RESUMEN
BACKGROUND: Hepatic histological responses described in hepatitis C virus (HCV) infection include bile duct damage, lymphoid follicles and/or aggregates in portal tracts, large- and small-droplet fat, Mallory body-like material in hepatocytes, liver cell dysplasia and multinucleation, and activation of sinusoidal inflammatory cells. The specificity of these lesions for HCV infection is uncertain. METHODS: In two multicenter trials of recombinant interferon alfa therapy for chronic hepatitis C and B, the frequency of these eight lesions in pretherapy and posttherapy liver biopsy specimens was examined to determine the set of features, if any, that distinguishes HCV from hepatitis B virus (HBV) infection. The lesions were scored in 317 HCV biopsy specimens and 299 HBV specimens. RESULTS: Stepwise logistic regression determined a set of three features more likely to be seen in HCV than in HBV infection: bile duct damage [odds ratio (OR), 4.7; 95% confidence interval (Cl), 1.8-12.3], lymphoid follicles and/or aggregates (OR, 2.4; 95% Cl, 1.2-4.7), and large-droplet fat (OR, 2.4; 95% Cl, 1.4-4.1). A fourth lesion, Mallory body-like material, was seen only in HCV biopsy specimens (OR, 71.6; 95% Cl, 4.4-996.1). CONCLUSIONS: These four histological lesions are useful pathological parameters in the diagnosis of liver disease caused by HCV.
Asunto(s)
Hepatitis B/patología , Hepatitis C/patología , Biopsia , Enfermedad Crónica , Citodiagnóstico , Hepatitis B/diagnóstico , Hepatitis B/terapia , Hepatitis C/diagnóstico , Hepatitis C/terapia , Humanos , Interferón Tipo I/uso terapéutico , Hígado/patología , Proteínas RecombinantesRESUMEN
A 71-yr-old male presented with a 2-month history of fever, malaise, and weight loss. Physical exam revealed chorioretinitis. Laboratory studies were notable for elevated levels of alkaline phosphatase, gamma-glutamyl transpeptidase, aspartate transaminase, and alanine transaminase. Immunoglobulin G antibody to Toxoplasma gondii was positive to a dilution of 1:4096, whereas serologic studies for hepatitis A virus, hepatitis B virus, cytomegalovirus, Epstein-Barr virus, human immunodeficiency virus, Brucella, and Tularemia were negative. A percutaneous biopsy of the liver revealed hepatic granulomas. Culture of the biopsy specimen was negative for growth of mycobacteria or fungi. Spontaneous improvement in clinical and laboratory parameters occurred over a 4-month period.
Asunto(s)
Coriorretinitis/complicaciones , Granuloma/complicaciones , Hepatopatías/complicaciones , Toxoplasmosis Ocular/complicaciones , Anciano , Humanos , MasculinoRESUMEN
Sixty-five patients with angiodysplasia were studied: 42 (64.6%) had normal renal function and 23 (35.4%) had renal insufficiency, defined as serum creatinine consistently greater than 1.5 mg/dl. Comparison of results in the two groups showed that there were no significant differences in the mode of presentation or anatomic distribution of angiodysplasia. Systemic hypertension, congestive cardiac failure, coronary artery disease, and diabetes mellitus were significantly more common in patients with renal failure. Recurrent bleeding from upper alimentary angiodysplasias occurred significantly more often in patients with renal failure than in those with normal renal function. However, a second source, as a cause of bleeding, was found significantly more often in patients with normal renal function.
Asunto(s)
Mucosa Gástrica/irrigación sanguínea , Mucosa Intestinal/irrigación sanguínea , Fallo Renal Crónico/complicaciones , Telangiectasia/complicaciones , Anciano , Femenino , Hemorragia Gastrointestinal/etiología , Humanos , Pruebas de Función Renal , Masculino , Persona de Mediana EdadRESUMEN
A 45-year-old woman receiving continuous infusions of 5-fluoro-2'-deoxy-uridine into the hepatic artery through a surgically implanted intraarterial catheter for hepatic metastases from adenocarcinoma of the colon, developed acute epigastric pain and anemia. Endoscopy demonstrated a duodenal ulcer with a portion of the catheter visible in the crater. Conservative management with sucralfate and ranitidine allowed endoscopically proven healing of the penetrating ulcer with subsequent successful reuse of the catheter.
Asunto(s)
Úlcera Duodenal/etiología , Infusiones Intraarteriales/efectos adversos , Úlcera Péptica Perforada/etiología , Adenocarcinoma/tratamiento farmacológico , Catéteres de Permanencia/efectos adversos , Femenino , Floxuridina/administración & dosificación , Arteria Hepática , Humanos , Infusiones Intraarteriales/instrumentación , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/secundario , Persona de Mediana EdadRESUMEN
A 56-yr-old man was admitted for evaluation of fever, chills, jaundice, and alcoholic stools. Laboratory studies suggested a cholestatic process. Ultrasonography, computed tomography, and transhepatic cholangiography failed to reveal any abnormalities. Acute infection with Francisella tularensis was confirmed serologically, and a liver biopsy revealed cholestatic hepatitis with focal coagulative necrosis. Recovery was coincident with antibiotic therapy.