The severity and activity of liver disease in chronic hepatitis C infection

Infection with hepatitis C virus (HCV) is the cause of 90% of cases of non -A, non -B hepatitis. Chronic HCV hepatitis is at least initially an asymptomatic illness, but a proportion of patients will develop symptomatic, complicated disease. The most common complications are hepatic cirrhosis and hepatocellular carcinoma (HCC); presently it is unclear whether all infected patients will develop these complications.AIMS OF THE THESIS There were two main aims. Firstly, to assess the clinical significance of staging investigations; in particular the significance of molecular virological investigations in terms of disease diagnosis and prognosis. The role of non- invasive investigations in staging the disease process was also considered. Secondly, to assess the impact of chronic hepatitis C infection was assessed in two populations; patients diagnosed as having hepatocellular carcinoma and those immunocompromised by chronic HIV infection.MATERIALS AND METHODS A well characterised Scottish population of over 200 HCV infected patients was examined in detail to define the clinical significance and interpretation of serum 17 and intrahepatic hepatitis C virus levels, particularly in the context of biochemical, epidemiological, virological and histological parameters. The role of two non -invasive investigations in predicting the presence of hepatic cirrhosis was also assessed in these patients; firstly, a serum marker of perisinusoidal fibrosis, hyaluronic acid, and secondly, artificial neural network analysis of host and virus parameters.Further, the impact of chronic HCV infection on two independent populations of patients was considered. Firstly, a population of 202 patients concurrently infected with the human immunodeficiency virus was examined in terms of clinical and immunological progression of disease. Secondly, the impact and association of chronic hepatitis C infection on the development of hepatocellular carcinoma in patients in Lothian (an area of low risk for the disease) over 10 years was investigated and compared with HCC associated with chronic HBV infection.RESULTS In the Scottish population studied, both serum and intrahepatic virus levels were not determined by host factors (age of patient, mode or duration of infection) or by virus factors (HCV genotype). Likewise, there was no correlation between serum and liver HCV RNA levels demonstrated; however, these data did demonstrate that repetitive negative RT -PCR for HCV RNA in serum did not indicate absence of HCV from the liver. Pilot studies of the two non- invasive investigations, serum hyaluronic acid and ANN in this population showed both to be reliable in predicting the presence of hepatic cirrhosis.Amongst the intravenous drug abusers with chronic HIV infection, HCV did not influence either the clinical progression of HIV disease to AIDS and it was not associated with a more rapid immunological decline. Chronic HCV infection was identified as a major risk factor for the development of hepatocellular carcinoma.CONCLUSIONS Molecular virological staging investigations should be interpreted with caution in chronic HCV infection; their most significant role is likely to be the initiation and monitoring of therapy rather than the inference of disease prognosis. Non -invasive investigations of hepatic cirrhosis are likely to be useful tests to monitor disease progression especially when a liver biopsy is contraindicated, although they should be first validated in larger, well described populations

Singers and Jazz Instrumentalists As Interpreters of the Popular Song

Dr. Haydon will look at America\u27s Golden Age of Popular Music with a sampling of songs from some of the great songwriters and lyricists of the 1920\u27s, 30\u27s, 40\u27s and 50\u27s. Selections will include but not be limited to Cole Porter, Irving Berlin, Fats Waller, Duke Ellington, George and Ira Gershwin, Richard Rodgers and Lorenz Hart/Oscar Hammerstein II, Jerome Kern, Harold Arlen, Johnny Mercer. We will look at how singers use both the music and lyric to interpret these songs. Then we will discuss how jazz musicians have adopted the same repertoire using it as a vehicle for their own creative aspirations

Symptomatic portal biliopathy:a single centre experience from the UK

BACKGROUND AND METHODS: Biliary obstruction as a consequence of portal biliopathy, because of extrahepatic portal vein occlusion is an uncommon cause of biliary disease in the western world. We reviewed all patients presenting to the Regional Liver Transplant Unit in Birmingham, UK with symptomatic portal biliopathy between 1992 and 2005 and report the presentation, investigation, management and outcome of these complex patients. RESULTS: Thirteen patients with symptomatic portal biliopathy were followed up for a median of 2 years (range 1-18 years). Jaundice was the presenting feature in all cases and was associated with bile duct stones or debris in 77% (10 of 13) of cases. Successful treatment of biliary problems was achieved by biliary decompression in six cases (metallic stent=three, plastic stent=one, combined procedure=one and sphincterectomy=one) and portal decompression in three cases (transjugular intrahepatic portosystemic shunt=two, meso-caval shunt=one). Successful biliary drainage could not be achieved endoscopically or by portal decompression in one case that was accepted for combined liver and small bowel transplantation. Three patients had spontaneous resolution without recurrence over the follow-up period. Ten patients (77%) experienced gastrointestinal bleeding. Two deaths over the follow-up period occurred; both were associated with portal hypertensive bleeding. CONCLUSION: Endoscopic management (sphincterectomy and stone extraction or stent insertion) is effective initial therapy for patients with symptomatic portal biliopathy. In the case of persistent biliary obstruction porto-systemic shunting (transjugular intrahepatic portosystemic shunt or surgical) should be considered, however, the extent of vascular thrombosis precludes this in most cases