RESUMO Racional: A obesidade é doença epidêmica e crônica que pode trazer outras comorbidades ao paciente. A doença hepática gordurosa não alcoólica está presente em até 90% desses pacientes e pode evoluir para hepatite e hepatocarcinoma. A relação desta hepatopatia e a obesidade já é bem conhecida; porém, é possível que alguns parâmetros das comorbidades estejam mais relacionados do que outros na fisiopatogenia da doença. Objetivo: Correlacionar a doença hepática gordurosa não alcoólica (DHGNA) com as comorbidades da síndrome metabólica em pacientes obesos mórbidos em pré-operatório de cirurgia bariátrica. Métodos: Avaliação ultrassonográfica e laboratorial de pacientes obesos em pré-operatório para cirurgia bariátrica. Durante o preparo para a operação em todos os pacientes foi avaliada DHGNA através de ultrassonografia. De acordo com o resultado, os pacientes foram separados em dois grupos: sem DHGNA e com DHGNA. Para análise entre os grupos, avaliaram-se as seguintes variáveis clínicas e laboratoriais: insulina, HOMA-IR, hemoglobina glicada, colesterol total e frações, triglicerídeos, transaminase pirúvica, transaminase glutâmico oxalacética, gama glutamil transferase, proteína C reativa, albumina, ferritina. Os pacientes que relataram uso de bebida alcoólica ou que apresentaram hepatite foram excluídos do estudo. Resultados: Avaliou-se um total de 82 pacientes (74 mulheres e 8 homens), sendo 53 (64.6%) com DHGNA e 29 (35.4%) sem. Os níveis de hemoglobina glicada (p=0.05) e de LDL (p=0.01) mostraram-se mais relacionados no grupo de pacientes com DHGNA. Conclusão: A hemoglobina glicada e o LDL tiveram relação com a presença de DHGA.

ABSTRACT Background: Obesity is an epidemic and chronic disease that can bring other comorbidities to the patient. Non-alcoholic fatty liver disease is present in up to 90% of these patients and can progress to hepatitis and hepatocarcinoma. The relationship of this liver disease and obesity is already well known; however, it is possible that some parameters of the comorbidities are more related than others in the pathophysiology of the disease. Aim: Was analyzed the relationship between non-alcoholic fatty liver disease (NAFLD) and the comorbidities of metabolic syndrome in morbidly obese patients. Methods: Was involved ultrasonography and laboratory assessment of obese patients before bariatric surgery. NAFLD was assessed using the same sonography parameters for all patients. Based on the results, the patients were divided into groups with and without NAFLD. Comparisons between them involved clinical and laboratory variables such as fasting blood glucose, insulin, HOMA-IR (homeostasis model assessment - insulin resistance), glycated hemoglobin, total cholesterol and fractions, triglycerides, alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transferase, C-reactive protein, albumin and ferritin. Patients who reported alcohol abuse (defined as the consumption of >14 drinks per week) or who had hepatitis were excluded. Results: Eighty-two patients (74 women and 8 men) were studied, of whom 53 (64.6%) had NAFLD and 29 (35.4%) did not. The levels of glycated hemoglobin (p=0.05) and LDL cholesterol (p=0.01) were significantly altered in patients with NAFLD. However, weight, body mass index and excess weight did not differ significantly between the groups (p=0.835, p=0.488 and p=0.727, respectively). Conclusions: Altered LDL cholesterol and glycated hemoglobin levels were related to the presence of NAFLD.

OBJETIVO: Avaliar a regeneração hepática com modulação pelo pré-condicionamento isquêmico após isquemia, reperfusão e hepatectomia parcial. MÉTODOS: Foram usadas 24 ratas Wistar, de 12 semanas de idade, distribuídas randomicamente em quatro grupos: Grupo Controle (SHAM), Grupo Hepatectomia (HEP), Grupo Isquemia e Reperfusão (GIR) e Grupo Pré-condicionamento Isquêmico (PRE). Foi feita a análise das enzimas hepáticas ALT e AST, avaliação da regeneração através dos pesos inicial e final do fígado e da proliferação dos hepatócitos pela análise imunoistoquímica com o Proliferating Cell Nuclear Antigen (PCNA). RESULTADOS: Em todos os grupos ocorreu regeneração do fígado, não havendo significância estatística entre eles. Houve diferenças significativas em relação a ALT e AST entre os grupos HEP-SHAM, GIR-PRE, GIR-SHAM E PRE-SHAM (p< 0,05). Também houve diferença significativa em relação à marcação de PCNA do grupo SHAM quando comparado aos demais grupos (p< 0,05). CONCLUSÃO: O pré-condicionamento isquêmico diminuiu a lesão hepática, mas não influenciou na regeneração até 48 horas.

OBJECTIVE: To evaluate liver regeneration modulated by ischemic preconditioning after ischemia, reperfusion and partial hepatectomy. METHODS: We used 24 Wistar rats of 12 weeks of age, which were randomly assigned into four groups: control (SHAM), hepatectomy (HEP), ischemia and reperfusion (IRG) and Ischemic Preconditioning (SRG). Analyses were made on liver enzymes ALT and AST, assessment of regeneration through the initial and final weight of the liver and the proliferation of hepatocytes by immunohistochemical analysis with Proliferating Cell Nuclear Antigen (PCNA). RESULTS: In all groups there was liver regeneration, with no statistically significant difference between them. There were significant differences in ALT and AST between groups HEP and SHAM, PRE and GIR, GIR and SHAM and PRE and SHAM (p <0.05). There were also significant differences in the PCNA labeling of the SHAM group as compared to other groups (p <0.05). CONCLUSION: The ischemic preconditioning decreased liver injury, but did not influence the regeneration up to 48 hours.

OBJETIVO: Avaliar o prognóstico dos pacientes com lesão iatrogênica da via biliar (LIVB) em relação ao tempo de referencia (TR) para a unidade de transplante hepático (TH). MÉTODOS: Foram revisados 51 prontuários de pacientes que sofreram algum tipo de LIVB durante a colecistectomia e que foram encaminhados para a unidade de TH no Hospital Geral de Bonsucesso (HGB). As lesões foram agrupadas de acordo com a classificação de Bismuth. Além da colecistectomia (momento da lesão), também avaliamos o TR e o desfecho. RESULTADOS: Dentre os 51 pacientes estudados encontramos 17 homens e 34 mulheres com uma média de idade de 42,7 anos. Vinte e dois pacientes (43,1%) tinham uma lesão do tipo II; 13 (25,5 %) do tipo III; 10 (19,6 %) do tipo I, 5 (9,8 %) do tipo IV; e apenas um (2 %) do tipo V. Quarenta pacientes foram operados, sendo que três não retornaram para revisão médica e portanto, 37 foram avaliados em relação ao desfecho. Dentre esses, 25 pacientes (67,6 %) tiveram resultados excelentes ou bons com TR médio de 11,5 meses (intervalo: 2-48 meses) e 47,2 meses (intervalo: 3-180 meses) respectivamente. Os 12 pacientes (32,4 %) com resultados ruins tiveram um TR médio de 65,9 meses (intervalo: 3-264 meses), que foi significativamente maior do que o grupo com resultados excelentes ou bons (p=0,004). Sete pacientes foram listadas para fila de TH, porém apenas dois foram realizados. O TR desses sete pacientes foi significativamente mais elevado (p=0,04) do que o daqueles pacientes não listados. Sete pacientes morreram, dos quais seis foram causados por complicações hepáticas. CONCLUSÃO: O TR influenciou significativamente no prognóstico dos pacientes da nossa amostra.

OBJECTIVE: To evaluate the prognosis of patients with iatrogenic bile duct injury (IBDI) regarding time of referral (RT) to the unit of liver transplantation (LT). METHODS: We reviewed 51 charts of patients who had suffered some kind of IBDI during cholecystectomy and who were referred to the Bonsucesso General Hospital (HGB) LT unit. Lesions were grouped according to the Bismuth classification. Besides cholecystectomy (time of injury), we also evaluated the RT and outcome. RESULTS: Among the 51 patients studied, there were 17 men and 34 women, with a mean age of 42.7 years. Twenty-two patients (43.1%) had a type II lesion, 13 (25.5%) type III, 10 (19.6%) type I, 5 (9.8%) type IV and only 1 (2%) type V. Forty patients were operated, and three did not return for medical review, therefore, 37 were evaluated in relation to outcome. Among these, 25 patients (67.6%) had excellent or good results with average RT of 11.5 months (range: 2-48 months) and 47.2 months (range: 3-180 months) respectively. The 12 patients (32.4%) with poor results had a mean RT of 65.9 months (range: 3 264 months), which was significantly higher than the group with excellent or good results (p=0.004). Seven patients were listed for LT, but only two were transplanted. The RT of these seven patients was significantly higher (p=0.04) than those patients not listed. Seven patients died, six of which were due to liver complications. CONCLUSION: RT significantly influenced the prognosis of patients in our sample.

Fulminant hepatic failure (FHF) is characterized by massive hepatocellular injury, whose physiopathology is still unclear. Hepatitis B (HBV) is probably the most common viral cause of FHF, while hepatitis A (HAV) virus seem occurs less frequently. However, the host and viral factors that determine the outcome of these infections are poorly understood. In the present study, viral load and genotyping determining regions of HAV and HBV genomes were sequenced. Eight FHF patients and one patient with severe acute hepatitis (SAH) were included. Liver and blood samples were collected during liver transplantation or necropsy procedures. HAV-RNA and HBV-DNA were extracted from serum, biopsy and paraffin liver. Nucleotide sequencing of HAV-RNA was performed from VP1/2A and HBV-DNA from PreS/S region. The amplified samples were quantified by Real-Time PCR. The cases of HAV infection were due to subgenotype IA. The cases of HBV infection were due to genotype A2 and D4. The case of HAV/HBV coinfection was infected by genotype IA and D3. Hepatitis A and B infection were associated with genotypes most prevalent in Brazil. In hepatitis A infection the mean of period evolution was 13 days. In hepatitis B, FHF patients infected by genotype D have a shorter period of evolution than FHF patients infected by genotype A (mean 15 v. 53 days). There was no association with genotype-determining region with the severity of hepatitis, however nucleotide differences and high viral load could be observed among FHF.

OBJETIVO: Investigar a área de necrose focal induzida pela injeção intra-hepática de quatro diferentes substâncias no fígado de ratos. MÉTODOS: Foram utilizados 25 ratos Wistar, com peso variando entre 200 a 250 g, distribuidos em 5 grupos, que receberam 0,1cc das seguintes substâncias: Grupo I (Gr. I) - soro fisiológico a 0,9% (controle). Grupo II (Gr. II) - glicose hipertônica a 50%. Grupo III (Gr. III) - NaCl a 20%. Grupo IV (Gr. IV) - formol a 10%. Grupo V (Gr. V) - etanol. Os animais foram submetidos a laparotomia para que a punção fosse realizada no lobo hepático médio sob visão direta. Todos os animais foram sacrificados após 24 horas da injeção.. Os fígados foram avaliados histologicamente, com o intuito de mensurar a área do tecido necrótico. RESULTADOS: Nos cinco grupos estudados observou-se: Gr. I - 2829mm² (controle); Gr. II - 3805mm² (glicose hipertônica); Gr. III - 3930mm² (NaCl); Gr. IV - 4532mm² (formol) e Gr. V - 6432mm² (etanol). A análise estatística destes valores foi feita pelo método das comparações múltiplas. CONCLUSÃO: 1. O soro fisiológico foi à substância que causou a menor área de necrose (P< 0,05). 2. O NaCl a 20% e a glicose hipertônica a 50% produzem efeitos semelhantes (P > 0,05). 3. O formol a 10% produziu necrose mais extensa que a glicose hipertônica a 50% (P < 0,05) e que o NaCl a 20%, porém não apresentou diferença estatisticamente significativa com esta última (P > 0,05). 4. O etanol foi à substância que, comparada com as outras, mais necrose produziu (P < 0,05).

PURPOSE: To investigate the extent of necrosis after the injection of four substances into the liver of rats. METHODS: Twenty-five male Wistar rats (weighting from 200 - 250g) and divided into five groups were used for this study. All the animals underwent a transverse laparotomy, each receiving 0,1ml of the following substances into the liver parenchyma: Saline solution (1st Group - Gr. I), 50% hypertonic glucose (2nd Group - Gr. II), 20% NaCl (3rd Group - Gr. III), 10% formaline solution (4th Group - Gr. IV) and ethanol (5th Group - Gr. V). All the animals were sacrificated 24 hours after surgical procedures. The livers were examined microscopically to measure the extent of induced necrosis. RESULTS: The results achieved were the following: 2829mm² - Gr. I; 3805mm² - Gr. II; 3930mm² - Gr. III; 4532mm² - Gr. IV; and 6432mm² - Gr. V.. Statistical analysis were made with Kruskal-Wallis test and P less than 0,05 were considered statistically significant. CONCLUSIONS: 1. A saline solution causes hepatic necrosis, although to a lesser extent than the other substances (P < 0,05). 2. 20% NaCl and 50% hypertonic glucose produce necrosis to the same extent (P > 0,05). 3. The necrosis induced by a 10% formaline solution was greater than that induced by 50% hypertonic glucose (P < 0,05) and 20% NaCl (P > 0,05). 4. The hepatic injection of ethanol produced the most intense hepatic necrosis when compared to saline solution, 20% NaCl, 50% hipertonic glucose and 10% formaline solution (P < 0,05).