Antiviral treatment in acute hepatitis C

BACKGROUND/AIMS

Several treatment schedules have been tried in acute hepatitis C, but due to the heterogeneity of included patients and to the non-practical interferon protocols, we assessed prospectively in a non-randomized pilot study, the efficacy of interferon 2b.

METHODOLOGY

Five million units of interferon 2b were given three times weekly by subcutaneous route for 6 months as soon as diagnosis of acute hepatitis C was established.

RESULTS

In 6 jaundiced patients, we have achieved a rate of 83% of sustained response, for at least one year, with normalization of ALT and clearance of HCV RNA. Interferon was very well tolerated and there was no need for changing treatment schedule.

CONCLUSIONS

These findings suggest that 5 MU TIW for 6 months is well tolerated and effective in preventing, in a non-aggressive way, a chronic course of hepatitis C infection.

[Use of lyophilized cellulose in peripheral nerve lesions with loss of substance]

Lyophilized cellulose was analysed to verify the degree of inflammatory reaction and axon realignment in the sciatic nerve after loss of neural substance. Ten mongrel dogs were divided into: Group 1 - 1 cm section of sciatic nerve which was replaced at lesion site; Group 2 nerve section without fragment replacement. The section site was involved with lyophilized cellulose. Group 3 -1 cm fragment section sutured epineurally. Motor response started at eighth week. Moderate fibrotic reaction to cellulose was seen in Group 1 and 2 animals. Groups 1 and 3 showed coaptation between the nerve and nerve graft with ongoing axons. In Group 2, 1 dog showed regrowth of axons through the empty space. It was concluded that lyophilized cellulose caused moderate fibrous reaction when implanted in peripheral nerve lesions with loss of substance; it can act as envelop protection in those lesions mainly if a neural graft is inserted.

The role of transjugular liver biopsy in a liver transplant center

Transjugular liver biopsy is a particularly useful procedure in overcoming the classic limitations of percutaneous biopsy, such as hemorrhagic diathesis or tense ascites. The authors evaluated the impact that this technique had in their liver transplant program, considering performance and safety in 160 procedures. Histologic characterization was accomplished in 75% of cirrhotic patients and in 96% of patients with acute liver disease. Confirmation of a presumptive diagnosis was made in 76% of patients and a previously unsuspected diagnosis was raised in 11%. Hemochromatosis, Wilson's disease, and acute alcoholic hepatitis were the most challenging diagnoses and, together with patients with liver failure, had the most relevant implications in transplant decisions. The availability of transjugular liver biopsy provided decisive information regarding patient selection and the best timing to proceed with transplantation.

[The first assessment of hepatitis E virus seroprevalence in northern Portugal]

Hepatitis E is an enterically transmitted acute viral hepatitis, etiologically associated with a recently characterized virus, the hepatitis E virus (HEV). Outbreaks mainly occur in developing countries and as sporadic cases in endemic regions. The authors present the first serological assessment in northern Portugal to assess the presence of anti HEV IgG, using the Elisa test, the EIA and HEV Abbott, in samples from 50 blood donors and 103 chronic liver disease patients. In 2 blood donors (4%) and in 7 (6.8%) liver patients, the HEV antibody was detected with optic densities/cut off always below 2.5. Only one patient had a sojourn in an endemic region; the presence of anti-HEV was not significantly associated with other hepatotropic viruses. With this test the authors conclude that 4% of our blood donors are seropositive for anti-HEV antibody and that this percentage is not significantly higher in chronic liver disease patients (6.8%). They also think that a new generation of immunological assays, designed for serological diagnosis of HEV infection, will provide a further understanding of hepatitis E epidemiology.

[Hepatic schistosomiasis: diagnostic difficulties in a non endemic area]

Schistosomiasis is a major cause of liver damage and portal hypertension, especially in tropical countries, affecting about 200 million people in the world. We report the cases of two patients presenting persistent alterations of serum liver enzymes. We enhance the importance of considering the history of past travels and a liver biopsy to diagnose an infrequent parasite induced liver disease in a non endemic area such as Portugal. Some observations are made about the diagnosis and treatment of this parasitic disease.

Relative impact of HLA phenotype and CD4-CD8 ratios on the clinical expression of hemochromatosis

Hemochromatosis is a hereditary iron-overload disease linked to HLA. The clinical expression of hemochromatosis is influenced by sex and age. However, other factors must account for the notorious heterogeneity of expression of the disease independent of sex, age, and HLA phenotype. The present study attempts to clarify some of these additional factors based on exhaustive statistical analysis of data collected from 43 selected patients with hemochromatosis. The statistical analysis focused on three groups of variables: the first group included variables reflecting the clinical expression of the disease; the second group represented the biochemical and hematological values at the time of diagnosis; and the third group consisted of the independent variables sex, age, HLA phenotype, and T-cell subset profile, i.e., the percentages and total numbers of CD4+ and CD8+ cells and the CD4-CD8 ratios. The results show that the relative expansion of the two main T-cell subsets, in the context of the HLA phenotype, correlates significantly with the clinical expression of hemochromatosis and the severity of iron overload. The present findings substantiate further the postulate that T cells have a role in the regulation of iron metabolism.

Granular cell tumour and leiomyomatosis of the esophagus--a non-coincidental association?

One case of esophageal granular cell tumour (GCT) associated with diffuse leiomyomatosis of the distal esophagus is presented. The rarity of each of the lesions per se raises the possibility that the association between GCT and diffuse leiomyomatosis, a previously unreported finding, is not coincidental. In view of the present knowledge on both conditions we suggest that an underlying genetic alteration may be responsible for the hereby described association.