Functional activity of protein C in liver cirrhosis and acute viral hepatitis on the Ivory Coast

Protein C activity was determined in 70 patients with liver disease, 30 with acute viral hepatitis and 40 with liver cirrhosis. Statistical comparison of the values for patients with those for healthy Ivorians showed a significant decrease in protein C activity, positively correlated with a prolongation of the prothrombin time.     

Chronic liver disease in Peru: role of viral hepatitis

Autologous or glutaraldehyde treated bovine pericardial valved patch was utilized for widening of the right ventricular outflow tract in 20 patients with tetralogy of Fallot (autologous pericardium group in 10 patients and bovine pericardium group in 10). Pericardial valve function of the both materials was evaluated by postoperative cardiac catheterization performed 1 year after the operation. There were no significant differences in pulmonary arterial and right ventricular pressures, and right ventricular ejection fraction and end-diastolic volume between the 2 groups. Pulmonary angiogram in the autologous pericardium group patients demonstrated the pulmonary regurgitation (PR) of grade 1 in 5 patients, grade 2 in 4 and grade 3 in 1. On the other hand, 1, 3 and 6 patients in the bovine pericardium group demonstrated no-PR, grade 1 PR and grade 2 PR, respectively. It was concluded that there were no significant differences between autologous and glutaraldehyde treated bovine pericardium as a material of valved patch for widening of the right ventricular outflow tract of tetralogy of Fallot.     

Compensated cirrhosis due to viral hepatitis: using MR imaging to predict clinical progression

OBJECTIVE: The goal of our study was to determine the relative value of multiple MR features in predicting clinical progression of disease in patients with compensated cirrhosis. MATERIALS AND METHODS: The MR examinations of 23 patients with compensated cirrhosis (Child A) were retrospectively reviewed independently by two radiologists and correlated with clinical progression after follow-up of all patients for more than 12 months each (12-87 months: average, 39 months) by the same experienced hepatologist. Clinical progression was defined as an increase of the Child grade or the Pugh score by at least two points (5- to 15-point scale). In the initial MR study of each patient, the following MR findings were assessed by each radiologist independently: volume indexes of the spleen and each segment of the liver (based on three-axis measurements), nodular surface, regenerative nodules, ascites, iron or fat deposition, and varices or collaterals. RESULTS: The volume index of the spleen was the most accurate predictor of clinical progression (p = .001), the next most accurate was the number of sites of varices or collaterals (p = .002), and the third most accurate was the ratio of caudate lobe to right lobe volume index (p = .02). Other MR findings failed to correlate with clinical progression. CONCLUSION: As revealed on MR imaging, the volume index of the spleen, the severity of varices, and the volume index ratio of caudate lobe to right lobe can be used to help predict clinical progression of disease in patients with compensated cirrhosis.     

Histopathology of the liver in children with chronic hepatitis C viral infection

Although the epidemiology, natural history, and pathological aspects of chronic hepatitis C are well-defined in the adult population, little is known about the characteristics of chronic hepatitis C infection in children. Reports on the histological features and progression of hepatitis C in children are scarce, and consist primarily of multicenter studies in Japanese and European children. Given the geographic variations in viral genotype and the association of pathology with genotype, whether the Japanese and European studies can be extended to the North American populations is unclear. We report the histopathology of the liver in 40 children with chronic hepatitis C infection treated in a single North American institution. The children included 19 males and 21 females ranging in age from 2.0 to 18.6 years at the time of liver biopsy (mean +/- SD: 11.4 +/- 4.3 years). Our findings indicate that the characteristic histopathological lesions of chronic hepatitis C infection, including sinusoidal lymphocytosis, steatosis, portal lymphoid aggregates/follicles, and bile duct epithelial damage, occur with approximately the same frequencies in children as have been reported in adults. Necroinflammatory activity was generally mild. Portal fibrosis was present in 78% of the specimens, including fibrous portal expansion (26%), bridging fibrosis (22%), bridging fibrosis with architectural distortion (22%), and cirrhosis (8%). Centrilobular pericellular fibrosis, which has not been previously reported in the context of chronic hepatitis C infection in adults or children, was also a prominent feature in our series, occurring with a similar frequency as steatosis or portal lymphoid aggregates/follicles. Our data suggest that in spite of mild histological necroinflammatory activity in general, the stage of fibrosis in children can be severe in spite of relatively short duration of infection.     

Chronic hepatitis in children after liver transplantation: role of hepatitis C virus and hepatitis G virus infections

BACKGROUND/AIMS: Chronic graft hepatitis occurs in 20-30% adults after liver transplantation but the prevalence and causes in children are not known. In adults, hepatitis C virus infection is prevalent prior to transplantation and recurrent infection is a frequent cause of graft dysfunction. The significance of the recently described hepatitis G virus infection remains unproven. The aim of this study was to examine the role of hepatitis C virus and hepatitis G virus infection in chronic graft hepatitis after paediatric liver transplantation. METHODS: The prevalence of graft hepatitis and the role of hepatitis C virus and hepatitis G virus infections in 80 children after liver transplantation have been studied, with a median follow up of 4.4 years (range 0.4 to 10.7), and the persistence of hepatitis G infection in the presence of immunosuppression has been determined. RESULTS: Chronic graft hepatitis was diagnosed in 19/80 (24%) children and was most frequently seen in children transplanted for cryptogenic cirrhosis (71%). There was no significant difference in the prevalence of chronic hepatitis in those transplanted before or after donor anti-HCV screening. Hepatitis C infection occurred in three children transplanted prior to donor screening but in only one was associated with chronic hepatitis. Hepatitis G infection was found in 22/79 (28%) transplant recipients but was not associated with graft hepatitis. In 17/21 children hepatitis G infection persisted for a median of 5.2 years after transplantation. CONCLUSION: Chronic hepatitis occurred in 24% of children after liver transplantation, a similar prevalence to that in adults. Cryptogenic liver disease predisposed to graft hepatitis, but neither hepatitis C nor hepatitis G infection was associated. Hepatitis G virus caused a frequent and usually persistent infection after transplantation.     

Interferon-induced vitiligo in a patient with chronic viral hepatitis C infection

Recurrent abdominal pain (RAP) syndrome is described by Apley 40 years ago. The definition of condition, still generally accepted, is at least three episodes of abdominal pain over a period of three months, with pain of intensity which affects the behaviour of the child. The prevalence of condition among school children is 10-15%. Apley's classic studies demonstrated organic disease in only 10% of the children. Apley's conclusions have dominated pediatric writing through present era. In recent years, however, a number of reports have appeared in the medical literature that have suggested that careful investigation of children with RAP may reveal previously unsuspected functional or morphologic abnormalities of the gastrointestinal tract. These have included reports of peptic disease and Helicobacter Pylori infection, abnormal antro-duodenal motility, lactase malabsorption, gastro-esophageal reflux. Nevertheless these abnormalities cannot be correlated always with specific complaints. Therefore pathogenetic background is not clarified. Despite greater understanding of these disorders the enigme remains. There is a need for controlled studies in non selected patients.     

Cytomegalovirus viremia: risk factor for allograft cirrhosis after liver transplantation for hepatitis C

BACKGROUND: Despite recent advances in diagnosis and treatment, cytomegalovirus (CMV) infection continues to be a common cause of morbidity in liver transplant (LT) recipients. Because CMV infection suppresses cell-mediated immunity, which seems to be important in neutralizing hepatitis C virus (HCV) infection, we assessed the impact of CMV infection on histopathological HCV recurrence after LT. METHODS: The study group was comprised of 43 consecutive LT recipients with at least 6 months of histologic follow-up. Group 1 consisted of the 8 patients who developed CMV viremia after LT; group 2 comprised the 35 patients without CMV viremia. There was no significant difference with regard to age, initial immunosuppression, incidence of rejection, distribution of HCV genotypes, or mean follow-up between the groups. Semiquantitative histopathologic assessment of allograft hepatitis was performed using the Knodell's score. RESULTS: The mean total Knodell score of the final allograft biopsy was significantly greater in group 1 patients (P=0.016), with most of the difference due to periportal/bridging necrosis (P=0.009) and lobular activity subitem (P=0.01) scores. Half of the CMV viremic patients eventually developed allograft cirrhosis as compared with 11% of the CMV-negative patients (P=0.027). Accordingly, the cirrhosis-free actuarial survival by Kaplan-Meier estimates was significantly diminished in the CMV viremic patients. Glycoprotein B genotype analysis of CMV isolates revealed no significant differences between patients who did and those who did not develop allograft cirrhosis. CONCLUSIONS: After LT for chronic HCV, patients who develop CMV viremia incur a significantly greater risk of severe HCV recurrence.     

Prognostic value of progressive decrease in serum cholesterol in predicting survival in Child-Pugh C viral cirrhosis

BACKGROUND: The identification of cirrhotic patients with low life expectancy is an open clinical problem. Hypocholesterolemia is frequently found in severe chronic hepatic insufficiency because the liver is the most active site of cholesterol metabolism, but poor information is available on its precise prognostic value. We evaluated the prognostic role of hypocholesterolemia in patients with advanced liver cirrhosis. METHODS: Serial serum cholesterol concentrations of 34 patients with virus-induced cirrhosis, from the first appearance of Child-Pugh class C to death, were considered. To compare survival functions, we established three base-line cholesterol cut-off points (150, 125, and 100 mg/dl) and stratified patients into groups A and B, with base-line cholesterol levels lower and higher than each cut-off value, respectively. RESULTS: Cholesterolemia decreased progressively in all patients. At the 100 mg/dl cut-off point all group-A patients died within 17 months, whereas 75% of group-B patients were alive at 24 months (P < 0.0001). Moreover, cholesterolemia was significantly correlated with cholinesterase, indirect bilirubin, and total bilirubin at entry time and immediately before death. No correlation was observed between cholesterol and these variables when stratified for the Child-Pugh score. CONCLUSIONS: Base-line serum cholesterol levels lower than 100 mg/dl identify a subgroup of Child-C cirrhotic patients with high mortality risk within a 2-year follow-up. The prognostic importance of cholesterolemia may also be deduced by the significant correlation with other well-established indicators of survival.     

The role of hepatitis C virus specific CD4+ T lymphocytes in acute and chronic hepatitis C

Since the discovery of hepatitis C virus it has become clear that chronic hepatitis C is a major health problem throughout the world. Because antiviral agents are of limited value in the treatment of chronic hepatitis C, research has focused on the antiviral immune response for the development of both a protective vaccine and effective immunotherapies for established chronic infection. Antiviral antibodies are present in almost all patients with chronic hepatitis C but do not seem to be virus neutralizing, probably due to the high mutational rate of viral envelope proteins. Studies on the antiviral T cell response have revealed the presence of virus-specific CD4+ helper and CD8+ cytotoxic T cells in a substantial proportion of patients with chronic hepatitis C. Recent studies describe an association between strong CD4+ T helper cell activity to certain hepatitis C virus antigens and a self-limited course of acute hepatitis C and possibly also a sustained response to treatment with interferon-alpha. Therapeutic manipulation of the virus-specific T cell response may thus develop into a new approach for prevention and treatment of hepatitis C virus infection.     

Transmission of hepatitis C virus in allografted patients: use of viral genotyping as an epidemiological marker

One hundred and ninety-two allografted patients were tested for hepatitis C virus (HCV) RNA from 1992 to 1995 in Saint-Louis Hospital (Paris). They received blood products and intravenous immunoglobulins (IVIG) and more particularly Gammagard IVIG suspected of transmitting HCV (batches distributed in France between January 1993 and February 1994). The presence of serum HCV RNA was tested by polymerase chain reaction (PCR) in 86 patients who received Gammagard IVIG during the critical period and in 106 patients treated with IVIG other than the suspected batches of Gammagard (negative controls). HCV RNA positive sera were HCV genotyped. Ten out of 86 patients who received Gammagard IVIG during the exposed period vs 0 out of 106 negative controls were HCV RNA positive showing a higher prevalence of HCV infection in the exposed patients that in the negative controls (P = 0.001). The link between HCV transmission and IVIG infusion was reinforced by the high frequency of genotype 2b (70%) in the exposed patients because genotype 2b is an underrepresented subtype in France (< 1%).     

Assisted reproduction and viral hepatitis: the virologist's viewpoint

Medical assistance to procreation in a couple with one of the parents having viral hepatitis raises the issue of the transmission of infection to the baby and of possible contaminations of gametes from virus-free parents in the laboratory. Today, the main problems are linked to hepatitis B and C viruses, which induce chronic disease transmissible to the baby and can be transmitted through laboratory contaminations.     

Repair processes in the liver in viral hepatitis

Reparative processe were studied on bioptic specimens taken from 190 patients with virus hepatitis. Figures of nitosis, amounts of binuclear and polyloid hepatocytes served as criteria of regneration. Phenomena of regeneration were shown to continue during the entire period of the disease. They were most pronounced in the areas adjacent to the zone of lesion of the parenchyma. A leading reparative process was intracellulr regneration.