Relationship between HBV markers and heroin as a cause of liver injury in drug addicts.

Fifty liver biopsies from heroin addicts on methadone maintenance were studied for histological features. The relationship between hepatic damage, HBV markers and the length of drug abuse was analysed. Infiltration was found in 95.6% of hepatitis B surface antigen (HBsAg) positive patients and in 50% of hepatitis B surface antibody (HBsAb) positive and HBV negative patients. The length of drug abuse showed a strong direct correlation with vacuolar degeneration (P less than 0.001) and an inverse correlation with fibrosis (P less than 0.05).

Hepatocellular carcinoma : role of hepatitis viruses and liver cell dysplasia.

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver. HCC is a major problem worldwide because of its high prevalence and severe natural history and it is the major cause of cancer-related mortality in sub-Saharan Africa and in the Far East (1). HCC is the seventh most prevalent cancer in men and the ninth most common in women, with an estimated total of one million cases occurring each year (2-6). It carries a dismal overall prognosis: 92% of affected individuals will die because of their disease (3). In general, tumor incidence increases with age and occurs most often between the third and fifth decades of life (2). The distribution pattern shows striking and pronounced geographic and racial variations. The biological characteristics of this tumor vary significantly in different geographical areas, from country to country and even from one part of a country to another. Because of the widely divergent rates of HCC worldwide, it is possible to identify high-, intermediate-, and low-incidence areas. In China and south-east and sub-Saharan Africa, as many as 10-30 new cases per 100,000 males in habitants are reported each year, whereas in northern Europe, North America, and Australia, the annual rates of HCC are less than 3 cases a year per 100,000 males.

Tegafur chemotherapy for the treatment of gut and liver cancer.

Thirteen patients with cancer of the gut, six with hepatocellular carcinoma and three with cancer of the bile duct have been treated with tegafur. All the patients were in an advanced stage of the disease with metastases to lymph-nodes or elsewhere. Each patient was given tegafur (oral daily dose of 600-1200 mg for 15-30 days with a dose-free interval of 25 days). Tegafur with other antiblastic drugs (such as cyclophosphamide, methotrexate, vincristine, doxorubicin, mitomycin) was given to ten patients. The results observed after the first treatment were as follows: partial remission in 14 patients (64%), no change in 4 (18%) and progression of the disease in 4 (18%). Only 10 patients among the 22 who were first treated, underwent one to three subsequent cycles of therapy obtaining with resultant partial remission in four cases, no change in two and progression of the disease in four patients. Side-effects (nausea and vomiting) during the treatment were recorded only in 14% of the patients. No significant impairment of blood functional tests has been documented. A comparison of the results obtained with tegafur and intravenous 5-fluorouracil has been made: the therapeutic effects of these two drugs are similar, but side-effects seem to be less during tegafur treatment.

Fluid absorption study in ultra-high molecular weight polyethylene (UHMWPE) sterilized and unsterilized acetabular cups.

The weight gain due to fluid absorption was measured in gamma-sterilized, ethylene oxide (ETO) gas-sterilized, and unsterilized ultra-high molecular weight (UHMW) polyethylene acetabular cups. After about 2 months the total average fluid absorption gain of the polyethylene cups was: 1.76 +/- 0.45 mg (average +/- standard deviation) for the unsterilized polyethylene cups, 2.81 +/- 0.95 mg for the gamma-sterilized polyethylene cups and 1.51 +/- 0.34 for the ETO gas-sterilized polyethylene cups. There was little difference in fluid absorption between the sterilized and unsterilized specimens. In particular, the gamma-sterilized acetabular cups absorbed more than the ETO gas-sterilized and the unsterilized cups. However, the weight gain was higher in serum compared with that in water.

[Poland syndrome associated with Moebius syndrome]. / Sindrome di Poland associata ad una sindrome di Moebius.

We present a case of a girl with Poland's Syndrome (absence of pectoral muscle and syndactyly) associated with Moebius Syndrome. More abnormalities, especially visceral, may be associated with it and therefore the clinician must know and identify them as soon as possible. We underline the importance of a precocious correction of the hand's abnormalities in order to avoid changes in the corporal pattern otherwise not correctible later. A retard in surgical treatment will produce a failure like in our patient.

Autoantibodies to gastrin-producing cells in antral (type B) chronic gastritis.

Autoantibodies that react exclusively with the gastrin-secreting cell of human antrum have been detected by immunofluorescence in eight of 106 patients with histologic evidence of chronic atrophic gastritis, Type B, involving mainly the antrum. These antibodies were of the IgG class and of low titer. However, follow-up studies one to two years later showed persistently positive reactions, despite symptomatic treatment. These data support the concept of an autoimmune variant of chronic "antral" gastritis, Type B.

What is the effect of a cytomegalovirus infection when superimposed on HBsAg-positive chronic hepatitis?

A non-transfusion-related cytomegalovirus infection was observed in two patients with chronic HBsAg-positive liver disease. Both patients were immunodepressed and died of acute hepatic failure. A superimposed CMV infection has a high fatality rate in the case of underlying chronic type B liver disease.

Clinical course of inflammatory bowel disease during treatment with interferon for associated chronic active hepatitis.

Seven patients with inactive ulcerative colitis and seven patients with Crohn's disease (5 inactive, 2 mildly active) received interferon treatment for associated chronic active hepatitis. Neither relapse (except in one patient) nor worsening of the clinical course of the inflammatory bowel disease was observed during treatment. According to these results chronic active hepatitis associated with inflammatory bowel disease can be treated with interferon without the risk of deteriorating the course of the inflammatory bowel disease.

Prediction of successful outcome in a randomised controlled trial of the long-term efficacy of interferon alpha treatment for chronic hepatitis C.

To evaluate the efficacy of a 12-month course of recombinant interferon alpha (IFN-alpha2b), and to assess predictive factors of successful response to IFN therapy in chronic active hepatitis C (HCV CAH), 242 patients with histologically proven HCV CAH were assigned randomly to two groups, one treated with IFN-alpha2b (3 MU three times weekly, intramuscularly), the other untreated. To determine the efficacy of IFN-alpha2b 12 months after therapy, a second liver biopsy was carried out on 100 treated patients and 27 untreated patients. The biochemical, virological, and serological response of patients followed up for at least 50 months after treatment was also evaluated to confirm the efficacy of IFN-alpha2b. The genotypes of infecting HCV, anti-HCV core IgM, and HCV-RNA concentrations were also analysed and the predictors of response determined by univariate and multivariate analyses. Response was defined in terms of the normalisation of aminotransferase activities and the disappearance of HCV-RNA. The overall long-term response was 39.4%. Anti-HCV core IgM levels were significantly lower in long-term responders. Patients with increased levels of IgM anti HCV core (>3.8 sample/cut-off), infected with genotype 1b were nonresponders. Liver histology improved significantly in patients with long-term response. Multivariate analysis identified three independent predictors of the likelihood of long-term response to IFN therapy: age younger than 40 years, basal anti-HCV core IgM levels < or = 3.8, and genotypes other than 1b. These data indicate that the treatment with IFN-alpha2b used in this randomised controlled trial is effective in HCV CAH. Anti-HCV core IgM was the strongest predictor of long-term response in the present study.