Total parenteral nutrition-related gastroenterological complications.

Total parenteral nutrition is a life saving therapy for patients with chronic gastrointestinal failure, being an effective method for supplying energy and nutrients when oral or enteral feeding is impossible or contraindicated. Clinical epidemiological data indicate that total parenteral nutrition may be associated with a variety of problems. Herein we reviewed data on the gastroenterological tract regarding: (i) total parenteral nutrition-related hepatobiliary complications; and (ii) total parenteral nutrition-related intestinal complications. In the first group, complications may vary from mildly elevated liver enzyme values to steatosis, steatohepatitis, cholestasis, fibrosis and cirrhosis. In particular, total parenteral nutrition is considered to be an absolute risk factor for the development of biliary sludge and gallstones and is often associated with hepatic steatosis and intrahepatic cholestasis. In general, the incidence of total parenteral nutrition-related hepatobiliary complications has been reported to be very high, ranging from 20 to 75% in adults. All these hepatobiliary complications are more likely to occur after long-term total parenteral nutrition, but they seem to be less frequent, and/or less severe in patients who are also receiving oral feeding. In addition, end-stage liver disease has been described in approximately 15-20% of patients receiving prolonged total parenteral nutrition. Total parenteral nutrition-related intestinal complications have not yet been adequately defined and described. Epidemiological studies intended to define the incidence of these complications, are still ongoing. Recent papers confirm that in both animals and humans, total parenteral nutrition-related intestinal complications are induced by the lack of enteral stimulation and are characterised by changes in the structure and function of the gut. Preventive suggestions and therapies for both these gastroenterological complications are reviewed and reported in the present review.

Efficacy of high dose of recombinant alpha 2b interferon on long term response in chronic hepatitis C and cirrhosis: prospective randomized multicentre study.

BACKGROUND/AIMS: The long-term response to alpha-Interferon in HCV-related chronic liver diseases is disappointing. A randomized controlled trial was conducted to investigate: 1) if doubling the standard regimen of 3 MU recombinant alpha 2b-interferon thrice weekly for one year could improve the long-term response, and 2) the efficacy of these two schedules in cirrhotic patients. PATIENTS AND METHODS: A series of 80 anti-HCV positive patients with biopsy proven liver disease (52 chronic hepatitis and 28 cirrhosis) were randomized to receive either 3 MU or 6 MU alpha 2b-interferon. RESULTS: Based on "intention-to-treat analysis", 38% in the 3 MU group and 53% in the 6 MU group had end-of-treatment response. After 24 months, 18% had long-term response: 5% in 3 MU group and 30% in 6 MU group (p < 0.008). HCV genotype had no influence on the response rate. Thirty-eight percent of the cirrhotics treated with 6 MU had long-term response, while none of those treated with 3 MU had long-term response (difference 38%; 95% confidence internal 10%-67%; p = 0.03). At the end of treatment, 38% of patients lost HCV-RNA. After 24 months only 19% remained HCV-RNA negative: 12 patients (31%) in the 6 MU group and 2 (6%) in the 3 MU group (p < 0.05). CONCLUSIONS: 6 MU of alpha 2b-interferon thrice weekly for 12 months is significantly better than 3 MU in inducing a long-term response and permanent loss of HCV-RNA. This result is particularly striking in the subgroup of cirrhotics.

[The peripheral blood lymphocyte subpopulations in chronic anti-HCV-positive liver disease: their significance and correlation with liver function]. / Sottopopolazioni linfocitarie ematiche nella malatta epatica cronica anti-HCV positiva: significato e correlazione con la funzione epatica.

To evaluate the role played by the immune system in the outcome of chronic C virus infection, we studied the peripheral blood lymphocyte subsets in patients with chronic hepatitis C and the correlation with the hepatic function assessed by the lidocaine test. To this end the peripheral lymphocyte subpopulations were enumerated by flow cytometry in 36 patients we had undergone a liver biopsy, prior the interferon therapy. The patients were classified as having severe chronic hepatitis with or without cirrhosis (17 subjects = group A) and mild/moderate chronic hepatitis without cirrhosis (19 subjects = group B). Twelve patients in group A and 9 in group B underwent the lidocaine test. The mean percentages of the lymphocyte subsets were not different in the two groups and in comparison with a standard healthy population, with the exception of okdr+ lymphocytes; they were significantly increased in group A (p = 0.04). The production of the lidocaine metabolite at 30 minutes prove, significantly decreased in patients with severe hepatic disease (p = 0.02), but there is no correlation between the decline of liver function and the peripheral increase of the okdr+ lymphocytes (r = 0.1877). It is probable that the increase in okdr+ lymphocytes, due to activated T-cells, is subordinated to the persistent viremia but it is independent of histological damage.

Prepacked kits for diagnosis and treatment of tuberculosis in former Yugoslavia.

SETTING: After the outbreak of armed conflicts in the republics of former Yugoslavia in 1991, basic health services deteriorated and shortages of essential medical supplies occurred. The World Health Organization (WHO) has taken part in emergency relief operations in the area since July 1992. There was a growing concern that poor living conditions and shortages of supplies could rapidly increase the tuberculosis problem. OBJECTIVE: To provide essential supplies, WHO included support of tuberculosis control in the emergency relief operations for former Yugoslavia. DESIGN: WHO designed a prepacked kit with anti-tuberculosis drugs and material for sputum smear examination for use in combination with policy recommendations and a treatment protocol. RESULTS: The initial distribution of the kits was completed by the end of April 1994. Medium term support from May 1994 onwards has included continued distribution of kits, together with assistance in adjusting tuberculosis control programmes according to the recommended WHO policy package. CONCLUSION: Support of tuberculosis control with essential supplies and strictly focusing on priority measures is proposed as the most adequate strategy, when dealing with a developed country dependent on humanitarian assistance.

Serological markers of hepatitis B virus infection in healthy volunteer blood donors in Campania (Southern Italy).

The prevalence of hepatitis B virus (HBV) serological markers was determined in a prospective fashion by radioimmunoassay in 2,084 healthy volunteer blood donors. The results showed that 51.2% of the donors were positive for at least one marker, and the percentage of occurrence of each marker was: HBsAg 5.3, anti-HBs alone 1.7, anti-HBc alone 10.8, anti-HBs and anti-HBc 33.3. Because of the size of the problem this investigation strongly demands further studies on the potential role of blood positive for anti-HBc in transmitting HBV infection in our geographical area.