Normal Alanine Research Articles

A rare cause of obstructive jaundice: Adenomatous bile duct polyp.

A 40-year-old female presented with a history of right upper quadrant pain and progressive jaundice for the last two months. She had associated clay-coloured stools, loss of appetite and loss of weight. She was icteric and had palpable hepatomegaly. There was no fever and the total leukocyte count was normal (6600/mm3). She had hyperbilirubinemia (total bilirubin- 23 mg/dl and direct-15 mg/dl), slightly elevated alkaline phosphatase (280 IU/dL) with a normal alanine and aspartate aminotransferase level.

A Novel Non-Invasive Approach Based on Serum Ceruloplasmin for Identifying Non-Alcoholic Steatohepatitis Patients in the Non-Diabetic Population.

Background and AimFew non-invasive models were established to identify patients with non-alcoholic steatohepatitis (NASH). Liver biopsy remains the gold standard in the clinic. Decreased serum ceruloplasmin (CP) is reported in patients with non-alcoholic fatty liver disease (NAFLD). We aimed to develop a non-invasive model incorporating CP for identifying NASH from NAFLD without type 2 diabetes mellitus (T2DM).MethodsA total of 138 biopsy-proven patients with NAFLD without T2DM were enrolled. The CP ratio was calculated for standardization as the CP value divided by the lower limit of normal. The clinical, anthropometric, biochemical, and histological parameters were compared between the low and high CP ratio groups divided by the median value. Multivariate logistic regression analysis was performed to develop a model for identifying NASH in patients with NAFLD.ResultsThe medians of the high (n = 69) and low (n = 69) CP ratio groups were 1.43 (1.28–1.61) and 1.03 (0.94–1.12), respectively. A comparison of the two groups showed that the severity of steatosis, hepatocellular ballooning, inflammation activity, fibrosis, and liver iron deposition decreased along with the CP ratio (p < 0.05). The median CP ratio of patients with NASH was significantly lower than those with NAFL [1.15 (1.01–1.41) vs. 1.33 (1.24–1.54), p = 0.001]. A novel model which consists of the CP ratio, BMI, and aspartate aminotransferase (AST) was developed. The AUCs of the model in discriminating NASH from NAFLD was 0.796 (0.694–0.899) and 0.849 (0.713–0.984) in the training and validation groups, and 0.836 (0.659–1.000), 0.833 (0.705–0.962), and 0.821 (0.612–1.000) in patients with normal serum alanine aminotransferase, AST, and both levels, respectively.ConclusionsDecreased CP ratio is associated with more severe histological activity, a diagnosis of NASH, and hepatic iron deposition among patients with NAFLD without T2DM. The CP ratio model could be served as a non-invasive approach to identifying patients with NASH, which might reduce the need for liver biopsy.

Newborn with Lethargy, Jaundice, and Coagulopathy.

Laboratory results include the following: white blood cell count, 21,600/μL (21.6 × 109/L; reference range, 9,000-30,000/μL [9-30 × 109/L]); hemoglobin, 18.2 g/dL (182 g/L; reference range, 14.0-24.0 g/dL [140-240 g/L]); platelet count, 111 × 103/μL (111 × 109/L; reference range, 150-450 × 103/μL [150-450 × 109/L]); blood type, B+; direct antiglobulin test, negative; and reticulocyte count, 4% (reference range, 3%-7%). Comprehensive metabolic panel is significant for hyponatremia, with a sodium level of 132 mEq/L (132 mmol/L; reference range, 135-145 mEq/L [135-145 mmol/L]). Liver enzyme levels are normal (alanine aminotransferase, 41 U/L [0.68 μkat/L]; aspartate aminotransferase, 86 U/L [1.44 μkat/L]), as are total protein (5.4 g/dL [54 g/L]) and albumin (3.0 g/dL [30 g/L]) levels. Repeated bilirubin level is 12.4 mg/dL (212 µmol/L) at 14 hours after birth, with an elevated direct bilirubin level of 2.9 mg/dL (49.6 µmol/L). Direct or conjugated hyperbilirubinemia is defined as a direct bilirubin level greater than 2 mg/dL (34.2 mmol/L) or more than 20% of total bilirubin. γ-Glutamyl transferase level is normal. Coagulation studies show an elevated prothrombin time of 23.4 seconds (reference range, 11-17 seconds), with an international normalized ratio of 2.1 (reference range, 0.9-1.3); activated partial thromboplastin level is 49.5 seconds (reference range, 30-60 seconds). Fibrinogen level is decreased at 70 mg/dL (0.70 g/L) (reference range, 230-450 mg/dL [230-450 g/L]). Lactate level is 24.3 mg/dL (2.7 mmol/L; reference range, 2.0-26.9 mg/dL [0.22-2.98 mmol/L]). Ammonia level is 96.6 µg/dL (69 μmol/L; reference range, 89.6-149.9 µg/dL [64-107 μmol/L]). Cerebrospinal fluid studies are unremarkable. Magnetic resonance imaging (MRI) of the brain and echocardiography are normal. Ultrasonography of the abdomen shows diffuse hepatic echogenicity. Blood and cerebrospinal fluid cultures are negative. Further testing reveals the diagnosis.

STUDY OF TOLERANCE OF THE DRUG BASED ON QUARTZETIN BY BLOOD INDICATORS IN CLINICALLY HEALTHY DOGS

The article presents the results of clinical trials of tolerance of the drug, containing the flavonoid quercetin, on clinically healthy dogs. Quercetin is a biologically active substance that can have antioxidant, membrane, gastro-, nephro-, hepato-, cardioprotective, antiplatelet, anti-inflammatory effects. The flavonoid quercetin belongs to the aglycones of many plant flavonoid glycosides of higher plants. Some pharmacological effects of quercetin have been discovered recently, but the prospects of its use in veterinary medicine are being intensively studied, given its promising positive effects on the animals` body. The bioavailability of quercetin is highest in combination with pectin and insoluble oligosaccharides, which is associated with changes in the quantitative and qualitative composition of the mammals’ intestinal micro flora. A prerequisite for the development and testing of new veterinary medicinal products in accordance with the requirements of the international community for the registration of medicinal products is the conduct of clinical trials in compliance with the requirements of "Good Clinical Practice" (GCP). The introduction of biologically active drugs in the practice of veterinary medicine requires careful researches on target species of animals. Therefore, to assess the tolerability, safety and efficiency of the drug containing quercetin, a comprehensive clinical trial was performed on small pets (dogs). The study was conducted in veterinary clinics on healthy dogs of all ages, genders and breeds. The drug was used at a dose of 4 mg/kg body weight orally with food for 30 days. Blood sampling in test animals was performed before drug use and on days 30 and 60 of the experiment. The effect of the drug on the body was evaluated by clinical indicators, hematological and biochemical parameters of dogs' blood. Stabilized EDTA blood was used for morphological studies and blood serum for biochemical studies.&#x0D; According to the evaluation of the animals’ clinical condition and the obtained data of laboratory studies, it was found that the tolerance of the studied drug, administered orally to healthy dogs, was good. According to the results of comparison of clinical, hematological and biochemical parameters on the 30th and 60th day of the study with the initial data obtained before the use of the study drug, no negative changes were detected.&#x0D; Hematological studies indicated the activation of hematopoietic processes, normalization of leukogram parameters on 30th day after the drug application. Changes in the lymphocytes` content in the leukogram and the γ-globulin fraction in the protein-gram indicated a strengthening of dogs` immune protection.&#x0D; The results of biochemical studies of dogs's blood on the 30th day showed a reliable increase, within normal limits, in glucose, creatinine contents, increased catalase and alanine aminotransferase activity and decreased gamma-glutamyltransferase activity and the contents of diene conjugates and malonic dialdehyde.&#x0D; Activation of protein metabolism was established, which was indicated by a reliable increase in the total serum protein content and albumin content in the dogs` proteinogram. On the 60th day of the drug application no significant changes in hematological and biochemical parameters of the blood of dogs were detected. There was a slight decrease in the activity of catalase and SOD and a decrease in the content of malonic dialdehyde in the serum of dogs, compared with the values on the 30th day. This, in turn, showed a decrease in the intensity of the formation of toxic compounds in animals and pronounced antioxidant properties of the drug Hepanephran.

High Serum Aspartate Aminotransferase, Underweight, and Weight Loss in Older People: Results of the KITCHEN-4.

Background: Reduced muscle mass is frequently observed in older people and can lead to being underweight and/or weight loss (WL), but prediction and screening systems utilizing hematological biochemical parameters are limited. High serum aspartatSe aminotransferase in conjunction with normal serum alanine aminotransferase (HASNAL) can reflect systemic muscle damage. HASNAL and the incidence of being underweight concomitant with WL (UWWL) were investigated in the present 6-year community-based cohort study. Methods: Clinical parameters, lifestyle, the incidence of being underweight, ≥5% WL, and UWWL were investigated in 238,536 Japanese people aged 40–68 years who had normal serum alanine aminotransferase. HASNAL was defined as serum aspartate aminotransferase ≥30 U/L and serum alanine aminotransferase <30 U/L. The subjects were divided into a younger group (<55 years) and an older group (≥55 years). Results: After 6 years, overall body weight had increased by 0.4% in the younger group and decreased by 0.4% in the older group. In logistic regression analysis, in the younger group ≥5% WL was significantly associated with baseline HASNAL compared to baseline low serum aspartate aminotransferase (<20 U/L). In the older group, baseline HASNAL was significantly associated with being underweight, ≥5% WL, and UWWL, even after adjustment for potential confounders, and UWWL was inversely associated with regular exercise and daily alcohol consumption—both of which modified the aforementioned associations. Conclusions: Older subjects with HASNAL were at an increased risk of UWWL, possibly via skeletal muscle damage, which may be affected by common lifestyles.

A 10-year-old boy with dyspnea and hypoxia: abernathy malformation masquerading as pulmonary arteriovenous fistula

BackgroundAbernethy malformation is an extremely rare congenital malformation characterised by an extrahepatic portosystemic shunt. Children with Abernathy malformation can develop hepatopulmonary syndrome (HPS) with pulmonary arteriovenous fistulas (PAVF) or pulmonary hypertension. PAVF manifests as central cyanosis with effort intolerance. We report a case of PAVF in a Ten-year-old Boy. Persistent symptoms identified Abernathy malformation as the cause of progressive symptoms and current understanding of this rare malformation is reviewed.Case presentationA case of 10-year-old boy with Abernethy malformation complicated with HPS initially managed as PAVF was presented. Selective lung angiography showed a typical diffuse reticular pattern on right lower lung, which suggested PAVF. However, cyanosis was not improved post transcatheter coil embolization. Then, liver disease was considered although the patient had normal aspartate aminotransferase and alanine aminotransferase. The significantly elevated serum ammonia was attracted our attention. Abdominal computed tomography also exhibited enlarged main portal vein (MPV), cirsoid spleen vein, and superior mesenteric vein (SMV). Angiography with direct opacification of the SMV with a catheter coming from the inferior vena cava (IVC) and going to the SMV via the shunt vessel (SHUNT) between the MPV and IVC. Occlusion the IVC with an inflated balloon, injection of contrast medium via a catheter placed in the SMV, MPV was showed and absence of intrahepatic branches. Abernethy malformation IB type is finally confirmed.ConclusionsAbernethy malformation is an unusual cause for development of PAVF and cyanosis in children. Clinicians must be suspicious of Abernethy malformation complicated with HPS. If patients have abnormal serum ammonia and enlarged MPV in abdominal CT, cathether angiography should be done to rule out Abernethy malformation.

Case 6: Abdominal Distention and Constipation in a 70-day-old Female Infant

1. Jeffrey Lancaster, MD* 2. Jessica Lear, MD* 3. Richard Brant, MD* 4. Brian Riedel, MD* 5. Joseph Minardi, MD† 1. *Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV 2. †Departments of Emergency Medicine and Medical Education, West Virginia University School of Medicine, Morgantown, WV A 70-day-old female infant presents to the emergency department (ED) with a 1-month history of abdominal distention and constipation. The patient was born at term via vaginal delivery. She is formula fed with a cow milk protein formula and routinely consumes 4 oz every 4 hours. She passed meconium within 24 hours after birth. However, since that time she has not stooled regularly, and her parents have administered daily diluted fruit juices and enemas every other day to promote defecation. Despite these interventions, her abdomen has become more distended, and the parents report that her constipation continues. In the ED her vital signs are temperature 98.6°F (37.0°C), blood pressure 111/62 mm Hg, pulse 137 beats/min, respiratory rate 22 breaths/min, and oxygen saturation 100% on room air. Her examination shows a well-appearing baby in no apparent distress. Her cardiopulmonary examination findings are normal. Extremity examination shows capillary refill within 2 seconds, and there is no appreciable edema. Peripheral pulses are strong. The patient’s abdomen is distended but nontender and without any cutaneous findings suggesting portal hypertension. Bedside abdominal ultrasonography performed by the ED physician demonstrates ascites without any organomegaly (Fig 1). She is admitted to the pediatric service at that time. Figure 1. Ascites is seen in the pelvis surrounding multiple intestinal loops. Results of laboratory studies are largely normal (aspartate aminotransferase, alanine aminotransferase, albumin, electrolyte panel, and lipase) except for peripheral eosinophilia noted on the complete blood cell count (white blood cell count, 10,500/μL [10.5 × 109/L]; eosinophils, 15%; absolute eosinophil count, 1.5 × 109/L). The total serum immunoglobulin E (IgE) level is normal at …

The overall computer/mobile devices usage time is related to newly diagnosed non-alcoholic fatty liver disease: a population-based study

Background: The computer/mobile devices usage time (CMD-UT) is closely related to a sedentary lifestyle, which is an important risk factor for non-alcoholic fatty liver disease (NAFLD). But their direct relationship remains unclear.Aims: We aimed to examine the relationship between CMD-UT and newly diagnosed non-alcoholic fatty liver disease (NAFLD) in Chinese adults.Methods: This cross-sectional study was conducted on 7516 adults in Tianjin, China. The CMD-UT was collected via a questionnaire included five categories. NAFLD [with normal or elevated alanine transaminase (ALT) levels] was diagnosed by at least twice liver ultrasonography examinations and serum ALT concentrations (>41 U/L in males and >33 U/L in females).Results: The prevalence of overall NAFLD, NAFLD with normal or elevated ALT levels was 18.2, 14.2, and 4.0%, respectively. After adjustments for potential confounding factors, the odds ratios (95% confidence interval) of having overall NAFLD by increasing CMD-UT levels were 1.00 for <1 h/d, 1.58 (1.22–2.05) for 1-3 h/d, 1.58 (1.18-2.11) for 3–5 h/d, 1.65 (1.21-2.27) for 5–10 h/d, and 1.99 (1.29-3.05) for ≥10h/d (P-trend for CMD-UT levels = 0.02), respectively. Similar relations were observed with the use of NAFLD with normal or elevated ALT levels.Conclusions: The present study is the first to find that CMD-UT levels are independently associated with NAFLD.Key MessagesThe computer/mobile devices usage time levels are independently associated with the prevalence of non-alcoholic fatty liver disease.

Immunosuppressive treatment combined with nucleoside analog is superior to nucleoside analog only in the treatment of severe thrombocytopenia in patients with cirrhosis associated with hepatitis B in China: A multicenter, observational study

No effective treatment has been identified for patients of liver cirrhosis (LC) associated with hepatitis B virus (HBV) and severe thrombocytopenia. We aimed to explore the effectiveness and safety of low-dose prednisone or cyclosporine A (CsA) combined with nucleoside analog (NA) in patients with severe thrombocytopenia associated with HBV-related LC. We included 145 consecutive compensated HBV-associated LC patients with severe thrombocytopenia between 1 January 2006 and 31 December 2013. We divided the patients into three groups by treatment strategy, including NA only (n = 57), NA plus prednisone (n = 46), and NA plus CsA (n = 42). We analyzed the platelet counts, bleeding events, liver function, replication of HBV, and outcomes in each group. At all time points during this observation, the platelet counts in prednisone or CsA group were higher than those in the NA only group. There are significant differences in the cumulative rates of bleeding events among the three groups. The platelet counts and treatment were factors associated with bleeding events in multivariate analysis. The differences in HBV-DNA negative rates, HBV-DNA elevated rates, normal serum alanine transaminase rates, serum alanine transaminase elevated more than two times the baseline rates, and HBeAg seropositive conversion ratio among the groups did not reach statistical significance. The adverse events in our study were, in general, mild and balanced among the three treatment groups. Treatment with low-dose prednisone or CsA plus NA could elevate the platelet counts and reduce the risk of bleeding events in HBV LC with severe thrombocytopenia.

Complementary laboratory indices for predicting the disease status of patients with hepatitis B virus infection

To identify complementary laboratory indices for determining the disease status of patients with hepatitis B virus. Subjects were divided into six groups: hepatitis B virus carrier, mild chronic hepatitis B, moderate chronic hepatitis B, severe chronic hepatitis B, fulminant hepatitis B and healthy controls. Serum alanine aminotransferase, total bilirubin and direct bilirubin were measured by an automatic analyser. The levels of T-cell immunoglobulin domain and mucin-domain-containing molecule-3, macrophage inflammatory protein 2, neutrophil gelatinase-associated lipocalin and inducible nitric oxide synthase were measured by ELISA. T-cell immunoglobulin domain, mucin-domain-containing molecule-3, macrophage inflammatory protein 2 and inducible nitric oxide synthase levels were significantly higher in patients with severe chronic hepatitis B compared with those in patients with mild and moderate chronic hepatitis B or fulminant hepatitis B (P < 0.05). When normal or abnormal alanine aminotransferase was present, significant differences between macrophage inflammatory protein 2 and T-cell immunoglobulin domain and mucin-domain-containing molecule-3 levels between patients with mild, moderate, severe chronic hepatitis B or fulminant hepatitis B were observed (P < 0.05). Our results suggest that T-cell immunoglobulin domain and mucin-domain-containing molecule-3 and macrophage inflammatory protein 2 could serve as alanine aminotransferase, direct bilirubin or total bilirubin complementary indices for determining the status of patients with hepatitis B.

Clinical significance of peripheral blood PD-1 and its ligands in patients with anti-HBe positive CHB =or anti-HBs positive of normal ALT

Objective To study the clinical significance of peripheral blood PD-1 (CD279) and its ligands(CD274 and CD273)between patients with anti-HBe positive chronic hepatitis B (CHB) or anti-HBs positive group of normal glutamic acid alanine aminotransferase (ALT).Methods A total of 70 subjects of normal ALT,including 23 patients with anti-HBe positive,22 anti-HBs positive and 25 normal controls,were enrolled.The expression level of CD279,CD274 and CD273 in peripheral lymphocyte were detected by flow cytometry.Compare the group differences by multivariate analysis of variance.Results The expression level of CD279 in control group,anti-HBe positive group and anti-HBs positive group was (33.3±5.4)％,(48.0±9.1) ％,(42.8±9.0) ％,respectively.The expression level of CD274 in control group,anti-HBe positive group and anti-HBs positive group was (59.4 ±4.4) ％,(71.3± 10.3) ％ and (62.9 ± 10.2) ％,respectively.The expression level of CD273 in control group,anti-HBe positive group and anti-HBs positive group was (5.3±2.2)％,(15.6±5.3)％ and (5.1±1.0)％,respectively.The expression level of CD279 and CD274 decreased gradually from anti-HBe positive group to anti-HBs positive group and then to normal control group.Three dependent variables in the overall difference was statistically significant (Pillai trace =0.988,F=3090.105,P=0.000),η partial square was 0.458.The difference for CD273 expression level of anti-HBs positive group compared with control group was not statistically significant (P =0.082) ; for other groups pairwise comparisons were statistically significant(P＜0.01).Conclusion Monitoring the alteration of PD-1 and its ligands of the HBeAg seroconversion CHB patients and the anti-HBs positive population can better understand the changes in course of HBV infection,thereby improving the prognosis of patients.with HBV infection. Key words: Hepatitis B; Programmed death 1; Ligand

Diabetic Myonecrosis of the Thigh

A46-yr-old man with a history of long-standing type 2 diabetes, hypertension, chronic atrial fibrillation, hemodialysis-requiring end-stage renal disease, and left below-the-knee amputation due to severe peripheral arterial disease presented with a 2-d history of atraumatic acute-onset and then progressively worsening right anteromedial thigh pain, which was constant, aching, and aggravated with motion. He was an ex-smoker and a social drinker, and he denied use of illicit drugs. Medications included sitagliptin, amlodipine, metoprolol, lisinopril, aspirin, simvastatin, erythropoietin, and warfarin. Physical examination was remarkable for weak distal pulses and severe tenderness, erythema, and edema of the affected thigh without paresthesia or focal weakness. He had a normocytic normochromic anemia without leukocytosis, serum creatinine of 12.4 mg/dl, normal alanine and aspartate aminotransferases, normal thyroid function, creatine kinase of 228 U/liter (normal range, 30– 200), and aldolase of 13.9 U/liter (normal range, 1.2–7.6). Blood cultures and tests for autoimmune myositis were negative. Magnetic resonance imaging showed extensive edema through the entire extent of vastus medialis (Fig. 1, A and B). A muscle biopsy was performed, which showed muscle fibers undergoing active necrosis with extensive perivascular and endomysial lymphohistiocytic infiltrate, consistent with a diagnosis of diabetic myonecrosis (Fig. 1, C and D). The patient was discharged on analgesics. Diabetic myonecrosis is a rare complication of diabetes with advanced microvasculopathy and presents most commonly with acute pain and swelling of the thigh (1). Other reported risk factors are antiphospholipid antibodies (2) and cirrhosis (3). Differential diagnosis includes pyomyositis, primary muscle lymphoma/sarcoma, necrotizing fasciitis, soft tissue abscesses, deep vein thrombosis, dermatomyositis, focal/proliferative/nodular myositis, and cellulitis (1). Pathogenesis involves muscle infarction due to arteriosclerosis or diabetic microangiopathy (4). Diabetic myonecrosis predicts a poor prognosis.

LIVER BIOPSY IN PATIENTS INFECTED WITH CHRONIC HEPATITIS C AND PERSISTENTLY NORMAL SERUM ALT LEVELS

INTRODUCTION: Approximately 30 to 40% of patients with Chronic Hepatitis “C” (CHC) have persistently normal serum alanine aminotransferase (ALT) levels. Historically, these patients have been classified as healthy or asymptomatic and have not received any treatment for CHC infection. However, definition and clinical significance of persistently normal ALT in CHC have been recently revised as new information on liver disease which is now getting available. AIMS: To evaluate the histological feature of liver of patients suffering from CHC with persistently normal ALT levels. METHODS: In this prospective observational study we recruited consecutive patients infected with CHC with persistently normal ALT since last six months, visited our hepatology clinic from September 2004 to April 2005.The METAVIR scoring system was used for liver histology grading (degree of inflammation) and staging (degree of fibrosis). RESULTS: A total of 55 patients were recruited from outpatient clinic with normal ALT during a follow up of six months. Mean age of these patients was 36.7± 9.78 years; out of these 39 (70.9%) were male. All these patients were diagnosed to have hepatitis C by HCV RNA PCR method. There were 24 (43.6%) patients with stage (fibrosis) equal or greater than 2 and 33 (60%) had biopsy grade equal or greater than 2. Eighteen (32.7%) patients had steatosis on liver biopsy. Twelve patients with stage > 2 had steatosis while 6 patients with stage < 2 had steatosis (p< 0.01). CONCLUSION: There was no correlation found between the transaminase level and biopsy scores. Approximately 44 % of the patients have fibrosis equal to or greater than stage 2. The extent of steatosis is directly related to the biopsy score of the patients.

P.010 Prevalency of hepatitis B with normal and elevated serum alanine aminotransferase in a part of population in Azerbaijan Republic

P.010 Prevalency of hepatitis B with normal and elevated serum alanine aminotransferase in a part of population in Azerbaijan Republic

495 Viral load is a strong predictor of hepatocellular carcinoma risk in people chronically infected with hepatitis B virus and with normal serum alanine aminotransaminase level

495 Viral load is a strong predictor of hepatocellular carcinoma risk in people chronically infected with hepatitis B virus and with normal serum alanine aminotransaminase level

Acquired hepatocerebral degeneration without overt liver disease

Acquired hepatocerebral degeneration (AHCD) is usually described in patients with chronic liver diseases with portal-systemic shunting and previous episodes of acute hepatic encephalopathy. We describe an atypical case with no overt evidence of hepatic disease in which the characteristic neuroradiologic findings first called attention to the diagnosis. A 45-year-old man had progressive quadriparesis, dysphagia, and dysphonia for 18 months. He then developed back pain, urinary retention, and weight loss. There was no history of alcoholism or electrolyte disturbances. The general physical examination was unremarkable. The neurologic examination disclosed mental slowing, asymmetric spastic quadriparesis predominating in the lower limbs, mild arm ataxia, dysarthria, and left palate paresis. EMG, CSF, and slitlamp examination were normal. Cranial CT showed moderate corticosubcortical atrophy; MRI revealed symmetric focal lesions in the cerebellar peduncles and white matter (figure, A through D). The patient developed recurrent fever from Staphylococcus aureus infection of undetermined origin. Liver enzymes were normal (alanine aminotransferase, 38 U/L; aspartate aminotransferase, 41 U/L), and ammonia level was not measured. IV …

Management of hepatitis C patients: a French population-based study

Our aim was to assess the proportion of patients in a well-defined population reaching specialized medical care after hepatitis C diagnosis. Hepatitis C-positive patients recorded in the population-based registry of Cote-d'Or, an administrative district in France, constituted the study population. Between 1994 and 1999, new hepatitis C-positive serology was diagnosed in 847 patients, of whom 690 were eligible for this study. A total of 135 patients had not been given specialized medical care after diagnosis; among them, 50.4% had a normal serum alanine transferase level at diagnosis, 62.2% had risk factors related to lifestyle (drug addiction, sexual risk...), and 26.7% were current alcoholics. The 555 other patients were involved in specialized medical care after diagnosis: 42.7% had a liver biopsy and 27.0% were treated. Treatment was carried out more often in males than in females (OR: 1.67; P<0.005), and in patients less than 65 years old (OR: 2.94; P<0.0002). Nearly 30.5% of patients with a Metavir score greater than A1F1 did not undergo treatment. This study shows that in a general population at least one patient out of five with hepatitis C infection remains outside the health care system. It also reveals that management practices vary with gender. Further surveys are needed to better understand this phenomenon.

Interferon treatment for chronic hepatitis B: enhanced response in children 5 years old or younger

To test the hypothesis that there is an improved response to interferon in children with chronic hepatitis B (HBV) who are < or =5 years of age. Retrospective chart review of 22 consecutive children with chronic HBV (ages 17 months to 17 years; median, 83.9 months; 14 male, 8 female) treated with interferon-alpha2b. Ten patients (48%) responded to treatment [HBeAg (-), Anti-HBe (+), HBV DNA (-), HBsAg (+) and normal alanine aminotransferase/aspartate aminotransferase (ALT/AST) at 6 months after treatment], and 5 seroconverted HBsAg [above plus HBsAg negative and anti-HBs (+)]. Seven of 9 patients (78%) < or =5 years of age responded (5 cleared HBsAg). Three of 13 patients (23%) >5 years of age responded. Patient age at treatment was significantly lower in responders (63 +/- 70 months) versus nonresponders (104 +/- 55 months, P =.005). AST, ALT, and HBV DNA at the start of treatment were not different between responders and nonresponders or between patients < or =5 and >5 years old. Interferon treatment may be more effective in younger children with chronic hepatitis B.

Interferon monotherapy for patients with chronic hepatitis C and normal serum aminotransferase levels at commencement of treatment.

Approximately 30% of patients with chronic hepatitis C have normal serum alanine amino transferase (ALT) levels. While interferon (IFN) monotherapy is approved for patients with chronic hepatitis C infection, the effectiveness of such therapy for chronic hepatitis C patients with normal ALT levels at commencement of treatment remains poorly understood. Ninety-four individuals (M/F, 54 : 40; median age, 46 years) with normal ALT levels (< 50 IU/l) at the commencement of treatment who were positive for both anti-hepatitis C virus (HCV) and serum HCV-RNA were studied. Among this group, 18 individuals (M/F, 9 : 9; median age, 50 years) had had persistently normal ALT levels for at least 3 months prior to treatment. All patients received their first course of IFN therapy in this study. Forty-three (45.7%) of 94 individuals had lost serum HCV-RNA at 6 months after cessation of therapy (complete response; CR). The proportion of patients with genotype 2a and HCV-RNA level over 1 Meq/ml who showed CR was significantly lower in those with normal ALT levels than in those with elevated ALT levels (23.8% vs 55.6%; P = 0.0189). Two patients who had persistently normal ALT levels and HCV-RNA level over 1 Meq/ml were nonresponders (NR) and had ALT flare-ups after IFN therapy. Patients with HCV-RNA levels of less than 1 Meq/ml did not show differential responses based on ALT levels. Our data suggest that IFN therapy is effective for patients with normal ALT levels and less than 1 Meq/ml HCV-RNA. Thus, such patients should be considered for curative IFN therapy.

ALT, Hepatic Histology, and Response to Interferon

Twenty to 30 percent of patients with chronic hepatitis C virus (HCV) infection have normal serum alanine aminotransferase (ALT) levels. The current