Dario Ierna

Controlled clinical trial to assess the response of recent heroin abusers with Chronic hepatitis C virus infection to treatment with interferon alpha-n2b

BACKGROUND Chronic infection with hepatitis C virus (HCV) is the most common infectious disease among heroin abusers, but it is recommended that specific treatment with interferon be delayed until at least 6 to 12 months after the end of drug addiction. OBJECTIVE We investigated the response of heroin abusers to interferon treatment shortly after the end of detoxification treatment with methadone. METHODS We studied 2 homogeneous groups of white Italian patients with chronic HCV infection: former male heroin abusers and males without a history of drug addiction. Tumor necrosis factor, interleukin-1beta, interleukin-2, activated monocytes, anti-HCV antibodies, HCV RNA, and alanine aminotransferase levels were assessed. Standard treatment was initiated with 5 MU interferon alpha-n2b administered subcutaneously once daily for 8 weeks. Patients with negative HCV-RNA findings at the end of 8 weeks received further treatment with 5 MU TIW subcutaneously for an additional 48 weeks. RESULTS Thirty of 47 patients in group A (former heroin abusers) and 30 of 30 patients in group B (controls) completed the study. Heroin abusers presented a significantly enhanced response to treatment compared with the controls. After 8 weeks, HCV-RNA test results were negative in 27 of 30 patients in group A (90.0%) and in 25 of 30 in group B (83.3%) (P = NS). Onset of relapse occurred significantly later in heroin abusers (mean [SD], 53 [3] weeks) than in controls (26 [2] weeks) (P < 0.05). Cytokine levels and activated CD11 antigen-expressing monocytes were significantly (P < 0.001) higher in heroin abusers than controls. CONCLUSION Heroin abusers with chronic HCV infection were successfully treated with interferon alpha-n2b soon after the end of detoxification treatment.

Duration of menopause and behavior of malondialdehyde, lipids, lipoproteins and carotid wall artery intima-media thickness

AIM our study assessed whether minor or major hormonal deficiency influenced oxidative status and vascular wall structure in menopausal women. METHODS the study series was made up of 62 non hypertensive non diabetic menopausal women (mean age 52.3+/-4.7 years) divided into two groups depending on duration of menopause (group 1 duration 0-5 years; group 2 duration over 5 years). Total cholesterol (TC), LDL cholesterol (LDL-C), HDL-cholesterol (HDL-C), triglycerides (TG), malondialdehyde (MDA) and common carotid artery wall intima-media thickness (IMT) were determined in the entire series. RESULTS mean TC, LDL-C, TG, MDA and IMT values were higher in group 2 than group 1. The intergroup difference between MDA (P<0.007) and IMT values (P<0.006) values was statistically significant. CONCLUSIONS the study revealed a close temporal correlation between plasma oxidative stress and carotid wall IMT, jeopardizes vascular wall status as menopause proceeds.

Hyde's prurigo nodularis and chronic HCV hepatitis

The authors describe a woman with chronic active hepatitis, Hydes prurigo nodularis and hepatitis C virus infection. The association of these three pathologies and their parallel evolution during treatment suggest a possible pathogenic link between the chronic hepatitis C virus infection and the skin disease.

Perihepatic lymphadenopathy in chronic hepatitis C: A complementary diagnostic element?

Background and Aims : The authors searched for perihepatic lymph nodes during ultrasonography performed for other symptoms in 1222 Sicilian outpatients in order to assess the incidence and possible significance of the association of perihepatic lymph nodes and chronic hepatitis C.

Oxidative stress and endothelial damage in patients with asymptomatic carotid atherosclerosis.

Abstract It is know that oxidative stress can be able to induce cytotoxicity of blood cells, stimulate release of inflammatory cytokines, and induce the production of growth factors. The aim of this study was to investigate oxidative stress and endothelial dysfunction in patients with asymptomatic carotid artery disease and healthy controls. Native low-density lipoproteins, oxidised low-density lipoproteins, malondialdehyde, nitrates, glutathione peroxidase activity and endothelin-1 were determined in patients without severe (range between 30% and 50%) carotid artery stenosis. Native low-density lipoproteins, oxidized low-density lipoproteins, malondialdehyde, glutathione peroxydase, and endothelin-1 concentrations were higher in patients than in health controls (P<0.001). No difference was observed in nitrate values (P<0.8). Our results revealed oxidative stress in patients without severe carotid artery stenosis and clinical symptoms. This was shown by the elevated malondialdehyde and oxidized low-density lipoprotein levels.

Can ultrasonographic findings of perihepatic lymphadenopathy promote investigations to detect possible presence of virus C infection in non-symptomatic subjects?

PURPOSE: Only early detection of non-symptomatic patients is able to arrest the diffusion of the non-symptomatic HCV infection and lead to prompt treatment. Our aim was to attempt to correlate the presence of perihepatic lymph nodes and hepatitis C infection and to assess whether ultrasonography can have a role to promote specific investigations for pre-clinical diagnosis of virus C infection. METHOD: We performed a controlled study on a cohort of 7974 subjects from a town of 27000 inhabitants on the eastern coast of Sicily. Serologic hepatitis A, B and C markers, alanine aminotransferase levels and abdominal ultrasound examination according to size and number of peri-hepatic lymph nodes were performed on blind basis. RESULTS: One or more pathological lymph nodes were present in 684/7974 subjects. Haematochemical tests revealed the presence of anti-HCV positivity in 528/684 subjects with pathological lymph nodes and in 8/7290 subjects without pathological lymph nodes, there being a significant difference (P<0.0001) between the two groups. CONCLUSION: Our results confirm the association between perihepatic lymph nodes and virus C infection. Correct diagnostic assessment of this datum could lead not only to early diagnosis by specific blood test for HCV and consequent prompt aimed treatment, but could pave the way for efficacious territorial prevention and detection of an elevated percentage of likely non-symptomatic carriers.

Role of Ademetionine (S-Adenosylmethionine) in Cyclosporin-Induced Cholestasis

AbstractObjective: To determine the efficacy of ademetionine (S-adenosylmethionine, SAME) administration in preventing hepatotoxicity in patients undergoing long-term cyclosporin treatment. Design: Randomised, controlled, double-blind trial followed up for 3 months. Setting: Subjects were studied for a period of 10 days in hospital and then followed up in the outpatient unit for 3 months. Patients: 72 male patients with psoriasis, of whom 36 were treated with cyclosporin and 36 with cyclosporin plus ademetionine. Interventions: Cyclosporin treatment alone (10 mg/kg/day) was compared with treatment with the same dosage of cyclosporin in combination with ademetionine 400 mg/day. Main outcome measures: Serum fractioned bilirubin, γ-glutamyltransferase, alkaline phosphatase and transaminases, plasma malondialdehyde and 4-hydroxynonenal, and erythrocyte glutathione peroxidase were determined. Results: Hepatotoxicity and cholestasis were observed in 15 of 36 patients treated with cyclosporin alone, whereas no cases of liver cytotoxicity were observed in the group treated with cyclosporin in combination with ademetionine (p < 0.005). Moreover, the study results revealed a significant difference in oxidation-reduction balance between the two groups, with more marked oxidative stress in patients on cyclosporin alone. Conclusions: Ademetionine may protect the liver against potentially hepatotoxic substances, such as cyclosporin, and coadministration of ademetionine should therefore be considered when hepatotoxic drugs are used.

A hyperdynamic portal syndrome with ascites after endoscopic laser treatment

Laser therapy has gained wide acceptance and application in many medical disciplines. Side effects of laser therapy are rare and the most frequent mainly involve the skin. We describe a patient affected by familial adenomatous polyposis that had been repeatedly controlled and treated endoscopically using an Nd:Yag laser. He presented with a progressive hyperdynamic portal syndrome with ascites caused by some arterovenous fistulas. We hypothesize that a rare side effect of the laser treatment may have caused ischemic and coagulative tissue inflammation that triggered off the pathological communications between the arterial and portal circulation.