RYGBP improves steatosis, necroinflammatory activity and hepatic fibrosis in patients with morbid obesity and NASH.

absent, and that it continued as an azygos towards the superior vena cava (SVC). We then punctured the right internal jugular vein and positioned the guide wire into the left inferior pulmonary vein. We then performed all the classic steps to close the ASD, without succeeding in obtaining a good position to release the prosthesis. In view of this, the procedure was interrupted, and re-planned. After obtaining the authorization of the patient and her parents, the procedure was carried out two weeks later by transhepatic puncture of the hepatic vein following the steps below: 1) General anesthesia with endotracheal tube. 2) Transesophageal echocardiogram. 3) Abdominal ultrasound. 4) IV cephalothin 2.0 grams. 5) Preparation of the region of the right hypochondrium and transhepatic puncture in the upper part of the inferior third of the liver at the level of the anterior axillary line using a Chiba 0.018 needle (Cook Inc.) (fi gure 2). The needle was positioned in parallel to the fl oor of the hemodynamics room and directed towards the spine. It was kept 2 cm away from it. The stylet was removed and a 5 ml-syringe with nonionic contrast medium was connected. The needle was slowly withdrawn and we aspirated until blood began to fl ow. At this point, we manually injected a small amount of contrast medium, and confi rmed the position in the hepatic vein (fi gure 3). A 0.035 guide wire was then introduced and positioned in the right atrium. We then performed the dilation with a 7F introducer, then introduced the 7F hemaquet, administered 5,000 U/kg of IV heparin, measured the pressures with a multipurpose catheter, positioned the catheter in the left superior Percutaneous atrial septal defect (ASD) closure is done by inferior vena cava (IVC) routinely. Occasionally this access is not possible due to obstruction or congenital absence of IVC. This case report shows the percutaneous implantation of an Amplatzer device to close large ASD in a patient with congenital absence of IVC. The procedure was done by a transhepatic punction of the hepatic vein with a Chiba needle (Cook Inc.) with no complications, taking the same amount of time, as the usual access. The transhepatic punction is a good option to central venous access in patients without other alternatives. The hepatic veins are large which make it possible to use large sheaths safely, even in neonates with low weight. This technique should be remembered, when it is impossible to use the usual venous access. CASE REPORTAn eighteen-year-old female patient was referred for percutaneous closure of atrial septal defect (ASD). On physical examination she had signs of right ventricle enlargement, fi xed splitting of the second heart sound, ejection systolic murmur in the upper left sternal edge (LSE) and mesodiastolic murmur in the lower LSE.Supplementary tests evidenced sinus rhythm and second degree right branch block on electrocardiogram, slight increase of heart area on thorax x-ray, and OS-ASD with 18 mm of diameter on transesophageal echocardiogram (TE-ECHO) (fi gure 1...

The present report describes the case of a child that after blunt abdominal trauma presented with portal thrombosis followed by progressive splenomegaly and jaundice. Ultrasonography and percutaneous cholangiography revealed biliary dilatation secondary to choledochal stenosis caused by dilated peribiliary veins, characterizing a case of portal biliopathy. The present case report is aimed at presenting an uncommon cause of this condition.

Objetivo: descrever alterações hepáticas ultrassonográficas, além de aspectos epidemiológicos, clínicos e laboratoriais de crianças com Larva migrans visceral. Casuística e Métodos: estudo prospectivo, de 37 crianças com sorologia ELISA-IgG antiToxocara canis positiva submetidas a exame clínico, laboratorial e ultrassonografia abdominal para investigar comprometimento hepático. Resultados: 11 (29,7%) crianças entre as 37 com toxocaríase apresentaram lesões hipoecoicas hepáticas e/ou alagamento de linfonodos periportais. Foram encontradas clinicamente hepatomegalia e esplenomegalia em seis (63,6%) e em um (9,1%) dos casos. Conclusões: a toxocaríase, de alta prevalência nas crianças do Brasil e do mundo, pode evoluir com alterações hepáticas clínicas e ultrassonográficas. A ultrassonografia é capaz de identificar no fígado pelo menos o dobro das alterações do que é aferido pelo exame físico e deve ser considerada como exame rotineiro na suspeita toxocaríase.

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