Imidacloprid affects the functional response of predator Podisus nigrispinus (Dallas) (Heteroptera: Pentatomidae) to strains of Spodoptera frugiperda (J.E. Smith) on Bt cotton

Podisus nigrispinus (Dallas) (Heteroptera: Pentatomidae) is one of the most common asopine species in the neotropical region and its occurrence was reported in several countries of South and Central America, as an important biological control agent for many crops. This study was carried out to identify the imidacloprid impacts on the functional response of predator P. nigrispinus fed on Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae) strain resistant to lambda-cyhalothrin, on Bt cotton expressing Cry1Ac (Bollgard(®)). Spodoptera frugiperda larvae were used in the following conditions: resistant (1) and susceptible (2) strains to lambda-cyhalothrin fed on Bollgard(®) cotton leaves (DP 404 BG); and resistant (3) and susceptible (4) strains to lambda-cyhalothrin fed on non-genetically modified cotton leaves (cultivar DP4049). The predatory behavior of P. nigrispinus was affected by imidacloprid and the type II asymptotic curve was the one that best described the functional response data. Handling time (T h ) of predator females did not differ among treatments in the presence of imidacloprid. The attack rate did decrease, however, due to an increase in the density of larvae offered. Regardless of the treatment (S. frugiperda strain or cotton cultivar), the predation of P. nigrispinus females on S. frugiperda larvae was significantly lower when exposed to imidacloprid, especially at a density of 16 larvae/predator. The predation behavior of P. nigrispinus on S. frugiperda larvae is affected by the insecticide imidacloprid showing that its applications should be used in cotton crop with caution.

Assessment of fennel aphids (Hemiptera: Aphididae) and their predators in fennel intercropped with cotton with colored fibers

The fennel aphid, Hyadaphis foeniculi (Passerini) (Hemiptera: Aphididae) is a major pest of fennel, Foeniculum vulgare Miller in northeast region of Brazil. We hypothesize that intercropping can be used as an alternative pest management strategy to reduce aphid yield loss in fennel. Thus, we investigated the severity of fennel plant damage in relation to infestation by the fennel aphid and predation by Cycloneda sanguinea (L.) (Coleoptera: Coccinellidae) (spotless lady beetle), green lacewing, Chrysoperla carnea (Stephens) (Neuroptera: Chrysopidae), and Scymnus spp. (Coleoptera: Coccinellidae) in sole fennel plots and plots of fennel intercropped with cotton with colored fibers. The fennel aphid populations in nontreated plots were significantly larger in sole fennel plots than in intercropped plots. The highest densities of C. sanguinea, green lacewings and Scymnus spp., associated with the suppression of fennel aphid populations was found in fennel in the intercropping systems. Fennel aphids reduced the fennel seed yield by 80% in the sole fennel plots compared with approximately 30% for all intercropping systems. The results obtained in this research are of practical significance for designing appropriate strategies for fennel aphid control in fennel-cotton intercropping systems. In summary, intercropping fennel with cotton with colored fibers apparently promoted biocontrol of fennel aphid in fennel.

Within-plant distribution of cotton aphids, Aphis gossypii Glover (Hemiptera: Aphididae), in Bt and non-Bt cotton fields

Knowledge of the vertical and horizontal distribution of Aphis gossypii Glover (Hemiptera: Aphididae) on genetically modified cotton plants over time could help optimize decision-making in integrated cotton aphid management programs. Therefore, the aim of the present study was to determine the vertical and horizontal distribution of A. gossypii in non-transgenic Bt cotton and transgenic Bt-cotton over time during two cotton seasons by examining plants throughout the seasons. There was no significant interaction between years and cotton cultivar treatments for apterous or alate aphids. Considering year-to-year data, analyses on season-long averages of apterous or alate aphids showed that aphid densities per plant did not differ among years. The number of apterous aphids found per plant for the Bt transgenic cultivar (2427 apterous aphids per plant) was lower than for its isoline (3335 apterous aphids per plant). The number of alate aphids found per plant on the Bt transgenic cultivar (12.28 alate aphids per plant) was lower than for the isoline (140.56 alate aphids per plant). With regard to the vertical distribution of apterous aphids or alate aphids, there were interactions between cotton cultivar, plant age and plant region. We conclude that in comparison to non-Bt cotton (DP 4049), Bt cotton (DP 404 BG (Bollgard)) has significant effects on the vertical, horizontal, spatial and temporal distribution patterns of A. gossypii, showing changes in its distribution behaviour inside the plant as the cotton crop develops. The results of our study are relevant for understanding the vertical and horizontal distribution of A. gossypii on Bt cotton cultivar (DP 404 BG (Bollgard)) and on its isoline (DP 4049), and could be useful in decision-making, implementing controls and determining the timing of population peaks of this insect.

Treatment and prognostic factors in patients with hepatocellular carcinoma

INTRODUCTION

Hepatocellular carcinoma is a leading cause of death from cancer worldwide. Survival of patients depends on tumor extension and liver function, but yet there is no consensual prognostic model.

AIMS

To evaluate the influence on survival of pretreatment parameters (clinico-laboratorial, liver function, tumor extension, Okuda and Cancer of the Liver Italian program (CLIP) staging) and treatment modalities.

METHODS

We retrospectively analyzed 207 patients, diagnosed between 1993 and 2003. The initial treatment was: surgery--six patients; radiofrequency ablation--21; percutaneous ethanol injection--29; transarterial chemoembolization--49; tamoxifen--49; supportive care alone--53. Factors determining survival were assessed by Kaplan-Meier method and Cox regression models.

RESULTS

Median survival was 24 months. In univariate analysis, Child-Pugh classification and Model for end-stage liver disease (MELD) score, portal vein thrombosis (PVT), tumor size, number of lesions, Okuda and CLIP scores were all associated with prognosis (P < 0.001). Alpha-fetoprotein levels were not predictive of survival. Independent predictors of survival were ascites, bilirubin, PVT and therapeutic modalities (P < 0.001). In early stage hepatocellular carcinoma (HCC), survival was similar for both percutaneous ablation modalities, either radiofrequency or ethanol injection (P = NS). In advanced HCC, survival was better in patients receiving tamoxifen than supportive care alone (P < 0.001).

CONCLUSION

This study reinforces the importance of baseline liver function (Child-Pugh classification and MELD score) in the survival of patients with HCC, although staging systems allowed the stratification of patients in different prognostic groups. Ascites, bilirubin and PVT were independent pretreatment predictors of survival. All treatments influenced the patient's outcome, whether in early or advanced stages.

Effect of diet on male reproductive tract of Podisus nigrispinus (Dallas) (Heteroptera: Pentatomidae)

The morphology and histology of the reproductive tract of males of the predator Podisus nigrispinus (Dallas) fed on different diets were studied. P. nigrispinus was fed on diets of: larvae of Alabama argillacea (Hübner), Tenebrio molitor L., Musca domestica L., and an artificial diet. The male reproductive tract, independent of diet, showed testes with intense red coloration in a compact, circular, or slightly oval structure. The vasa deferentia were similar in color to the testes and formed long filaments, which joined with the yellow-cream colored ejaculatory duct. The morphological characteristics of the male reproductive tract were similar under all diets, except for the artificial one. The histological studies demonstrated that independent of the diet the testes of P. nigrispinus were composed of four to six follicles. The testes with six follicles generally had four developed and two atrophied follicles. The morphological and histological differences of the testes of P. nigrispinus when fed with different prey are presented and discussed.

Estimate of Alabama argillacea (Hübner) (Lepidoptera: Noctuidae) development with nonlinear models

The objective of this work was to evaluate which nonlinear model [Davidson (1942, 1944), Stinner et al. (1974), Sharpe & DeMichele (1977), and Lactin et al. (1995)] best describes the relationship between developmental rates of the different instars and stages of Alabama argillacea (Hübner) (Lepidoptera: Noctuidae), and temperature. A. argillacea larvae were fed with cotton leaves (Gossypium hirsutum L., race latifolium Hutch., cultivar CNPA 7H) at constant temperatures of 20, 23, 25, 28, 30, 33, and 35ºC; relative humidity of 60 ± 10%; and photoperiod of 14:10 L:D. Low R² values obtained with Davidson (0.0001 to 0.1179) and Stinner et al. (0.0099 to 0.8296) models indicated a poor fit of their data for A. argillacea. However, high R² values of Sharpe & DeMichele (0.9677 to 0.9997) and Lactin et al. (0.9684 to 0.9997) models indicated a better fit for estimating A. argillacea development.

Spectral response for laser enhancement in hepatic regeneration for hepatectomized rats

BACKGROUND AND OBJECTIVES

The low intensity laser therapy (LILT) has been widely used in all medical fields due to its therapeutic effects in reparative process, pain relief, and biostimulation. Even though there is a therapeutic window of wavelengths for clinical application, little has been done concerning the frequency spectrum response to biological effects. In this work, we investigate the dependence of different wavelengths irradiation in the enhancement of the tissue regeneration after partial hepatectomy in Wistar rats.

STUDY DESIGN/MATERIALS AND METHODS

The proliferating cell nuclear antigen (PCNA) labeling index and the respiratory control (oxygen consumption in extracted mitochondria) were the tests used to evaluate the liver regeneration after laser irradiation with different wavelengths.

RESULTS AND CONCLUSIONS

The results show a correlated spectral response that can be explained based on the combined effect of light penetration on biological tissues and the biomolecular excitation efficiency for each wavelength used.

Spontaneous bacterial peritonitis in patients with hepatic cirrhosis: evaluation of a treatment protocol at specialized units

INTRODUCTION

Spontaneous bacterial peritonitis is a common and severe complication in patients with cirrhosis and ascitis. Its prognosis clearly depends on its precocious clinical recognition and efficacious therapy.

AIM

To optimize a treatment protocol, after auditing clinical efficacy and describe microorganisms implicated at our institution.

MATERIAL AND METHODS

Retrospective study of clinical files of patients with hepatic cirrhosis with positive culture of ascitic fluid (AF) and/or an AF polymorphonuclear (PMN) count of more than 250/mm3, treated at our units between 1st January, 2000 and 31st December, 2001 (n = 38). Patients showed a median age of 49 years (30-76), 63% of which were male. Forty-eight percent were classified as belonging to Child-Pugh B class, and 52% to C.

RESULTS

First, considering cases with PMN > 250/mm3 (n = 29), antibiotics were given to all patients (cefotaxime and ampiciline). Fifty-two percent had hepatic encephalopathy, 42% had fever, 66% abdominal pain. In 42% a microorganism was isolated. Although 24% of fatal cases (only two related to infection), we noted a 73% clinical and laboratorial response. Five patients (72%) that died, showed renal failure by the time of death. Second, in all cases with positive culture of ascitic fluid (n = 21), 42% of which with PMN > 250/mm3 and 9 monobacterial nonneutrocytic bacterascites' cases, one only agent was found: E. coli in 36%, Streptococci (37%), Staphylococci (14%), and other (14%): Klebsiella oxytoca, n = 1; Salmonella enteritidis, n = 1; Enterococcus faecium, n = 1, Acinectobacter anitratus, n = 1. Only one of the agents, E. faecium (3%) showed in vitro sensitivity exclusively to ampiciline; all other were cefotaxime sensitivite.

CONCLUSIONS

Our protocol will be modified, to treat patients with spontaneous bacterial peritonitis with cefotaxime, as monotherapy. Albumin infusion will also be added to the protocol, as, we found renal failure to be an important negative prognosis factor.

Alpha-interferon improves liver fibrosis in chronic hepatitis C: clinical significance of the serum N-terminal propeptide of procollagen type III

Our objective was to estimate the effect of interferon (IFN) on the evolution of fibrosis in chronic hepatitis C and the significance of the N-terminal propeptide of procollagen type III (PIIIP) as a marker of fibrogenesis. One hundred seventeen patients, 72 male (61%) and 45 female (39%), with a mean age of 40.7+/-11.9 years were treated with a2b-IFN, 3 to 5 MU, for 12 months: sustained responders (SR = 44), relapsers (RR = 35), and nonresponders (NR = 38). Liver biopsies were performed before treatment and 1 year after cessation of IFN for evaluation of the histological activity index (HAI). Serum PIIIP was obtained at the time of liver biopsy, at the beginning, during, and end of therapy and during the follow-up. The normal value in 29 healthy individuals was 0.37+/-0.18 U/L. Staging was reduced in 58% of SR, 12.5% of RR, and 11.5% of NR. There was a correlation between PIIIP and the HAI before (n = 71, r(s) = 0.41, P < 0.0004) and after IFN (n = 71, r(s) = 0.58, P < 0.0001). The SR had a better improvement in grading (90.3%; P < 0.05) and staging (58%; P < 0.001). The correlation of the HAI parameters with the variation of PIIIP showed significance only for fibrosis (r(s) = 0.36, P < 0.002) and portal inflammation (r(s) = 0.35, P < 0.01). PIIIP normalized only in patients whose fibrosis improved (P < 0.01). At the end of therapy, PIIIP had a predictive value in the distinction of SR from RR (PPV, 64; PNV, 55.6). During the follow-up, PIIIP remained lower in SR compared with RR and NR (P < 0.002). The response to a-IFN improved liver inflammation and fibrosis. Serum PIIIP is a useful noninvasive method to evaluate serially fibrogenesis in chronic hepatitis C treated with IFN.

[Autoimmune cholangiopathy]

We report two patients with mixed characteristics of primary biliary cirrhosis and autoimmune hepatitis. They are two female patients in their fifties (54 and 58 years-old) one of them with autoimmune phenomenon, rheumatoid arthritis and Sjögren syndrome. Both of them showed laboratory values of cholestasis and the liver biopsy revealed liver cirrhosis with significant lesions of the bile ducts. They were treated with prednisolone with a rapid improvement and normalisation of their blood tests. They belong to a group called as overlap syndrome or autoimmune cholangitis with mixed characteristics, clinical, biochemical, immunological, and histopathologic overlapping between primary biliary cirrhosis and autoimmune hepatitis type I.

Clastogenic factors as biomarkers of oxidative stress in chronic hepatitis C

BACKGROUND/AIMS

Clastogenic factors (CFs) are composed of lipid peroxidation products, cytokines and other oxidants with chromosome-damaging properties. They are regularly observed after radiation exposure and in chronic inflammatory diseases, where they are supposed to be risk factors for carcinogenesis. It appeared of interest to investigate their presence in the plasma of patients with chronic hepatitis C.

METHODS

CFs are detected by chromosomal breakage studies. They were compared to malondialdehyde (MDA), total plasma thiols (t-SH), alanine aminotransferase (ALT), viral load and histological data.

RESULTS

CFs were increased in 19 of 20 patients, 16 had increased MDA levels and 15 had decreased t-SH levels. Mean values were significantly different from the 20 controls (p<0.001). After the first 3 months of interferon treatment, all three markers showed significant improvement, but were not completely normalized. There was a positive correlation between CFs and necroinflammatory activity (p<0.03), while MDA was correlated with fibrosis (p<0.03). Viral load was correlated with necrosis and inflammation (p<0.05).

CONCLUSION

The presence of CFs in chronic hepatitis C confirms the occurrence of oxidative stress in this disease and could be useful in clinical trials for testing antioxidants. The CF test is a sensitive assay for the detection of oxidative stress and correlates with necroinflammatory activity.

Angiotensin-converting enzyme inhibition by lisinopril enhances liver regeneration in rats

Bradykinin has been reported to act as a growth factor for fibroblasts, mesangial cells and keratinocytes. Recently, we reported that bradykinin augments liver regeneration after partial hepatectomy in rats. Angiotensin-converting enzyme (ACE) is also a powerful bradykinin-degrading enzyme. We have investigated the effect of ACE inhibition by lisinopril on liver regeneration after partial hepatectomy. Adult male Wistar rats underwent 70% partial hepatectomy (PH). The animals received lisinopril at a dose of 1 mg kg body weight(-1) day(-1), or saline solution, intraperitoneally, for 5 days before hepatectomy, and daily after surgery. Four to six animals from the lisinopril and saline groups were sacrificed at 12, 24, 36, 48, 72, and 120 h after PH. Liver regeneration was evaluated by immunohistochemical staining for proliferating cell nuclear antigen using the PC-10 monoclonal antibody. The value for the lisinopril-treated group was three-fold above the corresponding control at 12 h after PH (P<0.001), remaining elevated at approximately two-fold above control values at 24, 36, 48 (P<0.001), and at 72 h (P<0.01) after PH, but values did not reach statistical difference at 120 h after PH. Plasma ACE activity measured by radioenzymatic assay was significantly higher in the saline group than in the lisinopril-treated group (P<0.001), with 81% ACE inhibition. The present study shows that plasma ACE inhibition enhances liver regeneration after PH in rats. Since it was reported that bradykinin also augments liver regeneration after PH, this may explain the liver growth stimulating effect of ACE inhibitors.

Apoptotic cell death does not parallel other indicators of liver damage in chronic hepatitis C patients

The mechanisms of hepatocyte damage and the events that lead to high rates of chronic liver disease in hepatitis C virus (HCV) infection remain unclear. Recent in vitro studies have suggested that the HCV core protein may disrupt specific signalling pathways of apoptosis. This prompted us to study patients with chronic HCV infection to: determine the extent of apoptosis in the liver; evaluate whether clinical and biochemical data are correlated with histological findings; and to investigate if apoptosis is related to the histological activity of the disease. Twelve patients with chronic hepatitis C were included in the study. Liver histology was scored by using the histological activity index (HAI) of Knodell et al. DNA fragmentation was assessed in liver tissue by the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labelling (TUNEL) assay. Routine methods were used to determine serum markers of liver disease. Bile acids were measured in serum and liver by gas chromatography. Patients were placed, according to their HAI score, into group A (3.8 +/- 0.3) or group B (7.8 +/- 0.8) (P < 0.01). Liver enzymes tended to be higher in group B patients than in patients of group A. Levels of toxic bile acids in serum were greater in patients than in controls (P < 0.01). Chenodeoxycholic acid values were slightly higher in serum and liver of patients in group A. Liver biopsies with low HAI scores showed an increased rate of apoptosis (18.0 +/- 4.0 apoptotic cells per field) compared to those with higher HAI scores (6.6 +/- 2.1, P < 0.05) or to controls (3.5 +/- 0.4, P < 0.01). Hence, less severe liver disease, associated with lower histological grades and biochemistries, as well as increased levels of chenodeoxycholic acid, induces an expanded apoptotic response. The lower apoptotic rate in advanced liver disease may be associated with the high incidence of hepatocellular dysplasia/neoplasia.

Correlation of genotypes and route of transmission with histologic activity and disease stage in chronic hepatitis C

Our objective was to evaluate the histopathological features of chronic hepatitis C of 64 liver biopsies and to correlate this with the route of transmission of hepatitis C virus, the genotype of HCV, and the patient's age. Moderate chronic hepatitis was the most frequently observed (62.5%). Cirrhosis was observed in 14 patients (21.9%) and was more frequently found among patients over 40 years of age (34.3% vs. 6.9%, P = 0.025). The mean histopathological activity index (HAI) was significantly higher in the sporadic (10+/-3.1) than the posttransfusional (7.5+/-3.7) and the intravenous drug use (IVDU) groups (6.3+/-2.8) (P<0.02). Moreover the sporadic group showed more fibrosis (P<0.04) than the posttransfusional group. No liver cirrhosis was found in the IVDU group. The overall prevalence of HCV variants was: 54.7% type 1b, 4.6% type 1a, 37.5% type 2c, 1.6% type 2b, 1.6% type 2. The genotype distribution showed no relation to the HAI, hepatitis activity (grade), and fibrosis (stage) of the liver disease. In conclusion, the sporadic route of transmission of HCV was related to a more severe chronic hepatic disease, a finding that could influence future antiviral therapies. The predominance of HCV type 1b in this study reflects the higher frequency of this variant in our area. Our data suggests that the ultimate consequence of HCV chronic infection depends on patient age rather than on HCV genotype.

The effect of insecticides on learning in the Africanized honey bee (Apis mellifera L.)

The present study was designed to examine the effects of endosulfan, decis, baytroid, and sevin on the learning ability of Africanized honey bees (Apis mellifera L.). Although these insecticides were recommended by the government of Brazil to control the cotton boll weevil, the effects on bees have been unknown. Results of the present research show that: (1) bees readily consume each of the pesticides when placed in a sucrose solution; (2) the odors of the pesticides are not repellent to bees, and such odors can serve as conditioned stimuli; (3) learning occurs to various degrees when the insecticides are combined with the sucrose solution and used as an unconditioned stimulus; and (4) feeding the insecticides to the bees 1 h prior to conditioning leads to differing mortality. Because of the importance of bees for honey production, as well as pollination of cotton and other crops, recommendations are made for the use of decis and other measures for boll weevil control.http://link. springer-ny.com/link/service/journals/00244/bibs/37n4p529.++ +html</HEA

Autoimmune cholangitis: case report

We report on 2 patients who showed mixed signs of primary biliary cirrhosis and autoimmune hepatitis. Both patients were female, in their fifties (54 and 58), their laboratory tests indicated cholestasis, and a liver biopsy revealed liver cirrhosis with significant lesions of the bile ducts. Both were treated with prednisolone with their liver tests showing a rapid normalization of their aminotransferases. These patients can be considered as presenting with what is known as the overlap syndrome or autoimmune cholangitis, which has the clinical, biochemical, immunological, and histopathological characteristics of primary biliary cirrhosis and autoimmune hepatitis type I.

[Vaccine against hepatitis B. Eight years of experience]

Hepatitis B virus infection is one of the world's major health problems and health care workers are especially at risk, leading to the need for a high priority vaccination program. Such a program was begun in 1989 in S. Maria Hospital and included all hospital personnel and students of the Faculty of Medicine. The screening included 2360 health care workers and 1153 students. Fifty-five percent of hospital health care workers and 41% of the students participated in the vaccination program. The overall prevalence of hepatitis B markers was 16.8%, for hospital personnel, the chronic carrier being 0.95%, and for the students, 5.5% and 0.3% respectively. The highest prevalence was observed in the Biochemical Laboratory--64% (7/11), Surgery--42% (13/31), Pneumology--39% (9/23), Emergency Department--29% (7/24), Hematology Laboratory--29% (7/24) and Orthopedics--29% (10/35). The prevalence was also higher in students in the last three years of Medical School compared to those in the first three years, 12.2% vs 7.2%, p = NS. Local pain has been the most frequent complaint in 8.6% of vaccinees. The control with the quantification of anti-HBs in the 7th month has shown a serological efficacy of about 95%. A non-response was observed in male workers, 13% compared to 5% for females, p < 0.05. Older employees also showed higher non-response: the average age of workers with anti-HBs of 0 U/L was 52.3 years, and those with anti-HBs of more than 100 U/L was 38.4 years, p < 0.02. Hepatitis B vaccine is a safe and effective preventative measure that has been widely used for years. Our study shows the need for a more aggressive approach to the vaccination of health care workers because a significant percentage of them in our country are not protected.

Diphenylhydantoin-induced hepatitis: a case report

This case report is of a 25-year old man with severe diphenylhydantoin-induced hepatitis, fever, rash and generalized lymphadenopathy. Hepatic histology and lymphocyte transformation tests strongly supported the diagnosis. He made an uneventful recovery with supportive therapy.

Idiopathic hypereosinophilic syndrome presenting as cholestatic liver disease

We report the case of a 34-year-old white man with recurrent episodes of abdominal pain, cholestasis and eosinophilia. The diagnosis of idiopathic hypereosinophilic syndrome (IHS) was made after exclusion of all known causes of eosinophilia. Liver biopsy revealed an eosinophilic infiltrate with biliary damage. The patient recovered after prednisolone treatment. We review the literature on the association between IHS and liver disease.

[A structural analysis of the entrance exams for specialist interns from 1994 to 1996]

In order to obtain specialist training in Portugal, doctors must pass a multiple-choice examination. The aim of this article is to present a structural and mathematical analysis of the examinations in the last three years. We based our work on the calculation of reliability coefficient of the examinations, and the difficulty and discrimination index of the questions and the examinations as a whole. A detailed analysis of the examinations, including that of each of the three hundred questions, will be published by the Department of Health Manpower in January, 1997.

Streptococcus bovis spontaneous bacterial peritonitis in patients with alcoholic cirrhosis

Spontaneous bacterial peritonitis (SBP) is a frequent cause of decompensated alcoholic cirrhosis. The authors describe the first two cases caused by infection with Streptococcus bovis. They suggest that this microorganism may be present in the intestinal flora of these patients more frequently than assumed. Furthermore, the course of SBP due to S. bovis may be particularly severe.

[Infection with hepatitis C virus in porphyria cutanea tarda]

The authors make a literature review on hepatitis C virus infection in porphyria cutanea tarda, illustrated by one clinical case. They also present some considerations about pathophysiologic mechanisms involved in this association.

[Prevalence of chronic hepatic disease in Portugal. Apropos of a review carried out in a hepatology unit]

The chronic elevation of Aminotransferases is one of the most frequent indications for percutaneous Liver Biopsy (LB). From a retrospective study of LB performed in the Hepatology liver Unit of Santa Maria Hospital, between 1989 and 1993, we correlated the histologic diagnosis with the etiology of liver disease, sex, age and the Aspartate aminotransferase/Alanine aminotransferase (AST/ALT) and Gama-Glutamyl transpeptidase (gamma GT) index in patients with chronic liver test abnormalities. 790 LB were reviewed retrospectively, of patients aged between 11 and 78 years, 68% males and 32% females. The most common etiology was Hepatitis C (34.6%), followed by Hepatitis B (20.1%) and alcohol (15.8%). Autoimmune diseases (Primary Biliary Cirrhosis and Autoimmune Hepatitis) were present in 3% of cases, and metabolic liver diseases in 1.4%. The distribution by sex revealed a predominance of Hepatitis C in both, alcoholic liver disease being more frequent in males (21.5% vs 3.9%). The main histological diagnoses were Chronic Active Hepatitis (27.2%), Liver Cirrhosis (19.5%), Steatohepatitis (9.5%) and minor lesions (24.6%). In alcoholic liver disease, 47.2% had Liver Cirrhosis and 16% Steatohepatitis; in Hepatitis B, Liver Cirrhosis was found in 12.6% and in Hepatitis C in 11.4%. Liver Cirrhosis had a prevalence between the 4th and 6th decade of life (82%) with a peak incidence in the 5th, and appeared earlier in Hepatitis B and later in Hepatitis C. The prevalence between sexes was similar. The main etiology of Liver Cirrhosis was alcohol (38.3%). The gamma GT index was greater in alcoholic liver disease (average 4.1) and was nearly twice in Hepatitis C than in Hepatitis B (1.7 vs 0.8).

CONCLUSIONS

1) Hepatitis C in our Hepatology Unit was the main indication for Liver biopsy. 2) The prevalence of alcoholic liver disease is greater in males, being the main etiology of Liver Cirrhosis. 3) The progression to Liver Cirrhosis seems to be similar in Hepatitis B and C. 4) The progression to Liver Cirrhosis is similar in both sexes, being dominant in the 5th decade of life. 5) The progression to Liver Cirrhosis is earlier in Hepatitis B than in Hepatitis C. 6) A gamma GT index elevation, without alcohol abuse, is suggestive of Hepatitis C. 7) Autoimmune and metabolic liver diseases seem to be rare in Portugal.

Effect of chronic ethanol consumption on the activities of residual small bowel brush-border enzymes after proximal jejunum resection in the rat

Ethanol consumption has a toxic effect on the epithelium of the small bowel, but enterocyte maturity is very difficult to measure under these circumstances. However, when ethanol intake is combined with enterectomy, enterocyte immaturity is greater, permitting an easier separation of these two effects. In a group of rats (13 male Wistar rats weighing approximately 220 g) fed a liquid diet containing 35% ethanol for 4 weeks after resection of the proximal jejunum, the residual small intestine brush border maltase, sucrase, and lactase activities were similar to those of a pair-fed control group (13 animals). However, alkaline phosphatase activity was decreased in the mucosa and in the enterocyte brush border, probably because of the lower activity of this enzyme in the jejunum-ileum remnant of the alcoholic group.

[Jejunal myenteric denervation induced by benzalkonium chloride]

The effects of benzalkonium chloride (BAC) on the number of myenteric neurons, muscle thickness and external perimeter after acute (until 10 days after BAC application) and chronic (30 and 60 days after BAC application) denervation of the proximal jejunum were determined in rats. There was a significant reduction in the number of myenteric neurons of all segments treated with BAC. The extent of denervation varied along the time, and it was reduced in the denervated segments of the chronic group in comparison with the acute group. This may be due to the neuroplasticity phenomenon appearing during the chronic phase. Myenteric denervation increased the thickness of the propria muscle layer, especially in the longitudinal muscle layer, suggesting a higher sensitivity of this layer to myenteric denervation.

Myenteric neuron number after acute and chronic denervation of the proximal jejunum induced by benzalkonium chloride

The effects of benzalkonium chloride (BAC) on the number of myenteric neurons after acute (until 10 days after BAC application) and chronic (30 and 60 days after BAC application) denervation of the proximal jejunum were determined in rats. There was a significant reduction in the number of myenteric neurons of all segments treated with BAC. The extent of denervation varied with time, and it was reduced in the denervated segments of the chronic group in comparison with the acute group. This may be due to the neuroplasticity phenomenon appearing during the chronic phase.

[Chronic hepatitis: the etiological spectrum. The implications for treatment]

The prevalence of chronic hepatitis and its different aetiologies was studied in all patients above 10 years of age seen in the specialised outpatient clinic of our hospital over a 3 year period. Defining chronic hepatitis as a persistent elevation of the transaminases, 988 patients (62% of all the patients observed) were classified as follows: viral aetiology in 82%, metabolic in 2%, biliary in 2%, alcoholic in 11%, autoimmune in 1.5% and idiopathic in 2%. Among the viral group, hepatitis B virus infection was predominant (65%), followed by hepatitis C virus (26%) and delta hepatitis (8%). While the hepatitis C and delta patients presented high transaminases, in the HBsAg carriers this occurred in 94% and 20% of the HBeAg and anti-HBe-positive patients, respectively. Thirty per cent of the patients with chronic hepatitis B, 35% of those with chronic hepatitis C and 18% with delta hepatitis were selected for alpha interferon therapy. This demonstrated that in a significant proportion of patients with chronic viral hepatitis, therapy with interferon is not indicated. Corroborating other studies, with even stronger data, our study shows that viral aetiology is the most frequent type of chronic hepatitis.

[The intrahepatic expression of the hepatitis B virus in chronic delta hepatitis]

In order to evaluate the interference of hepatitis delta virus (HDV) in hepatitis B viral particle (HBsAg, HBcAg) expression in the liver of chronic HDV patients, 39 and 81 liver biopsies of HBsAg carriers seropositive for anti-HDV and anti-HDV negative controls, respectively, were studied. HBcAg was positive in 16.7% of the HBeAg-positive patients with HDAg in the liver and in 91,4% of controls. In contrast, in HBeAg- and anti-HDV negative patients the intrahepatic expression of HBcAg was detected in 32.6%. In anti-HDV negative patients the HBcAg liver expression correlated significantly with the HBeAg in serum (p < 0.00001). The distribution of HBcAg was exclusively cytoplasmatic in 30% of HDV-infected patients but mixed nuclear and cytoplasmic in 38.3% of the controls. The nuclear expression of HBcAg was decreased in chronic HDV infection. HBsAg was positive in 70.3% of patients who were anti-HDV positive and in 82.3% of controls. The membranous expression of HBsAg was detected less frequently in HDV-infected patients (p < 0.05) than in controls, while associated with HBeAg in serum of HBV carriers without HDV superinfection (p < 0.00001). The prevalence and the HBsAg cytoplasmic expression was not different for the chronic HDV infection or controls. Our results show: 1) decreased intrahepatic expression of HBcAg and membranous HBsAg in HBV carriers superinfected with HDV, suggesting decreased HBV replication in the liver of these patients. 2) the changing of HBcAg and HBsAg expression in the liver of HDV-infected patients, suggest not so much a decrease but rather a modulation in HBV replication.

[Therapy of chronic non-A, non-B hepatitis with recombinant interferon alfa and factors that influence the response to the treatment]

To assess the efficacy of therapy with alfa Interferon in chronic hepatitis C (NANB), 18 patients were enrolled in an open trial. Eleven were males and 7 females with a mean age of 43 years. Interferon alfa 2b was used in titrated doses for 9 months and the treatment was started with 5 m.U./Ti. During therapy, the patients were evaluated clinically and biochemically. A liver biopsy was done within 3 months after the completion of treatment. The serum alanine aminotransferase (ALT) level 1 became completely normal in 11 patients (61%) at 3 months of therapy and a partial response was seen in 3 (16%). At the 6 months the ALT sustained normal in 10 patients (55%) and a partial response was seen in 5 (27.7%). Four out of 7 patients (57%) who completed the therapy had complete response and 2 (28.5%) a partial response. From 5 patients who completed the follow-up, 3 (60%) had a relapse of ALT levels. A low level of ALT at the beginning of treatment had a predictive value of response to the therapy (P less than 0.05). The side effects of interferon therapy were usually mild. Fever, myalgias and headaches were seen in 72% of patients in the first two weeks of therapy. No haematological alterations were seen. We conclude that a 9 month course of interferon therapy is effective in controlling disease activity in many patients with chronic NANB hepatitis. However, the high relapse rate suggest that future studies should establish the optimal dose and duration of treatment to induce a complete resolution of the disease.

[Viral infections in intravenous drug addicts. Clinical and prognostic significance]

A retrospective analysis of 135 drug addicts followed between 1986 to 1987, was done, in order to asses the seroprevalence of hepatitis B virus (HBV), hepatitis Delta virus (HDV), hepatitis C virus (HCV) and Human Immunodeficiency virus (HIV), as also their clinical and prognostic significance. A high prevalence of HBV, HDV and HCV infection was observed in this study: 81%, 64% and 83% respectively; in contrast just one case was positive for HIV. Among the drug addicts the frequency of multiple infections (HBV/HCV 51.6%; HBV/HDV/HCV 18.7%; HBV/HDV 2.2%; HCV/HIV 1.1%) was highest in comparison with isolated (HBV 5.5%; HCV 12.1%) or absent infection (73.6% vs 17.6% vs 8.8% respectively; p less than 0.001). Eleven of 12 (92%) patients with Delta hepatitis and HCV superinfection were seronegative for IgM anti-HD; in contrast the case without HCV superinfection was IgM anti-HD positive. In the former group the Alanine Amino-transferases (ALT) were significantly lower comparatively with those HBV positive patients superinfected by HCV (97 +/- 92 IU/L vs 249 +/- 125 IU/L; p = 0.001), and were not different from drug addicts with isolated HCV infection (62 +/- 49 IU/L). The results of this study indicate, a low prevalence of HIV infection in the Portuguese drug addicts and a high frequency of multiple HBV, HDV and HCV infection in the same period of study. Our observations suggest that HCV may have the capacity to inhibit the replication and pathogenic activity of hepatitis Delta virus.

Serum markers of hepatitis B virus replication, liver histology and intrahepatic expression of hepatitis B core antigen

The presence and distribution of hepatitis B core antigen (HBcAg) was studied in the liver of 227 chronic carriers of hepatitis B surface antigen (HBsAg) to investigate its relationship with serum HBV-DNA, the status of hepatitis B 'e' antigen/antibody (HBeAg/anti-HBe) and the underlying liver disease. HBcAg was detected in 144 of the 227 (63%) liver specimens and HBV-DNA in 132 (58%) of the corresponding sera. Serum HBV-DNA showed a constant link with intrahepatic HBcAg. Out of 96 HBeAg-positive patients, 91 (95%) had HBcAg in the liver and 85 (89%) had HBV-DNA in serum. Overall there was a significant link between HBeAg and HBV-DNA in serum, but there was no correlation in 58 out of 227 (26%) cases. In HBeAg/HBV-DNA-positive carriers, HBcAg expression was predominantly nuclear. It was nuclear and cytoplasmic in patients with the highest levels of viremia. Eleven out of 13 (85%) HBV-DNA-positive patients who had only cytoplasmic HBcAg were HBcAg-negative and had low levels of HBV-DNA. Nine of 13 (69%) patients with exclusively cytoplasmic HBcAg had severe chronic liver disease. Neither the presence of HBV-DNA and HBeAg in serum nor the nuclear localization of HBcAg were associated with the severity of liver damage. In the group of HBV-DNA-positive patients (132), the presence of liver disease was significantly connected with the absence of HBeAg in serum (P less than 0.05; C.L. 3-35).(ABSTRACT TRUNCATED AT 250 WORDS)

Increased stable E rosette-forming cells in alcoholic liver disease

Circulating total E rosette-forming cells (E-RFC) and stable E-RFC (activated T cells) were studied in 10 patients with alcoholic hepatitis (AH), 15 with alcoholic cirrhosis (AC) and 20 normal controls. Total E-RFC were significantly reduced in AH and AC as compared to the controls. By contrast, both proportions and absolute numbers of stable E-RFC were significantly increased in AH and AC, the increase was greatest in AH. These findings represent evidence for abnormalities in T cell subpopulations in alcoholic liver disease and suggest that monitoring stable E-RFC may prove useful in assessing disease activity in AH.

Active E rosette-forming cells in the peripheral blood of patients with chronic active hepatitis

E rosette-forming cells (E-RFC) and active E-RFC were studied in the peripheral blood in patients with chronic active hepatitis (CAH), chronic persistent hepatitis (CPH), and in control subjects. A significant reduction in active E-RFC (a subpopulation of T lymphocytes considered actively involved in cell-mediated immune reactions) was found in patients with untreated CAH, both HBSAg positive or negative. In contrast, patients with immunosuppressive-treated CAH showed an increased relative number of active E-RFC. A significant increase in active E-RFC was demonstrable in other immunosuppressive-treated chronic inflammatory disorders. In CPH active E-RFC were not different from normal controls. The number of E-RFC showed a relative and absolute decrease in both CPH and untreated CAH. These studies demonstrate an increase in active E-RFC in immunosuppressive-treated CAH and suggest that prednisone and azathioprine may have a differential effect on T lymphocyte subpopulations.