Value of inflammatory response and oxidative damage in the diagnosis of infections in severe alcoholic hepatitis.

Severe alcoholic hepatitis is the most lethal complication in alcohol dependent patients. The concurrence of infections in these patients is very frequent. Both produce a systemic inflammatory response syndrome (SIRS), secondary to intense release of inflammatory cytokines, which can complicate the diagnosis. In our study, Interleukin (IL)-6 and IL-10 levels are higher in patients with SIRS (p<0.001 and p = 0.033, respectively). IL-4, IL-6, Interferon-gamma (IFNγ), Tumor necrosis factor alpha (TNFα) and IL-17 levels correlate with liver function, as estimated by MELD-Na (p = 0.018, p = 0.008, p = 0.009, p = 0.016 and p = 0.006, respectively). Malondialdehyde (MDA), a product of lipid peroxidation and marker of cell damage, also correlates with liver function (p = 0.002), but not with SIRS or infections. Only elevated IL-6 correlates independently with the presence of infections (RR=1.023 IC 95% 1.000-1.047), so it may be useful for the correct diagnosis in these patients. Values greater than 30 pg/mL have a sensitivity: 86.7% and specificity: 94.7% for the diagnosis of infections.

Effects of selenium on liver and muscle contents and urinary excretion of zinc, copper, iron and manganese.

Selenium is a main component of glutathione peroxidase (GPX), a key antioxidant enzyme. Other elements, such as zinc, copper, manganese and iron, are also involved in the pathogenesis of oxidative damage as well as in other important metabolic pathways. The effects of selenium supplementation on the metabolism of these elements have yield controversial results .The aim of this study is to analyse the effects of selenium supplementation on liver, muscle and urinary excretion of zinc, copper, iron and manganese in a situation of oxidative stress, such as protein deficiency. The experimental design included four groups of adult male Sprague-Dawley rats, which received the Lieber-DeCarli control diet, an isocaloric 2 % protein-containing diet and another similar two groups to which selenomethionine (6 mg/l liquid diet) was added. After sacrifice (5 weeks later), muscle, liver and serum selenium were determined, as well as muscle, liver and urinary zinc, copper, manganese and iron and liver GPX activity and liver malondialdehyde. Selenium addition led to decreased liver copper, increased muscle copper, increased copper excretion and increased liver iron, whereas zinc and manganese parameters were essentially unaltered. Muscle, liver and serum selenium were all significantly correlated with liver GPX activity.

Relative and combined effects of selenium, protein deficiency and ethanol on bone.

UNLABELLED: Some observations suggest that oxidative damage may affect both osteoblastic function and osteoclastic activity in alcohol-mediated bone alterations. Selenium, a potent antioxidant, is decreased in alcoholics. OBJECTIVE: To analyse if the supplementation with selenium may alter bone changes observed in a murine model fed ethanol and/or a 2% protein-containing diet, following the Lieber-deCarli design. MATERIAL AND METHOD: Adult male Sprague-Dawley rats were divided into 8 groups, which received the Lieber-DeCarli control diet, an isocaloric, 36% ethanol-containing diet, an isocaloric, 2% protein-containing diet; and an isocaloric diet containing 2% protein and 36% ethanol diet, and another similar four groups to which selenomethionine (1mg/kg body weight). After sacrifice (5 weeks later), trabecular bone mass was histomorphometrically assessed, bone and serum selenium were determined by flame atomic absorption spectrophotometry, and serum osteocalcin, insulin growth factor 1 (IGF-1), PTH and telopeptide, by radioimmunoanalysis. Liver glutathione peroxidase (GPX) activity was also determined. RESULTS: Ethanol-fed rats showed decreased TBM, IGF-1 and osteocalcin, especially when ethanol was added to a 2%-protein diet. Selenium did not modify at all bone parameters, despite a marked increase in serum selenium and a less pronounced one in bone selenium, and an increase in liver GPX. CONCLUSION: Our results do not support the existence of a beneficial effect of selenium addition on bone changes observed in this murine model treated following the Lieber-deCarli experimental design.

Prognostic value of serum selenium levels in alcoholics.

In alcoholics, exposure of Kupffer cells to intestinal-borne Gram-negative bacteria increases free radical release, which may, in turn, enhance cytokine secretion, creating a positive feedback loop, which contributes to liver inflammation. Impaired antioxidant mechanisms further aggravates this scenario. Some trace elements, such as selenium, are main cofactors of antioxidant enzymes. Some authors have found low Se levels in alcoholics in relation either with undernutrition, liver dysfunction, or intensity of alcoholism, but in general, Se supplementation has no effect on survival. In this study we measured serum Se in 16 controls and 76 alcoholics, 34 of them cirrhotics, 68 of whom were followed up for a median period of 38 months; 17 died during this period. Se levels were lower in patients than in controls and were related to prothrombin activity and nutritional status, more closely to this last parameter (stepwise logistic regression analysis). Patients who died showed lower Se values than those who survived. Se values over the median were associated with better survival, assessed by Kaplan-Meier curves and log-rank test. However, in multivariate analysis (Cox regression model), prothrombin activity displaced serum Se as a prognostic factor. We conclude that serum Se levels are low in alcoholics; these low values depend more heavily on impaired nutrition but also on liver dysfunction; although low Se levels were associated with a higher mortality, prothrombin activity displaced serum Se when survival was assessed using Cox's regression model.

[Treatment of peripharyngeal abscesses by means of intra-oral puncture-aspiration and drainage]. / Tratamiento de los abscesos perifaríngeos mediante punción-aspiración y drenaje por vía intraoral.

INTRODUCTION: Parapharyngeal and retropharyngeal abscesses are life-threatening infections, with a much lower incidence since the advent of antibiotics. However, they still represent a considerable number of emergency visits to reference centres where they are managed with various protocols to improve both morbidity and mortality. PATIENTS AND METHOD: Medical records of 25 consecutive patients at our institution (17 adults and 8 children) diagnosed and treated with the same protocol for peripharyngeal abscess were retrospectively reviewed. RESULTS: All cases were managed using a minimally-invasive intra-oral approach, with resolution of the clinical findings and symptoms. CONCLUSIONS: Puncture with intra-oral aspiration and/or drainage of peripharyngeal abscesses is an effective option instead of the external approach.

Tratamiento de los abscesos perifaríngeos mediante punción-aspiración y drenaje por vía intraoral / Treatment of peripharyngeal abscesses by means of intra-oral puncture-aspiration and drainage

Introducción: Los abscesos perifaríngeos son infecciones graves, potencialmente mortales, cuya frecuencia de aparición ha descendido considerablemente desde el advenimiento de la antibioterapia. Sin embargo, aún representan un destacable número de urgencias en los centros hospitalarios de referencia, donde se emplean diversos protocolos para mejorar tanto la morbilidad como la mortalidad asociada a ellos. Pacientes y método: Estudio retrospectivo de 25 pacientes consecutivos (17 adultos y 8 niños) diagnosticados y tratados de flemones-abscesos perifaríngeos (retrofaríngeos y parafaríngeos). Resultados: El manejo de estos pacientes de forma mínimamente agresiva mediante el abordaje intraoral permitió en todos los casos la resolución del problema clínico. Conclusiones: La punción-aspiración y/o el drenaje intraoral de los abscesos perifaríngeos son una alternativa eficaz al abordaje externo

Introduction: Parapharyngeal and retropharyngeal abscesses are life-threatening infections, with a much lower incidence since the advent of antibiotics. However, they still represent a considerable number of emergency visits to reference centres where they are managed with various protocols to improve both morbidity and mortality. Patients and method: Medical records of 25 consecutive patients at our institution (17 adults and 8 children) diagnosed and treated with the same protocol for peripharyngeal abscess were retrospectively reviewed. Results: All cases were managed using a minimally-invasive intra-oral approach, with resolution of the clinical findings and symptoms. Conclusions: Puncture with intra-oral aspiration and/or drainage of peripharyngeal abscesses is an effective option instead of the external approach

Quiste epidérmico cervical profundo adquirido / No disponible

En las masas cervicales es fundamental un protocolodiagnóstico establecido, además de un conocimiento extensosobre la posible presentación clínica de un nutridogrupo de procesos patológicos que en determinados momentospodrían aparecer con sintomatología común.Aunque la causa de una lesión suele ser la más frecuentede las que podrían provocarlas, no se puede olvidar laposibilidad de que el motivo no sea sino otra poco comúno incluso una no descrita en esa localización

In the cervical masses a protocol is fundamental for anestablished diagnosis, in addition to an extensiveknowledge on the possible clinical presentation of a groupof pathological processes that at certain moments couldappear with common symptoms. Although the cause ofan injury is usually most frequent of those, whose reasoncan be a no described cause in that localization, it is notpossible to be forgotten