Gallstones and laparoscopic cholecystectomy in hepatitis C patients.

Our aims were to determine the incidence of gallstones in a cohort of patients infected with hepatitis C for 20 years, and to analyse the outcome of all patients infected with hepatitis C undergoing laparoscopic cholecystectomy. A hepatitis C screening programme in place in Ireland since 1994 identified 965 patients with hepatitis C antibodies out of 62,667 patients screened. The hepatology unit of Cork University Hospital has 318 patients with hepatitis C. Of patients identified by screening, 201 were post partum women infected via contaminated Anti-D immunoglobulin administered in 1977. Thirty-five (17.4%) of two hundred and one patients with hepatitis C since 1977 had developed gallstones after twenty years. A total of 34 patients with hepatitis C underwent laparoscopic cholecystectomy. One patient required conversion to open cholecystectomy. There were no complications and no mortality. There was a low rate of cirrhosis (11%) on examining liver histology. The incidence of gallstones in a cohort of patients infected with hepatitis C for twenty years approximates to that of the general population. The low rate of cirrhosis in this group may be related to a low consumption of alcohol. Laparoscopic cholecystectomy is a safe procedure in patients with mild chronic liver disease caused by hepatitis C.

Pregnancy and pregnancy outcome in hepatitis C type 1b.

A large cohort of rhesus-negative women in Ireland were inadvertently infected with hepatitis C virus following exposure to contaminated anti-D immunoglobulin in 1977-8. This major iatrogenic episode was discovered in 1994. We studied 36 women who had been infected after their first pregnancy, and compared them to an age- and parity-matched control group of rhesus-positive women. The presence of hepatitis C antibody was confirmed in all 36 by enzyme-linked immunosorbent assay and by recombinant immunoblot assay, while 26 (72%) of the cohort were HCV-RNA-positive (type 1b) on PCR testing. In the 20 years post-infection, all members of the study group had at least one pregnancy, and mean parity was 3.5. They had a total of 100 pregnancies and 85 of these went to term. There were four premature births, one being a twin pregnancy, and 11 spontaneous miscarriages. One miscarriage occurred in the pregnancy following HCV infection. There were two neonatal deaths due to severe congenital abnormalities in the PCR-positive women. Of the children born to HCV-RNA positive mothers, only one (2.3%) tested positive for the virus. Significant portal fibrosis on liver biopsy was confined to HCV-RNA-positive mothers apart from one single exception in the antibody-positive HCV-RNA-negative group. Comparison with the control group showed no increase in spontaneous miscarriage rate, and no significant difference in obstetric complications; birth weights were similar for the two groups.

Splenectomy in patients with undiagnosed splenomegaly.

Of splenectomies performed in the Cork Regional Hospital over an 11 year period, ten were undertaken primarily for diagnostic purposes. A definitive histological diagnosis was established in nine patients, seven of whom had lymphoma, two with Hodgkin's disease and five with non-Hodgkin's lymphoma. The weight of the excised spleen in all patients with lymphoma exceeded 1 kg; in all those with a diagnosis other than lymphoma, the spleen weighed less than 1 kg. A majority of patients also had symptomatic improvement from reversal of hypersplenism and from relief of the mechanical pressure effects of an enlarged spleen. Operative mortality was zero. Diagnostic splenectomy is a worthwhile procedure. Most patients will have lymphoma.

Partial lipodystrophy in coeliac disease.

The association of coeliac disease and partial lipodystrophy is described. The patient also had deficiencies of serum IgA and C3 complement (the latter associated with partial lipodystrophy). In addition, there was subclinical dermatitis herpetiformis confirmed by skin biopsy. The facial wasting of fully developed partial lipodystrophy may be misinterpreted as a sign of malabsorption but the facial, upper limb, and truncal lipodystrophy contrasts with normal pelvic and lower limb appearances.

Down syndrome and autoimmune chronic active hepatitis: satisfactory outcome with therapy.

A case of autoimmune chronic active hepatitis (C.A.H.) in a 12-year old Down Syndrome child is described. This represents the second only documented case of autoimmune C.A.H. occurring in Down Syndrome; the first well-described case died from the disease. The patient described below had a satisfactory response to steroid therapy with restoration of normal liver histological appearances and function despite severe disease at presentation. Chronic hepatitis in Down Syndrome, although more usually of hepatitis B viral aetiology, may also be autoimmune in nature and resolve satisfactorily with appropriate therapy.

Adult infectious diseases: management in a general hospital.

Conflicting views exist as to where patients with infectious diseases (IDs) are best managed. In an effort to define the role of an IDs Unit in this country, we undertook a four-year survey of IDs cases referred to our isolation facility which is part of the Gastroenterology department. Ninety-three per cent of 250 cases referred had either diarrhoea (48%) or jaundice (45%). Two thirds of the total had an infective, and one third a non-infective basis for their illness. Since diarrhoea and jaundice dominated the clinical presentations of these cases, having the IDs facility within the Gastroenterology department made for speedy diagnosis and management of both infectious and non-infectious cases. Where referral and/or transfer to other units was necessary, it still proved helpful to locate the IDs facility within a regional multidisciplinary hospital, particularly in view of the wide range of medical and surgical conditions referred as putative IDs.

Congenital absence of the gallbladder and cystic duct: nonoperative diagnosis.

A case of congenital absence of the gallbladder and cystic duct diagnosed by nonoperative means is presented. Hitherto, confident diagnosis of this condition during life required laparotomy. Improved hepatobiliary imaging techniques now enable diagnosis without resort to surgical intervention.