[Tuberculosis--recurrence of a forgotten infectious disease?]. / Tuberkulose--Wiederkehr einer vergessenen Infektionskrankheit?

Since 1985, more tuberculosis cases are being registered in the neighbouring European countries and in the USA. This is caused by HIV-infections, social problems (loss of work and living space as well as alcohol and drug dependence) and the high tuberculosis morbidity of emigrants from poor countries and war-zones. Resistance problems and nosocomial tuberculosis infections are gaining more significance besides the limited deficiencies in medical-training and the retrograde financial resources in prevention. In Germany, the Tb-incidence has been stagnant since 1991. It is a lot lower in East Germany in comparison to the Western parts of Germany. Since 1991 more and more Tb.-cases have been observed in the East-Berlin districts while the morbidity has decreased in West-Berlin.

[Genetic polymorphism in Gilbert-Meulengracht syndrome (GMS)]. / Genetische Polymorphismen bei Gilbert-Meulengracht-Syndrom (GMS).

N-Acetylation and debrisoquine hydroxylation phenotypes were determined in 54 patients with Gilbert's syndrome and in 247 (sulfamethazine) and 76 (debrisoquine) non-related healthy volunteers, respectively. 40 (74.1%) of the patients and 135 (54.7%) of healthy volunteers were slow acetylators (chi 2 = 6.87). In patients, the cumulative urinary excretion (CUE) of sulfamethazine (0-6 hours) was significantly reduced. No differences between the debrisoquine poor metabolizers were observed: Gilbert's syndrome 5/54 (9.3%), healthy volunteers 5/76 (6.6%). The metabolic ratios were similar in both groups as well as the CUE of debrisoquine and its metabolite. Gilbert's syndrome seems to be related in some way to N-acetylation but not to debrisoquine hydroxylation polymorphism.

Low dose alpha interferon treatment in chronic hepatitis B virus infection.

Fifty eight patients with chronic viral hepatitis B (HBV) were randomised in a prospectively controlled trial. Thirty patients were treated with 3 million units (MU) of interferon alfa-2b subcutaneously thrice weekly for four months. Twenty eight controls received no treatment. The follow up period after treatment was six months. Twenty eight treated patients and 27 controls completed the protocol. One woman in the treatment group showed a complete response, and eight other treated patients (32%) showed a partial response. Three patients in the control group (11%) lost hepatitis B e antigen and HBV-DNA spontaneously. This finding is statistically significant (p < 0.05). The elimination of HBV markers from the serum was associated with a return to normal of serum aminotransferase activities. Reactivation of hepatitis was not observed after seroconversion.

N-acetylation and debrisoquine hydroxylation polymorphisms in patients with Gilbert's syndrome.

1. N-acetylation and debrisoquine hydroxylation phenotypes were determined in 54 patients with Gilbert's syndrome and in 247 (sulphamethazine) and 76 (debrisoquine) non-related healthy volunteers. 2. Forty (74.1%) of the patients and 135 (54.7%) of the healthy volunteers were slow acetylators (chi 2 = 6.87). In the patients, the cumulative urinary excretion of sulphamethazine up to 6 h (Ae(0,6)) was significantly lower. No differences in the frequency of debrisoquine poor metabolizers were observed: Gilbert's syndrome 5/54 (9.3%), healthy volunteers 5/76 (6.6%). The metabolic ratios were similar in both groups as well as the urinary recoveries of debrisoquine and its 4-hydroxy metabolite. 3. Gilbert's syndrome seems to be related in some way to N-acetylation but not to the debrisoquine hydroxylation polymorphism.

[Significant laparoscopy and ultrasound findings in chronic hepatic porphyria]. / Laparoskopische und sonographische Befundauffälligkeiten bei chronischer hepatischer Porphyrie.

In the years from 1983 to 1989 we diagnosed in altogether 69 patients a chronic hepatic porphyria. As a rule the light microscopic and sonographic findings in the liver use to be uncharacteristic. Yet, unexpectedly by sonography in eight patients findings, suspicious for metastases, were stated. Multiple coin lesions with a marginal edge mostly rich in echoes were impressing. The laparoscopy resulted in grey/blue-discoloured depressions in an otherwise even surface of the liver, thus suggesting mass necroses respectively rebuilding processes. Subclinical stages of a chronic hepatic porphyria could have been proved by the partial red-fluorescence of bioptates and a corresponding porphyrin secretion. The histological changes of the liver were--in contrary to the impressing laparoscopic picture--rather insignificant. In case of a successful intervention the pathological porphyrin secretion was done in about eight months. Mostly, more than a year used to pass away till the sonographic findings normalized. The seldom described phenomena use to conceal the danger of a false interpretation and an unnecessary stress for the patient. More over the causes and the development of these peculiar porphyria findings are unclear; they need in an discussion among medical special branches.

[Treatment of chronic hepatitis B with interferon alpha-2b]. / Behandlung der chronischen Hepatitis B mit Interferon alpha-2b.

In a prospective randomized trial 58 patients (46 men, 12 women; mean age 41 [18-65] years) with histologically proven chronic hepatitis B and demonstration of HBs antigen and hepatitis B virus DNA in serum were randomly divided into two groups: 30 patients were treated with recombinant alpha 2b interferon. The interferon was administered subcutaneously, 3 x 10(6) IU, three times weekly for four months. 28 patients served as untreated controls. There was a six-month post-treatment follow-up. Two patients in the treatment group and one in the control group had to be excluded later. In the treatment group one patient responded completely (HBs antigen, HBe antigen and HBV-DNA negative) and eight partially (HBe antigen and HBV-DNA negative). In three patients of the control group, HBe antigen and HBV DNA were no longer demonstrated (P less than 0.05). The loss of HBV features was associated with normalization of serum transaminases activity. Reactivation of liver inflammation after seroconversion was not observed.

Treatment of chronic hepatitis B with interferon alfa-2b.

A total of 58 patients with histologically confirmed chronic viral hepatitis B and presence of hepatitis B surface antigen and hepatitis B virus DNA (HBV DNA) in the serum were randomized in a prospectively controlled trial. Thirty patients were treated with 3 megaunits of recombinant interferon alfa-2b (INTRON A, R Schering-Plough, Essex Corporation) subcutaneously thrice weekly for 4 months. Twenty-eight controls received no treatment. The post-treatment follow-up period consisted of 6 months. Twenty-eight treated patients and 27 controls completed the protocol. One female patient of the treatment group showed a complete response, and eight other treated patients (32%) showed a partial response to therapy. Three patients in the control group (11%) lost hepatitis B e antigen and HBV DNA spontaneously. This finding is statistically significant (p less than 0.05). The elimination of hepatitis B virus markers from the serum was associated with a normalization of aminotransferase activities in the serum. Reactivation of hepatitis was not observed after seroconversion.

[Dihydralazine hepatitis. Morphologic and clinical criteria for diagnosis]. / Die Dihydralazin-Hepatitis. Morphologische und klinische Kriterien für die Diagnose.

70 cases of acute dihydralazine-associated hepatitis with centrolobular or confluent necroses, registered in the files of the Berlin-Friedrichshain Institute of Pathology, between 1981 and 1985, were classified into 3 types of diagnostic probability for differential diagnosis versus virus hepatitis. Classification was conducted according to recommendations given by a working group of pathologists, specialised in liver pathology. 42 cases out of this material had come from Prenzlauer-Berg Hospital, Department of Infectious Diseases, and were re-examined under clinical aspects. 6 of them were discarded from evaluation. Type I proved to be of high diagnostic reliability, as was seen from 61% of all cases. Only 3 cases had to be discarded from that group and were associated with other drugs, such as halothane, methyldopa, and propranolol. The following clinical parameters proved to be of particular value for definite assessment of drug-induced hepatitis: time of exposure (for analysis of co-medication), time of recovery, and re-exposure test. Only circumstantial evidence so far can be provided for all histological types to causative relationship between drug ingestion and hepatitis. Compliance with mandatory notification should be ensured in all cases, since suspicious cases are explicitly included. Higher sex-related disposition of women to drug-induced hepatitis was confirmed in our material, with the female-to-male ratio being 3:1.

[Treatment of chronic hepatitis B with interferon alpha-2b]. / Zur Behandlung der chronischen Hepatitis B mit Interferon alpha-2b.

A total of 58 patients with histologically confirmed chronic viral hepatitis B and presence of HBsAg and HBV-DNA in the serum were randomized in a prospectively controlled trial. 30 patients were treated with 3 megaunits of rIFN a-2b s.c. thrice weekly for 4 months. 28 controls received no treatment. The post-treatment follow-up period consisted of 6 months. 28 patients treated and 27 controls completed the protocol. One female patient of the treatment group showed a complete response (loss of HBsAg, HBeAg and HBV-DNA), 8 other patients (32%) revealed a partial response to therapy (loss of HBeAg and HBV-DNA). Three patients of the control-group (11%) lost HBeAg and HBV-DNA spontaneously. This finding is statistically significant (p less than 0.05). The elimination of HBV-markers from the serum was associated with a normalization of aminotransferase activities in the serum. A reactivation of hepatitis was not observed after seroconversion.

Kinetics of antipyrine and sulfamethazine in patients recovered from dihydralazine-hepatitis.

Pharmacokinetic studies with sulfamethazine (500 mg) and antipyrine (15 mg/kg) were performed in 27 hypertonic patients (16 females, 11 males, 37-78 years) who had recovered from a dihydralazine-induced hepatitis, and 21 patients with essential hypertension (13 females, 8 males, 18-74 years) treated with antihypertonics excluding dihydralazine. 20 patients of the hepatitis group (74%) and 12 patients of the control group (57%) were slow acetylators. With regard to the pharmacokinetic parameters no differences were found in both slow and rapid acetylators between the sulfamethazine group and the antipyrine group.