[Efficacy of combination treatment with pegylated interferon plus ribavirin in patients chronically infected with HCV].

The Aim Of The Study: To evaluate the efficacy of combined antiviral treatment with pegylated interferon alpha plus ribavirin in patients with chronic HCV infection who have not yet been treated with antivirals (treatment-naive patients). To compare the treatment effect in patients with low (< 600,000 IU/ml) and high (> or = 600,000 IU/ml) initial viremia. METHODS AND TREATMENT REGIME: Treatment-naive patients with chronic HCV infection treated with the combination therapy of pegylated interferon-alpha2a plus ribavirin.

[Diabetes mellitus and the liver].

Liver diseases are frequently associated with disorders of the carbohydrate metabolism--impaired glucose tolerance, hyperinsulinaemia, insulin resistance. Impaired glucose tolerance is due in particular to impaired glucose uptake in the splanchnic area and periphery. Glucose production by the liver is normal, similarly as insulin secretion.

[Diagnosis and treatment of hepatic cysts].

Hepatic cysts are at the present time of widespread use of abdominal ultrasonography a frequent finding. The authors summarize contemporary diagnostic possibilities of liver cysts and submit variants of the therapeutic procedure in case of symptomatic liver cysts. They present their own experience with the treatment of hepatic cysts by the evaluation method combined with administration of 96% ethanol into the cyst.

Indel in the FIC1/ATP8B1 gene-a novel rare type of mutation associated with benign recurrent intrahepatic cholestasis.

Benign recurrent intrahepatic cholestasis (BRIC) is a rare inherited liver disease characterized by recurrent attacks of severe cholestasis with no progression to end stage liver disease. Patients have jaundice, however, serum gamma-glutamyltransferase and cholesterol levels remain within the normal range during the attacks. Three mutations in the familial intrahepatic cholestasis 1 (ATP8B1) gene encoding a P-type ATPase have been reported so far in patients with the autosomal recessive form of BRIC.

[Cholestasis].

Cholestasis is a condition, where the bile flow into the intestine is defective. The causes may be extrahepatic (in large biliary ducts) or intrahepatic (at the level of hepatocytes or minor biliary ducts). The lack of bile in the intestine results in serious consequences, mainly malabsorption, malnutrition and skeletal changes.

[Importance of liver biopsy in chronic hepatitis C virus infection].

Introduction: The importance of liver biopsy and knowledge of the histological activity of liver les on in chronic hepatitis C virus (HCV) infections is widely discussed recently. There are attempts to find an alternative evaluation which will make it possible to avoid liver biopsy. The crucial question in patients with chronic HCV infection is to differentiate patients with already developed liver cirrhosis from those with chronic hepatitis.

[Risk factors for transmission of hepatitis C in the the Czech population].

Background: Recent reports from all over the world have repeatedly indicated a change in the incidence of individual risk factors for hepatitis C virus (HCV) infection transmission compared with the pattern in the late 1980s and early 1990s. In the Czech Republic, HCV is very often referred to as an addicts' disease, rare in the general population. To establish the incidence of individual risk factors for HCV infection transmission in a group of patients on follow-up at the Department of Internal Medicine I.

Gilbert syndrome and ischemic heart disease: a protective effect of elevated bilirubin levels.

Background: Oxidation processes play an important role in atherogenesis. Bilirubin IXalpha is recognised as a potent antioxidant. In the present study, we assessed the role of elevated serum bilirubin levels in the prevention of ischemic heart disease (IHD).

Intestinal excretion of unconjugated bilirubin in man and rats with inherited unconjugated hyperbilirubinemia.

Patients with Crigler-Najjar syndrome and Gunn rats cannot form bilirubin glucuronides owing to a lack of bilirubin UDP-glucuronosyltransferase activity. Because increased serum and tissue bilirubin levels remain constant, an alternative excretory route has to substitute for this deficiency. Gunn rats excrete in bile only 2-13% of the bilirubins eliminated in Wistar rats.

[Ursodeoxycholic acid in the treatment of primary biliary cirrhosis].

Background: Pharmacotherapy of primary biliary cirrhosis (PBC) was not resolved unequivocally so far. During the last decade bile acids are used more widely. The objective of the submitted paper was to investigate under conditions of an open perspective study the influence of long-term administration of ursodeoxycholic acid on the clinical course and selected laboratory indicators.

[Etiology and epidemiology of hepatocellular carcinoma].

Hepatocellular carcinoma (HCC) is a highly malignant tumour with a poor prognosis. Its incidence is rising. The estimate incidence worldwide is 1 million cases.

[Portal hypertension--introduction to the problem].

Portal hypertension is a condition with a permanently raised pressure in the portal area. The most frequent cause is restricted blood flow through some part of the circulation. Depending on the site of obstruction, we classify portal hypertension into prohepatic, hepatic and posthepatic.

[Diet in liver diseases].

The liver is the metabolic centre of all nutrients. Liver disease can thus interfere with the metabolism of the whole organism, it can have a negative impact on the nutritional status and frequently lead to marked malnutrition. On the other hand, attempts to influence liver disease by dietetic provisions have an old tradition while actual evidence of a marked benefit of these prescriptions is lacking.

[The first case of Crigler-Najjar syndrome in the Czech Republic].

Background: Crigler-Najjar syndrome is a rare disease due to a congenital deficiency of bilirubin UDP glucuronosyl transferase in the liver tissue. It is characterised by high levels of unconjugated bilirubin in plasma through the whole life. The aim of the study was to confirm the clinical diagnosis of the first Crigler-Najjar syndrome case in our country.

[Treatment of chronic viral hepatitis B with interferon alfa. Experience of the last 3 years].

Background: interferon alpha is nowadays the drug of choice in the treatment of chronic viral hepatitis. The objective of the present work was to assess the effectiveness of interferon alpha in the treatment of chronic active hepatitis B in our population and to test whether the known "prognostic factors" of successful treatment are applicable in our patients.

Methods And Results: In 1991-1994 a total of 25 patients were treated (15 men, 10 women, mean age 46.

[Chronic hepatitis--diagnosis and differential diagnosis].

Since the first classification of chronic hepatitis (CHH) more than 25 years have elapsed. Since then conditions for assessment of the etiology, pathogenesis and therapy of the disease have improved. These findings must be applied in the contemporary diagnosis of CHH.

[Modern therapy of ascites in liver cirrhosis].

The most frequent cause of ascites in the Czech Republic is cirrhosis of the liver. Treatment of ascites in cirrhotic patients must be very careful as the use of strong diuretics is associated with some adverse complications. The latter are reviewed.

[Modern therapy of ascites in liver cirrhosis].

Ascites is a common sign of decompensated cirrhosis of the liver. In order to improve the patient's quality of life, it is essential to treat him systematically. The authors present an algorithm of therapeutic procedures.

[Prognostic significance of ascites in patients with liver cirrhosis].

The author evaluates the prognostic importance of ascites in 100 patients with cirrhosis of the liver. The patients were followed up on a log-term basis in a hepatology clinic and the diagnosis was confirmed morphologically. Ascites developed at a time when marked objective and laboratory signs of chronic liver disease were present.

[Diagnosis and therapy of cholestasis].

The submitted paper is a contribution to the problem of cholestasis from the aspect of contemporary knowledge recorded in the literature as well as the author's experience assembled in a hepatological department. The author expands on individual steps of the diagnostic procedure--is it a case of cholestasis? What type of cholestasis? The most frequent causes of intrahepatic cholestasis are discussed. The main point is a summary of therapeutic possibilities, in particular in chronic forms of cholestasis.

Disposition kinetics and concentration-effect relationship of metipranolol in patients with cirrhosis and healthy subjects.

The disposition kinetics and heart rate reducing effect of deacetylmetipranolol (DMP), the active form of the beta-adrenoreceptor blocking agent metipranolol (MP), administered as a single 40 mg oral dose have been compared in 6 patients with cirrhosis and 6 healthy volunteers. The mean maximal DMP concentration was significantly higher and the time to reach the peak level shorter in the patients compared to the healthy subjects. There was also a significantly higher AUC of DMP, a shorter half-life of the rapid phase of the decline in DMP concentrations, a smaller central compartment and lower apparent DMP clearance in patients.

[Changes in pharmacokinetics of trimecaine in patients with liver cirrhosis].

Trimecaine (Mesocain, Léciva) an analogous preparation to lidocaine is used as a local anaesthetic, antiarrhythmic and spasmolytic preparation. The purpose of the investigation was to assess the fate of trimecaine in nine patients with compensated cirrhosis of the liver. The pharmacokinetics were evaluated after intravenous infusion of trimecaine administered at a rate of 150-200 mg.

[Prolipase in the treatment of dyspepsia in chronic liver diseases].

In 12 patients with chronic liver disease without detectable pancreatic insufficiency the authors tested in clinical trials the pancreatic enzyme preparation Prolipase (Cilag AG, Switzerland) in an attempt to influence the marked dyspeptic complaints of patients. They administered three times per day two capsules before meals for a period of three weeks. Half the patients evaluated the therapeutic effect as excellent, one quarter as very good, only one quarter did not observe a marked favourable effect on dyspepsia.