Chronic hepatitis C infection. With special reference to prevalence, aggravating factors and longterm outcome

Since the discovery of hepatitis C virus (HCV) in 1989, it has proved to be a formidable health problem with a major impact on morbidity and mortality throughout the world. In this investigation, patients with chronic hepatitis C infection have been studied with special reference to prevalence, aggravating factors and longterm outcome. The prevalence of HCV infection was high (approximately 10 %) among patients assessed because of chronic liver disease. Although most patients were asymptomatic at entry, the majority of liver biopsied patients with HCV infection manifested histological changes such as CPH, CAH and cirrhosis. A parenteral route of HCV transmission was established in the majority of anti­HCV positive patients, and the frequency of community acquired chronic hepatitis C was low. Non-invasive assessment to predict histological grade and stage appears to be of limited value. Individual test results were characterized by considerable overlap between the histological groups, and PIIIP, CL­IV and IgG seem to be nonspecific correlates of histological activity. The rate of development of severe liver disease among HCV positive patients appears to be dependent both on endogenous and exogenous factors. Alcohol abuse and ACT deficiency were both independent risk factors for the development of cirrhosis. A high proportion of HCV infected individuals are at serious longterm risk of severe or fatal illness. During a median followup time of 10 years, more than 60 % of the deceased HCV positive patients developed cirrhosis, and approximately 30 % had concomitant HCC

Partial splenic embolization as pretreatment for antiviral therapy in hepatitis C virus infection

Antiviral therapy in hepatitis C virus (HCV) infection is limited by haematological side-effects, especially thrombocytopenia and leucopenia. The pancytopenia associated with liver cirrhosis has multifactorial causes, but hypersplenism seems to be a major contributor, especially regarding thrombocytopenia. The use of PSE as a 'Pretreatment' in order to make more patients with HCV-induced cirrhosis and pancytopenia suitable for antiviral therapy using ribavirin and pegylated interferon is a new, promising concept. The setting needs further investigation in prospective, longitudinal studies, in order to evaluate safety, define patient selection criteria, the timing between the PSE procedure and the antiviral therapy and to evaluate the long-term results. The setting needs further investigation in prospective, longitudinal studies, in order to evaluate safety, define patient selection criteria, the timing between the PSE procedure and the antiviral therapy and to evaluate the long-term results

Prevalence of hepatitis C in Swedish diabetics is low and comparable to that in health care workers.

OBJECTIVES: An association between hepatitis C virus (HCV) infection and diabetes has been reported, in particular from countries with a high prevalence of HCV. To assess if this association could be found in a region with low prevalence of HCV (0.33%), we determined the prevalence of anti-HCV in a large cohort of patients with diabetes. METHODS: The prevalence of anti-HCV was determined with an enzyme-linked immunosorbent assay in 874 patients with diabetes representing 72.5% of a total research cohort of 1205 patients who were invited to participate. The results were confirmed with immunoblot. Samples from confirmed patients were tested for HCV RNA and genotyped. RESULTS: In 499 patients with type 1 diabetes and 375 patients with type 2 diabetes six patients were anti-HCV positive (four with type 1 diabetes and two with type 2 diabetes corresponding to a prevalence of 0.80 and 0.53%, respectively, in accordance with the prevalence among health care workers in Sweden; 0.68%). Liver biopsies in three of the patients showed only mild inflammation without fibrosis and in two of the other three the albumin and/or PT-INR level was normal contradicting any substantial impairment of the liver function. CONCLUSIONS: The low anti-HCV prevalence that we found contradicts an etiologic role of HCV in the development of diabetes in Sweden. The risk of being infected with HCV when attending the health care system seems to be rather small in a low-prevalence area

Wetboek van Strafrecht van Curacao

This book contains the complete Criminal Code of Curacao and its Memorandum of Explanation. The practical use of this book is highly improved by adding Commentaries to the official articles. The book can be considered as the main guide for professionals and educational purposes

The clinical importance in differentiating portal from mesenteric venous thrombosis.

To relate the extent of portomesenteric thrombosis to the risk of intestinal infarction, concomitant venous thromboembolism and underlying diseases

High sustained response rate in patients with histologically mild (low grade and stage) chronic hepatitis C infection. A randomized, double blind, placebo controlled trial of interferon alpha-2b with and without ribavirin.

OBJECTIVE : To evaluate the efficacy and safety of therapy for patients with histologically mild hepatitis C virus (HCV) liver disease. DESIGN : A randomized, double blind, placebo controlled trial of interferon alpha-2b with or without ribavirin. SETTING : Regional and university hospitals. PARTICIPANTS : One hundred and sixteen treatment naive patients with mild chronic HCV infection. Mild HCV infection was defined according to Knodell as a grade score of >/= 1 and </= 6 and a stage score of </= 1. INTERVENTIONS : Interferon alpha-2b (3 MU three times weekly) for 52 weeks in combination with either ribavirin or a matched placebo. MAIN OUTCOME MEASURES : The study endpoint was the absence of HCV RNA in plasma and liver tissue 26 weeks post-treatment. In addition, liver histology was compared pre- and post-treatment. RESULTS : Combination therapy was superior to interferon monotherapy, with a virological sustained response rate of 54% (31/57) and 20% (12/59), respectively, in both serum and liver tissue (P = 0.001). The sustained response rate was higher with combination therapy than monotherapy both in genotype non-1 (81% vs 36%) and in genotype 1 (28% vs 4%). There was a significant improvement in mean grade score in all sustained responders, irrespective of treatment arm. CONCLUSION : Combination therapy with interferon and ribavirin was safe and as effective in patients with histologically mild HCV infection as previously reported for more advanced disease