RESUMEN
Aim of this study is to present a survey of the dog population and breed distribution in Switzerland from 1955 to 2008 as basis to realize a population based canine cancer register for Switzerland. The number of dogs rose from 309'000 in 1955 to approximately 500'000 in 2008 correlating with a parallel increase of human population. The ratio of dogs per 100 inhabitants remains stable. This ratio is lower in German speaking compared to French or Italian speaking Cantons. The variety and popularity of breeds changed from 1955 to 2008, "winners" are Labrador and Golden Retrievers, Yorkshire and Jack Russel Terriers. Less popular breeds over the years are German Sheherd dogs and Poodles.
Asunto(s)
Perros/clasificación , Animales , Demografía , Crecimiento Demográfico , SuizaRESUMEN
BACKGROUND: Plasma adiponectin is decreased in NASH patients and the mechanism(s) for histological improvement during thiazolidinedione treatment remain(s) poorly understood. AIM: To evaluate the relationship between changes in plasma adiponectin following pioglitazone treatment and metabolic/histological improvement. METHODS: We measured in 47 NASH patients and 20 controls: (i) fasting glucose, insulin, FFA and adiponectin concentrations; (ii) hepatic fat content by magnetic resonance spectroscopy; and (iii) peripheral/hepatic insulin sensitivity (by double-tracer oral glucose tolerance test). Patients were then treated with pioglitazone (45 mg/day) or placebo and all measurements were repeated after 6 months. RESULTS: Patients with NASH had decreased plasma adiponectin levels independent of the presence of obesity. Pioglitazone increased 2.3-fold plasma adiponectin and improved insulin resistance, glucose tolerance and glucose clearance, steatosis and necroinflammation (all P < 0.01-0.001 vs. placebo). In the pioglitazone group, plasma adiponectin was significantly associated (r = 0.52, P = 0.0001) with hepatic insulin sensitivity and with the change in both variables (r = 0.44, P = 0.03). Increase in adiponectin concentration was related also to histological improvement, in particular, to hepatic steatosis (r = -0.46, P = 0006) and necroinflammation (r = -0.56, P < 0.0001) but importantly also to fibrosis (r = -0.29, P = 0.03). CONCLUSIONS: Adiponectin exerts an important metabolic role at the level of the liver, and its increase during pioglitazone treatment is critical to reverse insulin resistance and improve liver histology in NASH patients.
Asunto(s)
Adiponectina/metabolismo , Hígado Graso/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Tiazolidinedionas/uso terapéutico , Adiponectina/sangre , Adulto , Estudios de Casos y Controles , Prueba de Tolerancia a la Glucosa , Humanos , Hígado/efectos de los fármacos , Hígado/metabolismo , Persona de Mediana Edad , Pioglitazona , Análisis de Regresión , Resultado del TratamientoRESUMEN
The purpose of this investigation was to compare neuromuscular control variables during successful and failed jump landings in multiple directions (sagittal, diagonal, and lateral). All data were collected during a single leg hop stabilization maneuver, which required subjects to stand 70 cm from the center of a force plate, jump off both legs, touch a designated marker placed at a height equivalent to 50% of their maximum vertical jump, and land on a single leg for all directions. Twenty-six subjects [10 males (22+/-3.9 years of age, 70.9+/-7.6 kg, and 176.8+/-0.5 cm) and 16 females (20.6+/-0.5 years of age, 65.6+/-9.1 kg, and 166.4+/-5.9 cm)] volunteered to participate in this investigation. Muscle activation times, average preparatory, and reactive electromyographic (EMG) amplitudes were calculated for the vastus medialis, semi-membranosis, lateral gastrocnemius, and tibialis anterior. EMG data revealed that successful jump landing trials had earlier activation times and higher preparatory and reactive EMG amplitudes. There was no difference for EMG activation times or amplitudes among directions. The results indicate neuromuscular control differences between successful and failed trials because of earlier muscle onset and greater amplitude. The results also suggest that in a healthy population, the direction of the jump protocol will not affect lower extremity EMG characteristics.
Asunto(s)
Pierna/inervación , Movimiento/fisiología , Contracción Muscular/fisiología , Músculo Esquelético/inervación , Músculo Esquelético/fisiología , Músculo Cuádriceps/inervación , Deportes/fisiología , Adulto , Electromiografía , Femenino , Humanos , Pierna/fisiología , Masculino , Fatiga Muscular/fisiología , Equilibrio Postural/fisiología , Postura/fisiología , Músculo Cuádriceps/fisiologíaRESUMEN
BACKGROUND: In utero ethanol exposure causes abnormal fetal brain development that may partly be due to enhanced cell death. The mechanisms underlying this remain to be defined, but ethanol-induced oxidative stress may play a role. The following studies investigated the effects of short-term in utero ethanol exposure on fetal brain mitochondrial events that are known to elicit apoptotic cell death. Evidence is presented suggesting that 4-hydroxynonenal (HNE), a toxic product of lipid oxidation, is a causal factor in the observed mitochondrial damage. METHODS: Mitochondria were isolated from control and ethanol-exposed fetal brains (days 17 and 18 of gestation). Permeability transition was determined spectrophotometrically, and cytochrome c and apoptosis-inducing factor (AIF) release were assessed by Western blotting. Caspase-3 activity and DNA fragmentation were determined both as markers for mitochondrially mediated apoptosis and as consequences of cytochrome c and AIF release. RESULTS: Maternal ethanol intake caused an increase in mitochondrial permeability transition, and this was accompanied by cytochrome c and AIF release from fetal brain mitochondria that exceeded control values by 62 and 25%, respectively (p < 0.05). In utero ethanol exposure resulted in a 30% increase in caspase-3 activity and a 25% increase in DNA fragmentation (p < 0.05) in the fetal brain. HNE levels were increased by 23% (p < 0.05) in mitochondria by in vivo ethanol exposure. In vitro treatment of fetal brain mitochondria with HNE (25-100 microM) also caused increases in mitochondrial permeability transition, as well as dose-dependent releases of cytochrome c and AIF. CONCLUSIONS: These studies illustrate that in utero ethanol exposure can elicit a cascade of events in the fetal brain that are consistent with mitochondrially mediated apoptotic cell death. Additionally, the increase in mitochondrial content of HNE after ethanol intake and the ability of HNE added to fetal brain mitochondria to mimic these effects of in vivo ethanol exposure support a potential role for HNE in the proapoptotic responses to ethanol.
Asunto(s)
Aldehídos/metabolismo , Apoptosis , Encéfalo/embriología , Encéfalo/ultraestructura , Etanol/efectos adversos , Intercambio Materno-Fetal , Mitocondrias/efectos de los fármacos , Aldehídos/análisis , Animales , Factor Inductor de la Apoptosis , Atractilósido/farmacología , Encéfalo/metabolismo , Calcio/farmacología , Caspasa 3 , Caspasas/metabolismo , Grupo Citocromo c/metabolismo , Fragmentación del ADN , Inhibidores Enzimáticos/farmacología , Femenino , Flavoproteínas/metabolismo , Proteínas de la Membrana/metabolismo , Mitocondrias/fisiología , Translocasas Mitocondriales de ADP y ATP/antagonistas & inhibidores , Permeabilidad , Embarazo , Ratas , Ratas Sprague-DawleyRESUMEN
BACKGROUND: Recent reports have suggested that food deprivation may contribute to acetaminophen hepatotoxicity by shunting drug detoxification from the conjugative to the potentially toxic oxidative pathways. METHODS: This study assessed this concept in a prospective study of food restriction of 500 calories/day over 5 days and also of 1000 calories/day over 13 days. Obese, otherwise normal, individuals received 2 g acetaminophen orally at the start and again after food restriction. Sequential liver tests, as well as serum and urine acetaminophen and its derivatives were measured. RESULTS: In both food-restricted groups there was no evidence of any change in the elimination or in the metabolic pattern of acetaminophen removal. Liver tests remained normal. The average weight loss was about 6 pounds. CONCLUSIONS: Our data, with this brief, but major degree of food restriction, and this load of acetaminophen (half-maximal daily dose), do not demonstrate an effect of caloric restriction on acetaminophen disposition.
Asunto(s)
Acetaminofén/farmacocinética , Analgésicos no Narcóticos/farmacocinética , Dieta Reductora , Hígado/metabolismo , Obesidad/metabolismo , Acetaminofén/administración & dosificación , Acetaminofén/efectos adversos , Administración Oral , Adulto , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/efectos adversos , Femenino , Humanos , Hígado/efectos de los fármacos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , Pérdida de PesoRESUMEN
The light-induced high-spin-->low-spin relaxation for the Fe(II) spin-crossover compounds [Fe(btpa)](PF6)2 and [Fe(b(bdpa))](PF6)2 in solution, where btpa is the potentially octadentate ligand N,N,N',N'-tetrakis(2-pyridylmethyl)-6,6'-bis(aminomethyl)-2,2'-bipyridine and b(bdpa) is the analogous hexadentate ligand N,N'-bis(benzyl)-N,N'-bis(2-pyridylmethyl)-6,6'-bis(aminomethyl)-2,2'- bipyridine, respectively, has been studied by temperature-dependent laser flash photolysis. [Fe(b(bdpa))](PF6)2 shows single-exponential 5T2-->1A1 relaxation kinetics, whereas [Fe(btpa)](PF6)2 exhibits solvent-independent biphasic relaxation kinetics. The fast process of [Fe(btpa)](PF6)2 with a rate constant, kHL, of 2.5 x 10(7) s-1 at 295 K and an activation energy, Ea, of 1294(26) cm-1 in methanol can be assigned to the 5T2-->1A1 relaxation as well. The slow process with a kHL(295 K) of 3.7 x 10(5) s-1 and a Ea of 2297(32) cm-1 in methanol--which is the slowest light-induced relaxation process observed so far for an Fe(II) spin-crossover complex in solution--is assigned to a coupling of the 5T2-->1A1 relaxation process to a geometrical rearrangement within the pendent pyridyl arms.
RESUMEN
Fetal alcohol syndrome (FAS) is frequently associated with intrauterine growth retardation (IUGR). One cause of ethanol-induced IUGR is thought to be related to increased pressor activity in the human placenta, resulting in decreased oxygenation and nutrient transport to the fetus. Thus, we have investigated the effect of ethanol on paracrine substances, such as thromboxane and prostacyclin, that act as vasoregulators within the intrauterine tissues. In these studies we have utilized the perfused single human cotyledon system to study the effect of ethanol on placental prostanoid production. We assessed the effect of longer (240 min) and more acute (60 min) exposure to ethanol on release of thromboxane B(2) (TxB(2)) and 6-keto-prostaglandin F(1 alpha) (6-keto-PGF(1 alpha)) at the maternal and fetal sides of the placenta. Thromboxane was increased by both longer and shorter ethanol exposure, especially on the fetal side of the placenta. Prostacyclin was essentially unchanged with exposure to ethanol. The thromboxane:prostacyclin ratio also tended to increase with both 60- and 240-min ethanol exposure, but a statistically significant increase was seen only at a few time points. In the 60-min ethanol exposure, an increase in thromboxane was observed both during and following exposure to ethanol. The increase in the thromboxane milieu observed with ethanol exposure may lead, at least in part, to the IUGR which is frequently associated with FAS. Prevention of this effect of ethanol on thromboxane production might be a beneficial intervention for FAS.
Asunto(s)
6-Cetoprostaglandina F1 alfa/biosíntesis , Etanol/farmacología , Placenta/efectos de los fármacos , Placenta/metabolismo , Tromboxano B2/biosíntesis , Femenino , Humanos , Técnicas In Vitro , Cinética , EmbarazoRESUMEN
BACKGROUND: Previous studies in our laboratory demonstrated that short-term ethanol consumption by maternal rats increased the hepatic levels of 4-hydroxynonenal (HNE) in both the adult and the fetus. Additionally, HNE inhibited cytochrome c oxidase (COX) by forming adducts with the enzyme subunits. The present study examined modification of COX by another major aldehydic lipid peroxidation product, malondialdehyde (MDA), and its role in COX inhibition by ethanol. METHODS AND RESULTS: It is demonstrated in vitro that MDA inhibits the activity of purified COX while forming adducts with the enzyme. Compared with HNE, MDA is a more potent inhibitor of COX. Overnight incubation at room temperature caused an 80% decrease in COX activity by MDA versus a 67% decrease by HNE. MDA produced marked inhibition of COX activity at physiologically relevant concentrations, e.g., 43% inhibition at 10 microM. Although our previous studies documented that HNE formed adducts primarily with subunit IV of COX via histidine residues, the current report showed that MDA forms adducts with both subunit IV and subunit V via lysine residues. Furthermore, both aldehydes induce carbonyl formation in subunit IV. The in vivo role of MDA in the impairment of COX by ethanol is assessed in both adult and fetal liver after maternal ethanol consumption. CONCLUSIONS: The results showed that: (1) there are significant increases in MDA levels in liver homogenate as well as mitochondria in both adult and fetal livers after ethanol exposure; (2) these MDA levels are in the nanomole/mg protein range, in contrast to picomole/mg protein range of HNE in identical setting; and (3) ethanol-induced production of MDA is accompanied by enhanced formation of MDA adducts with COX. These findings suggest that MDA may play at least as equally an important role as HNE in ethanol-induced inhibition of COX.
Asunto(s)
Depresores del Sistema Nervioso Central/farmacología , Complejo IV de Transporte de Electrones/efectos de los fármacos , Etanol/farmacología , Hígado/efectos de los fármacos , Malondialdehído/metabolismo , Aldehídos/metabolismo , Animales , Complejo IV de Transporte de Electrones/metabolismo , Femenino , Feto/efectos de los fármacos , Feto/metabolismo , Hígado/metabolismo , Mitocondrias Hepáticas/efectos de los fármacos , Mitocondrias Hepáticas/metabolismo , Embarazo , Ratas , Ratas Sprague-DawleyRESUMEN
AIMS: The primary objective of this study was to describe the single dose pharmacokinetics of ribavirin in subjects with normal liver function and those with various degrees of stable chronic liver disease. Additionally this study assessed the safety and tolerability of ribavirin in this population. METHODS: Single oral 600 mg doses of ribavirin were administered to healthy male and female volunteers (n = 6) and patients with stable chronic liver disease (n = 17), in a parallel group study. Pharmacokinetic sampling and tolerability assessments were performed up to 168 h post dose. RESULTS: Single oral doses of 600 mg ribavirin were well tolerated by healthy volunteers and patients with varying degrees of hepatic dysfunction. Although mean Cmax increased with the severity of hepatic dysfunction, there was no change in extent of absorption or renal clearance of ribavirin. CONCLUSIONS: There are no pharmacokinetic reasons for initial dose adjustment of ribavirin in patients with hepatic dysfunction.
Asunto(s)
Hepatopatías/metabolismo , Ribavirina/farmacocinética , Adulto , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The incidence of gallstone disease in patients with cirrhosis is greater than that in healthy patients. Previous surgical literature reported greater morbidity and mortality in patients with cirrhosis with both open and laparoscopic cholecystectomy (LC). We compared our recent experience with LC in patients with cirrhosis and controls. A retrospective review was performed using the search terms, "cirrhosis" and "laparoscopic cholecystectomy." Forty-eight patients with cirrhosis were identified and randomly matched with healthy controls by age and sex. Four controls were assigned per patient with cirrhosis. Outcomes assessed included mortality, duration of surgery, length of hospital stay, blood transfusion requirement, postoperative complications, and need for conversion to open cholecystectomy. Forty-eight patients with cirrhosis and 187 healthy controls underwent LC. Child-Pugh classification of severity of liver disease was as follows: Child's class A, 38 of 48 patients; Child's class B, 10 of 48 patients; and Child's class C, 0 of 48 patients. Patients with cirrhosis had statistically significantly lower albumin levels (P =.0001) and prolonged prothrombin times (P =. 05). Average duration of surgery for patients with cirrhosis was 1. 71 versus 1.57 hours (P =.57) for controls. Average length of hospital stay for patients with cirrhosis was 6.47 versus 4.77 days (P =.152) for controls. Average number of units of blood transfused in patients with cirrhosis was 0.156 versus 0.0 units (P =.025) in controls. Complications occurred in 6 of 48 patients with cirrhosis (12.5%) and 8 of 187 controls (4.2%; P <.05). No child's class C patient underwent LC. Four patients with cirrhosis (8.3%) and no controls were converted to open cholecystectomy. No postoperative infections were noted. There was no mortality in either group. LC in patients with Child's class A and B cirrhosis is reasonably safe and shows no increase in morbidity or mortality or worsening of outcome. Further studies are required to evaluate the management of acute gallbladder disease in Child's class C patients.
Asunto(s)
Colecistectomía Laparoscópica , Cirrosis Hepática/cirugía , Adulto , Anciano , Femenino , Humanos , Cirrosis Hepática/mortalidad , Masculino , Persona de Mediana Edad , Morbilidad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Trazodone (Desyrel) is a second-generation, nontricyclic antidepressant that has been in use in North America since the early 1980s. It has the advantage of being more sedating and having less anticholinergic side effects than other secondary amines in the piperazine class, namely, desipramine and nortriptyline. Five previous cases of trazodone hepatotoxicity have been reported in the literature, one describing chronic damage and the others, more acute cellular and cholestatic injury. We describe a case of acute reversible liver injury with the use of trazodone. This case is unique in that injury occurred after protracted (18 months) drug use and while the patient was on corticosteroids. Moreover, the diagnosis was confirmed by an inadvertent challenge with trazodone. This case reports not only a well documented instance of trazodone-induced liver injury, but also serves as a basis for a brief discussion of mechanisms, clinical monitoring, and therapy in drug-induced hepatotoxicity.
Asunto(s)
Antidepresivos de Segunda Generación/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Hígado/efectos de los fármacos , Trazodona/efectos adversos , Adulto , Antiinflamatorios/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Femenino , Glucocorticoides/uso terapéutico , Humanos , Ictericia/inducido químicamente , Prednisona/uso terapéuticoAsunto(s)
Hepatopatías Alcohólicas/dietoterapia , Animales , Grasas de la Dieta/uso terapéutico , Etanol/toxicidad , Humanos , Técnicas In Vitro , Hígado/efectos de los fármacos , Hígado/lesiones , Hígado/metabolismo , Hepatopatías Alcohólicas/etiología , Hepatopatías Alcohólicas/metabolismo , Fosfatidilcolinas/uso terapéuticoRESUMEN
1. The present study assessed the human transplacental transport of olanzapine, a new antipsychotic drug effective in the treatment of schizophrenia. 2. Using the normal-term placenta perfused single cotyledon system, we show that: (i) 5-14% of labelled olanzapine crosses from the maternal to foetal compartments in 4 h; (ii) transport depends significantly on binding characteristics, especially of albumin; (iii) no oxidative metabolites of olanzapine appear in the placental perfusate over 4 h; and (iv) approximately 17% of olanzapine, on average, is converted to the glucuronide, which is transferred by the placenta at a rate slightly slower than the parent drug.
Asunto(s)
Antipsicóticos/farmacocinética , Glucurónidos/farmacocinética , Intercambio Materno-Fetal/fisiología , Pirenzepina/análogos & derivados , Placenta/fisiología , Benzodiazepinas , Femenino , Humanos , Intercambio Materno-Fetal/efectos de los fármacos , Olanzapina , Pirenzepina/farmacocinética , EmbarazoRESUMEN
The fetotoxic effects of maternal ethanol (E) consumption have been documented for over two decades, yet the mechanisms underlying this devastating phenomenon remain uncertain. The wide variety of cellular/biochemical effects of E on fetal tissues is itself a puzzle and strongly suggests that fetotoxic responses to E reflect a multifactorial setting. Many of these responses can be conceptually connected to effects on membrane structure and function. Representative of this, are studies in our laboratory documenting E effects on fetal cell replication, membrane transport systems, membrane fluidity, Na+-K+ pump expression, and EGF receptor expression. Recent studies have provided evidence that oxidative stress may be one mechanism by which E produces these membrane-related events. We initially observed E-induced oxidative stress in cultured fetal rat hepatocytes, the latter exhibiting morphological and biochemical signs of mitochondrial damage. E increased H2O2, O2-, lipid peroxidation products, along with signs of membrane damage. Supplementation with antioxidants or agents that enhance glutathione stores reversed these effects. E was found to inhibit activities of mitochondrial respiratory chain components (a potential source of the enhanced levels of H2O2, and O2-) and this could be reversed by antioxidant treatment. Subsequent studies have documented oxidative stress and membrane lipid peroxidation in fetal brain and liver (gestation day 19) following a two day maternal E consumption and in gestation day 14 and 17 "embryos" immediately following a single dose of E to the pregnant dam. The means by which E can induce oxidative stress in fetal cells is under investigation. We have examined effects of E on activities of key antioxidant enzymes and found no depressant responses. However, the low levels of antioxidants in fetal tissues and an exaggerated response of fetal mitochondria to prooxidant stimulation in vitro, suggest that fetal cells are strongly predisposed to oxidative stress. Additionally, recent studies have suggested that fetal tissues are likewise prone to the formation and subsequent accumulation of at least one toxic lipid peroxidation product, 4-hydroxynonenal. We conclude that maternal E consumption induces oxidative stress in fetal tissues and that this is responsible for some toxic responses to E. Additionally, the low antioxidant defenses in fetal tissues and accumulation of toxic aldehyde products of lipid peroxidation predispose the fetus to oxidative damage.
Asunto(s)
Aldehídos/metabolismo , Etanol/toxicidad , Feto/efectos de los fármacos , Feto/metabolismo , Estrés Oxidativo , Animales , Antioxidantes/metabolismo , Desarrollo Embrionario y Fetal/efectos de los fármacos , Etanol/metabolismo , Femenino , Trastornos del Espectro Alcohólico Fetal/fisiopatología , Humanos , Metabolismo de los Lípidos , Hígado/efectos de los fármacos , Hígado/metabolismo , Peróxidos/metabolismo , Embarazo , Ratas , Ratas Sprague-DawleyRESUMEN
This study addresses the role of the lipid peroxidation product, 4-hydroxynonenal (HNE), in ethanol-related damage of cytochrome c oxidase (COX) in vivo. It utilizes an animal model with acute ethanol exposure in which HNE levels in liver mitochondria are strikingly increased. Pregnant female Sprague-Dawley rats were administered 5 doses of ethanol (4 gm/kg, po at 12-hour intervals) beginning on day 17 of gestation and were sacrificed on day 19. Controls were pair-fed and received dextrose isocaloric to ethanol. Mitochondria were isolated from maternal and fetal livers and COX activities were measured spectrophotometrically. Compared with the pair-fed controls, COX activity was decreased with exposure to ethanol by 25% in maternal rats and 43% in fetal rats (P<.05). Western Blot with an HNE-Histidine antibody showed enhanced formation of HNE adducts with COX from ethanol-exposed rats, which was more pronounced in fetal than in adult livers. The HNE adducts were mainly with subunit IV of COX. The cause and effect relationship between HNE adduct formation and COX inhibition was examined in vitro by incubating purified COX with HNE. COX inhibition was accompanied by concentration-dependent HNE adduct formation that was consistent with those found in in vivo ethanol-exposed samples. These results suggest that the ethanol-related decreases in COX activity found in liver mitochondria could be attributable to HNE adduct formation with the enzyme complex. This could be an important mechanism by which modification of proteins occur in in vivo oxidative stress.
Asunto(s)
Intoxicación Alcohólica/metabolismo , Aldehídos/metabolismo , Complejo IV de Transporte de Electrones/metabolismo , Feto/metabolismo , Mitocondrias Hepáticas/enzimología , Complicaciones del Embarazo/metabolismo , Animales , Sitios de Unión , Complejo IV de Transporte de Electrones/química , Complejo IV de Transporte de Electrones/aislamiento & purificación , Femenino , Histidina/metabolismo , Cinética , Hígado/embriología , Sustancias Macromoleculares , Embarazo , Ratas , Ratas Sprague-DawleyRESUMEN
Inflammatory pseudotumor of the liver (IPL) is a rare, nonneoplastic entity of unknown etiology. Our patient represents the first reported case of IPL that was managed conservatively during an intrauterine pregnancy.
Asunto(s)
Granuloma de Células Plasmáticas/epidemiología , Hepatopatías/epidemiología , Complicaciones del Embarazo/epidemiología , Adulto , Biopsia , Femenino , Granuloma de Células Plasmáticas/patología , Granuloma de Células Plasmáticas/terapia , Humanos , Hígado/patología , Hepatopatías/patología , Hepatopatías/terapia , Embarazo , Complicaciones del Embarazo/patología , Complicaciones del Embarazo/terapia , Resultado del EmbarazoRESUMEN
Alcoholic pancreatitis may be one of the most serious adverse consequences of alcohol abuse. Its diagnosis, as it has for many years, depends primarily on clinical acumen in interpreting properly the symptoms and signs of abdominal distress, buttressed by elevated pancreatic enzymes (amylase and lipase). More recently, the use of computerized tomography (CT) in selected situations has been both of confirmatory and prognostic value. Severity of abnormality by CT correlates reasonably well with a variety of clinical-laboratory clusters (APACHE system, Ranson's criteria, etc.) and aids in therapy. The pathogenesis of alcoholic pancreatitis is not fully defined. The ultimate picture is one of tissue autolysis by activated proteolytic enzymes. The triggers for such activation, however, are still not known. They are represented by three main theories: (1) large duct obstruction and/or increased permeability relative to pancreatic secretion, (2) small duct obstruction due to proteinaceous precipitates, and (3) a direct toxic-metabolic effect of ethanol on pancreatic acinar cells. While not mutually exclusive, we favor the last hypothesis as being most consistent with the effects of ethanol on other organ systems. The direct effects of ethanol and/or its metabolites may be mediated, at least in part, via oxidative stress or the generation of fatty acid ethyl esters. Autolysis (regardless of proximate mechanism(s)) leads to inflammation likely mediated via release of various cytokines. It also should be appreciated that "acute" pancreatitis (the topic of this chapter) likely represents an acute process within a chronic pancreatic exposure and injury from alcoholic abuse. The key question of why pancreatitis develops in only a small number of alcohol abusers is not resolved. Therapy depends on the severity of alcoholic pancreatitis, which is defined by clinical-laboratory and often CT criteria. Mild pancreatitis usually resolves acutely with alcohol abstention and supportive therapy. Severe pancreatitis has a significant morbidity and mortality, mainly related to the degree of pancreatic necrosis and infection. It requires meticulous combined medical-surgical care.