Uridine diphosphate glucose in acute viral hepatitis

200 mg UDPG or placebo respectively were administered after an observation period of 1 week to two randomly constructed groups of patients aged 15-35 yr with acute viral hepatitis but no prior history of disease. In the treated patients, mean decreases were most marked and most rapid in the case of SGOT, SGPT, alkaline phosphatase and total bilirubinaemia. These results offer good reason for supposing that UDPG can be usefully employed in the management of acute viral hepatitis.     

Prognosis in acute viral hepatitis B in children

Epidemiological evaluations indicate an increase of acute viral hepatitis B in children. In this study authors performed an analysis of disease prognosis in retrospective trial in children hospitalized in the Pediatric Department of Infectious Diseases from 1983 to 1993 because of acute viral hepatitis B. It was documented that a risk of persistent hepatitis B may be related to the age of patients with acute viral hepatitis B in the past. In 64% of analyzed patients below 1 year old and in 20% over 6 years-persistent hepatitis was diagnosed, especially in male subjects.     

Chronic viral hepatitis enhances the risk of infection but not acute rejection in renal transplant recipients

To assess the impact of chronic viral hepatitis on host immune response, we analyzed the incidence of acute rejection and the frequency of infections in 86 patients infected with hepatitis B and C viruses and had developed clinical evidence of chronic liver disease and 1283 control patients who were transplanted at our center during the same period, but had no evidence of chronic viral hepatitis. To compare the mean number of rejections and the mean number of infections between the two groups, we used multivariate linear regression analysis, which allowed us to adjust simultaneously for the effects of 10 other risk variables with potential impact on graft rejection and posttransplant infection. During a mean follow up of 5.3+/-5.2 years, 62% of hepatitis patients and 54% of control patients had experienced an acute rejection (P=NS). The mean rejections/patient in the hepatitis group was 1.3+/-0.14 versus 1.03+/-0.03 in control (P=NS). In the linear regression analysis, the number of acute rejections in the hepatitis group was 0.16 higher than in control (P=NS). With reference to infection, 84% of hepatitis patients experienced an infectious complication in the posttransplant period, compared with 75% in the control (P=0.05). The mean number of infections/patient was 5.7+/-0.73 in the hepatitis group compared with 3.9+/-0.14 in the control group (P=0.002). The linear regression model had shown that the hepatitis group had a relative increase of 1.18 infections/pt, compared with control. Of the different sites of infection, the hepatitis group had a significant increase in bloodstream (0.48+/-0.08 vs. 0.25+/-0.02) P=0.003; pulmonary (0.60+/-0.09 vs. 0.38+/-0.03) P=0.03; and CNS infections (0.08+/-0.03 vs. 0.02+/-0.004) P=0.05 compared with control. Among the different microorganisms causing infection, the hepatitis patients had a significant increase in gram negative bacterial infections compared with the control group (74% vs. 61%) P=0.04. Our data suggest that chronic viral hepatitis is associated with a significant increase in overall infections, and that of potentially fatal infections involving CNS, lungs and bloodstream. Since there is no significant increase in the rate of graft rejection, one could consider a cautious reduction in the doses of maintenance immunosuppressive agents in renal transplant patients with chronic viral hepatitis. The reduced immunosuppression may in turn lower the death rate from sepsis and progressive hepatic failure.     

The potential risk factors associated with acute viral hepatitis in children under 5 years old]

In studies of the effects of salt intake on blood pressure (SBP, MBP, DBP), influences on heart rate (HR) are usually neglected even though the longterm load on both left ventricle (LV) and systemic arteries (SA) is better related to the product of HR x SBP (or MBP) than to pressure alone. After all, altered salt intakes often induce considerable volume-related changes in HR, and the heart operates more economically at low HR and high stroke volume (SV). Thus, about 3/4 of LV metabolism is used for the build-up of systolic tension, while the cost for SV expulsion, or for SV increases, is far lower. Moreover, low HR prolongs the diastolic period, so important for LV coronary supply. Against this background we have used results from studies in both rats and man, in which both BP and HR were followed during marked changes in salt intake, to explore how this affected the HR x SBP (or HR x MBP) product. Briefly, in ordinarily salt-resistant organisms, whether normo- or hypertensive, salt intake increases, which in man ranged from 10-20 to 250-300 mM (in rats over 100-fold), if anything reduced the computed longterm load (HR x SBP, or MBP) on LV and SA, as consequences of an efficient reflex volume control. By contrast, in salt-sensitive man, HR reflex reductions to increased salt intake were almost absent despite substantial SBP elevations, suggesting the influence of a CNS suppression of bulbar reflex centres combined with CNS neurohormonal interference with renal salt volume excretion, as in SHR.     

Cytokine mediators in acute inflammation and chronic course of viral hepatitis

We examine the cognitive ability of 58 demented patients who were evaluated with the Spanish version of the Severe Impairment Battery (SIB). The SIB is composed of multiple simple subtests for memory, language, orientation, attention, visual perception and ability to construct. The battery also assesses social skills, praxis and the ability to respond appropriately to name. The mean SIB scores (72.55 +/- 17.99; range 8-99) correlated with mean scores (10.76 +/- 6.41; range 0-31) on the Spanish version of Folstein's Mini-Mental State Examination (MMSE). The SIB detected deterioration in the nine cognitive areas examined, even in the most severely impaired patients (MMSE = 0-6). These results indicate that the Spanish version of the SIB is a useful instrument for examining severely demented patients.     

The high rate of antibodies to hepatitis E virus in young, intravenous drug-abusers with acute hepatitis B-virus infection in a Swedish community: a study of hepatitis markers in individuals with intravenously or sexually acquired hepatitis B-virus infection

Sclerotic fibroma is an uncommon fibrotic neoplasm that occurs both sporadically as well as in patients affected by Cowden's disease. We present an additional case of solitary sclerotic fibroma not associated with Cowden's disease. Although most of the lesion was sclerotic, there was a cellular area with some multinuclear cells. We conclude that sclerotic fibroma is a mesenchymal neoplasm whose clinical and histopathologic features are not only different but opposite to those of dermatofibroma.     

Immune response to HBsAg, HBcAg and e-antigen in patients with acute hepatitis and HBsAg carriers with and without liver diseases

Humoral and/or cell-mediated (CMI) immune responses to HBAg components, human and rabbit liver specific proteins (HLP and RLP) and tuberculin were tested in patients with acute virus B and non-B-hepatitis, asymptomatic HBsAg carriers and HBsAg positive chronic active hepatitis (CAH). Furthermore, the presence of HBsAg, HBcAg and/or "e"-antigen has been studied in patients with sera and/or liver tissue. Asymptomatic HBsAg carriers are characterized by a status of immunological tolerance against HBsAg. HBcAg in liver nuclei could not be detected. All sera were positive for anti-HBc, some had anti "e". - Patients with uneventful acute virus-B-hepatitis developed CMI against HBsAg 4-6 weeks and anti-HBs 4-6 months after onset of the disease. Acute virus hepatitis without detectable HBsAg are defined as non-B-hepatitis by negative humoral and cell-mediated immune reaction against HBsAg 1-12 months after onset of the disease. - Patients with type B chronic active hepatitis are characterized by inadequate CMI against HBsAg without immune elimination of virus and virusantigens. Acute and chronic type-B-hepatitis showed temporary or constant CMI against HLP. These findings suggest an alteration or a carrier function of membrane antigens of virus infected hepatocytes or an induction of new membrane antigens by a virus. The results indicate that recovery from type B-hepatitis is associated with the ability to elicit a specific immune response to HBsAg. Furthermore immune responses to virus, virus antigens and virusinfected hepatocytes seemed to be the pathogenic principle of virus induced acute and chronic liver diseases.     

The transformation of acute viral hepatitis B into chronic

500 patients with hepatitis B have been followed up from the acute onset to long-term outcome. As for chronic transformation of the disease, at higher risk are patients with mild form, progredient run and inadequate immune response. Of the highest value for identification and prognostication was a dynamic quantitative control over the system HBeAg-anti-HBe providing separate prognosis of establishment of replicative or integrative variants of chronic hepatitis B. In progredient infection an early administration of reaferon in combination with thymogen is thought valid which in many patients is sufficient to prevent the disease transformation into a chronic form.     

Biopsychological relationships and prediction of the course of acute viral hepatitis

Psychosocial factors are discussed to influence the manifestation and course of infectious diseases. The results of psychoimmunological research during the past two decades have proved that different psychosocial factors can alter a great number of immune functions. Clinical studies on the relevance of such immune alterations are still rare. The course of viral hepatitis is strictly determined by individual immune-competence, and because it is not medically treated in acute stages it offers an ideal biopsychosocial research model. In 87 patients with acute viral hepatitis we measured every week complaints, moods (German adaptation of MACL), liver and immune-function (sIL-2R, alpha IFN, IL-1Ra, IL-6). It was shown that complaints are influenced by immune activity as well as by individual psychological factors. Patients could be differentiated by symptoms ad hospital admission into three groups: 1. with mainly bodily focused symptoms, 2. with predominantly anxious-depressive symptoms and 3. with elevated moods without complaints. In the further course patients in group 2 and 3 showed more often a delayed recovery, and hence we must presumed that the coping-process in group 1 is more likely to support immune functioning, whereas coping mechanisms in groups 2 and 3 are more likely to suppress it.     

The characteristics of the immune response in acute viral hepatitis B

The clinical and pathogenetic importance of a number of features characterizing cell-mediated immunity and nonspecific protective factors in acute virus hepatitis B. 124 patients with hepatitis B virus (HBV) infection were placed under observation. Of these, 115 patients had acute virus hepatitis B, 6 patients had acute virus hepatitis of mixed etiology (B + delta) and 3 patients had chronic virus hepatitis B. The study included, besides the detection of virus hepatitis markers and the biochemical analysis of blood, the determination of subpopulations of peripheral blood lymphocytes (CD3, CD4, CD8, CD57), the functional activity of natural killers, characteristics of the interferon status, serum neopterin and beta 2-microglobulin in blood serum. Considerable changes in cell-mediated immunity and the interferon system were found to occur and the optimum immune response in acute virus hepatitis B was characterized.     

Changes in thyroid hormone levels in patients with acute viral hepatitis

The authors describe the case of a 21-year-old female patient where for several months anaemia was the only symptom of subsequently diagnosed coeliac disease. They draw attention to the possibility of a monosymptomatic course of coeliac disease and discuss similar observations reported in the literature.     

Aplastic anemia in acute viral hepatitis type A. Our experience

Tropical pyomyositis is an infection of large muscle groups that can lead to sepsis and death. The most common etiologic agent is Staphylococcus aureus. It usually occurs in patients living in the tropics but is seen with increasing frequency in temperate climates, particularly in immunosuppressed patients, where it may be misdiagnosed and may cause severe morbidity and mortality. Diagnosis is based on the examination of pus from a muscle aspirate and treatment consists of surgical incision, drainage and appropriate antibiotic therapy. It is stressed to take into account pyomyositis in the differential diagnosis of immunocompromised patients with "cryptic" myalgia.     

Perinatal transmitted acute icteric hepatitis B in infants born to hepatitis B surface antigen-positive and anti-hepatitis Be-positive carrier mothers

Three infants born to mothers who were hepatitis B surface antigen (HBsAg) positive and had antibody to hepatitis Be antigen (anti-HBe), developed acute icteric hepatitis B within three months of birth. All three infants clinically recovered and developed circulating anti-HBs. Contrary to previous studies, these three cases indicate that mother-infant transmission of the hepatitis B virus (HBV) does occur in infants born to HBsAg-positive, HBe-Ag-negative carrier mothers, and these infants may develop severe acute icteric hepatitis. Therefore, immunoprophylaxis in such newborns may be indicated.