Psoriasis and Nonalcoholic Fatty Liver Disease. / Psoriasis e hígado graso no alcohólico.

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver condition in the West. The prevalence and severity of NAFLD is higher and the prognosis worse in patients with psoriasis. The pathogenic link between psoriasis and NAFLD is chronic inflammation and peripheral insulin resistance, a common finding in diseases associated with psoriasis. NAFLD should therefore be ruled out during the initial evaluation of patients with psoriasis, in particular if they show signs of metabolic syndrome and require systemic treatment. Concomitant psoriasis and NAFLD and the likelihood of synergy between them place limitations on general recommendations and treatment for these patients given the potential for liver toxicity. As hepatotoxic risk is associated with some of the conventional drugs used in this setting (e.g., acitretin, methotrexate, and ciclosporin), patients prescribed these treatments should be monitored as appropriate. Anti-tumor necrosis factor agents hold the promise of potential benefits based on their effects on the inflammatory process and improving peripheral insulin resistance. However, cases of liver toxicity have also been reported in relation to these biologics. No evidence has emerged to suggest that anti-p40 or anti-interleukin 17 agents provide benefits or have adverse effects.

Chronic hepatitis C treatment in a cystic fibrosis patient in the pulmonary pre-transplant stage.

The standard treatment of chronic hepatitis C, pegylated interferon and ribavirin (pegI/R), has many limitations in both effectiveness and secondary effects, which makes it unsuitable or even contraindicated for some patients. In hepatitis C virus-infected cystic fibrosis patients this treatment could increase respiratory infections with subsequent pulmonary function deterioration. On the contrary, hepatitis C virus (HCV) infection may make lung transplant (LT) unfeasible. We present the case of a cystic fibrosis-young man diagnosed with HCV infection during LT assessment who was treated with pegI/R. In spite of the lung function worsening and respiratory infections, he managed to complete treatment and even sustained virological response (SVR). At present he is on LT waiting list.

Correlation of high levels of hyaluronan and cytokines (IL-1beta, IL-6, and TGF-beta) in ascitic fluid of cirrhotic patients.

Our objective was to investigate the relationship between endotoxin and hyaluronan synthesis and release in serum and ascitic fluid from cirrhotic patients. We studied hyaluronan, endotoxin, albumin, and creatinine levels in ascitic fluid and plasma and cytokine levels (IL-1beta, IL-6, TGF-beta) in ascitic fluid. TGF-beta, IL-6, and IL-1beta correlation analyses indicated a strong dependence of the production of these cytokines on endotoxin levels. Correlation analyses for TGF-beta and IL-6 indicated a strong dependence of the production of hyaluronan on cytokine levels and, to a lesser extent, on IL-1beta levels. Hyaluronan analysis indicated that a certain glycosaminoglycan level is required in ascites before its appearance in plasma. Our results disclosed elevated plasma hyaluronan concentrations. The simultaneous increased hyaluronan levels in ascitic fluid do not seem to be derived from the systemic circulation. In conclusion, the high hyaluronan-ascites/hyaluronan-plasma ratio suggests an intrinsic hyaluronan production from peritoneal cells induced by endotoxins.

Anti-anisakis antibodies in the clinical course of Crohn's disease.

BACKGROUND: Human anisakidosis is a parasitic disease whose intestinal form shares several characterictics with Crohn's disease (CD), like the ileocolonic location predominantly and the presence of granuloma. METHODS: 73 CD patients diagnosed according to Lennard-Jones' criteria were studied. The disease activity was measured by means of Harvey-Bradshaw Index. Different clinical variables were analyzed. Antigenic extract of Anisakis simplex larvae extracted from blue whiting was prepared. Determination of IgG, IgM, IgA and total specific immunoglobulin against A. simplex were carried out in sera by enzyme-linked immunosorbent assay. Immunorecognition patterns of these sera were realized by immunoblotting analysis. Results were compared with prevalence of antibodies anti-Anisakis in 251 healthy controls. RESULTS: 29% of CD patients showed detectable specific total Ig (G+M+A) against A. simplex (95% CI, 19-41). For IgG, IgM and IgA the percentages were 44, 18 and 53% (95% CI, 32-56, 10-26, and 41-65) respectively. In positive specific total Ig cases CD was localized mainly in ileum. In IgG-, IgM- and IgA-positive cases the location was predominantly ileocolonic. CD activity index was higher for groups with positive IgA (2.86 vs. 5.55; p < 0.05). CONCLUSION: Patients with CD have high prevalence of specific immunoglobulin against A. simplex. Specific IgA are associated to higher activity index of CD.

[The usefulness of hydrogastric ultrasonography in the detection of neoplastic lesions of the gastric wall]. / Utilidad de la ecografía hidrogástrica en la detección de lesiones neoformativas de la pared gástrica.

Forty patients endoscopically diagnosed of different gastric neoplastic lesions were explored by hydrogastric ultrasonography to evaluate the usefulness of this method in the detection of such lesions and to analyze the characteristics of the ultrasonographic images and their correlation with the anatomopathologic findings. The sensitivity of the detection of the lesions was 87.5% being close to 100% in those located in the antrum, showing the body and fundus more difficulties due to gas and the costal ribcage. A clear correlation was observed between the ultrasonographic images and the anatomographic findings. It was concluded that this may be a complementary technique to gastroscopy in the diagnosis of sumucosal lesions and extrinsic compressions of the gastric wall. The infiltration of the wall may be delimited in neoplastic lesions and thus may contribute to correct T stratification of the tumor, although this should be confirmed in further studies.