Prevalência e implicaçöes do vírus da hepatite C em alcoolistas / Prevalence and implications of Hepatitis C virus in alcoholics

O vírus da Hepatite C parece ser mais prevalente em alcoolistas com e sem doença hepática associada. os autores avaliam a prevalência de anti-VHC em alcoolistas com e sem doença hepática alcoólica, bem como o comprometimento funcional hepático destes pacientes. Para tanto, foram avaliados prospectivamente 231 alcoolistas, tendo-se observado que o anti-VHC está presente em 8,2 por cento de 146 pacientes sem hepatopatia crônica e em 28,2 por cento de 85 pacientes com hepatopatia crônica. Embora neste estudo näo tenha havido correlaçäo da presença de anti-VHC com a classificaçäo de Child, os níveis de albumina e a atividade de protrombina foram menores naqueles pacientes com hepatopatia crônica e anti-VHC positivo, sugerindo um pior prognóstico nestes pacientes

Inhibición de rosetas E en la enfermedad hepática alcohólica / E rosette inhibition in alcoholic liver disease

Hemos estudiado la formación de Rosetas E y su inhibición en pacientes alcoholistas crónicos, con y sin cirrosis hepática. Los individuos fueron separados en 3 grupos: normales (n=21); alcoholistas sin lesión hepática (n=15) y alcoholistas con cirrosis (n=26). Se realizaron Test de Inhibición de Rosetas E, utilizando suero de los individuos en estudio, enfrentados con linfocitos de individuos sanos, efectuando 4 ensayos simultáneos: I.I. -S/A; I.I. -C/A; I.E. -S/A y I.E. -C/A. Analizados estadísticamente los resultados, observamos diferencias altamente significativas entre los pacientes con cirrosis y los controles, así como entre los cirróticos y los alcoholistas sin lesión hepática. Los ensayos que utilizaron la I.E. fueron los más eficientes para discriminar los grupos de individuos en estudio, siendo los que utilizan el suero no absorbido, los de mejor diferenciación. Con esta técnica observamos que 20/21 de los individuos control presentan inhibición inferior al 15//, y que todos los individuos con inhibición superior al 30// fueron cirróticos con sólo 2 excepciones. Proponemos la existencia de factores solubles en suero que provocan inhibición de la formación de rosetas E

Enfermedad alcohólica del hígado (EHA)

Alcohol consumption with all its severe organic complications has become one of the leading causes of morbidity and mortality in United States. In the metropolitan areas, alcohol consumption is the third cause of death between people aged 30 to 64. Latest estimates have shown that 20 percent of the total cost of health care is related to alcohol. Liver disease secondary to alcohol has been studied extensively and all its clinico-pathological consequences described. Alcoholic hepatitis characterized by anorexia, jaundice, hepatomegaly, fever, mental changes, leukocytosis and neutrophilia has been described associated to elevated bilirubin, low albumin, high AST levels and prolonged prothrombin time; histologically the picture has the following microscopic findings: degenerative changes of liver cells such as "ballooning" mainly around the terminal hepatic veins, acute and chronic inflammatory infiltrates and latest, pericellular fibrosis in the centrolobular area. Some patients develop sclerosing hyaline necrosis consistent in collapse of hepatocytes, alcoholic hyaline accumulation, neutrophilic inflammation and severe fibrosis leading to a functional obstruction of the hepatic veins, portal hypertension, ascitis and liver failure. A characteristic cytosqueletic abnormality is the Mallory Body that for many authorities constitutes the hallmark of alcoholic hepatitis. Recently the role of megamitochondrias in this entity has been unveiled showing that patients with increased number have better prognosis that the group with few megamitochondrias. Finally a significant role for cellular immunity, cytoquines, histocompatibility antigens and malnutrition has been found determinant in order to explain progression of disease after alcohol discontinuation, and prognosis after nutritional therapy.