Discordance between biochemical markers of liver activity and fibrosis (Actitest-Fibrotest) and liver biopsy in patients with chronic hepatitis C.

INTRODUCTION: The purpose of this clinical trial was to determine in routine practice and in comparison with liver biopsy the limitations of two blood tests, Actitest and Fibrotest, for the evaluation of hepatic activity and fibrosis in patients with chronic hepatitis C. METHODS: Routine blood tests, Actitest and Fibrotest, and liver biopsy were performed in 96 patients with chronic hepatitis C attending routine outpatient clinics. Receiver operating characteristics (ROC) curves were used to assess the diagnostic value of the biochemical tests in comparison with the METAVIR classification. RESULTS: The study population was predominantly male (63.5%) with a mean age of 48 years; 83.3% of the patients had genotype 1 hepatitis C virus infection. Treatment status was naive (62.5%), nonresponders (17.7%), relapsers (7.3%), or unknown (12.5%). The comparison of F0-F2 versus F3-F4 estimated the negative predictive value at 92% and the positive predictive value at 52% for a cut-off of 0.455. Discrepancies in activity score were more frequently due to a higher score of the biochemical test compared to biopsy (18 cases out of 19). Discrepancies for fibrosis were observed in 18 patients with a higher score for biochemical test in eight and a higher score for liver biopsy in 10 cases. A significant increase of gamma-glutamyl-transferase (GGT) (p=0.0001) and alanine aminotransferase (ALT) (p<0.0001) was observed in case of biochemical test overestimation of activity, and a significant increase of alpha2-macroglobulin (p=0.006) and GGT (p=0.018) in case of biochemical test overestimation of fibrosis. CONCLUSION: This prospective study confirms the good diagnostic value of biochemical tests for necrotico-inflammatory activity and fibrosis as compared with the histological analysis of liver biopsy. Clinicians must interpret Actitest and Fibrotest results with caution in patients with a significant elevation of ALT, and/or GGT and/or alpha2-macroglobulin which could overestimate hepatic injury.

[Subtotal colectomy under celioscopy]. / Colectomie subtotale sous coelioscopie.

Indications for laparoscopic surgery of digestive disease are increasing in scope and now include colorectal affections. A technique for subtotal colectomy with ileorectal anastomosis under laparoscopic control is described.

Nocturnal plasma melatonin levels in migraine: a preliminary report.

We determined by radioimmunoassay plasma melatonin levels on blood samples drawn at 11 p.m. in migraine patients and control subjects. Ninety-three cephalalgic outpatients (75 females, 18 males) were compared to a control group (24 females, 22 males) matched according to age. Patients were divided into subgroups presenting common migraine (n = 38); ophthalmic migraine (n = 12); and tension headache associated with ophthalmic or common migraine (n = 24), and associated depressive status (n = 19). Statistical analysis revealed a decrease in plasma melatonin levels for the entire migraine population, compared to the control one, and a heterogeneity in both controls and patients; this heterogeneity was found mainly in the depressive and tension headache subgroups. When the migraine population--from which the depressive patients were excluded--was divided into male and female subgroups, a decrease in plasma melatonin levels was observed only for the female subgroups. Results are discussed with reference to the role of the pineal gland in the synchronization of the organism with the environmental conditions.

[Hepatic anomalies in Mediterranean boutonneuse fever]. / Anomalies hépatiques au cours de la fièvre boutonneuse méditerranéenne.

We report 3 cases of rickettsial hepatitis observed in the Lyon area which were secondary to boutonneuse fever. The temperature was elevated and clinical signs were an often painful hepatomegaly and digestive disorders. These signs are only indicative when accompanied by atypical pneumonopathy or exantherma. Indeed, if the inflammatory syndrome is clear, hepatic function is little perturbed. Diagnosis is sometimes influenced by the epidemiological situation, and depends on serologic tests and histological evidence of granulomatous hepatitis (2 of the 3 cases here). The successful antibiotic treatment shows that patients presenting febrile granulomatous hepatitis should be tested for rickettsiosis.

Effects on migraine headache of MDL 72,222, an antagonist at neuronal 5-HT receptors. Double-blind, placebo-controlled study.

MDL 72,222 (1 alpha H, 5 alpha H-tropan-3 alpha-yl 3,5-dichlorobenzoate), a novel agent with antagonist activity at neuronal 5-HT receptors, was tested as an acute treatment for migraine pain under double-blind, placebo-controlled conditions. Forty-seven patients with common (n = 29) or classical (n = 8) migraine or mixed type with or without a psychogenic component (n = 10) received 20-40 mg MDL 72,222 (n = 24) or placebo (n = 23) intravenously during the headache phase of a migraine attack. MDL 72,222 was consistently superior to placebo in rapidly alleviating the migraine pain. The treatment was remarkably well tolerated. The results are consistent with the hypothesis that the pain of migraine is related to activation of neuronal 5-HT receptors and suggest that compounds such as MDL 72,222, which block neuronal 5-HT receptors, could be useful new therapeutic agents for the management of migraine.

Elevation of serum beta 2 microglobulin in liver diseases.

beta 2 Microglobulin levels were measured by radioimmunoassay in the serum of 160 patients with liver disease and compared to 63 normal controls and 75 asymptomatic HBs-Ag carriers. All the latter subjects had normal values. Elevated serum beta 2 microglobulin levels were found in most of the other categories: acute viral hepatitis (35/45); chronic persistent (8/26) or active (35/41) hepatitis and liver cirrhosis (27/38). beta 2 Microglobulin values were significantly lower in chronic persistent hepatitis than in the three other groups (p less than 0.05). Steroid therapy was followed by reduction of serum beta 2m levels in 11/11 cases of chronic active hepatitis, eight of whom returned to normal value. Although linked to the course of the disease, variations of beta 2 microglobulin were independent of transaminases, bilirubin and gamma globulins. Elevated serum beta 2 microglobulin correlated with demonstration of rheumatoid factor but not with detection of circulating immune complexes, hepatitis B virus markers or autoantibodies. The results suggest that elevation of serum beta w microglobulin is encountered mostly in the active forms of inflammatory liver diseases.

[The interaction of cellular immunity and of viral factors in the pathogenesis and the resolution of HB virus infections in hemodialysis (author's transl)]. / Pathogénie et résolution des infections à virus HB de l'hémodialysé. Interaction de l'immunité cellulaire et des facteurs viraux.

A study of delayed cutaneous hypersensitivity (DC) was carried out in 50 chronic hemodialysis patients divided into 3 groups according to their serological response to the HB virus (HBV): 31 chronic carriers of Ag HBs (13 HBe positive and 18 HBe negative and 19 having eliminated Ag HBs, antiHbs positive). The results of DCH testing were compared in relation to the 3 patient groups. The number and sum of indurations were reduced, this being more marked in the women, in all the uraemic patients tested. Male hemodialysis patients who were carriers of Ag HBe had the weakest responses, significantly more depressed than those of the HBe positive HBe negative or anti-HBs carrier patients. The presence of Ag HBe was correlated with persistently raised transaminases. In chronic carriers of Ag HBe, hepatic cytolysis was always absent when DCH reactions were negative, and was seen only in the presence of a cellular immune reaction. These results suggest the interaction, in the hemodialysis patient, of virological factors related to Ag HBe and cell mediated immunological factors in the pathogenesis of hepatic lesions related to HBV.

[Demonstration of a serum and liver antigen in acute or chronic non A-non B viral hepatitis]. / Mise en évidence d'un antigène sérique et hépatique au cours des hépatites virales non A-non B aiguës ou chroniques.

A new precipitating antigen-antibody system possibly was demonstrated by immuno-diffusion in the serum of patients suffering from non A-non B hepatitis. The antigen appears during the first four weeks of transaminases elevation. In acute cases was transient antigenemia (average 3 weeks). Antibodies appeared rapidly after the disappearance of antigen. The same antigen was also detected, by immunodiffusion and by immunofluorescence, in the liver nuclei of infected hepatocytes. This antigen specific appears for non A-non B hepatitis since it is neither found in the serum of normal subjects nor in that of patients with cirrhosis toxic or viral that hepatitis A or B. The hypothesis of a virus associated antigen is the most likely explanation.