[Hepatic lesions in acute cardiovascular failure in necropsy specimens]. / Valoración del daño hepático en el fallo agudo cardiocirculatorio en material de necropsias.

To evaluate quali-quantitatively ischemic liver injury due to acute cardiocirculatory failure (ischemic hepatitis), and its real clinical signification, 200 out of 1165 autopsy records with ACF clinical diagnosis were selected; 33/200 (16.5%) shown centrilobular necrosis without inflammatory component, accompanied or not by midzonal compromise. Grade IV centrilobular necrosis (50-100% involved lobules) was present in 96.9%, with 15.5% associated midzonal pattern, and 21.2% of confluent type; 2 additional cases with isolated midzonal necrosis (5.7%) were seen. Only six patients (3.0% of ACF patients, and 18.2% of those with histological injury) shown overt clinical liver disease, one of them with a fulminant hepatitis picture (0.5% of ACF, and 3.0% of patients with ischemic necrosis). Bilirubin levels were 3.4-10.2 mg%, and aminotransferases rose up to 540 times over their seric superior normal limits. Centrilobular necrosis involved 100% of lobules in all cases.

Valoración del daño hepático en el fallo agudo cardiocirculatorio en material de necropsias. / [Hepatic lesions in acute cardiovascular failure in necropsy specimens]

To evaluate quali-quantitatively ischemic liver injury due to acute cardiocirculatory failure (ischemic hepatitis), and its real clinical signification, 200 out of 1165 autopsy records with ACF clinical diagnosis were selected; 33/200 (16.5

) shown centrilobular necrosis without inflammatory component, accompanied or not by midzonal compromise. Grade IV centrilobular necrosis (50-100

involved lobules) was present in 96.9

, with 15.5

associated midzonal pattern, and 21.2

of confluent type; 2 additional cases with isolated midzonal necrosis (5.7

) were seen. Only six patients (3.0

of ACF patients, and 18.2

of those with histological injury) shown overt clinical liver disease, one of them with a fulminant hepatitis picture (0.5

of ACF, and 3.0

of patients with ischemic necrosis). Bilirubin levels were 3.4-10.2 mg

, and aminotransferases rose up to 540 times over their seric superior normal limits. Centrilobular necrosis involved 100

of lobules in all cases.

Evolución alejada en portadoras asintomáticos HBsAg(PA-HBsAg) en un área de baja prevalencia de hepatocarcinoma

Data provided by 51 voluntaru blood donnors identified as asymptomatic HBsAg carriers five to ten years (x = 7.5 years) before their inclusion in the study are analysed towards their long-term evolution. HBsAg clearance was estimated 2.5% yearly and 83.9% of those remaining positive showed the classical non-replicative serological pattern,; another 12.9% were negative for both HBeAg - Anti HBe (serovonversion window?), one of them presenting raised ASATALAT levels and enhanced histological activity (lobular chronic hepatitis). Neither alpha-fetoprotein seric levels (RIA) nor liver ultrasonography demonstrated hepato cellular carcinoma suspicion signs in 35 HBsAg positive cases to this methods; ASAT-ALAT levels raised over two fold the normal superior limit ion only 11.4%, and neither agressive chronic liver disease nor hepatocyte dissplasia was showed in 17 biopsed cases (70.6% normal; 23.6% chronic reactive or chronic persistent hepatitis; 5.8% chronic liobular hepatitis). One out of five patients biopsed with a seven years interval showed histologic worsening (AU)

Evolución alejada en portadoras asintomáticos HBsAg(PA-HBsAg) en un área de baja prevalencia de hepatocarcinoma

Data provided by 51 voluntaru blood donnors identified as asymptomatic HBsAg carriers five to ten years (x = 7.5 years) before their inclusion in the study are analysed towards their long-term evolution. HBsAg clearance was estimated 2.5% yearly and 83.9% of those remaining positive showed the classical non-replicative serological pattern,; another 12.9% were negative for both HBeAg - Anti HBe (serovonversion window?), one of them presenting raised ASATALAT levels and enhanced histological activity (lobular chronic hepatitis). Neither alpha-fetoprotein seric levels (RIA) nor liver ultrasonography demonstrated hepato cellular carcinoma suspicion signs in 35 HBsAg positive cases to this methods; ASAT-ALAT levels raised over two fold the normal superior limit ion only 11.4%, and neither agressive chronic liver disease nor hepatocyte dissplasia was showed in 17 biopsed cases (70.6% normal; 23.6% chronic reactive or chronic persistent hepatitis; 5.8% chronic liobular hepatitis). One out of five patients biopsed with a seven years interval showed histologic worsening

[Long-term course in asymptomatic carriers of HBsAg in an area of low prevalence of hepatocarcinoma]. / Evolución alejada en portadores asintomáticos HBsAg (PA-HBsAg) en un area de baja prevalencia de hepatocarcinoma.

Data provided by 51 voluntary blood donors identified as asymptomatic HBsAg carriers five to ten years (mean = 7.5 years) before their inclusion in the study are analysed towards their long-term evolution. HBsAg clearance was estimated 2.5% yearly and 83.9% of those remaining positive showed the classical non-replicative serological pattern; another 12.9% were negative for both HBeAg-Anti HBe (seroconversion window?), one of them presenting raised ASAT-ALAT levels and enhanced histological activity (lobular chronic hepatitis). Neither alpha-fetoprotein seric levels (RIA) nor liver ultrasonography demonstrated hepatocellular carcinoma suspicion signs in 35 HBsAg positive cases to this methods; ASAT-ALAT levels raised over two fold the normal superior limit in only 11.4%, and neither aggressive chronic liver disease nor hepatocyte dysplasia was showed in 17 biopsied cases (70.6% normal; 23.6% chronic reactive or chronic persistent hepatitis; 5.8% chronic lobular hepatitis). One out of five patients biopsied with a seven years interval showed histologic worsening.

Evolución alejada en portadores asintomáticos HBsAg (PA-HBsAg) en un area de baja prevalencia de hepatocarcinoma. / [Long-term course in asymptomatic carriers of HBsAg in an area of low prevalence of hepatocarcinoma]

Data provided by 51 voluntary blood donors identified as asymptomatic HBsAg carriers five to ten years (mean = 7.5 years) before their inclusion in the study are analysed towards their long-term evolution. HBsAg clearance was estimated 2.5

yearly and 83.9

of those remaining positive showed the classical non-replicative serological pattern; another 12.9

were negative for both HBeAg-Anti HBe (seroconversion window?), one of them presenting raised ASAT-ALAT levels and enhanced histological activity (lobular chronic hepatitis). Neither alpha-fetoprotein seric levels (RIA) nor liver ultrasonography demonstrated hepatocellular carcinoma suspicion signs in 35 HBsAg positive cases to this methods; ASAT-ALAT levels raised over two fold the normal superior limit in only 11.4

, and neither aggressive chronic liver disease nor hepatocyte dysplasia was showed in 17 biopsied cases (70.6

normal; 23.6

chronic reactive or chronic persistent hepatitis; 5.8

chronic lobular hepatitis). One out of five patients biopsied with a seven years interval showed histologic worsening.

[Algorithm in hepatology. Blind biopsy or laparoscopic biopsy?]. / Algoritmos en hepatología. Biopsia a ciegas o biopsia laparoscópica?

Data from 1035 laparoscopic examinations were evaluated with 1% general morbidity and 0.1% death rate - Comparative diagnostic sensibility, specificity and predictive value between endoscopic and histologic findings from 748 cases (408 diffusse - parenchimatous liver diseases, 246 focal - nodular lesions, and 94 normal liver) were calculated. General sensibility (s) was similar for both laparoscopy and histology (s = 93) with different behavior for diffusse liver disease (DLD) and focal-nodular disease (FND) as follows: DLD: Laparoscopy s = 90 +/- 3 Vs. Histology s = 100. FND: Laparoscopy s = 98 +/- 1.8 Vs. Histology s = 85 +/- 4.8 Laparoscopic specificity (Sp) for FND was high (Sp = 100), but 10.6% false positive was diagnosed as DLD (Sp = 90 +/- 6.5). Non histologic false positive were found. High positive predictive value (p.p.v.) was found all cases: DLD: Laparoscopy ppv = 0.97 Vs. Histology p.p.v. = 1. FND: Laparoscopy ppv = 1 Vs. Histology p p.p.v. = 1. On the other hand, negative predictive value (npv) evidences well diferentiated results: DLD Laparoscopy n.p.v. = 0.69 Vs. Histology n.p.v. = 1. FND Laparoscopy n.p.v. = 0.94 Vs. Histology n.p.v. = 0.68. Histologic findings can not replace high fiability of macroscopic ones for FND diagnosis; then, blind liver biopsy is not recommended for this cases, but it could be very useful for DLD diagnosis.

Algoritmos en hepatología. Biopsia a ciegas o biopsia laparoscópica? / [Algorithm in hepatology. Blind biopsy or laparoscopic biopsy?]

Data from 1035 laparoscopic examinations were evaluated with 1

general morbidity and 0.1

death rate - Comparative diagnostic sensibility, specificity and predictive value between endoscopic and histologic findings from 748 cases (408 diffusse - parenchimatous liver diseases, 246 focal - nodular lesions, and 94 normal liver) were calculated. General sensibility (s) was similar for both laparoscopy and histology (s = 93) with different behavior for diffusse liver disease (DLD) and focal-nodular disease (FND) as follows: DLD: Laparoscopy s = 90 +/- 3 Vs. Histology s = 100. FND: Laparoscopy s = 98 +/- 1.8 Vs. Histology s = 85 +/- 4.8 Laparoscopic specificity (Sp) for FND was high (Sp = 100), but 10.6

false positive was diagnosed as DLD (Sp = 90 +/- 6.5). Non histologic false positive were found. High positive predictive value (p.p.v.) was found all cases: DLD: Laparoscopy ppv = 0.97 Vs. Histology p.p.v. = 1. FND: Laparoscopy ppv = 1 Vs. Histology p p.p.v. = 1. On the other hand, negative predictive value (npv) evidences well diferentiated results: DLD Laparoscopy n.p.v. = 0.69 Vs. Histology n.p.v. = 1. FND Laparoscopy n.p.v. = 0.94 Vs. Histology n.p.v. = 0.68. Histologic findings can not replace high fiability of macroscopic ones for FND diagnosis; then, blind liver biopsy is not recommended for this cases, but it could be very useful for DLD diagnosis.

[Endoscopic cytological diagnosis of the upper digestive tract]. / Diagnóstico citológico endoscópico del tracto digestivo superior.

207 cases of oesopha-gastric endoscopic exfoliative citology was realized during 1976-1977, 126 was malignant and 81 non-malignant. The high general diagnosis posivity in oesophagus (96,9% without erroneous posivity, and a posivity of 88,8% en stomach, with 4,2% erroneous posivity are remarked. The quick diagnosis, the easy technique and the unexpensive process, both the needed of high professional capacity, are realized. The incidence of tumoral localization, macroscopic and histologic characters on diagnosis security are comented.

Diagnóstico citológico endoscópico del tracto digestivo superior. / [Endoscopic cytological diagnosis of the upper digestive tract]

207 cases of oesopha-gastric endoscopic exfoliative citology was realized during 1976-1977, 126 was malignant and 81 non-malignant. The high general diagnosis posivity in oesophagus (96,9

without erroneous posivity, and a posivity of 88,8

en stomach, with 4,2

erroneous posivity are remarked. The quick diagnosis, the easy technique and the unexpensive process, both the needed of high professional capacity, are realized. The incidence of tumoral localization, macroscopic and histologic characters on diagnosis security are comented.

Diagnóstico citológico endoscópico del tracto digestivo superior / [Endoscopic cytological diagnosis of the upper digestive tract]

207 cases of oesopha-gastric endoscopic exfoliative citology was realized during 1976-1977, 126 was malignant and 81 non-malignant. The high general diagnosis posivity in oesophagus (96,9

without erroneous posivity, and a posivity of 88,8

en stomach, with 4,2

erroneous posivity are remarked. The quick diagnosis, the easy technique and the unexpensive process, both the needed of high professional capacity, are realized. The incidence of tumoral localization, macroscopic and histologic characters on diagnosis security are comented.