Ascariasis hepatobiliar: informe de caso / Hepatobiliary ascariasis: A case report

Introducción. La ascariasis hepática es la complicación menos frecuente de la infección parasitaria por el helminto intestinal Ascaris lumbricoides. Sin embargo, el cuadro de ascariasis biliar complicada con abscesos hepáticos se observa en ciertas zonas endémicas como América Latina y el Sudeste Asiático, donde debe ser un diagnóstico a considerar en pacientes con sintomatología biliar obstructiva, principalmente en niños, ya que por el tamaño pequeño de sus órganos tienen mayor probabilidad de desarrollar obstrucción. Este gusano tiene la habilidad de entrar en ductos, como la vía biliar intra y extrahepática, y al morir dentro de la misma provoca serias complicaciones como obstrucción, colangitis y abscesos secundarios. Caso clínico. Se presenta el caso de una niña de 6 años de edad con antecedente de Síndrome de Down, desnutrición proteico-calórica crónica grado II y nivel socioeconómico bajo, que se presentó con historia de fiebre diaria no cuantificada, tos seca, dolor abdominal y hepatomegalia dolorosa de dos semanas de evolución. Se realizó ultrasonido abdominal donde se encontraron múltiples abscesos hepáticos con A. lumbricoides en hígado y vía biliar. La paciente desarrolló un choque séptico sin respuesta al tratamiento instaurado y falleció a los 30 días intrahospitalarios. Conclusiones. La ascariasis hepatobiliar, aunque rara, es más común en países endémicos y tiene una alta morbi-mortalidad si no se diagnostica y se instaura el manejo adecuado tempranamente. Es imperativo que los médicos hondureños conozcan esta parasitosis para que con un adecuado manejo contribuyan a disminuir la mortalidad, principalmente infantil, por esta causa. Es necesario implementar medidas de prevención y control eficaces para las geohelmintiasis en Honduras...(AU)

Ascariasis hepatobiliar: informe de caso / Hepatobiliary ascariasis: a case report

Introducción. La ascariasis hepática es la complicación menos frecuente de la infección parasitaria por el helminto intestinal Ascaris lumbricoides. Sin embargo, el cuadro de ascariasis biliar complicada con abscesos hepáticos se observa en ciertas zonas endémicas como América Latina y el Sudeste Asiático, donde debe ser un diagnóstico a considerar en pacientes con sintomatología biliar obstructiva, principalmente en niños, ya que por el tamaño pequeño de sus órganos tienen mayor probabilidad de desarrollar obstrucción. Este gusano tiene la habilidad de entrar en ductos, como la vía biliar intra y extrahepática, y al morir dentro de la misma provoca serias complicaciones como obstrucción, colangitis y abscesos secundarios. Caso clínico. Se presenta el caso de una niña de 6 años de edad con antecedente de Síndrome de Down, desnutrición proteico-calórica crónica grado II y nivel socioeconómico bajo, que se presentó con historia de fiebre diaria no cuantificada, tos seca, dolor abdominal y hepatomegalia dolorosa de dos semanas de evolución. Se realizó ultrasonido abdominal donde se encontraron múltiples abscesos hepáticos con A. lumbricoides en hígado y vía biliar. La paciente desarrolló un choque séptico sin respuesta al tratamiento instaurado y falleció a los 30 días intrahospitalarios. Conclusiones. La ascariasis hepatobiliar, aunque rara, es más común en países endémicos y tiene una alta morbi-mortalidad si no se diagnostica y se instaura el manejo adecuado tempranamente. Es imperativo que los médicos hondureños conozcan esta parasitosis para que con un adecuado manejo contribuyan a disminuir la mortalidad, principalmente infantil, por esta causa. Es necesario implementar medidas de prevención y control eficaces para las geohelmintiasis en Honduras...

Etiopathogenesis of hepatic osteodystrophy in Wistar rats with cholestatic liver disease.

The pathophysiology of hepatic osteodystrophy (HO) remains poorly understood. Our aim was to evaluate bone histomorphometry, biomechanical properties, and the role of the growth hormone (GH)/insulin-like growth factor-I (IGF-I) system in the onset of this disorder. Forty-six male Wistar rats were divided into two groups: sham-operated (SO, n = 23) and bile duct-ligated (BDL, n = 23). Rats were killed on day 30 postoperatively. Immunohistochemical expression of IGF-I and GH receptor was determined in liver tissue and in the proximal growth plate cartilage of the left tibia. Histomorphometric analysis was performed in the right tibia, and the right femur was used for biomechanical analysis. The maximal force at fracture and the stiffness of the mid-shaft femur were, respectively, 53% and 24% lower in BDL compared to SO. Histomorphometric measurements showed low cancellous bone volume and decreased cancellous bone connectivity in BDL, compatible with osteoporosis. This group also showed increased mineralization lag time, indicating disturbance in bone mineralization. Serum levels of IGF-I were lower in BDL (basal 1,816 +/- 336 vs. 30 days 1,062 +/- 191 ng/ml, P < 0.0001). BDL also showed higher IGF-I expression in the liver tissue but lower IGF-I and GH receptor expression in growth plate cartilage than SO. Osteoporosis is the most important feature of HO; BDL rats show striking signs of reduced bone volume and decreased bone strength, as early as after 1 month of cholestasis. The endocrine and autocrine-paracrine IGF-I systems are deeply affected by cholestasis. Further studies will be necessary to establish their role in the pathogenesis of HO.

Evaluation of the mitochondrial respiration of cardiac myocytes in rats submitted to mechanical bile duct obstruction.

PURPOSE: The objective of the present study was to evaluate the capacity of the myocardium for energy production by the analysis of mitochondrial respiration in rats with jaundice submitted to bile duct ligature. METHODS: Sixteen male Wistar rats were divided into 2 Groups: Group SO submitted to nontherapeutic laparotomy (sham operation) and Group IC (icteric group) submitted to bile duct ligature. After 7 days, laparotomy was again performed in all animals for cardiac muscle extraction and analysis. Mitochondrial oxygen consumption was determined by stage 3 velocity and stage 4 velocity. The respiratory control ratio (RCR) was obtained by the ratio of stage 3 to stage 4 velocity. Statistical analysis was performed by the Mann-Whitney test, with the level of significance set at 5% (p<0.05). RESULTS: Statistical analysis revealed a significant drop in oxygen consumption during stage 3 mitochondrial respiration in group IC compared with SO, whereas the values obtained during stage 4 were basically identical for the two groups. Likewise, RCR values exhibited a significant reduction. CONCLUSION: The cellular respiration of the "jaundiced heart" is depressed. This was demonstrated by the reduced capacity of cardiac mitochondria to consume oxygen and synthesize ATP, supporting the idea of a latent cardiac impairment responsible for the hemodynamic decompensation occurring during cholestasis.

[Hepatic anatomophatologic injuries by extrahepatic biliar tract obstruction in mice]. / Lesiones anatomopatológicas hepáticas por la obstrucción de la vía biliar extrahepática en ratones.

UNLABELLED: The aim is to evaluate the liver damage due to an experimental animal model based in the temporal obstruction of biliar extrahepatic duct and determine the relation between obstruction and severity of damage through time. METHODS: We used 20 adults male mice going from 25 to 35 g weight, previous to general anesthesia, a surgical incision was applied and biliar duct were localized and tied using linen cloth. Six animals were sacrificed each time at 1, 7 and 15 days of treatment, the hepatic, lung, kidney, hearth and brain were obtained for histopatologic analysis using optic microscope. RESULTS: In the first day 20% of hepatic samples, light lesions as sinusoidal congestion and dilation of portal vessel with hepatocelular biliar stasis were found. In 7th day additional lesions were found as accumulations of biliar pigments in the cholangiols, proliferation of portal collagens and light pericholangiolar proliferation in 60% of samples. At 15th day, severely lesions as hamartomatous proliferation of cholangiols and portal fibrosis of biliar ducts that deformed the boundary plaque and lobular in 15% of samples. In brain, hearth, and lung samples showed vascular dilation and severe congestion, except at 15th day, when samples of kidneys showed biliar pigment precipitation in lumen of collets ducts. CONCLUSIONS: The proposed method is useful to study the chronologic relationship of anatomophatologic damage produced by biliar obstruction.

Hepatoprotective effect of water soluble extract of Coleus barbatus on cholestasis on young rats.

PURPOSE: To test the effects of water extract of Coleus barbatus (WEB) on liver damage in biliary obstruction in young rats. METHODS: Forty 21 day-old male Wistar rats were divided into four groups of ten 21 day old (P21) submitted to sham or actual operation (S or L) combined with WEB or Water (B or A). At P48 pentobarbital sleeping time (ST) was measured. At P49 they were submitted to euthanasia to determine of serum activities of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), liver wet weight (PFF) and, on hepatic histological slides, the frequency of mitoses (FM), the number of necrotic areas (NN), intensity of fibrosis (IF) and intensity of ductal proliferation (IPD). Two Way ANOVA, the S.N.K. test and the Wilcoxon test for paired multiple comparisons were employed to study the effects of cholestasis and those of EAB and their interactions. The Pearson's coefficient of linear correlation of between paired histological variables separately for the groups LA and LD was determined. The test results were considered statistically significant when the p of alpha error <0.05. RESULTS: Cholestasis increased the TS, ALT, AST, PFF, MI, NN, IF and IPD. The EAB decreased the TS and IM in the animals without cholestasis (sham operated animals). The EAB decreased the TS, ALT, AST, PFF, MI, NN and IF of the cholestatic animals. In the LA group there was a positive correlation between the IPD and the IF, a negative correlation between the IPD and the FM and a negative correlation between the IF and the FM. In the LD group there was a negative correlation between the NN and the IPD. CONCLUSIONS: In the absence of cholestasis the EAB reduces the pentobarbital sleeping time and decreases the frequency of mitoses. The EAB has a hepatoprotective effect on the biliary cirrhosis secondary to extra-hepatic biliary obstruction.

Hepatoprotective effect of water soluble extract of Coleus barbatus on cholestasis on young rats / Efeito hepatoprotetor do extrato aquoso de Coleus barbatus na colestase em ratos jovens

PURPOSE: To test the effects of water extract of Coleus barbatus (WEB) on liver damage in biliary obstruction in young rats. METHODS: Forty 21 day-old male Wistar rats were divided into four groups of ten 21 day old (P21) submitted to sham or actual operation (S or L) combined with WEB or Water (B or A). At P48 pentobarbital sleeping time (ST) was measured. At P49 they were submitted to euthanasia to determine of serum activities of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), liver wet weight (PFF) and, on hepatic histological slides, the frequency of mitoses (FM), the number of necrotic areas (NN), intensity of fibrosis (IF) and intensity of ductal proliferation (IPD). Two Way ANOVA, the S.N.K. test and the Wilcoxon test for paired multiple comparisons were employed to study the effects of cholestasis and those of EAB and their interactions. The Pearson's coefficient of linear correlation of between paired histological variables separately for the groups LA and LD was determined. The test results were considered statistically significant when the p of alpha error <0.05. RESULTS: Cholestasis increased the TS, ALT, AST, PFF, MI, NN, IF and IPD. The EAB decreased the TS and IM in the animals without cholestasis (sham operated animals). The EAB decreased the TS, ALT, AST, PFF, MI, NN and IF of the cholestatic animals. In the LA group there was a positive correlation between the IPD and the IF, a negative correlation between the IPD and the FM and a negative correlation between the IF and the FM. In the LD group there was a negative correlation between the NN and the IPD. CONCLUSIONS: In the absence of cholestasis the EAB reduces the pentobarbital sleeping time and decreases the frequency of mitoses. The EAB has a hepatoprotective effect on the biliary cirrhosis secondary to extra-hepatic biliary obstruction.

OBJETIVO: Testar os efeitos do extrato aquoso de Coleus barbatus (EAB) na cirrose biliar secundária por obstrução das vias biliares extra-hepáticas em ratos jovens. MÉTODOS: Quarenta ratos Wistar machos com 21 dias de vida (P21), foram distribuídos em quatro grupos de 10 animais, submetidos a operação simulada ou dupla ligadura e ressecção do ducto biliar (S ou L) combinados EAB e a Água (B ou A). No P48, foi medido o tempo de sono com o pentobarbital (TS). No P49, foram submetidos a eutanásia para a determinação das atividades séricas do aspartato aminotransferase (AST) e da alanina aminotransferases (ALT); após a eutanásia foram avaliados o peso fresco do fígado (PFF) e, em cortes histológicos do fígado, a freqüência de mitoses (FM), o número de áreas de necrose (NN), a intensidade da fibrose (IF) e da proliferação ductal (IPD). Os efeitos da colestase, os do EAB e suas interações foram testados pela ANOVA com dois fatores, e as comparações múltiplas pareadas foram realizadas pelo teste de S.N.K ou teste de Wilcoxon. Também foi determinada a correlação linear de Pearson entre as variáveis histológicas duas a duas separadamente para os grupos LA e LD. O nível de significância estatística para os vários testes foi de p do erro alfa <0,05. RESULTADOS: A colestase aumentou significativamente o TS, a ALT, a AST, o PFF, a MI, o NN, a IF e a IPD. O EAB diminuiu o TS e a IM nos animais sem colestase (operação simulada). O EAB diminuiu o TS, a ALT, a AST, o PFF, a MI, o NN e IF na colestase. No grupo LA houve correlação positiva entre a IPD e a IF, correlação negativa entre a IPD e a FM e correlação negativa entre a IF a FM. No grupo LD houve correlação negativa entre o NN e a IPD. CONCLUSÕES: Na ausência de colestase o EAB encurta o tempo de sono e diminui a freqüência de mitoses. O EAB apresenta efeito hepatoprotetor no modelo de cirrose biliar secundária a obstrução biliar extra-hepática.

Evaluation of the mitochondrial respiration of cardiac myocytes in rats submitted to mechanical bile duct obstruction / Avaliação da respiração mitocondrial de miócitos cardíacos em ratos ictéricos sumetidos à obstrução do ducto biliar

PURPOSE: The objective of the present study was to evaluate the capacity of the myocardium for energy production by the analysis of mitochondrial respiration in rats with jaundice submitted to bile duct ligature. METHODS: Sixteen male Wistar rats were divided into 2 Groups: Group SO submitted to nontherapeutic laparotomy (sham operation) and Group IC (icteric group) submitted to bile duct ligature. After 7 days, laparotomy was again performed in all animals for cardiac muscle extraction and analysis. Mitochondrial oxygen consumption was determined by stage 3 velocity and stage 4 velocity. The respiratory control ratio (RCR) was obtained by the ratio of stage 3 to stage 4 velocity. Statistical analysis was performed by the Mann-Whitney test, with the level of significance set at 5 percent (p<0.05). RESULTS: Statistical analysis revealed a significant drop in oxygen consumption during stage 3 mitochondrial respiration in group IC compared with SO, whereas the values obtained during stage 4 were basically identical for the two groups. Likewise, RCR values exhibited a significant reduction. CONCLUSION: The cellular respiration of the "jaundiced heart" is depressed. This was demonstrated by the reduced capacity of cardiac mitochondria to consume oxygen and synthesize ATP, supporting the idea of a latent cardiac impairment responsible for the hemodynamic decompensation occurring during cholestasis.(AU)

OBJETIVO: A proposta deste trabalho é avaliar a capacidade de produção energética do miocárdio mediante análise da respiração mitocondrial em ratos ictéricos submetidos à ligadura do ducto biliar. MÉTODOS: Foram utilizados 16 ratos Wistar machos divididos em 2 Grupos: Grupo SO , os quais foram submetidos à Laparotomia branca e Grupo IC, os quais sofreram ligadura do ducto biliar para o desenvolvimento de icterícia obstrutiva. Todos os animais após 7 dias de cirurgia foram submetidos à nova laparotomia para extração e análise do músculo cardíaco. O consumo de oxigênio pelas mitocôndrias foi determinado pela velocidade do estado 3 e velocidade do estado 4. A razão do controle respiratório (RCR) foi obtida pela relação entre as velocidades dos estados 3 e 4. A análise estatística foi feita pelo teste de Mann-Whitney com nível de significância de 5 por cento (p<0.05). RESULTADOS: Observou-se queda estatisticamente significante nos valores do consumo de oxigênio do estado 3 da respiração mitocondrial no grupo IC em relação ao SO, no entanto os valores para estado 4 permaneceram basicamente inalterados entre os grupos. Os valores de RCR entre os grupos também apresentaram diminuição significativa. CONCLUSÃO: A respiração celular do 'coração ictérico' está deprimida em decorrência da redução da capacidade da mitocôndria cardíaca em consumir oxigênio e sintetizar ATP, o que pode contribuir para a disfunção cardiovascular na vigência da colestase.(AU)

Evaluation of the mitochondrial respiration of cardiac myocytes in rats submitted to mechanical bile duct obstruction / Avaliação da respiração mitocondrial de miócitos cardíacos em ratos ictéricos sumetidos à obstrução do ducto biliar

PURPOSE: The objective of the present study was to evaluate the capacity of the myocardium for energy production by the analysis of mitochondrial respiration in rats with jaundice submitted to bile duct ligature. METHODS: Sixteen male Wistar rats were divided into 2 Groups: Group SO submitted to nontherapeutic laparotomy (sham operation) and Group IC (icteric group) submitted to bile duct ligature. After 7 days, laparotomy was again performed in all animals for cardiac muscle extraction and analysis. Mitochondrial oxygen consumption was determined by stage 3 velocity and stage 4 velocity. The respiratory control ratio (RCR) was obtained by the ratio of stage 3 to stage 4 velocity. Statistical analysis was performed by the Mann-Whitney test, with the level of significance set at 5 percent (p<0.05). RESULTS: Statistical analysis revealed a significant drop in oxygen consumption during stage 3 mitochondrial respiration in group IC compared with SO, whereas the values obtained during stage 4 were basically identical for the two groups. Likewise, RCR values exhibited a significant reduction. CONCLUSION: The cellular respiration of the "jaundiced heart" is depressed. This was demonstrated by the reduced capacity of cardiac mitochondria to consume oxygen and synthesize ATP, supporting the idea of a latent cardiac impairment responsible for the hemodynamic decompensation occurring during cholestasis.

OBJETIVO: A proposta deste trabalho é avaliar a capacidade de produção energética do miocárdio mediante análise da respiração mitocondrial em ratos ictéricos submetidos à ligadura do ducto biliar. MÉTODOS: Foram utilizados 16 ratos Wistar machos divididos em 2 Grupos: Grupo SO , os quais foram submetidos à Laparotomia branca e Grupo IC, os quais sofreram ligadura do ducto biliar para o desenvolvimento de icterícia obstrutiva. Todos os animais após 7 dias de cirurgia foram submetidos à nova laparotomia para extração e análise do músculo cardíaco. O consumo de oxigênio pelas mitocôndrias foi determinado pela velocidade do estado 3 e velocidade do estado 4. A razão do controle respiratório (RCR) foi obtida pela relação entre as velocidades dos estados 3 e 4. A análise estatística foi feita pelo teste de Mann-Whitney com nível de significância de 5 por cento (p<0.05). RESULTADOS: Observou-se queda estatisticamente significante nos valores do consumo de oxigênio do estado 3 da respiração mitocondrial no grupo IC em relação ao SO, no entanto os valores para estado 4 permaneceram basicamente inalterados entre os grupos. Os valores de RCR entre os grupos também apresentaram diminuição significativa. CONCLUSÃO: A respiração celular do 'coração ictérico' está deprimida em decorrência da redução da capacidade da mitocôndria cardíaca em consumir oxigênio e sintetizar ATP, o que pode contribuir para a disfunção cardiovascular na vigência da colestase.

Genistein decreases liver fibrosis and cholestasis induced by prolonged biliary obstruction in the rat.

Fibrosis accompanies most chronic liver disorders and is a major factor contributing to hepatic failure. Therefore, the need for an effective treatment with the aim of modifying the clinical course of this disease is evident. The aim of this work is to determine whether genistein, which has been shown to modulate the physiology and pathophysiology of liver, is able to decrease experimental liver fibrosis and cholestasis. In male Wistar rats, the common bile duct was ligated. Administration of genistein (5 microg rat-1, day-1, p.o.) began four weeks after biliary obstruction and continued for a further four weeks. The liver was used for histological and ultrastructural analysis and for collagen quantification (hydroxyproline content). The degradation of Matrigel(R) and collagen type I was determined in homogenized liver. Bilirubins and enzyme activities were measured in serum. Genistein was able to improve normal liver histology, ultrastructure, collagen content, and biochemical markers of liver damage. It also increased Matrigel(R) and collagen type I degradation. In summary, the present report shows that genistein inhibits the fibrosis and cholestasis induced by prolonged biliary obstruction in the rat. Genistein has therapeutic potential against liver fibrosis.

Malignant hilar and perihilar biliary obstruction: use of MR cholangiography to define the extent of biliary ductal involvement and plan percutaneous interventions.

PURPOSE: To determine the usefulness of magnetic resonance (MR) cholangiography in defining the extent of biliary ductal involvement in patients with malignant hilar and perihilar biliary obstruction and to evaluate whether findings at MR cholangiography alone are sufficient to plan percutaneous interventions in these patients. MATERIALS AND METHODS: Twenty-nine patients with malignant hilar and perihilar biliary obstruction were examined with MR cholangiography. Two radiologists evaluated MR images and determined the extent of biliary ductal involvement. A hypothetical plan for biliary drainage was established prior to any intervention. All patients underwent percutaneous cholangiography, and 27 of 29 patients also underwent biliary drainage and/or stent placement within 7 days after MR cholangiography. By using direct cholangiography as the standard of reference, the usefulness of MR cholangiography in defining the extent of biliary ductal involvement was determined. The type of drainage performed was compared with the type that had been anticipated at MR cholangiography. RESULTS: MR cholangiography was adequate in helping predict the extent of biliary ductal involvement in 28 (96%) of 29 patients and led to underestimation of the extent of the disease in one patient. The therapeutic plan anticipated with MR cholangiography matched the one actually used in 24 (83%) of 29 patients. CONCLUSION: The high accuracy of MR cholangiography for defining extent of ductal involvement in patients with malignant hilar and perihilar obstruction allows adequate planning of percutaneous interventions in a majority of patients.

Insuficiência hepática aguda da gravidez: experiência clínica com sete casos / Acute liver failure of pregnancy: clinical experience with seven cases

Objetivos: avaliar a dificuldade diagnóstica, o tratamento e seu resultado em casos de insuficiência hepática aguda da gravidez. Métodos: sete pacientes com insuficiência hepática aguda da gravidez admitidas em nosso Serviço nos últimos quatro anos foram estudadas com ênfase nos sintomas presentes, achados laboratoriais, curso clínico, complicaçöes maternas e sobrevida fetal. Resultados: a média de idade foi de 25,8 anos (sendo duas primigestas) com idade gestacional média de 30,1. Destas, quatro receberam diagnóstico final de esteatose hepática aguda da gravidez e três de colestase intra-hepática da gravidez. Os principais sinais e sintomas encontrados foram: anorexia, náusea, dor abdominal, icterícia e encefalopatia. Ocorreu morte materna em dois casos: uma paciente por falência hepática enquanto aguardava órgäo para transplante e outra por falência hepática, coagulopatia grave e choque hemorrágico após biopsia hepática. Uma paciente com esteatose hepática aguda evoluiu para cronicidade e encontra-se viva um ano após transplante hepático. Nos quatro casos restantes houve completa remissäo do quadro com as medidas de suporte, associadas à interrupçäo da gravidez. As mortalidades materna e fetal foram, respectivamente, 28,6 por cento e 57,1 por cento. Conclusöes: conclui-se, nesta experiência inicial, que a insuficiência hepática aguda da gravidez constitui evento clínico grave, de elevada mortalidade materno-fetal, e que seu pronto reconhecimento e encaminhamento para centros terciários especializados em fígado, além da imediata interrupçäo da gestaçäo, säo fatores decisivos para o sucesso do tratamento.

Complicaciones de las prótesis en las ictericias obstructivas extrahepáticas / Stent complications in extrahepatic obstructive jaundice

Investiga la causa de la obstrucción en las prótesis de plástico y realiza una revisión de la literatura sobre las principales complicaciones de las prótesis y su manejo

Osteodistrofia hepática: revisão da literatura e relato de experiência pessoal em um grupo de crianças em adolescentes com colestase crônica / Hepatic osteodystrophy: literature review and report of personal experience with children and adolescents with chronic cholestasis

Osteodistrofia hepática é o termo usado para definir a doença óssea metabólica associada à hepatopatia crônica. Estudada principalmente em indivíduos adultos com colestase crônica, é igualmente prevalente em adolescentes e crianças hepatopatas crônicos. A patogênese é desconhecida mas parece ser multifatorial. Na maioria dos pacientes ocorre perda progressiva de densidade óssea, causa de importante fragilidade esquelética. Esta predispõe à perda de estatura, dor óssea e surgimento de fraturas associadas ou não ao trauma. A densidade óssea mineral pode ser medida por densitometria óssea de dupla emissão. Nenhuma medida, farmacológica ou profilática, tem se mostrado efetiva para reduzir a osteopenia da hepatopatia crônica, observando-se porém que aproximadamente um ano após transplante hepático, ocorre aumento de massa óssea em grande parte dos pacientes. Nesta revisão, discutimos a fisiopatologia, diagnóstico e tratamento da osteodistrofia hepática e relatamos nossa experiência com 20 pacientes com colestase crônica acompanhados na Unidade de Gastroenterologia Pediátrica do HCPA

Prurito cutáneo en medicina interna / Dermatological pruritus in internal medicine

El prurito puede ser localizado o generalizado sin lesiones cutáneas y es un síntoma clínico frecuente. El prurito esencial sin lesiones cutáneas es de común ocurrencia en Medicina Interna y sus causas pueden ser: -Colestasias extrahepaticas (ictericias obstructivas: coledocolitiasis, atresia de vías biliares, neoplasias, pancreatitis crónica, colangitis esclerosante, etc.). Colestasias intrahepáticas (ictericias hepatocanaliculares, cirrosis biliar primaria, hepatitis virales y colestasia beninga del embarazo). -Insuficiencia renal. -Enfermedades hematológicas (enfermedad de Hodgkin y linfomas no Hodgkin, mastocitosis cutánea, sideropenia, etc. -Diabetes mellitus. -Senilidad. -Factores psicogénicos (depresión o ansiedad). -Medicamentos inductores del prurito. El tratamiento del prurito generalizado no dermatológico es difícil y por lo general es de poca efectividad. Los recursos posibles son numerosos. Varias drogas han sido usadas con pobres resultados (barbitúricos, antihitamínicos, antidepresivos, ansiolíticos, colestiramina y ácido ursodeozicólico, etc.)

Imprint cytology of the gallbladder mucosa. Its use in diagnosing macroscopically inapparent carcinoma.

The diagnosis of early gallbladder carcinoma is almost impossible before surgery; in many cases the tumors are grossly inapparent. The usefulness of imprint cytology in detecting early carcinoma of the gallbladder mucosa was assessed. Eight macroscopically inapparent carcinomas were diagnosed, and nine grossly evident carcinomas were confirmed by imprint cytology in 120 cholecystectomies. The sensitivity of cytologic diagnosis of macroscopically inapparent carcinoma was 80%, specificity and predictive value were 100%, and efficiency was 97.7%. If overt carcinomas are included, both the sensitivity and efficiency increase, to 89.6% and 98%, respectively. For the diagnosis of dysplasia the sensitivity and predictive value was 84%, specificity 97.6% and efficiency 95.8%. Because of the simplicity and rapidity of imprint cytology of gallbladder mucosa, coupled with its high sensitivity and reliability, it is recommended for the detection of inapparent carcinoma during cholecystectomy in patients at high risk of cancer.

[Mirizzi's syndrome: a rare cause of obstructive jaundice]. / Síndrome de Mirizzi: una causa rara de ictericia obstructiva.

We present five patients with Mirizzi syndrome diagnosed by ERCP. This syndrome is a rare cause of obstructive jaundice due to common biliary duct compression by a gallstone impacted in the cystic duct, neck of the gallbladder or Hartmann's pouch. Complications are bilio-biliary fistula, cholangitis and secondary biliary cirrhosis. Diagnostic methods, importance of preoperative diagnosis and surgical technics are reviewed.

Ictericia neoplásicas / Neopasics jaundice

Se presenta la experiencia entre los años 1971-1990 de las ictericias neoplásicas en la División Cirugía del Hospital "Dr. Cosme Argerich" y Policlínico Bancario "9 de Julio"' así como la práctica privada, habiéndose recopilado 188 casos. Se propone un algoritmo para el diagnóstico y tratamiento. Los resultados hasta la fecha son desalentadores. Se describe la morbimortalidad de la serie. Se destacan dos épocas hasta el año 1980 y a partir del mismo en que el el advenimiento de los métodos no invasivos permite el diagnóstico de estos tumores en forma más oportuna