Adenine arabinoside 5'-monophosphate in patients with chronic hepatitis B: comparison of the efficacy in patients with high and low viral replication.

This study compared the response to adenine arabinoside 5'-monophosphate (ARA AMP) in 60 patients with chronic hepatitis B according to the pretreatment serum hepatitis B virus DNA concentration. The level of hepatitis B virus replication was defined as low (30 patients) or high (30 patients) when serum hepatitis B virus DNA concentration was below or above 100 pg/ml, respectively. Patients received a 28 day course of ARA AMP and a second course of ARA AMP was given six months later to patients with persistent hepatitis B virus replication. At the end of the first course of ARA AMP, 11 of the patients (37%) with low replication and one of the patients (3%) with high replication became negative for hepatitis B virus DNA (p = 0.0012); five of the patients (17%) with low replication and none of the patients with high replication had HBe seroconversion (p = 0.06). Two of these five patients lost HBsAg. Kinetics of serum hepatitis B virus DNA during treatment showed a considerable but transient antiviral effect of ARA AMP. Three of 32 retreated patients became negative for hepatitis B virus DNA and one patient had HBe seroconversion. In conclusion, ARA AMP exerts a considerable but transient antiviral effect on hepatitis B virus. Complete and sustained inhibition of hepatitis B virus replication was only obtained in the patients with low hepatitis B virus replication.

Recombinant human alpha-interferon in patients with chronic non-A, non-B hepatitis: a multicenter randomized controlled trial from France.

We have conducted a multicenter randomized controlled trial comparing two doses of recombinant human alpha-interferon for efficacy in 60 patients with chronic non-A, non-B hepatitis. The source of infection appeared to be transfusion in 30 patients, intravenous drug abuse in 16 patients and was unknown in 14 patients. Patients were randomly assigned to no treatment or to treatment with either 1 or 3 MU of alpha-interferon given three times a week for 24 wk. Forty-five patients (75%) were positive for antibody to hepatitis C virus. During the 24-wk treatment period, mean serum ALT levels decreased in both treatment groups, but the decrease was statistically significant only in the 3 MU group. However, at 24 wk, the proportion of patients with normal ALT levels was similar in the 3 MU group (39%) and the 1 MU group (45%), and both were significantly higher than in controls (0%). Repeat liver biopsy specimens showed a significant decrease in the severity of histological changes in the 3 MU group but not in the 1 MU group or in controls. Responses to alpha-interferon did not correlate with patient's age, gender, source of infection, pretreatment serum ALT, presence of anti-hepatitis C virus or cirrhosis. After treatment, the mean ALT levels rose in both treated groups. The proportion of patients with normal ALT levels at wk 48 was 28% in the 3 MU group and 20% in the 1 MU group. In conclusion, a dose of 3 MU was superior to 1 MU of alpha-interferon given three times weekly for 24 wk in inducing improvements in serum ALT levels and liver histological examinations.(ABSTRACT TRUNCATED AT 250 WORDS)

[Primary adenocarcinoma of the ileostomy after total proctocolectomy for ulcerative colitis]. / Adénocarcinome primitif sur iléostomie après proctocolectomie totale pour rectocolite ulcéro-hémorragique.

A 61-year-old man developed primary adenocarcinoma with skin invasion, at the ileostomy site 33 years after a proctocolectomy for ulcerative colitis. A total of eleven patients with ileostomy adenocarcinoma have been reported in the literature. Ten patients were treated surgically for ulcerative colitis and the other for adenomatous polyposis coli. The diagnosis of stomal malignancy was made 9 to 36 years after the ileostomy (mean interval, 22 years). The pathogenesis of the malignant growth is uncertain and several possibilities are discussed: stasis, severe chronic inflammation, colonic metaplasia and severe dysplasia of the ileal mucosa. When an ileostomy requires late revision for inflammatory changes, careful pathologic examination of the entire stoma and surrounding skin is essential.

[Comparative study of the data of fine-needle aspiration biopsy and echographic aspects of hepatic tumors as a function of the circumstances of discovery. Apropos of 206 patients]. / Etude comparée des données de la cytoponction à l'aiguille fine et des aspects échographiques des formations tumorales hépatiques en fonction des circonstances de découverte. A propos de 206 patients.

This study was carried out in order to compare the accuracy of ultrasound and ultrasonically guided fine-needle aspiration biopsy in screening for tumoral hepatic syndrome in 206 patients. According to their different clinical presentations, patients were divided into 4 groups: 1: Documented cancer, 2: Hepatic cirrhosis, 3: Fortuitous ultrasonic detection, 4: Clinical hepatic tumor. Cytologic findings were divided into 4 types: benign, primary malignant tumor, secondary malignant tumor (with or without etiologic orientation) non significant result. The ultrasonic and cytologic results were retrospectively compared to definitive diagnosis which was known in 199 patients. No early or delayed complications related to fine-needle aspiration biopsy were recorded. Ultrasonic imaging globally suggested the final diagnosis in 116 patients (diagnostic precision: 58.2 percent) while the cytologic result corresponded to final diagnosis in 183 patients (diagnostic precision: 92.5 percent). Improved results by fine-needle aspiration biopsy with regard to ultrasound was recorded in each group, particularly in group 3; its diagnostic sensitivity was 92 percent for malignant lesions with 100 percent specificity and an excellent value in discriminating between their primitive or secondary nature. Fine-needle aspiration biopsy gave an exact etiologic orientation in half of cases with metastasis and helped to discover the primitive tumor in some patients when this was not known previously. We conclude that fine-needle aspiration biopsy is a simple, moderately invasive and accurate procedure in the diagnosis of hepatic lesions. As ultrasound alone is not suggestive, especially in the case of a fortuitous ultrasonic detection, fine-needle aspiration biopsy improves diagnostic precision.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value of ultrasound-guided cytopuncture in the diagnosis of hepatocellular carcinoma]. / Valeur de la cytoponction écho-guidée dans le diagnostic du carcinome hépatocellulaire.

Ultrasonically guided fine needle aspiration biopsy cytologies (external diameter inferior to 1 mm) were carried out in 28 patients with proved hepatocellular carcinoma. In all cases, the diagnosis of malignant involvement of the liver was firmly established by cytological examination. A correct diagnosis of hepatocellular carcinoma was made in 26 of 28 patients (sensitivity = 93%). The specificity of the procedure was 100%. No complications were observed. The present study shows that fine needle aspiration biopsy under ultrasound guidance is a safe and accurate diagnostic procedure in hepatocellular carcinoma even associated with cirrhosis.

[Echographic detection of hepatocellular carcinoma in patients hospitalized for cirrhosis]. / Dépistage échographique du carcinome hépatocellulaire chez les patients hospitalisés pour cirrhose.

This study was carried out in order to assess the accuracy of ultrasound in a) screening for hepatocellular carcinoma in patients hospitalized for cirrhosis and b) determining the possibility of hepatic resection. From January 1983 to January 1987, 492 patients with cirrhosis were investigated for hepatocellular carcinoma using clinical examination, serum alphafetoprotein measurement and ultrasound study. Four hundred and thirty-seven patients had alcohol-related cirrhosis (88.8 p. 100); ascites was found in 280 cases (56.9 p.100). Ultrasonography-guided aspiration cytology was performed whenever a tumor was found. Four hundred and nineteen patients underwent ultrasonography and alpha-fetoprotein chemistry. The diagnosis of hepatocellular carcinoma was confirmed in 66 of 419 patients (15.8 p. 100). Sixty of the 88 patients diagnosed as having tumor on ultrasound were found to have hepatocellular carcinoma. In 6 out of 66 patients (9.1 p. 100), the tumor was not identified by ultrasonography but the level of alphafetoprotein was high (greater than 1,000 ng/ml). Sixteen cancers (24.2 p. 100) were diagnosed by ultrasonography only. All patients were men with alcohol-related cirrhosis, their ages ranging from 52 to 82 years. The results of ultrasound investigation were: 8 solitary tumors, 5 multicentric tumors, 3 diffuse tumors. Only 2 of the 16 tumors were resectable. We conclude that ultrasound is an accurate procedure in the diagnosis of hepatocellular carcinoma associated with cirrhosis. However, in hospitalized patients, the value of screening for hepatocarcinoma is small because liver resection is often impossible due to the wide spread tumor involvement or advanced liver cirrhosis at the time of diagnosis. On the other hand, screening should be performed in patients with compensated cirrhosis.

[Trends of mortality from cirrhosis in France between 1925 and 1982]. / Evolution de la mortalité par cirrhose en France entre 1925 et 1982.

In 1982, 13,866 deaths secondary to cirrhosis were reported. Between 1925 and 1982, the number of deaths increased by 163 p. 100. This overall change was observed gradually: profound drop in the cirrhosis mortality rate during the Second World War, increase between 1945 and 1967, stabilization between 1967 and 1975 and more pronounced decline from then on. Cirrhosis mortality rate per 100,000 increased from 9.17 to 28.21 (+208 p. 100) in males and from 3.63 to 10.38 (+186 p. 100) in females from 1945 to 1982. The increase was approximately the same whatever the age. A cohort effect was observed in both sexes. There were two successive waves of increased mortality separated by an interval of non augmentation for the cohorts born between 1906 and 1915 and between 1931 and 1940. Since 1967, mortality due to cirrhosis has stopped increasing in both sexes. These changes may be related to decreasing alcohol consumption in France, certainly one of the major objectives in present day health programs. Abrupt reduction of alcohol consumption should be followed by a dramatic fall in the number of deaths from cirrhosis. Progressive decline of consumption is possibly associated with a decrease in the incidence of the disease. In 2,000, the rate for cirrhosis mortality is expected to be the same as that observed in the middle of the 20th century.