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  • 1
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : Treatment with interferon-alpha has been shown to be effective in one-third of hepatitis B e antigen-positive chronic hepatitis B patients, but is clinically associated with relevant adverse events.Aim : To investigate the safety of pegylated interferon alpha-2b in 300 hepatitis B e antigen-positive patients with compensated liver disease.Methods : Patients were treated with pegylated interferon alpha-2b for 52 weeks combined with either lamivudine 100 mg/day or placebo. Pegylated interferon alpha-2b was administered for 100 μg once a week for 32 weeks; thereafter, the dose was reduced to 50 μg once a week. Adverse events and their effect on study medication were reported at monthly visits in a standardized way.Results : The most frequently reported side-effects were flu-like syndrome (68%), headache (40%), fatigue (39%), myalgia (29%) and local reaction at the injection site (29%). These symptoms typically occurred within the first month of therapy and subsided during the course of therapy. Neutropenia and thrombocytopenia induced by pegylated interferon alpha-2b increased the risk of infections and bleeding complications, but these complications were rare and mild. The frequency of all side-effects was not different between patients treated with pegylated interferon alpha-2b combined with lamivudine or placebo. In 69 (22%) patients the dose of pegylated interferon alpha-2b was reduced prematurely. Of these dose reductions, 36 (52%) were because of neutropenia. Therapy was discontinued in 28 (8%) patients. The most frequent reasons for early discontinuation were psychiatric side-effects (depression, psychosis) and flu-like symptoms. Multivariate Cox regression analysis showed that low neutrophil count at baseline and cirrhosis were independent predictors of dose reduction or therapy discontinuation.Conclusion : We conclude that in patients with chronic hepatitis B and compensated liver disease prolonged pegylated interferon alpha-2b therapy is safe, and that pre-existent cirrhosis and neutropenia are the most important predictors of dose reduction or early treatment discontinuation.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Biochemical and Biophysical Research Communications 182 (1992), S. 617-623 
    ISSN: 0006-291X
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Biology , Chemistry and Pharmacology , Physics
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-2307
    Keywords: Key words Immunopathology of bile ducts ; T lymphozyte subtyping ; Epithelial cells as immune targets
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are chronic autoimmune-mediated diseases of the biliary tree, resulting in a loss of bile ducts. There are morphological features that clearly distinguish them from each other: in PBC, there is overt destruction of the bile ducts with disruption of the basement membrane; in PSC there is abundant periductular fibrosis with shrinkage and subsequent loss of the bile ducts. In order to see if the disparate histopathology is paralleled by different immunohistology we looked at a panel of epitopes on bile duct epithelia especially to see if biliary epithelial cells may present as targets for cell mediated immune respone. In PBC bile duct epithelial cells mostly expressed CD58 (lymphocyte function-associated antigen 3), CD80 (B7 BB1), and CD95 (Fas). In PSC, however, these epitopes were only expressed in a few examples to a lower degree. The respective effector T lymphocytes were positive for CD2 and CD28. Subtyping of the lymphocytes in the liver tissue further showed a predominance of CD4 positive T cells over CD8 cells up to 2-to-1 in both diseases. Determination of lymphocytes by cytokines to Th1 or Th2 subtype showed a majority of Th1 lymphocytes in PBC and PSC. We conclude that in PBC bile duct epithelial cells may display features of target cells of a T cell-mediated immune reaction with the Th1 cells predominating. In PSC other mechanisms of bile duct loss may play a role, since in this disease the majority of cells lack essential epitopes that constitute targets of cell mediated immunity.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1440
    Keywords: Guillain-Barré syndrome (GBS) ; Herpes simplex virus (HSV)-IgM antibodies ; Immunohistology ; Plasma exchange ; Immunosuppression
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Herpes simplex virus (HSV) has been associated with various neurological disorders. In contrast, HSV infection is very rarely found in acute polyneuroradiculitis. In this report, a patient is described with a severe course of Guillain-Barré syndrome (GBS). HSV IgM-specific antibodies and a rise of complement-fixation antibodies were detected. During the acute phase of neurologic syndrome, a nerve biopsy showed myelin damage and IgM deposits on the inner layer of the perineurium. Plasma exchange, in combination with immunosuppression, was successfully applied as a treatment in the relapsing course of GBS. Finally, after recovery, HSV-specific IgM antibodies disappeared.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Der Chirurg 69 (1998), S. 522-529 
    ISSN: 1433-0385
    Keywords: Key words: Viral hepatitis ; Liver function ; Liver cirrhosis ; Immunprophylaxis ; Treatment of viral hepatitis. ; Schlüsselwörter: Virushepatitis ; Leberfunktion ; Lebercirrhose ; Immunprophylaxe ; Behandlung der Virushepatitis.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Virushepatitiden gehören weltweit zu den wichtigsten Infektionskrankheiten. Allein über 300 Millionen chronische HBsAg-Träger und etwa die gleiche Anzahl chronischer Hepatitis-C-Virusträger werden geschätzt. Nach der Tuberkulose steht die Virushepatitis in der Statistik der infektiös bedingten Berufskrankheiten an zweiter Stelle. Insbesondere Teile Asiens, Afrikas, Lateinamerikas sowie der Mittelmeerraum und der Nahe Osten werden zu den Hochendemiegebieten der Virushepatitis gezählt. Aufgrund der immunologischen und molekularen Differenzierung sind heute die Virushepatitiden von A bis E einschließlich G weitgehend charakterisiert. Während die enteral übertragene Hepatitis A und E nur akute und in seltenen Fällen fulminante Verläufe induzieren, sind die Hepatitis B, ihre Koinfektion und Superinfektion mit Hepatitis Delta und die Hepatitis C insbesondere durch chronische Verläufe von großer medizinischer Bedeutung. Diese Erkrankungen können als Spätfolge in eine Lebercirrhose mit all ihren Komplikationen, einschließlich des primären Leberzellcarcinoms übergehen. Die für die Chirurgie besonderen Aspekte der Virushepatitis sollen diskutiert werden.
    Notes: Summary. Viral hepatitis belongs to the most important infectious diseases worldwide. More than 300 million chronic HBsAg carriers and chronic HCV carriers exist, respectively. High endemic areas of viral hepatitis are Asia, Africa, Latin America and the Near, Middle and Far East. Viral hepatitis is also very important in health care workers. Today viral hepatitis can be differentiated from type A to type E (G) based on immunological and molecular assays. While enterally transmitted hepatitis type A and type E only induce acute and rare fulminant disease, hepatitis type B, C and D often induce chronic progressive disease including liver cirrhosis with typical complications due to the portal hypertension and with a high rate of association with the development of primary liver cancer (HCC). This review focusses on viral hepatitis-related surgical problems, including liver transplantation.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1432-0584
    Keywords: CTL-p ; Cytokines ; Limiting dilution analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Experimental animal and human in vivo studies have previously demonstrated the impact of exogenous administration of various cytokines on frequencies of circulating myeloid and LAK precursor cells. For the first time we investigated whether exogenous cytokines, in the absence of antigeneic challenge, may also influence frequencies of circulating antigenspecific cytotoxic T-lymphocyte precursor cells. We further asked whether triggering of autoimmune pathways as has been reported for several cytokines can be confirmed on the cellular level by demonstration of induction of autoreactive CTL-p. Limiting dilution analysis was used to determine alloreactive CTL-p frequencies in 31 patients with nonhematologic diseases before and after short-term systemic treatment with either rIL-2 (4.8×106 IU/m2 bid), rIL-3 (2.5, 5.0 or 10.0μg/kg qd), rGM-CSF (5μ/kg qd), rIFN-gamma (200 or 400μg qd), or IFN-alpha (3 or 5×106 IU qod). Simultaneously, autoreactive CTL-p frequencies were determined by split-well analysis in 25 of these patients. We found that rIL-2 significantly expands the circulating precursor pool of alloreactive CTL (p〈0.05). rIL-3 affected CTL-p frequencies in a dosedependent fashion. Low and intermediate doses of rIL-3 did not exhibit significant effects, whereas 10μg/kg rIL-3 led to expansion of alloreactive CTL-p in the same order of magnitude as did rIL-2. This effect was statistically significant when compared with rGM-CSF (p〈0.02), which apparently had no influence on alloreactive CTL-p frequencies. In contrast to rIL-2 and rIL-3, exogenous rIFN-gamma markedly reduced the circulating precursor pool of CTL. This again was statistically significant compared with rIFN-alpha (p〈0.03), which, like rGM-CSF, did not exhibit any effects on the level of alloreactive CTL-p. Frequencies of autoreactive CTL-p were invariably below the limit of detection in our system (〈1/300000). In conclusion, these data demonstrate that (a) short-term systemic administration of rIL-2, rIL-3, and rIFN-gamma differently affects the clone size of circulating precursors of alloreactive CTL in man, while rGM-CSF and rIFN-alpha do not exhibit measurable effects, and (b) none of the cytokines administered is capable of uncovering detectable frequencies of autoreactive CTL-p.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1432-1440
    Keywords: Hepatocellular carcinoma (HCC) ; Non-cirrhotic liver ; Hepatitis B virus (HBV) ; Hepatitis C virus (HCV) ; Nodular regenerative hyperplasia (NRH)
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The case of a 71-year-old man with a primary hepatocellular carcinoma in a non-cirrhotic liver is reported. There were no risk factors of hepatocellular carcinoma (HCC)-like liver cirrhosis, alcohol drinking, tobacco smoking, exposure to vinyl chloride, thorotrast, aflatoxin or α1-antitrypsin deficiency. Serologically, the patient was positive for antibodies to the hepatitis B virus (anti-HBc, anti-HBs) and for anti-hepatitis C virus (HCV) antibodies. Virologically, positive and negative strands of HCV RNA could be detected in the patient's serum and tumorous liver tissue by reverse transcription polymerase chain reaction as a sign of persistent HCV replication. Histologically, the HCC was completely surrounded by liver tissue which showed the signs of nodular regenerative hyperplasia. Indeed, the mechanism of hepatocarcinogenesis remains to be clarified. However, this case supports the observation that HCC may also develop in patients with HCV infection without preexisting liver cirrhosis.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Journal of molecular medicine 71 (1993), S. 875-881 
    ISSN: 1432-1440
    Keywords: Acute hepatic failure ; Liver transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1432-1440
    Keywords: Human immunodeficiency virus ; Hepatitis B virus ; Interferon-α ; Corticosteroid
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A 48-year-old male patient was admitted with acquired immunodeficiency syndrome (stage III, Centers for Disease Control 1993) and viremic hepatitis B. Blood CD4 count was 15/μl. Discontinuation of prednisolone, previously prescribed by the patient's family practitioner because of elevated liver enzymes, resulted in severe hepatitis (alanine aminotransferase 〉 300U/1). Administration of interferon-α, (9 × 106U s.c. 3 × weekly) was initiated. Serum markers of viral replication disappeared, and aminotransferase levels returned to normal within a few weeks. The patient's serum was found negative for HBsAg after 3 months. Immunohistochemical analysis of liver biopsies before and during interferon therapy showed disappearance of all hepatitis B virus antigens and a marked reduction in inflammatory activity. Hepatitis B virus seroconversion remained stable until the patient died from the syndrome 2 years later. This case shows that in spite of severe HIV-associated immune deficiency with CD4 counts constantly below 100/μl, interferon-α can lead to sustained serological and histological improvement of viremic hepatitis B. Previous administration and discontinuation of cortisone may have helped to reach this effect.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1432-8798
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary.  Quantification of serum HCV-RNA and HCV genotyping was studied in 27 patients with chronic hepatitis C undergoing interferon treatment. Pretreatment serum HCV-RNA levels were quantified using competitive RT-PCR and compared to a quantitative RT-PCR assay based on co-amplification of HCV-RNA with a synthetic RNA standard. HCV genotyping was performed using a line probe reversed hybridisation assay or direct solid-phase sequencing. This study shows the feasibility of performing HCV-RNA quantification. RT-PCR based on co-amplification HCV-RNA titer less than 6× 104 genome equivalents/ml serum did correlate with a complete sustained response to α interferon in chronic hepatitis C. HCV genotype 1b was α predominantly associated with a high non-responder rate. Future prospective trials will be required to evaluate quantitative HCV-RNA levels and HCV genotyping as response predicting parameters for interferon-treatment.
    Type of Medium: Electronic Resource
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