Miguel Ángel y el hígado de Noé: ¿Una lección secreta de anatomía? / Michelangelo and Noah's liver: a hidden anatomy lesson?

Miguel Ángel Buonarroti (1475 - 1564) es considerando uno de los más grandes artistas de la historia. Estudió en detalle la anatomía humana a través de la disección de cadáveres, práctica hasta entonces relegada por motivos religiosos. Desde que en el año 1990 el médico Frank Lynn Meshberger publicara su interpretación del fresco "La Creación de Adán" basada en la neuroanatomía, en donde comparaba la imagen de Dios con la de una sección sagital del cerebro humano, muchos autores han encontrado diversas referencias anatómicas ocultas en la obra de Miguel Ángel. En el presente trabajo exponemos el hallazgo de una inédita lección de anatomía hepática oculta en el fresco La Embriaguez de Noé de la Capilla Sixtina.

Michelangelo Buonarroti (1475 - 1564) is considered one of the greatest artists in history. He studied in detail the human anatomy through corpses dissection, practice until then relegated for religious reasons. Since the physician Frank Lynn Meshberger published in 1990 his interpretation of the fresco "The Creation of Adam" based on neuroanatomy, where he compared the image of God with a sagittal section of the human brain, many authors have found various hidden anatomical references in the work of Michelangelo. In the present paper we expose the finding of a hidden lesson on liver anatomy in the fresco The Drunkenness of Noah of the Sistine Chapel.

Polymorphism in the Promoter Region of NFE2L2 Gene Is a Genetic Marker of Susceptibility to Cirrhosis Associated with Alcohol Abuse.

Alcoholic liver disease (ALD) is a highly prevalent spectrum of pathologies caused by alcohol overconsumption. Morbidity and mortality related to ALD are increasing worldwide, thereby demanding strategies for early diagnosis and detection of ALD predisposition. A potential candidate as a marker for ALD susceptibility is the transcription factor nuclear factor erythroid-related factor 2 (Nrf2), codified by the nuclear factor erythroid 2-related factor 2 gene (NFE2L2). Nrf2 regulates expression of proteins that protect against oxidative stress and inflammation caused by alcohol overconsumption. Here, we assessed genetic variants of NFE2L2 for association with ALD. Specimens from patients diagnosed with cirrhosis caused by ALD were genotyped for three NFE2L2 single nucleotide polymorphisms (SNP) (SNPs: rs35652124, rs4893819, and rs6721961). Hematoxylin & eosin and immunohistochemistry were performed to determine the inflammatory score and Nrf2 expression, respectively. SNPs rs4893819 and rs6721961 were not specifically associated with ALD, but analysis of SNP rs35652124 suggested that this polymorphism predisposes to ALD. Furthermore, SNP rs35652124 was associated with a lower level of Nrf2 expression. Moreover, liver samples from ALD patients with this polymorphism displayed more severe inflammatory activity. Together, these findings provide evidence that the SNP rs35652124 variation in the Nrf2-encoding gene NFE2L2 is a potential genetic marker for susceptibility to ALD.

Implications of alcoholic cirrhosis in atherosclerosis of autopsied patients.

INTRODUCTION:: Alcoholism is a major public health problem, which has a high social cost and affects many aspects of human activity. Liver disease is one of the first consequences of alcohol abuse, and steatosis, liver cirrhosis and hepatitis may occur. Other organs are also affected with pathological changes, such as pancreatitis, cardiomyopathies, dyslipidemias and atherosclerosis. OBJECTIVE:: To identify the occurrence and degree of atherosclerosis in alcohol-dependent individuals with liver cirrhosis, observing macroscopic and microscopic changes in lipid and collagen deposits and in the liver. We also aimed to verify the association of lipid and collagen fiber deposits with gender, age and body mass index, and to relate alcoholism, liver cirrhosis and atherosclerosis. METHOD:: We performed a study based on autopsy reports of patients with alcoholic liver cirrhosis, with analysis of aorta and liver fragments to verify the occurrence and degree of atherosclerosis, as well as collagen contents. RESULTS:: Microscopic atherosclerosis was higher in young subjects (early injury) and in patients with alcoholic liver cirrhosis. The macroscopic analysis of atherosclerosis in aortas showed that patients in more advanced age groups presented more severe classifications. Atherosclerosis, both micro and macroscopically, and the percentage of fibrosis in the liver and aorta were more expressive in females. CONCLUSION:: Cirrhotic patients presented a higher percentage of fibrosis and lipidosis, and may represent a group susceptible to the accelerated progression of cardiovascular diseases. Investigative studies contribute to targeting health-promoting interventions, reducing the mortality and costs of treating cardiovascular disease.

Implications of alcoholic cirrhosis in atherosclerosis of autopsied patients / Implicações da doença hepática alcoólica na aterosclerose de pacientes autopsiados

Summary Introduction: Alcoholism is a major public health problem, which has a high social cost and affects many aspects of human activity. Liver disease is one of the first consequences of alcohol abuse, and steatosis, liver cirrhosis and hepatitis may occur. Other organs are also affected with pathological changes, such as pancreatitis, cardiomyopathies, dyslipidemias and atherosclerosis. Objective: To identify the occurrence and degree of atherosclerosis in alcohol-dependent individuals with liver cirrhosis, observing macroscopic and microscopic changes in lipid and collagen deposits and in the liver. We also aimed to verify the association of lipid and collagen fiber deposits with gender, age and body mass index, and to relate alcoholism, liver cirrhosis and atherosclerosis. Method: We performed a study based on autopsy reports of patients with alcoholic liver cirrhosis, with analysis of aorta and liver fragments to verify the occurrence and degree of atherosclerosis, as well as collagen contents. Results: Microscopic atherosclerosis was higher in young subjects (early injury) and in patients with alcoholic liver cirrhosis. The macroscopic analysis of atherosclerosis in aortas showed that patients in more advanced age groups presented more severe classifications. Atherosclerosis, both micro and macroscopically, and the percentage of fibrosis in the liver and aorta were more expressive in females. Conclusion: Cirrhotic patients presented a higher percentage of fibrosis and lipidosis, and may represent a group susceptible to the accelerated progression of cardiovascular diseases. Investigative studies contribute to targeting health-promoting interventions, reducing the mortality and costs of treating cardiovascular disease.

Resumo Introdução: O alcoolismo é um grande problema de saúde pública, de elevado custo social e que afeta vários aspectos da atividade humana. Hepatopatia é uma das primeiras consequências do abuso de álcool, podendo ocorrer esteatose, cirrose hepática e hepatite. Outros órgãos, porém, também são afetados, ocorrendo alterações patológicas, como pancreatite, cardiomiopatias, dislipidemias e aterosclerose. Objetivo: Identificar a ocorrência e a intensidade de aterosclerose em alcoolistas com cirrose hepática, observando alterações macro e microscópicas do depósito lipídico e de fibras colágenas e fígado. Verificar a associação de depósito lipídico e de fibras colágenas com gênero, idade e índice de massa corporal (IMC). Relacionar alcoolismo, cirrose hepática e aterosclerose. Método: Foi realizado estudo com base em laudos de autópsias de pacientes com cirrose hepática alcoólica, sendo estudados aortas e fígados para verificar a ocorrência e a intensidade de aterosclerose, bem como a quantidade de colágeno encontrada. Resultados: A aterosclerose microscópica foi maior em jovens (lesão inicial) e em pacientes com cirrose hepática alcoólica. A análise macroscópica da aterosclerose nas aortas mostrou que pacientes com faixas etárias mais avançadas apresentaram classificações mais intensas. A aterosclerose, tanto micro quanto macroscopicamente, e a porcentagem de fibrose no fígado e na aorta foram mais expressivas no gênero feminino. Conclusão: Os pacientes cirróticos apresentaram maior porcentagem de fibrose e lipidose, e podem representar um grupo susceptível à acelerada progressão de doenças cardiovasculares. Estudos investigativos contribuem para o direcionamento das intervenções promotoras da saúde, reduzindo a mortalidade e os custos no tratamento das doenças cardiovasculares.

Behavior of Oxidative Stress Markers in Alcoholic Liver Cirrhosis Patients.

Alcohol is the most socially accepted addictive substance worldwide, and its metabolism is related with oxidative stress generation. The aim of this work was to evaluate the role of oxidative stress in alcoholic liver cirrhosis (ALC). This study included 187 patients divided into two groups: ALC, classified according to Child-Pugh score, and a control group. We determined the levels of reduced and oxidized glutathione (GSH and GSSG) and the GSH/GSSG ratio by an enzymatic method in blood. Also, protein carbonyl and malondialdehyde (MDA) content were estimated in serum. MDA levels increased in proportion to the severity of damage, whereas the GSH and GSSG levels decreased and increased, respectively, at different stages of cirrhosis. There were no differences in the GSH/GSSG ratio and carbonylated protein content between groups. We also evaluated whether the active consumption of or abstinence from alcoholic beverages affected the behavior of these oxidative markers and only found differences in the MDA, GSH, and GSSG determination and the GSH/GSSG ratio. Our results suggest that alcoholic cirrhotic subjects have an increase in oxidative stress in the early stages of disease severity and that abstinence from alcohol consumption favors the major antioxidant endogen: GSH in patients with advanced disease severity.

Diethylcarbamazine: possible therapeutic alternative in the treatment of alcoholic liver disease in C57BL/6 mice.

Alcoholic liver disease is a major cause of chronic liver disease worldwide. Diethylcarbamazine (DEC) is a drug that has anti-inflammatory properties due to its effects on the metabolism of arachidonic acid. The present study examined the anti-inflammatory effects of DEC on the mechanisms of alcoholic liver disease. C57BL/6 mice were divided into seven groups: (i) control; (ii) DEC 50 mg/kg; (iii) alcohol; (iv) alcohol + DEC 50 mg/kg; (v) alcohol + celecoxib 50 mg/kg; (vi) alcohol + pyrrolidine dithiocarbamate 100 mg/kg; and (vii) alcohol + pyrrolidine dithiocarbamate 100 mg/kg + DEC 50 mg/kg. Liver fragments were stained with haemotoxylin-eosin and Sirius red, and processed for immunofluorescence, western blot, and immunohistochemistry. Serum was also collected for biochemical measurements. Alcohol induced liver damage, elevated collagen content, and increased expression of nuclear factor kappa-light-chain-enhancer of activated B cells and inflammatory markers (tumour necrosis factor-α, interferon-γ, interleukin-1ß, inducible nitric oxide synthase, cyclooxygenases-2, and transforming growth factor-ß). Treatment with DEC was able to reduce liver damage, collagen content, the expression of nuclear factor kappa-light-chain-enhancer of activated B cells and inflammatory markers; it also ameliorated biochemistry parameters (total cholesterol, high-density lipoprotein cholesterol, triglyceride content and aspartate aminotransferase) and increased the expression of anti-inflammatory markers (p-5' adenosine monophosphate-activated protein kinase and interleukin-10). Future clinical trials may demonstrate that oral administration of DEC may be suitable for the treatment of alcoholic liver disease and other liver diseases.

Percepção materna quanto aos filhos recém-nascidos hospitalizados / Maternal perception regarding hospitalized newborns / Percepción materna con respecto a hijos recién nacidos hospitalizados

Estudo transversal e descritivo, desenvolvido em unidade neonatal de um hospital público de ensino do estado de São Paulo, Brasil, em que se objetivou verificar a percepção das mães quanto aos filhos recém-nascidos hospitalizados. A amostra foi constituída por 100 mulheres, questionadas, por meio do Inventário de Percepção Neonatal de Broussard, sobre quanta dificuldade esperavam que os bebês da unidade, em geral, apresentassem para comportamentos como: chorar; alimentar; regurgitar ou vomitar; evacuar; dormir e estabelecer uma rotina. Em seguida, as mesmas perguntas foram repetidas sobre o próprio filho. Noventa mães consideraram os filhos com menos dificuldades que os outros bebês da unidade. As mulheres mais jovens e as mães de bebês com maiores pesos tenderam a considerar seus filhos com mais dificuldade. O Inventário é de fácil aplicação e pode ser útil no processo de avaliação da interação mãe-filho, embora seu resultado não possa ser considerado de forma isolada.

Cross-sectional descriptive study conducted in the neonatal unit of a public teaching hospital in the state of São Paulo, Brazil, which aimed to determine the perceptions of mothers about their newborns hospitalized children. The sample consisted of 100 women questioned, through the Neonatal Perception Inventory Broussard, about how much trouble was expected to be presented by babies of the general unit, on behaviors such as crying; feeding; regurgitate or vomit; evacuate; sleep and have a routine. Then, the same questions were repeated about their own babies. Ninety mothers considered their children with fewer difficulties than other babies at the unit. Younger women and mothers of infants with higher weights tended to consider their children with more difficulty. The Inventory is easy to apply and may be useful in the evaluation of mother-child interaction, although its result cannot be considered in isolation.

Estudio descriptivo transversal realizado en la unidad neonatal de un hospital público de enseñanza en el estado de São Paulo, Brasil, que tuve como objetivo determinar las percepciones de las madres con respecto a sus hijos recién nacidos hospitalizados. La muestra consistió en 100 mujeres a quien, a través del Inventario de Percepción Neonatal Broussard, se preguntó por la cantidad de problemas esperaban que los bebés de la unidad general presentasen respecto a comportamientos como el llanto; alimentos; regurgitar o vomitar; evacuar; dormir y establecer una rutina. Entonces, las mismas preguntas se repitieron a respecto de su propio hijo. Noventa madres consideraran a sus hijos con menos dificultad que los otros bebés en la unidad. Las mujeres más jóvenes y las madres de los recién nacidos con pesos mayores tendían a ver a sus hijos con más dificultades. El inventario es fácil de aplicar y puede ser útil en la evaluación del proceso de interacción madre-hijo, aunque sus resultados no pueden ser considerados aisladamente.

Unusual cause of gastrointestinal bleeding in a cirrhotic patient: hepatocellular carcinoma with gastric invasion.

BACKGROUND: Upper gastrointestinal (GI) bleeding is a common complication of portal hypertension in cirrhotic patients, and hepatocellular carcinoma (HCC) is the most common tumor in cirrhotic livers. Bleeding from tumor erosion into the GI tract is very rare. A patient with HCC and gastric tumor invasion was described and the previously reported cases were reviewed. METHOD: A patient with upper GI bleeding was treated in a tertiary hospital. RESULTS: A cirrhotic patient with a HCC invading the stomach leading to upper GI bleeding was treated by left lateral segmentectomy and sub-total gastrectomy. The bleeding was controlled and a good surgical outcome was achieved. CONCLUSIONS: HCC with gastric invasion should be differentially diagnosed from upper GI bleeding in cirrhotic patients. Bleeding can be controlled and symptomatic relief marked in selected cases.

Prevalencia de la enfermedad hepática alcohólica y algunos factores de riesgo en pacientes que acuden a los ambulatorios de Barquisimeto

Para determinar la prevalencia de enfermedad hepática alcohólica y algunos factores de riesgo en pacientes que acuden a los Ambulatorios de Barquisimeto, Estado Lara, se realizo esta investigacion con 268 sujetos, entre 18 y 65 anos de edad, de ambos sexos y sin patologías hepáticas previas. La prevalencia general de enfermedad hepática alcohólica fue 3,7 por ciento; la prevalencia de enfermedad hepática alcohólica no cirrótica fue 2,2 por ciento; la enfermedad hepática alcohólica no cirrótica con sospecha de cirrosis represento el 1,12 por ciento y la enfermedad hepática alcohólica cirrótica 0,38 por ciento, los enfermos fueron mayoritariamente hombres. En consumidores de alto riesgo, estos resultados se triplicaron. En resumen, las prevalencias de enfermedad hepática alcohólica y enfermedad hepática alcohólica cirrótica fueron superiores a las reportadas internacionalmente, hallazgos debidos, probablemente, a la elevada frecuencia de consumo de alto riesgo. Se requieren estudios analíticos observacionales para confirmar la anterior aseveracion, así como, los resultados relacionados con el mayor riesgo que aparentemente demostraron los hombres sobre las mujeres

A research to determine the prevalence of alcoholic liver disease and some risk factors in patients who visit the outpatient centers of Barquisimeto, Lara State, was carried out. The sample was made up of 268 individuals between 18 and 65 years old, both male and female, without any previous liver pathologies. The general prevalence of alcoholic liver disease was 3.7 percent and 2.2 percent for non-cirrhotic alcoholic liver disease, for non-cirrhotic alcoholic liver disease with suspected cirrhosis 1.12 percent and 0.38 percent for cirrhotic alcoholic liver disease, being always predominated in male individuals. In patients with highrisk consumption, the results were threefold. In conclusion, the prevalence of alcoholic liver disease and non-cirrhotic alcoholic liver disease were above those internationally reported. This is due to, probably, the increased frequency of high-risk consumption. Analytic observational studies are required to confirm the previous affirmation as well as the results related with the greater risk that apparently was demonstrated by men over women

Para determinar o predomínio da doença hepática alcoólica e alguns fatores de risco em pacientes que freqüentam o ambulatorios de Barquisimeto, Estado Lara, foi realizado a pesquisa com 268 sujeitos, dentre 18 e 65 anos de idade, de ambos os sexos e sem patologias hepáticas previas. O predomínio geral da doença hepática alcoólica foi 3,7 por cento; o predomínio da doença hepática alcoólica nao-cirrótica foi 2,2 por cento; A doença hepática alcoólica nao-cirrótica com suspeita de cirroses representou o 1,12 por cento e a doença hepática alcoólica cirrótica 0,38 por cento, os doentes foram na maior parte homens. Nos consumidores de alto risco, os resultados se triplicaram. Em resumo, o predomínio da doença hepática alcoólica e doença hepática alcoólica cirrótica foi superior as descobertas internacionais, devido a elevada frequencia de consumo de alto risco. Se requerer de estudos analíticos de observaçào para confirmar a primeira hipótese, assim como também, os resultados relacionados com o alto risco predominante em homens com relação às mulheres

Prevalência da pancreatite crônica em pacientes portadores de cirrose hepática alcoólica: estudo histopatológico / Prevalence of chronic pancreatitis in patients with alcoholic liver cirrhosis: histopathological study

INTRODUÇÃO: O abuso crônico do álcool é importante causa de cirrose hepática e de pancreatite crônica. OBJETIVO: Avaliar a frequência de pancreatite crônica (PC) em pacientes portadores de cirrose hepática alcoólica (CHA) por exame histopatológico. Casuística: Analisaram-se necropsias de 18 homens e sete mulheres portadores de CHA, com idade média e desvio padrão de 47,2 ± 13,8 anos (24 a 83 anos), que consumiam em média 239,6 ± 155,3 g de etanol/dia por um período médio de 16,7 ± 7,2 anos. MÉTODOS: O diagnóstico histopatológico de cirrose hepática baseou-se na fibrose sistematizada com formação de septos delimitando nódulos, associada à inflamação crônica inespecífica. O diagnóstico histológico de PC baseou-se na identificação de exsudato mononuclear (EM) em torno dos ductos e no tecido conjuntivo inter e intralobular, acompanhado de traves de fibrose. A PC foi classificada como leve quando havia discreto EM em região periductal, interlobular ou intralobular acompanhado por finas traves de fibrose; moderada, pelo aumento da intensidade do exsudato e da fibrose, ocasionalmente associado com pequena dilatação dos ductos; a forma grave caracterizou-se pelo EM, densa fibrose, presença de rolhas, dilatação dos ductos, atrofia glandular e, às vezes, calcificação. RESULTADOS: Observou-se PC em 20 pacientes portadores de CHA (80 por cento), que foi leve em 13 (52 por cento), moderada em dois (8 por cento) e grave em cinco (20 por cento). CONCLUSÃO: A pancreatite crônica está frequentemente associada à CHA, sendo histologicamente grave em aproximadamente 1/4 dos casos.

INTRODUCTION: The chronic alcohol abuse is an important cause of liver cirrhosis and chronic pancreatitis. OBJECTIVE: To evaluate the prevalence of chronic pancreatitis (CP) in patients with alcoholic liver cirrhosis (ALC) based on histopathological assays. Subjects: Autopsies of 25 patients with ALC, 18 men and seven women, age ranging from 24 to 83 years (mean ± standard deviation: 47.2 ± 13.8) were retrospectively analyzed. They ingested on average 239.6 ± 155.3 g ethanol/day for a mean period of 16.7 ± 7.2 years. METHODS: Liver cirrhosis histopathological diagnosis was based on the findings of systemized fibrosis with formation of septum-delimited nodules and nonspecific chronic inflammation. CP histopathological diagnosis was based on identification of mononuclear cell infiltration (MCI) around the ducts and in the inter- and intra-lobular connective tissue and presence of strands of fibrosis. CP was classified as mild (discrete MCI in the periductal, inter- or intra-lobular areas with thin strands of fibrosis), moderate (increased exudates and fibrosis, occasionally associated with small dilatation of ducts), and severe (evident MCI, dense fibrosis, presence of plugs in the ducts, irregular ductal dilatation, glandular atrophy and, sometimes, calcification). RESULTS: CP was observed in 20 patients (80 percent) with ALC, and was considered mild in 13 (52 percent), moderate in two (8 percent) and severe in five (20 percent) patients. CONCLUSION: CP is often associated with the ALC, and it can be histologically severe in approximately 1/4 of the cases.

Budd-Chiari like syndrome in decompensated alcoholic steatohepatitis and liver cirrhosis.

A rare case of pseudo-Budd-Chiari Syndrome in a patient with decompensated alcoholic liver disease is reported. Although clinical and radiological findings suggested Budd-Chiari Syndrome, the liver biopsy revealed micronodular cirrhosis and absence of histological signs of hepatic outflow obstruction.

Hepatocellular carcinoma: incidental finding in cirrhotic explanted livers.

INTRODUCTION: Cirrhosis predisposes to the development of hepatocellular carcinoma (HCC), demanding that these patients undergo follow-up with imaging methods for the early detection of neoplastic nodules. Morphologic study of the explanted livers allows identification of lesions not detected pre-operatively. OBJECTIVE: To assess the frequency and to characterize the HCC found incidentally at pathological evaluation of explanted cirrhotic livers. MATERIAL AND METHODS: Thirty patients had HCC diagnosed in explanted cirrhotic livers. The livers were sectioned at intervals of 0.5 cm. Each detached nodule was selected for microscopic study according to size, color and/or consistency. Retrospective analysis of the clinical records was performed comparing available data from various imaging methods. RESULTS: In 11 patients, 16 HCC had previously been identified in the explants by one or more imaging methods. In the other 19 explanted livers (63.3%), HCC was incidentally found. All HCC identified in 9 patients and some of them in 10 patients were incidentally found, varying from microscopic focuses to 2 cm diameter lesions. They varied from only one (5 cases) to multiple nodules (7 cases). DISCUSSION: Imaging methods may underestimate the number of HCC in cirrhotic livers. Histological study is an essential tool that can early detect tumor nodules not previously detected by imaging methods. In our study, although small, multicentric HCC were identified, illustrating the multifocal nature of the hepatic carcinogenesis. Future studies must correlate these findings with patient outcomes. CONCLUSION: Characterization of explanted cirrhotic livers for HCC is important for previously known and incidentally found lesions.

Liver necrosis induced by acute intraperitoneal ethanol administration in aged rats.

It is generally agreed that the deleterious pathophysiological effects of ethanol are caused, at least partially by an increase in free radical production. However, little attention has been directed to the effects of ethanol upon elderly organisms. Male Wistar rats at ages 3, 6, 12, 18 and 24 months were treated either with a single i.p. dose of 35% ethanol (v/v) at 3 g ethanol/kg body weight or an isovolumetric amount of 0.9% saline solution. We then assessed the plasma levels of transaminases and hepatic levels of oxidative stress-related parameters, followed by liver histological evaluation. The younger rats (3 months old) were not affected by the treatment with ethanol with respect to any of the studied parameters except for a lowering of total hepatic GSH and an increase in hepatic thiobarbituric acid reactants (TBARS) formation, while animals older than 3 months were increasingly more affected by the treatment. Acute ethanol treatment elicited the similar responses to those in the 3 months-old group, plus a decrease in the hepatic and plasma levels of beta-carotene and the plasma level of alpha-tocopherol, as well as an increase in the activity of plasma transaminases. In the 12,18 and 24 months old groups, there was increasing liver necrosis. These findings suggest that liver damage induced by acute ethanol administration in elderly rats may involve a lack of antioxidants.

Prevalence of hepatitis B and hepatitis C markers in alcoholics with and without clinically evident hepatic cirrhosis

Nos avaliamos a frequencia de marcadores sorologicos das hepatites B e C em 365 alcoolistas, determinando pelo metodo ELISA, a presenca de HBsAg, anti-HBc, anti-HBs e anti-HCV. Cinquenta deles eram cirroticos e 315 nao tinham evidencias de cirrose hepatica; nestes ultimos determinamos HBsAg em todos, anti-HBc e anti-HBs em 130, e anti-HCV em 210. Entre os alcoolistas as frequencias de HBsAg (1,9 por cento), anti-HBc (28,3 por cento) e anti-HCV (3,8 por cento) foram maiores (p<0,001) do que entre os controles (N=17,059), 0,4 por cento, 4,0 por cento e 0,4 por cento respectivamente. A frequencia de HBsAg+ no grupo de alcoolistas sem cirrose (0,95 por cento) foi semelhante a do grupo controle (0,4 por cento) e menores (p<0,001) do que no grupo cirrotico (8,0 por cento)...

Marcadores virales en pacientes con cirrosis hepática e ingesta de alcohol / Viral markers in alcoholic patients with hepatic cirrhosis

El objetivo de este trabajo es determinar la seroprevalencia de marcadores virales para virus B y C en pacientes con cirrosis e ingesta alcohólica y determinar si existen diferencias clínicas y bioquímicas en los pacientes con marcadores virales positivos. Se incluyeron un total de 58 pacientes, 52 hombres y mujeres, con una edad comprendida entre 26 y 72 años, promedio 53 años. 14 pacientes (24,1 por ciento) resultaron Anticore total del virus B (AnticHB) positivo, 6 (10,3 por ciento), Antígeno de superficie (AgsHB) positivo y 8 (13,7 por ciento) Anticuerpo anti virus C (ANtiHVC) positivo, 3 pacientes resultaron positivos para los tres marcadores. Un total de 19 pacientes 33 por ciento tenían algún marcador viral presente. Todos los pacientes resultaron HIV negativos. No se encontró diferencia en los diferentes grupos en cuanto a edad, tiempo y cuantía de ingesta alcohólica, valores de transaminasas, bilirrubina, GGTP, PT, Globulina y Plaquetas. Sólo se encontró diferencia en los valores de albúmina al comparar pacientes AntiHVC positivos y pacientes con marcadores negativos. No se encontraron factores de riesgo en los pacientes con marcadores virales positivos. La seroprevalencia de marcadores virales en pacientes cirróticos alcohólicos es 4 veces superior a la determinada en donantes de sangre para virus B y 18 veces para virus C, no encontrándose factores de riesgo asociados a la presencia de infección viral, por lo que se recomienda descartar la presencia de infección por virus B y C en todo paciente cirrótico con ingesta alcohólica

Marcadores de fibrogénesis hepática en pacientes alcohólicos / Hepatic fibrogenesis markers in alcoholic patients

Serum P-III-P and laminim levels were measured in asymptomatic alcoholics during detoxication treatment. Liver biopsies were obtained, in order to detect liver damage, which was graded with a numeric score, considering values over 6 as severe damage. Serum fibrogenesis markers were also measured in a group of decompensated alcoholic cirrhotics. P-III-P levels were significantly higher in cirrhotic patients compared to alcoholics with or without liver damage and to normal controls. Laminin was not different between groups. P-III-P did not correlate with histological score in asymptomatic patients. In this study P-III-P and P1 laminin were not usefull discriminators of severe liver damage among asymptomatic alcoholics; their levels were found to rises significantly only when liver disease has become clinically evident

Fatty acid composition of liver total lipids in alcoholic patients with and without liver damage.

Alcohol ingestion may promote lipid peroxidation, and the presence of polyunsaturated fatty acids in liver lipids may be essential for the generation of liver damage through this mechanism. The aim of this study is to examine fatty acid composition of liver lipids in chronic alcoholics with and without histological liver damage. A percutaneous liver biopsy was performed to 28 patients hospitalized for treatment of their alcoholism. Liver total lipids were extracted from a portion of the tissue sample and fatty acid composition was measured by gas chromatography. Another piece of the sample was sent for histological study. Six patients had histological cirrhosis or alcoholic hepatitis in their biopsies, the rest of the patients had minimal changes. Patients with liver damage had higher levels of oleic acid and total monoenoic fatty acids, a higher 18:1/18:0 ratio, lower levels of polyunsaturated fatty acids, a lower 20:4/18:2 ratio, and a lower peroxidability index in liver total lipids, than patients without liver damage. Alcoholic patients with asymptomatic liver damage have less unsaturated fatty acids in liver total lipids than their counterparts with normal livers.