[Constipation and digestive bleeding as an atypical presentation of Whipple's disease]. / Estreñimiento y hemorragia digestiva como formas de presentación inusual de la enfermedad de Whipple.

Whipple's disease is a rare systemic disease of infectious etiology. Its clinical presentation is highly variable. The most common symptoms are diarrhea, weight loss, abdominal pain and joint manifestations. Non-digestive manifestations frequently precede digestive symptoms by several years. For all these reasons, diagnosis is difficult. Definitive diagnosis is established by the finding of PAS-positive macrophages in the lamina propria of the thin intestine. It is important to start appropriate antibiotic therapy early, as this improves the prognosis. We present the case of a male patient in whom the first manifestations of the disease were constipation and upper gastrointestinal hemorrhage, two forms of clinical presentation that have rarely been described in the literature on Whipple's disease.

[Increase of gamma-glutamyltranspeptidase in patients with compensated hypoalphalipoproteinemia and type IIa dyslipidemias]. / Elevación de gammaglutamiltranspeptidasa en pacientes con hipoalfalipoproteinemia y dislipemias tipo IIa compensadas.

Twenty-one asymptomatic patients presenting isolated elevations of gamma-glutamyltranspeptidase (GGT) were studied over the previous 10 years with all the findings being accidental. No other analytical alterations were demonstrated. Ingestion of alcohol, drugs or another type of toxic substance, diabetes, neurologic disease or neoplasm were discarded. Echography of the liver and the biliary tract was normal. In the first nine patients studied, liver biopsy was performed being normal or with minimum unspecific alterations. In two patients endoscopic retrograde cholangiography was carried out with no alterations being observed. Lipid study was performed in all the patients with alpha hypolipoproteinemia being found in 15 patients, compensated type II lipid profile in 5 and a normal lipid profile in one. To the author's knowledge there have been no reports of this lipid disorder causing elevations in GGT. However, on being the only abnormality found in these patients the authors believe that this may be the cause although the mechanism is unknown.

[Symptomatic primary biliary stenosis without cholestasis]. / Cirrosis biliar primaria sintomática sin colestasis.

The case of a 59-years old patient with typical clinical manifestations of primary biliary cirrhosis (PBC): pruritus, asthenia, arthralgias and dry syndrome, with skin pigmentation and AMA positivity, hypergammaglobulinemia and an elevation of IgM is presented. Liver biopsy was compatible with stage II PBC. No analytical data of cholestasis, has been seen over 26 months of follow up with normal transaminases, alkaline phosphatase, gamma-glutamyltranspeptidase and cholesterol. The absence of cholestasis in the presence of symptoms is of interest.