[[ENDOTHELIAL DYSFUNCTION AND ITS LOW-LEVEL LASER THERAPY CORRECTION IN PATIENTS WITH CHRONIC VIRAL HEPATITIS].

UNLABELLED: The aim of the work to study the influence of the low-intensive laser therapy on the endothelium function in chronic virus hepatitis patients. RESEARCH METHODS: All patients have been divided into three groups: In the first (control) group (30 persons) the traditiona medicamentous therapy was used only, the patients of the experimental 11 group (45 person) alongside with complex medicamentous therapy received the course of intravenous laser therapy and Ill group of patients (45 person) received a rate complex medicamental and laser (cutaneous) therapy. RESULTS: Medicamentous therapy of patients chronic virus hepatites is not accompanied by authentic improvement of the maintenance in plasma of blood NOx, and inclusion in a complex of medical actions of laser therapy promotes authentic improvement of parameters in plasma of blood NOx. THE CONCLUSION: Various methods of laser therapy improve NO--producing function endothelium, improve a functionacondition of vascular endothelium.

Clinical study on treatment of chronic viral cholestatic hepatitis with chishaodanpi decoction.

OBJECTIVE: To observe the therapeutic effect of Chishaodanpi decoction (CSDPD) on chronic viral cholestatic hepatitis. METHODS: A total of 107 subjects with chronic viral cholestatic hepatitis were enrolled in our hospital from March 2007 to November 2012. Patients were randomly divided into treatment (54 cases) and control groups (53 cases). The control group was treated with potassium magnesium aspartate, diammonium glycyrrhizinate, glucurolactone, vitamin C, and lamivudine, once a day. The treatment group was treated with modified CSDPD, 100 mL a time, twice a day, in addition to the treatment given to the control group. The patients in both groups were treated for 8 weeks. The main symptoms and signs were recorded every day throughout the clinical trial. Before and after the trial, changes in liver function including total bilirubin (TBil), direct bilirubin (DBil), total bile acid (TBA), and the activities of alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyl transferase (γ-GT), were all detected. Adverse reactions were also recorded. RESULTS: There were no differences in gender, age, disease duration, symptoms, signs, or laboratory findings between the two groups (P > 0.05). After an 8-week treatment, improvements in jaundice, weakness, poor appetite, abdominal distention, and skin itching were significantly better in the treatment group than in the control group (P < 0.05). In the treatment group, 43 patients had a significant response to the treatment, seven patients had a response, and four patients had no response, with 21, 12, and 20 patients in the control group, respectively. The total effective rate was 92.6% in the treatment group and 62.3% in the control group, which was a significant difference (P < 0.05). The levels of TBil, DBil, TBA, ALP, ALT, AST, and γ-GT in both groups were significantly lower after treatment, and were significantly different between the two groups (P < 0.05). A few patients in the treatment group had mild adverse effects such as increased bowel movement frequency and mild stomach-ache. No other adverse reactions were observed in either group.

A randomized controlled trial to assess the safety and efficacy of silymarin on symptoms, signs and biomarkers of acute hepatitis.

PURPOSE: Milk thistle or its purified extract, silymarin (Silybum marianum), is widely used in treating acute or chronic hepatitis. Although silymarin is hepatoprotective in animal experiments and some human hepatotoxic exposures, its efficacy in ameliorating the symptoms of acute clinical hepatitis remains inconclusive. In this study, our purpose was to determine whether silymarin improves symptoms, signs and laboratory test results in patients with acute clinical hepatitis, regardless of etiology. METHODS: This is a randomized, placebo-controlled trial in which participants, treating physicians and data management staff were blinded to treatment group. The study was conducted at two fever hospitals in Tanta and Banha, Egypt where patients with symptoms compatible with acute clinical hepatitis and serum alanine aminotransferase (ALT) levels >2.5 times the upper limit of normal were enrolled. The intervention consisted of three times daily ingestion of either a standard recommended dose of 140 mg of silymarin (Legalon, MADAUS GmbH, Cologne, Germany), or a vitamin placebo for four weeks with an additional four-week follow-up. The primary outcomes were symptoms and signs of acute hepatitis and results of liver function tests on days 2, 4 and 7 and weeks 2, 4, and 8. Side-effects and adverse events were ascertained by self-report. RESULTS: From July 2003 through October 2005, 105 eligible patients were enrolled after providing informed consent. No adverse events were noted and both silymarin and placebo were well tolerated. Patients randomized to the silymarin group had quicker resolution of symptoms related to biliary retention: dark urine (p=0.013), jaundice (p=0.02) and scleral icterus (p=0.043). There was a reduction in indirect bilirubin among those assigned to silymarin (p=0.012), but other variables including direct bilirubin, ALT and aspartate aminotransferase (AST) were not significantly reduced. CONCLUSIONS: Patients receiving silymarin had earlier improvement in subjective and clinical markers of biliary excretion. Despite a modest sample size and multiple etiologies for acute clinical hepatitis, our results suggest that standard recommended doses of silymarin are safe and may be potentially effective in improving symptoms of acute clinical hepatitis despite lack of a detectable effect on biomarkers of the underlying hepatocellular inflammatory process.

Coffee and caffeine consumption reduce the risk of elevated serum alanine aminotransferase activity in the United States.

BACKGROUND & AIMS: Based on experimental and epidemiologic studies, we investigated whether coffee and caffeine consumption reduced the risk of elevated alanine aminotransferase (ALT) activity in persons at high risk for liver injury in a national, population-based study. METHODS: Participants were 5944 adults in the Third US National Health and Nutrition Examination Survey, 1988-1994, with excessive alcohol consumption, viral hepatitis, iron overload, overweight, or impaired glucose metabolism. Liver injury was indicated by abnormal serum ALT activity (>43 U/L). RESULTS: Elevated ALT activity was found in 8.7% of this high-risk population. In unadjusted analysis, lower ALT activity was associated with increasing consumption of coffee ( P = .001) and caffeine ( P = .001). Multivariate logistic regression analyses showed that the risk of elevated ALT activity declined with increasing intake of coffee ( P for trend = .034) and caffeine ( P < .001). Comparing persons who drank more than 2 cups per day with noncoffee drinkers, the odds ratio was .56 (95% confidence interval, .31-1.0). Comparing persons in the highest caffeine quintile with the lowest, the odds ratio was .31 (95% confidence interval, .16-.61). These relationships were consistent across subgroups at risk for liver injury and were relatively unchanged when analyses included the entire population or when limited to persons without impaired liver function or right upper quadrant pain. Fasting insulin concentrations did not mediate the effects. CONCLUSIONS: In this large, national, population-based study, among persons at high risk for liver injury, consumption of coffee and especially caffeine was associated with lower risk of elevated ALT activity.

Trace elements in viral hepatitis.

In this study, serum trace elements, including selenium (Se), zinc (Zn), copper (Cu), were determined by using Atomic Absorption Spectrophotometer (SpectrAA 250 Plus Zeeman, Varian, Australia) in sera of patients with viral hepatitis (A, B, C, D, E) cases (n = 102), and statistically compared with the controls (n = 52). In viral hepatitis, Cu levels were found as 3.23 +/- 1.02 mg/L, and this value was significantly higher than the control group (1.13 +/- 0.21) (p < 0.01). Both, Se and Zn levels found to be significantly low in viral hepatitis cases (p < 0.01). While Se level was 81.4 +/- 26.01 microg/L in viral hepatitis (n = 101), it was found to be 166.15 +/- 4.58 microg/L in healthy individuals. Meanwhile, Zn levels were 0.230 +/- 0.081 mg/L and 0.748 +/- 0.392 mg/L in hepatitis cases (n = 101) and the control group, respectively. There was no difference amongst viral hepatitis groups classified in regard with agents and clinical manifestation, such as A, acute hepatitis B, chronic hepatitis B, C, D and E. Previously, it was indicated that absorption disorders in gastrointestinal system, especially in chronic cases, were not main causes of decrease of trace elements by iron and several other parameters in sera of the cases. Therefore, we suggest that decrease in Zn and Se levels and elevation in Cu levels are probably resulted from defence strategies of organism and induced by the hormone-like substances.

Epidemiological and clinical aspects of hepatitis G virus infection in blood donors and immunocompromised recipients of HGV-contaminated blood.

BACKGROUND AND OBJECTIVES: The infectiousness and clinical relevance of the newly discovered blood-borne Flaviviridae-like agent, termed hepatitis G virus (HGV), are not well understood. MATERIALS AND METHODS: Twenty-three transfusion recipients of two HGV-affected long-term blood donors were studied for HGV genome and antibodies to the putative envelope 2 glycoprotein (anti-E2) of HGV. Nine recipients had nonhematological disorders and 14 suffered from severe hematological diseases and 7 of them received allogeneic bone marrow or blood stem cell transplantation. The molecular epidemiology of the observed HGV infection was studied by direct sequencing of parts of the 5'-noncoding region, NS3, and NS5 region of HGV in the 2 long-term donors and in their 6 recipients who became HGV RNA positive. Additionally, 549 individuals-homologous (n = 254) and autologous blood donors (n = 202), and medical staff (n = 89)--were investigated for the presence of HGV RNA. RESULTS: HGV RNA in serum was found in 15 of the 23 (65%) transfusion recipients with known exposure of HGV-contaminated blood. Seven of the remaining 8 recipients showed only an anti-E2 response, indicating previous HGV infection with spontaneous clearance of the virus. In one recipient neither HGV RNA nor anti-E2 could be detected. Molecular evidence for HGV transmission by the 2 donors was found in 3 of the 6 recipients studied. The alanine aminotransferase levels were not significantly different in the HGV RNA positive and negative recipients, and none of the 23 recipients developed posttransfusion hepatitis. Persistent HGV infection was observed especially in recipients with severe hematological disorders or in those in whom intensive immunosuppressive treatment was necessary. Of the 549 individuals studied, 10 (1.8%) were healthy carriers of HGV RNA. CONCLUSION: The persistence of transfusion-acquired HGV infection is not associated with acute or chronic hepatitis, but may be influenced by the recipient's underlying disease.

Hepatitis por citomegalovirus: evolución en lactantes / Cytomegalovirus hepatitis: course in infants

Se presentan 10 niños estudiados en el servicio desde mayo de 1991 a mayo de 1992 con hepatitis por citomegalovirus, con una edad promedio al diagnóstico entre 1 y 3 meses. Se realizaron determinaciones bioquímicas para la evaluación de la colestasis y/o hepatitis: serológicas (sífilis, Chagas, toxoplasmosis, hepatitis A y B, citomegalovirus); alfa 1 antitripsina, test del sudor. La permeabilidad de la vía biliar fue evaluada con ecografía abdominal y cámara gamma TcPipida. Además se estudió la configuración histológica. El seguimiento bioquímico mostró a los seis meses de evolución que normalizaron 7/10 la bilirrubina, 8/10 las transaminasas y sólo 3/10 la fosfatasa alcalina. En la totalidad se detectó IgM anti CMV positiva por ELISA. Las alteraciones histológicas encontradas en los pacientes fueron variadas desde triaditis leve, colestasis, hepatitis neonatal, fibrosis portal e interlobulillar y metamorfosis grasa. Se concluye que la remisión de nuestros 10 pacientes no planteó diferencias con respecto a la evolución habitual pero subraya la necesidad de investigar esta etiología en lactantes de corta edad con hepatomegalia y/o síndrome colestático o hepatitis (AU)

Hepatitis por citomegalovirus: evolución en lactantes / Cytomegalovirus hepatitis: course in infants

Se presentan 10 niños estudiados en el servicio desde mayo de 1991 a mayo de 1992 con hepatitis por citomegalovirus, con una edad promedio al diagnóstico entre 1 y 3 meses. Se realizaron determinaciones bioquímicas para la evaluación de la colestasis y/o hepatitis: serológicas (sífilis, Chagas, toxoplasmosis, hepatitis A y B, citomegalovirus); alfa 1 antitripsina, test del sudor. La permeabilidad de la vía biliar fue evaluada con ecografía abdominal y cámara gamma TcPipida. Además se estudió la configuración histológica. El seguimiento bioquímico mostró a los seis meses de evolución que normalizaron 7/10 la bilirrubina, 8/10 las transaminasas y sólo 3/10 la fosfatasa alcalina. En la totalidad se detectó IgM anti CMV positiva por ELISA. Las alteraciones histológicas encontradas en los pacientes fueron variadas desde triaditis leve, colestasis, hepatitis neonatal, fibrosis portal e interlobulillar y metamorfosis grasa. Se concluye que la remisión de nuestros 10 pacientes no planteó diferencias con respecto a la evolución habitual pero subraya la necesidad de investigar esta etiología en lactantes de corta edad con hepatomegalia y/o síndrome colestático o hepatitis

Long-latency event-related potentials in acute hepatitis patients with severe coagulopathy.

In 19 acute hepatitis patients with severe coagulopathy who were fully alert and oriented without any changes of mood or behavior, the P300 latency and the arterial blood ketone body ratio (KBR) were assessed as predictors of fulminant hepatitis. All 5 patients developing fulminant hepatitis had a corrected P300 latency longer than 345 msec and 4 of them had a KBR below 0.6. There was a significant negative correlation between the KBR and the blood ammonia level and between the KBR and the corrected P300 latency, while there was a positive correlation between the blood ammonia level and the corrected P300 latency. These data suggest that hepatic encephalopathy develops when loss of hepatic detoxifying activity allows toxic substances to reach the brain and induce cerebral edema. Our findings also suggest the clinical value of using the P300 latency combined with the KBR as predictors of fulminant hepatitis.

[Diagnosis on blood stasis in viral hepatitis by computer multi-criteria analysis--an analysis of 63 cases].

This study is based on the criteria for diagnosis of Blood Stasis formulated by the international conference held in Beijing in 1988. The patient that has one, two, three, and over four items could be diagnosed as I-, II-, III-, IV-degree hepatic Blood Stasis respectively. The data of pathologic findings from liver biopsy, nail-fold microcirculation, blood rheology, hepatogram, B-ultrasonography and blood biochemical examination were stored in computer to carry on single and multiple factor analysis in order to evaluate these indexes in the diagnostic value of hepatic Blood Stasis. Stepwise regression analysis formula was used to determine the severity of Blood Stasis. By substitute related data into the formula, mathematical model of hepatic Blood Stasis was compared with clinical Syndrome Differentiation, it revealed that 59 cases were coincided with each other (93.6%). According to numerical value, the increase and decrease of the pre-and posttherapy, the curative effect of promoting blood circulation to remove Blood Stasis could be determined to provide some references for diagnosis and treatment of hepatic Blood Stasis and prevention and treatment of hepatic fibrosis.

Hemorrheological changes in chronic hepatitis and liver cirrhosis and their relations to the syndromes differentiated by traditional Chinese medicine.

Blood and plasma viscosity, hematocrit and erythrocyte sedimentation rate were examined in 146 cases of chronic hepatitis and liver cirrhosis. In addition, blood fibrinogen and blood flow of the tongue and skin were studied in 123 and 46 of them respectively. The same indices were observed in 39 cases before and after treatment. The results showed definite hemorrheological patterns in different syndromes and therapeutic efficacy was also correlated with the changes in the mentioned indices. Thus it is believed that these indices of hemorrheology may serve as supplementary means for the differentiation of syndromes, evaluation of therapeutic effect and prognosis in chronic liver diseases.

Use of the ferritin/alanine aspartate transaminase ratio as an iron overload marker independent of liver cell damage.

To define an iron overload index independent of liver cell damage, the mean annual levels of alanine aspartate transaminase (ALAT) and serum ferritin and their ratios were determined. Ferritin/ALAT ratio values were compared between two groups of patients with acute or chronic hepatitis without iron overload, and one group of thalassaemic patients with iron overload. The two groups without iron overload exhibited ferritin/ALAT ratio values of 2 and 1.2 respectively; a ratio value higher than 10 was always observed in those patients with iron overload. The ferritin/ALAT ratio is correlated with the degree of iron overload. This ratio increases in regularly-transfused patients without chelation treatment. It generally remains stable or decreases after initiation of iron chelation therapy. The ferritin/ALAT ratio thus appears useful in the follow-up of patients subjected to a long-term transfusional treatment particularly when acute or chronic liver cell damage may interfere with iron overload by increasing serum ferritin values.