Asunto(s)
Acalasia del Esófago/complicaciones , Fístula Esofágica/diagnóstico por imagen , Fístula Esofágica/etiología , Fístula/diagnóstico por imagen , Fístula/etiología , Cardiopatías/diagnóstico por imagen , Cardiopatías/etiología , Pericardio , Neumoperitoneo/diagnóstico por imagen , Neumoperitoneo/etiología , Tomografía Computarizada por Rayos X , Adulto , Medios de Contraste , Diatrizoato de Meglumina , Humanos , MasculinoRESUMEN
BACKGROUND/AIMS: Toll-like receptors (TLR's) are critical receptors that promote innate immune responses to pathogen-associated molecular patterns. Activation of TLR's leads to production of pro-inflammatory cytokines such as tumour necrosis factor (TNF)-alpha. This study investigates whether peripheral blood monocyte expression of TLR's is disturbed in patients with chronic hepatitis C and whether levels of expression of these molecules are significantly correlated with hepatitis C virus (HCV) genotype, viral load, hepatic necroinflammatory activity, histological stage and circulating TNF-alpha concentrations. METHODS: In 18 non-cirrhotic patients with biopsy-proven, virologically-confirmed chronic hepatitis C and 32 controls, we measured expression of TLR2 and TLR4 on peripheral blood monocytes. HCV genotype, viral load, serum alanine aminotransferase (ALT) levels, histological stage of disease and circulating TNF-alpha and endotoxin levels were also determined. RESULTS: Peripheral blood monocyte expression of TLR2 and TLR4 were significantly increased in patients with chronic hepatitis C compared to controls, irrespective of HCV genotype or histological stage of disease. Circulating levels of TNF-alpha were also significantly increased in patients with chronic hepatitis C. In both the overall study cohort and patients with chronic hepatitis C, monocyte expression of TLR2, but not of TLR4, correlated significantly with serum TNF-alpha levels. In patients with chronic hepatitis C, monocyte expression of TLR2, but not of TLR4, also correlated significantly with serum ALT levels. Expression of TLR's was not significantly correlated with viral load. CONCLUSIONS: Up-regulation of peripheral blood monocyte expression of TLR2 and TLR4 occurs in patients with chronic hepatitis C. Increased monocyte expression of TLR2, but not of TLR4, correlates significantly with both increased circulating TNF-alpha levels and hepatic necroinflammatory activity in this disorder.
Asunto(s)
Citocinas/biosíntesis , Regulación de la Expresión Génica , Hepatitis C/metabolismo , Hepatitis C/virología , Hígado/metabolismo , Receptores Toll-Like/biosíntesis , Adolescente , Adulto , Niño , Preescolar , Humanos , Inflamación , Hígado/lesiones , Modelos Biológicos , Monocitos/metabolismo , Receptor Toll-Like 2/biosíntesis , Receptor Toll-Like 4/biosíntesisAsunto(s)
Acetilcisteína/farmacología , Antineoplásicos/antagonistas & inhibidores , Antioxidantes/farmacología , Neoplasias Encefálicas/tratamiento farmacológico , Hígado/efectos de los fármacos , Melanoma/tratamiento farmacológico , Compuestos de Nitrosourea/antagonistas & inhibidores , Compuestos Organofosforados/antagonistas & inhibidores , Acetilcisteína/administración & dosificación , Adulto , Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Antioxidantes/administración & dosificación , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Femenino , Humanos , Neoplasias Pulmonares , Compuestos de Nitrosourea/administración & dosificación , Compuestos de Nitrosourea/efectos adversos , Compuestos Organofosforados/administración & dosificación , Compuestos Organofosforados/efectos adversos , Resultado del TratamientoRESUMEN
Gastrointestinal (GI) bleeding is not uncommon and responsible for considerable morbidity and mortality. Radionuclide red blood cell scintigraphy (RBCS) is a well established imaging modality for identifying patients with ongoing active GI bleeding. However, false positive RBCS are known to occur. The authors report the findings of a RBCS in an elderly female, who developed GI bleeding following the commencement of anticoagulant therapy. Although active GI bleeding was not identified, two abdominal wall hematomata and a cecal adenocarcinoma were detected. Distinguishing features of these lesions are described.
Asunto(s)
Pared Abdominal/irrigación sanguínea , Pared Abdominal/diagnóstico por imagen , Adenocarcinoma/diagnóstico por imagen , Neoplasias del Colon/diagnóstico por imagen , Eritrocitos/diagnóstico por imagen , Hemorragia Gastrointestinal/diagnóstico por imagen , Hematoma/diagnóstico por imagen , Anciano , Neoplasias del Colon/complicaciones , Diagnóstico Diferencial , Femenino , Hemorragia Gastrointestinal/complicaciones , Hematoma/complicaciones , Humanos , CintigrafíaRESUMEN
In patients who develop liver damage following moderate paracetamol overdose in the order of 5-10 g daily, recent fasting and nutritional impairment have been identified as key precipitants. Hepatotoxicity caused by paracetamol at recommended dosage, in the absence of exposure to enzyme-inducing drugs, has recently been described as an idiosyncratic phenomenon. The possible importance of fasting and malnutrition in this setting is uncertain. We report a severely malnourished 53-year-old woman who developed severe hepatotoxicity whilst receiving paracetamol at recommended dosage (4 g daily) following a period of fasting, in the absence of enzyme-inducing agents. Subsequent paracetamol exposure up to 2.6 g daily thrice weekly, in the setting of ongoing malnutrition and fasting as before, did not lead to recurrent liver damage. These findings indicate that paracetamol-related liver damage occurring within recommended dosage guidelines can be a dose-dependent rather than necessarily idiosyncratic phenomenon, at least in the setting of recent fasting and severe malnutrition.