Biomedical subjects
D Kershenobich
Publications and source records attributed to D Kershenobich.
[Early detection of alcoholism in a hospital population (author's transl)].
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[Endotoxins and liver].
Endotoxins are macromolecules containing lipopolysacharides that form part of the bacteria wall. They are released only when the cell integrity is lost. They are suceptible to be absorved and pass to the portal circulation. However, in normal individuals endotoxins are not detected in peripheral blood, due to a filter effect of the liver. The possibility that liver failure could produce alterations in the detoxification of endotoxins is analyzed as well as the role of endotoxins to initiate or perpetuate liver damage. The biological effects of endotoxins on bile secretion, liver circulation, energy and carbohydrate metabolism in the liver are described.
[Cholangitis. Study of 240 patients (author's transl)].
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[Non-alcoholic fatty liver: 10 years' experience at the Insituto Nacional de la Nutrición Salvador Zubirán].
AIM: To describe the characteristics of non-alcoholic steatohepatitis (NASH) at the Instituto Nacional de la Nutricion Salvador Zubiran. MATERIAL AND METHODS: We reviewed all liver biopsy reports from January 1982 to December 1991. From patient records we obtained the following data: clinical, biochemical, imaging studies and we reviewed the histological material. We correlated clinical, biochemical and histological data. RESULTS: From 2963 biopsies reviewed we obtained 16 cases of NASH. We found a 7:1 female/male ratio. Median age was 30 years and six patients were obese. Eleven patients had concomitant disease (diabetes in seven) and nine were using drugs. All had been studied for biochemical abnormalities and were asymptomatic. Ten patients had hepatomegaly and six splenomegaly. Ultrasound suggested the diagnosis in 50% of the cases. All had steatosis, inflammatory infiltrate, necrosis, fibrosis and Mallory bodies at different stages. One case had cirrhosis on initial biopsy and two developed cirrhosis on follow-up (one and eight years later). We did not find any correlation between clinical, biochemical or imaging characteristics and histological findings. When we compared these findings between obese and non obese patients and primary and secondary NASH we did not find any differences between groups. CONCLUSIONS: NASH is infrequent in our institution. The underlying pathogenesis seems to be multifactorial. There is no biochemical-histological correlation. Cirrhosis can develop in some cases.
[Clinical characteristics and endoscopic-histologic correlation in patients with chronic non-specific ulcerative colitis].
UNLABELLED: Our objective was to evaluate prospectively, objectively and in a systematic way the evaluation of patients with Ulcerative Colitis (UC) with moderate activity. We studied 14 outpatients, who were evaluated for an experimental therapeutic protocol. The activity of the disease was established using clinical, endoscopic and histologic parameters. The Kappa Index (K) was used for statistical analysis. The average number of bowel movements was 4/day; rectal bleeding and urgency were found in 100%, diarrhea in 78% and abdominal pain in 64%. The severity of rectal bleeding and urgency was graded II or III in 92% and 78% respectively. The correlation between endoscopy and histology (K = 0.55), and between clinical and endoscopy (K = 0.45) was moderate. There was no correlation between clinical and histological parameters. IN CONCLUSION: the variability of symptoms impairs the clinical evaluation as the unique method to determine the activity of UC and to take therapeutical decisions is necessary to perform a endoscopic/histology correlation.
[Prevalence of antinuclear antibodies in primary biliary cirrhosis, with negative antimitochondrial antibodies].
Recently it has been described in the literature a subpopulation of PBC patients with negative AMA that might represent patients with ANA positive autoimmune cholangitis. We review 25 cases of PBC (23 females) with AMA negative. Our aim was to determine the frequency of ANA(+) in this group. We studied serum transaminases, total bilirubin, AMA and ANA by indirect immunofluorescence considering positive dilutions of 1:40. All patients had elevated alkaline phosphatase (641 +/- 389 U/l). Total bilirubin was below 2.5 in 59%. Thirteen patients had esophageal varices. The histologic stage was I-II in eleven and III-IV in 14 cases. Fourteen patients (56%) has ANA(+) (dilution 1:40), 44% had lower dilutions. We confirm the presence of a subpopulation of PBC AMA negative, ANA positive patients and the observations of different and diverse immune alterations in PBC patients.
[Diarrhea as clinical expression of gastrinoma. A case report].
We present a case of Zollinger Ellison Syndrome (ZES), that manifested itself as chronic diarrhea, without the presence of peptic ulcer disease. The purpose of this work in to report a case of ZES with and unusual clinical manifestation and to review the diagnostic methods (gastrin, secretin stimulation and angiotomography) and surgical therapeutic treatment (tumor resection).
[Hepatitis B and liver cancer].
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[Viral hepatitis and alcohol: a synergistic relationship].
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[Experience with primary biliary cirrhosis in Mexico].
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[Primary biliary cirrhosis: clinical features and survival of a Mexican population].
BACKGROUND: PBC progresses to cirrhosis and results in death due to liver failure or bleeding portal hypertension. Data of the clinical characteristics and survival of PBC patients allows the assessment of therapeutical alternatives as well as the establishment of inclusion criteria for liver transplantation. AIMS: One hundred and twenty patients with histological diagnosis of PBC, admitted from 1972 to 1992, were selected with the purpose of studying the clinical and biochemical characteristics and survival. METHODS: Patients who underwent liver transplant or those who had an incomplete follow-up were excluded. RESULTS: Therefore only 80 patients were included: these were seventy five women and five men, with mean age 46 +/- 11 years (X +/- SD) to whom demographic data, biochemical analysis, liver function (Child-Pugh) and liver damage (Ludwig) were recorded at the time of histological diagnosis, which was considered zero for calculating the survival (Kaplan Meier). The most common symptoms at diagnosis were pruritus in 63 patients, jaundice in 48, asthenia and adynamia in 55 patients. Eight cases were asymptomatic. According to Child-Pugh's classification, patients were grouped as follows: forty in stage A, 29 in B, and three in C; and according to liver damage (Ludwig), 8 in grade I, 28 in grade II, 22 in grade III and 14 in grade IV. The most frequent clinical associations were Sjögren's syndrome, in 30% of patients, although one case was associated to progressive muscular dystrophy and another one to multiple myeloma and hypothyroidism; in 58.7% of the cases, antimitochondrial antibodies were negative. One year survival was 75%, five years 44%, and seven years 13%. CONCLUSIONS: The most important characteristics of the studied patients were elevated percentage of negative antimitochondrial antibodies and short survival. it is important to impel the development of liver transplantation as the only mean to improve survival.
[Hepatitis A: is universal vaccination justified in Mexico?].
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[Homage to Dr. Salvador Zubirán (1898-1998)].
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