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ABSTRACT: Withdrawal syndrome is a hallmark of alcohol dependence. The characteristics of alcohol consumption, closely related to dependence, could influence the development of alcoholic liver disease. The study aimed to investigate if patients with severe alcohol withdrawal syndrome have a peculiar profile of liver disease.
The study included 256 heavy drinkers (aged 19-75 years, 70.3% males) admitted to an Internal Medicine Department. Patients admitted for complications of liver disease were not included. Severe alcohol withdrawal syndrome (seizures, disordered perceptions, or delirium) developed in 150 patients (58.6%). Alcohol consumption (daily quantity, duration, and pattern [regular or irregular]) was assessed by questionnaire. Liver biopsy was performed in all cases.
Patients with alcohol withdrawal syndrome showed a lower prevalence of liver cirrhosis and a higher prevalence of alcoholic hepatitis than patients without it. The negative association of alcohol withdrawal syndrome with liver cirrhosis persisted after we adjusted for sex, daily intake, duration, and pattern of alcohol consumption. Alcoholic hepatitis was independently associated with the irregular pattern of alcohol consumption, which was closely associated with severe alcohol withdrawal syndrome.
The profile of liver injury is different in heavy drinkers who develop and who do not develop a severe alcohol withdrawal syndrome when admitted to the hospital.
Alcoholism Clinical and Experimental Research 02/2004; 28(1):131-6. · 3.34 Impact Factor
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ABSTRACT: Cytokine balance alterations are responsible for some of the systemic and hepatic manifestations of alcoholism. The present study was aimed to evaluate the influence of both acute alcohol abstinence (in alcoholics) and acute alcohol intake (in healthy subjects) on serum IL-6, IL-8, IL-10, and IL-12 levels. Serum cytokine concentrations were determined on admission and after a median of 6 days of ethanol abstinence in 29 patients with alcohol withdrawal syndrome. The same determinations were made in five healthy volunteers at baseline and after 36 h of a single 60 g-dose alcohol intake. Increased serum levels of IL-6, IL-10 and, to a lesser extent IL-8, declined in the few days after alcohol abstinence in patients with alcohol withdrawal syndrome. Serum IL-8 values increased after alcohol intake in healthy subjects. Rapid variation of serum cytokine levels along with alcohol intake or abstinence should be taken into account in cytokine studies in alcohol abusers.
Cytokine 10/2000; 12(9):1437-40. · 3.02 Impact Factor
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Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 07/2000; 92(6):412-3. · 1.55 Impact Factor
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ABSTRACT: Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) share common routes of transmission. Therefore, markers of either active or past HBV infection are present in many HIV-infected patients, particularly in intravenous drug users (IDUs). The aim of this study was to analyze the serological pattern of past HBV infection (presence or absence of anti-HBs) and the course of past HBV infection (changes in anti-HBs status, and HBV reactivation) in two cohorts of IDUs with and without HIV infection.
HBV serum markers were studied in 388 HIV-positive and 197 HIV-negative IDUs. Among them, 263 HIV-positive and 50 HIV-negative patients with past HBV infection (serum HBsAg negative and anti-HBc positive, with or without anti-HBs) were followed-up for a median of 21 and 13 months, respectively, to detect changes in anti-HBs status and HBV reactivation.
The prevalence of HBV infection (either active or past) was higher in HIV-positive than in HIV-negative cases (90% vs 62%, p < 0.001), even when stratified by years of drug use. Most cases (92% of HIV-positive and 89% of HIV-negative) had markers of past infection. Among those patients with past HBV infection, 60% of HIV-positive and 72% of HIV-negative presented serum anti-HBs (p = 0.03). The incidence of anti-HBs loss was 1.8 cases/100 person-year in HIV-positive, and 1.8 cases/100 person-year in HIV-negative patients (RR 1.0, 95% CI 0.1-94, p = NS). Incidence of anti-HBs development was 17.6 cases/100 person-year in HIV-positive and 25.6 cases/100 person-year in HIV-negative IDUs (RR, 1.5, 95% CI, 0.6-3.5, p = NS). Only one HIV-positive patient with markers of past HBV infection developed an active infection (0.2 events/100 person-year).
HBV infection (either active or past) is particularly frequent in HIV-positive IDUs. Most cases have markers of past infection. Isolated detection of anti-HBc (absence of anti-HBs) is more common in HIV-positive than in HIV-negative IDUs. Despite their progressive immunosuppression, both anti-HBs loss and HBV reactivation are rare in HIV-infected IDUs.
The American Journal of Gastroenterology 06/2000; 95(5):1316-22. · 7.28 Impact Factor
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ABSTRACT: It has been reported that total serum IgE is increased in alcohol abusers, but the mechanisms responsible are not known. Production of IgE depends on B-cell stimulation by both antigens and some cytokines, particularly IL-4 and IL-13. Chronic alcoholism and alcoholic liver disease are accompanied by changes in cytokine production.
To evaluate if IgE increase in alcoholics could be associated to a ethanol-induced imbalance of the cytokine profile.
A total of 65 patients (53 males and 12 females, aged 47 +/- 12 years), admitted to the hospital because of ethanol abstinence symptoms entered the study. On admission, total serum IgE was measured by chemiluminescent EIA and serum IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-13, and interferon-gamma were measured by ELISA. Data were compared with those of 40 healthy control subjects.
Serum IgE, IL-6, IL-8, IL-10, IL-12, and IL-13 were found to be high in alcoholic patients compared with healthy volunteers. Some parallelism was observed between serum IgE and both serum IL-10 and IL-13 were increased in alcoholics.
Total serum IgE elevation in alcoholics with abstinence syndrome is accompanied by an increase of some type 2 cytokines. Ethanol-induced alterations in the cytokine profile may contribute to increased IgE levels in alcoholics.
Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 08/1999; 83(1):61-7. · 2.83 Impact Factor
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ABSTRACT: Cardiac arrhythmias might explain cases of sudden death in alcoholics during ethanol abstinence.
To evaluate QT interval (and its outcome) in patients with alcohol withdrawal syndrome.
Sixty-two patients (52 male and 10 female, mean age 43.7 years, range 18-71 years), admitted to the hospital as a result of alcohol abstinence syndrome (tremulousness in 7 cases, agitation in 12 cases, delirium tremens in 11 cases, and seizures in 32) were studied. The QT interval was measured on 12 lead ECGs performed on admission in all cases. QTc was obtained using Bazett's formula. In 27 patients a second ECG was performed during hospital stay. Results. Mean QTc interval on admission was 439 +/- 32 ms (range 350-525 ms); 29 patients (46.8%) showed a prolonged (> 440 ms) QTc interval. No significant differences were observed between patients with normal and high QTc values as regards to age, sex, type of withdrawal syndrome, duration of abstinence, liver function tests, serum electrolytes or blood cell counts. In cases where two ECG recordings could be evaluated (n = 27), the mean QTc interval was significantly shorter in the latter than in the former (417 +/- 26 ms versus 447 +/- 30 ms, respectively, p < 0.001). Eight patients found to have prolonged QTc on admission had a second ECG performed on them after complete recovery from withdrawal symptoms. In all these cases the QTc interval eventually became normal.
The QTc interval is frequently prolonged during alcohol withdrawal syndrome and tends to become normal over time, along with remission of abstinence symptoms.
Acta cardiologica 02/1997; 52(3):285-94. · 0.61 Impact Factor
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ABSTRACT: It has been reported that total serum IgE is increased in patients with alcoholic cirrhosis, but it is not clear if this fact is related to alcoholic liver disease or to alcohol intake.
To measure serum IgE in a group of chronic alcoholics with different stages of liver injury in order to elucidate if IgE increase in related to alcoholic liver damage.
Total serum IgE was determined by enzyme immunoassay in 186 chronic alcoholic patients (137 male/49 female) and 101 healthy controls. Patients and controls with known reasons for IgE elevation were excluded. Among alcoholic patients, 24 had fatty liver, 28 hepatic fibrosis, 29 alcoholic hepatitis, and 67 liver cirrhosis (38 patients were not evaluable concerning liver injury).
Total serum IgE was found to be increased in alcoholics (median 154.5 IU/mL, range 1-7329 IU/mL) with respect to healthy controls (median 20 IU/mL, range < 1-1417 IU/mL) (P < 0.001). IgE increase was moderate (180-1000 IU/mL) in 60 alcoholics (32.3%) and marked ( > 1000 IU/mL) in 27 (14.5%). Male alcoholics had higher IgE levels than females (median 191 IU/mL and range 1-7329 IU/mL vs 105 IU/mL and range 2-2189 IU/mL) ( P = 0.009). On logistic regression analysis, alcoholism, male sex and younger age (but not smoking) were independently associated with higher IgE levels. No clear relationship was noted between serum IgE and severity of alcoholic liver disease. Thus, no correlation was observed between IgE and parameters of liver function (serum bilirubin, albumin or prothrombin index). Likewise, IgE concentrations were not significantly different in patients with liver cirrhosis with respect to patients with less severe liver disease. Serum IgE was increased ( > 180 IU/mL) in 47.8% of cirrhotics and in 44% of patients without liver cirrhosis. In contrast, other immunoglobulins (IgG, IgA and IgM) were significantly correlated with liver dysfunction.
Chronic alcoholism should be considered as a cause of increased total serum IgE, regardless of the severity of the underlying liver disease.
Clinical & Experimental Allergy 09/1995; 25(8):756-64. · 5.03 Impact Factor
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Journal of Infection 08/1995; 31(1):81-2. · 4.13 Impact Factor
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ABSTRACT: It has been reported that chronic alcoholics show a high prevalence of hepatitis C virus (HCV) infection, with a possible role in the pathogenesis and severity of underlying liver disease. Thus, the present study was aimed to evaluate the prevalence of HCV antibodies (anti HCV-Ab) in a group of patients admitted to an Internal Medicine Department, as well as to compare characteristics of anti-HCV-Ab(+ve) respect to anti-HCV(-ve) patients. The presence of anti-HCV-Ab was prospectively studied in 180 alcoholic patients admitted during a 16-month period using a second generation ELISA. Intravenous drug abusers were excluded. Reasons for admittance were as follows: alcohol withdrawal syndrome (92 cases), complications of liver cirrhosis (mainly ascites) (54 cases), acute pancreatitis (12 cases) and miscellaneous causes (22 cases). Sixty-six patients were cirrhotics, 23 had fatty liver, 27 had liver fibrosis and 28 alcoholic hepatitis (36 patients were not evaluable concerning liver lesion). Twelve patients (6.7%) were anti-HCV-Ab(+ve). Prevalence was higher in patients admitted because of complications of cirrhosis (16.7%) than that of those admitted due to alcohol abstinence syndrome (1.1%, p < 0.01). Likewise, the proportion of HVC-Ab(+ve) patients was higher in patients with liver cirrhosis (16.7%) respect to those with lesser degrees of liver injury (1.3%; p < 0.01). In the latter group, the prevalence of anti-HCV-Ab(+ve) was similar to that of the normal population. Anti-HCV-Ab patients were older than anti-HCV-Ab(-ve) cases.(ABSTRACT TRUNCATED AT 250 WORDS)
Revista Clínica Española 06/1995; 195(6):367-72. · 2.01 Impact Factor
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ABSTRACT: Isolated Systolic Arterial Hypertension (ISAH) is the most frequent form of AHT in the aged population, resulting in an increase of the cardiovascular risk, mainly at the cerebrovascular level. In this open non-comparative study, we analyze the effect of doxazosin, an alpha-adrenergic blocker in 40 patients older than 60 years, diagnosed of isolated systolic hypertension. After 2 weeks of lavage, the patients received treatment with doxazosin according to a monotherapy scheme, with progressive increase of the dose, from 1 to 16 mg/day during a period of 14 weeks. Doxazosin significantly reduces the systolic and diastolic arterial pressure (p < 0.001) with a therapeutical response in 86.5% of the cases, using an average dose of 3.4 mg/day and without observing modifications in the heart rate. This drug improves the lipidic profile, with a reduction of the plasmatic levels of total cholesterol and cholesterol linked to low density proteins (LDL) with p < 0.05 and a reduction of triglycerides. Among the 40 patients included in the study, 10 (25%) referred side effects; there were 2 drop-outs (5%) and the dose had to be reduced in 2 patients (5%). In conclusion, doxazosin shows its antihypertensive effectiveness in the treatment of isolated systolic hypertension in patients older than 60 years and it is well tolerated by most of the patients, improving at the same time the lipidic profile. Hence, it contributes to the reduction of the cardiovascular morbidity-mortality in this group of patients.
Anales de medicina interna (Madrid, Spain: 1984) 03/1995; 12(3):122-6.
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Medicina Clínica 08/1994; 103(5):197. · 1.38 Impact Factor
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ABSTRACT: Rat liver cirrhosis induced by CCl4+ethanol was employed to assess the effectiveness of nifedipine in reducing liver injury. Nifedipine reduced the severity of hepatocellular necrosis, significantly decreased Mallory bodies (p < 0.01), decreased polymorphonuclear inflammatory infiltrate (p < 0.05) and reduced perivenular fibrosis. Plasma lactic acid levels were significantly increased in the CCl4+ethanol group (p < 0.01). Lactacidaemia remained at normal values when the calcium antagonist blocker was employed. Nifedipine did not significantly alter the incidence of cirrhosis in this experimental model.
Veterinary and human toxicology 02/1994; 36(1):14-6.
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ABSTRACT: The first two cases of HIV-2 infection in autoctonous Spanish subjects are presented. Two sailors (62 and 42 years of age) of Galician origin who travelled to east African countries are reported. The epidemiologic, clinico-evolutive characteristics--with manifestations similar to HIV-1 infection (oral candidiasis and villous leukoplasia)--, and therapeutic response to zidovudine are described. The risk of HIV-2 infection in sailors travelling to Africa and the absence of opportunistic infections in a period of at least 6 to 11 years following infection despite CD4+ lymphocytes being under 0.200 x 10(9)/l, are of note.
Medicina Clínica 02/1994; 102(3):101-3. · 1.38 Impact Factor
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Medicina Clínica 11/1993; 101(13):518. · 1.38 Impact Factor
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ABSTRACT: Lactic acidosis has been described in patients with liver disease. Hyperlactacidaemia results from an imbalance in lactate production versus lactate utilization. It is estimated that the liver utilizes approximately 30 percent of the total lactate produced in the body under basal conditions, primarily by gluconeogenesis. The gluconeogenesis from lactate 10 mM and lactacidaemia were determined in order to investigate the effects of CCl4+ethanol administration in liver injury and, the possible effect of colchicine in our experimental fibrosis model. The tests were determined after 15, 30 or 45 days of treatment. The results indicate that the gluconeogenesis was significantly inhibited in both CCl4+ethanol groups and CCl4+ethanol+colchicine groups. By contrast, the lactacidaemia levels were much higher in the CCl4+ethanol groups than the colchicine groups. Summarising, we have documented that hyperlactacidaemia is due to the inhibition of lactate utilization by the isolated hepatocytes in experimental cirrhosis, and that the improvement in lactacidaemia caused by colchicine is not primarily due to an increase in hepatic lactate utilization.
Life Sciences 02/1993; 52(3):PL13-8. · 2.53 Impact Factor
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ABSTRACT: An experimental rat liver cirrhosis, by means of carbon tetrachloride and ethanol during 8 weeks, was employed to assay the effect of Nifedipine (a calcium antagonist blocker), S-Adenosylmethionine (a precursor of glutathione); singly and in combination on rat liver cirrhosis. A slight decrease of cirrhosis (N.S.) was observed with the pharmacological therapy employed singly. The combination therapy (Nifedipine+S-Adenosylmethionine) significantly inhibited liver cirrhosis (p < 0.01).
Life Sciences 01/1993; 52(20):PL217-20. · 2.53 Impact Factor
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ABSTRACT: An experimental model of toxic liver injury in rats was employed to assay the effect of Nifedipine (a calcium antagonist blocker) and S-Adenosylmethionine (a precursor of glutathione). An important decrease in both perivenular fibrosis and cirrhosis was found. Furthermore, a significant decrease in lactic acid levels was found in the group of animals treated with pharmacologic therapy, although no correlation was seen between lactic acid levels and the different degrees of perivenular fibrosis. No significant variations in ALT and AST enzymes were observed between both groups, as opposed to a significant decrease in LDH enzyme in the Nifedipine+S-Adenosylmethionine group. The results indicate an improvement in the histologic picture of the liver in rats treated by means of pharmacological association, without any change in inflammatory infiltrate and with a slight decrease in necrosis, indicating an action mechanism via creeping fibrosis (instead of a hepatitis pathway).
Life Sciences 02/1992; 51(10):PL113-8. · 2.53 Impact Factor
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Nephron 02/1992; 62(4):477-8. · 13.26 Impact Factor
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ABSTRACT: A 60 year-old white woman presented with sudden painless dysphagia, hoarseness and dysphonia. A diagnosis of sarcoidosis was made based on bilateral hilar lymphadenopathy, gallium uptake, elevated serum angiotensin-converting enzyme levels, as well as non-caseating granulomatous lymphadenitis in a prescalenic node. Symptoms were attributed to isolated vagus neuropathy, a rare form of presentation of neurosarcoidosis.
Hepato-gastroenterology 46(28):2414-8. · 0.66 Impact Factor
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