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  • 1
    ISSN: 1432-2307
    Keywords: Chronic hepatitis B virus ; Piecemeal necrosis ; Immunohistochemistry ; Liver
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Forty chronic untreated paediatric carriers of hepatitis B virus (HBV) infection, with no other causes of liver disease, were biopsied on presentation, when the disease was in the active viral replication phase. After a period ranging from 1 to 13 years, all patients underwent a control biopsy. At the time of the last biopsy, 31 of the patients were anti-HBe positive, whereas 9 persisted in the active replication phase. In this latter phase, necrotic and inflammatory lesions and the presence of nuclear HBcAg were found significantly more frequently than when replication had terminated. The necrotic and inflammatory lesions detected in the first biopsy of patients who subsequently underwent antiHBe seroconversion were significantly more severe than in patients failing to reach seroconversion. All patients who maintained viral replication showed generalized nuclear reactivity for HBcAg on presentation; such reactivity was also found in 16 of 31 (52%) patients who reached anti-HBeAg seroconversion. All these cases had piecemeal necrosis (PMN) in the biopsy. PMN may therefore be considered as a positive prognostic factor in that it identifies those patients who may seroconvert with significant remission of liver disease
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  • 2
    ISSN: 1573-2568
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Sera from two groups of untreated HBsAg-positive patients with chronic active hepatitis on liver biopsy were tested for antibodies to liver cell membrane antigens (liver-specific protein, LSP; and liver membrane antigen, LM-Ag). Among the 14 HBeAg-positive cases, seven (50%) were positive for anti-LSP, whereas only two (13%) of 15 anti-HBe-positive cases circulated this antibody. Liver membrane autoantibody (LMA) was detected only in two sera from delta-positive patients (1 HBeAg positive and 1 anti-HBe positive). Anti-LSP-positive patients presented transaminase values significantly higher than those of the negative cases. Our data do not support the hypothesis that a liver-specific autoimmune mechanism plays a significant role in the immunopathogenesis of liver cell necrosis in anti-HBe-positive chronic active hepatitis type B. The relationship between hepatocyte necrosis and anti-LSP antibody response is confirmed.
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  • 3
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Während eines Zeitraums von sieben Jahren wurden in Padua (Norditalien) die Fälle von symptomatischer akuter Virushepatitis erfaßt und 207 nacheinander aufgetretene Fälle von Hepatitis A (120 männliche und 87 weibliche Patienten mit einem mittleren Alter von 22,7 ± 11,4 Jahren) auf ihre epidemiologischen Charakteristika hin untersucht. Zwischen den Jahren 1978/79 und 1981–1984 hat sich die jährliche Inzidenz an Erkrankungen von 0,11/1000 Einwohner auf 0,04 bis 0,03/1000 Einwohner signifikant vermindert (p 〈0,05). Dabei nahm vor allem die Prävalenz der Erkrankungen im Kindesalter ab. Mit der Verlagerung der Hepatitis A-Erkrankungen in das Erwachsenenalter nahm die Bedeutung einzelner Infektionsquellen, die vor allem mit dem Lebensstil Erwachsener assoziiert sind, mehr und mehr zu, wie zum Beispiel Auslandsreisen und der Genuß roher Schalentiere. Die Verbreitung der Drogenabhängigkeit hatte in unserer Gegend keinen Einfluß auf die Epidemiologie der Hepatitis A.
    Notes: Summary During a seven-year survey of acute symptomatic viral hepatitis in Padua (Northern Italy), the epidemiological features of hepatitis A were evaluated in 207 consecutive patients (120 males, mean age 22.7 ± 11.4 years). The annual attack rate of the disease decreased significantly (p 〈0.05) between 1978 and 1979 (0.11/1000 inhabitants) and 1981 and 1984 (0.04–0.03/1000 inhabitants), mainly due to its declining prevalence in the pediatric age. In parallel with the shifting of hepatitis A towards adulthood, single sources of infection, mainly associated with adult life-style such as foreign travel and raw shellfish ingestion, have become more and more prominent. The spread of drug abuse has not influenced the epidemiology of hepatitis A in our area.
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  • 4
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Im Verlauf einer 1978 begonnenen, prospektiven Studie über die akute symptomatische B-Virus-Hepatitis wurde die Diagnose bei 664 Patienten gesichert (anti-HBc IgM-positiv); in dieser Gruppe waren 223 Drogensüchtige und 441 Nicht-Drogensüchtige. Verlaufsbeobachtungen erfolgten bei 443 der Patienten bis zu 12 Monate nach Ausbruch der Krankheit. 2,4% der Infektionen nahmen einen chronischen Verlauf, dabei bestanden zwischen den Drogensüchtigen und Nicht-Drogensüchtigen keine signifikanten Unterschiede. Dies deutet darauf hin, daß die akute symptomatische B-Virus-Hepatitis nur selten in die chronische Form übergeht. Ein Fortschreiten der Leberschädigung nach dem Verschwinden von HBsAg aus dem Serum wurde nur bei Drogensüchtigen (14% der Fälle) beobachtet. Die klinischen, biochemischen und virologischen Parameter der akuten Krankheitsphase wurden bei Patienten mit persistierender HBV-Infektion und bei Patienten mit unkompliziertem Verlauf verglichen. Eine anikterische Hepatitis und niedrigere Transaminasenwerte sowie eine höhere Prävalenz der HBV-DNA, DNA-Polymerase und HBcAg-Positivität waren signifikant mit einem chronischen Verlauf assoziiert (p〈0,05). Die Testung der HBV-DNA und DNA-Polymerase in der Frühphase der Infektion hat sich als sehr wertvoll für die Prognose des weiteren Krankheitsverlaufes erwiesen.
    Notes: Summary During a prospective study of acute symptomatic viral hepatitis, started in 1978, 664 consecutive adult patients, including 223 drug abusers, fulfilled the diagnostic criteria (anti-HBc IgM positivity) for acute type B hepatitis. In order to evaluate the outcome of the disease, 443 patients were followed for up to 12 months after the onset. 2.4% of the infections became chronic; the rate did not significantly differ between drug addicts and non-drug abusers, suggesting that chronic hepatitis is a rare complication of acute symptomatic hepatitis type B. Ongoing liver damage after clearance of HBsAg from serum was observed in drug abusers only (14% of the cases). Clinical, biochemical and virological features of the acute phase in patients with ongoing infection were compared with those of uncomplicated cases. Anicteric hepatitis and lower transaminase values were significantly (p〈0.05) associated to a chronic evolution of the disease, as well as a higher prevalence of HBV-DNA, DNA polymerase and HBcAg positivity in serum. Testing HBV-DNA and DNA polymerase early in the course of the infection appeared to be of high predictive value for the subsequent outcome of the illness.
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  • 5
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In Padua wurde während der vergangenen 16 Jahre eine Überwachungsstudie zur akuten, symptomatischen Virushepatitis durchgeführt. Dabei fanden sich 404 (20%) Fälle von Non-A-, Non-B-Hepatitis, einschließlich 55% mit offensichtlicher parenteraler Exposition (35% Drogenabhängige) und 45% mit unbekannter Exposition. Von 1978 bis 1982 war eine signifikante Zunahme der Fälle (p 〈 0,01) bei männlichen Adoleszenten und Jugendlichen (von 3,8 auf 17,3/105 Einwohner) zu beobachten. 1982 stieg der Anteil der Drogenabhängigen auf bis zu 58% an. Dies läßt auf einen Ausbruch in dieser Risikogruppe schließen. In den folgenden Jahren kehrte die Infektionsrate bei Männern auf die ursprüngliche Höhe zurück. Drogenabusus ist jedoch nach wie vor die wichtigste Infektionsdeterminante. Die Infektionsrate hat bei Frauen, vor allem nach Verschwinden der Posttransfusionshepatitis, seit 1991 abgenommen. Eine nachträgliche Testung der bis 1990 beobachteten Fälle auf anti-HCV und die prospektive Untersuchung der danach stationär aufgenommenen Patienten ließ bei parenteral infizierten Fällen eine Antikörperprävalenz von 88% erkennen. Von den anderen Patienten waren 29% anti-HCV positiv. Zwischen den retrospektiv und prospektiv untersuchten Fallgruppen ergaben sich keine signifikanten Unterschiede. Die Befunde lassen auf eine Hepatitis C-Epidemie in den frühen 80er Jahren in unserer Gegend schließen. Es ist anzunehmen, daß Drogenmißbrauch noch immer der wichtigste Übertragungsmodus für die akute Hepatitis C ist.
    Notes: Summary During a survey of acute symptomatic viral hepatitis conducted in Padua over the last 16 years, 404 (20%) cases of non-A, non-B hepatitis were observed, including 55% with overt parenteral exposure (35% drug abusers) and 45% with unknown exposure. Between 1978 and 1982 the attack rate of the disease increased significantly (p 〈 0.01) in males, (from 3.8 to 17.3/105 inhabitants), in adolescents and in youths. The prevalence of drug abusers rose up to 58% in 1982 suggesting the occurrence of an outbreak in this risk group. In subsequent years the attack rate returned to initial levels in males, although drug abuse still remains the single most important route of infection, and declined in females, especially after the disappearance of post-transfusion hepatitis since 1991. Retrospective anti-HCV testing of patients seen up to 1990 and prospective investigation of patients hospitalized later have shown an antibody prevalence of 88% among parenterally transmitted cases, and of 29% in the other patients, without significant differences between the prospective and the retrospective study. These findings suggest that an outbreak of hepatitis C occurred in our area in the early eighties and that drug abuse is still the most important mode of transmission of acute hepatitis C.
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  • 6
    ISSN: 1573-2568
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Recent studies on the natural history of chronic hepatitis B virus infection have provided evidence for a close temporal relationship between the phase of active virus replication and development of liver lesions. To assess the role that virus replication plays in this phase in determining the severity of the liver disease, we studied serum levels of virus-specific DNA-polymerase activity and hepatitis Be antigen/antibody status in 48 chronic carriers of the hepatitis B surface antigen found positive for the hepatitis B core antigen in the liver. There was a remarkably evident inverse correlation between virus replication activity and liver disease activity, patients with minimal histological changes having the highest DNA-polymerase levels (mean±sd: 3879±2557 cpm) and those with severe chronic active hepatitis the lowest enzyme levels (419±246 cpm), while cases of chronic persistent hepatitis and of mild chronic active hepatitis had intermediate levels. Serum hepatitis Be antigen was detected in 31/32 patients with milder liver lesions and in 11/16 with severe liver lesions; the remaining five cases were anti-HBe-positive despite the presence of the core antigen in the liver. Serum levels of virus replication markers closely correlated with the distribution pattern of the core antigen in the liver. These findings indicate that in chronic hepatitis B the severity of liver disease is not directly related to levels of virus replication, thus suggesting a predominant role of host immune mechanisms.
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