V. Feletti

Clinical trial: modulation of human placental multidrug resistance proteins in cholestasis of pregnancy by ursodeoxycholic acid

Backgroundu2002 The effects of ursodeoxycholic acid on human placental bile acids and bilirubin transporters in intrahepatic cholestasis of pregnancy are still undefined.

C-11 acetate does not enhance usefulness of F-18 FDG PET/CT in differentiating between focal nodular hyperplasia and hepatic adenoma.

Purpose of the Report: We assessed the usefulness of F-18 fluorodeoxyglucose positron emission tomography (FDG PET) and C-11 acetate PET (AC PET) in distinguishing hepatic lesions due to consequential disease (hepatocellular adenoma and malignant lesions) from focal nodular hyperplasia (FNH) in patients at low risk of malignancy. Materials and Methods: Thirty-one patients with 43 lesions were prospectively enrolled. The diagnostic work-up included Doppler and contrast-enhanced ultrasonography, contrast-enhanced computed tomography, and/or magnetic resonance imaging. Fine needle biopsy was performed if the imaging study was inconclusive. The work-up revealed 36 FNH and 7 consequential lesions (5 hepatocellular adenoma, 1 hepatoma, and 1 metastasis). All patients underwent FDG and AC PET. FDG PET with target/background ratio (T/Br) grater than 1.2 and AC PET with T/Br of less than 1.2 were considered positive test for consequential disease. Results: On FDG PET, we had 6 true-positive out of 7 lesions due to consequential diseases, with a sensitivity of 85.7%, and 33 true-negative out of 36 lesions with FNH, with a specificity of 91.7%. Using AC PET, there were 2 true-positive lesions out of 7 caused by neoplasms, with a sensitivity of 28.6%, and 34 true-negative lesions out of 36 FNH, with a specificity of 94.4%. Conclusions: When the goal is differentiating FNH from liver neoplasms, AC PET offered no additional diagnostic advantage over what is achieved with FDG PET.

Higher doses of peginterferon alpha-2b administered twice weekly improve sustained virological response in difficult-to-treat patients with chronic hepatitis C: results of a pilot randomized study

Summary.u2002 Beside substantial progress in treatment of chronic hepatitis C (CHC) particular patients (genotype 1/4, high viral load, previous nonresponse, cirrhosis) remain difficult to treat. The aim of our pilot randomized study was to compare efficacy and tolerability of standard doses of Peginterferon alpha‐2bu2003+u2003ribavirin with higher doses of Peginterferon alpha‐2b administered twice weeklyu2003+u2003ribavirin. Sixty‐five outpatients with CHC were subsequently enrolled. Group A (nu2003=u200322) received recommended doses of Peginterferon alpha‐2b and group B (nu2003=u200343), received high doses twice weekly. Groups were comparable for baseline characteristics. All genotype 1/4 patients had high baseline viraemia. Sustained virological response (SVR) was significantly higher in group B among naïve patients (72%vs 25%, Pu2003=u20030.024). A significantly higher rate of SVR was observed in group B both considering only genotype 1/4 patients, (46%vs 13%, Pu2003=u20030.03) and grouping together genotype 1/4 naive and relapsers (57%vs 11%, Pu2003=u20030.039). Discontinuation rate was 32% (7 of 22) in group A and 19% (8 of 43) in group B. Our response rates are the highest reported for genotype 1/4 with high viraemia. Our pilot study supports the need of randomized studies to evaluate both viral kinetics and efficacy of high dose and twice weekly administration of Peginterferon alpha‐2b in genotype 1/4 patients with high viraemia who may need personalized treatment schedules.

657 UDCA UP-REGULATES HUMAN PLACENTAL BCRP EXPRESSION: PRELIMINARY RESULTS

published studies assessing the specificity of the AIH criteria when applied to patients with primary sclerosing cholangitis (PSC). Aim: The purpose of this study was to test the specificity of the simplified criteria for AIH in a population of patients with PSC. Methods: 123 patients with a primary diagnosis of PSC were identified in the Mayo Clinic database. Patients were excluded if they had overlap syndromes. Demographic information, liver enzymes, bilirubin, prothrombin time, creatinine, hepatitis B and C serologies, antinuclear antibody (ANA), smooth muscle antibody (SMA), gamma globulins, liver-kidney microsomal antibody (LKM1), soluble liver antigen (SLA) and liver histopathology results were recorded. Diagnostic scores for AIH were calculated using the simplified criteria for AIH. Statistical analysis was performed using Jump software. Results: There were 55 female and 67 male patients. All subjects obtained the diagnosis of PSC between 1989 and 1992 with liver biopsy or cholangiography, and hepatitis B and C were excluded. 6 subjects did not have a liver biopsy and were excluded from further analysis. 68 subjects had ANA measured; it was positive in 29. 36 subjects had SMA measured; it was positive in 12. 4 subjects had LKM1 measured; it was positive in 1. IgG was measured in 84 subjects. IgG was positive in 40 patients and greater than 1.1 times the upper limit of normal in 26. 109 patients had a biopsy incompatible with AIH and 8 patients had a biopsy compatible with AIH. No patients had a biopsy typical for AIH. Using the simplified criteria for AIH, only one patient had probable AIH, and no patients had definite AIH. Conclusion: The simplified criteria for AIH have excellent specificity when applied to a PSC population.