Educational pathways of childhood cancer survivors-a parental cohort

PURPOSE

Using the International Standard Classification of Education (ISCED), we examined the educational and vocational pathways of two comparable, parental cohorts: childhood cancer survivors (CCS) and their siblings. Both cohorts had previously entered parenthood. The aim of the study was to elucidate whether childhood cancer and treatment affect the educational pathways chosen by parents who are former patients.

METHODS

We analysed data that was collected from childhood cancer survivors and their siblings regarding their offspring's health within the FeCt Multicentre Offspring Study (conducted 2013-2016). We evaluated and compared the professional pathways of (i) all participating survivors and all participating siblings and those of (ii) survivors and their biological siblings.

RESULTS

Overall information on parental gender, age, and education were available from 1077 survivors and 246 siblings (group (i)). The majority of participants were female with a mean age of 35.2 (survivor) and 37.9 (sibling) years at time of survey. For subgroup (ii), analysis information was available on 191 survivors and 210 siblings. Fathers achieved university degrees significantly more often than mothers (p = 0.003 (i), p < 0.001 (ii)). The distribution of professional education was not significantly different between cancer survivors and siblings in either cohort (i) or (ii).

CONCLUSIONS

Regarding our research on the educational and vocational trajectory of CCS, patients can be reassured that family planning and vocational education are well compatible. Inequalities regarding gender-specific educational pathways remain to be addressed.

IMPLICATIONS FOR CANCER SURVIVORS

CCS should monitor their fertility status regularly and, if necessary, cryopreserve germ cells or tissue in order to optimize their family planning. Educational opportunities should be pursued as desired and with confidence. Local as well as European aftercare programs can assist with family planning and education.

First-line immunosuppressive treatment in children with aplastic anemia: rabbit antithymocyte globulin

Immunosuppressive therapy is the treatment of choice in children with acquired severe aplastic anemia (AA) and no HLA-matched family donor. The paper presents results of a multicenter study of 63 children with AA treated with rabbit antithymocyte globulin (r-ATG) and cyclosporine A as the first line treatment in the years 1996-2012. Therapeutic effects were evaluated at Days 112, 180, and 360. At Day 112, remission was achieved in 28 out of the 63 patients (44.4 %), complete remission in 10 patients (15.9 %), and partial remission in 18 (28.5 %). At Day 180, 31 patients (49.2 %) were in remission including 15 cases in complete (23.8 %), and 16 cases in partial remission (25.4 %). One year after therapy onset, 34 patients (64.9 %) were in remission including 24 patients (38.0 %) in complete and 10 (15.9 %) in partial remission. Relapse occurred in 4 patients, from 8 months up to 2 years and 2 months after remission. One child, 5 years after remission, was diagnosed with paroxysmal nocturnal hemoglobinuria. The estimated 10-year overall survival rate and 10-year event-free survival rate were 67 % and 57 %, respectively.

Concentrations of ssDNA in liver tissue and its correlation with sFas and sFasL in serum of patients infected with HBV, HCV, HCV and HIV

PURPOSE

The concentration of nucleic acids that undergo apoptosis (ssDNA) determines the actual activity of programmed cell death. ssDNA concentrations in liver tissue of patients with chronic HBV, HCV and HCV and HIV infections were assessed. The concentration of this nucleic acid was analyzed in relation to the concentrations of serous apoptosis indicators, sFas and sFasL receptor proteins, the activity of inflammatory processes and fibrosis in liver tissue as well as HBV, HCV and HIV viraemia.

PATIENTS

The study included 153 patients: 48 chronic HBV infected, 86 chronic HCV infected and 19 HCV and HIV infected.

PATIENTS AND METHODS

The concentrations of HBV-DNA, HCV-RNA and HIV-RNA were determined by use of RT-PCR method. CD3+, CD4+ and CD8+ lymphocytes count were detected in HIV infected patients' blood by use of a flow cytometer. The concentration of ssDNA was determined by use of monoclonal antibodies and ELISA tests. The concentrations of sFas and sFasL in serum were determined by use of an immunoenzymatic method (ELISA).

RESULTS

The concentration of ssDNA in liver tissue of both HCV and HBV infected patients was higher in comparison to those co-infected with HCV and HIV (1332 x 10(-6) g/mg, +/-664 x 10(-6); vs 1508 x 10(-6) microg/mg, +/-810 x 10(-6); vs 886 x 10(-6) microg/mg, +/- 388 x 10(-6); p < 0.004). No correlation between ssDNA concentration and HBV and HCV viraemia was observed. In patients infected with HCV genotype 3, the concentration of ssDNA was 1343 x 10(-6) microg/mg, +/-700 x 10(-6), comparable from patients infected with genotype 1, 296 x 10(-6) microg/mg, +/- 615 x 10(-6). The highest concentration of ssDNA in liver tissue was detected in HBV infected patients with low inflammatory activity (1645 x 10(-6) microg/mg, +/-987) and low fibrosis (1606 x 10(-6) microg/mg, +/- 876 x 10(-6). Mild inflammatory changes and low fibrosis were observed in all HCV and HIV infected patients. No correlation between ssDNA concentration in liver tissue and HIV viraemia (r = 0.03; p = 0.90), HCV, CD8+ and CD4+ count (r = -11; p = 0.66) was observed. The concentration of ssDNA among HCV and HIV infected patients correlated with the concentration of sFas in serum (r = 0.52; p < 0.02).

CONCLUSIONS

HCV, HBV and HIV viraemias do not correlate with ssDNA concentration in liver tissue. In patients with HCV and HIV infections, CD4+ and CD3+ counts do not correlate with the concentration of ssDNA in liver tissue. HIV infection seems to inhibit apoptosis processes in liver tissue of HCV and HIV co-infected patients. In the case of HCV and HIV infections, the concentration of sFas in serum correlates with the concentration of ssDNA in liver tissue.

Mucosal gastrin cells and serum gastrin levels in children with Helicobacter pylori infection

PURPOSE

Impaired control of gastric juice secretion is observed in chronic gastritis due to Helicobacter pylori (H. pylori) infection. G cells are stimulated by such cytokines as tumor necrosis factor (TNF-alpha), interferon gamma (IFN-gamma) and interleukin-8 (IL-8). The number of D cells producing somatostatin decreases simultaneously. An increase in gastrin levels could also depend on alkalization in G cell environment caused by bacterial urease. The aim of the study was to evaluate G cell counts in the antrum and gastrin levels in the serum of children with H. pylori infection and after bacterium eradication.

MATERIAL AND METHODS

The study was performed in 106 patients. Children were divided into 3 groups with regard to the presence and course of H. pylori infection. Fifty nine children (55.7%) had chronic gastritis in the course of H. pylori infection with a positive titre of antibodies in IgG class against H. pylori; 29 children (27.3%) with past H. pylori infection, without bacterium colonization and gastritis but with a positive titre of antibodies in IgG class against H. pylori; 18 children (17%) with functional disorders of the gastrointestinal tract but without H. pylori infection.

RESULTS

The quantitative analysis of gastrin cells in the antral mucosa of children performed by immunohistochemical method showed the highest gastrin cell count in group I with H. pylori infection (112.1 +/- 58.9 cell/mm2) and in group II with past H. pylori infection (105.3 +/- 73.1 cell/mm2). The serum gastrin level (92.9 +/- 41.6 microU/ml) was the highest in children with H. pylori infection. In controls, it was 70.0 +/- 15.3 microU/ml and could be compared to the results of children with past H. pylori infection.

CONCLUSIONS

1. The H. pylori infection plays a significant role in the stimulation of G cells increase and gastrin release in the blood serum in children. 2. The eradication of H. pylori infection is probably a main factor in gastric secretion down-regulation during gastritis in children.

Event-related cerebral potentials for the diagnosis of subclinical hepatic encephalopathy in patients with liver cirrhosis

PURPOSE

Subclinical hepatic encephalopathy (SHE) seems to be a common problem in liver cirrhosis, however, studies assessing the pathogenesis of this disease remain unclear. Currently no gold standard exists for the diagnosis of this complex neuropsychiatric syndrome. The present study was undertaken firstly to examine the diagnostic usefulness of auditory event-related cerebral potentials (ERPs) in the detection of SHE, and secondly to compare it with that of the most validated psychometric test.

MATERIAL AND METHODS

22 patients with liver cirrhosis without overt hepatic encephalopathy and 28 healthy controls were studied, using auditory ERPs. In addition they underwent a battery of neuropsychological and laboratory tests.

RESULTS

P300 latency analysis turned out that cirrhotics patients had significantly longer P300 latency than controls. The only neuropsychological test showing significant difference between clinical and control group was the similarities subtest of WAIS-R.

CONCLUSIONS

The results of the present study suggest that ERPs are more sensitive method than psychometric tests in detecting early changes in the brain function of patients with cirrhosis and for this reason this neurophysiological method should be applied in clinical practice.

Search for hepatitis delta virus (HDV) infection in hepatitis C patients in north-eastern Poland. Comparison with anti-HDV prevalence in chronic hepatitis B

Hepatitis C virus and hepatitis D virus have been shown to suppress HBsAg synthesis. Thus it is possible that HDV infection occurs despite the lack of detectable HBsAg. The aim of our study was to (a) determine the prevalence of HDV infection in patients with chronic hepatitis C (b) compare it with the prevalence of HDV infection in HBsAg positive patients with hepatitis B. The study group consisted of 51 chronic hepatitis C patients, 30 HIV infected drug addicts (27 of them were also positive for anti-HCV) and 102 hepatitis B patients. The participants were tested for anti-HDV, anti-HCV and HBsAg. All anti-HCV positive patients were negative for anti-HDV. Four individuals with anti-HDV belonged to hepatitis B group and constituted 3.9% of all HBsAg positive subjects. We conclude that (a) there is currently no evidence of HDV infection among HCV infected patients in our region (b) hepatitis delta infection is rare in north-eastern Poland.

MR and 1H MR spectroscopy of the brain in patients with liver cirrhosis and early stages of hepatic encephalopathy

BACKGROUND/AIMS

Hepatic encephalopathy is a serious problem in patients with liver cirrhosis and precise pathophysiological mechanisms responsible for encephalopathy are not fully understood. Magnetic resonance imaging and magnetic resonance spectroscopy can be used to detect specific morphological and metabolic abnormalities in the brain even in patients with early stages of hepatic encephalopathy.

METHODOLOGY

Twenty patients with liver cirrhosis and 14 patients with grade I-II hepatic encephalopathy were studied with magnetic resonance and proton magnetic resonance spectroscopy. Localized magnetic resonance spectra were acquired in the parietal gray/white matter regions and basal ganglia. Control group consisted of 20 healthy volunteers.

RESULTS

Frequency and degree of brain atrophy and bilateral signal hyperintensities in globus pallidus were similar in groups with liver cirrhosis and with encephalopathy. Decreased myoinositol, choline and increased glutamine levels were noted in both groups whereas N-acetylaspartate levels were unchanged. The statistically significant differences between cirrhotic and encephalopathic groups were observed only in myoinositol/creatine ratio in basal ganglia. There were no significant differences in metabolic concentrations between parietal and basal ganglia regions.

CONCLUSIONS

Metabolic brain alterations occur earlier than clinical evidence of hepatic encephalopathy but there is no correlation between presence of symptoms encephalopathy and magnetic resonance and magnetic resonance spectroscopy findings.

Immunological response in HIV-positive patients vaccinated against tick-borne encephalitis

BACKGROUND

Vaccination against infectious diseases is a recommended preventive measure in patients with impaired immunity. The aim of the study was to estimate the immunogenicity of the vaccine against tick-borne encephalitis (TBE) in HIV-infected patients and to determine its safety for this group.

PATIENTS AND METHODS

The TBE vaccine FSME-IMMUN-inject was tested on 29 HIV-positive patients and the response compared to that of 40 healthy controls. The vaccination protocol for the HIV-positive group was modified by the addition of a fourth dose according to a 0/1/2/9-month schedule.

RESULTS

No serious adverse reactions were observed in patients with deficient immunity. A better response was obtained in HIV-infected patients with CD4 counts >or= 500/microl (55% of the patients had levels of IgG antibody > 126 VIEU/microl) than in those with CD4 counts of 200-499/microl (40%). However, the difference did not reach significance. 85% of healthy controls achieved protective antibody titers after a full course of vaccination.

CONCLUSION

The correlation between post-vaccine seroconversion and CD4 lymphocyte count showed that the FSME-IMMUN-inject vaccine can be considered to be a CD4 cell-independent vaccine. The examinations carried out 1 year after the completed vaccination protocol showed maintenance of the anti-TBE response acquired after the third vaccination in healthy subjects and in HIV-infected patients.

Autoantibodies in chronic liver diseases

177 patients with chronic liver disease, among 115 with chronic hepatitis and 61 with liver cirrhosis were subjected to the autoantibodies examinations (ANA, AMA, ASMA, APCA, LKM, ATA) by means of immunofluorescent method (IFA). 25% of cases showed autoantibodies of autoimmunological disease index titre (1:80). Autoantibodies occurred more frequently in woman (75%), mainly in the age of 40-60. Patients with hepatic cirrhosis revealed autoantibodies as frequently as other patients. Among patients infected with hepatotropic viruses (HBV, HCV) with chronic liver diseases, autoantibodies were present in 23-28% of cases and in patients with chronic liver diseases of non-infectious etiology, autoantibodies were observed in 25% of cases.

Peripheral blood T, B lymphocytes and NK cells in primary biliary cirrhosis

Primary biliary cirrhosis (PBC) is an autoimmune disease with progressive destruction of the bile ducts and cholestasis. The most of epithelial cells in the bile ducts has molecule MHC I and II class expression which induced intensive immunological reaction and produced antimitochondrial autoantibodies (AMA). It leads to the destruction of own cells in PBC. The main part in the development of the disease have T cells, B cells, and NK cells. We analyzed subpopulation of lymphocytes in peripheral blood in 16 patients with PBC by flow cytometry. We noted statistically significant increase of NK CD16+ + CD56+ cell value and activated T CD3+ + HLA DR+ cell value in peripheral blood in PBC. Slightly increase in the value of CD4+ cells and slightly decreased CD8+ cell value were observed. However, the CD4/CD8 ratio was elevated statistically and it was 2.3 (healthy subjects--1.7). Lymphocyte T and B subpopulations remained normal. The results showed that the main role in PBC is played by NK cells and activated T cells.

Bone marrow failure and hematological abnormalities in alcoholic liver cirrhosis

Long term alcohol abuse may result in bone marrow damage and hematologic abnormalities. In the study we evaluated bone marrow and peripheral blood changes in patients with alcoholic cirrhosis. Although majority of the patients (91%) presented with hematologic abnormalities such as leukopenia, thrombocytopenia, low hemoglobin level, only mild alterations in bone marrow were observed. The hematopoietic tissue was of high cellularity with features of activation and moderate myelofibrosis.

Platelet autoantibodies in liver cirrhosis and thrombocytopenia

One of frequently occurring hematological disorders accompanying advanced liver diseases is thrombocytopenia (TP). Immunological disorders in patients with liver cirrhosis, loss of tolerance to own antigens, and the change of platelet antigenicity enable antiplatelet antibody formation under the influence of continuous activation. The aim of the study was to determine the rate of autoimmunological thrombocytopenia occurrence in patients with liver cirrhosis and TP. Antiplatelet autoantibody occurrence were determined in blood serum with the use of ELISA method in 15 patients with liver cirrhosis and TP (mean plt number 67.9 +/- 24.9 x 10(3)/microliter). Three patients (20%) presented anti-GPIIb/IIIa antibodies and 2 patients--anti-GPIa/IIa. These patients had liver failure (stage C according to Child-Pugh classification) and splenomegaly. Plt morphological parameters were also evaluated. The significant decrease of plt crit as well as the decrease of mean platelet volume (MPV) was observed in liver cirrhosis with thrombocytopenia. The increase of megathrombocyte population (MPV > 20fl) up to 5.5% of all plt was also observed. Megathrombocytes in healthy individuals were 2.25% of platelet population. Examinations confirmed that autoimmunological factors play an important role in the development of thrombocytopenia in liver cirrhosis.

[Autoimmune thrombocytopenia in chronic liver disease]

Thrombocytopenia (TP) often accompanies chronic liver diseases. The causes are numerous and include impaired production of blood platelets, spleen sequestration, and the immune factors, e.g. antiplatelet autoantibodies. ELISA (GTI-PAKPLUS) examinations were conducted in order to estimate the rate of autoimmune thrombocytopenia occurrence in patients with thrombocytopenia in the course of chronic hepatitis (10 patients) and liver cirrhosis (20 patients). Blood platelet activity was also evaluated as well as the expression of platelet glycoproteins (GPIIb, GPIIIa, and GPIX) in platelets of the patients and the controls. It was observed that autoimmune TP occurred in 30% of patients with liver cirrhosis and in 10% of patients with chronic hepatitis, in which anti-GPIIb/IIIa, GPIa/IIa, and HLA class I antibodies were detected. In all patients there occurred significant/marked platelet activation with CD61P expression. Thrombocytopenia in patients showed a similar activity after thrombin stimulation to that in healthy individuals. Expression on GPIIb platelet receptors was markedly increased and GPIX decreased in patients in comparison to the controls. There was no correlation between the occurrence of certain types of anti-platelet autoantibodies and the expression of GP on thrombocytes in these patients.

[Liver biopsy: the mandatory test in liver diagnosis in adults]

The aim of the study was clinical and morphological analysis patients with liver biopsy. In this work technique of percutaneous liver biopsy, indications, contraindications and complications were presented. Among 547 liver biopsy 56% patients was HCV infected and a 14% patient was HBV infected. Microscopic examination was performed the similar percentage the stage of inflammation and fibrosis. Among patients without viral infection (HBV and HCV) the most finding was steatosis and liver cirrhosis. Agreement of clinical diagnosis with results of microscopic investigations with reference to of inflammable changes carried out 90%, the less agreement with steatosis, cholestasis and hemosiderosis. In 30% patients after biopsy were pains in place executed of intervention and right arm for 6 hours. 0.5% of patients was sub capsular bleeding after intervention. We no observed dangerous complications after liver percutaneous biopsy. Liver biopsy is very important investigation in liver diagnosis, comparatively safety if contraindications are complains.

Activation of blood platelets in chronic hepatitis and liver cirrhosis P-selectin expression on blood platelets and secretory activity of beta-thromboglobulin and platelet factor-4

BACKGROUND/AIMS

Blood platelets are cells that quite often undergo damage in chronic liver diseases. Endotoxemia and hyperkinetic circulation influence platelets in an active manner. The role of platelets in the development of hepatitis and liver fibrosis is speculative. The aim of the study was to determine the influence of chronic liver diseases on platelets morphologic parameters, their secretory activity and P-selectin expression.

METHODOLOGY

The examination was completed in the group of 29 patients with chronic hepatitis and 27 with liver cirrhosis of postinflammatory etiology (HBV, HCV). Liver biopsies were carried out in all patients. Thirty-two healthy individuals were the control group. Platelets morphological parameters (number, volume, platelet crit, micro- and macrothrombocyte fraction) were estimated. beta-thromboglobulin concentration and platelet factor 4 in blood serum as well as P-selectin expression on resting platelets and after thrombin activation were also examined.

RESULTS

Number, volume, and platelet crit decreased with the advancement of a liver disease. Megathrombocyte fraction increased inversely with the severity of liver damage. The concentration of beta-thromboglobulin and platelet factor 4 alpha-granule contents in blood serum was higher 2- and 7-times, respectively than in healthy controls. P-selectin expression on resting platelets was considerably higher. After stimulation with thrombin, P-selectin expression was equal (chronic hepatitis) or higher (liver cirrhosis) than in the control.

CONCLUSIONS

There are changes of platelet morphological parameters, with accompanying megathrombocyte fraction increase that occur in chronic liver diseases. Thrombocytes in chronic liver diseases and liver cirrhosis are more activated. Platelet sensitivity to stimuli in these ailments is higher (liver cirrhosis) than in the healthy controls.

[Autoimmune thrombocytopenia in recurrent polietiological malaria (Plasmodium falciparum, Plasmodium vivax)]

Thrombocytopenia frequently appear in severe malaria. The reasons of low blood platelets count are different and its results of hypersplenism, subclinical course of intravascular coagulation (DIC). Thrombocytopenia from "consumption" is consequence of sequestration of blood platelets in blood vessels of lungs and cerebral. We examination 29 years old men, who was as forest worker in islands on Indonesia. He was treated with recurrent, poliethiological malaria (Plasmodium falciparum, Plasmodium vivar) and severe thrombocytopenia (17.0 G/L) without hepatosplenomegalia. Antiplatelet antibody was examined in blood serum by ELISA methods (GTI - PAKPLUS. In blood serum was detected IgG antibody agai nstglicoprotein receptors on surface of blood platelets GPIIb/IIIa, GPIV, GPIb/IX, GPV, GPIa/IIa. Chronic infections of Plasmodium may conduct to autoimmune destruction of blood platelets.

Efficacy of interferon therapy on patients with HCV infection in dependence from the time of treatment

Among 45 patients with chronic hepatitis C the efficiency of interferon alpha 2b treatment was evaluated. The efficiency of interferon therapy was determined after 6 months of treatment in the group of 28 patients (group I) treated for 6 months and 17 patients (group II) treated for 12 months. The side effects were investigated with respect to such a factor as time of treatment. 11 (39%) patients from group I had eliminated HCV RNA and 14 (50%) patients had normalized AlAT levels in the serum. Five (29%) patients from group II eliminated HCV RNA and 8 (47%) patients had normalized AlAT levels in the serum. The flu-like syndrome, thrombocytopenia, vision disorder, depression and somnolence were most often the side effects observed in treated patients. Proportionally to time of treatment vision disorder, depression and somnolence increased.

Estimation of platelet function state in the course of trichinella spiralis infection

Platelets are part of body defence system, especially the antiparasite immunologic response. Platelets manifest their functions only after their activation. Thrombin activates platelets inducing change of their shape and causing secretion of certain substances. This study was designed to estimate blood platelets morphology as an indicator of their activation and effectiveness of antiparasite therapy. The study was conducted in group of 21 patients infected with T.spiralis before treatment (T1) and group of 19 patients after two weeks of treatment (T2). The diagnosis of trichinellosis was established on the bases of epidemiologic history, clinical picture and immunologic investigations. In the course of trichinellosis and after antiparasitic treatment increase of blood platelet count was observed. The decreased mean platelets volume observed in trichinellosis may be connected with their activation and releasing platelet factor 4 and beta-thromboglobulin. We suggest that T.spiralis activates platelets and the degree of their activation determines their morphologic parameters.

[Role of blood platelets in parasitic diseases]

Blood platelet are of crucial importance in hemostasis. Little attention has been paid to their bacteriocidal activity and their potential role in parasitic infections. Activation of blood platelets may result from direct contact with a parasite or IgE, IgG, complement factors, lymphokines, CRP. Blood platelets reveale cytotoxic activity through release various inflamatory mediators, phagocitic activity and cooperation with other cells of immunologic system. The precise mechanism of all platelet cytotoxic effects remains unclear.

Alcohol dehydrogenase (ADH) activity in the sera of patients during the course of viral hepatitis

Total alcohol dehydrogenase activity in the sera of 77 patients in the course of viral hepatitis was determined by means of photometric method based on p-nitrosodimethylaniline reduction. Blood samples were taken 5 times at intervals of 7 to 9 day. We found that serum total ADH activity was higher at the onset of disease than that of the control group. The highest increase of activity was observed in the first week of hospitalisation, and exceeded the mean control value about 7 times. After that, the activity of ADH gradually decreased, and reached the value of the control group in the last period of the study. During five weeks of the study the total activity of ADH showed a good linear correlation with alanine and aspartate aminotransferases. We concluded that total alcohol dehydrogenase activity measured by photometric method increase in the course of viral hepatitis and correlate with the progress and treatment of disease measured by commonly accepted enzymatic markers of liver cell damage.

The bactericidal activity of blood platelets in patients infested with Entamoeba histolytica/Entamoeba dispar

Blood platelets participate actively in organism defensive reactions and particularity in antiparasitic immunity. Platelets stimulation can be the result of contact with a parasite, the presence of immunoglobulins, complement and lymphokines. The aim of the study was to evaluate the blood platelets bactericidal activity in the course of amoebiasis. The examination was carried out in the group of 22 patients with E. histolytica/E. dispar, diagnosed on the basis of cyst forms presence in faeces. The results show that blood platelets bactericidal activity is significantly impaired in the course of amoebiasis.

Does the concentration of alpha 1-proteinase inhibitor reflect the transformation of liver cirrhosis to liver carcinoma?

Serum concentration of alpha1-proteinase inhibitor (alpha1-PI) was determined by nephelometric method in forty seven patients with liver cirrhosis (LC) and fifteen patients with hepatocellular carcinoma (HCC). Our data show an increase in the concentration of alpha1-PI in the group with decompensated LC by 17% and in HCC by 29%. The level of alpha1-PI higher than (220 mg%) may be indicative of the disease progression towards decompensated LC or HCC. In the conclusion, an increase in alpha1-PI concentration in patients with LC may be considered as an alarming factor, but is not sufficiently specific to become a diagnostic tool for the detection of HCC development.

[Snake bites]

Vipera berus is the only viper i.e. venomous (poisonous) snake that is found in Poland. Snakebites occur rarely und usually follow attempts of catching the viper or accidental treading on it. Appropriate treatment consists of administering specific antivenom serum (antivenin). Four cases of snakebites hospitalized in 1989-1995 in the Department of Infectious Diseases of the University Medical School in Białystok are reported.

[Multiorgan changes in AIDS in a reported case]

The clinical course of HIV infection and results of autopsy examination in 49 years old patient was shown. The attention was paid to difficulties of diagnosis of opportunistic infections in a patients with advanced HIV disease. Variety of infectious factors, that could affect a patient with significant immunodeficiency was outlined.

Human serum alcohol dehydrogenase isoenzymes as a markers of liver injury during viral hepatitis

We examined the activity of class I and II of alcohol dehydrogenase isoenzymes in the sera of patients with viral hepatitis using fluorogenic substrates, 4-methoxy-1-naphthaldehyde for class I and 6-methoxy-2-naphthaldehyde for class II. It was found that serum activities of class I and II of alcohol dehydrogenase isoenzymes during five weeks of hospitalisation were higher than that of control. The greatest increase in activities was found at the onset of disease, and exceeded the mean control value about 30 times for class I and 4 times for class II. These were lower than the aminotransferase activities but higher than the activity of lactate dehydrogenase, alkaline phosphatase and gamma-glutamyltransferase. In the following periods of investigation the activity of alcohol dehydrogenase isoenzymes gradually decreased, but did not reach the values of the control groups in the last period of the study. Activity of class I and II of alcohol dehydrogenase isoenzymes showed a good correlation with alanine and aspartate aminotransferase and lactate dehydrogenase in the first weeks of the illness. These results clearly demonstrate that particularly the activity of class I of alcohol dehydrogenase isoenzymes measured by a fluorimetric method can be a useful marker of liver cell damage in the course of viral hepatitis.

Does anti-parasitic treatment normalize platelets morphology in patients infested with Entamoeba histolytica?

Platelets are part of body defence system, especially the anti-parasite immunologic response. Platelets manifest their functions only after their activation. Thrombine activates platelets inducing change of their shape and causing secretion of certain substances. This study was designed to estimate platelet morphology as an indicator of their activation and effectiveness of anti-parasite therapy. The study was conducted in group of 30 patients infested with E. histolytica before treatment (A) and group of 23 patients after 2-week treatment course (B). The diagnosis of amoebiasis was based on detection of cyst forms in faeces. During the course of amoebiasis increase of platelets count and platelet crit (PCT) was observed. Mean platelet volume (MPV) in both groups (A and B) was decreased as compared with control group. We suggest that E. histolytica activates platelets, and the degree of their activation determines their morphologic parameters, and these changes come back to normal values during anti-parasite treatment.

[Phagocytic activity of blood platelets in patients infected with Giardia intestinalis]

Blood platelets take part in immune reactions of the organism, especially in anti-parasitic immunity. We conducted this study measuring the phagocytic activity of blood platelets. The experiments were done on 35 patients infected G. intestinalis. Diagnosis was supported on finding trophozoits in bile cysts and GSA-65 protein in feces. We have found some decrease of blood platelets count and the increase the percentage of phagocytic platelets. Our general conclusion is, the parasite is able to stimulate the phagocytic activity of blood platelets.

[Appendicitis and its atypical causes]

The authors analysed 2849 patients who were admitted to the Department of General Surgery, Regional Hospital in Pisz in the years 1980-1989 with symptoms suggestive of appendicitis. In 983 cases surgical intervention was abandoned, because the symptoms regressed spontaneously or were caused by diseases of other organs. The pathological conditions associated with appendicitis are analysed in 1866 surgically treated patients. Cases of appendicitis caused by Oxyuris vermicularis, Salmonella-enteritidis and actinomycosis (one case each) and appendicular carcinoma (2 cases) are described in more detail. Attention is called to the aetiology, pathogenesis and treatment of these rare causes of appendicitis.

[Morphological changes of bone marrow in patients with bronchial and gastrointestinal carcinoma and hematological abnormalities in peripheral blood]

The authors carried out the morphological and clinical analysis of 200 cases patients suffering from carcinoma but not treated (104 cases of carcinoma of the bronchus, 30 cases of the stomach, 26 cases of the pancreas, 24 cases of the liver and gallbladder and 16 cases of the large intestine) and have estimated the hematological and bone marrow abnormalities. Most frequently occurring hematological changes in this group were: anaemia (28.5%), thrombocytopenia (22.4%), clinical symptoms of thrombosis (22.0%) and changes of bone marrow: sclerosis (42.5%), neoplastic metastases (30.0%), and atrophy (27.5%). In the examined cases the authors have not found any particular connection between the kind of hematological abnormalities and the kind of morphological changes of the bone marrow. The most common changes in the bone marrow which accompanied hematological abnormalities were neoplastic metastases and atrophy of the marrow especially in cases with anaemia and thrombocytopenia.

[The NBT test in bacterial infections complicating prednisone-treated nephrotic syndrome]

The spontaneous nitroblue tetrazolium reduction test was done in children with nephrotic syndrome treated with prednisone and with secondary bacterial infections and in children with urinary tract infections not treated with prednisone. In healthy children 9.0 +/- 1.3% of polymorphonuclear leucocytes in peripheral blood showed presence of deposits in the NBT test. In children not treated with prednisone the number of NBT (+) leucocytes was increased over fourfold. The value of the NBT test was highest at the beginning of the disease. In children treated with prednisone the value of the NBT test increased slowly. The highest results were obtained in the second week of infection treatment. In relation to controls the proportion of NBT (+) test in peripheral blood was increased threefold.