Platelet-Derived Growth Factor C in Alcoholics.

AIMS: Platelet-derived growth factor (PDGF) promotes liver collagen deposition, acting on hepatic stellate cells. Despite this, low serum PDGF levels were reported in chronic hepatitis C or B infection, although some studies yield the opposite result. Since PDGF may be related not only to fibrosis but also with vascular, neuronal or muscle disease, it is important to analyze its behavior in alcoholics. METHODS: In total, 17 controls and 62 alcoholic patients consecutively admitted to the hospitalization unit of the Internal Medicine Service were included. We determined serum levels of PDGF C, routine laboratory evaluation, tumor necrosis factor-α, interleukin (IL)-6 and IL-8 and malondialdehyde (MDA) levels. We analyzed the relationships between PDGF and liver function, ethanol intake and inflammatory reaction by both univariate and multivariate analysis to discern which variables PDGF levels depend on. RESULTS: Serum PDGF levels were significantly lower among patients (675 ± 466 pg/ml) than among controls (1074 ± 337 pg/ml; Z = 3.70; P < 0.001), and even lower among cirrhotics (549 ± 412 among cirrhotics vs 778 ± 487 among non-cirrhotics; Z = 2.33; P = 0.02). PDGF levels showed a direct correlation with prothrombin activity (ρ = 0.50; P < 0.001), platelet count (ρ = 0.44; P < 0.001) and inverse ones with bilirubin (ρ = -0.39; P = 0.002), IL-6 (ρ = -0.33; P = 0.016), IL-8 (ρ = -0.47; P < 0.001), and MDA levels (ρ = -0.44; P < 0.001). By multivariate analysis, only prothrombin activity and platelet count were independently related to PDGF. CONCLUSION: PDGF-C levels are decreased in alcoholics, especially among cirrhotics. Multivariate analysis discloses that only prothrombin activity and platelet count are independently related to PDGF-C levels.

Vein thrombosis in a patient with agenesis of inferior vena cava

We report a 29-year-old woman with bilateral deep vein thrombosis. CT-scan was performed and an agenesia of inferior vena cava was found. With regard to the case report, we provide a brief review of the embryogenesis of the inferior vena cava, and of anomalies in the genesis of this vessel. In young patients with idiopathic deep venous thrombosis the existence of an abnormality in the inferior vena cava should be considered

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Serum sclerostin in alcoholics: a pilot study.

AIMS: Sclerostin is an endogenous inhibitor of the Wnt/ß-catenin pathway secreted by osteocytes, which inhibits osteoblast function, differentiation and survival. As a consequence, sclerostin tends to decrease bone mass. Alcoholics frequently present osteoporosis, mainly due to decreased bone synthesis. The behaviour of sclerostin in these patients is unknown. The aim of this work was to analyse the relationship between serum sclerostin levels and bone mineral density (BMD), ethanol consumption, nutritional status, liver function derangement and biomarkers of bone homeostasis in alcoholic patients. METHODS: We included 31 alcoholic patients, of whom 11 were infected with Hepatitis C virus (HCV) and 7 age and sex-matched controls. All underwent densitometry, and serum sclerostin, osteocalcin, collagen telopeptide, parathyroid hormone (PTH), vitamin D, cortisol and testosterone were determined. RESULTS: Sclerostin levels were significantly higher in patients (30.95 ± 18.91 pmol/l) than controls (t = 4.4; P < 0.001), especially in non-HCV patients; they showed an inverse correlation with osteocalcin, prothrombin activity and serum albumin, and a direct correlation with bilirubin and telopeptide, but not with BMD, nutritional status or ethanol intake. CONCLUSIONS: Serum sclerostin was raised in alcoholic patients, and it correlated with decreased markers of bone synthesis and increased markers of bone breakdown. The elevation in sclerostin levels was clearly related with liver function, but not with ethanol intake, nutritional status or concomitant HCV infection.

Prognostic value of changes in lean and fat mass in alcoholics.

BACKGROUND & AIMS: The prognostic value of nutritional status and/or lean and fat mass assessed by dual-energy X-ray absorptiometry (DEXA) has been widely analyzed, in both alcoholics and non-alcoholics. However, the prognostic value of changes in fat and lean mass over time in alcoholics has scarcely been studied, nor has the effect of alcohol abstinence on these changes. METHODS: From an initial cohort of 113 alcoholic patients, 70 prospectively underwent two DEXA assessments six months apart. One hundred and five patients (including 66 of those who underwent two DEXA assessments) were followed up for 34.9 ± 36.4 months (median = 18 months, interquartile range = 7.25-53.75 months). During this follow-up period, 33 died (including 20 of those who had undergone a second DEXA assessment). RESULTS: Forty-two of the 70 patients undergoing a second DEXA assessment had abstained from alcohol. Of these, 69.04% (29) gained left arm lean mass, compared with only 35.71% (10 of 28) of those who had continued drinking (χ² = 7.46; p = 0.006). Similar results were observed regarding right arm lean mass (χ² = 4.68; p = 0.03) and right leg lean mass (χ² = 7.88; p = 0.005). However, no associations were found between alcohol abstinence and changes in fat parameters. Analysis by means of Kaplan-Meier curves showed that loss of total lean mass, right leg lean mass, left leg lean mass and total fat mass were all significantly associated with reduced survival. However, within 30 months of the second evaluation, significant associations were observed between changes of all parameters related to lean mass, and mortality, but no association between changes in fat parameters and mortality. CONCLUSIONS: Loss of lean mass over a period of six months after a first assessment is associated with worse prognosis in alcoholics, irrespective of whether they stop drinking during this period or not. Continued drinking is associated with greater loss of lean mass, but not with changes in fat mass.

Alcoholic myopathy: vitamin D deficiency is related to muscle fibre atrophy in a murine model.

AIMS: Chronic myopathy has been described in alcoholics, characterized by atrophy of type II fibres, and vitamin D deficiency. Low serum vitamin D levels are frequent in alcoholics. The possibility exists that serum vitamin D levels are related to muscle changes in a murine experimental model. METHODS: Histological analysis of the right gastrocnemius muscle was performed in four groups of adult Sprague-Dawley rats, sacrificed after 5 weeks of treatment following the Lieber-DeCarli model. We studied the association between muscle histological changes and the activity of glutathione peroxidase (GPX), superoxide dismutase (SOD) and lipid peroxidation products (malondialdehyde); parathyroid hormone (PTH), insulin-like growth factor 1 (IGF-1), free testosterone, 1,25 dihydroxyvitamin D3 (vitamin D) and corticosterone; and serum calcium and magnesium. RESULTS: Alcoholic animals showed type IIa and IIb fibre atrophy, especially the low-protein-fed ones, an effect dependent on protein deficiency. A significant relationship was observed between serum vitamin D levels and IIa fibre area (rho = 0.56, P = 0.002), and also, as a trend, between vitamin D and type IIb fibre area (rho = 0.39, p = 0.053); between vitamin D and muscle GPX (rho = 0.40, P = 0.025) and SOD activities (rho = 0.43, P = 0.012). Muscle GPX activity was significantly related with type I fibre area (rho = 0.49, P = 0.01) and muscle SOD, with type IIa fibre area (rho = 0.38, P = 0.045). Serum testosterone was also related with type IIa fibre area (rho = 0.61, P < 0.001). No relation was observed between serum PTH, corticosterone, or IGF-1 and fibre area PTH and antioxidant systems. Multiple regression analysis disclosed that the only parameter independently related with type IIa fibre area was serum vitamin D. CONCLUSION: Low vitamin D levels are related to muscle fibre atrophy, and altered levels of muscle antioxidant enzymes could play a role in alcoholic myopathy.

Relación entre homocisteína y masa ósea en pacientes alcohólicos / Relationship between homocysteine and bone mass in alcoholic patients

Introducción. En el paciente alcohólico se observa la presencia de osteopatía. La homocisteína puede interferir con la formación del colágeno, la mineralización ósea y aumentar el riesgo de fracturas osteoporóticas. Algunos autores han encontrado relación entre la homocisteína y las fracturas óseas pero no se ha estudiado en pacientes alcohólicos. Pacientes y métodos. Estudiar en 43 pacientes alcohólicos la relación entre la densidad mineral ósea, hormonas, osteocalcina, N-Telopéptido terminal y la homocisteína. Grupo control de 63 individuos. Resultados. Los niveles séricos de homocisteína estaban ligeramente más elevados en los pacientes respecto a los controles (más en cirróticos que en no cirróticos) pero no de forma significativa. Un 38,5% de los pacientes presentaba osteoporosis. Aunque en los pacientes con osteoporosis los niveles de homocisteína estaban más aumentados no hallamos relación entre la homocisteína y la densidad mineral ósea en ninguna de las localizaciones analizadas ni en los valores hormonales ni en los marcadores óseos. Conclusiones. No hemos encontrado relación entre el aumento de la homocisteína y la osteoporosis de los pacientes alcohólicos

Introduction. Alcoholism leads to osteoporosis. Homocysteine (tHcys) may weaken bone by interfering with collagen cross-linking. Some authors hve found a relation between tHcys and bone fracture in clinical settings differents from alcoholism. Methods. We studied the relationship between bone mineral density, hormones, bone metabolism markers and homocysteine in 43 alcoholics patients. Data were compared with those obtained on 63 controls. Results. Serum homocysteine were slightly non-significantly higher among patients than controls and among cirrhotic than non-cirrhotic patients. A total of 38.5% patients had osteoporosis. Although homocysteine levels were slightly highly in patients with osteoporosis, no relationships were observed between homocysteine and bone mineral density at any of the bone sites analyzed or in hormones or serum markers of bone metabolism. Conclusion. We found no relationship between the number of homocysteine and osteoporosis of alcoholic patients

Effects of hypothermic deep-anaesthesia on energy metabolism at brain and peripheral levels: a multi-probe microdialysis study in free-moving rat.

Reduction of central energy metabolism is a strategy to protect brain against neurotoxic events. The aim of this microdialysis study in rats is to evaluate changes in energy metabolite levels at central level (striatum) comparatively to peripheral level (subcutaneous adipose tissue) during hypothermic barbituric deep-anaesthesia (sodium pentobarbital 60 mg/kg intraperitoneally). At brain level, extracellular glucose increases (+14.9%) while lactate decreases (-16.6%); opposite results were observed at subcutaneous level (-29.2% for glucose and +68.3% for lactate). Lactate/pyruvate ratio remains unchanged at brain level, but increases at subcutaneous level (+73.5%). In light of previous studies on the effects of pentobarbital on regional blood flow and tissue glucose consumption, our data correlates the fact that pentobarbital reduces preferentially brain energetic metabolism. We suggest that those regional effects are explained, at least for a part, by the fact that central isoform glucose transporters (Glut1 and Glut3) are known to be more sensitive to pentobarbital than peripheral isoforms. Such facts can be involved in the protection of brain tissue against ischemic risk due to decreased cerebral blood flow decrease.

In vivo study of tumor metabolism: an application of new multi-probe microdialysis system in the striatum of freely moving rats grafted with C6 cells.

The purpose of this study is to investigate the in vivo tumoral brain metabolism in free moving rats using microdialysis. Cells from C6 glioma cell line were inoculated in one striatum 15 days before the microdialysis experimentation. Then, using a new system allowing perfusion of several microdialysis probes in free moving rat, normalised dialysate levels of glucose, lactate and pyruvate were monitored in both glioma and control striatum. At the end of the procedure, animals were sacrificed for histological study. Data shows that probe functioning is similar in both tissues. The results for normalised glucose level were in striatum control: 2.14 mM, in tumoral striatum: 1.71 mM (P>0.1); for lactate, respectively, 0.86 and 1.65 mM (P<0.05) and for pyruvate, respectively, 65.56 and 140. 94 microM (P<0.05). This data clearly shows a significant increase of pyruvate and lactate in tumoral striatum compared to normal striatum, correlating previous in vitro studies on glioma metabolism. We conclude that this microdialysis technique is of value in tumoral brain and could constitute an interesting tool for a better understanding of glioma metabolism.

Hepatobiliary scintigraphy after biliary tract surgery.

Hepatobiliary scintigraphy provides a rapid, noninvasive, accurate means of assessing patients after biliary tract surgery. This is especially important, given the high incidence of biliary and enteric diseases. In this review article, the role of radionuclide imaging in postcholecystectomy and postgastroenteric surgery patients will be examined, as well as following invasive procedures and trauma.

Increased Tc-99m MDP in multiple lumbar intervertebral disk spaces in Scheuermann disease without concomitant radiographic calcification or diskitis.

A radionuclide bone scan serendipitously revealed deposition of Tc-99m MDP in multiple lumbar intervertebral disk spaces in a 29-year-old man with extensive trauma to the left femur as a result of a motor vehicle accident. In the authors' experience, alcoholic liver disease or altered weight bearing secondary to prior trauma are not associated with intervertebral radiotracer uptake. Although it is possible that radiographically undetectable microcalcifications in the intervertebral disk spaces associated with degenerative changes, common in Scheuermann disease, account for this unusual finding, a literature search found that increased disk uptake had been reported only in two patients with Scheuermann disease who had concomitant active or healing diskitis. No other causes of increased disk uptake of Tc-99m MDP were found.

Scintigraphic evaluation of postoperative complications of laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is gaining popularity as an alternative to standard open cholecystectomy. At our institution, approximately 400 laparoscopic cholecystectomies have been performed since May 1989. The frequency of major postoperative complications has been approximately 1.5% (6 out of 400 cases). The most common complications have been biliary tree injury, bile leak, and retained stone. We present three patients who developed postoperative complications that were properly diagnosed on 99mTc-DISIDA cholescintigraphy. Our report indicates that 99mTc-DISIDA scintigraphy facilitates the rapid and precise diagnosis of bile leaks in patients with abdominal pain and/or hyperbilirubinemia following laparoscopic cholecystectomy.

Diagnosing osteomyelitis in Gaucher's disease. Observations on two cases.

Bone scans in two patients with Gaucher's disease were reported as consistent with Gaucher's-associated osseous crises. A bone-radiogallium subtraction study was also initially negative in each individual (although it later became positive in one). At surgery both patients were seen to have osteomyelitis. These two cases point out the difficulty in attempting to diagnose osteomyelitis in the presence of Gaucher's bone disease. A possible role for MRI in such instances was mentioned. Also noted was clinical reluctance to accept a diagnosis of osteomyelitis (positive bone-radiogallium subtraction study) in an afebrile Gaucher's patient.

The "warm" sacroiliac joint. A finding in pelvic abscess.

Two patients with pain referable to the low back and sacroiliac regions had bone scans with similar findings. In each, one sacroiliac joint was "warm" (uptake on that side was slightly greater than that in the contralateral area). Ga-67 imaging also demonstrated increased uptake in the same locale. Subsequent CT scanning revealed pelvic abscesses adjacent to the affected joints. Asymmetric uptake of bone imaging agent may have been related to hyperemia and "heating" of the sacroiliac joint. Rapid defervescence with antibiotics and drainage (and no CT evidence of bone involvement) suggested that osteomyelitis was not involved in these cases.

Nuclear medicine studies of aging: X. Relationship of liver and spleen lengths at age 65 years and older.

For 3 groups of patients aged 65 years or greater, liver and spleen lengths were measured from calibrated radiocolloid images. Length relationships between liver (L) and spleen (S) were examined in terms of S as a function of L, as well as (S/L) and (L-S) vs S or L. Liver and spleen lengths were the least well correlated in these patients. The S/L ratio vs S produced the most significant correlation in all 3 groups. This suggests a complex but describable relationship between liver and spleen lengths in the overall aging population, and provides a baseline for comparing the effects of various diseases on S and L.