Hasan Telatar

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

Treatment of Behçet disease with indomethacin.

ABSTRACT: Thirty patients with Behçet disease (BD) were treated with oral indomethacin 25 mg four times daily for 3 months as an open label study. The study population consisted of 13 women and 17 men from 15 to 45 years of age (mean 27 years). At the initiation of the therapy, 28 patients had oral aphthous lesions, 23 had joint involvement, 13 had genital ulcerations, 8 had cutaneous lesions, and 4 had eye involvement. Eighty‐eight percent of patients with skin lesions, 80% with joint involvement, 43% with oral aphthous lesions, and 38% with genital ulcerations responded to indomethacin therapy. In three patients indomethacin was changed to the suppository form due to gastrointestinal side effects. Although it is difficult to assess the efficacy of indomethacin in BD because of the intermittent nature of symptoms, the majority of patients showed improvement in their symptoms of arthritis and skin lesions. This study indicates that indomethacin can be used as effective therapy particularly in patients with joint involvement.

Budd-Chiari syndrome: analysis of 30 cases.

The authors report their experience with 30 adult patients with Budd-Chiari syndrome (BCS), which is a rare and serious disorder, characterized by hepatic outflow obstruction caused by many different conditions. The diagnosis was based on the clinical data, ultrasonography (US), vena cavography and hepatic venography, computed tomography (CT), and liver bi opsy. Behçets disease (BD) was found in 10 patients with BCS as an underlying disease. Two patients used oral contraceptive drugs, 2 had liver tumor hepato cellular carcinoma and liver lymphoma, and 1 patient had chronic lymphocytic leukemia. Despite full investigation, the authors could not find any obvious un derlying cause in the other 15 patients. The results suggest that (1) BCS must be considered as a possible complica tion in patients with Behçets disease when they have hepatomegaly even if there were no cardinal manifestations of the disease at the time of admission, and BD is the most common etiologic factor in BCS (33%) in Turkey, where the inci dence of Behçets disease is relatively high. (2) Anti-aggregant treatment seems to be effective in many instances. (3) There were space-occupying lesion-like appearances in the liver of 7 cases by CT and US examination in the acute stage, and these disappeared on the follow-up CT and US in 5 patients but continued in 2. BCS should thus be differentiated from other liver lesions. (4) There were other great-vessel involvements in 43% of the cases, mostly venous, but only 1 pulmonary arterial occlusion.

Monoclonal gammopathy with hyperlipidemia

A sixty year old man was found to have a monoclonal gammopathy, probably due to multiple myeloma, associated with markedly elevated serum cholesterol and total lipid levels. There were no xanthomas. A low fat, low carbohydrate diet had no effect on the hyperlipidemia. There was no familial hyperlipidemia. The patient later died of heart failure.

Functional asplenia and portal hypertension in a patient with primary splenic hemangiosarcoma

A 60-year-old man with primary splenic hemangiosarcoma (PSH) presented with weakness, weight loss, abdominal pain, and anemia. Physical examination reveaied hepatomegaly, ascites, and firm, huge splenomegaly. Ultrasonography showed many nodular structures characterized by hypoechogenic and hyperechogenic areas. The patient also had portal hypertension, which was confirmed by physical findings and by measurement of portal vein pressure during operation. A liver-spleen scan using Tc-99m sulfur colloid and Tc-99m labeled heat denatured erythrocytes failed to demonstrate any splenic uptake, a reliable feature of functional asplenia. Although on a total body scan with Ga-67 citrate there was no splenic uptake, there was gallium uptake in the liver, where the presence of the metastatic lesion was histopathologically verified and confirmed by operation. There was also uptake in the middle zones of the lungs. Ga-67 citrate imaging appears to be helpful in the diagnosis of metastasis of PSH, and PSH can rarely cause portal hypertension.

Treatment of Chronic Hepatitis C Infection with Interferon α-2 a in a Turkish Population

Recombinant interferon (IFN) α has been shown to normalize the aminotransferase levels in approximately half of patients with chronic hepatitis C virus (HCV) infection. Twenty four patients with chronic HCV infection were treated with IFN α-2a subcutaneously, three times a week for 6 months. All patients responded to IFN therapy with a decrease of alanine aminotransferase (ALT) level. Thirteen out of 24 cases (54.2%) had normal ALT levels at the end of the sixth month of therapy. However, four of these complete responders (30.8%) relapsed during the 12 month follow-up. Relapse was high in the partial responder group (45.5%). Overall relapse rate was 37.5% at 6 months. HCV genotype II, which is associated with a low response rate to IFN was prevalent (85 – 87%) in our patient population. This study shows that interferon therapy can be effective in reducing transaminase levels in patients with chronic hepatitis C in a population with a high prevalence of HCV type II. The relapse rate after discontinuation of treatment, however, remains a problem.

Living Related Liver Transplantation in an Adult and a Child

Orthotopic liver transplantation is the most effective treatment for end-stage liver diseases in adults and children; however, the lack of convenient donors is the main restrictive factor existing in this particular area. The paucity of infant and child donors remains a worldwide problem, especially in developing countries where the number of adult cadavers is also very limited. The desperate search for organ sources has led surgeons to transplant a portion of the liver from an adult into a child, and this approach has been accepted by some centers [4, 6, 9].

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

Scintigraphic evaluation of reduced-size liver transplant from living related donor in Byler's disease

Bylers syndrome is a rare form of autosomal recessive intrahepatic cholestasis that is fatal in children. A 10-year-old girl diagnosed with Bylers syndrome underwent reduced-size liver transplantation using lateral segments of her living mothers liver. The donors and the recipients liver functions after transplantation were evaluated using Tc-99m disofenin and Tc-99m SC to investigate morphology, liver perfusion, and hepatobiliary function.

Angiographic Findings of Great Vessel Involvement in Behçet's Disease

Behçets disease (BD) is a systemic disorder and vasculitis is a common pathologic finding that may give clues in the understanding of the vascular involvement. During the period between 1968 and 1988, 30 patients with BD had vascular complications that were diagnosed by conventional venography (indud ing cavography) (in 15 patients prior to 1985) and then by computed tomography, digital subtraction angiography (DSA), and sonography in the remaining 15 patients for the last four years . The group included 13 patients with superior vena caval obstruction (SVCO), 3 with inferior vena caval obstruction (IVCO), 4 with both SVCO and IVCO, 2 with IVCO and hepatic veins obstruction (Budd-Chiari syndrome, BCS), 1 patient with SVCO, IVCO, and BCS, 1 with BCS, 1 with portal vein and IVCO, 4 patients pulmonary artery occlusion (1 of them also had pulmonary artery aneurysm), and finally, 1 patient with right illiac artery aneurysm. In many cases, classical clinical features of BD were not evident when great vessels were involved. The authors concluded that DSA and sonography are the preferred method in demonstrating vascular complications of BD and that BD should be taken into consideration when a patient presents with a great vessel involvement due to unknown cause.