Miguel Ángel y el hígado de Noé: ¿Una lección secreta de anatomía? / Michelangelo and Noah's liver: a hidden anatomy lesson?

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.

Implications of alcoholic cirrhosis in atherosclerosis of autopsied patients / Implicações da doença hepática alcoólica na aterosclerose de pacientes autopsiados

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.

Percepção materna quanto aos filhos recém-nascidos hospitalizados / Maternal perception regarding hospitalized newborns / Percepción materna con respecto a hijos recién nacidos hospitalizados

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.

Alcoholic Liver Disease / 대한소화기학회지

A study conducted 15-year ago showed that only 13.5% of chronic alcoholics developed alcohol-induced liver damage, which misled some people to believe a lack of relationship between the amount of alcohol and the occurrence of liver disease. However, it is true that a significant correlation exists between per capita consumption and the prevalence of cirrhosis. Alcoholic fatty liver is observed in most of chronic alcoholics even though the severity is not uniform. Abstinence remains the cornerstone of therapy for alcoholic liver disease (ALD). There is also consensus for the use of corticosteroids and pentoxifylline in severe alcoholic hepatitis maintaining good nutritional status to treat comorbidities in all forms of ALD, and liver transplantation in the end-stage ALD patients who can stop drinking for 6 months pre-transplantation period. Several clinical trials targeting tumor necrosis factor (TNF-alpha) and reducing oxidative stress have not been successful at this time. There is still a large field of alcohol research to explore in order to go farther in the area of pathophysiology. We need to understand a role of various cytokines and immune cells in the development of ALD to have more treatment tools to cope with ALD.

Prevalencia de la enfermedad hepática alcohólica y algunos factores de riesgo en pacientes que acuden a los ambulatorios de Barquisimeto

Para determinar la prevalencia de enfermedad hepática alcohólica y algunos factores de riesgo en pacientes que acuden a los Ambulatorios de Barquisimeto, Estado Lara, se realizo esta investigacion con 268 sujetos, entre 18 y 65 anos de edad, de ambos sexos y sin patologías hepáticas previas. La prevalencia general de enfermedad hepática alcohólica fue 3,7 por ciento; la prevalencia de enfermedad hepática alcohólica no cirrótica fue 2,2 por ciento; la enfermedad hepática alcohólica no cirrótica con sospecha de cirrosis represento el 1,12 por ciento y la enfermedad hepática alcohólica cirrótica 0,38 por ciento, los enfermos fueron mayoritariamente hombres. En consumidores de alto riesgo, estos resultados se triplicaron. En resumen, las prevalencias de enfermedad hepática alcohólica y enfermedad hepática alcohólica cirrótica fueron superiores a las reportadas internacionalmente, hallazgos debidos, probablemente, a la elevada frecuencia de consumo de alto riesgo. Se requieren estudios analíticos observacionales para confirmar la anterior aseveracion, así como, los resultados relacionados con el mayor riesgo que aparentemente demostraron los hombres sobre las mujeres

A research to determine the prevalence of alcoholic liver disease and some risk factors in patients who visit the outpatient centers of Barquisimeto, Lara State, was carried out. The sample was made up of 268 individuals between 18 and 65 years old, both male and female, without any previous liver pathologies. The general prevalence of alcoholic liver disease was 3.7 percent and 2.2 percent for non-cirrhotic alcoholic liver disease, for non-cirrhotic alcoholic liver disease with suspected cirrhosis 1.12 percent and 0.38 percent for cirrhotic alcoholic liver disease, being always predominated in male individuals. In patients with highrisk consumption, the results were threefold. In conclusion, the prevalence of alcoholic liver disease and non-cirrhotic alcoholic liver disease were above those internationally reported. This is due to, probably, the increased frequency of high-risk consumption. Analytic observational studies are required to confirm the previous affirmation as well as the results related with the greater risk that apparently was demonstrated by men over women

Para determinar o predomínio da doença hepática alcoólica e alguns fatores de risco em pacientes que freqüentam o ambulatorios de Barquisimeto, Estado Lara, foi realizado a pesquisa com 268 sujeitos, dentre 18 e 65 anos de idade, de ambos os sexos e sem patologias hepáticas previas. O predomínio geral da doença hepática alcoólica foi 3,7 por cento; o predomínio da doença hepática alcoólica nao-cirrótica foi 2,2 por cento; A doença hepática alcoólica nao-cirrótica com suspeita de cirroses representou o 1,12 por cento e a doença hepática alcoólica cirrótica 0,38 por cento, os doentes foram na maior parte homens. Nos consumidores de alto risco, os resultados se triplicaram. Em resumo, o predomínio da doença hepática alcoólica e doença hepática alcoólica cirrótica foi superior as descobertas internacionais, devido a elevada frequencia de consumo de alto risco. Se requerer de estudos analíticos de observaçào para confirmar a primeira hipótese, assim como também, os resultados relacionados com o alto risco predominante em homens com relação às mulheres

Ameliorative effect of Partysmart in rat model of alcoholic liver disease.

Present study was designed to investigate the effect of polyherbal formulation PartySmart in experimental model of alcoholic liver disease in male Wistar strain rats. Alcohol plus fish oil were administered to animals for 8 weeks to induce liver injury. PartySmart was administered at doses of 250 and 500 mg/kg body weight. After 8 weeks, parameters such as liver weight, liver function serum markers alanine transaminase (ALT), aspartate transaminase (AST) and alkaline phosphatase (ALP) and lipid peroxidation were studied. Livers from all the groups were subjected for histological evaluation. Treatment with PartySmart at the dose of 500 mg/kg body weight showed significant reduction in the levels of serum ALT, AST and ALP with a decrease in liver weight as compared to ethanol-fed rats. A significant decrease was also observed in malondialdehyde levels following treatment with PartySmart at 500 mg/kg body weight. Histological profile of liver tissue in PartySmart-treated animals showed lesser vacuolar degeneration and intactness of hepatic architecture along with improved glycogen deposition as demonstrated by PAS staining. PartySmart ameliorated alcohol-induced liver injury by preventing cell membrane disturbances, reduction of oxidative stress by free radical scavenging and antioxidant activity and normalization of altered intracellular redox status. Thus, PartySmart can be beneficial in the treatment of alcohol-induced liver damage.

Prevalência da pancreatite crônica em pacientes portadores de cirrose hepática alcoólica: estudo histopatológico / Prevalence of chronic pancreatitis in patients with alcoholic liver cirrhosis: histopathological study

INTRODUÇÃO: O abuso crônico do álcool é importante causa de cirrose hepática e de pancreatite crônica. OBJETIVO: Avaliar a frequência de pancreatite crônica (PC) em pacientes portadores de cirrose hepática alcoólica (CHA) por exame histopatológico. Casuística: Analisaram-se necropsias de 18 homens e sete mulheres portadores de CHA, com idade média e desvio padrão de 47,2 ± 13,8 anos (24 a 83 anos), que consumiam em média 239,6 ± 155,3 g de etanol/dia por um período médio de 16,7 ± 7,2 anos. MÉTODOS: O diagnóstico histopatológico de cirrose hepática baseou-se na fibrose sistematizada com formação de septos delimitando nódulos, associada à inflamação crônica inespecífica. O diagnóstico histológico de PC baseou-se na identificação de exsudato mononuclear (EM) em torno dos ductos e no tecido conjuntivo inter e intralobular, acompanhado de traves de fibrose. A PC foi classificada como leve quando havia discreto EM em região periductal, interlobular ou intralobular acompanhado por finas traves de fibrose; moderada, pelo aumento da intensidade do exsudato e da fibrose, ocasionalmente associado com pequena dilatação dos ductos; a forma grave caracterizou-se pelo EM, densa fibrose, presença de rolhas, dilatação dos ductos, atrofia glandular e, às vezes, calcificação. RESULTADOS: Observou-se PC em 20 pacientes portadores de CHA (80 por cento), que foi leve em 13 (52 por cento), moderada em dois (8 por cento) e grave em cinco (20 por cento). CONCLUSÃO: A pancreatite crônica está frequentemente associada à CHA, sendo histologicamente grave em aproximadamente 1/4 dos casos.

INTRODUCTION: The chronic alcohol abuse is an important cause of liver cirrhosis and chronic pancreatitis. OBJECTIVE: To evaluate the prevalence of chronic pancreatitis (CP) in patients with alcoholic liver cirrhosis (ALC) based on histopathological assays. Subjects: Autopsies of 25 patients with ALC, 18 men and seven women, age ranging from 24 to 83 years (mean ± standard deviation: 47.2 ± 13.8) were retrospectively analyzed. They ingested on average 239.6 ± 155.3 g ethanol/day for a mean period of 16.7 ± 7.2 years. METHODS: Liver cirrhosis histopathological diagnosis was based on the findings of systemized fibrosis with formation of septum-delimited nodules and nonspecific chronic inflammation. CP histopathological diagnosis was based on identification of mononuclear cell infiltration (MCI) around the ducts and in the inter- and intra-lobular connective tissue and presence of strands of fibrosis. CP was classified as mild (discrete MCI in the periductal, inter- or intra-lobular areas with thin strands of fibrosis), moderate (increased exudates and fibrosis, occasionally associated with small dilatation of ducts), and severe (evident MCI, dense fibrosis, presence of plugs in the ducts, irregular ductal dilatation, glandular atrophy and, sometimes, calcification). RESULTS: CP was observed in 20 patients (80 percent) with ALC, and was considered mild in 13 (52 percent), moderate in two (8 percent) and severe in five (20 percent) patients. CONCLUSION: CP is often associated with the ALC, and it can be histologically severe in approximately 1/4 of the cases.

AgNOR counts are not altered in alcoholic cirrhosis.

One hundred and two liver biopsy specimens were stained for Argyrophilic nucleolar organizer regions and associated proteins to assess its utility in differentiating normal, cirrhotic and neoplastic liver tissue. A statistically significant (p < 0.001) difference was observed between mean AgNOR counts of normal (1.53 +/- 0.4), post-hepatitic cirrhosis (3.65 +/- 0.53) and hepatocellular carcinoma (7.94 +/- 1.18). In contrast the mean AgNOR count of biopsies with alcoholic cirrhosis (1.57 +/- 0.06) was significantly less (p < 0.001) than post-hepatitic cirrhosis and was similar to that of normal liver tissue. It is concluded that AgNORs can act as a good adjuvant to histology in diagnosing liver diseases especially in differentiating post-hepatitic and alcoholic cirrhosis.

An Experimental Model of Hepatic Fibrosis Induced by Alcohol and CCl4: Can the Lipopolysaccharide Prevent Liver Injury Induced by Alcohol and CCl4? / 대한간학회지

BACKGROUND/AIMS: It is well known that alcohol enhances the toxicity of CCl4. We tried to establish an alcoholic liver cirrhosis model by administration of alcohol and CCl4 to rats. We also wanted to know the hepatoprotective effect of low doses of lipopolysaccharide(LPS) in this animal model. METHODS: Of 20 female adult rats, 8 were ingested with alcohol ad libitum(group 1) Another 6 were ingested with 10% alcohol and 50% 1mL/kg CCl4 intragastrically by Sonde twice a week(group 2) The remaining 6 were ingested with 10% alcohol, CCl4, and 0.1mg/kg LPS intraperitoneally twice a week(group 3) The fibrosis was evaluated semiquantitatively on a scale of 0(none) to 3(cirrhosis). RESULTS: 1) After 10 weks, septal fibrosis or cirrhosis was produced in 9 out of 12 rats in groups 2 and 3 but there was no fibrotic change in group 1. 2) There was no significant difference in pathological grading between groups 2 and 3. CONCLUSIONS: Hepatic fibrosis or cirrhosis can be sufficiently induced by alcohol and repetitive CCl4 ingestion for 10 weeks. We can not prove the hepatoprotective effect of low dose LPS by semiquantitative evaluation of pathological grading.

Prevalence of hepatitis B and hepatitis C markers in alcoholics with and without clinically evident hepatic cirrhosis

Nos avaliamos a frequencia de marcadores sorologicos das hepatites B e C em 365 alcoolistas, determinando pelo metodo ELISA, a presenca de HBsAg, anti-HBc, anti-HBs e anti-HCV. Cinquenta deles eram cirroticos e 315 nao tinham evidencias de cirrose hepatica; nestes ultimos determinamos HBsAg em todos, anti-HBc e anti-HBs em 130, e anti-HCV em 210. Entre os alcoolistas as frequencias de HBsAg (1,9 por cento), anti-HBc (28,3 por cento) e anti-HCV (3,8 por cento) foram maiores (p<0,001) do que entre os controles (N=17,059), 0,4 por cento, 4,0 por cento e 0,4 por cento respectivamente. A frequencia de HBsAg+ no grupo de alcoolistas sem cirrose (0,95 por cento) foi semelhante a do grupo controle (0,4 por cento) e menores (p<0,001) do que no grupo cirrotico (8,0 por cento)...

Marcadores virales en pacientes con cirrosis hepática e ingesta de alcohol / Viral markers in alcoholic patients with hepatic cirrhosis

El objetivo de este trabajo es determinar la seroprevalencia de marcadores virales para virus B y C en pacientes con cirrosis e ingesta alcohólica y determinar si existen diferencias clínicas y bioquímicas en los pacientes con marcadores virales positivos. Se incluyeron un total de 58 pacientes, 52 hombres y mujeres, con una edad comprendida entre 26 y 72 años, promedio 53 años. 14 pacientes (24,1 por ciento) resultaron Anticore total del virus B (AnticHB) positivo, 6 (10,3 por ciento), Antígeno de superficie (AgsHB) positivo y 8 (13,7 por ciento) Anticuerpo anti virus C (ANtiHVC) positivo, 3 pacientes resultaron positivos para los tres marcadores. Un total de 19 pacientes 33 por ciento tenían algún marcador viral presente. Todos los pacientes resultaron HIV negativos. No se encontró diferencia en los diferentes grupos en cuanto a edad, tiempo y cuantía de ingesta alcohólica, valores de transaminasas, bilirrubina, GGTP, PT, Globulina y Plaquetas. Sólo se encontró diferencia en los valores de albúmina al comparar pacientes AntiHVC positivos y pacientes con marcadores negativos. No se encontraron factores de riesgo en los pacientes con marcadores virales positivos. La seroprevalencia de marcadores virales en pacientes cirróticos alcohólicos es 4 veces superior a la determinada en donantes de sangre para virus B y 18 veces para virus C, no encontrándose factores de riesgo asociados a la presencia de infección viral, por lo que se recomienda descartar la presencia de infección por virus B y C en todo paciente cirrótico con ingesta alcohólica

Marcadores de fibrogénesis hepática en pacientes alcohólicos / Hepatic fibrogenesis markers in alcoholic patients

Serum P-III-P and laminim levels were measured in asymptomatic alcoholics during detoxication treatment. Liver biopsies were obtained, in order to detect liver damage, which was graded with a numeric score, considering values over 6 as severe damage. Serum fibrogenesis markers were also measured in a group of decompensated alcoholic cirrhotics. P-III-P levels were significantly higher in cirrhotic patients compared to alcoholics with or without liver damage and to normal controls. Laminin was not different between groups. P-III-P did not correlate with histological score in asymptomatic patients. In this study P-III-P and P1 laminin were not usefull discriminators of severe liver damage among asymptomatic alcoholics; their levels were found to rises significantly only when liver disease has become clinically evident

Formas clínicas e anatomopatológicas das hepatopatias alcoólicas / Clinic and anatomopathologic manifestations in alcoholic liver diseases

Os autores estudam e analisam aspectos clínicos, laboratoriais e anatomopatológicos em grupo de 50 pacientes alcoolistas. Inicialmente conceituam um espectro da doença em três formas anatomoclínicas e parâmetros que definem o que é "alcoolista". Säo discutidos os sinais e sintomas clínicos mais freqüentes nesses pacientes, os exames laboratoriais indicadores de alteraçöes, bem como os achados morfológicos. Os resultados estatisticamente mais significativos säo analisados separadamente, segundo as formas anatomoclínicas, procurando-se correlaçöes. O estudo de revisäo da literatura, 78 artigos no total, é cotejado com os achados