Schistosomiasis mansoni in low transmission areas: abdominal ultrasound

In endemic areas with low prevalence and low intensity of infection, the diagnosis of hepatic pathology due to the Schistosoma mansoni infection is very difficult. In order to establish the hepatic morbidity, a double-blind study was achieved in Venezuelan endemic areas, with one group of patients with schistosomiasis and the other one of non-infected people, that were evaluated clinically and by abdominal ultrasound using the Cairo classification. Schistosomiasis diagnosis was established based on parasitologic and serological tests. The increase of the hepatic size at midclavicular and midsternal lines (in hepatometry) and the hard liver consistency were the clinical parameters able to differentiate infected persons from non infected ones, as well as the presence of left lobe hepatomegaly detected by abdominal ultrasound. The periportal thickening, especially the mild form, was frequent in all age groups in both infected and uninfected patients. There was not correlation between the intensity of infection and ultrasound under the current circumstances. Our data suggest that in Venezuela, a low endemic area of transmission of schistosomiasis, the hepatic morbidity is mild and uncommon. The Cairo classification seems to overestimate the prevalence of periportal pathology. The specificity of the method must be improved, especially for the recognition of precocious pathology. Other causes of hepatopathies must be investigated.

[Leptospirosis in Gastroenterology. Study of 14 cases in the Hospital Universitário de Caracas 1984-1994]

14 cases that were admitted to the Hospital Universitario de Caracas, between 1.989 and 1.994, with a definitive diagnosis of Leptospirosis by microaglutination of live antigens were studied. Most of them hospitalized at the gastroenterology service. The serovar most frequently found was icterohemorragiae 11 cases. There was a predominium for the male gender 12/2 and the majority of patients belonged to the range of age between 31 and 40. The most common forms of presentations were: fever (14), jaundice (10) and myalgias (10) while the most relevant findings at physical examination were: jaundice (12), fever (11) and hepatomegaly (8). All patients had abnormal laboratory tests and among these, aminotransferases, bilirrubin, creatinin, CPK, platelets and urinary sediment were more frequently altered. Only half of the patients were diagnosed as Leptospirosis at the moment of admission. We conclude that even though Leptospirosis is an infectious disease distributed worldwide only few cases are hospitalized and differential diagnosis is difficult because of diversity of clinical presentations and lack of laboratory resources. It is important for gastroenterologists because most of complicated cases present as jaundiced patients.

[Intrahepatic lithiasis]

The intrahepactic lithisis is unusual in the Occidental hemisphere. The prevalence in Venezuela in unknown. We study all the edoscipic retrograde cholangiography carried for lithiasic pathology, in the Servicio de Gastroenterología, Hospital Universitario de Caracas, since January 1993 until April 1995. Over 342 patients, 9 were intrahepatic lithisis (1.16%). Seven cases of Caracas and two refered of the rest of the country. The sex was female in seven patients and males in two. The age range was 15 to 67 years old. The clinic feature much frequent was abdominal pain. The diagnosis was ultrasound and endoscopic retrograde cholangiography. The treatment was endoscopic with sphincterotomy and removal stones and surgical with resection in two cases, and choledocotomy in the other four cases.

[Hemobilia. Its clinical presentation and diagnosis]

Hemobilia is a rare cause of upper GI bleeding that must be suspect in order to make an early and precise diagnosis, that permits to decrease the high rate of mortality. We present our experience in three cases and analyze the clinical manifestations, diagnostic methods and follow-up.

[Cytologic diagnosis of abdominal lesions with fine needle aspiration guided by ultrasound]

The purpose of this work was to analyse the advantages and disadvantages of puncture-aspiration with fine needle, guided by ultrasonography, trying to determine its usefulness in our hospitals and its reliability in the diagnosis of intraabdominal lesions of different locations. 29 punctures were practiced on 19 patients, 9 women and 10 men of ages comprised between 34 and 94 years, with lesions in different organs of the abdominal cavity diagnosed by ultrasonography with real time equipment and lineal 3.5 and 5 MHz transducers. After cleaning and antisepsis a Chiba needle is introduced under ultrasonographic vision, up to the location of the lesion, the guide is removed and under a negative pressure, the sample is taken, which is later dried into the air and coloured using the May-Grünwald-Giemsa Technique. Only in one case it was not possible to obtain adequate material for the cytological study. There were 11 positive cases for malignity and 7 negative, one of which was a false negative. The sensibility of the method was of 91.6% with a specificity of 100% and a reliability of 89.4%. We definitely believe that the method is practical, very easy to carry out in our hospitals with a minimum amount of risk, and most of all, dependable to clarify certain diagnoses.