[Is healthcare personnel the only professional group exposed tothe risk of occupational HBV, HCV or HIV infections?]. / Czy ryzyko narazenia zawodowego na zakazenie wirusami HBV, HCV, HIV dotyczy tylko pracowników ochrony zdrowia.

BACKGROUND: Our paper presents the problem of exposure to potentially infectious material among health care workers, and also in police officers, prison guards, cleaning service personnel and ordinary citizens. MATERIALS AND METHOD: In the study period, 200 patients were admitted to the Infectious Diseases Clinic after exposure to potentially infectious materials in order to evaluate the risk of HBV, HCV and HIV infections and initiate post exposure prophylaxis. HBsAg, a-HCV and a-HIV were carried out on the day of admission, a-HBs was measured in patients who had been vaccinated against hepatitis B virus. Clinical evaluation of HBV, HCV, HIV infections was performed in the source patients' plasma. RESULTS: The study population consisted of 93 health-care workers (63 nurses, 25 physicians, and 5 medical students), 30 policemen, 23 prison guards, 42 cleaning service workers employed in health-care centers. The remaining 12 patients were inhabitants of the Lodz region who had not been occupationally exposed to potentially infectious material. CONCLUSIONS: Although "safe needles" are in use, exposure among health care personnel still occurs. The problem of occupational exposure among police officers and prison guards is highly underestimated. The lack of control over the vaccination against hepatitis B virus in groups not related with health care creates the risk of new infections.

Primary perivascular epithelioid cell tumor (PEComa) of the liver: report of a case.

PEComa is very rare mesenchymal neoplasm which is formed by perivascular epithelioid cells and is characterized by dual melanocytic and myoid differentiation. Up to now only a very few cases of PEComa of the liver have been described worldwide. We herein present a patient who underwent a right hemihepatectomy for a huge tumor which could not be identified by imaging investigations. A final histopathologic examination revealed a benign epithelioid tumor with a solid growth pattern, abundant vascularity, and frequently dilated vascular channels. Immunohistochemically, the tumor cells were strongly positive for HMB-45, moderately positive for actin, and faintly positive for S-100, respectively. Based on the above findings, a diagnosis of a primary clear cell "sugar" tumor was established. Because the natural history of PEComas is mostly unpredictable, the patient has been closely followed up; however, no recurrence has so far been observed. Immunohistochemical findings play a crucial role in avoiding a misdiagnosis, and a surgical resection with an adequate margin of healthy tissue remains the gold standard of treatment. A long-term periodic follow-up is reasonable in all cases presenting with PEComa.

[Depressive disorders and symptoms accompanying pegylated interferon alpha and ribavirin treatment of chronic hepatitis C patients]. / Zaburzenia i objawy depresyjne towarzyszace leczeniu chorych na przewlekle zapalenie watroby typu C pegylowanym interferonem alpha i rybawiryna.

UNLABELLED: The aim of the study was to describe describe the frequency of depressive symptoms and episodes accompanying peg-interferon alpha and ribavirin (peg-IFN-alpha/RBV) treatment of chronic hepatitis C patients (CHC). MATERIAL METHODS: 47 CHC patients were enrolled in the study. They were divided into two groups: experimental and control consisting of 26 and 21 participants, respectively. Experimental group patients were given peg-IFN-alpha/RBV2a (n = 18) or 2b (n = 9) and ribavirin treatment in doses recommended by manufacturers. Control group patients did not receive the above treatment. Both groups underwent psychiatric examination using semi-structured clinical interview (MINI) at the beginning (t0) and after 12 weeks of treatment or observation (t12). Depressive episodes were diagnosed according to ICD-10 criteria. Hamilton Rating Scale for Depression (HRSD) was used to assess depressive symptoms intensity at the same time points. RESULTS: Three and two participants in the control and experimental group were diagnosed with depression in t0. Six new patients developed depression in t12 twelve weeks after peg-IFN-alpha/RBV treatment. No new cases were seen in the control group. There was also observed a significant increase in depressive symptoms intensity during peg-IFN-alpha/RBV treatment. No significant changes in the frequency of depressive episodes and their intensity were seen in the control group over the period of observation. CONCLUSIONS: The findings suggest a connection between peg-IFN-alpha/RBV therapy and the development of depressive symptoms and episodes. The above changes may be the effect of IFN-alpha-induced neurotransmission abnormalities in limbic system and basal ganglia. The above findings necessitate a routine psychiatrist involvement in the management of CHC.

[Cognitive disturbances observed in chronic hepatitis C patients during pegylated interferon alpha and ribavirin therapy]. / Zaburzenia procesów poznawczych obserwowane u pacjentów z przewleklym zapaleniem watroby typu C w trakcie terapii pegylowanym interferonem alfa i rybawirynq.

UNLABELLED: Chronic hepatitis C (CHC) patients treated with peg-interferon alpha and ribavirin (peg-IFNalpha/RBV) complain of irritability, attention and memory disturbances which may indicate cognitive impairment associated with treatment. AIM: Assessment of the probable connection between peg-IFNalpha/RBV treatment and the development of cognitive disturbances in CHC patients. METHOD: 47 CHC patients were divided into two groups: experimental (n=26) and control (n=21). The experimental group patients were given peg-IFNalpha2a (n=18) or peg-IFNalpha2b (n=8) plus RBV in standard doses as recommended by the manufacturers. Control group patients did not receive the above treatment. Both groups underwent a neuropsychological examination consisting of R. Brickenkamp d2 test, Auditory Verbal Learning Test and Hooper Visual Organization Test at the beginning (t=0) and after 12 weeks of treatment or observation (t=1). RESULTS: The experimental group patients showed significant deterioration in all the measured cognitive functions in t=1 comparing to t=0. Cognitive decline was not seen in the control group. The observed cognitive performance changes could not be correlated sufficiently enough with the presence of organic affective disorders diagnosed according to ICD-10 criteria. CONCLUSIONS: The findings suggest that peg-IFNalpha/RBV therapy of CHC patients is connected with the deterioration in cognitive functioning including attention, auditory verbal memory and visuo-spatial skills. These changes may be the effect of peg-IFNalpha-induced neurotransmission abnormalities in the dorso-lateral prefrontal cortex, anterior cingulate cortex, hippocampus and parieto-orbital cortical regions and can impair patients' ability to drive a motor vehicle, operate machinery, or their engagement in hazardous activities requiring attention and coordination. Medical professionals should thoroughly inform patients about the possibility of cognitive decline associated with peg-IFNalpha/RBV therapy.

[Attention abnormalities in patients with chronic hepatitis C after pegylated interferon alpha and ribavirin treatment]. / Zaburzenia uwagi utrzymujace sie u chorych na przewlekle zapalenie watroby typu C po zakonczeniu leczenia pegylowanym interferonem alfa i rybawiryna.

THE AIM OF THE STUDY: To (a) describe the influence of peg-IFNalpha 2a and 2b on attention processes and (b) to assess whether attention abnormalities induced by peg-IFNalpha/RBW resolve 8 weeks after treatment discontinuation in chronic hepatitis C patients. MATERIAL AND METHODS: 26 chronic hepatitis C patients treated with peg-IFNalpha2a (n=18) or 2b (n=8) and RBV were enrolled in the study. Attention processes were tested three times: before the beginning (t=0), after 12 weeks of medication (t=1) and 8 weeks after treatment discontinuation (t=2). Attention was assessed with Brickenkamp d2 test and the results were compared in groups of patients treated with different kinds of peg-IFNalpha. RESULTS: The two kinds of peg-IFNalpha did not differ significantly regarding the influence on attention processes. 8 weeks after treatment discontinuation (t=2) there was observed a significant decrease all aspects of attention measured by d2 test, i.e. work accuracy, speed of processing and ability to focus attention comparing with t=0 and t=1. CONCLUSIONS: Peg-IFNalpha/RBW therapy is connected with a decrease in attention processes performance and the two kinds of peg-interferon alpha (2a and 2b) may exert a similar influence. Attention dysfunction did not resolve 8 weeks after treatment discontinuation and may be the irreversible effect of the dorso-lateral prefrontal cortex or anterior cingulate cortex damage.

[The usefulness of P300 potential in hepatic encephalopathy diagnostics of alcoholic etiology]. / Przydatnosc potencjalu P300 w diagnostyce encefalopatii watrobowej o etiologii alkoholowej.

UNLABELLED: The consequence of consuming excessive amount of alcohol is the damage of internal organs, particularly liver. In the liver there comes in turn to its fatty degeneration, hepatitis, fibrosis and finally to its cirrhosis. The aim of the study was the analysis of P300 potential in subjects chronically abusing alcohol with alcohol-related toxic liver damage and the assessment of the usefulness of this potential in the diagnosis of hepatic encephalopathy. MATERIAL AND METHODS: Group I--consisted of 30 men meeting the criteria of alcohol dependency syndrome, with diagnosed alcohol-related toxic liver damage. Comparative group--consisted of 30 physically and mentally healthy men, with no alcohol dependency syndrome. The following were carried out in all the examined: examination of auditory endogenic P300 potential. RESULTS: In subjects chronically abusing alcohol, with diagnosed toxic liver damage statistically significant prolonged latency and also reduced amplitude (p < 0.001) were found in comparison with the control group. CONCLUSIONS: 1. Changes in P300 parameters (latency elongation and amplitude reduction) in alcohol-dependent subjects with alcohol-related liver damage were confirmed. 2. P300 potential may be a complementary method in the diagnosis of hepatic encephalopathy.

[Central pontine myelinolysis--case report]. / Centralna mielinoliza mostu--opis przypadku.

Central pontine myelinolysis (CPM) is a neurologic disorder, consists of demyelinisation without inflammation in the base of pons, with a relative sparing of the axons and the nerve cells. Clinical symptoms have various manifestations. They include pseudobalbular paralysis, tetraparesis, locked-in syndrome, coma. Rapid correction of persistence hyponatremia is a well recognized factor predisposing to CPM and nutritional deficiency is a commonly evoked cause of CMP as well. In more than half the cases it appeared in the late stages of chronic alcoholism. Among other medical conditions conjoined with CMP are liver failure and transplantation, electrolyte disturbances, cachexia from various causes, carcinoma, and severe bacterial infections. The autors report the cases of 31 year old patient with 4 year history of alkohol abuse in whom CPM developed with mild tetraparesis.

[Does the assay of acute phase protein concentrations in cerebrospinal fluid and/or in serum in patient with viral meningitis have a diagnostic value? Part II. Lymphocytic meningitis caused by echo 30 virus]. / Czy oznaczanie stezen bialek ostrej fazy w plynie mózgowo-rdzeniowym lub/i w surowicy w wirusowym zapaleniu opon mózgowo-rdzeniowych u dzieci ma znaczenie diagnostyczne? Czessc II. Limfocytarne zapalenie opon mózgowo-rdzeniowych wywolane wirusem ECHO 30.

The aim of the study was to evaluate dynamics of selected acute phase proteins in serum and cerebrospinal fluid (CSF) in children with viral meningitis and to assess diagnostic power of protein determination for detection and treatment monitoring. 51 children with viral meningitis caused by ECHO 30 virus were included in the study group. Concentration of C-reactive protein (CRP), alpha 1-antitrypsin (AAT), alpha1-acid glycoprotein (AAG), alpha2-haptoglobin (HPT) and C3 complement fragment were determined in serum and CSF at entry and at day 14 after admittance to hospital. Control group for serum determination consisted in 30 healthy children (Group K1) and control group for CSF determination consisted in 19 hospitalized children in whom the diagnosis of meningitis was not confirmed (group K2). The greatest rise of acute phase proteins concentration was observed in children in case of HPT, AAG and C3 complement when determined in serum. Meningitis in children that was caused by ECHO 30 virus produces slight acute phase reaction that is more evident in serum than in CSF. It is confirmed by remarkable increase of AAG, HPT, C3 complement in serum and HPT in CSF either at entry or at the day 14. The determination of AAG, HPT and C3 complement in serum have diagnostic power that is strong enough to meningitis diagnostics and monitoring of treatment.

[Cancer antigen 125 as a marker of ascites in patients with liver cirrhosis]. / Antygen rakowy CA-125 markerem wodobrzusza w marskosci watroby.

Cancer antigen 125 (CA-125) is usually used to monitor the course of epithelial ovarian cancer. It has recently been reported that liver cirrhosis is associated with elevated serum CA-125, especially in the presence of ascites. The aim of the study was to evaluate CA-125 as a marker of ascites in patients with liver cirrhosis. Seventy-two (72) patients with liver cirrhosis of different aetiology were studied. Ca-125 levels were measured in stored serum collected from the patients. Ca-125 concentrations were elevated in patients with liver cirrhosis and ascites, irrespective of patients' sex and cirrhosis aetiology. CA-125 concentrations were normal in cases of liver cirrhosis without ascites. Elevated cancer antigen 125 is a sensitive marker of cirrhotic ascites. An inappropriate use of this test in cases of liver cirrhosis in females may suggest the ovarian cancer incident and lead to unnecessary surgical intervention.

Alterations in the erythrocyte plasma membranes in patients with alcohol-induced liver cirrhosis - preliminary results.

INTRODUCTION: Conformations of membrane proteins, membrane fluidity of erythrocytes in patients with AILC were studied with the use of electron paramagnetic resonance and spectrophotometric methods. The concentration of substances reacting with thiobarbituric acid was also determined. The aim of the study was to recognize the nature, level and causes of changes in the structure of erythrocytary membrane observed in erythrocytes of patients compared to erythrocytes from healthy controls. MATERIAL AND METHODS: SPIN LABELS: MSL and ISL binding covalently to thiol groups of membrane cytoskeleton proteins were used to analyse modifications occurring in erythrocytary membrane proteins. Doxyl derivatives of fatty acids: 5-DS, 12-DS and 16-DS binding hydrophobically to erythrocytary membrane were used as spin labels for the analysis of erythrocyte membrane lipid fluidity. RESULTS: Modification of membrane cytoskeleton proteins and increase of membrane lipids fluidity were observed in erythrocytes of the investigated patients. An increase of the concentration of substances reacting with thiobarbituric acid was also confirmed in the erythrocytes of AILC patients. CONCLUSIONS: Observed disorders in the structure of erythrocyte cytoskeleton proteins in patients, which might developed as a consequence of oxidative stress may be conformation changes in the structure of proteins which affect membrane cytoskeleton. The differences in the structure of membrane proteins could be associated with an increase in membrane lipids fluidity. Increased fluidity of erythrocyte membrane may be a result of disorders in protein-lipid interaction or membrane lipid peroxidation activity.