Esin Özyilkan

Increased prevalence of hepatitis C virus antibodies in patients with diabetes mellitus

DEAR SIR, hyperglycaemia and glucose intolerance are frequently observed in patients with chronic liver disease [l. 21. Taliani et al. [3] found the prevalence of diabetes mellitus to be 18.7% amongst patients with chronic hepatitis C virus (HCV) infection. In this study, we investigated hepatitis virus markers in 100 patients with diabetes mellitus. One hundred patients (42 men and 58 women) with diabetes mellitus diagnosed by conventional criteria [4] were studied. Their mean age was 50 (range 20-75) years and mean duration of diabetes was 8.1 (range 6 months-27) years. Twenty-five patients with type 1 diabetes were treated with insulin. Of the 75 patients with type 2 diabetes, 22 received insulin injections and 53 were on oral hypoglycaemic agents or special diet. Hepatitis B surface antigen (HBsAg) and immunoglobulin G antibody to hepatitis B core antigen (anti-HBc) were detected using enzyme-linked immunosorbent assays (ELISA) (Institut Pasteur, Paris, France). HCV antibody (anti-HCV) was detected by second-generation ELISA (Abbott Laboratories) and the positive results were confirmed by recombinant immunoblot assay (RIBA 11) (Ortho Diagnostic). The results were compared using the chi-squared test with Yate’s

Ceruloplasmin Level in Women with Breast Disease Preliminary Results

The average ceruloplasmin levels of 29 patients with active breast cancer and 22 patients in remission were 824 +/- 61 mg/l and 630 +/- 18 mg/l respectively. The average ceruloplasmin level of 17 patients with benign breast diseases was 555 +/- 29 mg/l and of 18 healthy women in a control group 584 +/- 17 mg/l. Breast cancer patients not in remission had ceruloplasmin levels which were significantly increased when compared to the other 3 groups. The CA 15-3 levels and ceruloplasmin levels were positively correlated. We propose that ceruloplasmin may be used as a tumour marker in the follow-up of patients with breast cancer.

Interleukin-1β in chronic hepatitis C virus infection

cillin, 500 mg/8 hr + ciprofloxacin, 200 mg/12 hr), so that, at the fifth day the patient began to eat a normal diet. Coproculture (obtained at admission) was positive for Salmonella sp. The following day, however, the patient complained of right upper abdominal pain, and fever persisted. The Murphy sign was positive. Laboratory evaluation at this time revealed 21,300 leukocytes/mm, ASAT 24 units/ liter, ALAT 26 units/liter, alkaline phosphatase, 336 units/liter, and GGT 44 units/liter. An ultrasound scan revealed a moderately dilated gallbladder without stones and a thickened wall. A gallbladder nuclear scan showed nonvisualization of the gallbladder, consistent with acute cholecystitis. The clinical picture slowly improved during the following days until hospital discharge on the fourteenth day after admission. The patient remains doing well on further ambulatory control. Although acute cholecystitis is a frequent complication of typhoid fever and other Salmonella infections, it almost always occurs in the presence of morphological anomalies of the biliary tract and/or gallbladder stones (5). As in the case described by Avalos et al, our patient presented with complaints attributable to acute gastroenteritis, and signs and symptoms derived from biliary disease appeared a few days later. The few reported cases of acute acalculous cholecystitis due to Salmonella precludes the existence of a standard therapy for them. For chronic carriers without stones, a six-week course of oral antibiotherapy has been recommended (6, 7); the patient of Avalos et al was treated with an l 1-day ampicillin course; other cases have been subjected to cholecystectomy (2); our patient completed a 25-day course of ciprofloxacin, remaining asymptomatic afterwards. In summary, the present report adds a new case to the short number of patients affected by this entity. P. GARRIDO-BENEDICTO E. GONZALEZ-REIMERS F. SANTOLARIA-FERNANDEZ F. RODRfGUEZ-MORENO Dpt. de Medicina Interna Hospital Universitario de Canarias La Laguna, Tenerife, Canary Islands, Spain

Prevalence of Antibodies to Hepatitis C Virus Among Turkish Patients with Chronic Liver Disease

DEAR SIR. in a recent article, Verbaan et al. in the July 1992 issue reported that the prevalence of antibodies against hepatitis C virus (anti-HCV) was 13.8% in 566 patients undergoing liver biopsy during a 10year period [ 11. In Turkey, hepatitis B virus (HBV) had been found to be the main aetiologic agent of chronic liver diseases [2, 31. Hepatitis C virus (HCV) has been identified as the major agent of blood-borne non-A non-B hepatitis, and circulating antibodies to HCV have been found to reflect persistent infection [4]. In the present study, we investigated HBV and HCV status in patients with chronic liver disease seen in the period 1990-1992. HCV antibody was detected by second generation enzyme-linked immunosorbent assay (ELISA) (Abbott Laboratories). The positive results were confirmed by recombinant immunoblot assay (RIBA 11). (Ortho Diagnostic). Histologic diagnosis was obtained in all patients with chronic hepatitis and 80 patients (86.9%) with cirrhosis. In the remaining 12 patients (1 3.1 %) with cirrhosis biopsy was contraindicated or refused. The results were compared using the chi-squared test with Yates correction and Students t-test as appropriate. There were 136 male and 69 female patients with a mean age of 42.3 years (range 17-70). Of the 205 patients, 68 (33.1 %) had evidence of HCV infection, a level higher than the percentage of 0.3 % reported for blood donors in Turkey [ 51. This prevalence was higher than the frequency found in Verbaan et al. [ 11 series and similar to the prevalence of 38.8 %reported by Gessoni et al. [6]. In our study, 108 patients (52.6%) were positive only for hepatitis B surface antigen (HBsAg) and 1 5 patients (7.3 %) had both HBsAg and anti-HCV in their serum. The prevalence of HBsAg in our series was higher than the percentage of 1 .5 %-1 4.5 % reported in the literature [ 1, 71. Fourteen patients were negative for markers of both HCV and HBV infections. Fifteen patients were in the miscellaneous group (9 alcoholic, 2 autoimmune, 2 metabolic liver diseases and 2 primary biliary cirrhosis) and none of them were found to be anti-HCV positive. The comparison of patients who were anti-HCV negative with those who were positive is summarized in Table 1. There was no difference in respect to age and sex, (P > 0.05), in disagreement with Verbaan et al. [ 11 series where they found antiHCV positive patients were younger and male/female ratio was higher. A history of known parenteral exposure was more frequent among anti-HCV positives (64.7%) than among anti-HCV negatives (13.8%, P -= 0.0001). Verbaan et al. [ l ] only compared the history of previous surgery and found that prior operation accounted for 37.2% of HCV infections. The higher frequency in our study may be due to the involvement of patients with history of blood transfusion without surgery. In contrast to their study [ l ] , history of hepatitis was more frequent among anti-HCV negatives (21.8 %) than among anti-HCV positives (5.8%, P = 0.0037). Liver histology showed chronic persistent hepatitis (CPH) in 33 patients (16.1 %), chronic active hepatitis (CAH) in 80 (39.0%). Cirrhosis was diagnosed in 92 patients (44.9%) (in 12 patients diagnosis was based on the presence of esophageal or gastroesophageal varices, utrasonographic findings of portal hypertension, splenomegaly. and ascites). In contrast to the lack of difference in the anti-HCV prevalence in groups in relationship to cirrhosis in Verbaan al. [ 11