The negative impact of HBV/HCV coinfection on cirrhosis and its consequences.

BACKGROUND: Hepatitis B virus (HBV)/hepatitis C virus (HCV) confection has been rarely studied in nonasian series. AIM: To compare the characteristics of HBV/HCV coinfected patients to those of HBV- or HCV-monoinfected patients in the ANRS CO22 HEPATHER cohort study. PATIENTS AND METHODS: Of the 20 936 included patients, 95 had HBV/HCV coinfection (hepatitis B surface antigen, anti-HCV antibody and HCV RNA positive) and were matched with 375 HBV- and 380 HCV-monoinfected patients on age, gender and time since HBV or HCV diagnosis. RESULTS: F3-F4 fibrosis was more frequent in coinfected patients (58%) than in HBV- (32%, P < .0001), but similar in HCV-monoinfected patients (52%, P = .3142). Decompensated cirrhosis was more frequent in coinfected patients (11%) than in HBV- (2%, P = .0002) or HCV- (4%, P = .0275) monoinfected patients. Past excessive alcohol use was more frequent in coinfected patients (26%) than in HBV (12%, P = .0011), but similar in HCV monoinfected patients (32%, P = .2868). Coinfected patients had a higher proportion with arterial hypertension (42%) than HBV- (26%) or HCV-monoinfected patients (25%) (P < .003). Multivariable analysis confirmed the association between F3-F4 fibrosis and HCV infection in HBV-infected patients (OR = 3.84, 95% CI 1.99-7.43) and the association between decompensated cirrhosis and coinfection in HBV infected (OR = 5.58, 95% CI 1.42-22.0) or HCV infected patients (OR = 3.02, 95% CI 1.22-7.44). CONCLUSIONS: HCV coinfection harmfully affects liver fibrosis in HBV patients, while decompensated cirrhosis is increased in coinfected patients compared with HBV- or HCV-monoinfected patients. HCV treatment is as safe and effective in coinfected as monoinfected patients and should be considered following the same rules as HCV monoinfected patients.

[Severe hepatitis in a patient with adult-onset Still's disease treated with anakinra]. / Hépatite aiguë médicamenteuse à l'anakinra chez une patiente traitée pour une maladie de Still de l'adulte.

INTRODUCTION: Adult-onset Still's disease is characterized by non-specific polymorphic features. The efficacy of anakinra, an IL-1 receptor antagonist, has been shown in several studies. This medication is well-tolerated, and only one case of severe hepatitis has been previously reported. CASE REPORT: A 22-year-old woman presented with fever, rash, arthritis, and pericarditis, associated with systemic inflammatory response syndrome and elevated ferritin serum level with low glycosylated ferritin. Adult-onset Still's disease was diagnosed, but treatment with steroids did not achieve remission. The patient was then treated with anakinra, which resulted in spectacular improvement, but 3 weeks after the initiation of the treatment she experienced severe hepatitis that resolved after the discontinuation of anakinra. CONCLUSION: Hepatitis is a rare side effect of anakinra and the monitoring of liver tests should be recommended during anakinra therapy.

Hepatic iron overload and risk of hepatocellular carcinoma in cirrhosis.

Iron accumulation in the liver is considered to be a co-factor for progression of liver disease. Iron overload can enhance the effects of oxidative stress and influence the natural history of patients with cirrhosis, exposing them to a higher risk of hepatocellular carcinoma. The results of clinical studies designed to assess the impact of liver iron content on the risk of tumor development have remained controversial for some time. It is known that common factors can affect both liver iron overload and the risk of cancer, necessitating multivariate analyses of these features in large cohorts of cirrhotic patients. Furthermore, the causes and consequences of hepatic iron overload appear to depend on the cause of the underlying liver disease. Thus, the only solid evidence of a relationship between liver iron overload and event occurrence has come from longitudinal studies conducted in homogeneous cohorts of patients with cirrhosis. So far, the available data suggest that iron accumulation in the liver is an independent risk factor for hepatocellular carcinoma in patients with alcoholic cirrhosis and/or nonalcoholic hepatosteatosis, but not in those with viral hepatitis C cirrhosis.

Liver stiffness measurement as a predictive tool of clinically significant portal hypertension in patients with compensated hepatitis C virus or alcohol-related cirrhosis.

BACKGROUND: Hepatic venous pressure gradient (HVPG) is the gold standard for assessing the presence and the severity of portal hypertension (PHT). Liver stiffness measurement (LSM) is a non-invasive method for liver fibrosis assessment. AIMS: To assess the relationship between LSM and HVPG in patients with compensated cirrhosis related to hepatitis C virus (HCV) or alcohol and to define the performance and the best cut-off of LSM for the diagnosis of PHT in these patients. METHODS: Between January 2004 and September 2006, we studied all the consecutive patients with compensated HCV or alcohol-related-cirrhosis referred for transjugular liver biopsy with HVPG measurement and LSM performed the same day. RESULTS: Ninety-two patients were eligible, 44 had HCV related-cirrhosis and 48 alcoholic cirrhosis. LSM was positively correlated to HVPG in both groups. The area under the receiver operating characteristic curve for the diagnosis of significant PHT was 0.76 +/- 0.07 in HCV patients (best cut-off at 20.5 kPa) and 0.94 +/- 0.03 (best cut-off at 34.9 kPa) in alcoholic patients. CONCLUSIONS: Liver stiffness measurement and HVPG were significantly correlated in patients with compensated cirrhosis because of HCV infection or alcohol. LSM could predict significant PHT in both these groups of patients with a higher cut-off and a better performance in alcoholic patients.

[Immunohistochemical and ultrastructural heterogeneity of gastrointestinal stromal tumors]. / Hétérogénéité immunohistochimique et ultrastructurale des tumeurs stromales digestives.

AIMS AND METHODS: Digestive stromal tumors are the most frequent undifferentiated mesenchymal tumors. The prognosis of these tumors is difficult to predict and the histogenesis is still subject to controversy. However, the frequent and specific expression of CD117 (c-kit) by these tumors could suggest an origin from interstitial cells of Cajal. The aim of this study was to analyse the histological and immunohistochemical characteristics of 46 digestive stromal tumors surgically resected, with comparaison of CD34 and CD117 expression in these tumors. Sixteen tumors were analyzed on electron microscopy. RESULTS: Sixty three and 74% of the stromal tumors were positive for CD117 and CD34 respectively. While CD117 expression was similar in all locations, on the contrary, there was a decreasing gradient of CD34 expression between gastric (87%) and jejunal (33%) tumors. All tumors with skeinoid fibers expressed CD117. Focal expression of smooth muscle actin was noted in 43% of the cases. The ultrastructural study showed no correlation with the immunohistochemical results. CONCLUSION: Digestive stromal tumors show an immunophenotypic and ultrastructural heterogeneity. CD117 expression is frequent, but not constant.

[Spontaneous rupture of the spleen under ticlopidine. Apropos of two cases]. / Rupture spontanée de la rate sous Ticlopidine. A propos de deux observations.

We observed two cases of spontaneous rupture of an apparently healthy spleen in two patients who were taking ticlopidine as anti-platelet aggregation treatment. The notion that the spleen was apparently healthy was based on well-defined criteria, essential for the imputability of the spontaneous lesions. In general drug-induced spontaneous ruptures of the spleen have been reported for anticoagulants but no case due to antiplatelet aggregation has been reported to our knowledge. The analysis of these two cases and a review of the recent literature suggests that ticlopidine was the causal agent in these two cases of splenic rupture.

[Incidental discovery of a pseudocyst of the spleen. Possible role of previous pregnancy]. / Découverte fortuite d'un pseudo-kyste de la rate. Rôle possible d'une grossesse antérieure.

Non-parasite pseudo cysts of the spleen are rarely observed and most often are related to trauma. They can be differentiated from true cysts due to the lack of a true capsule. We incidentally observed a pseudocyst of the spleen which may have been related to pregnancy two years earlier.

Isolation and characterization of monoclonal antibodies to cytoskeletal and membrane proteins of the Paramecium cortex.

Monoclonal antibodies have been generated against whole cortical fragments of Paramecium to provide tools for the analysis of cortex morphogenesis as well as for the biochemical dissection of this complex membrane-cytoskeleton structure. Of 80 positive hybridomas in ELISA tests, 17 monoclonal were characterized by immunoblotting, immunofluorescence tests on sectioned as well as on Triton-permeabilized cells (including confocal microscopy), and by EM immunocytochemistry on permeabilized cells. Five classes of monoclonals were obtained directed, respectively, against the epiplasm (or elements tightly associated with it), the trichocysts, the microtubules, the surface membranes, and poorly defined intracellular antigens. Of these, the newest and most promising appear to be a set of monoclonals decorating both intensely and sharply some specific parts of the epiplasm (outer periphery, outer central part or core). These antibodies therefore provide the first demonstration of a molecular heterogeneity of composition at the level of individual epiplasmic scales in Paramecium. In addition, they offer powerful tools to follow the biogenesis of these structures during cell division. Finally, they have allowed the identification of a number of previously uncharacterized protein components of the cortex.