Cryoglobulinemia due to chronic viral hepatitis infections is not a major problem in clinical practice.

Background: Essential mixed cryoglobulinemia (EMC) is a systemic disease frequently associated with chronic viral hepatitis. This study was conducted in order to assess the prevalence of EMC in patients with hepatitis B virus (HBV) or hepatitis C virus (HCV) infections. We also evaluated the possible associations of EMC with (1) the clinical, virological, and histological status of liver disease; (2) the presence of EMC-related symptoms; and (3) the response rate to interferon-alpha (IFN-alpha) treatment, in an attempt to address whether EMC is a major problem in hepatitis patients. Methodology: A total of 154 consecutive patients (104 with HBV and 50 with HCV infection) were investigated for the presence of rheumatoid factor (RF), cryoglobulins, and EMC-related manifestations. Sixty-two HBV patients were chronic carriers of hepatitis B surface antigen, 29 had chronic hepatitis B, and 13 HBV cirrhosis. Thirty-five HCV patients had chronic hepatitis C and 15 HCV cirrhosis. HCV genotyping was performed in 44 patients. Results: The prevalence of cryoglobulins was significantly higher (P<0.001) in HCV patients (46%) than in HBV patients (13.4%). EMC was associated with a high frequency of RF detection, older age, and longer duration of viral diseases. Weakness or malaise, arthralgias, and purpura were significantly more frequent in cryoglobulin-positive patients. These manifestations, however, were mild in most of the patients. The EMC-related symptoms were significantly associated with the presence of HCV infection, increased levels of cryoglobulins, and RF detection (P<0.01, P<0.05, and P<0.000005, respectively). Worse liver histology was unrelated to a higher prevalence or increased levels of cryoglobulins in both HBV and HCV infection. There was no relationship between EMC and a specific HCV genotype. IFN-alpha therapy led to the disappearance of cryoglobulins and EMC-related manifestations in most cases. The response rate to IFN-alpha was similar in both groups of patients (with and without EMC). Conclusions: A higher prevalence of EMC was observed in HCV patients than in HBV patients. However, this finding was unrelated to overt clinical manifestations of EMC, a specific HCV genotype, or worse liver histology. The latter suggests that EMC does not contribute to liver injury and vice versa, that EMC pathogenesis is rather unrelated to the degree of liver injury. From a clinical point of view, testing for cryoglobulins seems reasonable only for HCV patients with EMC-related manifestations, since this may have therapeutic consequences. RF detection could be used primarily as a surrogate marker for the existence of cryoglobulins.

Amount and composition of bone minerals in chronic liver disease.

Alterations in bone mineral are a common complication of chronic liver disease. The aim of the current study was to assess bone mineral status in patients with chronic liver disease not treated with corticosteroids and to investigate any possible correlation with the histological stage of liver disease. Bone mineral status in 27 patient with chronic active hepatitis, and 17 with active cirrhosis was compared to that of matched controls. Partial body neutron activation analysis was applied for measuring hand bone phosphorus, single-photon absorptiometry for measuring forearm bone mineral content, and dual-energy x-ray absorptiometry for measuring spinal bone mineral density. These noninvasive measurements were supplemented with data obtained by high resolution radiography and biochemistry. Decreased metacarpal cortical thickness was found in five patients, all in the cirrhotic group. In addition, both mean intact parathyroid hormone and 25-hydroxyvitamin D levels were reduced in this group of patients. The mean values of the quantities assessed by the in vivo techniques in patients in the early stages of the hepatic disease did not differ statistically from those of matched normal controls. On the contrary, these quantities were reduced by 9% in the patients at the late stages relative to controls. In conclusion, only the late stages of liver disease are associated with an increased risk of fractures.

Prevalence of hepatitis B and C viruses infection in chronic alcoholics with or without liver disease in Ioannina, Greece: low incidence of HCV infection.

Intravenous heroin abusers comprise a high risk group for hepatitis B and C viruses (HBV and HCV) infection. Chronic alcoholics with liver disease (LD) also comprise a high risk group for HBV infection whereas the frequency of antibodies to HCV (anti-HCV) ranges from 27-42.6%. In this study, HBV and HCV infection markers were determined in alcoholic patients with (83 patients) or without LD (68 patients) in order to assess the prevalence of these markers (HBsAg, HBsAb, HBcAb and anti-HCV). The reason for the study was a lack of established data in this group of patients in Greece. The disease control groups consisted of 70 non-alcoholic hospitalized patients and 60 heroin addicts, whereas 1342 healthy blood donors were also investigated. Our results showed significantly increased prevalence of HBV infection markers in chronic alcoholic patients compared to healthy controls and non-alcoholic hospitalized patients. The findings were independent of the presence or absence of LD. In contrast to heroin addicts, where anti-HCV antibodies were observed in 90%, there was no difference in the prevalence of anti-HCV antibodies in chronic alcoholics (with or without LD), nonalcoholic hospitalized patients or healthy controls. In conclusion, we found that in this area of north-western Greece, chronic alcoholics, independent of the presence of LD, comprise a high risk group for HBV infection but very rarely have HCV infection. The latter finding may reflect technical or socio-economic differences regarding the lifestyle of our patients, and our population in general.

Pathogenetic mechanisms of hypomagnesemia in alcoholic patients.

The aim of our study was to describe the possible pathophysiologic mechanisms of hypomagnesemia in alcoholic patients. A total of 127 chronic alcoholic patients admitted to our university hospital for causes related to alcohol abuse were studied. Hypomagnesemia was the most common electrolyte disturbance observed in 38 patients (29.9%). In 18 of them inappropriate magnesiuria was evident, possibly due to hypophosphatemia, to metabolic acidosis or to a direct magnesiuric effect of acute alcohol consumption. The causes of hypomagnesemia in the remaining 20 patients were alcohol withdrawal syndrome and diarrhea. Respiratory alkalosis was evident in 10 hypomagnesemic patients and could have played a role in the development of hypomagnesemia. A decreased magnesium intake could also have contributed to the hypomagnesemia, especially in malnourished alcoholic patients. Hypomagnesemic patients more frequently had other acid-base and electrolyte abnormalities, such as hypophosphatemia, hypokalemia, hypocalcemia, and respiratory alkalosis, as compared with the normomagnesemic patients. Moreover, in hypomagnesemic patients serum magnesium levels were correlated with the indices of potassium and phosphorus excretion, suggesting that serum magnesium levels play a central role in the homeostasis of the other electrolytes. In conclusion, hypomagnesemia is the most common electrolyte abnormality observed in alcoholic patients, as a result of various pathophysiologic mechanisms.

Hidradenitis suppurativa in Crohn's disease. A further support to this association.

A patient with Crohn's disease (CD) subsequently developed the clinical and histological features of hidradenitis suppurative (HS). So far, only five cases with such an association have been reported. Azathioprine (150 mg/d) and methylprednisolone (16 mg/d) for CD combined with isotretinoin (0.7 mg/kg) and periodic administration of antibiotics for HS were used. The treatment was satisfactory, and the patient is now in clinical remission for both diseases.

Incidence of inflammatory bowel disease in north west Greece: rarity of Crohn's disease in an area where ulcerative colitis is common.

Ulcerative colitis (UC) and Crohn's disease (CD) are generally regarded as diseases of affluent societies of the Western World, although their frequency in less affluent areas is not well established. This retrospective study therefore, assesses the incidence of UC and CD in a semirural area of north west Greece during the 10 year period 1982-1991. By the 31 December 1991, 61 patients had met standard diagnostic criteria for UC (annual incidence 4.0/10(5), 95% confidence intervals 3.0 to 5.0/10(5)) and only five patients met the diagnostic criteria for CD (annual incidence 0.3/10(5), 95% confidence intervals 0.1 to 0.8/10(5)) in this area of 157,214 inhabitants. UC incidence was lowest in the first three years at 1.8/10(5) per annum and subsequently increased to 4.8 and 5.1/10(5) per annum for the successive four and three year periods respectively. UC incidence was slightly higher in men. A third of all cases of UC had pancolitis while a quarter had only proctitis. More than one half were categorised as having moderate or severe colitis. Three quarters of the patients resided in urban areas. The incidence of CD was a twelfth of the UC incidence, which is in considerable contrast with most Western countries where the incidence of CD is usually no less than a third that for UC. The rarity of CD points to the absence of aetiological environmental factors specific for CD.

Acid-base and electrolyte abnormalities in alcoholic patients.

This study was undertaken to analyze the acid-base and electrolyte abnormalities and the pathogenetic mechanisms involved in alcoholic patients admitted to our department for causes related to alcohol abuse. We studied 79 alcoholic patients aged 31-78 years. None had any other disease or was receiving drugs influencing acid-base balance and electrolyte parameters. On their admission and before any therapeutic intervention laboratory investigation of the acid-base status and electrolyte parameters in both sera and urine was carried out. Thirty-two patients (40.5%) had acid-base disturbances. Ten patients (12.6%) had pure respiratory alkalosis, 2 patients (2.5%) pure metabolic alkalosis, while 20 patients (25.3%) had the so-called syndrome of alcoholic ketoacidosis. Forty-one patients (52%) had electrolyte abnormalities. Eighteen patients (22.8%) had hyponatremia. However, 5 patients had pseudohyponatremia due to alcohol-induced hypertriglyceridemia. Two patients (2.5%) with increased insensible losses had hypernatremia. Hypokalemia was found in 10 patients (12.6%), hypomagnesemia in 25 patients (31.6%), hypophosphatemia in 23 patients (29.1%), hyperphosphatemia in 2 patients (2.5%), and hypocalcemia in 17 patients (21.5%). However, only 7 patients had true hypocalcemia. In conclusion, alcoholic patients develop a series of acid-base and electrolyte disturbances owing to various pathogenetic mechanisms.

Water as contrast medium for computed tomography study of colonic wall lesions.

A tap water enema combined with intravenous iodine contrast medium was used for computed tomographic (CT) study of the entire clean colon in 35 patients. Thirty of them showed a high suspicion of rectal, colon, or cecal pathology at either clinical examination, barium enema study, or endoscopy. The remaining five patients were examined for suspected local recurrence of carcinoma. This CT technique detected the wall abnormality in all but one case with two small adenomatous polyps. This procedure, which is simple, inexpensive, and has a good acceptance and tolerance, can accurately detect mural wall abnormalities.

Use of water or air as oral contrast media for computed tomographic study of the gastric wall: comparison of the two techniques.

Thirty-four patients with a high suspicion of gastric lesion at endoscopy were studied by two computed tomographic (CT) techniques: one using a gas-producing agent and the other using water as an oral contrast media. Intravenous contrast medium was also given in all patients who underwent the water technique. Final histologic proof was obtained either by endoscopy or at surgery. Both CT techniques detected the wall abnormality in 32 of the 34 patients, and both techniques missed the same lesion in two patients. The water technique showed more gastric wall details and the lesion's limits could be defined more accurately. The acceptance and tolerance of the gas-producing agent was better in severely ill patients than tap water.