A case of hairy cell leukemia resembling asymptomatic chronic liver disease on presentation

Hepatic infiltration in hairy cell leukemia is quite common but results of liver test are usually normal. A 44-year-old man with a history of alcohol abuse was evaluated for persistent elevation in serum aminotransferases. A percutaneous liver biopsy showed an extensive mononuclear cell infiltrate in the sinusoids and this finding led to the diagnosis of hairy cell leukemia. Liver involvement in hairy cell leukemia is discussed. Hairy cell leukemia should be considered as a potential cause of persistent increase in liver-related enzymes.

[HELLP syndrome. Analysis of 2 cases]

HELLP syndrome (Hemolysis, Elevated Liver Enzymes, Low Platelets), one of the gestational diseases of the third trimester of pregnancy associated to eclampsia or preeclampsia, has a varied clinical expression, that include poor symptomatic patterns with malaise and/or dyspepsia, even several patterns with fatal outcome. We show two cases with clinical and laboratory criterion of HELLP syndrome, but with different clinical presentations. It's analyzed the pathogenicity, clinical-pathological expression, course and therapeutics options in HELLP syndrome.

[Chronic cholestasis as a presentation form of portal cavernoma]

A 37 year-old-woman was evaluated in 1993 for a chronic asymptomatic cholestasis. An endoscopic retrograde cholangiopancreatography showed the biliary tract compressed, and a mesenteric angiogram disclosed that the cause of biliary obstruction was a portal cavernoma. In addition, large esophageal varices with "red spots" were observed at endoscopy. Propranolol and ursodeoxicolic acid were started and the patient has remained asymptomatic to date. The biliary features of portal cavernoma are reviewed, as well as its pathogenesis, diagnosis and management. Portal cavernoma should be considered in the differential diagnosis of chronic cholestasis.

[Chronic asymptomatic intrahepatic cholestasis associated with Turner's syndrome]

Turner syndrome or the gonadal dysgenesis syndrome which is monosomic because of the lack of an X chromosome (45 X) is associated to a greater incidence of autoimmune, particularly thyroidal, disorders and inflammatory intestinal disease, but is rarely associated to hepatic disorders. A female patient with chronic asymptomatic intrahepatic cholestasis which, to our knowledge, is the first reported in Spain, is herein presented. The 40-year old patient with a 45 X karyotype, feminine phenotype was accidently found to have a chronic alteration in the hepatic profile. Hepatic biochemical tests revealed AST 59 U/L, ALT 90 U/L, GGT 201 U/L and alkaline phosphatase 320 U/L. Hepatic echography was normal. Percutaneous liver biopsy was performed demonstrating minimum changes consisting of sinusoidal dilatation and pigment accumulation in the hepatocyte biliary pole. Treatment with ursodeoxycholic acid 15 mg/kg/day was administered showing a marked decrease in the laboratory parameters during follow up. Different hypothesis which may explain the association between chronic asymptomatic intrahepatic cholestasis and Turner syndrome are discussed.

Effect of injection sclerosis with alcohol on the rebleeding rate of gastroduodenal peptic ulcers with nonbleeding visible vessels: a prospective, controlled trial

To assess the efficacy of injection therapy with alcohol on prevent rebleeding and emergency surgery in patients with gastroduodenal ulcers and nonbleeding visible vessels, we have performed a prospective controlled trial involving 39 patients who were classified into two groups according to the time of the day on which emergency endoscopy was performed: group 1 (25 patients) in which endoscopic hemostasis with absolute alcohol was performed, and group 2 (14 patients) in which conventional therapy was applied (blood transfusions, antacids, and ranitidine). The two groups were comparable with regard to age, sex, and type of bleeding. The rebleeding rate/emergency surgery rate of 8%/4%, respectively, for group 1 was lower than the 57%/50% for group 2 (p less than 0.001). Our results suggest that endoscopic hemostasis with alcohol should be considered as the initial treatment of choice in patients who present with major upper gastrointestinal hemorrhage and are found to have an ulcer with a nonbleeding visible vessel.