[Allergy effect on migraine course in older children and adolescents]. / Wplyw alergii na przebieg migreny u dzieci starszych i mlodziezy.

UNLABELLED: The interaction between allergy and migraine has been discussed since many years. The aim of the present study was the evaluation of: 1. allergy prevalence in the studied children with migraine, 2. allergy effect on the clinical course of migraine. MATERIAL AND METHOD: The studied group comprised 30 children and adolescents aged 11-17 years with the diagnosis of migraine with or without aura by IHS criteria. In each case the migraine index was determined and symptoms of allergy were sought. Skin prick test and tests for immunoglobulin E in serum were done. The analysis of results showed the presence of allergy in 12 cases (40%), and on this basis two groups were isolated: with and without allergy. The allergic children were given antiallergic treatment for 6 months (pharmacological or diet restriction). RESULTS: In the allergy group the migraine index decreased significantly from 2.45 to 0.33. Headache intensity decreased as well. CONCLUSIONS: 1. In 40% of cases migraine was associated with allergy. 2. Treatment results suggest that allergy and antiallergic treatment may influence the course of migraine attacks.

Hepatotropic viruses seen by clinicians.

During last decades we have been witnessing substantial progress in hepatology, particularly in relation to viral hepatitis. Novel diagnostic tools allowed researchers to define new etiological agents, understand their epidemiology and pathogenesis as well as develop effective preventive measures. However, several important questions still remain to be answered and no satisfactory therapeutical agents for chronic hepatitis are available. Basic epidemiological, preventive and clinical aspects of viral hepatitis are being discussed in this paper.

Does hepatitis B virus or hepatitis C virus infection influence CD4 count in HIV-positive individuals?

Objective of the study was to determine whether there is any influence of hepatitis B virus (HBV) or hepatitis C virus (HCV) infection on CD4 count decline rate in HIV-infected individuals. Retrospective analysis of consecutive CD4 counts was conducted in 72 HIV-infected untreated individuals (including 57 intravenous drug addict (i.v.d.a.)) in relation to their serological markers of HBV and HCV infection and the history of i.v. substance abuse. Anti-HBc seropositive individuals had slower CD4 count decline rates compared to anti-HBc seronegative ones (-0.20%/month vs. -2.90%/month, Kruskal-Wallis H = 4.77, p = 0.029). Anti-HCV serostatus had no influence on CD4 count decline rates (-0.47%/month for anti-HCV seropositive persons vs. -0.61%/month for anti-HCV seronegative ones, p = 0.91). History of i.v. substance abuse did not affect the CD4 count decline rates too (-0.83 for i.v.d.a. vs +0.74 for non-i.v.d.a., p = 0.26). In our study HIV-infected individuals seropositive for anti-HBc tended to have substantially lower CD4 count decline rates compared to seronegative ones. Neither anti-HCV serostatus nor the history of i.v. substance abuse influenced the CD4 count decline rate. This observation arises question about the possible nature (molecular?, immune-based?) of potential mutual interactions between HIV and HBV infections.

Comparison of the long-term effects of treatment with oral and parenteral interferon alpha in chronic viral hepatitis patients.

This report presents the interferon alpha (IFN-alpha) treatment results for 75 patients with chronic hepatitis B virus (HBV) (51 cases) and hepatitis C virus (HCV) (24 cases) induced hepatitis in maximal 61 months follow-up. Among the group of 51 patients with chronic HBV hepatitis, 35 were treated orally with IFN-alpha in the form of lozenges in low daily doses (37.5-150 U). The treatment was completed in 32 cases. The remaining 16 patients with chronic HBV hepatitis completed the treatment with parenteral IFN-alpha (3 x 10(6) U, 3 times a week). Positive results measured by the use of seroconversion in the HBe-antigen system were obtained for 68.7% (5-61 months follow-up) and 56.2% (7-44 months follow-up) of the patients treated with oral and parenteral IFN-alpha, respectively. Among the group of 24 patients with chronic HCV hepatitis, the first 6 patients were initially treated with IFN-alpha in the form of lozenges, in low daily doses. Biochemical remission was not achieved in these patients; genotype 1b was documented in 4 of them. Both, the first 6 patients (after a break) and the remaining 18 were treated with IFN-alpha parenterally, as in HBV patients. Temporary clinical and biochemical remission was achieved in 62.5% of the cases during the treatment, however the durable remission observed during 6-29 months of follow-up was achieved in 20.4 of the cases only.

[Gdansk HIV-AIDS project, yesterday, today and future]. / Gdanski program walki z HIV/AIDS: przeszlosc, terazniejszosc i przyszlosc.

Medical care project for HIV positive and AIDS patients in Gdansk voivodship was established in 1988 in the Clinic for Infectious Diseases of Gdansk Medical University. The aim of this modern and multidirectional program was to provide full medical care for HIV/AIDS patients and introduce effective prophylaxis against spread of HIV infection. According to the project-clinical ward, outpatient clinic for HIV positive and AIDS patients, diagnostic and laboratory units, were established. Close cooperation including specialistic and general medical care, was set with detoxication ward, rehabilitation centers for drug addicts, prison medical services and the Korczak Orphanage. Education of medical staff and some social groups was provided (teachers, teenagers of secondary schools, journalists, police employees). Clinical ward for HIV positive patients who are in need of inpatient medical care is localized in the Clinic for Infectious Diseases of Gdansk Medical University. The ward has 16 double - bed Melcer's boxes which are used for other HIV/AIDS patients according to present needs. Free beds are used for HIV negative patients. HIV/AIDS Outpatient Clinic is localized in Venerologic Outpatient Unit. This was because of some psychological, social, professional and organization aspects. Outpatient Clinic staff is responsible for first patients' examination. Serological diagnostics of HIV infection is follow up for everyone (anonymous testing is possible); testing for STD is available also. Diagnostic laboratory base for clinical ward and other units are the laboratories of Gdansk Voivodship Hospital for Infectious Diseases. Clinic for Infectious Diseases supervises all co-operating units. These are the following: 10-beds detoxication ward for drug addicts in Psychiatric - Neurological Hospital "Srebrzysko", 70-80 places in rehabilitation centers for drug addicts in Zapowiednik and Smazyno, remand prison ward for HIV positive patients (this is the first ward established in Poland, thanks to our initiative, in 1990). One of very important units of our Center is the Korczak Orphanage for children aged 0-7 years, which is subjected to Voivodship Health Department. This orphanage is the place for children with positive HIV serology from the whole Poland. Children who need inpatient medical care, among them AIDS children, are admitted to the Clinic for Infectious Diseases and can be diagnosed and consulted in all units of Gdansk Medical University. In 1992 the co-operation with Gdansk homosexual society represented by the Gdansk Initiative (a submit of Lambda organization), was established. Education program is the next very important part of the Clinical and Diagnostic HIV/AIDS Center work. Until now medical staff and Education Department staff were mainly concerned. It is planned to establish Voivodship Social Needs Outpatient Clinic which would continue all hitherto activities, which would be extended by social law counseling. Such outpatient clinic would facilitate education activity. It would be the base for medical research on social pathology and HIV/AIDS related problems.

[Antibiotic-associated diarrhea in light of personal observations]. / Zespoly biegunkowe po antybiotykoterapii w swietle wlasnych obserwacji.

Examination was performed in a group of 539 adult patients with diarrhea admitted to the Department of Infectious Diseases in Gdansk from 1991 to 1994. The group of 17 patients with antibiotic-associated colitis (AAC) was analysed. The antibiotics responsible for AAC were lincosamides, cephalosporins and penicillins. AAC was diagnosed by anamnesis, medical examination and detection of toxin A Clostridium difficile in stool samples. The contrast enema, colonoscopy and histopathological examination of colon mucosa were performed only in severe, protracted cases. The course of disease was mild in 2 cases, moderate in 13 and severe in 2 patients. Relapses of AAC were observed in 2 cases. Initial treatment of AAC included discontinuation of the antibiotic therapy that precipitated the disease and the replacement of fluid and electrolyte losses. Moreover, oral metronidazole and oral vancomycin were administered. All patients made a complete recovery.

[HIV infections and their prophylaxis in the homosexual community of the Gdansk province]. / Zakazenia HIV i ich profilaktyka w spolecznosci homoseksualnej województwa gdanskiego.

From 1985 to the end of 1993, 15,000 investigations were performed in total, for HIV infection in the Province of Gdansk. Positive results of the tests were found in 316 persons, over 60% of whom being intravenous drug-addicts. In the group of persons reporting the possibility of infection through sexual contacts, the infection was found only in 15 out of 1755 studied subjects. Among homosexuals the infection was found in four out of 167 persons who underwent the investigation. In the whole group of 316 infected subjects this accounted for 1.2%. The above mentioned numbers are certainly too low. The causes of this should be seen in generally low attendance rate to the tests connected with low social awareness. However, in persons with different sexual orientation this is caused also by the fear of manifestation of their pecularity. In the activities for the control of HIV epidemic spreading in Poland indispensable is multi-sided educational initiative including the whole population, in which great help may be provided by homosexuals themselves. An evidence of this may be the results as yet of the cooperation between representatives of health care and homosexuals, discussed in the present paper.

[An epidemiologic assessment of viral hepatitis type A morbidity in the Gdansk province in the years 1989-1990]. / Próba oceny epidemiologicznej wzrostu zachorowan na wzw A na terenie województwa gdanskiego w latach 1989-1990.

The considerable increase in viral hepatitis type A morbidity was observed in 1989-1990 in the area of Gdansk province. That increase was clearly focusing, it concerned only the chosen towns and communities. In these areas and also in regions where the increase in morbidity did not take place, the special researches have been carried out among children and adults which determined the frequency of passed HAV infection. It has been tried to investigate the ways and to describe the reasons of epidemic enlargement. It was proved that in adults group, the difference of the passed infection HAV frequency was not significant statistically comparing to the towns and villages dwellers, either for the regions where epidemic took place or without it. Comparison of the examined children revealed statistically the essential differences between the towns and villages-dwellers and significantly higher anti-HAV frequency among the children from the areas with morbidity increase. For explanation of the epidemic enlargement ways, the fast spreading of infection was emphasised on the areas situated at Wierzyca river and all its tributary streams.

Treatment of six patients with chronic active HCV hepatitis, with low dose natural human interferon alpha administered orally.

Following the widely accepted therapeutic standard of treatment of HCV infection with parenteral interferon alpha, and encouraged by the author's won good experience with orally administered natural human interferon alpha in low doses (leuHuIFN alpha (ldou)), applied to chronic active HBV hepatitis patients, this form of interferon was given to six randomly selected HCV infected patients (2 women, 4 men) aged 34-62 years. The diagnosis was made based on a clinical and histological evaluation and confirmed by anti-HCV antibodies detection. In 2 out of 6 patients, leuHuIFN alpha (ldou) was employed immediately after steroid discontinuation. Patients were instructed to take one lozenge daily, in the morning, on an empty stomach, and keep it in the mouth until fully dissolved. Observation period varies from 19 to 69 weeks. In 3 patients the therapy concluded, after 19, 61 and 62 weeks, respectively. One patient after 4 weeks of treatment reported increasingly troublesome small joints pain and swelling, which forced leuHuIFN alpha (ldou) discontinuation after 19 weeks. In no patient transaminases normalization was seen during treatment; biochemical and clinical remission after the drug discontinuation was observed in only one patient, in whom the treatment was interrupted due to articular adverse symptoms. With HCV RNA levels assessment being unavailable at the moment, the treatment impact on the virus replication remains difficult to evaluate objectively. The treatment was well tolerated. All patients stressed significant increase of drive and appetite as well as improvement of the exercise tolerance.

Treatment of fourteen chronic active HBsAg+, HBeAg+ hepatitis patients with low dose natural human interferon alpha administered orally.

The therapy concept is based on a theory of the immunocorrective effect of orally administered natural human interferon alpha in low doses (leuHuIFN alpha (ldou)), manifolded by the logistic amplification system seated in the oral cavity. Fourteen randomly selected patients with chronic active type B hepatitis, aged 7-59 years, were assigned to treatment. All the patients had been treated for several months to several years with steroids, with no beneficial effect--clinical and biochemical symptoms of active liver disease, with histopathological progression (up to liver cirrhosis) had been permanently present. Treatment with leuHuIFN alpha (ldou) (doses: 50-100 U daily) was introduced immediately after the immunosuppression (steroids, steroids+azathioprine) discontinuation, and its influence on the course of the disease was monitored by means of hematological and biochemical tests, humoral and cellular immune response parameters, serological markers of HBV infection, HBV DNA concentration and immunohistochemical evaluation of liver biopsy specimens. The observation period ranges from 15 to 32 months. In all patients, within the first 3-6 weeks of treatment, transient deterioration of biochemical liver function tests was noted (e.g. 2-3 fold increase of ALAT), with no clinical symptoms of the disease exacerbation. The phenomenon lasted for 4-16 weeks. In all the treated patients, intensive immune system activation was seen, which lasted beyond the therapy period. Seven patients eliminated serum HBV DNA; all of them also eliminated HBeAg and seroconverted to HBeAb. Up to date, one person have lost serum HBsAg, in nine others its titre decreased significantly.

[Hepatocellular carcinoma (CHC) in patients chronically infected with HBV]. / Carcinoma hepatocellulare (CHC) u chorych przewlekle zakazonych HBV.

42 cases of hepatocellular carcinoma (CHC) in patients chronically infected with HBV are presented. These are 37 men and 5 women, aged 12 to 78 years. The underlying disease was liver cirrhosis in 38 cases and chronic active hepatitis in 4. HBV infection was confirmed by the detection of viral markers in serum or/and in liver tissue. 52 percent of patients were HBsAg positive and 92 HBcAg positive. In 64 percent of cases the course of HBV infection had been subclinical before the CHC was revealed. The first signs of neoplasm are not characteristic, as the concomitant liver cirrhosis may well justify them. In all patients the diagnosis of CHC was established with presence when manifest clinical symptoms were present according to advanced lesions in most of cases. For the estimation of the stage of disease, the OKUDA system was used. In 24 patients cytostatic treatment was applied. The liver artery embolisation was performed in two cases. The surgical treatment took place in 2 cases of monolobular tumours. The survival period of the non-treated and treated patients was: in the 1st group 2.5 and 7.7 mths, in the 2nd group 1.5 and 5.2 mths, in 3rd group 1.2 and 1.1 mths, and in the 4th group 1.0 and 2.5 mths, respectively. In the groups 1 and 2 improvement of live comfort, due to Zubrod scale, was obtained. The results presented are the argument for attempts of treatment in patients from the 1st and 2nd groups.

[Preliminary results of the treatment of patients with chronic active hepatitis (CAH) HBsAg+,HBeAg+ with low oral doses of human interferon-alpha]. / Wstepne wyniki leczenia chorych z przewleklym czynnym zapaleniem watroby (p. c. z. w.) HBsAg+, HBeAg+ niskimi doustnymi dawkami ludzkiego interferonu alfa.

The treatment conception was based on the theory of immunocorrective activity function of low doses of human interferon alpha (HuIFN alpha) multi-played by logistic amplifier system included in oral cavity. Twelve patients with chronic hepatitis, HBV infected, aged 7-59, were randomly chosen for treatment. Previously they underwent immunosuppression without success. All of them revealed clinical and biochemical symptoms of steel active disease with morphological progression including active cirrhosis (3 cases). HuIFN alpha therapy was started just after withdrawal of immunosuppression (steroids, steroids and azathioprine). Effects of 50-100 U/d dose of HUIFN alpha were monitored by examination of hematological, biochemical parametres and indicators of humoral and cellular immune response and HBV markers in control liver biopsy specimens too. The HBVDNA serum level was measured besides, using the method of molecular hybridisation. Observation period is from 5 to 17 month, now. Among all patients during 1-2 months from the treatment beginning, transient increase of biochemical parametres of liver function (f. ex: 2-3 times ALAT increase) were observed without any clinical signs of disease exacerbation. All patients revealed immune system activation that lasted longer than incipiens intensive stimulation. Four from twelve patients that finished therapy, eliminated HBVDNA from blood serum. One of them eliminated HBsAg too. Three further confirmed decrease of HBsAg with e system seroconversion. Three from 8 patients treated 6-9 months reveal decrease of HBVDNA concentration in blood serum.

[HBV, HCV and HIV infections among drug addicts-residents of rehabilitation and social adjustment centers in the Gdansk district]. / Zakazenie HBV, HCV i HIV wsród narkomanów, mieszkanców osrodków rehabilitacji i resocjalizacji w województwie gdanskim.

Among 46 i.v. drug abusers we revealed HBV infection in 36, presence of anti-HCV antibodies in 33, and HIV infection in 21. Prevalence of HBV markers and anti-HCV antibodies increased with a period of time of i.v. drug abuse. The course of HBV and HCV infection was often subclinical. IgG levels turned out to be higher in HBV infected persons, with or without HIV infection.