RESUMO
Granular cell tumor or Abrikosoff's tumor is an infrequent and usually benign neoplasm which is found predominantly in the head and neck region, especially in the tongue. Its esophageal location is unusual, where most of them present as small, well circumscribed lesions which follow a benign course. Because of its low incidence in this site (less than 200 cases having been reported until 1993), we report two cases of esophageal granular cell tumors, both of them in male patients. CASE 1: A 34 year old patient who presented with epigastralgia, heartburn and abdominal distention. He was treated endoscopically because he had a firm new growth in the lower third of the esophagus measuring 1 cm in diameter. CASE 2: A 50 year old patient who presented with digestive tract haemorrhage (hematemesis and melena) 5 cm above the cardias a submucosal polyp was found of 0.8 cm in its largest diameter. MICROSCOPY: Both cases showed a subepithelially located new growth, composed of polygonal cells with eosinophilic granular cytoplasm, small rounded nuclei, and conspicuous intracytoplasmatic positivity for S100 protein. With these elements we reached the diagnosis of granular cell tumor. The bibliography is reviewed and an update is made of its histopathologic characteristics in addition to histogenetic and clinical considerations.
Assuntos
Neoplasias Esofágicas/patologia , Tumor de Células Granulares/patologia , Adulto , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Mucosa/patologiaRESUMO
Granular cell tumor or Abrikosoff's tumor is an infrequent and usually benign neoplasm which is found predominantly in the head and neck region, especially in the tongue. Its esophageal location is unusual, where most of them present as small, well circumscribed lesions which follow a benign course. Because of its low incidence in this site (less than 200 cases having been reported until 1993), we report two cases of esophageal granular cell tumors, both of them in male patients. CASE 1: A 34 year old patient who presented with epigastralgia, heartburn and abdominal distention. He was treated endoscopically because he had a firm new growth in the lower third of the esophagus measuring 1 cm in diameter. CASE 2: A 50 year old patient who presented with digestive tract haemorrhage (hematemesis and melena) 5 cm above the cardias a submucosal polyp was found of 0.8 cm in its largest diameter. MICROSCOPY: Both cases showed a subepithelially located new growth, composed of polygonal cells with eosinophilic granular cytoplasm, small rounded nuclei, and conspicuous intracytoplasmatic positivity for S100 protein. With these elements we reached the diagnosis of granular cell tumor. The bibliography is reviewed and an update is made of its histopathologic characteristics in addition to histogenetic and clinical considerations.
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Neoplasias Esofágicas , Tumor de Células Granulares , Imuno-Histoquímica , MucosaRESUMO
Granular cell tumor or Abrikosoffs tumor is an infrequent and usually benign neoplasm which is found predominantly in the head and neck region, especially in the tongue. Its esophageal location is unusual, where most of them present as small, well circumscribed lesions which follow a benign course. Because of its low incidence in this site (less than 200 cases having been reported until 1993), we report two cases of esophageal granular cell tumors, both of them in male patients. CASE 1: A 34 year old patient who presented with epigastralgia, heartburn and abdominal distention. He was treated endoscopically because he had a firm new growth in the lower third of the esophagus measuring 1 cm in diameter. CASE 2: A 50 year old patient who presented with digestive tract haemorrhage (hematemesis and melena) 5 cm above the cardias a submucosal polyp was found of 0.8 cm in its largest diameter. MICROSCOPY: Both cases showed a subepithelially located new growth, composed of polygonal cells with eosinophilic granular cytoplasm, small rounded nuclei, and conspicuous intracytoplasmatic positivity for S100 protein. With these elements we reached the diagnosis of granular cell tumor. The bibliography is reviewed and an update is made of its histopathologic characteristics in addition to histogenetic and clinical considerations.
RESUMO
Granular cell tumor or Abrikosoffs tumor is an infrequent and usually benign neoplasm which is found predominantly in the head and neck region, especially in the tongue. Its esophageal location is unusual, where most of them present as small, well circumscribed lesions which follow a benign course. Because of its low incidence in this site (less than 200 cases having been reported until 1993), we report two cases of esophageal granular cell tumors, both of them in male patients. CASE 1: A 34 year old patient who presented with epigastralgia, heartburn and abdominal distention. He was treated endoscopically because he had a firm new growth in the lower third of the esophagus measuring 1 cm in diameter. CASE 2: A 50 year old patient who presented with digestive tract haemorrhage (hematemesis and melena) 5 cm above the cardias a submucosal polyp was found of 0.8 cm in its largest diameter. MICROSCOPY: Both cases showed a subepithelially located new growth, composed of polygonal cells with eosinophilic granular cytoplasm, small rounded nuclei, and conspicuous intracytoplasmatic positivity for S100 protein. With these elements we reached the diagnosis of granular cell tumor. The bibliography is reviewed and an update is made of its histopathologic characteristics in addition to histogenetic and clinical considerations. (AU)
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Neoplasias Esofágicas/patologia , Tumor de Células Granulares/patologia , Imuno-Histoquímica , Mucosa/patologiaRESUMO
To assess epidemiological and clinical significance of drug hepatotoxicity in the setting of liver diseases consultation, ten thousand and three hundred forty two prospectively designed clinical records from patient cared for in our Liver Unit in the period 1988-1998 were incorporated into the study; 58 out of 10,342 (prevalence = 5.6%) fulfilled at least the first three of the following causality requirements: 1.--Liver injury associated in time to drug exposition; 2.--Negative evaluation of more common other etiologies; (alcohol, viruses, immunologic, metabolic, etc) 3.--Favourable response to drug withdrawal (ALT < 50% of baseline in 8 to 30 days in acute hepatitis type, and alkaline phosphatase and/or total bilirubin < 50% of baseline up to 6 months, in acute cholestasis) 4.--Inadverted or rarely prescribed positive challenge. Acute hepatitis type of injury were considered when serum ALT rise 8 times or more above normal superior level with alkaline phosphatase (APh) below 3 times; "pure" cholestasis when APh rise 3 times or more above normal with ALT below 8 times; mixed acute injury or cholestatic hepatitis when both ALT and APh were elevated above 8 and 3 times respectively, and indeterminate type when both enzymes were below the referred levels. Chronic injury were considered when six or more month of evolution and compatible liver histology happens. Clinical severity were expressed as mild (absence of major clinical complications, serum bilirubin < 5 mg/dl and prothrombin concentration > 75%), moderate (presence of clinical complications, bilirubin > 5 mg/dl and prothrombin concentration between 50-75%), and severe (major clinical complications with bilirubin > 5 mg/dl and prothrombin concentration < 50%). Female/male ratio was 1.4:1, with age average 39 years (R = 15-77) and major concentration of cases above 40. More than 50% of cases received 2 or more drugs. Jaundice was present in 60.4%, and systemic manifestations of hypersensibility (fever, adenomegalies, rush, mononucleosis like syndrome, eosinophilia) in 29.3%. Acute injury represented 91.4% of the cases: 41.4% acute hepatitis, 15.5% "pure" cholestasis, 24.1% cholestatic hepatitis, and 10.3% indeterminate type. Four patients (4.5% of acute injury cases) were presented as severe acute liver failure, leading to liver transplant in one of them, drug association (INH-rifampicin and carbamazepine-phenobarbital) and inadverted challenge (sulphonamides and pemoline) were associated to clinical severity. Chronic injury were found in five patient (8.6%), four of them associated to chronic hepatitis and the other one to a ductopenic syndrome. Six drugs represented 53.4% of our cases; oral contraceptives (7 cases), INH alone or combined with rifampicin (6 cases), sulfonamides and clorpropamida (5 cases each), carbamazepine and amiodarone (4 cases each). Normalization of liver enzymes after drug suppression took 2 to 8 weeks in acute hepatitis type (X = 4 weeks), 4 to 20 in "pure" cholestasis (X = 12 weeks) and 8 to 24 weeks in cholestatic hepatitis or mixed type (X = 16 weeks). Two cases of chronic hepatitis normalize the histological activity index in 20 and 18 month respectively, one case remains as chronic hepatitis at 10 month and the other one progress to cirrhosis; the ductopenic syndrome normalize histology in 19 months receiving urso-deoxicolic acid, 10 mg/k/day.
Assuntos
Doença Hepática Induzida por Substâncias e Drogas , Hepatopatias/epidemiologia , Doença Aguda , Adolescente , Adulto , Idoso , Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Colestase/induzido quimicamente , Colestase/epidemiologia , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos ProspectivosRESUMO
Se analizaron los datos epidemiológicos y clínico-evolutivos de la hepatotoxicidad por fármacos en una experiencia de 10 años (1988-1998) de nuestra Unidad de Hígado, que incluye 10342 historias clínicas de registro prospectivo. La prevalencia en este material fué de 5,6 por ciento, con ligero predominio femenino (1.4:1) y en mayores de 40 años; más del 50 por ciento ingirieron 2 o más fármacos. Predominaron las formas agudas (91.4 por ciento) e ictéricas (60.4 por ciento) con manifestaciones sistémicas de hipersensibilidad en 29.3 por ciento, el 4.5 por ciento de las formas agudas se presentaron como fallo hepático agudo severo, con necesidad de transplante hepático en un caso. los 4 casos de hepatitis crónica presentaron evolución a la cirrosis en un caso, y un caso de colestasis con ductopenia (CBP-simil) evolucionó favorablemente en 19 semanas, recibiendo ácido ursode-soxicólico 10 mg/k/día. Seis fármacos representaron el 53.4 por ciento de los casos: anticonceptivos orales, isoniacida, sulfamidas, clorpropamida, carbamacepina y amiodarona.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Hepatopatias/induzido quimicamente , Hepatopatias/epidemiologia , Doença Aguda , Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Anti-Infecciosos/efeitos adversos , Anticonvulsivantes/efeitos adversos , Antituberculosos/efeitos adversos , Carbamazepina/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Colestase/induzido quimicamente , Colestase/epidemiologia , Doença Crônica , Anticoncepcionais Orais/efeitos adversos , Hipoglicemiantes/efeitos adversos , Isoniazida/efeitos adversos , Prevalência , Sulfonas/efeitos adversosRESUMO
To assess epidemiological and clinical significance of drug hepatotoxicity in the setting of liver diseases consultation, ten thousand and three hundred forty two prospectively designed clinical records from patient cared for in our Liver Unit in the period 1988-1998 were incorporated into the study; 58 out of 10,342 (prevalence = 5.6
) fulfilled at least the first three of the following causality requirements: 1.--Liver injury associated in time to drug exposition; 2.--Negative evaluation of more common other etiologies; (alcohol, viruses, immunologic, metabolic, etc) 3.--Favourable response to drug withdrawal (ALT < 50
of baseline in 8 to 30 days in acute hepatitis type, and alkaline phosphatase and/or total bilirubin < 50
of baseline up to 6 months, in acute cholestasis) 4.--Inadverted or rarely prescribed positive challenge. Acute hepatitis type of injury were considered when serum ALT rise 8 times or more above normal superior level with alkaline phosphatase (APh) below 3 times; [quot ]pure[quot ] cholestasis when APh rise 3 times or more above normal with ALT below 8 times; mixed acute injury or cholestatic hepatitis when both ALT and APh were elevated above 8 and 3 times respectively, and indeterminate type when both enzymes were below the referred levels. Chronic injury were considered when six or more month of evolution and compatible liver histology happens. Clinical severity were expressed as mild (absence of major clinical complications, serum bilirubin < 5 mg/dl and prothrombin concentration > 75
), moderate (presence of clinical complications, bilirubin > 5 mg/dl and prothrombin concentration between 50-75
), and severe (major clinical complications with bilirubin > 5 mg/dl and prothrombin concentration < 50
). Female/male ratio was 1.4:1, with age average 39 years (R = 15-77) and major concentration of cases above 40. More than 50
of cases received 2 or more drugs. Jaundice was present in 60.4
, and systemic manifestations of hypersensibility (fever, adenomegalies, rush, mononucleosis like syndrome, eosinophilia) in 29.3
. Acute injury represented 91.4
of the cases: 41.4
acute hepatitis, 15.5
[quot ]pure[quot ] cholestasis, 24.1
cholestatic hepatitis, and 10.3
indeterminate type. Four patients (4.5
of acute injury cases) were presented as severe acute liver failure, leading to liver transplant in one of them, drug association (INH-rifampicin and carbamazepine-phenobarbital) and inadverted challenge (sulphonamides and pemoline) were associated to clinical severity. Chronic injury were found in five patient (8.6
), four of them associated to chronic hepatitis and the other one to a ductopenic syndrome. Six drugs represented 53.4
of our cases; oral contraceptives (7 cases), INH alone or combined with rifampicin (6 cases), sulfonamides and clorpropamida (5 cases each), carbamazepine and amiodarone (4 cases each). Normalization of liver enzymes after drug suppression took 2 to 8 weeks in acute hepatitis type (X = 4 weeks), 4 to 20 in [quot ]pure[quot ] cholestasis (X = 12 weeks) and 8 to 24 weeks in cholestatic hepatitis or mixed type (X = 16 weeks). Two cases of chronic hepatitis normalize the histological activity index in 20 and 18 month respectively, one case remains as chronic hepatitis at 10 month and the other one progress to cirrhosis; the ductopenic syndrome normalize histology in 19 months receiving urso-deoxicolic acid, 10 mg/k/day.
RESUMO
Se analizaron los datos epidemiológicos y clínico-evolutivos de la hepatotoxicidad por fármacos en una experiencia de 10 años (1988-1998) de nuestra Unidad de Hígado, que incluye 10342 historias clínicas de registro prospectivo. La prevalencia en este material fué de 5,6 por ciento, con ligero predominio femenino (1.4:1) y en mayores de 40 años; más del 50 por ciento ingirieron 2 o más fármacos. Predominaron las formas agudas (91.4 por ciento) e ictéricas (60.4 por ciento) con manifestaciones sistémicas de hipersensibilidad en 29.3 por ciento, el 4.5 por ciento de las formas agudas se presentaron como fallo hepático agudo severo, con necesidad de transplante hepático en un caso. los 4 casos de hepatitis crónica presentaron evolución a la cirrosis en un caso, y un caso de colestasis con ductopenia (CBP-simil) evolucionó favorablemente en 19 semanas, recibiendo ácido ursode-soxicólico 10 mg/k/día. Seis fármacos representaron el 53.4 por ciento de los casos: anticonceptivos orales, isoniacida, sulfamidas, clorpropamida, carbamacepina y amiodarona. (Au)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Hepatopatias/induzido quimicamente , Hepatopatias/epidemiologia , Anticoncepcionais Orais/efeitos adversos , Isoniazida/efeitos adversos , Antituberculosos/efeitos adversos , Sulfonas/efeitos adversos , Anti-Infecciosos/efeitos adversos , /efeitos adversos , Carbamazepina/efeitos adversos , Anticonvulsivantes/efeitos adversos , Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Prevalência , Doença Aguda , Doença Crônica , Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Colestase/induzido quimicamente , Colestase/epidemiologiaAssuntos
Hepatite C/complicações , Falência Renal Crônica/complicações , Transplante de Rim , Hepatopatias/complicações , Seleção de Pacientes , Obtenção de Tecidos e Órgãos/organização & administração , Listas de Espera , Argentina/epidemiologia , Hepatite C/epidemiologia , Humanos , Falência Renal Crônica/terapia , Hepatopatias/epidemiologia , Prevalência , Diálise RenalRESUMO
The risk of HBV infections in health workers and the different prevalence according to the hospital activities has been shown in a great number of papers. In order to establish the prevalence of serological HBV markers in health workers fron high complexity hospital, we have analyzed 730 inquiries refilled in the period 1994-1995 before receiving the antihepatitis B vaccine. We studied 730 health workers, 282 (38.8%) males and 447 (61.2%) females with a mean age of 40.1 years old. We found 75/730 (10.2) serums antiçHBc reactives. The found prevalence was significantly larger than the one found in blood donors. The analysis of the prevalence according to the hospital activities showed that the infirmary personnel is the only with anti-HBc prevalence significantly superior to the blood donors, and the other health workers prevalence. Differences in the anti-HBc prevalence between the physicians specialties were not found. Our results agree with other publications that clearly show that health workers are a risk group for HBV infection. However, what attracts attention in the analyzed population is that the only ones with anti-HBc prevalence significantly superior to the blood donors' and the other health workers prevalence were the nurses, suggesting that nurses are the only health workers that have risk of HBV infections.
Assuntos
Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Hepatite B/epidemiologia , Recursos Humanos em Hospital/estatística & dados numéricos , Adolescente , Adulto , Idoso , Argentina/epidemiologia , Feminino , Hepatite B/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
We present a new case of hepatic sinusoidal dilatation associated to giant lymph node hyperplasia or Castleman's disease in a 23-year-old patient with xanthelasmas and history of celiac disease. He presented with weight loss, hepatomegaly, periorbital xanthomas, anemia, accelerated erythrosedimentation rate, hypoalbuminemia, hypergammaglobulinemia at the expense of immunoglobulin G (IgG), high titers of autoantibodies, and increase of serum alkaline phosphatase and gamma glutamyl transpeptidase activity. A liver biopsy showed sinusoidal dilatation. Fifteen months later, a computed axial tomography showed a retroperitoneal tumor that turned out to be a giant lymph node hyperplasia. After resection of the tumor all clinic and biochemical manifestations had faded, suggesting an association between xanthelasmas, Castleman's disease, sinusoidal dilatation, and celiac disease. A humoral factor produced by the lymph tumor of the patient may have been responsible for the immunologic alterations he presented.
Assuntos
Hiperplasia do Linfonodo Gigante/complicações , Doença Celíaca/complicações , Fígado/patologia , Doenças Orbitárias/complicações , Xantomatose/complicações , Adulto , Hiperplasia do Linfonodo Gigante/patologia , Hiperplasia do Linfonodo Gigante/cirurgia , Dilatação Patológica , Humanos , MasculinoRESUMO
In order to have knowledge on the histopatologic characteristics of the HCV infections in our geographical area and its relation with some epidemiologic variables, a serie of 54 biopsias of Anti HCV (R) patients was analized. The histologic lesions found in this study correspond mostly to patients with relatively early infections, on the contrary to other studies of the some kind. The most frequent histopathologic diagnosis were crhonic hepatitis 38/54 (70.4 percent), steatosis 4/54 (7.4 percent) and 12/54 (22.2 percent) with no changes. The presence of lymphoid follicles in the portal tracts was the most frequent histological change in this series (66.7 percent), followed by the alteration in bile ducts (53.7 percent); they occurred in a significally higher proportion in the biopsies which had a diagnosis of chronic hepatitis (p=0.02) (p=0.000002). The presence of steatosis and acidophilic bodies in the acinus were found in nearly one third of the biopsies. This findings suggest that the hepatic damage in the anti HCV reactive patients might take through inmunologic mechanisms and citopatic direct action. It was not found that histologic changes produced by HCV might differ according to epidemiologic variables (post-tranfutional, drug abuse IV and sporadic).
Assuntos
Adulto , Pessoa de Meia-Idade , Feminino , Humanos , Hepatite C/patologia , Fígado/patologia , Argentina/epidemiologia , Biópsia , Distribuição de Qui-Quadrado , Fatores Epidemiológicos , Anticorpos Anti-Hepatite C/sangue , Hepatite C/epidemiologiaRESUMO
In order to have knowledge on the histopatologic characteristics of the HCV infections in our geographical area and its relation with some epidemiologic variables, a serie of 54 biopsias of Anti HCV (R) patients was analized. The histologic lesions found in this study correspond mostly to patients with relatively early infections, on the contrary to other studies of the some kind. The most frequent histopathologic diagnosis were crhonic hepatitis 38/54 (70.4 percent), steatosis 4/54 (7.4 percent) and 12/54 (22.2 percent) with no changes. The presence of lymphoid follicles in the portal tracts was the most frequent histological change in this series (66.7 percent), followed by the alteration in bile ducts (53.7 percent); they occurred in a significally higher proportion in the biopsies which had a diagnosis of chronic hepatitis (p=0.02) (p=0.000002). The presence of steatosis and acidophilic bodies in the acinus were found in nearly one third of the biopsies. This findings suggest that the hepatic damage in the anti HCV reactive patients might take through inmunologic mechanisms and citopatic direct action. It was not found that histologic changes produced by HCV might differ according to epidemiologic variables (post-tranfutional, drug abuse IV and sporadic). (AU)
Assuntos
Adulto , Pessoa de Meia-Idade , Feminino , Humanos , Fígado/patologia , Hepatite C/patologia , Anticorpos Anti-Hepatite C/sangue , Fatores Epidemiológicos , Biópsia , Distribuição de Qui-Quadrado , Hepatite C/epidemiologia , Argentina/epidemiologiaRESUMO
In order to have knowledge on the histopathologic characteristics of the HCV infections in our geographical area and its relation with some epidemiologic variables, a series of 54 biopsies of Anti HCV (R) patients was analyzed. The histologic lesions found in this study correspond mostly to patients with relatively early infections, on the contrary to other studies of the some kind. The most frequent histopathologic diagnosis were chronic hepatitis 38/54 (70.4%), steatosis 4/54 (7.4%) and 12/54 (22.2%) with no changes. The presence of lymphoid follicles in the portal tracts was the most frequent histological change in this series (66.7%), followed by the alteration in bile ducts (53.7%); they occurred in a significantly higher proportion in the biopsies which had a diagnosis of chronic hepatitis (p = 0.02) (p = 0.000002). The presence of steatosis and acidophilic bodies in the acinus were found in nearly one third of the biopsies. This findings suggest that the hepatic damage in the anti HCV reactive patients might take place through immunologic mechanisms and cytopathic direct action. It was not found that histologic changes produced by HCV might differ according to epidemiologic variables (post-transfusional, drug abuse i.v. and sporadic).
Assuntos
Anticorpos Anti-Hepatite C/sangue , Hepatite C/patologia , Fígado/patologia , Adulto , Biópsia , Fatores Epidemiológicos , Feminino , Hepatite C/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos SoroepidemiológicosRESUMO
The aim of this prospectively designed study is to analyse the prevalence of HBV and HCV infections in 115 chronic alcohol abusers, their relation to epidemiological variables, and their meaning in pathogenesis and severity of alcoholic liver injury. A prevalence of 13.9% anti-HBc and 20.0% anti-HCV reactivity (EIA II) were found, significantly higher that found in blood donors (3.75 and 0.65% respectively). It is striking our finding of 69.6% "sporadic" type of HCV infection. Histological diagnostic of chronic hepatitis was done in 3 cases, all of them reactive to anti-HCV, enhancing the ethiologic role of HCV in the so called "alcoholic chronic hepatitis". No differences in histological final diagnosis were found related to HBV and HCV markers reactivity, suggesting no clear influence of viral infections on the severity of liver damage in alcoholics in our series. Neither anti-HCV positivity ratio seemed have to influence on these results. Despite a high prevalence of HBV and HCV infection in chronic alcohol abusers, our finding suggest no clear role for them in histological damage.
Assuntos
Hepatite B/epidemiologia , Hepatite C/epidemiologia , Hepatite Alcoólica/epidemiologia , Hepatopatias Alcoólicas/epidemiologia , Adolescente , Adulto , Idoso , Argentina/epidemiologia , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Feminino , Hepatite B/sangue , Hepatite B/complicações , Hepatite C/sangue , Hepatite C/complicações , Hepatite Alcoólica/sangue , Hepatite Alcoólica/complicações , Hepatite Alcoólica/patologia , Humanos , Hepatopatias Alcoólicas/complicações , Hepatopatias Alcoólicas/patologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos ProspectivosRESUMO
Se presenta un estudio prospectivo sobre 115 alcohólicos crónicos destinado a conocer la prevalencia de marcadores séricos de virus de hepatitis B y C (HBV) (HCV) en ese tipo de pacientes, la asociación de las infecciones por HBV y HCV con diversas variables epidemiológicas y la influencia de esos virus sobre el grado de lesión hepatica. Se halló una prevalencia de marcadores de HBV del 13.9 por ciento de Anti HCV del 20.0 por ciento ambas significativamente mayores a las de los donantes de sangre. La alta prevalencia de Anti HCV en esta serie de alcohólicos, con un 69.6 por ciento de formas espor dicas de infección, resulta difícil de justificar. El diagnóstico histológico de hepatitis crónica (HC) realizado en 3 de los 115 pacientes estudiados, recayó la totalidad de las veces sobre pacientes Anti HCV (R), demonstrando una clara asociación de las HC con el HCV en los alcohólicos crónicos. Con respecto a los otros diagnósticos histológicos, no se halló diferencias entre los pacientes con sueros reactivos para algún marcador del HBV o para el Anti HCV y aquellos con sueros no reactivos; sugiriendo que el HBV y el HCV no influyen en el grado de lesión hep tica de los alcohólicos crónicos. No hallamos que la relación de positividad del Anti HCV en los 23 pacientes fuera diferente según los distintos diagnósticos histopatológicos. Tampoco apreciamos en esta serie, que la cirrosis acurriera mas tempranamente en los Anti HCV R que en los NR; discrepando con algunas comunicaciones recientes.
Assuntos
Adulto , Pessoa de Meia-Idade , Feminino , Humanos , Adolescente , Hepacivirus , Vírus da Hepatite B , Hepatite Alcoólica/epidemiologia , Hepatopatias Alcoólicas/epidemiologia , Argentina/epidemiologia , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Hepatite Alcoólica/sangue , Hepatite Alcoólica/patologia , Hepatopatias Alcoólicas/patologia , Prevalência , Estudos ProspectivosRESUMO
Se presenta un estudio prospectivo sobre 115 alcohólicos crónicos destinado a conocer la prevalencia de marcadores séricos de virus de hepatitis B y C (HBV) (HCV) en ese tipo de pacientes, la asociación de las infecciones por HBV y HCV con diversas variables epidemiológicas y la influencia de esos virus sobre el grado de lesión hepatica. Se halló una prevalencia de marcadores de HBV del 13.9 por ciento de Anti HCV del 20.0 por ciento ambas significativamente mayores a las de los donantes de sangre. La alta prevalencia de Anti HCV en esta serie de alcohólicos, con un 69.6 por ciento de formas espor dicas de infección, resulta difícil de justificar. El diagnóstico histológico de hepatitis crónica (HC) realizado en 3 de los 115 pacientes estudiados, recayó la totalidad de las veces sobre pacientes Anti HCV (R), demonstrando una clara asociación de las HC con el HCV en los alcohólicos crónicos. Con respecto a los otros diagnósticos histológicos, no se halló diferencias entre los pacientes con sueros reactivos para algún marcador del HBV o para el Anti HCV y aquellos con sueros no reactivos; sugiriendo que el HBV y el HCV no influyen en el grado de lesión hep tica de los alcohólicos crónicos. No hallamos que la relación de positividad del Anti HCV en los 23 pacientes fuera diferente según los distintos diagnósticos histopatológicos. Tampoco apreciamos en esta serie, que la cirrosis acurriera mas tempranamente en los Anti HCV R que en los NR; discrepando con algunas comunicaciones recientes. (AU)
Assuntos
Adulto , Pessoa de Meia-Idade , Idoso , Feminino , Humanos , Estudo Comparativo , Adolescente , Hepatopatias Alcoólicas/epidemiologia , Hepacivirus , Hepatite Alcoólica/epidemiologia , Vírus da Hepatite B , Prevalência , Estudos Prospectivos , Distribuição de Qui-Quadrado , Biomarcadores/sangue , Argentina/epidemiologia , Hepatite Alcoólica/patologia , Hepatite Alcoólica/sangue , Hepatopatias Alcoólicas/patologiaRESUMO
Data from 219 hemodyalized patients receiving attention in our Hospital and other private centers in our city are shown. Mean age was 46.9 (range: 14-85), and 132 were male; mean time under dialysis was 20 months, and subjects received an average of 5 transfusions per patient year. Serological reactivity to HBs Ag, Anti HBs and IgG anti HBc by ELISA were investigated in all of them, and anti HCV by second generation enzimo-immunoassay (EIA II) in 73 HBe Ag/anti HBe system were determined in HBs Ag positive patients and those reactive to anti HCV (EIA II) were confirmed by LIA (immunoblotting of synthetic peptides LIA-TEK Organos Teknica). Recombinant anti HBV vaccine 40 mcg at 0-1 and six month were received by 81 cases without HBV markers in their sera and a protective response was considered when anti HBs titration of 10 mU/ml or more were obtained two months later. Prevalence for anti HBc and anti HBs were 38.8% respectively and that for HBs Ag was 21% with 78% of them reactive for HBs Ag. True reactivity for anti HCV (confirmed by LIA) was present in 35.6%, but it was 9.7% in our Hospital and 54.8% in private units (p < 0.0002). Anti HBs titration was done in 69/81 patients who received anti HBV vaccine, and a protective response in 49% were obtained; the other 12 patients underwent acute hepatitis B during the vaccination period.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Vacinas contra Hepatite B , Hepatite B/prevenção & controle , Hepatite C/prevenção & controle , Diálise Renal/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hepatite B/epidemiologia , Hepatite B/transmissão , Anticorpos Anti-Hepatite B/sangue , Antígenos da Hepatite B/sangue , Hepatite C/epidemiologia , Hepatite C/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Reação TransfusionalRESUMO
La infección por virus de hepatitis B (HBC) y C (HCV) en hemodializados es elevada, y genera problemas epidemiológicos, aumento de la morbilidad y menores expectativas de éxito para el transplante renal; de hecho, la vacunación anti HBV es una indicación racional para este grupo de pacientes, aunque su respuesta es variable. En esta comunciación se analiza el impacto de esta problemática en nuestro medio. Se presentan 219 pacientes (132 del sexo masculino) hemodializados en nuestro hospital y unidades privadas de nuestra ciudad, con edad media de 46,9 años (R=14-85); la media de permanencia en diálisis fue de 20 meses, y la de transfusiones de 5 por ciento/años. En todos los casos se investigó por enzimo-inmunoanálisis (EIA) la presencia en suero de HBs Ag, anti HBs y anti HBc, y en 73 pacientes anti HCV por EIA II; en los casos HBs Ag positivos confirmados se determinó HBe Ag y HBe, y los anti HCV reactivos fueron confirmados por immunobloting de Péptidos Sintéticos LIA-TEK Organon Teknika. Recibieron 40 mcg de vacuna anti HBC recombinante intra deltoidea a 0,1 y 6 meses, 81 pacientes sin marcadores HBC en suero; la respuesta anti HBstitulada dos meses depués de la última dosis fue considerada protectora con títulos superiores a 10µ/ml. La prevalencia de anti HBc y anti HBs fue de 38 por ciento y la de HBs Ag de 21 por ciento; 78 por ciento de los evaluados resultaron reactivos a HBe Ag. La reactividad anti HCV se presentó en 35.6 por ciento, confirmada por LIA (9,7 por ciento en nuestro hospital y 54,8 por unidades privadas con p=0.007). Se halló niveles superiores a 10 mu/ml de anti HBs en 49 por ciento vacunados en los que se tituló el mismo. Los 12 casos restantes (14,8 por ciento) experimentaron hepatitis aguda B durante el período de vacunación...
Assuntos
Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Diálise Renal/efeitos adversos , Vacinas contra Hepatite B/uso terapêutico , Hepatite B/prevenção & controle , Hepatite C/prevenção & controle , Idoso de 80 Anos ou mais , Antígenos da Hepatite B/sangue , Fatores Epidemiológicos , Anticorpos Anti-Hepatite B/sangue , Hepatite B/epidemiologia , Hepatite B/transmissão , Hepatite C/epidemiologia , Hepatite C/transmissão , Biomarcadores/sangue , Prevalência , Fatores de Tempo , Transfusão de Sangue/efeitos adversosRESUMO
Data from 219 hemodyalized patients receiving attention in our Hospital and other private centers in our city are shown. Mean age was 46.9 (range: 14-85), and 132 were male; mean time under dialysis was 20 months, and subjects received an average of 5 transfusions per patient year. Serological reactivity to HBs Ag, Anti HBs and IgG anti HBc by ELISA were investigated in all of them, and anti HCV by second generation enzimo-immunoassay (EIA II) in 73 HBe Ag/anti HBe system were determined in HBs Ag positive patients and those reactive to anti HCV (EIA II) were confirmed by LIA (immunoblotting of synthetic peptides LIA-TEK Organos Teknica). Recombinant anti HBV vaccine 40 mcg at 0-1 and six month were received by 81 cases without HBV markers in their sera and a protective response was considered when anti HBs titration of 10 mU/ml or more were obtained two months later. Prevalence for anti HBc and anti HBs were 38.8
respectively and that for HBs Ag was 21
with 78
of them reactive for HBs Ag. True reactivity for anti HCV (confirmed by LIA) was present in 35.6
, but it was 9.7
in our Hospital and 54.8
in private units (p < 0.0002). Anti HBs titration was done in 69/81 patients who received anti HBV vaccine, and a protective response in 49
were obtained; the other 12 patients underwent acute hepatitis B during the vaccination period.(ABSTRACT TRUNCATED AT 250 WORDS)