Portopulmonary hypertension (PPHTN) is a rare complication in patients with portal hypertension. A role of endothelin 1 (ET-1) and other cytokines was demonstrated in primary pulmonary hypertension but not in PPHTN. We evaluated the possible role of ET-1, interleukin 6 (IL-6), interleukin 1β (IL-1β), and tumor necrosis factor alpha (TNF-α) in the pathogenesis of PPHTN. Plasmatic concentrations of ET-1, IL-6, IL-1β, and TNF-α were measured in patients with pulmonary systolic arterial pressure (PAPs) >30 mm Hg and in patients with cirrhosis. In all, Six out of 11 patients with PAPs >30 mm Hg had PPHTN on right heart catheterization. The remaining 10 patients had an hyperdynamic circulation (HC). In PPHTN patients, ET-1 and IL-6 were significantly higher compared with HC and patients with cirrhosis. Endothelin 1 and IL-6 could be implicated in the pathogenesis of PPHTN. On the basis of these results, ET-1 receptor antagonists or anti-IL-6 could have a rationale in the treatment of PPHTN.

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ContextIn our Allergy Unit, we incidentally observed that a low Nickel diet, prescribed for delayed allergy to Nickel sulfate, reduced body mass index (BMI) and waist circumference in overweight patients.ObjectivesThis pilot cross-sectional analysis was undertaken to compare the prevalence of Nickel allergy of overweight individuals versus the general population. We also had the chance to report the efficacy of a low Nickel diet on BMI and waist circumference in Nickel-sensitive overweight subjects.MethodsEighty-seven overweight subjects, with a BMI >26 Kg/m2, were consecutively enrolled in a health prevention program, and screened for the presence of Nickel allergy. The enrolled population was mostly females (72/87) (82.8%). Forty-three overweight women and two men showed a Nickel allergy and started a low Nickel diet. After 6-months of dieting, 24 overweight allergic women could be traced and changes in BMI and waist circumference were calculated.Main Outcome MeasurementsPrevalence of Nickel allergy in overweight.ResultsPrevalence of Nickel allergy in overweight female was 59.7%, compared with a prevalence rate of 12.5% in the general population. A significant reduction in BMI was observed in 24 out of 43 overweight females with Nickel allergy after 24 weeks of a low Nickel diet. Relative to baseline, mean BMI decrease was 4.2±0.5 (P <0.001) and the mean decline in waist circumference was 11.7±0.6 cm (P< 0.001).ConclusionsThis pilot observational analysis showed a substantially higher prevalence of Nickel allergy among overweight females, especially those with metabolic syndrome and fatty liver disease. A normocaloric low Nickel diet was effective in reducing BMI in this population. Further research is strongly needed to confirm these preliminary findings.

BACKGROUNDHCV-induced chronic hepatitis is a major health problem world-wide because of its propensity to progress to liver cirrhosis and hepatocellular carcinoma. 1±3 Until recently, interferon-a has been the only approved pharmacological treatment for chronic hepatitis C in the United States and Europe. However, many patients do not respond to treatment and roughly two thirds of those who respond will relapse after discontinuing treatment. 4 The combination of interferon-a and ribavirin has been shown to signi®cantly improve the response rate to interferon-a monotherapy, both in relapsers to a previous interferon-a course and in naive patients. 5,6 Yet this combination is associated with signi®cant side-effects and the overall results are unsatisfactory, as sustained responders still represent less than half of the patients. Thus, there is an obvious need for more effective forms of therapy. SUMMARYBackground: The prognosis of chronic hepatitis depends on the progression of hepatic ®brosis. Aim: To investigate whether the anti®brotic drug colchicine, in combination with interferon-a has a role in the treatment of chronic hepatitis C. Methods: Sixty-®ve HCV±RNA positive patients with chronic hepatitis were randomized to receive interferona, 6 MU t.i.w. for 6 months followed by 3 MU t.i.w. for further 6 months, with or without the adjunct of colchicine, 1 mg o.d., 6 days a week, for 3 years. We report an interim analysis after the ®rst 18 months. Results: Thirty-four patients received interferon-a and 31 received interferon-a and colchicine. The two groups were comparable for baseline data, including HCV±RNA levels, genotypes and histological grading/staging. Drop-outs and side-effects were similar. The proportion