Combination therapy with interferon-alpha 2b and ribavirin for the treatment of relapse patients and non-responders with chronic HCV infection.

Background: Treatment of patients with chronic hepatitis C after failure of an interferon monotherapy remains controversial. While relapse patients have a sustained response after a combination therapy with interferon-alpha 2b 3 x 3 MU/week plus ribavirin 1,000/1,200 mg daily for 24 weeks in up to 49%, the standard therapy for initial non-responders remains to be determined.

Methods: We therefore conducted a large multicenter trial to compare efficacy and safety of a combined interferon/ribavirin therapy in 327 non-responders and 181 relapse patients with chronic HCV infection outside of highly specialized institutions.

Treatment of posttransplant lymphoproliferative disorder with the anti-CD20 monoclonal antibody rituximab alone in an adult after liver transplantation: a new drug in therapy of patients with posttransplant lymphoproliferative disorder after solid organ transplantation?

Background: Posttransplant lymphoproliferative (PT-LPD) disorder is a life-threatening complication with an incidence of 1-10%. Uniform treatment, so far, does not exist.

Methods: In December 1996, 5 months after a liver transplant, a 43-year-old patient developed a PT-LPD with para-aortal lymphomas and splenomegaly.

A German drug-monitoring study in general practice patients receiving cisapride for functional dyspepsia.

An open prospective drug monitoring study was undertaken to assess the efficacy and tolerability of 5 mg cisapride three times daily in 37,925 general practice patients with functional dyspepsia. Short-term (mean, 4 weeks) cisapride treatment was associated with a significant reduction in overall dyspeptic symptom scores and improvements in scores of all eight individual dyspeptic symptoms (epigastric discomfort, fullness, nausea, bloating, heartburn, acid regurgitation, loss of appetite, and vomiting). Physician's and patient's subjective global evaluations of antidyspeptic efficacy were good or very good in 80% to 90% of cases.

Morphology of non A-non B hepatitis (HNANB). A study of 104 cases.

A series of 104 liver biopsies from patients with clinical HNANB were classified under code into established histologic groups. Activity and basic features were semiquantitatively assessed using a score system. In 23/104 cases non viral lesions were diagnosed.

[Clinical studies of the specificity of detecting viral DNA in non-A, non-B hepatitis in liver tissue and lymphocytes].

The clinical specifity of an intraparticular virus-DNA of 5001 Bp associated with non-A, non-B hepatitis (HNANB) was evaluated. Investigations were done in liver biopsies and lymphocytes in 173 patients having acute or chronic HNANB (n = 107) or liver diseases of other etiology (n = 66). The sensitivity of the test system (polymerase chain reaction, southern-transfer, DNA-hybridisation with synthetic oligonucleotides) was less than 100 virus particles per probe.

[Rapid development of liver cirrhosis following acute non-A, non-B hepatitis].

Four cases of shortly developed liver cirrhosis as consequence of non-A-non-B-hepatitis are described. Liver cirrhosis was diagnosed by liver histology at days 254, 298, 651 and 891 after acute infection, respectively. For the first time a normal liver histology was documented in one case immediately before infection together with follow up biopsies of chronic hepatitis up to liver cirrhosis (day 891) after acute posttransfusion non-A-non-B-hepatitis.

[Hepatitis non-A, non-B-associated DNA--demonstration of DNA in proven infectious anti-D-immunoglobulin].

An anti-D-immunoglobulin preparation implicated in a hepatitis non-A,non-B transmission was analyzed for the presence of a DNA, which was originally isolated, cloned and sequenced from feces of a patient with posttransfusion HNANB. The investigation was performed by a DNA polymerase chain reaction using synthetic oligoprimers. Commercially available immunoglobulin preparations served as controls.

[Hepatitis non-A, non-B-associated substance in stool from patients with posttransfusion and sporadic hepatitis].

A hepatitis non-A,non-B-associated substance (HNANB-AS) excreted in feces has been detected by means of a sandwich radioimmunoassay using reconvalescent serum and IgG from patients with posttransfusion HNANB. 4380 stool filtrates from 1599 patients were screened with this assay. In patients with posttransfusion or sporadic acute and chronic HNANB the substance was detected with a mean frequency of 34%, in acute posttransfusion HNANB, where samples were screened at the beginning of the clinical symptoms, 71.

Cutaneous papulo-vesicular eruptions in non-A, non-B hepatitis.

A relapsing papulo-vesicular rash with or without pruritus was observed in 54 out of 148 patients (36%) with posttransfusion or sporadic, acute or chronic, non-A, non-B (NANB) hepatitis. The predominant location was the trunk and the anterior surfaces of the upper extremities. The face was affected less often.

Virus-binding activity of fibronectin: masking of hepatitis A virus.

Human plasma fibronectin interacts with viruses. When fibronectin-containing human sera negative for antibodies to hepatitis A virus (HAV) were added to suspensions of HAV, radioimmunological detection of HAV was reduced. This masking effect seemed to depend on the fibronectin concentration of the sera: plasma fibronectin purified by cryoprecipitation and affinity chromatography showed a masking effect on purified HAV which was dependent on the concentrations of fibronectin and HAV.

[Hepatitis non-A, non-B. Retro- and prospective studies on the epidemiology of the acute disease].

The epidemiology was studied in 159 consecutively admitted patients (1981-1983) with acute and chronic parenteral and non-parenteral type non A, non B hepatitis (HNANB). To establish the frequencies of types A (HAV), B (HBV) and HNANB data were collected from the official health statistic of the Federal Republic of Germany (1980-1982). Accordingly, 5 out of 100 000 persons acquired HNANB each year.

[Nonalcoholic fatty liver hepatitis and fatty cirrhosis mimicking alcoholic liver diseases].

Non-alcoholic steatosis hepatitis and fatty cirrhosis represents an unfamiliar liver disease of yet unknown etiology, which is usually indistinguishable from alcoholic lesions by histological criteria. For the affected patients this means automatically the inappropriate assumption of hidden alcohol abuse. Out of 1467 liver biopsies during 1979 to 1982 we selected 25 patients (group I), who either denied alcohol intake or reported negligible consumption.

Characterization of a non-A, non-B hepatitis associated substance in stools.

Using the 125J-labeled isolated IgG-fraction of reconvalescent sera from patients with NANB-hepatitis a radioimmunoassay for the detection of the NANB-hepatitis associated antigen in stool was established (RS). To characterize the antigen, stool suspensions of healthy persons and NANB-patients were analyzed by sedimentation on sucrose gradient (3-35%) before and after incubation of 125J-labeled normal IgG or IgG from reconvalescent patients. Stool was spiked with normal sera and with serum completely free from immunoglobulins.

Detection of a non-A, non-B hepatitis associated substance in stools.

Investigation of stool samples (N = 2223) from 1377 persons revealed an antigen-like substance in the fecess of patients with clinically defined non-A, non-B hepatitis. Manifold investigation showed an intermittent excretion which correlated to the typical increases and decreases of transaminases in this disease. Positive results could be obtained by a randomized study in 30% of patients with NANB-hepatitis.

The cyclic behaviour of NANB hepatitis as basis for standardized diagnostic.

Efforts were made to characterize the clinical and biochemical behaviour of NANB hepatitis in 51 patients. 15 patients had posttransfusion NANB hepatitis, 36 a sporadic form of the disease. The patients' complaints predominantly were nausea and vomiting (64%), in about each 25% cardial complaints, lassitude, muscle pain and fever were observed.

[Peliosis hepatis. A clinical status inventory].

Peliosis hepatis is a rare condition, recognizable by macroscopical view. It is characterized by multiple blood-filled cystic spaces in the liver parenchyma. According to 49 out of 152 more recent case reports (1951-1981/82) its spontaneous occurrence is frequently associated with malignant and toxic processes.

[Alpha 1-antitrypsin deficiency and the liver (author's transl)].

Alpha 1-antitrypsin (alpha 1 AT) is a glycoprotein of hepatic origin which functions as a systemic protease inhibitor (Pi). Its production is controlled by two autosomal-codominantly transmitted alleles. Among the numerous genetic variants some alleles (predominantly PiZ) may induce alpha 1 AT-deficiency, facultatively associated with childhood liver disease.

[The clinical behaviour of by immunology unique courses of NANB hepatitis (author's transl)].

By means of both immunohistology and immunodiffusion a number of 7 by definition from NANB hepatitis suffering patients were found to belong to an unique antigen-antibody system. These patients responded to NANB infection with certain similarities: 1. The course of the disease exhibited a phasic pattern since increases in SGPT activity were observed at days 47 +/-- 10, 76 +/- 14, 117 +/- 18 and 157 +/- 7.