A. López San Román

Toxicidad hepática recurrente secundaria a metilprednisolona intravenosa

Adverse drug reactions (hepatotoxicity) are a frequent cause of acute liver injury with a wide clinical and histological spectrum. An early recognition of drug-related liver disease has been considered essential in clinical practice due to potential risks. In most cases exposure discontinuation improves the clinical picture. Steroids are used in a variety of clinical settings. However, in travenous steroids have rarely been associated with hepatotoxici ty. We report the case of a middle-aged woman with multiple scle rosis who received a bolus of methylprednisolone on three occasions for the management of relapsing disease, with the de velopment of repeated episodes of elevated liver enzymes after corticoid administration. In the third episode a liver biopsy was performed, which showed acute hepatitis with bridging necrosis; such histological picture has not been described before in patients treated with intravenous steroids.

Fibrin-glue sealed liver biopsy in patients with a liver transplantation or in liver transplantation waiting list: preliminary results

Liver biopsy is frequently necessary for candidate evaluation or histologic follow-up of transplanted livers. Although generally considered to be safe, it carries a risk of complications in up to 0.5% of cases; hemorrhage being the most important. It can present as an asymptomatic intra- or perihepatic hematoma or result in overt hemorrhage of variable intensity. Patients with deranged hemostasis or on antiaggregant therapy are at high-risk for hemorrhagic complications. Percutaneous liver biopsy may be contraindicated if hemostasis is profoundly disordered. Safety values are not well defined: arbitrary limits are 60% prothrombin activity and 60,000 platelets per mm3. Patients with more altered values are candidates for alternative techniques, such as transjugular biopsy. Another option is the so-called plugged percutaneous liver biopsy, which uses direct injection of a plugging material into the biopsy tract. Different materials have been used: Tissucol, absorbable gelatin sponge, or hemostasis coils. We communicate our experience with Tissucol (fibrin glue) plugging in 30 percutaneous liver biopsies on 16 patients after liver transplantation with prothrombin activity < 60%, platelet count < 60,000 per mm3, or both. Only two complications were observed. Plugged liver biopsy is an efficient and relatively safe procedure in patients with impaired hemostasis; it can be performed even when transjugular biopsy is not available.

[A prospective study about the usefulness of ultrasonographic monitoring after invasive liver procedures--liver biopsy and fine-needle aspiration (FNA)].

Objective: to determine the need to perform ultrasound scans to all patients after liver biopsy or fine-needle aspiration (FNA) in order to detect complications with or without symptoms. Material and methods: after liver biopsy or FNA using a regular protocol the patient is observed for 24 hours at the hospital, and all patients undergo an abdominal sonography at that time even in the absence of evident complications. Results: 298 liver biopsies and 98 FNAs were performed. There were complications in 37 patients (9.34%): 36 (9.09%) were minor complications such as pain, vasovagal episodes, or small bleeding, and 1 (0.25%) was a major complication with severe hemorrhage. Only 1 out of all 396 procedures had a complication detected by ultrasounds (intrahepatic hematoma) while the patient was asymptomatic. Conclusions: the low incidence of complications occurring without symptoms, and their favorable course suggest that routine ultrasonography is not necessary after these techniques, and that it should be only performed when a complication is suspected.

Riesgo de transmisión del virus de la hepatitis B de donantes de hígado anti-HBc positivos

Fundamento Estudiar el riesgo de transmitir el virus de la hepatitis B (VHB) a los receptores dehigados de donantes AgHBs negativos y anti-HBc positivos. Pacientes y metodo Se han analizado retrospectivamente los marcadores sericos del VHB (MHB) (AgHBs, anti-HBc y anti-HBs) de 43 donantes, junto con los 41 receptores de estos organos. La determinacion de MHB se realizo por ELISA, y el ADN del VHB por tecnica de hibridacion molecular. Resultados Trece sueros de donantes (30,2%) presentaron algun MHB: 6 anti-HBc y anti-HBs(13,9%), 4 anti-HBc (9%) y tres anti-HBs (6,9%). De los receptores que recibieron un injertosin MHB, ninguno desarrollo infeccion despues del trasplante de higado. De los 13 receptores de organos con MHB, 9 han sido controlados durante 39 (DE 17) meses. Los 5 receptores de un injerto anti-HBc positivo, con anti-HBs o sin el, y que no presentaban MHB desarrollaron hepatitis B (100%). Los dos receptores de organos anti-HBs positivos unicamente y sin MHB no desarrollaron infeccion (0%). Entre los receptores 15 tenian algun MHB antes del trasplante de higado (31,7%); 5 de ellos tenian anti-HBs positivo antes del trasplante. Los dos receptores de este grupo que recibieron un injerto anti-HBc positivo no desarrollaron infeccion (0%). Conclusiones En este estudio la prevalencia de MHB entre los donantes y receptores es del 30,2 y del 31,7%, respectivamente. Los injertos anti-HBc positivos con anti-HBs o sin el transmitieronla enfermedad en el 100% de los receptores. La presencia de anti-HBs en el receptor protegio de la infeccion. Los injertos unicamente positivos para anti-HBs no ransmitieron la enfermedad.

Serum alanine aminotransferase (ALT) assay and incidence of posttransfusion non-A,non-B hepatitis.

Wenz B. Apuzzo J . Polyethylene glycol improves the indirect antiglobulin test. Transfusion 1989;29:218-20. Cowan KM. Lysis of sheep erythrocytes by a long-chain polymer, polyethylene glycol, and complement. Baltimore: The Johns Hopkins University School of Hygiene and Public Health, 1954. Dissertation. Grundbacher FJ. Immunohemolysis as a method for quantitation of the A antigen of human erythrocytes. J Immunol 1964;93:205-12. Giblett E, Brookes L. A simple and practical method for concentrating blood group antibodies. Transfusion 1962;2:261-4. Nance SJ, Garratty G. Polyethylene glycol. Am J Clin Pathol 1987:81:633-5.

TASA DE COLECTOMÍA EN UNA COHORTE HISTÓRICA DE COLITIS ULCEROSA

La morbilidad en la colitis ulcerosa (CU) y el tratamiento medico elegido para su control se relaciona directamente con la necesidad de cirugia en el curso de la enfermedad. Objetivo Determinar el riesgo de colectomia en nuestra cohorte historica de pacientes con CU, desde el diagnostico hasta el 31 de Dic 2006 o la muerte. Identificar los factores asociados a cirugia y compararlos con los ptes no intervenidos. Averiguar los cambios de la tasa quirurgica sufridos en el tiempo. Metodos Estudio epidemiologico descriptivo, poblacional, prospectivo. Incluimos 636 (49,25% mujeres) ptes, diagnosticados de CU, en el Area Sanitaria V de Gijon, poblacion 225.798 hab >14 anos. Media de seguimiento en ptes vivos de 12.11 anos y en los 74 ptes muertos de 10,84 anos. Se realiza Test X 2 , exacto de Fisher, Mann-Whitney U,y Kruskal-Wallis para diferencias de sexo,edad,extension,uso de tabaco y otros parametros, entre ptes que requieren cirugia y los que no. Resultados Se intervienen 33 ptes (48,48% mujeres), riesgo acumulado de colectomia: 5,18% (media de seguimiento de ptes operados de 12,90 anos). Entre ptes operados y no operados, no habia ninguna diferencia significativa en la edad al diagnostico (44,66 vs 44,40 anos), tiempo sintomatico previo al diagnostico (11,39 vs 11,66 meses), sexo, Panca+ y ASCA+. El % de ptes no fumadores en el grupo operado vs no operado es de 59,4% vs 51,8%, los ex-fumadores en el grupo operado vs no op es de 25,0% vs 34,1% (p=ns). La duracion de la enfermedad es superior en ptes no op. (3,31 anos vs 11,97 anos) (p Conclusiones Nuestro riesgo de colectomia en CU, es intermedio al descrito para Europa del norte y del sur. La colectomia, solo se asocia con la duracion de la enfermedad, c.extensa y t.de mortalidad. La t. quirurgica no se ha modificado en el tiempo.

Hairy esophagus: una complicación de la cirugía reconstructiva faringoesofágica

La cirugía reconstructiva faringoesofágica con frecuencia precisa el empleo de colgajos miocutáneos para restaurar la anatomía y la función de la zona intervenida. El colgajo cervical dermo-platisma-fascial es un colgajo miocutáneo bien vascularizado y de gran plasticidad, por lo que se utiliza frecuentemente en este tipo de cirugía. Presentamos el caso de un paciente que debutó con disfagia secundaria a crecimiento piloso faríngeo tras el empleo de este tipo de colgajo.