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... ribavirina en un paciente con hepatitis C crónica con viremia indetectable Bernardo Frider,* María Eugenia Buonsante,** Jorge Tiscornia,** Analía Alessio,* Graciela Pellerano ** Acta Gastroenterol Latinoam 2006;36:38-41 ... 21.... more
... ribavirina en un paciente con hepatitis C crónica con viremia indetectable Bernardo Frider,* María Eugenia Buonsante,** Jorge Tiscornia,** Analía Alessio,* Graciela Pellerano ** Acta Gastroenterol Latinoam 2006;36:38-41 ... 21. Castillo I, Rodriguez-Inigo E, Bartolome J, et al. ...
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A case of cholestasis due to a synchronous pancreatic head metastasis from an occult lobular breast carcinoma is presented. The patient had a clinical and radiological picture compatible with a pancreatic head primary tumor with... more
A case of cholestasis due to a synchronous pancreatic head metastasis from an occult lobular breast carcinoma is presented. The patient had a clinical and radiological picture compatible with a pancreatic head primary tumor with cholestasis and ascites. Ultrasonographically guided fine needle aspiration cytology demonstrated a metastatic breast lobular cancer (positive for cytokeratin AE1 and AE3, cytokeratin 7 and epithelial membrane antigen and negative for cytokeratin 20, CA 19.9, CA 125, CEA and estrogenic receptors). The same cytologic findings were observed in skin and subcutaneous armpit nodules. Clinical and radiological breast examination was unable to demonstrate any tumor in the breast. Pancreatic metastases are rare events and the majority of them are secondary to renal and lung cancer and rarely to breast cancer. In these latter cases, metastases are usually disclosed after a disease-free interval of months or years between primary tumor resection and recognition of the...
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Ultrasonography offers rich information of the gallbladders wall and its contents. Its high sensibility and specificity depends of the type of pathology. Its impossible to pretend an echographic histologic diagnosis but the sensibility of... more
Ultrasonography offers rich information of the gallbladders wall and its contents. Its high sensibility and specificity depends of the type of pathology. Its impossible to pretend an echographic histologic diagnosis but the sensibility of this method to reveal macroscopic alterations that correspond with anatomic macroscopic pathology is of sufficient hierarchy to induce a precocious surgical exploration. 85 cases of non lithiasis pathology of the gallbladder is presented. They were found in a revision of 2831 hepatobiliary echographic studies. A correlation with surgery and other methods with the ultrasonographic finding is made.
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The IgG4-related sclerosing disease is characterized by the presence of plasmatic IgG4 positive cells and T-lymphocytes infiltration in different organs. We herein report a case of cholestasis due to autoimmune cholangitis associated to... more
The IgG4-related sclerosing disease is characterized by the presence of plasmatic IgG4 positive cells and T-lymphocytes infiltration in different organs. We herein report a case of cholestasis due to autoimmune cholangitis associated to IgG4 disease. A 40-year-old woman with a history of pruritus, anosmia, Sjögren's syndrome and diabetes, was referred for a pancreatic tumor. Alkaline phosphatase was 24-fold upper limit of normal (ULN), gamma-glutamyl transpeptidase 21-fold ULN, aspartate aminotransferase 3-fold ULN, alanine aminotransferase 2-fold ULN, cholesterol 408 mg/dL, bilirubin normal, gamma-globulin 3.92 g/dL, IgG4 4.6 g/L, antinuclear antibody positive (1/320), and antimitochondrial antibodies negative. Ultrasound scan (US) showed a mass in the pancreatic head and thickening of the gallbladder and the bile duct walls. Dilation and strictures of the main pancreatic duct and intrahepatic bile ducts were detected by MR cholangiopancreatography. Liver biopsy showed chronic ...
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The aim of this work was to evaluate the diagnostic reliability of fine needle cytology guided by ultrasonography in hepatic masses. One hundred and fifty nine patients underwent this procedure. The final diagnosis was confirmed by... more
The aim of this work was to evaluate the diagnostic reliability of fine needle cytology guided by ultrasonography in hepatic masses. One hundred and fifty nine patients underwent this procedure. The final diagnosis was confirmed by histology obtained by percutaneous biopsy, surgery, laparoscopy and necropsy or adequate clinical follow-up in 139 cases. Twenty cases were excluded since no final diagnosis was available. In 102 cases the method was applied on an outpatient basis, while the remainder were hospitalized. There were 9 (6.4%) false negatives, whose final diagnosis were hepatocarcinoma in 4, adenocarcinoma in 3, cholangiocarcinoma in 1 and in a non Hodgkin lymphoma. The global sensitivity of the method was 93.5%, the specificity 100% and the efficiency 93.5%. In hepatocarcinomas the sensitivity was 73.3%, the specificity 100% and the efficiency 73.3%. In metastatic adenocarcinomas the sensitivity was 96.2%, the specificity 100% and the efficiency 73.3%. Except for a single he...
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To study the acute variations in portal and systemic hemodynamics after propranolol and 5-isosorbide mononitrate (IMN) administration in cirrhotic patients. Seventeen cirrhotic patients with portal hypertension were studied with... more
To study the acute variations in portal and systemic hemodynamics after propranolol and 5-isosorbide mononitrate (IMN) administration in cirrhotic patients. Seventeen cirrhotic patients with portal hypertension were studied with catheterization and Doppler duplex Ultrasound Systemic hemodynamics. Hepatic venous pressure gradient (HVPG), portal blood flow and resistance were evaluated in baseline, after intravenous propranolol (0.15 mg/kg), and after 20 mg p.o. of IMN. Patients who showed a decrease > or = 20% and/or < 12 mm/hg in HVPG were considered responders. There were no significant differences in clinical or portal hemodynamic baseline data between responders and non-responders to the drugs. After propranolol administration cardiac index decreased (p < 0.05) and pulmonary capillary pressure increased (p < 0.0001). Six patients (35%) were responders; lack of response was associated with an insufficient decrease in portal blood flow or with an increase in portal resi...
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Sarcoidosis is a multisystemic granulomatous disorder of unknown etiology that most commonly affects young adults. A probable induction of sarcoidosis by interferons (IFN) has been published. To this date, few cases of cutaneous... more
Sarcoidosis is a multisystemic granulomatous disorder of unknown etiology that most commonly affects young adults. A probable induction of sarcoidosis by interferons (IFN) has been published. To this date, few cases of cutaneous sarcoidosis inpatients with chronic hepatitis C under interferon treatment have been reported. We describe a 50-year-old woman with chronic hepatitis C who developed lesions of cutaneous sarcoidosis three months after IFN treatment. The possible role of INF therapy in the development of cutaneous sarcoidosis in a patient with chronic hepatitis C should be considered.
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To analyze the changes in portal pressure, blood flow and resistance after propranolol administration, and to assess the predictive value of the variations of Doppler Duplex Ultrasonography (DDU) measurements according to the response of... more
To analyze the changes in portal pressure, blood flow and resistance after propranolol administration, and to assess the predictive value of the variations of Doppler Duplex Ultrasonography (DDU) measurements according to the response of the hepatic venous pressure gradient (HVPG). 30 cirrhotic patients were studied. Assessment of systemic hemodynamics and HVPG were performed in baseline and after intravenous propranolol administration (0.15 mg/kg). Patients who showed a decrease > or = 20% &/or < 12 mm/Hg in HVPG were considered responders. The DDU study was performed in blind conditions, in baseline and after propranolol. Measurement of blood flow of the portal vein, splenic vein and femoral artery were performed. Portal resistance was calculated as HVPG/portal blood flow. All patients were beta blocked and 14 (47%) were responders. There were no significant differences in systemic or splachnic hemodynamic baseline data between responders and non responders. Femoral blood fl...
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Our aim was to identify prospectively, with a case-control survey, risk factors for hepatitis C virus (HCV) infection in volunteer blood donors and to assess the histological features and their correlation with transaminase (ALT) level... more
Our aim was to identify prospectively, with a case-control survey, risk factors for hepatitis C virus (HCV) infection in volunteer blood donors and to assess the histological features and their correlation with transaminase (ALT) level and viremia. In a Liver Unit of a referral-based University Hospital, 248 blood donors were evaluated for risk factors, according to definitive ELISA test and 132 were considered true positive. Of these, 132 anti-HCV(+) blood donors were age and sex-matched with the anti-HCV-negative group (n = 116). There was a high frequency in the anti-HCV(+) group of intravenous drug abuse (IVDA) (22%), history of major surgery (20.4%), tattooing (12.1%), non IVDA (17.4%), and multiple sexual partners or history of sexual transmitted diseases (25.7%). At least one risk factor was identified in 76.52% of the antiHCV(+) donors vs 34.4% in the anti-HCV (-) group (p = 0.000). A total of 71 patients accepted a liver biopsy; chronic liver disease was present in 85.9% (n...
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The risk of HBV and HCV liver infection in kidney graft recipients was evaluated in 35 patients. All were tested for anti-HBc, HBsAg, HBeAg, anti-HBs, Anti-HBe, anti-HCV (c-100-3 and c-100-3, c-22, 33-c), anti-HDV and anti-HIV by ELISA,... more
The risk of HBV and HCV liver infection in kidney graft recipients was evaluated in 35 patients. All were tested for anti-HBc, HBsAg, HBeAg, anti-HBs, Anti-HBe, anti-HCV (c-100-3 and c-100-3, c-22, 33-c), anti-HDV and anti-HIV by ELISA, and for HBV-DNA by hybridization. Liver biopsy, immunostaining for HBcAg and Knodell's hepatic inflammatory index were performed in 18. Mean time elapsing form transplant to inclusion was 20.7 months (range 1-108). HBsAg was the only marker searched for prior to transplant. Twenty six (74.2%) patients presented HBV and/or HCV markers, while 9 (25.8%) had none; 16 (45%) proved anti-HBc+, 6(17.1%) HBsAg+, (3 HBeAg+ and 3 anti-HBe+), 7 (20%) anti-HBs+ and 3 (8.5%) isolated anti-HBc. Anti-HCV (C-100-3) was positive in 9/32 (28.1%), while 2nd. generation anti-HCV was positive in 20/35 (57.1%) cases. No false positives for 1st. generation test were found. Both anti-HDV and anti-HIV were negative in all the sample. Raised aminotransferases were present ...
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A prospective study on biliary and pancreatic obstruction during gallstone migration was performed in patients without acute pancreatitis. From January to October 1986, 125 patients with upper abdominal pain due to cholelithiasis were... more
A prospective study on biliary and pancreatic obstruction during gallstone migration was performed in patients without acute pancreatitis. From January to October 1986, 125 patients with upper abdominal pain due to cholelithiasis were admitted to the hospital. Ultrasonography performed in all patients at admission demonstrated a distal bile duct measuring 7 mm or more in 39 patients, who were monitored for diameter changes of the biliary and pancreatic duct every 24 h and their stools screened for gallstones. Patients underwent surgery at least 8 days after admission. Gallstone migration was found preoperatively in 10 patients, of whom 6 had total serum bilirubin values lower than 2 mg/100 ml. Migration time was accurately determined by the sudden decrease in bile duct caliber. Simultaneous dilatation of biliary and pancreatic duct was found in 4 out of 10 patients with migrating gallstones and in 7 out of 23 patients without gallstone migration, though differences proved non-signif...
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Until a short time ago, hydatidosis was considered a pathology that could only be resolved surgically. However, in recent years progress has been made with the epidemiology, diagnosis, and treatment of the disease, and new information on... more
Until a short time ago, hydatidosis was considered a pathology that could only be resolved surgically. However, in recent years progress has been made with the epidemiology, diagnosis, and treatment of the disease, and new information on the natural history of hydatidosis has helped define new criteria for its treatment. It is now known that as many as 67% of the carriers of liver cysts who are asymptomatic remain so throughout their lives. This situation produces special results in immunologic testing. Enzyme-linked immunosorbent assay (ELISA) has a sensitivity of 63% and a specificity of 97% with asymptomatic carriers, while the double diffusion arc 5 test (DD5) achieves a sensitivity of only 31% with the same population. On the other hand, imaging studies based on ultrasonography have become the method of choice to detect asymptomatic carriers. Ultrasonography studies are 49% to 73% more sensitive than serological tests, and they can even be used as a part of epidemiological surv...
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The usefulness of ultrasonography (US) in the early diagnosis of hydatidosis, applied in large-scale surveys to populations lacking clinical symptoms of the disease, has been amply documented. However, the rate of false positive and... more
The usefulness of ultrasonography (US) in the early diagnosis of hydatidosis, applied in large-scale surveys to populations lacking clinical symptoms of the disease, has been amply documented. However, the rate of false positive and negative results is poorly described. Due to this, the present paper is aimed to evaluate the sensitivity, specificity and predictive value of a conventional rural ultrasonographic survey in comparison with higher imaging complexity. Accordingly, during 1997 and 1998 a total of 1054 children from 7 to 14 years of age were evaluated by means of US, in the town of Ingeniero Jacobacci, Province of Rio Negro, Argentina, employing a portable device for population studies. All detected cases were referred to a high complexity center specialized in imaging diagnosis for their re-evaluation with US, CT scanning and X-rays. A control group comprising 3 children negative by US for each positive case in the mass screening survey was selected and reexamined by US an...
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The aim of this work was to assess if the diversity of hepatitis C virus (HCV) quasispecies is related to histological severity and duration of infection in a cohort of untreated patients with an estimated onset of the disease. A total of... more
The aim of this work was to assess if the diversity of hepatitis C virus (HCV) quasispecies is related to histological severity and duration of infection in a cohort of untreated patients with an estimated onset of the disease. A total of 27 patients with diagnosis of chronic liver disease and history of blood transfusion (n = 16) or intravenous drug use (IDU) (n = 11) were included. All were anti-HCV positive and had detectable serum HCV-RNA. The onset and the duration of the disease were estimated from the time of the transfusion or the first drug injection. Patients who consumed drugs for more than 2 years, or were coinfected with HBV or HIV were excluded. History of alcohol intake (> 80 g/day), ALT level and age at infection were recorded. Histological assessment of grading and staging was performed according to Knodell score. The quasispecies diversity was investigated by single strand conformation polymorphism (SSCP) targeted to HVR-E2 region and SSCP pattern was evaluated ...
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Our aim was to investigate if interferon plus ribavirin has any effect on serum HCV quasispecies distribution and the relationship between diversity of HCV quasispecies and treatment response. In all, 21 patients were treated with... more
Our aim was to investigate if interferon plus ribavirin has any effect on serum HCV quasispecies distribution and the relationship between diversity of HCV quasispecies and treatment response. In all, 21 patients were treated with interferon plus ribavirin for 48 weeks. The presence of HCV quasispecies was determined in serum samples at baseline and at the fourth week of treatment by SSCP analysis of the hypervariable region. SSCP pattern was defined as single or multiple band. A single band was found in six patients and multiple bands in nine. No significant difference was found between SSCP pattern in pretreatment samples and response to the therapy. In none of the patients were observed changes in number of SSCP bands between samples taken at baseline and in the fourth week of the therapy. In conclusion, the complexity of HCV quasispecies before the therapy was not related to treatment response; combined therapy did not affect serum HCV quasispecies.
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TO THE EDITOR: Noncirrhotic portal fibrosis (NCPF), also called portal idiopathic hypertension or hepatoportal esclerosis represents from 2.5% to 3% of portal hypertension (PH) cases and has been associated with ingestion of vinyl... more
TO THE EDITOR: Noncirrhotic portal fibrosis (NCPF), also called portal idiopathic hypertension or hepatoportal esclerosis represents from 2.5% to 3% of portal hypertension (PH) cases and has been associated with ingestion of vinyl chloride, cooper sulfate, vitamin A abuse, and ...
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... Both drugs were shown to be active, when used in single doses of 0.2 to 0.5 mg/kg of ivermec-tin, or 26 mg/kg for levamizole. ... MH: STAPLEY , EO; ALBERSSCH Ü NBERG , G. &amp;amp;amp; JACOB . T A. Ivermec tin: a potent new... more
... Both drugs were shown to be active, when used in single doses of 0.2 to 0.5 mg/kg of ivermec-tin, or 26 mg/kg for levamizole. ... MH: STAPLEY , EO; ALBERSSCH Ü NBERG , G. &amp;amp;amp; JACOB . T A. Ivermec tin: a potent new antiparasitic agent Science, 221: 823 828. 1983. ...
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Hepatitis E virus (HEV) has been identified in 2 Argentine patients with acute hepatitis who reported no history of travel to regions in which HEV is considered endemic. These isolates are the first to be identified in South America. By... more
Hepatitis E virus (HEV) has been identified in 2 Argentine patients with acute hepatitis who reported no history of travel to regions in which HEV is considered endemic. These isolates are the first to be identified in South America. By use of degenerate primers from open reading frames 1 and 2, HEV sequences were obtained from these patients&#39; serum and compared with published HEV sequences. The Argentine isolates are different from all previously identified HEV isolates and are most closely related to each other. The Argentine isolates are distinct from the most geographically related isolate from Mexico as well as isolates from other endemic (China, Southeast Asia, and India) and nonendemic (the United States and Europe) regions. Phylogenetic analysis indicate that the Argentine isolates represent a new genotype of HEV, genotype 8, distinct from the Burmese-like genotype 1, Mexican genotype 2, US genotype 3, Chinese/Taiwan genotype 4, and European genotypes 5-7.
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Research Interests: Dermatology, Adolescent, Hepatitis C, Hepatology, Prospective studies, and 15 moreHumans, Child, Female, Male, Hepatitis C Virus, Psoriasis, Clinical Sciences, Aged, Prevalence, Middle Aged, Adult, Public health systems and services research, hepatitis E, Enzyme Linked Immunosorbent Assay, and Transaminases
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... The title proverb, When Greek meets Greek, then comes the tug-of-war, is from the novel The Ri-val Queens by Nathaniel Lee (1655 ... Photographs of this case (patient 1) along with the history of perilesional bulla and subsequent... more
... The title proverb, When Greek meets Greek, then comes the tug-of-war, is from the novel The Ri-val Queens by Nathaniel Lee (1655 ... Photographs of this case (patient 1) along with the history of perilesional bulla and subsequent milia for-mation suggest a diagnosis of Bart ...
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In areas where human cystic echinococcosis (CE) is endemic, the results of ultrasonographic or X-ray examinations have revealed a surprisingly high prevalence of abdominal cysts in asymptomatic individuals. The results of preliminary... more
In areas where human cystic echinococcosis (CE) is endemic, the results of ultrasonographic or X-ray examinations have revealed a surprisingly high prevalence of abdominal cysts in asymptomatic individuals. The results of preliminary studies indicate that the ratio of liver infection:lung infection (LI:LU) is much higher in the asymptomatic individuals (9:1 or 7:1) than is usual among symptomatic cases of liver CE (2:1). This difference may indicate that, compared with lung cysts, liver cysts rarely cause morbidity, perhaps because they grow at a slower rate than those in the lungs. In an attempt to explore this possibility, the published results of ultrasonographic and radiological surveys on general populations and the records of autopsies and hospital-based investigations of symptomatic cases of liver CE were reviewed. In general populations, the overall prevalence of cysts in the liver (2.5%) was found to be much higher than that of cysts in the lungs (0.3%), giving a LI:LU ratio of 8.3:1. In the symptomatic cases, however, LI:LU ratios were only 2.5:1 (based on hospital records) or 4.1:1 (based on autopsy records). In addition, the estimated mean growth rate of the cysts in 53 surgical cases of CE from the province of Río Negro in Argentina was found to be significantly higher than that of the cysts in 89 asymptomatic cases detected during ultrasonographic surveys in the same area.
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Ultrasonography (US) and serology (double diffusion for antigen 5 (dd5] were used for the screening of hydatid disease in 1,418 asymptomatic individuals from two provinces in Argentina. A total of 122 positive subjects were identified and... more
Ultrasonography (US) and serology (double diffusion for antigen 5 (dd5] were used for the screening of hydatid disease in 1,418 asymptomatic individuals from two provinces in Argentina. A total of 122 positive subjects were identified and in 120 of them lesions consistent with hydatid disease were observed at US (98.4%) while only 19 had positive dd5 tests (15.8%). Chest radiography was performed in 647 of the subjects and an additional 4 lesions were found. Surgery was performed in 32 patients, confirming in all of them the sonographic diagnosis. It is suggested that US should be used in the screening for hydatidosis in high-risk populations as well as in follow-up programmes.