Federico Miglio

Serum Pancreatic Enzyme Concentrations in Chronic Viral Liver Diseases

Serum amylase and lipase concentrations weredetermined in 78 patients with chronic liver diseases[26 chronic active hepatitis (CAH) and 52 livercirrhosis] and in 15 healthy subjects. Pancreaticisoamylase concentrations and macroamylase complexes wereassayed in hyperamylasemic sera. Serum amylase levelswere abnormally elevated in 27 patients (35%; 22 livercirrhosis, 5 CAH), whereas serum lipase levels were elevated in 16 patients (21%; 15 livercirrhosis, 1 CAH). In 9 of the 27 hyperamylasemicpatients, the hyperamylasemia was of pancreatic type.Macroamylasemic complexes were not detected inhyperamylasemic sera. Patients with liver cirrhosis had serumlevels of amylase and lipase significantly higher thanboth the healthy subjects and the patients with CAH,while no significant differences were found in serum levels of these enzymes in patients with CAH ascompared to the healthy subjects. A decreased livermetabolism of serum amylase and lipase in patients withchronic infective liver disease, especially in those having liver cirrhosis, may lead to anaccumulation of these enzymes in the blood.

Hepatocellular carcinoma: Prognostic factors and survival analysis in 135 Italian patients

This is a retrospective study to evaluate the history of hepatocellular carcinoma and find the relationship between clinical, biochemical and ultrasonographic features and survival in Italian patients. In 135 consecutive patients median follow-up was 16 months (range 1-66 months) and median survival from the time of diagnosis was 12 months. Univariate analysis showed that individual variables associated with significantly decreased survival included: absence of therapy, Okudas Stage III, Child-Pughs Class C, alpha-fetoprotein greater than 400 ng/ml, presence of symptoms, moderate or severe ascites, tumor involving both lobes, mixed internal echo pattern, and multinodular or massive type. Multiple regression analysis (Cox model) revealed that the mixed internal echo pattern of hepatocellular carcinoma, the presence of moderate or severe ascites and Okudas Stage III were independent predictors of high risk of death. These data can help in selecting patients whose probability of survival is considered high enough to undergo treatment and may be useful for stratifying patients in randomized controlled trials.

Seroprevalence of hepatitis A virus and Helicobacter pylori infections in the general population of a developed European country (the San Marino study): evidence for similar pattern of spread.

Objective: To evaluate the role of faecal‐oral transmission in the spread of Helicobacter pylori. Design: A cross‐sectional comparison of the patterns of hepatitis A and H. pylori seropositivity. Methods: At interview, blood samples and questionnaire data were collected from a random sample of 1528 healthy subjects aged 20‐85 years from the Republic of San Marino. Serum samples from each subject were then tested for anti‐H. pylori and anti‐hepatitis A antibodies. Results: Overall, 529 of 670 H. pylori‐seropositive subjects (78.9%) and 460 of 858 H. pylori‐seronegative subjects (53.6%) were hepatitis A seropositive (P<0.01; odds ratio=3.2; confidence interval 95%=2.6‐4.1). This association remained after adjustment by a multiple logistic regression analysis for the confounding effect of age and length of schooling, as surrogate for socio‐economic status (OR=2.0; CI 95%= 1.3‐3.3). The agespecific prevalence curves for H. pylori and hepatitis A infections showed a parallel increase by age, although to a lesser extent for H. pylori. Conclusion: These findings provide evidence that in the community studied H. pylori may have spread in a manner similar to that of hepatitis A.

Expression of major histocompatibility complex class II antigens on bile duct epithelium in patients with hepatic graft-versus-host disease after bone marrow transplantation

We studied the expression of major histocompatibility complex (MHC) class II antigens in liver biopsies taken from ten patients with clinical and biochemical evidence of liver damage after bone marrow transplantation. In all six patients who had histologically confirmed graft-versus-host disease, MHC class II antigens were detected on intrahepatic bile ducts. In four patients with no histological features of graft-versus-host disease, MHC class II antigens were not detected. In controls, a positive reaction for bile duct MHC class II antigens was only detected in the patients with primary biliary cirrhosis. Characterisation of the lymphocytes surrounding the bile ducts showed a prevalence of Leu 3+ cells in graft-versus-host disease and primary biliary cirrhosis. We propose that the aberrant expression of class II antigens on bile duct epithelium cells may play a role in the pathogenesis of graft-versus-host disease. A similar pattern in primary biliary cirrhosis may suggest a common pathogenetic mechanism.

Acute liver injury related to the use of niperotidine

BACKGROUND/AIMSnH2-receptor antagonists are widely used for the therapy of peptic disease, since they ensure a protracted and intense inhibition of gastric acidity. Niperotidine (piperonyl-ranitidine) is a new H2 blocking agent recently proposed for clinical use.nnnMETHODSnTwenty-five cases of acute hepatitis associated with the use of niperotidine were reported in Italy between March and August 1995. Intercurrent viral infections, recent drug and alcohol consumption and blood transfusions were excluded as causes.nnnRESULTSnAll patients showed an increase in the parameters of liver cell injury and the clinical symptoms of acute hepatitis. After withdrawal of the drug, all patients showed a good outcome, except one who developed a fulminant hepatitis and died from digestive tract bleeding.nnnCONCLUSIONSnThe absence of other causes of acute liver injury suggests that the observed liver injury may be a niperotidine-adverse reaction. Moreover, the lack of a relationship between the dose of the drug and the degree of liver damage, the variable latent period and the rarity and unpredictability of the injury are suggestive of an idiosyncratic reaction.

Population-based survey of hepatitis A virus infection in the Republic of San Marino

In 1990–1991, the prevalence of antibodies to hepatitis A virus infection (anti-HAV) was assayed by the ELISA method among 1528 apparently healthy subjects, 20–85 years old in the Republic of San Marino. Subjects were selected from the list of residents by a random stratified sampling procedure with a proportional allocation by age, sex and district of residence. The overall anti-HAV prevalence was 64.7%; it increased from 28.6% in subjects 20–30 years old to 97% in those > 60 years (p < 0.01). No gender difference was observed. At the multivariate analysis age > 40 years (OR: 39.5; 95% CI: 12.4–126) and lowest level of schooling (OR: 1.8; 95% CI: 1.1–2.9), which is a good indirect indicator of socio-economic status, resulted both independent predictors of anti-HAV seroposi-tivity. These findings reflect the improved sanitation standards in this area and indicate that the proportion of non-immune adults is increasing with a higher risk of symptomatic infection in the near future.

Rhabdomyolysis and acute pancreatitis

Aims: To establish the incidence of rhabdomyolysis in patients with acute pancreatitis and to determine the effectiveness of myoglobin in assessing the severity of the disease.

Hepatitis B Virus Markers in Hematologic Patients: Relation to Transfusion Treatment and Hospitalization

Abstract. Screening tests for hepatitis B virus (HBV) markers were performed in 266 hematologic patients in order to evaluate the role of transfusion therapy in HBV infection and to identify other possible causes of the high rate of HBV markers positivity in onco‐hematologic units. As control groups we tested 99 nonhematologic polytransfused patients, 66 nonhematologic, nontransfused inpatients with various diseases and 72 subjects randomly selected from the general population. Higher HBV markers prevalence was found in hematologic patients, nonhematologic polytransfused patients and nonhematologic, non‐transfused inpatients than in the general population. HBV markers prevalence correlated with the length of hospitalization in all inpatients studied. Our data suggest that hospital admission is a major factor in HBV transmission in hematologic patients and in other inpatients studied. Blood transfusions represent a risk factor only when utilized as chronic treatment.

Immunological Studies of the Jejunal Mucosa in Normal Subjects and Adult Celiac Patients

The density of the three principal immunoglobulin containing cells (IgA, IgM, IgG) in the human jejunal mucosa was determined in eight adult celiac patients and in eight subjects without any gastrointestinal abnormalities, using immunofluorescent techniques. A statistical comparison of the results showed a particularly significant increase of the IgM cells and a less significant increase of the IgG cells in celiac disease. A decrease of the IgA cells was also found in celiac disease but with no statistical significance. These results are discussed in relation to other phenomena observed in the intestinal wall of celiac patients and indicate the importance of the immunoglobulins in this disease. One particular celiac patient with a high IgG cell count who later developed lymphosarcoma of the intestine is discussed in detail.

Radioimmunoassay for Hepatitis B ‘e'Antigen and Antibody: Correlations with Viral Replication and Prognostic Value

The presence of hepatitis B ‘e’ antigen (HBeAg) and its antibody (anti‐HBe) was evaluated by radioimmunoassay (RIA) in various groups of HBsAg‐positive patients. HBeAg was present in the majority of the sera from patients with acute viral hepatitis at the onset of clinical symptoms and disappeared after 1 year. Almost all hemodialysis patients had HBeAg in their sera. 40% of the patients who had chronic active hepatitis and 50% with chronic persistent hepatitis had HBeAg with no relationship to the inflammatory activity of the disease evaluated by the presence of mononuclear infiltration in liver biopsy. The comparison between the presence of HBeAg and Dane particle‐associated DNA‐poly‐merase activity showed that HBeAg was consistently found in almost all the sera which presented DNA‐polymerase activity. HBeAg, as determined by RIA, may therefore be useful in the screening of highly infective patients with elevated viral replication.