Predictors of antiviral treatment initiation in hepatitis C virus-infected patients: a Danish cohort study.

Predictive factors for initiation of antiviral therapy in chronically infected hepatitis C virus (HCV) patients are not fully elucidated. The aim of this study was to determine predictive factors for initiation of treatment with standard or pegylated interferon either alone or combined with ribavirin. A Danish cohort of individuals chronically infected with HCV was used and observation time was calculated from the date of inclusion in the cohort to date of death, last clinical observation, 1 January 2007, or start of HCV antiviral treatment in treatment-naïve patients. Kaplan-Meier survival analysis was used to construct time to event curves. Cox regression was used to determine the incidence rate ratios as estimates of relative risk (RR) and 95% confidence intervals (CI). A total of 1780 patients were enrolled in the study. The cumulative chance of treatment initiation over 5 years was 33.0%. We found several strong predictors of treatment initiation: elevated alanine aminotransferase [>2 times upper limit (RR = 2.17, 95% CI 1.64-2.87), >3 times upper limit (RR = 3.64, 95% CI 2.75-4.81)], genotype 2 or 3 (RR = 1.86, 95% CI 1.49-2.31) and HIV co-infection (RR = 0.28, 95% CI 0.15-0.53). To our knowledge, this study is the first to estimate factors predicting initiation of antiviral treatment in patients with chronic HCV infection on a nationwide scale. We found that several of the factors predicting initiation of antiviral treatment correlate with factors known to predict a better response to treatment and factors known to increase the progression of liver disease.

Tolerability of interferon alpha-2b, a possible new treatment of active Crohn's disease.

BACKGROUND AND AIMS: Due to the need for new principles for the treatment of Crohn's disease and due to the documented immunomodulatory effects of interferon alpha, the tolerability and effect(s) of interferon alpha-2b (Introna) in active Crohn's disease were examined in a pilot study. METHODS: Five patients with active Crohn's disease (activity index (CDAI) scores of 235-517), were treated with interferon alpha-2b for 12 weeks. RESULTS: All patients tolerated the treatment, but developed influenza-like symptoms, which were fully controlled by paracetamol. Two patients obtained partial remission with a decline in activity index scores of 39% and 50%. The activity of 2',5'-oligoadenylate synthetase, which together with two other interferon-induced proteins, neopterin and beta 2-microglobulin were increased during treatment, indicated clearly an in vivo uptake of interferon. Sedimentation rate, C-reactive protein, orosomucoid, albumin, specific inflammatory markers: soluble interleukin-2 alpha-receptors (sIL-2R) and intercellular adhesion molecule-1 (ICAM-1) did not show any changes before or after treatment. CONCLUSION: Future multicentre investigations are required to evaluate the clinical effect of interferon alpha-2b treatment in active Crohn's disease.

Prevalence of hepatitis B virus infection among alcoholic patients with liver disease.

The aim of this investigation was to elucidate a possible role of hepatitis B virus (HBV) in the pathogenesis of liver diseases in alcoholics. Two hundred and fifty-three alcoholics with liver disease were admitted to two medical departments in Copenhagen during a 15 months period. Seventy-nine patients (31%) showed serological signs (HBsAg, anti-HBs) of previous or active HBV infection. This is a significantly higher prevalence than found in an age-matched control population. Among the 79 patients with HBV markers, a total of 11 was found to be HBsAg-positive. From these 11 patients liver specimens were available for re-evaluation in nine cases. In only three of these liver biopsies, morphological changes indicating alcohol as the aetiological cause were found. In conclusion, different or concomitant aetiology must be considered in alcoholics with liver disease.

[Can measurement of oral or axillary temperature replace rectal temperature measurements?]. / Kan oral- eller aksiltemperatur erstatte rektal temperaturmåling?

The Craftemp thermometer is an electrical device for measurement of oral and axillary temperatures. The applicability of this thermometer in clinical practice was investigated by comparison with rectal temperatures measured with a mercury thermometer. Ninety-five patients hospitalized in a medical department participated in the study. The median differences between rectal/oral and rectal/axillary temperatures were 0.8 degrees C and 1.2 degrees C, respectively. The range of the extrarectal measurements was unacceptably wide. In previous studies of the Craftemp thermometer, few investigators performed the temperature measurements on hospitalized patients and found the electrical thermometer usable. In the present investigation the measurements were performed by the permanent staff during their daily routine. It was concluded, that the oral and axillary temperatures measured with an electrical thermometer were unsuitable for determination of body temperature in patients hospitalized in a medical department.

[Amyloidosis. A review]. / Amyloidose. En oversigt.

Amyloidosis is a heterogenous group of diseases, all characterized by extracellular deposition of amyloid either systemically or localized. Of wellknown diseases are Alzheimer's dementia, AL-amyloidosis (e.g. in multiple myeloma) and AA-amyloidosis (e.g. in rheumatoid arthritis). Amyloid is composed of three components of which the fibrillary component is the basis of amyloid classification. Many types of amyloid have a systemic distribution and give rise to varying symptoms. The diagnosis is based on biopsy, preferably of abdominal subcutis. The prognosis is poor, however, recent investigations on the three-dimensional structure of the P-component provide hope for future therapy.

[Amyloidosis: rapid course of AL-amyloidosis in a patient without myelomatosis]. / Amyloidose: rapidt forløb af AL-amyloidose hos en patient uden myelomatose.

A case of severe AL-amyloidosis in a 72-year-old man is presented. Amyloid was especially deposited in the kidneys and the liver. The patient died one year after diagnosis with impaired kidney function and severe ascites. Despite the type of amyloid (AL-type), multiple myelomata or lymphoproliferative disease could not be demonstrated.

[Epicrisis. A report from the county of Copenhagen]. / Udskrivningsbreve. En opgørelse fra Københavns amt.

During a random week in 1987, 35% of the general practitioners from all of the municipalities in the County of Copenhagen participated in a questionnaire survey whose objective was to illuminate the quality, expedition time, and possible problems associated with the letter of discharge (LD), an important link between the primary and secondary medical services. It can be concluded that the expedition time for a large number of LD's from the hospitals of Copenhagen County is unacceptably lengthy. A surprisingly large number of patients visited their own general practitioner during the week following discharge with questions about the information which had been given them during their hospital stay, regardless of agreements for ambulatory monitoring at the department from which they had been discharged. A preliminary LD can, to a certain extent, alleviate the problems brought about by the lack af an LD but ought not to replace or delay the issuance of the actual LD, and is a more expensive solution. The quality and content of the LD can be evaluated generally as good, but could be improved if the recommended follow-up treatment and information to the patients and relatives is routinely carried out.

[Transjugular intrahepatic portosystemic shunt. Treatment of patients with recurrent bleeding from esophageal varices]. / Transjugular intrahepatisk portosystemisk shunt. Behandling af patienter med recidiverende esophagusvariceblødning.

We report the results of transjugular intrahepatic portosystemic shunt (TIPS) procedure in six patients with liver cirrhosis and recurrent bleeding or acute intractable bleeding from oesophageal varices in spite of multiple sessions of sclerotherapy. Median follow-up was 15 months (range 1-24 months). The procedure was technically successful in all patients without procedure-related morbidity or mortality. Four of the procedures were performed electively and two as an emergency procedure. The portosystemic pressure gradient decreased to below 12 mmHg following TIPS implantation and the shunt bloodflow was one quarter to three-quarters of the portal bloodflow determined by Doppler ultrasound. Recurrent bleeding occurred in one patient but was amenable to endoscopic sclerotherapy. In this patient the shunt had developed a stenosis that was treated by balloondilatation and insertion of an additional stent six months following the initial procedure, and no further bleeding occurred. The remaining five patients had no rebleeding episodes. Repeated Doppler examinations in the followup period demonstrated patency of all shunts. None of the patients developed portosystemic encephalopathy. One patient died of cerebral haemorrhage, unrelated to TIPS, 16 months following implantation. Another patient died 14 months following TIPS due to acute mesenteric occlusion and septicaemia. We conclude that TIPS is feasible and effective in selected patients with liver cirrhosis and persistent or recurrent variceal bleeding following repeated endoscopic therapy.

[Is hepatitis B antigenemia a risk in adjuvant cytostatic treatment of breast cancer?]. / Er hepatitis B antigenaemi en risiko ved adjuverende cytostatisk behandling for cancer mammae?

One-hundred and fifteen consecutive patients with breast cancer were examined for hepatitis B. All the patients received adjuvant chemotherapy. The median age was 46 years (range 26-54 years). None of the patients were found to be HBsAg-positive. The prevalence of HbsAg was within the limits of 0-0.026 (95% confidence interval). Vaccination of patients receiving chemotherapy is not indicated. Furthermore, regular HBsAg screening among patients under 55 years cannot be recommended.

[Penicillin treatment of non-nosocomial pneumonia in Danish medical departments. A questionnaire]. / Penicillinbehandling af ekstranosokomielt erhvervet pneumoni på medicinske afdelinger i Danmark. En spørgeskemaundersøgelse.

This study describes the most common penicillin-regime for hospitalized patients with community-acquired pneumonia in Denmark. One hundred and seventy-one consultant physicians received an anonymous questionnaire, 85% were returned and 75% were evaluated. The most common regime is a treatment duration of six to ten days with 3-6 million IU of penicillin daily given in three doses. The most common route of administration is intravenously until the patient's body temperature drops. Then the same dose is given orally. Variations in strategy were revealed and call for further investigations to establish and maintain restrictive antibiotic regimes.

[Plasmapheresis as life-saving treatment in acute hepatic failure]. / Plasmaferese som livsbevarende behandling før levertransplantation ved akut leversvigt.

Emergency liver transplantation is the treatment of choice in acute liver failure without signs of spontaneous regeneration. However, many patients rapidly contract irreversible neurological complications before transplantation can be performed. We used high-volume plasmapheresis to increase the time span to obtain a donor liver. Four patients with acute liver failure of unknown cause and a galactose elimination capacity indicative of a virtually extinct liver function were assigned maximum priority for liver transplantation. Plasmapheresis were performed daily until transplantation. Each time 8-10 liters of patient plasma were replaced with an equal volume of fresh donor plasma. There were no major complications. None of the patients developed irreversible neurological complications for 48-144 h at which time liver transplantation was performed. High volume plasmapheresis increases the time to obtain a donor liver for emergency liver transplantation and optimizes the condition for the surgical procedure.

[Garcin syndrome. Clinical aspects and diagnosis of a rare cranial nerve syndrome with special reference to computerized tomography and nuclear magnetic resonance image findings]. / Garcin-Syndrom. Klinik und Diagnostik eines seltenen Hirnnervensyndroms unter besonderer Berücksichtigung computer- und kernspintomographischer Befunde.

Garcin syndrome is an ipsilateral step-by-step deterioration of all 12 brain cranial nerves, first described in 1927. The underlying cause is usually a sarcoma or carcinoma of the skull base. The pathogenesis of the Garcin syndrome is chiefly determined by the slow localized growth of these tumors, rather than by their histology and primary localisation. The prognosis is as a rule unfavourable. The findings on computed and magnetic resonance tomography are important for an early diagnosis. Two cases of Garcin syndrome are reported, one of which was probably due to a tonsillar carcinoma, while the other was caused by a mucinous adenocarcinoma of the nasopharynx.