Effect of nitric oxide synthase inhibition on renal circulation and excretory function in anaesthetized rats.

The effects of nitric oxide synthase (NOS) inhibition (effected using L-NAME, 14 mg (kg body mass (BM))(-1), administered intravenously) on systemic and renal circulation and renal excretory function has been investigated in anaesthetized Wistar rats subjected to one of two different degrees of isotonic extracellular (EC) volume expansion (40 and 60 ml x kg(-1) (240 min)(-1)). The administration of L-NAME resulted in an increase in mean arterial blood pressure and total peripheral vascular resistance (TPR), and a significant reduction in cardiac output (CO) and the kidney fraction of CO in both experimental groups. The total renal blood flow (RBF) dropped from 557 + 43.4 to 149 +/- 13.1 ml x min(-1) (100 g BM)(-1) and from 592 +/- 45.9 to 191 +/- 16.3 ml x min(-1) (100 g BM)(-1) in the 40 and 60 ml x kg(-1) (240 min)(-1) experimental volume expansion groups, respectively. A redistribution of the intrarenal circulation from the medulla of the kidney toward the cortex may have occurred. The NOS inhibition induced a significant decrease in the glomerular filtration rate (GFR; from 1.18 +/- 0.10 to 0.53 +/- 0.08 ml x min(-1) (100 g BM)(-1) and from 1.26 +/- 0.07 to 0.73 +/- 0.08 ml x min(-1) (100 g BM)(-1) in the 40 and 60 ml x kg(-1) (240 min)(-1) experimental volume expansion groups, respectively), and the filtration fraction increased. The urine excretion dropped in parallel with the GFR, while the reduction in sodium and potassium excretion was more marked than that of the GFR, raising the possibility of a direct effect on the kidney tubules. The difference in EC volume expansion (the calculated increases in the EC volume in the last 90 min were 1.30 and 5.44% in the two time control groups and 3.66 and 7.45% in the two L-NAME-treated groups) did not induce any significant modification of the L-NAME effect.

[Interferon therapy of chronic viral hepatitis in Hungary: 5-year experience. A multicenter study]. / Krónikus vírushepatitisek interferon kezelése Magyarországon: 5 éves tapasztalatok. Multicentrikus tanulmány. Hepatológiai Centrumok Munkacsoportjai.

In Hungary over the past 5 years more than thousand patients with chronic viral hepatitis have been examined and included in a treatment program with interferon (IFN) at 16 major hepatology centers, using unified diagnostic and therapeutical criteria. Authors give an account of their experiences on the clinical features of patients with chronic viral hepatitis and report the results of the treatment with IFN. According to the rules and availability of IFN for patients with chronic viral hepatitis in the country, virtually the entire Hungarian population with this diseases who required IFN therapy have been included. A total of 94 patients suffered from hepatitis B virus (HBV) infection, in addition 11 HBV + hepatitis Delta virus (HDV), 24 HBV + Hepatitis C virus (HCV) related liver disease, and 993 had chronic hepatitis C. IFN therapy for chronic HBV hepatitis consisted of IFN 5 MU thrice weekly for 6 months, and resulted in 33% seroconversion and sustained remission with 14% HBsAg clearance. For chronic hepatitis C treatment protocols (dose of IFN and duration of therapy) have changed with the time (from a weekly dose of 3 x 3 MU IFN for 6 months, to 3 x 3 MU for 12 months), and even a combination with ribavirin has been introduced. Although the therapeutic results showed a gradual improvement form a 13% sustained response over 22% in the first and second periods, respectively, differences were most significant with the advent of the combination therapy, that resulted in 36% remission rate. Only fibrosis in histology and baseline pretreatment HCV-RNA level appeared as predictors of response in chronic hepatitis C. Neither age nor gender did influence the outcome, but longer duration of treatment and higher total dose of IFN resulted moderately higher sustained remission rates. The experiences are in accordance with findings of suboptimal efficacy of IFN monotherapy reported worldwide and emphasize the need of seeking for newer and combination therapeutic modalities for these chronic viral diseases.

Hepatitis C virus infection: pathogenesis, diagnosis and treatment.

We discuss the basic questions concerning hepatitis C virus (HCV) infection and describe the molecular biological and epidemiological features of the causative agent HCV, as well as the pathogenetic mechanisms of the HCV-related hepatic and non-hepatic diseases. We then summarize the diagnostic and therapeutic procedures in accordance with the recent literature. All the problems are discussed from the point of view of Hungarian hepatologists who have given an account of the experiences and possibilities concerning these fields in Hungary.

[Old, in need of care and homosexual. Experiences of an patient and his nursing team]. / Alt, pflegebedürftig und homosexuell. Das Erleben eines betroffenen Patienten und seines Pflegeteams.

As many other homosexuals of his generation, Mr. X had to lead to double life. Now over 80 years old, he continues to live according to its rules. His behaviour, his effeminate nature and his sexual reactions evoke feelings of disgust, anger and rejection-emotions that have a relieving effect on the team. Those members of the nursing staff that allow these emotions to arise assume that Mr. X makes use of nursing care as a means of sexual stimulation. Both patient and team suffer from this situation. On the other hand there are also moments of true affection and fascination. This qualitative individual study gives a methodological framework for research by using interpretative biography. The results show how social contempt, involuntary prejudices and mental hospitalism serve each other's purposes.

[How great is the risk of personal contact in the transmission of hepatitis C virus infection?]. / Mekkora kockázattal jár a személyes kontaktus a C hepatitis vírus terjedésében?

The sexual, household and nosocomial transmission of Hepatitis C virus infection were studied in patients with HCV-RNA positive chronic active hepatitis, confirmed by PCR. Liver function tests and hepatitis C virus serology were performed in family members living in the same household of patients, sexual partners as well as members of the hospital environment in the Department of Hepatology. Fifty-three members of 27 families and 32 staff-members were examined. Quantitative HCR-RNA-PCR and virus serotype of anti-HCV (III.gen.) positive individuals were also identified. Two of the family members turned out to be anti-HCV positive. The husband in one of the married couples was treated for hepatitis of unidentified etiology in an Infectology Department four years ago. His wife was found to have chronic hepatitis C since two years. They both had C virus of serotype 1. The mother and daughter in another family suffered from von Willebrand factor deficiency syndrome. It was documented that they were infected by blood transfusion at different occasions. Their C virus serotypes were different. All the staff members of Hepatology Department were anti-HCV negative. These results confirmed the possibility of the non-parenteral transmission of hepatitis C virus, however, its incidence is very low.

[Freedom versus safety]. / Freiheit versus Sicherheit.

Nurses maintain frequently that freedom and safety are, to a great extent, mutually exclusive in the care of elderly patients. On hand of reflected personal experience and an analysis of literature this article will show 1. how painful limiting restrictions, and especially restraining measures, can be for patients, relatives and nurses, and 2. that modern nursing has various instruments and methods to ensure almost invariably freedom and safety.

[Effect of interferon-alpha2b therapy in chronic hepatitis C]. / Interferon-alpha 2B kezelés hatása chronicus C hepatitisben.

In chronic hepatitis C the interferon treatment given three times a week in a dosage of 3 million units (MU) normalizes the values of alanin-amino-transferase in a part of cases (25-40%), and produces bettering in the subjective complains of patients. In the short term therapy (3-6 months) the activity of ALT increases again after leaving the therapy, and the disease becomes active. The aim of this multicenter study in Hungary was to give newer data in the case of longterm efficacy with alpha-interferon. Ninety-one patients with chronic hepatitis C were selected into the open prospective clinical study in university and hospital departments. Treatment protocol was the following: Patients with chronic hepatitis C diagnosed by clinical and histological methods were treated with interferon-alpha 2B given 3 times a week in a dosage of 3 MU. Treatment period had lasted for one year and afterwards the patient had been on control for an other half a year. In non responder cases after 3 month treatment with interferon the dose of therapy was increased for 3 x 5 MU. In 37 cases (40.6%) out of 91 patients the authors found longterm sustained remission and in other 22 cases (24.2%) they observed a partial remission (among them 5 cases with late relapse). The rate of longterm sustained remission under 40 years was higher, than above 40. Higher rate was found when the treatment was started with a shorter chronicity of the disease. On te basis of the results the authors conclude: Interferon-alpha 2B is a good therapeutic modality for the treatment of patients with chronic hepatitis C. Efficacy of therapy is higher in younger patients and also in earlier application.

[Benign recurrent intrahepatic cholestasis]. / Benignus rekurráló intrahepaticus cholestasis.

The authors report the medical history of a 19-year-old male patient, who had been admitted to the department of infectious diseases three times with recurrent icterus of unknown origin, suspected of viral hepatitis before his internal examination. The clinical picture and the histological results of liver biopsy performed in acute phase proved the presence of a rare hyperbilirubinaemia syndrome, "the syndrome of benign recurrent, intrahepatic cholestasis". The authors briefly describe Summerskill-Walshe syndrome and its place in different hyperbilirubinaemia disorders.

[Clinical immunological features and interferon therapy in chronic hepatitis C]. / Klinikai immunológiai megfigyelések és interferon terápia krónikus C hepatitisben.

Clinical and immunological findings of 74 patients with chronic hepatitis C have been reported and experiences with interferon-alpha treatment of 31 patients are summarized. In addition, the first results of anti-HCV screening of blood donors are also briefly described. Transfusion in the history was noted in 69% of patients and the time, elapsed from the transfusion to the diagnosis was a mean of 7.15 +/- 8.1 years. Concerning the severity of the liver disease, chronic persistent hepatitis was established in 40%, active hepatitis in 45% and cirrhosis in 15% of the patients, respectively. Cholestasis was recorded in 32% of the cases. A significant elevation of serum immunoglobulin levels was noted in 83%, an antibody to liver specific protein (anti-LSP) has occurred in 80%, cryoglobulinaemia in 44% and circulating immune complexes in 33% of the patients. Natural killer cell activity of peripheral blood mononuclear cells significantly decreased. HLA B8 and DR3 antigens were found with elevated frequency (36.6% and 42.1%). Recombinant interferon-alpha at a weekly dose of 3MU thrice, for six months, has normalized serum alanine aminotransferase in 45% of patients and a sustained remission was found in 26%. The treatment resulted in the clearance of HCV-RNS from the serum in 40% of patients and that well correlated with the complete remission. In the good responders, a decrease in CD4+ cell count and a moderate decrease in CD8+ cell count as well as a transient rise in B cell count were seen during the treatment. Mitogen-induced lymphoproliferative response and natural killer cell activity increased. Predictors of response were as follows: female sex, shorter time elapsed from transfusion, absence of HLA, A1, B8, DR3 and serum anti-HBc negativity. Anti-HCV has been found in 0.33--0.38% of blood donors screened, and it is suggested, that a liver disease accompanied with elevated serum alanine aminotransferase, may be present in about 25-30% of anti-HCV positive symptom-free persons.

[Effect of lovastatin on serum lipids and lipoproteins. Hungarian multicenter, open-label study]. / Lovastatin kezelés hatása a serum lipidekre és lipoproteinekre. Hazai, nyitott, többcentrumos vizsgálat.

The authors studied the effects of lovastatin on the parameters of serum and lipoprotein lipids in an open multicenter trial. 160 patients with hypercholesterolemia participated in the study, 151 of whom completed the trial. After a 4 week period of dietary measures, the patients were treated with lovastatin for 12 weeks while combining standard lipid lowering diet. The initial dose of the drug was 20 mg, this was increased until serum cholesterol level decreased under 5.2 mmol/l, or to a maximal daily dose of 80 mg. By the end of the 12th week, serum cholesterol level was reduced by an average of 33% (p < 0.001), LDL-cholesterol by an average of 45% (p < 0.001), serum triglyceride concentration by an average of 22% (p < 0.001) and HDL-cholesterol increased by an average of 13% (p < 0.001). Lovastatin showed a very good safety profile, therapy had to be cancelled due to the occurrence of adverse events only in 4 cases.

[Reducing low density lipoprotein-cholesterol levels by apheresis]. / A low density lipoprotein-cholesterin csökkentése apheresis segítségével.

The predominate number of homozygote familial hypercholesterolemic and approximately 20% of heterozygotes are resistant to low cholesterol diet and lipid lowering pharmacological treatment even in combination of 2 or more drugs. In such cases, the selective lipoprotein apheresis has become a promising alternative and indicated absolute (homozygotes) or relative (heterozygotes). The combination of low density lipoprotein apheresis, together with diet and drugs, should allow a maximal lowering of low density lipoprotein-cholesterol (-60-70%). Besides low density lipoprotein, various apheresis procedures may also eliminate other potentially atherogenic factors, such as lipoprotein(a) and fibrinogen and acutely improve the haemo-rheological status of the patient. The authors review several lipoprotein apheresis procedures with varying degrees of selectivity, those have and furthermore analysis the advantages and disadvantages and cost of each procedure.

[Isoprinosine therapy in chronic hepatitis C (multicenter placebo-controlled double-blind prospective study)]. / Krónikus C hepatitis isoprinosin kezelése (Multicentrikus, prospektív, placebo-kontrollos kettös-vak vizsgálat).

A placebo controlled clinical trial. Thirty two patients with chronic C hepatitis have been enrolled in a double blinded study to assess the therapeutic effect on an orally given antiviral-immunomodulatory drug, Isoprinosine. Seventeen patients were given Isoprinosine (3 g/day) and fifteen were on placebo. The treatment has been lasted for four months, when patients examined monthly. Clinical signs, liver function tests and side effects were evaluated. At the end of the trial, side effects and elevated serum alanine aminotransferase (ALT/GPT) levels occurred with higher frequency in Isoprinosine-treated patients. The results show that this antiviral drug has no beneficial effect in chronic C hepatitis.

A prospective multicenter study of insulin and glucagon infusion therapy in acute alcoholic hepatitis.

A randomized, single-blind controlled multicenter study of insulin and glucagon infusion was carried out in 66 patients with acute alcoholic hepatitis. Thirty-three patients were treated with insulin 10 U and glucagon 1 mg in 500 ml 5% glucose in water via a peripheral vein for 2-6 h three times every day for 3 weeks. Patients in the control group received 5% glucose in an identical fashion. Fourteen control patients and five treated patients died from liver failure during the study (P less than 0.02). Clinical features of liver disease on entry into the study were similar in the two groups, but the total serum bilirubin, aspartate aminotransferase, gamma-glutamyltranspeptidase activities and prothrombin time significantly improved in the treated patients (P less than 0.05). Insulin and glucagon infusion appears to be a promising treatment of acute alcoholic hepatitis.