RESUMEN
The aim of the present study was to characterize the neurophysiological profile of cognitive impairment associated with patients with chronic alcoholic and nonalcoholic liver disease. The authors evaluated 43 patients with cirrhotic liver disease: 19 patients with chronic alcohol ingestion and 24 nonalcoholic patients who had been infected with hepatitis B or C virus. Eleven healthy subjects were included as control subjects. A battery of 12 psychological tests was used to investigate cognitive deficits in the patients with chronic liver disease. It was observed that alcoholic patients with chronic liver disease showed a more important cognitive deterioration than those affected by hepatitis B or C virus.
Asunto(s)
Alcoholismo/metabolismo , Trastornos del Conocimiento/etiología , Cirrosis Hepática/complicaciones , Adulto , Análisis de Varianza , Enfermedad Crónica , Trastornos del Conocimiento/diagnóstico , Femenino , Humanos , Discapacidad Intelectual/etiología , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Escalas de Valoración Psiquiátrica , Adulto JovenRESUMEN
The esophageal tuberculosis is the rarest form of this infection in the gastrointestinal tract, corresponding to 0.15% of the cases. This pathology is unusual even in countries with high prevalence of tuberculosis. Its clinical presentation could be easily confused with the one of esophageal carcinoma. The diagnosis is reached by demonstrating in a sample of the mucosa the presence of caseating granulomas or by finding the Mycobacterium tuberculosis in a sample of tissue. In the present case report 73-year-old male with dysphagia, weight loss and fever is presented. At the endoscopy an ulcerated lesion of 5 centimeters in the lower third of the esophagus that compromises 50% of the circumference is observed. In the chest x-ray there are bilateral lung infiltrates confirmed by the CT scan. A baciloscopy is done and the result is positive. At the histological analysis giant cells are found and there is evidence of tuberculous bacillus. The patient develops an intestinal obstruction secondary to chagasic megacolon. He presents a massive hemoptisis and die. The aim of this presentation is to comment a pathology rarely reported in the literature and enhance the importance of considering it according to the clinical context.
Asunto(s)
Enfermedades del Esófago/diagnóstico , Tuberculosis Gastrointestinal/diagnóstico , Anciano , Biopsia , Esofagoscopía , Resultado Fatal , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
The role of the different lymphocyte populations in liver microenvironment of chronic hepatitis C (CHC) patients is still matter of debate. Since Th17 and Treg have opposite functions, their balance could affect disease progression. The aim was to explore liver microenvironment and its peripheral blood counterpart in adult CHC patients. CD4+ lymphocytes were predominant in the liver, with high Foxp3+ but low IL-17A+ frequency. IL-17A+ lymphocytes and IL-17A+/Foxp3+ ratio displayed association with advanced fibrosis (p = 0.0130; p = 0.0236, respectively), while Foxp3+ lymphocytes and IL-10 expression level inversely correlated with fibrosis severity (p = 0.0381, p = 0.0398, respectively). TGF-ß/IL-6 ratio correlated with IL-17A+/Foxp3+ ratio (p = 0.0036, r = 0.5944) and with IL-17A+ lymphocytes (p = 0.0093; r = 0.5203). TNF-α and TGF-ß were associated with hepatitis severity (p = 0.0409, p = 0.0321). Peripheral blood lymphocyte frequency was not associated with liver damage. There are functionally different immune cell populations actively involved in liver damage, but the liver cytokine milieu actually drives the pathogenesis. The intrahepatic Foxp3+ lymphocytes predominance beside the low IL-17A+ lymphocytes frequency, delineate a skewed IL-17A+/Foxp3+ balance towards Foxp3+ lymphocytes. However, the IL-17A+ lymphocytes association with advanced fibrosis denotes their role in the pathogenesis. Therefore, the interplay between Th17 and Treg conditions liver fibrogenesis.