The natural course of hepatitis C virus infection 18 years after an epidemic outbreak of non-A, non-B hepatitis in a plasmapheresis centre.

BACKGROUND: The natural history of hepatitis C virus (HCV) infection is variable and factors determining the course of the illness are unclear. AIMS: To determine the natural course of HCV infection in a well characterised group of patients 18 years after an epidemic outbreak of non-A, non-B hepatitis at a plasmapheresis centre. METHODS: Between 1994 and 1996, 20 of 30 affected individuals were studied. HCV infection was confirmed using second and third generation ELISA test kits. HCV RNA was detected by a polymerase chain reaction (PCR) method and HCV genotyping was performed by analysing amplicons from the conserved 5'-non-translated region generated by nested PCR. Thirty two liver biopsies were carried out in 14 patients. RESULTS: HCV antibodies were detected in all subjects. Eighteen patients had abnormal liver enzymes and 17 were HCV RNA positive, all of whom were infected with genotype 1a. Ninety per cent of this cohort showed evidence of chronic HCV infection with 50% having progressive liver disease and 20% cirrhosis 18 years after acute onset of non-A, non-B hepatitis. Considerable variation in disease outcome occurred between individuals and no correlation with clinical features of the acute illness was found. CONCLUSIONS: Variability in the consequences of HCV infection in cases infected with the same virus suggests that host factors are important in determining disease outcome. The factors which determine differences in the natural history of the disease still remain to be elucidated.

[Animal bite injuries in the head and neck area and their care]. / Tierbissverletzungen im Kopf-Hals-Bereich und ihre Versorgung.

Animal bites in the head and neck vary in severity. Surgical treatment depends on the size, extent and site of the wound. Straightforward injuries need only to be cleaned and disinfected or may require simple surgery. Extensive, complex bites must be treated by the techniques of plastic-reconstructive surgery. Good cosmetic results can only be achieved in this way. Lacerations should be treated immediately. Bites with loss of tissue can be treated immediately by flaps, skin or composite grafts or revascularised flaps. Usually however, the wound is covered by gauze impregnated with ointment or artificial skin. Two to three weeks after granulation the lesion is reconstructed. An anti-tetanus injection must be given for every animal bite. Simple bites do not require antibiotics, but extensive wounds do. The indication for rabies vaccination is described and questions concerning the treatment of injuries caused by rabid or suspected-rabid animals are clearly explained.

Epidemic outbreak of non-A, non-B hepatitis in a plasmapheresis center. I: Epidemiological observations.

An epidemic outbreak of non-A, non-B hepatitis occurred in 1977/78 involving 30 donors at a plasmapheresis center. A chimpanzee inoculated with serum of one donor developed non-A, non-B hepatitis with characteristic tubular alterations in the endoplasmatic reticulum. Infections were detected over a period of several months, with two well defined peaks in December 1977 and between the end of January and the beginning of February 1978. Epidemiological data suggested a spread within the center. The most probable mode of transmission was contamination with serum from plastic bags used for reinfusing erythrocytes. The estimated mean incubation time was 41 days (range 27 to 59 days).

Epidemic outbreak of non-A, non-B hepatitis in a plasmapheresis center. II: Clinical observations and a four-year follow-up of patients.

An epidemic outbreak of non-A, non-B hepatitis occurred in 1977/78 involving 30 donors at a plasmapheresis center. Of 27 hospitalized patients with peak ALT values between 334 and 1736 (mean 831) IU/l, only 16 had subjective symptoms like fatigue and lack of appetite, 11 had nausea, 11 were jaundiced and one developed transient arthritis. Patients with jaundice became chronically ill significantly less frequently than those without jaundice. Nineteen of 26 patients followed up had elevated ALT values after 12 months (73%) and 11 after 46 months (42%). Needle liver biopsies performed in 18 of the 19 patients with elevated ALT after 12 months revealed chronic persistent hepatitis in 14 and chronic active hepatitis in three. Follow-up biopsies always showed improvement (nine patients) or complete recovery (eight patients).

[Effect of acute beta 1 and beta 1/beta 2 receptor blockade on carbohydrate and lipid metabolism during exertion]. / Einfluss einer akuten beta 1- und beta 1/beta 2-Rezeptorenblockade auf den Kohlenhydrat- und Fettstoffwechsel unter Belastungsbedingungen.

The influence of acute beta 1-receptor blockade using 50 mg metoprolol or beta 1/beta 2-blockade using 40 mg propranolol resulted in an equipotent reduction of cardiac frequency and systolic blood pressure without influencing diastolic pressure in ten healthy probands. There was no reduction of maximal bicycle ergometric exercise by either beta-receptor blocking agent. Serum glucose levels did not change during metoprolol in comparison to pre-test values. In contrast, propranolol resulted in a significant decrease of glucose levels during maximal exercise and 5 minutes after end of exercise. Plasma lactate was moderately lowered by both beta-receptor blockers after 20 min constant exercising when compared to pre-medication. Both substances reduced the insulin level in a comparable way during the exercise test. Serum triglyceride concentrations did not alter significantly during exercise tests. Serum free fatty acid levels showed a decreasing tendency until maximal exercise; however, there was no significant difference between values obtained with metoprolol or propranolol and drug-free pre-test.

[Non-A, non-B-hepatitis (author's transl)]. / Non-A, non-B-Hepatitis.

In addition to hepatitis type A, B and hepatitis due to infection with Epstein-Barr or cytomegaly-virus, the existence of a further type of hepatitis could be demonstrated by comprehensively sensitive and specific serologic assays. In 85% of the patients, the transmission was parenteral. The source of infection is identical with that of hepatitis B. Until now, the methods for detection of this type of hepatitis consists of double immunodiffusion, immunoelectrophoresis and indirect immunofluorescence. Improvement of sensitivity and specificity of these methods are to be expected in the near future. The rate of chronicity is approximately 30%. Aggressive courses seem to be less frequent than in hepatitis B. No general recommendation can be given for pre- or post-expositional vaccination with normal serumglobulins, since the results of controlled studies are contradictory and different.

[Investigations on the cardiovascular system at altitudes up to a height of 7,800 meters (author's transl)]. / Herz-Kreislauf-Untersuchungen im Hochgebirge bis 7800 m Höhe.

During a Karakorum expedition electrocardiographic investigations were performed. In the basic camp, 4,800 meters above sea level, ECG of test persons were registered in the resting state and after physical exercise. In addition, long-time recordings of heart rate reactions were made during various phases of mounting up to a height of about 7,800 meters. The ascent in extreme altitudes without an artificial oxygen supply did not cause electrocardiographical signs of myocardial hypoxia. Only supraventricular or ventricular ectopic beats could be detected in some instances. During continuous mounting, the heart rate rises to 120-140 beats per minute and reached 150 beats per minute during the last part up to the summit. Resting blood pressure measured in the basic camp over a period of 15 days showed no significant changes.

[Echocardiographic determination of left ventricular function during isometric muscle exertion and the Valsalva maneuver]. / Echokardiographische Beurteilung der linksventrikulären Funktion während isometrischer Muskelarbeit und der Valsalvaschen Pressdruckprobe.

Left ventricular dimensions and function were estimated in 11 healthy volunteers by means of echocardiography during isometric exercise and the Valsalva manoeuvre. Isometric exercise induces a rise of heart rate and Vcf by 14% and of cardiac output as well as of the cardiac index by 12%. Stroke volume remains unchanged. During Valsalva's manoeuvre a marked decrease in left ventricular dimensions is observed. A reduction of the stroke volume by 29% was not compensated by increasing heart rate. However, cardiac output and cardiac index is found 10% below control values.