Dupuytren's contracture,chronic liver disease and IgA immune complexes

ABSTRACT— Contrary to previous reports, Dupuytren's contracture was found to be equally common in patients with alcoholic and non-alcoholic biopsy-proven liver disease (25% v 28%). Furthermore, in 69 patients with Dupuytren's contracture referred for surgical correction, there was no significant increase in either history of alcohol abuse or abnormality of liver function compared to a matched control group. Patients with Dupuytren's contracture were found to have increased levels of circulating IgA immune complexes compared to those without (p<0.05 for those with liver disease; p<0.001 for those awaiting surgical correction). Circulating immunoglobulins and immune complexes of other classes were similar between the groups with and without Dupuytren's contracture. These results suggest that the importance of alcohol has previously been exaggerated but that IgA immune complexes may be involved in the pathogenesis of the condition.     

Dupuytren's contracture: a review

DC is a slow fibrotic process of the palmar fascia usually beginning in middle age in the form of small nodules at the distal ulnar aspect of one or both palms, gradually resulting in a permanent contracture of one or more fingers. The incidence varies between 1% and 3% of whites, and is six to ten times more frequent in males than in females. The etiology is unknown. Heredity certainly plays an important role, while local or distant trauma, neurogenic, and metabolic factors may be of significance in the development of this condition. Alcoholism, diabetes mellitus, and epilepsy are often associated with this moderately disabling ailment. Similar conditions of the plantar fascia may be seen isolated or concomitantly with DC of the hand. The natural history of DC varies greatly from one individual to another. Successful conservative treatment is possible only at the very beginning of the disease. Subsequently, various surgical methods should be considered. Whatever the method, recurrences are possible, especially in young people.     

Favorable effect of modest alcohol consumption to fatty liver disease

We previously reported that modest alcohol consumption was significantly inversely associated with fatty liver disease.Feng et al pointed out a discrepancy of statistical significance between our current larger scale cohort and a previous cohort.However,the prevalence of non-alcoholic fatty liver disease was higher in non or minimal drinkers than those in light drinkers in both cohorts.They also argue that some potential co-factors such as soft drink consumption and genetic variations should be discussed.     

The impact of alcohol and chronic liver disease of micronutrients metabolism

Liver disease, alcohol and malnutrition are combinations usually associated with micronutrient impairment. Chronic liver disease courses with lower storage and activation of vitamin-coenzymes related to their malabsorption. Alcohol worsens the picture by reducing food intake, increasing micronutrients utilization and decreasing their absorption secondary to either intestinal or pancreatic injuries. Other concurrent causes would be drug treatments, urinary losses, protein deficiency and oxidative stress. As consequences the clinical signs are anemia, liver steatosis, oxidative stress and immunosuppression.     

Increased susceptibility to liver disease in relation to alcohol consumption in women

Sex-related differences were prospectively studied in patients with the first presentation of alcoholic liver disease. Among 42 patients the diagnosis was cirrhosis in 8 women and 15 men, alcoholic hepatitis in 4 women and 1 man, steatosis in 6 women and 6 men, and no histologic changes were found in the liver biopsy specimens from 2 men (p greater than 0.1). The median (range) antipyrine clearance was 14.6 (1.0-64) versus 17.2 (3.0-83) ml/min and the clinical score in accordance with the Pugh modification of the Child-Turcotte classification was 8 (5-13) versus 8 (5-11) in the women and men, respectively (p greater than 0.05). In 5 women and only 1 man the antipyrine clearance was less than 5 ml/min, indicating an almost total loss of functional liver mass (p less than 0.05), whereas the Pugh score was above 11 in 6 women, but not in any of the men (p less than 0.05). On an average, the men estimated their total lifetime consumption of alcohol to be 2.1 times greater and the number of days they had consumed more than 5 drinks 2.9 times higher than the women (p less than 0.05). These ratios are reduced to 1.4 and 1.7, respectively (p greater than 0.05), if the female alcohol intake is adjusted to the average male volume of distribution. The results support the concept that women may develop similar, and sometimes even more severe, liver disease after consumption of less alcohol than men. The apparent difference in susceptibility to alcohol may be partly explained by differences in volume of distribution.     

Gamma-glutamyltranspeptidase, aspartate aminotransferase, and erythrocyte mean corpuscular volume as indicators of alcohol consumption in liver disease

Gamma-glutamyltransferase (GGT), aspartate aminotransferase (ASAT), and erythrocyte mean corpuscular volume (MCV) were used as indicators of continued alcohol abuse in 178 patients with known liver disease studied for 5-49 months after diagnosis. Abstension was checked by interviews and blood alcohol determinations. Persistent alcoholics had significantly higher values for all three tests than abstainers. At values above upper normal limits, GGT was the most sensitive test, but the least specific. A positive predictive value of 80% for continued alcohol consumption was chosen, and the corresponding discriminating levels of the tests were compared. With this specificity GGT was the least sensitive test, and it did not add to the efficiency of ASAT or MCV when the tests were combined. Abstinence could not be predicted by low levels of the tests. It is concluded that these biochemical tests are valuable as indicators of alcohol consumption in patients with liver disease and that ASAT and MCV are equally efficient, whereas GGT is inferior to these.     

Dupuytren's disease

Dupuytren's disease is a contracture of the hand derived from the retractile fibrosis of the palmar aponeurosis, that leads to a progressive deformity in flexion of fingers. It has been named from the French surgeon Guillaume Dupuytren (1777-1835), that described it in 1831. In this note it is sketched a short biography of Dupuytren and the main clinical features of the disease are described, underlining some particular aspects of therapy.     

内毒素与酒精性肝病

酒精 (乙醇 )对肝细胞有直接毒性作用 ,其机制涉及乙醇的代谢产物乙醛的毒性、还原型辅酶Ⅰ /辅酶Ⅰ (ＮＡＤＨ/ＮＡＤ )比值增高所致代谢紊乱、氧缺乏、氧应激和自由基的损害等多个方面。近年来 ,许多学者认为肠源性内毒毒血症及其对库普弗细胞的激活可能是乙醇一系列肝毒性作     

Patterns of alcohol consumption after liver transplantation

Background—Uncertainty exists aboutthe extent and consequences of a return to alcohol consumption afterliver transplantation for alcoholic liver disease (ALD).
Aims—To determine the prevalenceand consequences of alcohol consumption in patients transplanted for ALD.
Methods—A retrospective casecontrolled study of all patients transplanted for ALD at the QueenElizabeth Hospital, Birmingham, between 1987 and 1996.
Results—Seventy patients with ALDwere transplanted, of which 59 survived more than three months; 56 wereinterviewed. Twenty eight had consumed some alcohol aftertransplantation; for the nine "heavy drinkers" (HD), the mediantime to resumption of alcohol intake was six months and for the 19 "moderate drinkers" (MD) it was eight months. There was nosignificant difference in episodes of acute rejection or compliancewith medication between those who were abstinent, MD, or HD.Histological evidence of liver injury was common in ALD patients whohad returned to drink. Mild fatty change was found in 1/11 biopsyspecimens from abstinent patients but moderate to severe fatty changeand ballooned hepatocytes were seen in 3/5 MD and 2/5 HD specimens. TwoHD patients had early fibrosis. One HD patient has died of alcoholrelated complications.
Conclusions—Moderate to heavyalcohol consumption occurs in patients transplanted for ALD. Patientrecall of abstinence advice is unreliable, and patients return toalcohol mainly within the first year after liver transplantation.Return to alcohol consumption after liver transplantation is associatedwith rapid development of histological liver injury including fibrosis.

Keywords:alcohol consumption; liver transplantation

     

Dupuytren''s contracture and alcohol.

Reported alcohol consumption was quantified and scored by a validated questionnaire administered by an interviewer to 64 patients (10 female) with Dupuytren's contracture (DC) before hand surgery and to 89 controls (44 female) admitted for other hand or foot surgery. Serum urate (SUA), gamma-glutamyl transferase (GGT), and mean red cell volume (MCV) were measured on admission. Thirteen of 54 men with DC reported current daily alcohol intake of 40 g or more compared with one of 45 male controls (p = 0.0001). Two of 10 women with DC (but none of 44 controls) admitted consuming at least 40 g alcohol daily (p = 0.03). MCV was higher in men (but not women) with DC than in controls (p less than 0.0005). Current alcohol consumption score of patients with DC correlated with SUA (r = 0.308, p less than 0.05), MCV (r = 0.44, p less than 0.01), and GGT (r = 0.54, p much less than 0.001) on admission. DC among men is strongly associated with heavy drinking, reflected both in self reporting and haematological data.