Transforming growth factor beta1 and prostaglandin E2 concentrations are associated with bone formation markers in ulcerative colitis patients.

Osteoporosis is a significant complication of a multifactoral etiology associated with inflammatory bowel disease. The aim of study was to evaluate the relationships between bone mineral density as well as bone turnover markers and inflammatory activity modulators (i.e., PGE2 and TGFbeta1) in ulcerative colitis (UC). Twenty-one active ulcerative colitis subjects and 14 healthy individuals were included into the study. We observed no significant differences in serum concentrations of osteoprotegerin and osteocalcin, as well as bone mineral density between UC patients and healthy individuals. Plasma concentrations of PGE2, TGFbeta1 and TNF-alpha were significantly higher in UC patients than in controls. Serum osteocalcin demonstrated a positive correlation with both serum PGE2 and plasma TGFbeta1. Moreover there was significant correlation between osteoprotegerin and TGFbeta1 as well as serum TNF-alpha concentrations. In conclusion a positive association between PGE2 and TGFbeta1 and bone formation markers-osteoprotegerin and osteocalcin, as well as a comparable BMD in UC patients and healthy individuals was shown. Our results may indicate that increase of PGE2 as well as TGFbeta1 concentrations may play a protective role against bone loss in ulcerative colitis patients.

Medical procedures and the risk of iatrogenic hepatitis C infection: case-controlled study in north-eastern Poland.

Many hepatitis C virus (HCV)-infected individuals do not have any obvious risk factors and one of the putative sources of infection may be inadvertent exposure to infected blood or body fluids in the clinical setting. The aim of this study was to assess the role of medical procedures in transmission of hepatitis C in north-eastern Poland. In total, 194 patients with chronic hepatitis C were eligible for the study. The control group consisted of 275 age- and sex-matched individuals. Patients with a history of intravenous drug use were excluded. On multivariate analysis, transfusions [odds ratio (OR) = 3.7, 95% confidence interval (CI) 2.2-6.3], minor surgery (OR = 3.2, 95% CI 1.5-6.7) and dental care (OR = 2.3, 95% CI = 1.4-4.0) were independently associated with HCV infection. We conclude that apart from transfusion, minor medical procedures and dental care may carry a significant risk of hepatitis C infection. Improvements in basic hygiene routines and strict adherence to universal precautions may be essential to prevent iatrogenic transmission of the infection.

One year follow-up of patients treated with misoprostol in acute phase of viral hepatitis B.

The study was undertaken to determine the long-term effect of misoprostol, on hepatitis B virus (HBV) elimination in patients treated during acute phase of viral hepatitis B. Forty male patients were evaluated 12 months after treatment with misoprostol (M-group) or sylimarin (S-group). HBsAg clearance, as an indicator of HBV elimination, and serum bilirubin concentration, prothrombin index, and activities of alanine transaminase, aspartate transaminase, alkaline phosphatase as well as gamma glutamyltranspeptidase were analysed. At the end of treatment phase, improvement of liver function demonstrated through these biochemical indices was faster in M-group. After 12 months of follow-up HBsAg was cleared in all misoprostol treated patients and in 85% among S-group. Moreover misoprostol treatment resulted with normalization of bilirubin concentration and enzymes activity in all patients. Two among sylimarin treated patients (both HBsAg positive), had transaminases activities elevated over 100 U/l, that resulted with significantly higher values than in M-group. These results confirm beneficial effect of misoprostol treatment in patients with liver injury, but promising effect on HBV clearance should be confirmed in a study involving more patients.

Effects of ulcerative colitis activity on plasma and mucosal prostaglandin E2 concentration.

The aim of this study was to determine effects of changes in ulcerative colitis activity on mucosal and plasma PGE2 concentrations measured with an EIA in 49 patients who underwent sigmoidoscopy. The disease was diagnosed in 37 patients. Twelve patients with normal colonic mucosa served as controls. Patients were divided into three groups depending on the changes of endoscopic picture during a three-month follow-up. Some laboratory markers of the disease activity, such as C-reactive protein, albumin, gamma-globulin and hemoglobin concentrations, sedimentation rate, and white blood and platelets counts, were also evaluated. Initial examination revealed a significant, positive correlation of mucosal and plasma PGE2 concentration with endoscopic score. Follow-up of patients without significant progression of mucosal changes revealed constant and close to normal concentration of mucosal PGE2. Plasma PGE2 was higher at the second examination, yet without significant difference. Improvement of endoscopic picture resulted in significant decrease of plasma and mucosal PGE2 concentrations. Worsening of mucosal changes reflected endoscopically was associated with significant increase of PGE2. There were no remarkable changes in the values of analyzed laboratory markers of the disease activity. These results indicate the usefulness of mucosal or plasma PGE2 measurement as a possible prognostic marker in patients with ulcerative colitis.

Effect of misoprostol on serum beta2-microglobulin in the course of viral hepatitis B.

OBJECTIVE: Beta2-microglobulin (beta2-m), as part of the HLA-I complex, is responsible for transportation of the viral antigens on the hepatocyte surface. Misoprostol and other prostaglandin analogues have been found to protect the liver against injury of various origins. DESIGN: The study was undertaken to evaluate whether the profitable effect of misoprostol on viral hepatitis B is related to beta2-m serum concentration, as a marker of viral expression. METHODS: Thirty-one male patients with viral hepatitis B were assigned at random into groups treated with misoprostol or silymarin (control group). Biochemical indices of liver injury and concentration of beta2-m were measured once a week. RESULTS: Decreases in the serum concentration of bilirubin and activity of alanine transaminase were faster in misoprostol-treated patients, resulting in significantly shorter hospitalization. The mean serum concentration of beta2-m was the highest at the beginning of the study and decreased more slowly in patients treated with misoprostol. However, in the third week of the disease they demonstrated very fast normalization, whereas values in controls remained significantly higher than normal beta2-m concentration. There were no side-effects related to either misoprostol or silymarin treatment. CONCLUSIONS: These data confirm the beneficial effect of misoprostol treatment in patients with viral hepatitis B. A possible mechanism of action seems to be its effect on serum concentration of beta2-m, related to antigen presentation on the hepatocyte surface.

Effect of misoprostol on the course of viral hepatitis B.

BACKGROUND/AIMS: Some prostaglandins revealed hepatoprotective effects, that was confirmed mostly in experimental liver injury. The aim of the study was to determine the effects of misoprostol on the course of viral hepatitis B and associated gastric mucosal injury. METHODOLOGY: Fifty two male patients with viral hepatitis B were assigned at random to receive either misoprostol (800 micrograms/day), silymarin (210 mg/day) or no drug treatment at all (control group). Biochemical indices of liver injury were measured once a week, and HBsAg clearance was analysed 6 months later. Moreover serum levels of endogenous prostaglandins (PGE2, PGI2) and stomach mucosal injury (scored endoscopically) were evaluated before and after treatment. RESULTS: Decrease of serum concentration of bilirubin, activities of transaminases and alkaline phosphatase as well as hepatomegaly reduction were significantly faster in misoprostol treated patients, that resulted in significantly shorter time of hospitalization. The best effect of misoprostol treatment on liver injury was observed in patients suffering from a severe course of the disease. HBV elimination, evaluated 6 months after the disease onset, was similar in both groups. Misoprostol treatment had a significant effect on the improvement of stomach mucosal injury. Serum concentrations of main endogenous prostaglandins produced by the liver (PGE2 and PGI2), were not affected by exogenous administration of misoprostol. There were no side effects related to misoprostol or silymarin treatment. CONCLUSIONS: Our data demonstrates the beneficial effect of misoprostol treatment in patients with viral hepatitis B. Faster convalescence related to normalization of biochemical indices of liver injury and healing of associated stomach mucosal lesions was also observed.

Mucosal and plasma prostaglandin E2 in ulcerative colitis.

BACKGROUND/AIMS: Despite extensive studies, the role of prostaglandins in the course of inflammatory bowel diseases and their possible usefulness as predictive indicators of inflammation, remain largely speculative. The aim of this study was to determine whether mucosal and plasma concentrations of prostaglandin E2 (PGE2) are affected by the clinical course and degree of colonic injury in patients with ulcerative colitis. METHODOLOGY: PGE2 concentration was measured with an enzyme immunoassay (EIA) in biopsies of rectal mucosa and in the plasma of 38 patients with ulcerative colitis and 12 controls. Patients were divided into groups according to mild or severe clinical course of the disease, and with respect to scored endoscopical picture. RESULTS: Ulcerative colitis resulted in an increase of mucosal and plasma concentrations of PGE2, that was significantly elevated in patients with a severe clinical course of the disease. These concentrations increased depending on degree of mucosal injury. A significant, positive correlation with endoscopical score regarding plasma and mucosal PGE2 concentration, as well as between them, was found. CONCLUSIONS: Plasma and mucosal PGE2 rise simultaneously with degree of colonic injury. Because of a good correlation with mucosal injury and PGE2 content, measurement of plasma PGE2 could be considered as a possible surrogate marker of bowel inflammation.

The incidence of HLA DRB1*0103 in ulcerative colitis patients in north-eastern Poland.

BACKGROUND/AIMS: Susceptibility to inflammatory bowel disease is partially genetically determined and the HLA (human leukocyte antigen) alloantigens and genes located in the HLA region have been studied over the course of many years as the candidate genes responsible for ulcerative colitis. Improvements in molecular genotyping have allowed disease association with HLA to be narrowed down to specific subtypes. For class II antigens, increasing phenotype frequency of DRB1*0103, DRB1*1502 is observed and positive correlation to disease susceptibility is proposed. We investigated the incidence of HLA DRB1*0103 in ulcerative colitis patients in North-Eastern Poland and possible association with overall disease susceptibility and clinical course of the disease. METHODOLOGY: 41 patients and 45 healthy control blood donors were included in this study. All subjects were Polish. RESULTS: The incidence of HLA DRB1*0103 was low (2.44%), but was associated with fulminant course of the disease (pancolitis with megacolon toxicum). None of the ethnically matched healthy control blood donors possessed the HLA DRB1*0103 allele (0.00%). CONCLUSIONS: The results gained in the presented study confirm, that in the Polish population HLA DRB1*0103 allele is uncommon and it would not be a useful marker of disease susceptibility.

MR and 1H MR spectroscopy of the brain in patients with liver cirrhosis and early stages of hepatic encephalopathy.

BACKGROUND/AIMS: Hepatic encephalopathy is a serious problem in patients with liver cirrhosis and precise pathophysiological mechanisms responsible for encephalopathy are not fully understood. Magnetic resonance imaging and magnetic resonance spectroscopy can be used to detect specific morphological and metabolic abnormalities in the brain even in patients with early stages of hepatic encephalopathy. METHODOLOGY: Twenty patients with liver cirrhosis and 14 patients with grade I-II hepatic encephalopathy were studied with magnetic resonance and proton magnetic resonance spectroscopy. Localized magnetic resonance spectra were acquired in the parietal gray/white matter regions and basal ganglia. Control group consisted of 20 healthy volunteers. RESULTS: Frequency and degree of brain atrophy and bilateral signal hyperintensities in globus pallidus were similar in groups with liver cirrhosis and with encephalopathy. Decreased myoinositol, choline and increased glutamine levels were noted in both groups whereas N-acetylaspartate levels were unchanged. The statistically significant differences between cirrhotic and encephalopathic groups were observed only in myoinositol/creatine ratio in basal ganglia. There were no significant differences in metabolic concentrations between parietal and basal ganglia regions. CONCLUSIONS: Metabolic brain alterations occur earlier than clinical evidence of hepatic encephalopathy but there is no correlation between presence of symptoms encephalopathy and magnetic resonance and magnetic resonance spectroscopy findings.

Activation of blood platelets in chronic hepatitis and liver cirrhosis P-selectin expression on blood platelets and secretory activity of beta-thromboglobulin and platelet factor-4.

BACKGROUND/AIMS: Blood platelets are cells that quite often undergo damage in chronic liver diseases. Endotoxemia and hyperkinetic circulation influence platelets in an active manner. The role of platelets in the development of hepatitis and liver fibrosis is speculative. The aim of the study was to determine the influence of chronic liver diseases on platelets morphologic parameters, their secretory activity and P-selectin expression. METHODOLOGY: The examination was completed in the group of 29 patients with chronic hepatitis and 27 with liver cirrhosis of postinflammatory etiology (HBV, HCV). Liver biopsies were carried out in all patients. Thirty-two healthy individuals were the control group. Platelets morphological parameters (number, volume, platelet crit, micro- and macrothrombocyte fraction) were estimated. beta-thromboglobulin concentration and platelet factor 4 in blood serum as well as P-selectin expression on resting platelets and after thrombin activation were also examined. RESULTS: Number, volume, and platelet crit decreased with the advancement of a liver disease. Megathrombocyte fraction increased inversely with the severity of liver damage. The concentration of beta-thromboglobulin and platelet factor 4 alpha-granule contents in blood serum was higher 2- and 7-times, respectively than in healthy controls. P-selectin expression on resting platelets was considerably higher. After stimulation with thrombin, P-selectin expression was equal (chronic hepatitis) or higher (liver cirrhosis) than in the control. CONCLUSIONS: There are changes of platelet morphological parameters, with accompanying megathrombocyte fraction increase that occur in chronic liver diseases. Thrombocytes in chronic liver diseases and liver cirrhosis are more activated. Platelet sensitivity to stimuli in these ailments is higher (liver cirrhosis) than in the healthy controls.

Effect of cortisone on the behavior of serotonin, 5-hydroxy-indoloacetic acid and monoaminooxidase in the liver tissue, the blood and the urine in experimental rabbit liver injury with CCl4.

The aim of this study was to investigate the effect of cortisone on the behavior of serotonin metabolism indicators in experiments carried out in rabbits. The following parameters were determined: the level of serotonin (5-hydroxy-tryptamine), (5-HT) in liver tissue and blood, the activity of monoamino-oxidase (MAO) in liver tissue and serum, and the level of 5-hydroxy-indoloacetic acid (5-HIAA) in liver tissue and in 24-hour urine of 52 rabbits. The experimental model involved acute liver injury with carbon tetrachloride--CCl4 and the effect of exogenous cortisone on the behavior of the above-mentioned indicators. On the basis of the experimental findings the authors demonstrate a dependence of serotonin metabolism on the liver injury, and an absence of normalization of the estimated parameters after cortisone administration.

Effect of misoprostol in ethanol-induced liver injury.

Prostaglandins appeared protective against acute experimental liver injury of different origin. Misoprostol, stable, orally active, synthetic derivative of PGE1 attenuates several functional alterations in liver mitochondria during ethanol administration. To study its possible hepatoprotective effects on ethanol-induced liver injury in rats we measured: serum activities of alanine aminotransferase (ALT), gamma-glutamyltranspeptidase (GGT) and concentrations of ammonia in blood and liver tissue. Histopathological evaluation of liver slices was also performed. Activities of both enzymes and ammonia values were elevated after intragastric ethanol administration for 60 days. Treatment for 30 days with misoprostol resulted in their decrease. This effect was not observed in the control group. Beneficial results were also obtained in histopathological evaluation of the liver tissue. These results indicate potential therapeutic effects of misoprostol on ethanol-induced liver injury in rats.

[Diversity in the clinical course of toxoplasma encephalitis in two patients infected with human immunodeficiency virus (HIV)]. / Róznorodnosc przebiegu klinicznego zapalenia mózgu wywolanego Toxoplasma gondii u dwóch chorych zakazonych ludzkim wirusem uposledzenia odpornosci(HIV).

The central nervous system (CNS) is the most common site of Toxoplasma gondii infection in HIV-positive patients, mainly due to reactivation of Toxoplasma cysts. The diagnosis is difficult since no sensitive and specific non-invasive diagnostic tests exist. The patient may present with rather unspecific signs and symptoms. We present atypical course of CNS-toxoplasmosis in two HIV-positive persons.

[Diphtheria--new threat or traditional disease]. / Blonica--nowe zagrozenie czy choroba tradycyjna?

Clinical and epidemiological data of the diphtheria have been described on the basis of literature findings and own observations. It have been introduced the informations presented during Meeting on Diphtheria Epidemic in Europe, Saint Petersburg, 1993. I have concentrated on the some differences between diphtheria in nowadays and in previous years and offer some suggestions concerning the treatment of this disease. It concern also plasmapheresis as a special effective procedure in toxic forms of the diphtheria.

[Complications imminent in patients with salmonellosis]. / Powiklania zagrazajace chorym na salmonelozy.

In 1038 patients with salmonellosis treated in the last 20 years in Department of Infectious Diseases, Medical School, Bialystok and literature data defined, distribution and type of complications and consequences these diseases. In acute period of salmonellosis complications are: hypovolemic or infectious and toxic shock, metabolic acidosis, circulation collapse and ileus paralytic. As a late complications are mentioned organs changes and anemias. Salmonellosis nowadays may exist as a complications diseases with immunodeficiency (AIDS).

[Active immunization against tick-borne encephalitis virus infection in residents of North-Eastern Poland]. / Uodpornianie czynne mieszkanców pólnocno-wschodniej Polski przeciw zakazeniu wirusem kleszczowego zapalenia mózgu.

Group consisted of 78 persons was selected among 1587 persons vaccinated against tick-borne encephalitis. Efficiency of vaccination, controlled by measurement of specific IgM and IgG antibodies presence, was evaluated as 70.2% (47.4%-90%). The highest efficiency was observed in urban residents occasionally stayed in forest areas, that showed trace, of antibody level at the begining of study.

[Cryptosporidium parvum: an emerging threat to the man]. / Cryptosporidium parvum--wspólczesne zagrozenie czlowieka.

The current opinions on the biology, epidemiology and potential role of Cryptosporidium parvum as an emerging, highly infectious threat are presented. Available Polish data concerning the frequency of cryptosporidiosis were gathered and the diagnostic procedures, pathogenesis and treatment of cryptosporidiosis are described.

[Toxocariasis]. / Toksokaroza (Toxocarosis).

Up to present time the data concerning toxocariasis++ have been presented. Toxocariasis++ is difficult for diagnosis because of lack of specificity and multiorgan changes due to the invasion by Toxocara canis or cati. We pay attention the problem distribution of this parasitosis in Poland and world is still actual especially among children. We have presented epidemiological data and means diagnosis of this diseases and the treatment patients and prophylaxis has been stressed.

[Epidemiological factors of mushroom poisoning in the north-east of Poland]. / Cechy epidemiologiczno-kliniczne zatruc grzybami w regionie pólnocno-wschodnim Polski.

Mushroom poisoning (m.p.) are still real and increasing problems in Poland. Epidemiological characteristics, clinical picture and the outcome of the therapy with and without plasmapheresis are reported in 83 patients with mushroom poisoning. M.p. are occurring every year, between June and December. The most often m.p. cases occurred as collective intoxication (89%). The most often m.p. cases occurred as a collective intoxication (89%). The most severe cases are caused by the consumption of Amantia phalloides (31 cases), and deaths were reported only after consumption of that mushroom (6 deaths). Cases were also seen eating of not properly prepared eatable mushrooms (neurotoxins arisen from choline). Symptoms seen in our patients concluded: nausea, vomiting, abdominal pain, headache and fever. Particularly severe course of the disease was seen in children following intoxication with Amanita phalloides. Plasmapheresis was an effective therapy only when applied within 48 hours following intoxication.

[Distribution of antibodies against Encephalitis ixodica viruses among north-east healthy populations of Poland]. / Wystepowanie przeciwcial przeciwko wirusowi kleszczowego zapalenia mózgu wsród mieszkanców Polski pólnocno-wschodniej.

We have undertaken the investigations for the detection of the presence of antibodies against Encephalitis ixodica viruses among North-East population of Poland. We have found these antibodies in 6.5% among 676 of tested healthy persons. The highest % of detected antibodies were noted in forest rangers and in physicians acting as hunters. Our data seems to indicate that Encephalitis ixodica is still actual disease in this region. Therefore one can suggest the necessity vaccination against Encephalitis ixodica.