Taste and appetite disorders of chronic hepatitis C patients.

OBJECTIVE: Decreased appetite is one of the main factors that influences quality of life of patients with chronic liver diseases. The reason for appetite disorders remains unclear but taste perturbations are one of the postulated causes. The potential role of taste alterations and, connected to these, appetite disorders in chronic hepatitis C (CHC) patients are poorly investigated. The aim of this study was to evaluate potential taste alterations (dysgeusia) including all five tastes (sweet, salty, bitter, sour and umami) in CHC patients. METHODS: Forty CHC patients (16 men and 24 women) infected with genotype 1 hepatitis C virus participated in this study. All the patients had a compensated liver disease and were being treated with any agents. One hundred and ten healthy volunteers were matched to the patients by age and sex. The study included gustatory tests (taste recognition threshold, taste intensity with hedonic perception) and analysis of the pleasure derived from eating. RESULTS: In CHC patients, the recognition threshold of umami taste was increased (P<0.01) and the intensity of sweet taste perception was higher (P<0.05). The hedonic response did not differ between the groups. A significant increase in declared pleasure derived from eating (P<0.001 to P<0.05) was also observed. Some differences in case of the patients with more advanced disease were also found. CONCLUSION: Alterations in taste, especially umami and sweet taste disorders, may alter real food perception and lead to a reduction in food intake in some CHC patients.

[Changes in food preferences in pregnant women]. / Zmiana upodoban pokarmowych u kobiet w ciazy.

INTRODUCTION: Pregnant women frequently show significant changes in their eating habits. The aim of the study was to evaluate the pleasure derived from the consumption of selected food groups in women during the first and second trimester of pregnancy. MATERIAL AND METHODS: The studied group included 64 healthy women, aged 23-38. 32 women were in the first trimester of pregnancy and 32 women in the second trimester. The food preference interviews were conducted by the presentation of colourful photographs showing selected food groups. Then each participant answered the following question: "How much pleasure do you take from this food?". The results were recorded on a linear analogue scale. The women evaluated the pleasure they derived from food before pregnancy and in the first or second trimester of pregnancy. RESULTS: The women in the first trimester of pregnancy, showed a lower preference for eggs, sweets, pasta, red meat, fast food, salty snacks, spicy food, and seafood as compared to their preferences before the pregnancy. The women in the second trimester declared a significantly higher preference for chicken soup, fruit and sour food, and rated the taste of beef and pork, spicy food and salty snacks as less pleasurable than before the pregnancy. CONCLUSIONS: The first trimester of pregnancy is a period of decreased pleasure derived from food, whereas the perception of food in the second trimester is characterized by a general hedonic dimension similar to that from before the pregnancy. Both in the first and the second trimester of pregnancy women show a lower preference for beef and pork, spicy food and salty snacks.

Association between liver steatosis and angiogenesis in chronic hepatitis C.

BACKGROUND: The relationship between steatosis and angiogenesis in chronic hepatitis C (CHC) is unclear. AIM AND METHODS: The aim was to explain whether liver steatosis presence and its extent are associated with the number of new-formed blood vessels in lobules and portal tracts in CHC. 72 CHC patients infected with viral genotype 1b, 35 of whom had steatosis were evaluated. Monoclonal antibody anti-CD34 was used to identify new-formed blood vessels. RESULTS: Patients with steatosis had a significantly more advanced stage of fibrosis (p = 0.002) and higher inflammatory activity grade (p = 0.062). CD34 expression in portal tracts (CD34pt), lobules and fibrous septa (CD34lfs) and total (CD34) were significantly higher in patients with steatosis (p = 0.034; p = 0.021; p = 0.023, respectively). CD34, CD34pt and CD34lfs differed significantly between patients with various steatosis grade (p = 0.006; p = 0.009; p = 0.013, respectively). CD34 and CD34pt differed significantly between each steatosis grade whereas CD34lfs between grade 1 and 3. Fibrosis stage and inflammatory grade were positively associated with steatosis extent (p = 0.015; p = 0.003, respectively). CONCLUSIONS: Our observations suggest that extensive steatosis of liver parenchyma in CHC patients is associated with formation of new blood vessels in lobules and portal tracts. Understanding the relationship between steatosis, fibrosis and angiogenesis is therefore of great importance for the introduction of new therapeutic approaches and in the evaluation of CHC progression.

Taste disturbances during therapy with pegylated interferon-alpha 2b and ribavirin in patients with chronic hepatitis C.

INTRODUCTION: The effectiveness of current standard therapy of chronic hepatitis C with pegylated interferon-alpha and ribavirin is unsatisfactory and associated with a variety of side effects. In addition to common side effects, appetite disorders and weight loss are universal problems that lead to decreased quality of life. The causes of appetite disorders are not known. The aim of the present study was to evaluate the influence of pegylated interferon-alpha 2b and ribavirin therapy on taste sensitivity, hedonic perception of taste sensations, and food preferences. MATERIAL AND METHODS: Nineteen chronic hepatitis C patients infected with genotype 1 HCV participated in the study. All patients received combined therapy with pegylated interferon-alpha 2b and ribavirin in adequate doses. The study included gustatory tests (taste recognition threshold and taste intensity with hedonic perception) using a gustometric method and an evaluation of the pleasure derived from eating. All examinations were performed before therapy and during the thirteenth week of therapy. RESULTS: After 12 weeks of therapy, patient sensitivity to salty and sweet was significantly decreased (p < 0.05), and bitter was described as being more unpleasant than before the therapy (p < 0.05). Also, the therapy decreased appetite without significant changes in patients' food preferences. CONCLUSIONS: We found multidirectional taste disturbances during treatment with pegylated interferon and ribavirin. The results may be useful in determining the role of taste in the development of appetite disorders in chronic hepatitis C patients treated with pegylated interferon and ribavirin.

Angiogenesis in chronic hepatitis C is associated with inflammatory activity grade and fibrosis stage.

Data regarding the assessment of angiogenesis in liver tissue in chronic hepatitis C (CHC) are rare. The study was performed to explain the association between the histopathological features and the number of new blood vessels in lobules and portal tracts in CHC. The second aim of the study was to define the localization of sprouting and pattern of formation of new vessels by estimating CD 34 antigen expression in the liver. The study involved 74 patients with CHC, infected with viral genotype 1b before antiviral therapy. The number of new-formatted blood vessels was positively associated with fibrosis stage and inflammatory activity grade in the liver biopsy from CHC patients. The relationship was evident in the portal tract, fibrous septa and periportal zones of lobules. The results suggest that inflammatory hepatocyte injury may promote neo-angiogenesis.

Sole use of dexmedetomidine has limited utility for conscious sedation during outpatient colonoscopy.

BACKGROUND: This study evaluated the ability of dexmedetomidine to provide analgesia and sedation for outpatient colonoscopy, examining outcomes including cardiorespiratory variables, side effects, and discharge readiness. METHODS: Sixty-four patients were randomly assigned to one of three treatment regimens. In group D, patients received 1 microg/kg dexmedetomidine over 15 min followed by an infusion of 0.2 microg x kg x h. Group P received meperidine (1 mg/kg) with midazolam (0.05 mg/kg), and group F received fentanyl (0.1-0.2 mg intravenous) on demand. The assessment included measurements of heart rate, blood pressure, oxygen saturation, respiratory rate, quality of sedation/analgesia, and an evaluation of the recovery time. RESULTS: The study was terminated before the planned 90 patients had been recruited because of adverse events in group D. In all groups, negligible hemoglobin oxygen saturation and respiratory rate variations were observed. In group D, there was a significantly larger decrease in heart rate (to approximately 40 beats/min in 2 of 19 cases) and blood pressure (to less than 50% of the initial value in 4 of 19 patients). Supplemental fentanyl was required in 47% of patients receiving dexmedetomidine to achieve a satisfactory level of analgesia (vs. 42.8% of patients in group P and 79.2% of patients in group F). Vertigo (5 patients), nausea/vomiting (5 patients), and ventricular bigeminy (1 patient) were observed only in group D. Time to home readiness was longest in group D (85 +/- 74, 39 +/- 21, and 32 +/- 13 min in groups D, P and F, respectively; P = 0.007). CONCLUSIONS: The use of dexmedetomidine to provide analgesia/sedation for colonoscopy is limited by distressing side effects, pronounced hemodynamic instability, prolonged recovery, and a complicated administration regimen.

[Genetic aspects of colorectal carcinogenesis]. / Genetyczne aspekty karcynogenezy w jelicie grubym.

Colorectal cancer (CRC) is one of the most common forms of cancer and the second leading cause of death in Poland. Most cases of CRC are sporadic but a small percentage occurs in heritable syndromes such as dominant autosomal adenomatous and hamartomatous polyposis syndromes and hereditary nonpolyposis colorectal cancers. In a majority of cases CRCs are thought to develop in a step wise progression from normal epithelium through polyp form to carcinoma. Many genetic changes are observed in this process like inactivation of the tumor suppressor genes as well as the activation of specific oncogenes. Molecular biological studies have shown mutations of p53, Apc, k-ras and/or changes in proteins like APC and DNA microsatellite instability or loss of heterozygosity. For several years now great progress in this field and new concepts of screening strategies and therapeutic options have been made (gene therapy).

Conscious analgesia/sedation with remifentanil and propofol versus total intravenous anesthesia with fentanyl, midazolam, and propofol for outpatient colonoscopy.

BACKGROUND: This study tested the hypothesis that, for colonoscopy, analgesia/sedation with remifentanil and propofol might be more effective compared with anesthesia by intravenous administration of midazolam, fentanyl, and propofol. METHODS: In a prospective, randomized trial, 100 adult patients received either conscious analgesia/sedation (Sedation group) or total intravenous anesthesia (TIVA group). Analgesia/sedation was achieved by infusion of remifentanil (0.20 to 0.25 microg/kg/min) and propofol in titrated doses. TIVA was induced by intravenous administration of fentanyl (2 microg/kg), midazolam (0.05 mg/kg) and propofol (dosage titrated). Cardiorespiratory parameters and bispectral index were monitored and recorded. The quality of the analgesia was assessed with a Numerical Pain Rating Scale (NRS); recovery level and return of psychomotor efficiency were evaluated with, respectively, the Aldrete scale and a Modified Post Anesthesia Discharge Scoring (MPADS) system. RESULTS: Both groups of 50 patients were comparable with respect to demographic data, initial parameters, and duration of colonoscopy. All patients in the TIVA group found the colonoscopy painless (NRS score 0). In the Sedation group, the average pain intensity score was 0.4 (0.8). There was a marked difference between the Sedation and TIVA groups with respect to the time from the end of the procedure until the maximum MPADS score was reached: respectively, -6.9 (4.0) versus 25.7 (8.4) minutes (p < 0.001). In the TIVA group, changes in mean arterial pressure and heart rate and signs of respiratory depression were significant (p < 0.05). CONCLUSIONS: Combined administration of remifentanil and propofol for colonoscopy provides sufficient analgesia, satisfactory hemodynamic stability, minor respiratory depression, and rapid recovery, and allows patients to be discharged approximately 15 minutes after the procedure.

[Lung function tests and bronchoalveolar lavage (BAL) findings in patients with primary biliary cirrhosis]. / Czynnosc ukladu oddechowego oraz sklad komórkowy popluczyn oskrzelowo-pecherzykowych (BAL) u chorych na pierwotna zólciowa marskosc watroby.

Primary biliary cirrhosis (PBC) is a rare cholestatic liver disease with an autoimmune etiology. The present study was done to estimate the frequency of occurrence of pulmonary disturbances and to analyse the results of bronchoalveolar lavage (BAL) findings in patients with PBC. Thirteen patients (only women) aged 50.4 with histologically proved PBC were investigated. Mean values of lung function tests in the study group were within normal range. In 38% of patients the impairment of DICO was observed. Only in one patient decrease of lung compliance (Cdyn) was observed. BAL findings showed the increase of lymphocytes ratio (> 15%) in 5 patients (38%). The disturbances in lung function and BAL were observed in patients with different stage of PBC and without clinical symptoms of lung disease.