Increased soluble CD36 is linked to advanced steatosis in nonalcoholic fatty liver disease.

BACKGROUND: Soluble CD36 (sCD36) clusters with insulin resistance, but no evidence exists on its relationship with hepatic fat content. We determined sCD36 to assess its link to steatosis in nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis C (CHC) patients. MATERIALS AND METHODS: Two hundred and twenty-seven NAFLD, eighty-seven CHC, and eighty-five patients with histologically normal liver (NL) were studied. Steatosis was graded by Kleiner's histological scoring system. Serum sCD36 and hepatic CD36 expression was assessed by immunoassay and immunohistochemistry, respectively. RESULTS: In NAFLD, serum sCD36 levels were significantly higher in simple steatosis than in NL (361.4 ± 286.4 vs. 173.9 ± 137.4 pg/mL, respectively; P < 0.001), but not in steatohepatitis (229.6 ± 202.5 pg/mL; P = 0.153). In CHC, serum sCD36 levels were similar regardless of the absence (428.7 ± 260.3 pg/mL) or presence of steatosis (387.2 ± 283.6 pg/mL; P = 0.173). A progressive increase in serum sCD36 values was found in NAFLD depending on the histological grade of steatosis (P < 0.001), but not in CHC (P = 0.151). Serum sCD36 concentrations were independently associated with advanced steatosis in NAFLD when adjusted by demographic and anthropometric features [odds ratio (OR), 1.001; 95% confidence interval (CI), 1.000 to 1.002; P = 0.021] and by metabolic variables (OR, 1.002; 95% CI, 1.000 to 1.003; P = 0.001). Interestingly, a significant correlation was observed between hepatic CD36 and serum sCD36 (ρ = 0.499, P < 0.001). CONCLUSIONS: Increased serum sCD36 is an independent factor associated with advanced steatosis in NAFLD.

Microbiological profile of peritoneal dialysis peritonitis and predictors of hospitalization.

Peritonitis, the major complication of peritoneal dialysis (PD), is associated with high morbidity and mortality. It is a major cause of hospitalization and transfer to hemodialysis. In the present study, we aimed to identify predictors of hospitalization in PD-related peritonitis and to examine its microbiology profile over time in our unit to determine the best therapeutic approach. We studied all peritonitis episodes that occurred in a 6-year period (January 1, 2004, to December 31, 2009), evaluating whether adequate treatment could be delivered on an outpatient basis. During the study period, 411 patients were on PD, and 229 peritonitis episodes were recorded in 91 patients. Peritonitis were treated according to unit protocol. The average hospital stay was 11.6 +/- 6.6 days. We observed an increase of Streptococcus (to 19.4% from 7.7%) and a stabilization of coagulase-negative Staphylococcus, S. epidermidis, and S. aureus (from 9.5%, 22.6%, and 3.2% to 7.7%, 30.8%, and 3.8% respectively) peritonitis episodes. The main risk factors for hospitalization were fungal infection, poor 72-hour outcome, inability to perform self-care, and age greater than 80 years. We observed a decline in the incidence of peritonitis, and despite changes in its microbiology profile, no loss of sensitivity to antibiotics used was observed.

Biliopancreatic diversion in a renal transplant patient.

Surgery is usually the only solution to modify the evolution of morbid obesity and resolve the associated co-morbidities. There is very little written regarding malabsorptive surgery and transplantation. A 48-year-old male with hypertension, hyperuricemia and obesity underwent renal transplantation in 1994 for renal amyloidosis. He was maintained on oral immunosuppressive cyclosporine. The patient developed uncontrollable hypertension, hyperlipemia, hyperglycemia and increasing weight to a BMI of 44. Thus, in December 2004, he underwent biliopancreatic diversion (BPD). After 18 months follow-up, he has lost 85% of his excess weight, and his hypertension, hyperglycemia and hyperlipemia are markedly improved. Renal function was not modified, nor were the levels of cyclosporine. He has had no complications derived from the BPD, and has a better quality of life.

Effects of weight loss after biliopancreatic diversion on metabolism and cardiovascular profile.

BACKGROUND: Obesity is associated with increased prevalence of cardiovascular risk factors. Biliopancreatic diversion (BPD) for morbid obesity has been reported to produce anemia and malnutrition in short-term follow-up. The aim of our study was to analyze the effect of weight reduction on cardiovascular profile, renal function and nutritional status. METHODS: 35 morbidly obese patients underwent BPD. We analyzed the presence of cardiovascular risk factors, renal status, proteinuria and nutritional status before and 1 year after BPD. RESULTS: Excess weight loss was 67% at 1 year after BPD. All cardiovascular risk factors (hypertension, diabetes, hyperlipidemia) improved during follow-up. We could not find any relevant signs of malnutrition in the patients. Microalbuminuria decreased and proteinuria disappeared after weight loss. We observed less urinary calcium and citrate excretion, with an increase in oxaluria, but these changes did not increase the incidence of renal stones. CONCLUSIONS: BPD was followed by improved cardiovascular profile and a lower pro-inflammatory state. BPD did not produce significant malnutrition, anemia or renal stone disease.

Pancreatic fibrosis in rats and its response to antioxidant treatment.

CONTEXT: Oxidative stress plays a role in the development of pancreatic fibrosis. OBJECTIVES: In the present study, we hypothesized that the administration of an antioxidant complex could ameliorate cerulein and cyclosporin A pancreatic fibrosis, assessed by changes in oxidative stress and a histopathological study in an experimental rat model. ANIMALS: Four groups of ten rats each. In Group A, the rats served as controls and were treated with intraperitoneal saline solution. In Group B, six courses of cerulein pancreatitis were induced at weekly intervals. In Group C, the rats received cyclosporin A the day before and the day on which pancreatitis was induced in Group B. In Group D, the rats were treated as in Group C but also received antioxidants. All rats were sacrificed at the seventh week. MAIN OUTCOME MEASURES: The presence of fibrosis was evaluated according to a scoring system. Glutathione peroxidase was utilized as an indicator of oxidative stress and total antioxidant status as an indicator of total antioxidant tissue capacity. RESULTS: The rats in Groups B and C showed more pancreatic fibrosis than those in Groups A and D (90%, 70%, 0%, and 20%, respectively). The glutathione peroxidase increased in Group B (455+/-196 mU/g protein) and Group C (243+/-206 mU/g protein) with respect to those in Group A (137+/-80 mU/g protein) and Group D (135+/-105 mU/g protein). Total antioxidant status was significantly higher in Groups B (1.41+/-0.96 mmol/g protein) and D (1.28+/-0.09 mmol/g protein) with respect to Groups A (0.10+/-0.06 mmol/g protein) and C (0.15+/-0.09 mmoL/g protein). CONCLUSION: The administration of cerulein and cyclosporin A caused fibrosis, whereas antioxidant administration showed preventive effects regarding cerulein and cyclosporin A-induced pancreatic fibrosis.

[Pulmonary and brain metastases from well-differentiated thyroid carcinoma]. / Cáncer diferenciado de tiroides. Metástasis pulmonares y cerebrales.

Total thyroidectomy is the surgical treatment of choice for differentiated thyroid carcinoma. Despite this surgical treatment, locoregional and distant metastases can develop. Postoperative follow-up should include determination of serum thyroglobulin levels and radioactive iodine (131I) and thallium (201Tl) whole body scans. These techniques are more reliable in patients who have undergone total thyroidectomy. We stress the importance of routine medical follow-up after surgical treatment of thyroid cancer, even in the absence of symptoms.

Evaluation of the potential protective effect of 21-aminosteroid U-74389G on liver injury induced by reduced and prolonged partial hepatic ischaemia reperfusion in rats.

The protective effect of the 21-aminosteroid U-74389G was studied in an experimental model of partial ischaemia reperfusion liver injury. Previous studies have proven the remarkable potency of 21-aminosteroids to prevent oxidant-induced cell injury in vitro and in vivo. However, the capability of these compounds to limit oxidative injury in clinical trials has been considered to be less certain. The potential protective effect exerted by U-74389G on reduced and prolonged models of ischaemia reperfusion liver injury was studied in male rats subjected to 75 min. of segmentary hepatic ischaemia followed by 1 or 24 hr of reperfusion. Liver injury was evaluated by measuring serum levels of liver enzymes and by histopathological studies. The oxidative status of liver cells was measured by evaluating the levels of liver lipid peroxidation products such as malondialdehyde and the levels of reduced glutathione. Our results lead us to think that treatment with U-74389G (6 mg/kg) does not bring about any protective effect neither in the levels of transaminases nor in the percentage of hepatocellular necrosis and cellular infiltration observed in any reperfusion-period groups. In fact and in contrast with our expectations, U-74389G seemed to increase enzyme release. Furthermore, at the dose used, this 21-aminosteroid is not capable of inhibiting the lipoperoxidation processes, although it induced an important increase of GSH levels at any time-period of reperfusion. This last finding seem to suggest that U-74389G could increase the resistance to oxidant-induced liver tissue damage. However, our results show that, at the dose used, this compound did not exert any protective effect on liver tissue, thus explaining, at least partially, the absence of beneficial effects on the part of these compounds in clinical trials carried out to limit organ injury in transplants.

Cáncer diferenciado de tiroides. Metástasis pulmonares y cerebrales / Pulmonary and brain metastases from well-differentiated thyroid carcinoma

La tiroidectomía total es el tratamiento de elección en el cáncer diferenciado de tiroides. A pesar de esta intervención, pueden aparecer metástasis regionales y a distancia. El control posterior de la enfermedad se realiza con la determinación de los valores de tiroglobulina, y el rastreo corporal con 201Tl y 131I. Éstos son más fiables en los pacientes a los que se ha practicado una tiroidectomía total. Queremos enfatizar en la importancia del seguimiento médico tras el tratamiento quirúrgico, incluso en ausencia de síntomas (AU)

Total thyroidectomy is the surgical treatment of choice for differentiated thyroid carcinoma. Despite this surgical treatment, locoregional and distant metastases can develop. Postoperative follow-up should include determination of serum thyroglobulin levels and radioactive iodine (131I) and thallium (201Tl) whole body scans. These techniques are more reliable in patients who have undergone total thyroidectomy. We stress the importance of routine medical follow-up after surgical treatment of thyroid cancer, even in the absence of symptoms (AU)

Bypass biliopancreático / Biliopancreatic bypass

La derivación, o bypass, biliopancreática, introducida por Scopinaro en 1976, consigue una pérdida del sobrepeso eficaz y mantenida a largo plazo, y mejora la calidad de vida y las comorbilidades asociadas a la obesidad mórbida sin estrictas limitaciones dietéticas. Presentamos los resultados de 320 pacientes intervenidos entre julio de 1997 y mayo de 2003, con un peso medio de 132,01 ñ 26,02 kg (rango, 52-236) y un índice de masa corporal medio de 51,23 ñ 7,93 kg/m2 (31-90).Entre las complicaciones perioperatorias destacan 10 dehiscencias de gastroyeyunostomía, 5 de muñón duodenal, 12 hemorragias que precisaron reintervención o transfusión y 15 infecciones de herida quirúrgica. Nueve pacientes fallecieron. Entre las complicaciones a largo plazo, cabe señalar 4 hernias internas y 8 casos de hipoproteinemia grave que motivaron 3 alargamientos de asa.El sobrepeso perdido medio a 5 años es del 75 por ciento, con rangos entre el 79 por ciento en los casos con un índice de masa corporal entre 35 y 50 kg/m2 y el 68 por ciento en aquellos en que éste es superior a 60 kg/m2. La comorbilidad del tipo diabetes mellitus o hipertensión arterial desaparece en más del 95 por ciento de los casos. En la actualidad, la técnica se está llevando a cabo por laparoscopia sobre los principios técnicos establecidos en la técnica abierta y con similares buenos resultados (AU)