RESUMO
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.
Assuntos
Humanos , História do Século XVI , Anatomia/história , Cirrose Hepática Alcoólica/patologia , Medicina nas Artes/história , Intoxicação Alcoólica/patologiaRESUMO
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.
Assuntos
Predisposição Genética para Doença , Cirrose Hepática Alcoólica/genética , Fator 2 Relacionado a NF-E2/genética , Polimorfismo de Nucleotídeo Único , Regiões Promotoras Genéticas , Adulto , Estudos de Casos e Controles , Etanol/farmacologia , Feminino , Expressão Gênica , Hepacivirus/crescimento & desenvolvimento , Hepacivirus/patogenicidade , Hepatite C/patologia , Hepatite C/virologia , Humanos , Fígado/efeitos dos fármacos , Fígado/metabolismo , Fígado/patologia , Cirrose Hepática Alcoólica/metabolismo , Cirrose Hepática Alcoólica/patologia , Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Estresse OxidativoRESUMO
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.
Assuntos
Doenças da Aorta/etiologia , Doenças da Aorta/patologia , Aterosclerose/etiologia , Aterosclerose/patologia , Cirrose Hepática Alcoólica/complicações , Cirrose Hepática Alcoólica/patologia , Alcoolismo/complicações , Aorta/patologia , Índice de Massa Corporal , Colágeno/análise , Feminino , Fibrose/patologia , Humanos , Masculino , Índice de Gravidade de Doença , Fatores Sexuais , Estatísticas não ParamétricasRESUMO
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.
Assuntos
Humanos , Masculino , Feminino , Doenças da Aorta/etiologia , Doenças da Aorta/patologia , Aterosclerose/etiologia , Aterosclerose/patologia , Cirrose Hepática Alcoólica/complicações , Cirrose Hepática Alcoólica/patologia , Aorta/patologia , Índice de Gravidade de Doença , Fibrose/patologia , Índice de Massa Corporal , Fatores Sexuais , Colágeno/análise , Estatísticas não Paramétricas , Alcoolismo/complicaçõesRESUMO
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.
Assuntos
Biomarcadores/sangue , Cirrose Hepática Alcoólica/patologia , Estresse Oxidativo , Adulto , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Estudos de Casos e Controles , Feminino , Glutationa/sangue , Dissulfeto de Glutationa/sangue , Humanos , Fígado/metabolismo , Cirrose Hepática Alcoólica/metabolismo , Masculino , Malondialdeído/sangue , Pessoa de Meia-Idade , Carbonilação Proteica , Índice de Gravidade de DoençaRESUMO
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.
Assuntos
Anti-Inflamatórios/farmacologia , Dietilcarbamazina/farmacologia , Cirrose Hepática Alcoólica/tratamento farmacológico , Fígado/efeitos dos fármacos , NF-kappa B/antagonistas & inibidores , Proteínas Quinases Ativadas por AMP/metabolismo , Animais , Aspartato Aminotransferases/sangue , Colágeno/metabolismo , Ciclo-Oxigenase 2/genética , Citocinas/metabolismo , Citoproteção , Mediadores da Inflamação/metabolismo , Lipídeos/sangue , Fígado/metabolismo , Fígado/patologia , Cirrose Hepática Alcoólica/metabolismo , Cirrose Hepática Alcoólica/patologia , Masculino , Camundongos Endogâmicos C57BL , NF-kappa B/metabolismo , Óxido Nítrico Sintase Tipo II/metabolismo , Transdução de Sinais/efeitos dos fármacos , Fator de Crescimento Transformador beta/metabolismoAssuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Homocisteína/sangue , Hepatopatias Alcoólicas/sangue , Alcoolismo/sangue , Aminobutiratos/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Cistationina/sangue , Progressão da Doença , Homocisteína/química , Cirrose Hepática Alcoólica/sangue , Cirrose Hepática Alcoólica/patologia , Hepatopatias Alcoólicas/patologia , Fígado/patologia , Metionina/sangue , Enxofre/químicaRESUMO
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.
Assuntos
Humanos , Animais , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Camundongos , Ratos , Bebidas Alcoólicas/efeitos adversos , Hepatopatias Alcoólicas/etiologia , China/epidemiologia , Fígado Gorduroso Alcoólico/epidemiologia , Fígado Gorduroso Alcoólico/etiologia , Fígado Gorduroso Alcoólico/patologia , Cirrose Hepática Alcoólica/epidemiologia , Cirrose Hepática Alcoólica/etiologia , Cirrose Hepática Alcoólica/patologia , Hepatopatias Alcoólicas/epidemiologia , Hepatopatias Alcoólicas/patologia , Ratos Wistar , Vinho/efeitos adversosAssuntos
Acantócitos/patologia , Anemia Hemolítica/patologia , Sobrecarga de Ferro/sangue , Cirrose Hepática Alcoólica/sangue , Fígado/patologia , Pâncreas/patologia , Anemia Hemolítica/etiologia , Humanos , Sobrecarga de Ferro/etiologia , Sobrecarga de Ferro/patologia , Cirrose Hepática Alcoólica/complicações , Cirrose Hepática Alcoólica/patologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Baço/patologiaRESUMO
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.