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Current Issue

October - December, 2006

Vol. 5 Issue 4

On the cover: Official Journal of the Mexican Association of Hepatology

HEPATOLOGY HIGHLIGHTS

CONCISE REVIEW

  • Interferon alfa-2b triggers transforming growth factor-β1-induced apoptosis on preneoplastic liver María Cristina Carrillo, María de Luján Álvarez, Ariel Darío Quiroga Page 244-250

    Considerable expectations to prevent hepatocellular carcinoma (HCC) appearance are connected with the use of Interferon α (IFN α) in antiviral treatment of hepatitis B or C. Several studies have reported that the incidence of HCC may be reduced after IFN therapy in patients with chronic B or C hepatitis although its real preventive effect is still debatable. The purpose of the studies from our laboratory was to evaluate the action of IFN α2b on preneoplastic foci in a two-phase model of preneoplasia development in rat. We demonstrated that IFN-α2b administration significantly decreased both number and volume percentage of altered hepatic foci (AHF). This reduction could be explained by an induced programmed cell death in the foci. This apoptotic effect of IFN-α2b on preneoplastic liver foci was mediated by the production of endogenous TGFβ1 from hepatocytes acting by a paracrine/autocrine way. Further studies confirmed that these results were a consequence of the perturbation of the redox status induced by the IFN-α2b. In conclusion, IFN-α2b could enhance the proapoptotic effects of TGFβ1 in early stages of hepatocarcinogenesis, which could be highly beneficial in cancer therapy.

  • Hepatic sarcoidosis Alexandros Karagiannidis, Maria Karavalaki, Anastasios Koulaouzidis Page 251-256

    Sarcoidosis is a multisystem disease of unknown aetiology. Histological evidence of non-caseating granulomas represents the main finding. It affects mostly young people, targeting primary the lung and hilar lymph nodes although liver involvement is often encountered. Hepatic sarcoidosis covers a broad spectrum from asymptomatic hepatic granulomas formation and slightly deranged liver function tests to clinically evident disease with cholestasis or, in advanced cases, cirrhosis and portal hypertension. Other granulomatous diseases (mainly systemic infections like tuberculosis) should be excluded prior to treatment, as longstanding corticosteroid administration is the main stem of therapy. In advanced cases, liver transplantation represents the ultimate therapeutic option.

ORIGINAL ARTICLES

  • Hepatitis C virus infection and non-Hodgkin´s lymphoma: a review and case report of nine patients Javier Lizardi-Cervera, Jorge Luis Poo, Karla Romero-Mora, Beatriz Castañeda, Raúl Pichardo-Bahena, Segundo Morán, Misael Uribe Page 257-262

    The role of hepatitis C virus (HCV) is well established in the development of chronic hepatitis, cirrhosis and hepatic carcinoma, as well as in mixed type II cryoglobulinemia, membranoproliferative glomerulonephritis (MPGN) and porphyria cutanea tarda (PCT). Increasing evidence has been reported of a close association of HCV infection with autoimmune and hematological processes, mainly cytopenias and lymphoproliferative disorders such as B cell non-Hodgkin's lymphoma. We describe the demographic, clinical and histopathological findings of nine patients from the Mexican population with non-Hodgkin's lymphoma and HCV infection.

  • Response of negative estrogen-receptor hepatocarcinoma to tamoxifen, and survival of non-resectable patients Jorge García-Leiva, Armando Gamboa-Domínguez, Tania Ceron-Lizarraga, Daniela Morales-Espinosa, Judith Meza-Junco, Oscar Arrieta Page 263-267

    Hepatocellular carcinoma is the fifth most common malignant neoplasm worldwide. Most patients are not candidates to surgical treatment. The prognosis of this neoplasm is poor, with an overall survival rate of 8 weeks in unresectable tumors. Estrogen receptors have been found in up to 33% of this tumors, reason why treatment with tamoxifen or progesterone compounds have been tried to diminish this neoplasm's progression but its use remains controversial. In our institution, thirteen patients were treated with tamoxifen (20- 40 mg/day) and 26 received supportive measures only. The clinical and tumoral characteristics were similar in both groups. Survival in the Tamoxifen group was of 5.5 ± 1.7 months while in the supportive measures group was of 2.1 ± 0.5 months (p = 0.018). Other factors related to an increased survival were: female gender and the Okuda score; age, TNM and αFP were not related to survival. The multivariate analysis showed that treatment with tamoxifen duplicates survival independently of the tumoral stage and functional hepatic reserve. It seems that the benefit of treatment with tamoxifen is limited and is not associated to the presence of estrogen receptors. In our study a 69 year-old man with diagnosis of non-resectable hepatocellular carcinoma and negative estrogen receptors, was treated with tamoxifen with a partial response and an overall survival of 4 years until November 2005. Despite some case reports that have shown tumoral regression, while other studies do not report any survival benefits. It is important to identify patients that would benefit from treatment with tamoxifen.

  • Phytotherapeutic compound YHK exerts an inhibitory effect on early stage of experimentally-induced neoplastic liver lesions F Marotta, M Harada, KL Goh, A Lorenzetti, F Gelosa, E Minelli Page 268-272

    The aim of this study was to investigate the effects of the herbal compound YHK on hepatocarcinogenesis induced by diethylntrosamine (DEN) in Sprague Dawley rats. Rats were randomly divided into 3 groups and followed up for 15 weeks. Groups 1 was given standard food and represented the healthy control. Liver preneoplastic foci were induced using the DEN method in groups 2 and 3 (20 rats each). However, group 3 was concomitantly given 50mg/kg/day of YHK. For quantitative assessment of liver preneoplastic foci, the placental form of glutathione-S-transferase (GST-P) positive foci were measured using immunohistochemical staining and image analysis. Treatment using DEN caused a significant decrease in body weight and increase in liver weight compared to the control group while concomitant supplementation with YHK prevented body weight loss and liver weight increase. As compared to DENonly treated rats, the group given YHK showed a significant decrease in the number, size and volume of GSTP- positive foci. Moreover, co-administration of YHK significantly reduced the incidence, number, size and volume of hepatocellular carcinoma. Anti-inflammatory, anti-fibrotic as well as antioxidative properties of this compound are mechanisms which are likely to be advocated for to explain its protective effect. It is concluded that herbal compound YHK by preventing hepatocarcinogenesis in DEN-induced liver preneoplastic lesions in rats has the potential to a large clinical application as a functional food.

  • Are there inflammatory changes in the hepatic biopsies of patients with acute cholangitis of lithiasic origin? Manuel Vial Gallardo, Carlos Manterola Delgado, Héctor Losada Morales, Viviana Pineda Nesbet, Adriana Vasconcellos Costa Page 273-275

    Introduction: Acute cholangitis (AC) is a clinical diagnosis entity. A high prevalence of acute inflammatory changes (AIC) are found in hepatic needle biopsies (HB) in these patients. The aim of our study is to determine the prevalence of AIC in HB performed on patients with AC due to biliary stones. Methods: Cross-sectional study. Surgery was performed at the Hospital Regional of Temuco. Patients with Charcot's triad, over 15 years of age, and surgical exploration of common bile duct were included. There was exclusion if periampullary tumor or liver cirrhosis was suspected. Bile macroscopy and hepatic histopathology were determined. A hepatic needle biopsy was taken during surgery. Biopsies were analyzed by two independent pathologist groups and kappa statistics were applied. Results: From January to June, 2002, fifty-three patients (83% female) with a median age of 60.7 years with AC were operated on. We found 83% with pus in the biliary system and 17% with cloudy bile. Histopathology: minimal changes (32%), hepatic steatosis (25%), chronic periportal infiltration (17%), liver cirrhosis (11%), AIC (6%) and normal (9%). Kappa statistics were 0.77. In conclusion a low prevalence of AIC was found in the HB of patients with AC.

  • Risk factors and prevalence of hepatitis virus B and C serum markers among nurses at a tertiary-care hospital in Mexico City, Mexico: a descriptive study Nahum Méndez-Sánchez, Daniel Motola-Kuba, Daniel Zamora-Valdés, Karla Sánchez-Lara, Guadalupe Ponciano-Rodríguez, Martha H. Uribe-Ramos, Francisco Vásquez-Fernández, Jezer Lezama-Mora, Julio A. Pérez-Sosa, Hector A. Baptista-González, Misael Uribe Page 276-280

    Background & aim: Alcohol consumption and viral infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) are the first causes of chronic hepatopathy in Mexico. Medical personnel are at high risk of developing HBV and HCV infection because both viruses are transmitted parenteraly. The aim of this study was to determine the prevalence of HCV and HBV infection as well as risk factors in nurses working at Medica Sur Clinic and Foundation. Methods: The complete nurse staff personal from our hospital was included; a questionnaire of risk factors for HCV and HBV infection was assessed. HBV and HCV infection (anti-HCV anti-HBc, and HBsAg) was determined to all of them. In anti-HCV positive persons HCV genotype and viral load was assessed. Results: Three hundred seventy six nurses where studied, Anti-HBc was positive in 1.6% of all participants, none were positive for HBsAg. 0.8% of all studied population was positive for anti- HCV. Major risk factors for HBV infection where tattooing and having more than 4 sexual partners previously, and for HCV infection transfusions before 1992 and age. Only one person was anti-HCV positive with a viral charge of 5 X 106 copies, genotype 2b. Conclusions: HCV seropositivity in people with high risk was lower than general population. None was positive for HBV infection.

  • Efficacy of oral L-ornithine-L-aspartate in cirrhotic patients with hyperammonemic hepatic encephalopathy. Results of a randomized, lactulose-controlled study Jorge Luis Poo, Julieta Góngora, Francisco Sánchez-Avila, Sergio Aguilar-Castillo, Guillermo García-Ramos, Mario Fernández-Zertuche, Lourdes Rodríguez-Fragoso, Misael Uribe Page 281-288

    Despite steady progress in therapeutics of liver disease, portal systemic encephalopathy remains to be a great challenge for clinicians because of the heterogeneity of neuropsychiatric symptoms, multiple risk factors and complexity on achieving a sustained response. We aimed to evaluate the efficacy of L-Ornithin, L-Aspartate versus lactulose in Mexican patients with hyperammonemic hepatic encephalopathy. A total of 20 patients were randomly allocated to receive either lactulose (n = 10) or L-ornithine - L-aspartate (n = 10) for 2 weeks. At baseline, patients of both groups were comparable in age (64 ± 7 versus 60 ± 6) and degree of hepatic failure according to the Child-Pugh scale (9.2 ± 1.3 versus 9.2 ± 1.1). A significant decrease in ammonia levels was observed both in the lactulose group (120.4 ± 8.1 versus 91.4 ± 10, p < 0.05) and in the LOLA group (141.6 ± 9.1 versus 96.9 ± 9.3, p < 0.05). Moreover, in patients who received LOLA a significant improvement was observed in mental status (1.0 ± 0.14 versus 0.4 ± 0.16, p < 0.05), Number Connection Test (184 ± 43 versus 88 ± 7, p < 0.05), asterixis (14.6 ± 2.8 versus 6.7 ± 1.5, p < 0.05), as well as EEG findings (6.8 ± 0.6 versus 8.1 ± 0.2 cycles per second, p < 0.05). Compliance with study medications was similar between the lactulose group (94%) and the LOLA group (100%). No serious adverse events were reported in the two groups; however, in the lactulose group an increase in the number of weekly defecations was reported, as well as a higher incidence of abdominal pain or flatulence. Finally, both patient groups reported an improvement in the Visual Analogue Scale for EuroQol index (51.1 ± 24.1 versus 61.5 ± 15.8, p < 0.05, in the lactulose group; 56.5 ± 24.5 versus 70 ± 19.4, p < 0.05, in the LOLA group). In conclusion, oral administration of lactulose or L-ornithine - L-aspartate to Mexican patients with cirrhosis and hyperammonemic encephalopathy significantly reduced serum ammonia levels in study groups and additionally improved mental status parameters, number connection test, asterixis scores, and EEG activity in the group receiving L-ornithine-L-aspartate.

IMAGES IN HEPATOLOGY

CASE REPORTS

  • Central pontine myelinolysis S Bhat, A Koulaouzidis, M Haris, C Tan Page 291-292

    The case is described of a 46 year old female alcoholic, presenting with confusion, jaundice and reduced level of consciousness. The patient was hyponatraemic on admission and despite gradual correction of serum sodium the patient deteriorated neurologically. Magnetic Resonance Imaging scan of the brain revealed characteristic findings of Central Pontine Myelinolysis (CPM). We provide an overview of the first published cases of CPM. The clinical and pathological features of CPM are described. No specific therapy has been shown to improve outcome; current literature advocates supportive management. Identification of patients at risk and gradual correction of hyponatraemia is recommended.

  • Vitamin A toxicity in a physical culturist patient: A case report and review of the literature Gustavo Castaño, Cristina Etchart, Silvia Sookoian Page 293-295

    Excessive intake of vitamin A may produce acute or chronic toxicity. Vitamin A can be consumed in foods, fortified products and supplements. We present a case of a young physical culturist man who was referred to our Unit because of chronic liver disease of unknown origin. The patient had a history of increased vitamin A intake from natural source with the addition of high dose of vitamin A supplements with the purpose of improving his muscular development. Our patient showed chronic liver disease with severe fibrosis, signs of portal hypertension and marked hyperplasia of Ito cells. In conclusion, chronic vitamin A toxicity may produce severe liver damage and should be recognized in the differential diagnosis of chronic liver diseases.

SPECIAL NOTICE

The Official Journal of the Mexican Association of Hepatology, the Latin-American Association for the Study of the Liver and the Canadian Association for the Study of the Liver

ALEH Hepatología CASL ACEF Médica Sur
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