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A C Jmelnitzky

Publications and source records attributed to A C Jmelnitzky.

17 recordsLinked to original sources
PubMed2002

[HCV / HIV co-infection: a different perspective].

The clinical significance of HCV-HIV co-infection has notoriously changed due to the introduction of new anti-retroviral therapeutic combinations against HIV infection. Their effectiveness in dramatically reducing AIDS mortality, and the corresponding increase in hospitalization and death related to liver disease. Considerations facing this new reality will have to include epidemiological aspects, pathogenetic interactions, the influence of highly active anti-retroviral therapies (HAART) on the natural history of HCV infection, including their HCV--enhanced liver toxicity, and current new strategies about therapeutic measures against HCV infection in the frame of the most recent advances in HIV therapy.

Antiretroviral Therapy, Highly Active↗
PubMed2001

[Idiopathic portal hypertension with splenic infarct. An unreported complication].

We present a case of Idiopathic Portal Hypertension (IPH) with Splenic infarct in a 23-year-old female. She was referred to the hospital because of enlargement of liver and spleen. A computed axial tomography revealed Splenic infarct. The spleen was surgically removed. At laparotomy the liver was found to be enlarged and a liver biopsy performed. The biopsy showed characteristic changes of IPH. After the splenic resection all hematologic manifestations disappeared, suggesting that they were due to hypersplenism. The IPH is very uncommon in western countries. We don't know of any case previously reported in Argentina and our patient is the first case of IPH with Splenic infarct.

Adult↗
PubMed2001

[Hepatitis C and alcohol: notes for consensus].

Alcohol abuse is accompanied by a high prevalence of hepatitis C virus (HCV) infection, which arise in the Great La Plata up to 20%. This condition worsen the histological necro-inflamatory activity of HCV chronic hepatitis patients, accelerating the evolution to liver cirrhosis, to cirrhosis decompensation, and surely facilitating the development of hepatocellular carcinoma. Besides of that, active alcohol abuse implies severe decrease in therapeutic response and yet more, a real contraindication for IFN mono-drug or combined treatment. All of that remarks the need for a correct investigation of alcohol consumption in HCV infected patients through a careful clinical examination, routine use of biological markers and incorporation of specialized systematic questionnaires, submitting the patient as early as possible to a special treatment (mental health team, self-help groups, naltrexone or similar trials). Alcohol abuse suppression is the first great therapeutic gesture in chronic hepatitis C patients to allow specific combined treatment and eventually a more successful liver transplant.

Alcoholism↗
PubMed2000

[Clinic-epidemiological significance of drug hepatotoxicity in liver disease consultation].

To assess epidemiological and clinical significance of drug hepatotoxicity in the setting of liver diseases consultation, ten thousand and three hundred forty two prospectively designed clinical records from patient cared for in our Liver Unit in the period 1988-1998 were incorporated into the study; 58 out of 10,342 (prevalence = 5.6%) fulfilled at least the first three of the following causality requirements: 1.--Liver injury associated in time to drug exposition; 2.--Negative evaluation of more common other etiologies; (alcohol, viruses, immunologic, metabolic, etc) 3.--Favourable response to drug withdrawal (ALT < 50% of baseline in 8 to 30 days in acute hepatitis type, and alkaline phosphatase and/or total bilirubin < 50% of baseline up to 6 months, in acute cholestasis) 4.--Inadverted or rarely prescribed positive challenge. Acute hepatitis type of injury were considered when serum ALT rise 8 times or more above normal superior level with alkaline phosphatase (APh) below 3 times; "pure" cholestasis when APh rise 3 times or more above normal with ALT below 8 times; mixed acute injury or cholestatic hepatitis when both ALT and APh were elevated above 8 and 3 times respectively, and indeterminate type when both enzymes were below the referred levels. Chronic injury were considered when six or more month of evolution and compatible liver histology happens. Clinical severity were expressed as mild (absence of major clinical complications, serum bilirubin < 5 mg/dl and prothrombin concentration > 75%), moderate (presence of clinical complications, bilirubin > 5 mg/dl and prothrombin concentration between 50-75%), and severe (major clinical complications with bilirubin > 5 mg/dl and prothrombin concentration < 50%). Female/male ratio was 1.4:1, with age average 39 years (R = 15-77) and major concentration of cases above 40. More than 50% of cases received 2 or more drugs. Jaundice was present in 60.4%, and systemic manifestations of hypersensibility (fever, adenomegalies, rush, mononucleosis like syndrome, eosinophilia) in 29.3%. Acute injury represented 91.4% of the cases: 41.4% acute hepatitis, 15.5% "pure" cholestasis, 24.1% cholestatic hepatitis, and 10.3% indeterminate type. Four patients (4.5% of acute injury cases) were presented as severe acute liver failure, leading to liver transplant in one of them, drug association (INH-rifampicin and carbamazepine-phenobarbital) and inadverted challenge (sulphonamides and pemoline) were associated to clinical severity. Chronic injury were found in five patient (8.6%), four of them associated to chronic hepatitis and the other one to a ductopenic syndrome. Six drugs represented 53.4% of our cases; oral contraceptives (7 cases), INH alone or combined with rifampicin (6 cases), sulfonamides and clorpropamida (5 cases each), carbamazepine and amiodarone (4 cases each). Normalization of liver enzymes after drug suppression took 2 to 8 weeks in acute hepatitis type (X = 4 weeks), 4 to 20 in "pure" cholestasis (X = 12 weeks) and 8 to 24 weeks in cholestatic hepatitis or mixed type (X = 16 weeks). Two cases of chronic hepatitis normalize the histological activity index in 20 and 18 month respectively, one case remains as chronic hepatitis at 10 month and the other one progress to cirrhosis; the ductopenic syndrome normalize histology in 19 months receiving urso-deoxicolic acid, 10 mg/k/day.

Acute Disease↗
PubMed2000

[Evidence-based Medicine and continuing education in gastroenterology and hepatology].

Evidence Based Medicine (EBM) provide a new philosophy and useful tools to incorporate the scientific method to medical practice in Gastroenterology, Hepatology and Digestive Endoscopy. Large and well designed multicenter randomized clinical trials validated if necessary by metaanalysis, are the main support to the system; in spite of that individual decisions will owe to take into account interests and beliefs of patients and their relatives, doctors and society National or regional consensus and guide-lines elaborated by experts of scientific institutions are published in first line publications and easily available by computerized ways. Incorporation of econometric studies specially centered on quality of life quantification would be excellent weapons in the process of decision making Computers technology as a tool of fast access to scientific bases of medical problems and as a real participant of the process of health care, should owe to be inserted to educational programs at the universities and scientific institutions, at levels of specialization and continuing medical education.

Curriculum↗
PubMed1999

[Ethical dilemmas in gastroenterology practice in Latin-American countries: the AIGE survey].

A survey sponsored by the Interamerican Association of Gastroenterology (AIGE) related to decision making in conflictive ethical situations in the setting of gastroenterological practice was designed (AJ-JCG). Seven problem-cases with 3 to 5 pre-established and not-excluding answers each, demographic and occupational data were included, by public invitation during 1996-97 AIGE educational activities in La Plata (Argentina), Montevideo (Uruguay) and Santo Domingo (Dominican Republic). Data were inserted in a computerised data base, and chi square, Fischer and Maentel-Henzel tests were used for statistical studies. 118 out of 460 doctors registered to educational activities answered at the survey (25.6%). Mean age was 42 +/- 15 years and 57.6% were male; 48.5% were under 10 years of professional practice and 19.5% were over 20 years. Gastroenterology was the main specialty in 89.8%. Although only 15.2% of participants reported as not having Ethical Committee (EC) in their institutions, the option of consulting was not very frequently selected, except in cases of request about pregnancy interruption in the HCV infected mother (22.9%), inclusion of the young alcoholic cirrhotic man in the waiting list for liver trasplant (17.8%), and the Jehova's Witness conscious patient with bleeding esophageal varices (13.5%). Cases of direct communication to the patient of early colon cancer diagnosis (66.1%), and inclusion of the young end stage alcoholic cirrhotic patient in the waiting list for liver trasplantation (65.2%), had the higher consensus. On the other hand, lower consensus (39%) was seen in the case of variceal bleeding in the encephalopathic Witness of Jehova patient. Differential criterla were observed related to sex: 38% of women versus 14.7% of men (p < 0.01) refuse the interruption of pregnancy to the infected HCV patient because of personal convictions against abortion. In the case of suspected HIV co-infection in the IVD HBsAG + carrier, 46% of women vs. 27.9% of men (p < 0.05) indicate HIV screening test without any explanation to the patient because "he could transmit a fatal disease". In this same case, time from graduation was related to differences in option selection: 80.9% in the group > 20 years of professional exercise asked for patient consent and accepted his decision, versus 52.7 and 27.5% in 0-9 and 10-19 years group respectively (p < 0.05). Usual medical and social worries as communication (truth, informed consent), the autonomic decision of biological death versus the sacrament of life, justice in allocation resources, confidentiality and social concern, abortion, and many other controversies linked to tecno-scientific development, impact the practice of Gastroenterology in latinoamerican countries. However medical answers to ethical dilemmas are not uniform. Although our results ought to be verified by other studies they clearly suggest the needs for systematic incorporation of applicated Ethics in pre and postgraduate Gastroenterology curricula, besides the regular activities of our regional institutions.

Adult↗
PubMed1997

[Liver histopathological characteristics in patients with HCV-positive sera].

In order to have knowledge on the histopathologic characteristics of the HCV infections in our geographical area and its relation with some epidemiologic variables, a series of 54 biopsies of Anti HCV (R) patients was analyzed. The histologic lesions found in this study correspond mostly to patients with relatively early infections, on the contrary to other studies of the some kind. The most frequent histopathologic diagnosis were chronic hepatitis 38/54 (70.4%), steatosis 4/54 (7.4%) and 12/54 (22.2%) with no changes. The presence of lymphoid follicles in the portal tracts was the most frequent histological change in this series (66.7%), followed by the alteration in bile ducts (53.7%); they occurred in a significantly higher proportion in the biopsies which had a diagnosis of chronic hepatitis (p = 0.02) (p = 0.000002). The presence of steatosis and acidophilic bodies in the acinus were found in nearly one third of the biopsies. This findings suggest that the hepatic damage in the anti HCV reactive patients might take place through immunologic mechanisms and cytopathic direct action. It was not found that histologic changes produced by HCV might differ according to epidemiologic variables (post-transfusional, drug abuse i.v. and sporadic).

Adult↗
PubMed1995

[New suggestions for the management of alcoholic liver diseases].

Some recent proposals in management of alcoholic liver disease are discussed focusing on early diagnosis and treatment of alcohol abuse itself, alcoholic hepatitis early mortality, clinical meaning of nutritional therapy, serological approach and treatment of hepatic fibrosis, and problems in liver transplantation for end stage alcoholic liver cirrhosis. CAGE or similar systematized brief questionnaires, and desialylated transferrin/total transferrin ratio as serological marker, seems to be interesting contributions to "hidden" alcohol abuse diagnosis and abstinence control while psycho-social support and voluntary incorporation to self-aid groups are the best weapons to reach persistent abstinence. Corticosteroids seems to improve survival in a selected group of patients with severe alcoholic hepatitis, specially in those presenting encephalopathy but free of GI bleeding, decompensated diabetes, active infections, pancreatitis, and other contraindications or adverse effects of these drugs. Relationship between direct toxicity and nutritional deficiencies in pathogenesis of alcoholic liver injury are not clear enough, but malnutrition is generally present in patients requiring hospitalization, and related to clinical severity; oral, enteral or parenteral nutritional supplementation in this order of preference according to patients condition, associated or not with steroid anabolics, are useful in cases with moderate to severe alcoholic hepatitis or decompensated cirrhosis to eliminate the catabolic state, reaching a better nitrogen balance and liver function tests, without special adverse effects. A special role on liver regeneration is discussed. Antioxidants and supernutrients are special "modern" aspects of nutritional therapy in alcoholic liver disease generally related to the MEOS activation in chronic alcoholism, the excessive production of free radicals, and the depletion of glutathione, membrane phospholipids (specially phosphatidycholine), and vitamin A, E, and C. Natural supplements as soybean polyunsaturated lecithin, with high concentration of phosphatidycholine, or oral supplementation with natural metabolic products depleted from the liver of chronic heavy drinkers, such SAMe, have an interesting rationale based on experimental and clinical findings besides availability and costs. Carotenoids and tocopherols supplementation seems to be an useful tool, but are limited in the case of vitamin A because its special toxicity in chronic alcoholism. Serological markers of metabolism of liver connective tissue are clearly involved in fibrogenesis process and other inflammatory connected events; standardization of laboratory methods surely will result in new possibilities of non-invasive valuation of liver injury, evolution and therapeutic response; special histological damage such as sinusoidal "cappilarization" (type i.v. collagen and laminin), endothelial sinusoidal cell function (seric hyaluronate), or collagenase activity (TIMP-1 or tissue inhibitor of metalloproteinases-1) seems to be valuable by these new technologies.(ABSTRACT TRUNCATED AT 400 WORDS)

Adrenal Cortex Hormones↗
PubMed1994

[Viral hepatitis infection and response to the hepatitis B vaccine in hemodialyzed patients].

Data from 219 hemodyalized patients receiving attention in our Hospital and other private centers in our city are shown. Mean age was 46.9 (range: 14-85), and 132 were male; mean time under dialysis was 20 months, and subjects received an average of 5 transfusions per patient year. Serological reactivity to HBs Ag, Anti HBs and IgG anti HBc by ELISA were investigated in all of them, and anti HCV by second generation enzimo-immunoassay (EIA II) in 73 HBe Ag/anti HBe system were determined in HBs Ag positive patients and those reactive to anti HCV (EIA II) were confirmed by LIA (immunoblotting of synthetic peptides LIA-TEK Organos Teknica). Recombinant anti HBV vaccine 40 mcg at 0-1 and six month were received by 81 cases without HBV markers in their sera and a protective response was considered when anti HBs titration of 10 mU/ml or more were obtained two months later. Prevalence for anti HBc and anti HBs were 38.8% respectively and that for HBs Ag was 21% with 78% of them reactive for HBs Ag. True reactivity for anti HCV (confirmed by LIA) was present in 35.6%, but it was 9.7% in our Hospital and 54.8% in private units (p < 0.0002). Anti HBs titration was done in 69/81 patients who received anti HBV vaccine, and a protective response in 49% were obtained; the other 12 patients underwent acute hepatitis B during the vaccination period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

[Hepatitis non-A, non-B: epidemiological significance in acute viral hepatitis and chronic active hepatitis of hepatological consultation].

157 acute viral hepatitis and 60 chronic active ones have been analyzed focusing on NANB etiology. HAV was implicated in 36.3% of the hole acute viral hepatitis sample, HBV in 29.3%, and HNANBV was presumed as etiology in 31.2%, 5 patients (3.2%) had acute infection by HAV, on previous one by HBV, except for Epstein-Barr virus, no other test for viruses were determined (CMV, HSV, etc.). Male/female ratio was 1.4:1, 1.9:1, and 1.4:1 for HAV, HBV and HNANBV acute hepatitis respectively; HAV was the main etiology in the 0-9 age group (72.2%) although it only represents 11.5% of the sample; small occurrence of HAV hepatitis were found in patients over 40 (8.8%); HBV was clearly prevalent in patients over 50 (65.2%); the highest concentration of NANB etiology was found between 20-39 years old, but it was represented in all age-groups. Out of 49 NANB acute hepatitis, 12.2% had related transfusional antecedents, 12.2% belonged to health care worker group, and 4.1% had a close family NANB hepatitis contact; 71.5% had no reported antecedent. Viral source was presumably implicated in 75.0% of chronic active hepatitis, 25.0% attributable to HNANBV. Results seem not feasible to transfer to general population due to the facts that most patients were of specialized consult, and pediatric assistance is unusual to the authors practice.

Argentina↗
PubMed1985

[Drug metabolism in the septic liver: conclusions about the pharmacokinetics of chloramphenicol].

In nine patients in anaerobic septic shock, five of them with hepatic injury compatible with sepsis liver failure, hematic chloramphenicol concentration was determined at 5 minutes, 1, 2, 3 and 6 hours after intravenous administration of the first of three daily dose (50 mg/k/day); in the hepatic failure group the procedure was repeated with the next dose, previous attempt of haemodynamic compensation with two hours dopamine (3-10 mcg/k/min.) infusion. Starting from experimental data computation adjustment of time-concentration curve and lineal regression with a p = 0.0001 adjustment was done, determining half live (HL), distribution volume (DV), constant of elimination (K) and clearance (CL). In septic shock without hepatic injury patient group, there was noticed a uniform behavior in time-concentration graphic, withdrawn from chloramphenicol bone-marrow depression levels and pharmacokinetics parameters quite near the normal ones, with a reasonable extension of (DV). When attempting hepatic injury patient group, though an individual variability, drug concentration reach bone marrow depression levels and there was a significant lowering of Cl (p = 0.001) and a reasonable one of DV. Dopamine haemodynamic compensation attempt results in an increase of chloramphenicol hematic concentration in the sepsis liver group and the pharmacokinetics levels bear new deterioration. Practical meaning of the methodology used in drug handling in severe hepatic failure is stressed, to allow mathematic valuation of different pathogenic compounds. Though each patient should be individually evaluated, in septic shock without liver injury chloramphenicol dosification should not been any changes but in presence of sepsis liver doses should be diminished to half and administration interval extended to 11.5 hours.

Chloramphenicol↗
PubMed1984

[Current significance of polypectomy of the upper gastrointestinal tract].

Author's experience about 70 endoscopic polipectomy of high gastrointestinal tract, realized on 53 patients during 1978-1983 period was evaluated. Esophaguel polyps incidence was 0.06% among 7.900 endoscopic studies; gastric polyps was 0.8% and duodenal was 0.03%. Diagnosis was radiologically suspected in 58%. Gastric antrum was the predominant localization (45.7%) and macroscopic Yamada types IV (32.8%) and III (30.0%) were found more frequently. Most of patients presented solitary polips (86.7%). 63.2% of pieces were under 10 mm in size and 35.2% between 10 - 20 mm. High frecuency of adenomas (23.5%) and a low one of hyperplasiogenic (7.3%) was the prominent finding; only one case of early gastric cancer was founded (1.5%). Neither adenoms or hyperplasiogenic polyps were founded on gastric fundus, and no direct relation between size and histopatologic type was observed. Only one hemorragic complication (1.4%) was present. Polips incidence on 800 consecutive auptopsy protocols in adults was 0.12%.

Adult↗
PubMed1981

[Endoscopic polypectomy in the diagnosis and treatment of early colorectal cancer].

The rectocolon cancer (RCC) behavior in La Plata is clearly shown to be similar to the one found in high risk countries, both from the epidemiological and the histopathological point of view. The disagreement among different polyps coming from necropsy, endoscopy or surgery is found and discussed in relation to distribution, size and histopathological type. The evidence of de sequence adenoma-carcinoma is once more found in the cases studied. On the other hand, displastics lesions in non-neoplastic flat mucosa are not found. THe malignant potential of the adenomas is found to increase with the increment of their size, villous component and atipía degree. This evidence come from 100 adenomas considered. It is also found that in this sample that the malignant potential is high in small lesions -4,3%of invasive carcinoma on adenomas smaller than 10 mm. In a sample of 1000 colonoscopies, 122 endoscopic polipectomies where performed without evidence of either morbility or mortality. In this material, 4 rectocolonic early cancer were detected in polyps smaller than 10 mm. This fact strongly support the indication of resection in every rectocolonic elevated lesions. 11.4% of total resected polyps were found to be of the early RCC type this figure increases if the incidence of the polipectomy in children is discarded because in this cases adenomatous polyps do not appear in our experience. The clinic-epidemiologic character of 13 early RCC cases followed for periods until 5 years are described.

Argentina↗