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Alagille's syndrome or arteriohepatic dysplasia has been described in Cuba in nine patients between nine months and 12 years of age (8 males and one female). Among the clinical features we found five major abnormalities: chronic cholestasis with neonatal jaundice (9/9), peculiar facies (9/9), peripheral pulmonary artery hypoplasia associated with cardiac murmur (6/9), butter-fly-like arch defects (4/9), and posterior embryotoxon (6/7). Two children had a severe xanthomatosis. Laparoscopy showed green hepatomegaly depending on the degree of cholestasis, and only one patient had incipient signs of micronodular cirrhosis. Liver histology showed a paucity of interlobular bile ducts. Survival was of 60%. One patient survived more than 30 years. Four patients died of liver carcinoma (unique report in infants), broncho-pneumonia, acute renal failure, and sudden death respectively. Among the minor features were mental retardation (5/9), a peculiar voice (3/9), growth retardation observed in some of our patients. This is the first report on Alagille's syndrome in Latin America, because so far reports have come only from Europe and North America.

During the last decade, a number of epidemiological and laboratory investigations have shown a close association among hepatitis B, dietary exposure to aflatoxin, and an increased incidence of hepatocellular carcinoma. An immunoenzymatic method for aflatoxin detection in urine was developed and assessed at the National Institute of Oncology. Fifty four children (age range 4-16 years) from the pediatric service at the National Institute of Gastroenterology were studied. Thirty patients had a diagnosis of chronic active hepatitis (CHA 17 of which 56%) were found aflatoxin- positive, 20 where HbsAg-positive carriers of which 7 of 35% were positive to aflatoxin, and 4 patients suffered from metabolic diseases from which 1 (25%) was found aflatoxin- positive. Controls and patients were matched by age, with 7.5% of aflatoxin-positive patients. Our results confirm the link between hepatitis B and aflatoxin in this type of patients compared to controls. The immunoenzymatic system proved to be specific for aflatoxin detection with a sensitivity of 100 picograms/milliliter.