[Predictive value of a rapid negativity of serum virus C viremia during treatment with interferon alpha in patients with chronic hepatitis C]

Interferon alpha (INF) used for chronic hepatitis C treatment induces a response in less than 25% of patients. The aim of this study was to appreciate the predictive value of the delay of clearance of hepatitis C virus (HCV) viremia after onset therapy and to compare it with other virological markers such as viral load before treatment and viral type. Thirty one patients with chronic hepatitis C, treated with 3 MU Interferon, 3 times a week for 6 months, were followed until 6 months post-treatment. Response was defined according to the normalisation of transaminases levels and loss of HCV viremia. Five patients were long term responder, eleven patients were complete to relapse responder and fifteen patients were non responder. Serum HCV RNA level, HCV type and serial detection of serum HCV RNA were determined and correlated with the long term response to INF. Patients with long term response had lower pre-INF viral load compared to the complete to relapse responder or to the non responder (p < 0.001). A rapid clearance of serum HCV RNA (1 month) is observed for all the long term responder (p < 0.001). The lowest viral load is also observed in these patients (p < 0 05). By contrast, although the number of patient is low, we were not able to observe a relation between the viral type and the response to treatment. In conclusion this data indicate that the delay of clearance of HCV RNA is also a good predictor of response to INF therapy. Furthermore a rapid clearance of HCV RNA in patients with a very weak pre-INF viral load is strongly associated with long term response (positive predictive value: 100%).

[Prevalence and risk factors of hepatitis C virus infection in a hospitalized population in a gastroenterology unit. Role of endoscopic biopsies]

OBJECTIVES AND METHODS

In order to study the prevalence and risk factors of HCV infection in a population hospitalized in a Gastroenterology Unit, 3,767 patients were tested for serum anti-HCV, and 2,607 filled out a questionnaire about risk factors.

RESULTS

With the RIBA 2 test, the overall prevalence was 5.9%. Because of the age distribution, two populations were studied. In patients younger than 45, intravenous drug use was the only independent risk factor linked to serum anti-HCV positivity (Odds ratio: 151, CI 95%: 66.9-340). In patients older than 45, the independent risk factors were chronic liver disease (Odds ratio: 8.5, CI 95%: 4.4-16.8), per-endoscopic biopsies (Odds ratio: 2.7, CI 95%: 1.4-5.4), and blood transfusions (Odds ratio: 1.8, CI 95%: 0.9-3.5). Two variables were dominant for the entire population: IV drug use and chronic liver disease. In patients without these factors, only one risk factor was linked to serum anti-HCV positivity: perendoscopic biopsies (Odds ratio: 5.2, CI 95%: 1.6-16.5).

CONCLUSION

These results suggest that HCV may be transmitted by perendoscopic biopsies.

[Psoas abscess exteriorized in the groin revealed late after acute pancreatitis]

Two cases of psoas abscess complicating acute necrotizing pancreatitis are reported. These cases were particular because the abscesses exteriorized in the groin and symptoms were misleading. The abscesses were detected late, three and five months after the beginning of the pancreatitis respectively. The difficulties in diagnosis and the long delay to diagnosis are emphasized as possible sources of superinfection.

Pharmacokinetics of molsidomine and its active metabolite, linsidomine, in patients with liver cirrhosis

The pharmacokinetics of molsidomine were investigated in six healthy volunteers and in seven patients with alcoholic cirrhosis. After a 2 mg oral dose, molsidomine elimination half-life was prolonged in cirrhotic patients (13.1 +/- 10.0 h vs 1.2 +/- 0.2 h, P less than 0.01) because of a decrease in its apparent plasma clearance (CL/F) (39.8 +/- 31.9 ml h-1 kg-1 in patients with cirrhosis vs 590 +/- 73 ml h-1 kg-1 in volunteers). The elimination half-life of the active metabolite, linsidomine (SIN-1) was also prolonged in cirrhotic patients (7.5 +/- 5.4 h vs 1.0 +/- 0.19 h, P less than 0.05). The AUC values of both molsidomine and linsidomine were increased in the cirrhotic group, but the increase in the former was considerably greater than in the latter as shown by the significant decrease of the ratio AUClinsidomine/AUCmolsidomine x 100 (4.5 +/- 6.1 in cirrhotic patients vs 23.5 +/- 3.4 in healthy volunteers, P less than 0.001). These results suggest that liver cirrhosis profoundly alters the pharmacokinetics and metabolism of molsidomine.

[Cystic dystrophy on aberrant pancreas. Contribution of ultrasound-endoscopy]

Cystic dystrophy of aberrant pancreatic tissue without chronic pancreatitis is a rare disease described by Potet and Duclert in 1970. Clinical diagnosis is possible by endoscopy and intraluminalsonography; we report the first case diagnosed by intraluminalsonography.

Pharmacokinetics of ranitidine in acute upper gastrointestinal haemorrhage

A pharmacokinetic study of ranitidine was performed in 14 patients with haematemesis divided into two groups according to the severity of blood loss. Pharmacokinetic values were calculated from plasma concentrations after the first of three daily injections (100 mg) and compared with those obtained in five healthy volunteers (50 mg i.v.). There were no significant differences between patients in the two haemorrhage groups and controls. The low, or even questionable, effectiveness of histamine H2-receptor antagonists in the treatment of upper gastrointestinal haemorrhage does not seem to be due to pharmacokinetic factors.

[Familial cancer of the colon without polyposis and the familial cancer syndrome. Apropos of 2 cases over 3 generations]

Two cancer-prone families are reported. In the first one four first-degree relatives over three generations presented a colonic carcinoma, three of them at a proximal anatomic site. For grandmother and father these occurred at ages of 43 and 54 years, respectively, for the son and the daughter at ages of 26 and 22. The grandmother underwent a palliative ileotransversostomy, surgery typically associated with a bad prognosis, but she survived for forty years that initial neoplasm and had an hysterectomy with oophorectomy at age of 63 for endometrial malignancy; she deceased at age of 83 a few days after surgical treatment of tumoral small bowel obstruction: pathological evaluation disclosed a fourth cancer on first duodenum. The second kindred shows over three generations 11 cancer-affected individuals, three of them with double primary cancer: breast and sigmoid, breast and endometrium, colon and Hodgkin disease. This pedigree includes 8 colorectal neoplasms occurring at 47 years of mean age. These findings are consistent with the cancer-family syndrome and hereditary non-polyposis colon cancer described by Henry Lynch upon four criteria: high frequency of adenocarcinoma, excess of multiple primary malignancies, synchronous or metachronous, early age of onset of cancer and autosomal dominant inheritance. Moreover the hereditary colon cancer is usually localised to the proximal colon, not associated to polyposis coli and allows a prolonged survival. Up to day such families are only identified by pedigree data. The identification of a cancer-prone family calls for an active follow-up of relatives putatively at risk starting at the age of 15 to 20.

[Autochthonous Plasmodium falciparum malaria and the malarial liver]

When P. falciparum malaria is diagnosed in France in a patient who has not travelled to an endemic area, transmission by blood transfusion or direct contact with an infected person, and indigenous malaria should be considered. With reference to the observation reported in this paper, the manifestations of malarial hepatitis are recalled and their diagnostic significance is discussed. In P. falciparum malaria, malarial hepatitis indicates the development of a complete cycle including the pre-erythrocytic phase; this is strongly in support of indigenous malaria, and against malaria following blood transfusion or direct contact in which there is no pre-erythrocytic phase.

[Fulminating pneumococcal septicemia (author's transl)]

Two cases of fulminating pneumococcal septicemia (FSP) are reported, and 47 confirmed cases were discovered after a review of the published literature. The syndrome is that of a malignant infection with fever, collapse, and disseminated intravascular coagulation, with a rapid mortal outcome in most cases. Etiologically, FSP is usually the consequence of functional or anatomical asplenia, and the relative frequency of this affection after splenectomy following trauma confirms this observation. Lack of a splenic filter and a deficiency in the phagocytic system are the reasons for microbial proliferation in the blood, and the lymphocytic defence mechanisms are inactive because of the absence of any focus of infection.