remarkable tolerance to proteins, so that no patient has been on a low protein diet.