Streszczenia wydrukowane w Experimental & Clinical Hepatology:

13.05.06- sobota (sesje poranne) I Sesja plenarna

OI_1

APOPTOSIS IN NON-ALCOHOLIC LIVER DISEASE
Panasiuk A, Dzięcioł J
Department of Infectious Diseases, Department of Human Anathomy, Medical University of Bialystok, Poland
 
Non-alcoholic fatty liver disease (NAFLD) is a most common occurrig liver disease, with various etiology and whose pathology is not still explained. Lipid accumulation in hepatocyte cytoplasm may be a result of insulin resistance, damaged removal of triacyloglycerols from the cell, or damage of b-oxidation in mitochondria. It is suggested that free fatty acids (FFA) may play a crucial role in the intensification of steatosis as well as necrotic and inflammatory processes. The role of apoptosis in NAFLD is still unclear. The aim of the study was the analysis of expression of proteins essential in apoptosis in NAFLD.
Material and methods. Liver biopsies were performed in 84 patients with liver steatosis. The immunohistochemical method was used to evaluate the expression of proapoptotic proteins p53, Bax, and antiapoptotic Bcl2 in hepatocytes with and without steatosis in various stages of the disease.
Depending on the enhancement of steatosis, the examination was carried out in the group of slight (<33% of steatosed hepatocytes), moderate (33-66%), and serious (>66%) liver steatosis. 
Results: Bax expression is significantly higher in steatosed hepatocytes (HS) (68?23%) as compared to non-steatosed hepatocytes (HNS) (59?21, p<0.03) in the whole group of patients with NAFLD. The highest expression of Bax was observed in HS in the group of slight liver steatosis.  As the expression of BAX grew in HS, p53 expression is also higher p53 (r0.32, p<0.01) and p53 (r0.33, p<0.01). There is a positive correlation of p53 expression and the stage of liver steatosis (r0.49, p<0.01 in HNS, r0.54, p<0.01 in HS). Bcl-2 expression was decreased in steatosed and non-steatosed hepatocytes together with the stage of liver steatosis.
Conclusions: It seems that apoptosis is one of essential mechanisms leading to hepatocyte elimination in NAFLD. The intensification of inflammatory changes in NAFLD induces proapoptotic protein (p53) and inhibits antiapoptotic ones (Bcl-2).

 

OI_2

SHORT- AND MEDIUM-TERM REPRODUCIBILITY OF 13C-METHACETIN BREATH TEST
Kasicka-Jonderko A, Jonderko K, Nita A, Błońska-Fajfrowska B
Dept of Basic Biomedical Science, School of Pharmacy, Medical University of Silesia, 3 Kasztanowa Street, PL-41-205 Sosnowiec, Poland
 
Background/Aims: Breath tests with 13C substrates constitute nowadays an excellent tool to measure the amount of intact liver tissue. In the study we searched for a quantitative parameter which would offer the best reproducibility of a standard 13C-methacetin breath test.
Methods: Twelve healthy volunteers were recruited (7F, 5M, aged 24.9?0.5 years). On three separate days they drunk 200 ml unsweetened black tea into which 75 mg 13C-methacetin (Euriso-Top S.A., Saint-Aubin, France) was added. Samples of expiratory air for 13CO2 measurement (IRIS apparatus, Wagner Analysen Technik Vertriebs GmbH, Germany) were collected at 3, 6, 9, 12, 15, 18, 21, 24, 27, 30, 40, 50, 60, 75, 90, 105, 120, 150 and 180 min after intake of the substrate. Short-term reproducibility was assessed with paired examinations taken 2-4 days (median 2 days) apart, whereas paired examinations separated by 16-23 days (median: 19 days) served for the medium-term reproducibility assessment. The order of intervals between the consecutive sessions (short- or medium-term reproducibility) was randomized.
Results: According to the coefficients of variation for paired examinations (CVp), reproducibility of the time to peak 13C recovery was poor (38.44% short-term, 40.69% medium-term). Good short-term reproducibility (CVp=10.48%) of the maximum momentary 13C recovery deteriorated significantly with increased time interval between repeat examinations (CVp=19.28%). Noteworthy, excellent reproducibility of the cumulative 3-hour 13C recovery (area under the curve) appeared to be insusceptible to the length of the time gap separating the examinations (CVp: 8.85% and 5.54% in the case of the short- and medium-term reproducibility, respectively).
Conclusion: Excellent short- and medium-term reproducibility speaks in favour of appointing the cumulative 3-hour 13C recovery the most reliable measure among parameters commonly used to provide quantitative result of the 13C-methacetin breath test.

 

13.05.06- sobota (sesje poranne) I Sesja plakatowa

PI_1

ANALYSIS OF INDICATIONS FOR LIVER TRANSPLANTATIONS IN PATIENTS WITH WILSON'S DISEASE ACCORDING TO NEW KING'S COLLEGE SCORING SYSTEM
Socha P1, Pawłowska J1, Dądalski M1, Jankowska J1, Schmidt H2, Dhawan A3
1-Departament of Gastroenterology, Hepatology and Immunology, Children's Memorial Health Institute, Warsaw
2-Charite Mitte, Berlin
3-King's College, Londyn

Background: King's College has lately proposed new scoring system to be used to assess clinical course and indications for liver transplantation (LTx) in patients with Wilson's disease (WD) (A. Dhawan et al. Liver Transplantation 2005, 11: 441-448). Scoring (based on bilirubin and albumin concentrations, INR, leucocytosis and AspAT activity) over 11 corresponds to poor outcome without LTx.
Patients and Methods: Indications for LTx in patients with WD in our centre within last two years were analyzed.
Results: Two patients with WD were qualified for LTx. In the first of them the clinical onset (jaundice, liver and spleen enlargement, ascites, coagulopathy) of the disease was at the age of 8. Normal aminotranspherases, elevated bilirubin 4,7/2,7 mg/dl, INR 2,16, albumin concentration 38,75 g/l, leucocytosis 7,7 were found in laboratory tests. Basing on molecular analysis, decreased serum ceruloplazmin concentration (13 mcg/dl) and increased 24h urinary copper excretion (152 mcg) WD was diagnosed. Treatment with penicyllamine was started. King's College scoring equals 5. Because after one month of therapy no improvement was observed, patent was qualified for LTx (PELD 11), but it was not performed. After nine months of therapy ascites, hepatomegaly and cholestasis recovered and INR returned to normal ranges - 1,12.
The second patent had clinical onset of the disease (cholestasis, encephalopathy, hepatomegaly and ascites) At the age of 13. Slightly elevated AspAT (130), bilirubin (2,1/0,8) and leucocytosis (13,7), increased INR (3,3) and albumin concentration 36,05 g/l were found in laboratory tests. Due to serious clinical course patient was qualified for LTx (MELD 23) before final diagnosis was established. WD was later diagnosed according to molecular analysis, increased liver copper (759 mcg/g), decreased serum ceruloplazmin concentration (13 mcg/dl) and increased 24h urinary copper (357 mcg). King's College scoring equals 9. Treatment with penicyllamine was started. After nine months of therapy ascites, hepatomegaly and cholestasis recovered and INR improved to 1,36.
Conclusion: The case reports analysis supports King's College opinion that clinical outcome without LTx in case of WD is better than in other liver diseases and standard indications for LTx ought to be replaced with those corresponding to WD.

 

 PI_2

INFLUENCE OF URSODEOXYCHOLIC ACID AND ETHANOL ON APOPTOSIS OF PERIPHERAL BLOOD MONONUCLEAR CELLS OF PATIENTS WITH ALCOHOLIC LIVER CIRRHOSIS.
1Daniluk J, 1Zwolak A, 2Szuster-Ciesielska A, 3Bojarska A, 1Kasztelan-Szczerbińska B
1Clinic and Department of Gastroenterology, University Medical School, Jaczewskiego 8, 20-950 Lublin
2Department of Virology and Immunology, Maria Curie-Skłodowska University, Akademicka 19, 20-033 Lublin
3Department of Cell Biology, Maria Curie-Skłodowska University, Akademicka 19, 20-033 Lublin

Introduction : Long administration of ursodeoxycholic acid (UDCA) to patients with primary biliary cirrhosis improves both clinical and biochemical parameters and delays liver fibrosis. However, administration of UDCA to patients with alcoholic liver cirrhosis is still controversial. The aim of this study was to evaluate the influence of UDCA and ethanol administration on in vitro apoptosis of peripheral blood mononuclear cells (PBMCs) derived from patients with alcoholic liver cirrhosis in comparison with healthy controls.

Methods :
PBMCs were isolated from the blood of 21 patients with alcoholic liver cirrhosis and of 6 healthy controls. The effect of 256 &#61549;M UDCA and 80mM ethanol on cells apoptosis was examined in vitro. Cultured cells from cirrhotics and healthy controls were divided into three treatment groups : the first one- treated with UDCA alone; the second one- treated with ethanol alone and the third one treated with combination of UDCA and ethanol.

Results :
We observed increased spontaneous apoptosis of PBMCs of patients with alcoholic liver cirrhosis comparing to healthy controls. Administration of UDCA alone, as well as ethanol alone, had accelerated in vitro apoptosis of PBMCs both in patients with liver cirrhosis and haelthy control group. The highest level of PBMCs apoptosis in both these groups was observed after administration of UDCA together with ethanol. Flow cytometry evaluation revealed that CD 3+ and CD 4+ lymphocytes of cirrhotics were only slightly more sensitive to UDCA, ethanol and to combination treatment than these of healthy controls. On the other hand, the highest apoptosis level of CD 8+ lymphocytes was observed in all three treatment groups of healthy controls comparing to patients with alcoholic liver cirrhosis.

Conclusion :
The results of our study suggest that ethanol consumption together with UDCA treatment may induce severe apoptosis of PBMCs and increase abnormalities of patients immune system.

 

 PI_3

PI_4

ACTIVITY OF N-ACETYL-b-D-HEXOSAMINIDASE (HEX) IN RATS LIVER AFTER 5 DAYS OF HYPOXIA.
D. Dudzik 1, M. Knas 1 , R. Wiśniewska 2, M. Borzym-Kluczyk 1 ,  S. D. Szajda 1, K. Zwierz 1
Department of  Pharmaceutical Biochemistry (1) and Department of Pharmacology (2), Medical Universyty of Bialystok, Poland
 
Hypoxia is a reduction in the amount of oxygen passing into the blood and it is a state of oxygen deficiency in the body which is sufficient to cause an impairment of function. Hypoxia is caused by the reduction in partial pressure of oxygen, inadequate oxygen transport, or the inability of the tissues to use oxygen.
N-acetyl-b-D-hexosaminidase catalyzes removal of N-acetylglucosamine or N-acetylgalactosamine residues from the non-reducing end of oligosaccharide chains of glycoconjugates.
The aim of our work was determination of N-acetyl-b-D-hexosaminidase concentration in rats liver after 5 days of hypoxia.
Material and methods: Hypoxia was induced to laboratory rats by the five days of anoxaemia. Concentration of N-acetyl-b-D-hexosaminidase (pKat/ml of homogenate) in rat liver homogenates was determined by the method of Chatteriee modified by Zwierz.
Results: The mean concentration of  N-acetyl-&#946;-D- hexosaminidase in homogenates of rats liver were: in control group - 9.3623  pKat/ml of homogenate, after 5 days of hypoxia - 12.347 pKat/ml of homogenate.
Conclusion: We observed increase in the concentration of N-acetyl-b-D-hexosaminidase in 5 days of hypoxia comparatively to the control group.

 

PI_5

PRIMARY SCLEROSANS CHOLANGITIS - UNTYPICAL BEGINING
Dybowska D., Kozielewicz D.
Katedra i Klinika Chorób Zakaźnych i Hepatologii CM UMK
ul. Floriana 12, 85-030 Bydgoszcz
 
A case of 20 years old male was presented in this work. The first time he was hospitalized on April 2004 because of fever, a focal change in the liver and elevation of aminotransferases and cholestatic enzymes' activity. In bon marrow analyses eosynophilia was found. Parasitic disease was suspected. When the patient was admitted to the Department of Infectious Diseases and Hepatology (July 2004) based on clinical manifestation abscess of the liver was recognized. After antibiotic therapy focal change in the liver disappeared and activity of obstructive enzymes decreased. Any pathological changes were observed in cholangioMRI and morphological picture of the liver. Echinoccocosis, toxocarosis, lambliosis, infection of HAV, HBV, HCV, CMV, Wilson`s disease and autoimmune hepatitis were excluded. During one year's outpatient observation symptoms of cholestasis and periodically elevation of aminotransferases activity occurred. The patient was admitted again at the Center on July 2005. During that hospitalization typical for primary sclerosans cholangitis (PSC) changes were observed in endoscopic retrograde cholangio-pancreatography (ERCP). The first stage of PSC was shown at histopatological analyses of the liver. The therapy with antibiotic, steroid and ursodeoxycholic acid was applied. Biochemical symptomes of the disease completely disappeared.
Conclusion:
An abscess of the liver can be the first manifestation of PSC.

 

PI_6

KINETICS OF 13CO2 RECOVERY IN BREATH AIR AFTER PERORAL ADMINISTRATION OF 13C-METHACETIN IN TWO GROUPS OF DIFFERENT AGE
Kasicka-Jonderko A, Jonderko K, Chabior E, Błońska-Fajfrowska B
Dept of Basic Biomedical Science, School of Pharmacy, Medical University of Silesia, 3 Kasztanowa street, PL-41-205 Sosnowiec, Poland
 
Background/Aims: We investigated if age were a factor influencing the results of a 13C-methacetin breath test, which in case of a positive answer would imply the necessity of determining separate normative values for people of different age.
Methods: Two groups of healthy volunteers, comprising each 6 men and 6 women, but differring in average age (Y=young, 25.1?0.6 years, MA=middle-aged, 46.0?2.1 years) were examined. The subjects drunk in the morning 200 ml unsweetened black tea into which 75 mg 13C-methacetin (Euriso-Top S.A., Saint-Aubin, France) was added. Samples of expiratory air for 13CO2 measurement were collected at 3, 6, 9, 12, 15, 18, 21, 24, 27, 30, 40, 50, 60, 75, 90, 105, 120, 150 and 180 min after intake of the substrate.
Results: Between 15 and 150 min the curve the momentary 13C recovery in breath air was shifted upwards in elderly compared to young subjects. The time to peak of the curve was similar in either group (17.5?1.8 min young vs 18.2?1.7 min middle-aged). However, the maximum momentary 13C recovery in breath air was higher in the elder compared to the younger group: 38.55?2.02 %dose/h vs 34.59?2.67 %dose/h (a difference statistically not significant). In accordance with the pointed-out shift upwards of the curve the momentary 13C recovery, the cumulative three-hour 13C recovery was found to be statistically significantly greater in the middle-aged compared to the young healthy subjects (42.20?1.18 %dose vs 37.57 %dose, p=0.0011).
Conclusion: The study results imply that the microsomal metabolic efficiency of the liver is not compromised in middle-aged healthy subjects. Nevertheless a better result of the test obtained in the elder compared to the younger group requires elucidation in future research.

 

 PI_7

ACTIVITY OF BETA-GLUCURONIDASE IN NASH AFTER TREATMENT WITH UDCA.
M. Knas 1 , O. Lukivskaya 2, D. Dudzik 1, S. D. Szajda 1, M. Borzym-Kluczyk 1 , V. Buko 2, K. Zwierz
1 Depart. of  Pharmaceutical Biochemistry, Medical Universyty, Bialystok, Poland; 2 Depart. of Experimental Hepatology, Inst. of Biochemistry, National Academy of Sciences, Grodno,
 
Nonalcoholic steatohepatitis (NASH) is a serious disorder of liver with the potential to gradually progress to cirrhosis. NASH is generally associated with obesity, diabetes and hyperlipidemia. Currently, there is no established therapy for NASH.
Ursodeoxycholic acid (UDCA) has cytoprotective, anti-apoptotic, membrane stabilizing, anti-oxidant and immunomodulative effects.
The aim of our research was to determine effects of ursodeoxycholic acid (UDCA) on b-glucuronidase activity nonalcoholic steatohepatitis.
Material and methods: NASH was induced to 24 laboratory rats (8 in each group) by the methionine-choline deficient diet. Activity of b-glucuronidase (pKat/kg protein) in rat liver homogenates was determined by the method of Chatteriee et al modified by Zwierz et al.
Results: The mean activity of b-glucuronidase in homogenates of liver were in control group - 2,379  pKat/kg protein, after 10 weeks of MCDD - 5,018 pKat/kg protein and after 10 weeks of MCDD + 20 mg UDCA/kg b.w. - 4,768 pKat/kg protein.
Conclusion: We observed an increase in activity of b-glucuronidase after 10 weeks of MCDD in comparision to the control group and tendency to decrease in the activity of b-glucuronidase after 10 weeks feeding with MCDD + 20 mg UDCA/kg b.w. in comparision to the group of rats feeded by 10 weeks with MCDD.

 

PI_8

THE ASSESSMENT OF NON ALCOHOLIC FATTY LIVER DISEASE IN DEPARTMENT OF INFECTIOUS DISEASES PATIENTS
1Michalska Z, 1StalkeP, 1Sikorska K, 1Chmielecka S, 1Lakomy A, 2Jaśkiewicz K
1) Department of Infectious Diseases, 2) Department of Pathology, Medical University of Gdansk
 
Introduction:
Non alcoholic fatty liver disease (NAFLD) and non alcoholic steatohepatitis (NASH) are relatively new described chronic liver disease (CLD), which occurred generally in Western countries. The aim was the assessment of NASH and NAFLD prevalence in the hepatology ward of Infectious Diseases Department.
Material and methods:
 25 patients (3 female, 22 male), mean age 46 years (range 21-60) were admitted to Department of Infectious Diseases Medical University of Gdansk in 2004/2005 because of NAFLD suspicion. The initial diagnosis was established based on patients' anamneses, results of liver function tests, disturbances of iron, carbohydrates and lipids metabolism, and result of abdominal US imagining. In all cases autoimmune and viral hepatitis, other metabolic and toxic disorders were excluded. A diagnosis was confirmed by liver biopsy.
Results:
A body mass index (BMI) was larger than 30kg/m2 in 18/25 cases and ranged 27-29 in the reminder patients. The ALT activity in 15/25 cases was 41-100IU/l, in 7/25 was 101-200IU/l and only in 3/25 individuals was normal. 20/25 patients were diagnosed the impair glucose tolerance and diabetes. In 17/25 cases hypercholesterolaemia and in 8/25 cases hyperglyceridaemia were found. Disturbances of iron metabolism were found in 15/25 individuals. In 16/25 liver specimens a NASH signs, in 9/25 hepatocytes steatosis were found. Concomitant fibrosis in 3/9 cases was present. Arterial hypertension was discovered in 15/25 studied cases.
Conclusions:
A NAFLD should be taken into consideration of CLD diagnosis, especially in obese patients. The liver biopsy in these patients seems to be essential in NASH and NAFLD diagnosis.

PI_9

Liver steatosis in relation to iron overload and HFE gene mutations

Sikorska K¹, Stalke P¹, Bielawski KP², Jaśkiewicz K³, Lakomy EA¹, Michalska Z¹, Romanowski T²

1.      Department of Infectious Diseases, Institute of Internal Diseases, Medical University of Gdańsk 80-214 Gdansk, ul. Smoluchowskiego 18; Ten adres e-mail jest ukrywany przed spamerami, włącz obsługę JavaScript w przeglądarce, by go zobaczyć

2.      Department of Biotechnology, University of Gdańsk

3.      Department of Pathology, Medical University of Gdańsk

Aim: Analysis of corelation between liver steatosis and disorders of iron metabolism in association with HFE gene mutations.

Patients, methods: 104 patients (91men, 13 women, mean age 46±12 years) routinely diagnosed because of liver disease with biochemical parameters of iron overload were included to the study. In all cases the histopathological examination of the liver biopsy specimen was performed with assessment of inflammation activity, fibrosis, iron deposits and steatosis. 58 patients were infected with HCV, 5 with HBV. In 37 patients diabetes and in 29 hyperlipidemia were diagnosed. 35 patients were suspected for hereditary hemochromatosis. PCR and RFLP methods were used to detect C282Y and H63D mutations of HFE gene.

Results: Histopathological steatosis was diagnosed in 59/104 patients. It was detected statistically more frequently in patients with arterial hypertension and hyperlipidemia. Occurrence of hepatocyte iron deposits in 68/104 patients did not corelate with intensity of steatosis. Degree of liver steatosis was a negative predictor of HCV infection and activity of inflammation in the study group. C282Y mutation was detected in 16 patients with confirmed histopathological steatosis without statistical significance in comparison to patients with no steatosis. Prevalence of H63D mutation was significantly more frequent in patients without marks of liver steatosis (20/45 vs 17/59). In the subgroup of patients suspected for hereditary hemochromatosis (n=35) liver steatosis was described with significant corelation in 23 cases and 12 patients appeared to be homozygotes C282Y and 3 - homozygotes H63D.

Conclusions: Liver steatosis may be associated with metabolic syndrome and iron overload but its corelation with HFE gene mutations needs further detailed studies.

PI_10

Detection of Helicobacter species in liver tissue of Polish patients with chronic liver diseases by PCR-DGGE and sequence analysis

¹Stalke P, ²Bielawski KP, ³Al-Soud WA and ³Wadström T

¹ Department of Infectious Diseases Medical University of Gdansk, Poland

² Department of Biotechnology, Intercollegiate Faculty of Biotechnology University of

  Gdansk and Medical University of Gdansk, Poland

³ Section of Medical Microbiology, Dept. of Laboratory Medicine, Lund University,

   Sölvegatan 23, SE-223 62 Lund, Sweden

Background: DNA of number of Helicobacter species, which have been isolated from the stomach, intestinal tract and liver of a variety of animals, was also detected in human bile and liver samples. The aim of this study was to determine the possible presence of Helicobacter species in the liver tissue samples of patients with chronic liver diseases of different aetiology.

Materials and methods: 97 patients (46 females, 51 males), aged 18-66 years (mean 41±1) were admitted to the Hospital for Infectious Diseases in Gdansk, Poland because of a chronic liver disease. Liver biopsy specimens were examined for the presence of Helicobacter species by a genus-specific PCR assay. PCR- products of positive samples were subsequently characterized by denaturing gradient gel electrophoresis (DGGE) and DNA-sequencing.

Results: Using Helicobacter genus-specific PCR assay, Helicobacter DNA was detected in 69/97 (68%) of liver tissue samples. Among them, 45/70 (55%) positive samples were detected in patients chronically infected with hepatotropic viruses (HBV or HCV), 9/14 (64%) in patients with toxic liver damages and 9/13 (85%) in patients with autoimmune liver diseases. No correlation was found between the frequency of Helicobacter PCR-positive results and aetiology of liver diseases and presence of signs of liver inflammation.

Conclusions: The presence of Helicobacter species DNA in liver tissue may suggest possible role of Helicobacter infection in human chronic liver diseases, but further study are underway in order to elucidate the probable relation of different Helicobacters to chronic inflammation of human liver.

PI_11

INFLUENCE OF NEOGLANDYNA ON ACTIVITY OF β-D-GALACTOSIDASE IN SERUM AND URINE OF ALCOHOL DEPENDENT PEPLE HOSPITALIZED AFTER A LONG- LASTING DRINKING PERIOD

Szajda SD¹, Zaniewska A¹, Stypułkowska A¹, Zwierz P¹, Waszkiewicz N², Knaś M¹, Borzym-Kluczyk M¹, Gołaszewska Z¹, Zwierz K¹

¹Department of Pharmaceutical Biochemis try, Medical Uniwersity in Białystok, ul.Mickiewicza 2a, 15-222 Białystok,

²Department of Psychiatry, Medical Uniwersity in Białystok, ul. Plac Brodowicza 1, 16-070 Choroszcz,

β-D-galactosidase (GAL) –EC 3.2.1.23 is lysosomal exoglycosidase releasing galactose from a non reducing end of oliogosaccharide chains of glycoproteins, glycosaminoglycans and glycolipids. The activity of GAL was detected in liver, kidney, alimentary tract, brain ,serum and urine. In alcohol dependent people it was found increase in activity of lysosomal exoglycosidases: N-acetyl-β-hexosaminidase and α-mannosidase in serum and urine  and α-mannosidase and α-fucosidase in serum.

The aim of the present report is evaluation of Neoglandyna administration (preparation containing oil from Borago officinalis- plant used in medicine for long time) on activity of Aim: Gal in serum and urine of alcohol dependent people hospitalized after a long-lasting drinking period.

Materials and methods: We used serum and urine taken  on 1, 4 ,7 ,14 and 30 day of hospitalization from 8 men after a long-lasting drinking period without treatment with Neoglandyna and 8 men after long-lasting drinking period whom Neoglandyna was administered. Activity of Gal was determined colorimetrically by the method of Chateriee et. al. (modified by Zwierz et. al). and expressed in pkat/mg of protein. Statistical significance was established at p < 0.05.

There were no significant differences in activity of Gal after administration of Neoglandyna in serum and urine of alcohol dependent people hospitalized after a long-lasting  drinking period.

Conclusion: our results suggest that administration of Neoglandyna did not change significantly metabolism of liver in alcohol dependent people hospitalized after a long-lasting drinking period. 

PI_12

USEFULNESS OF MAGNETIC RESONANCCE IMAGING IN DETECTION OF HEMOCHROMATOSIS 
Szurowska E, *Sikorka K., Dubaniewicz-Wybieralska M., Stalke P., **Iżycka-Świeszewska E., Studniarek M.,
Department of Radiology, Medical University, Gdańsk, 80-211ul. Dębinki 7, tel. (0-58) 341-6234, Poland
* Department of Infectious Diseases, Medical University, Gdańsk, Poland
** Department of Pathology, Medical University, Gdańsk, Poland

Hemochromatosis is a disorder of parenchymal iron overload. Definitive diagnosis of iron deposition generally requires invasive methods, such as direct tissue biopsy. Magnetic resonance imaging (MRI) shows a decrease in liver signal intensity.
Purpose
The purpose of the study was the evaluation of the role of MR imaging in the detection of liver iron overload.
Materials and methods
MR imaging at 1,5 T was prospectively performed in 37 patients suspected of cirrhosis, who had undergone liver biopsy (with hepatic iron concentration quantification). 24 patients had normal hepatic iron concentration and 13 had hemochromatosis. In all patients the following sequences were used: SE, FSE, GRE - T2 and T1. Signal intensity (SI) was measured on images obtained with each T2 weighted sequence by means of regions of interest placed in the liver and paraspinal muscle. Correlation between iron concentration and SI ratio was verified.
Results
In 24 patients with cirrhosis and normal hepatic iron levels and 1 patient with hemochromatosis, we noted higher signal intensity of liver than that of skeletal muscle on GRE -  T2 weighted images. In 12 patients with confirmed hemochromatosis by biopsy, their liver demonstrated lower signal intensity than paraspinal muscle. This effect was observed only in 7 patients with hemochromatosis in FSE T2-weighted images.
Conclusion
MR imaging is a useful and noninvasive diagnostic tool for detection of hemochromatosis.
GRE T2-weighted sequence is more sensitive than FSE T2-weighted images for the diagnosis of liver iron overload.



 

PI_13

ISOENZYMES OF HUMAN SALIVARY N-ACETYL-b-HEXOSAMINIDASE AFTER ACUTE ETHANOL INTOXICATION

Waszkiewicz N², Szajda SD¹, Zwierz P¹, Dobryniewski J³, Zaniewska A¹, Zwierz K¹

¹Department of Pharmaceutical Biochemistry, Medical Academy in Białystok, ul.Mickiewicza 2a, 15-222 Białystok,

²Department of Psychiatry, Medical Academy in Białystok, ul. Plac Brodowicza 1, 16-070 Choroszcz,

³SPP ZOZ in Choroszcz ul.Plac Brodowicza 1, 16-070 Choroszcz.

N-Acetyl-b-hexosaminidase is a lysosomal glycosidase which releases N-acetylglucosamine and N-acetylgalactosamine from the non-reducing end of oligosaccharide chains of glycoproteins, glycolipids and glycosaminoglycans.

N-Acetyl-b-hexosaminidase has two major isoenzymes HEX A and HEX B with different charge, subunit composition (HEX A=a+b subunits, HEX B=b+b subunits), and heat stability (isoenzymes A, S-heat labile, isoenzymes B, P-heat stabile).Isoenzymes of HEX have been detected in liver, kidney, brain, stomach, spleen, placenta, serum, urine, cerebrospinal fluid and saliva.

Increased activity of isoenzyme B is observed in sera of alcoholics admitted to detoxification treatment, and some kind of cancers. Increased activity of isoenzyme P in serum is observed in chronic alcoholism, liver diseases and pregnancy. Proportion of isoenzyme B to A is significantly lower in serum of diabetics. There is no studies on the effect of acute alcohol consumption on activity of HEX isoenzymes in saliva. The  objective of this study was comparison salivary HEX isoenzymes activity in acute alcohol intoxication with that of normal saliva.

AIM: The aim of our study was to compare activity of HEX isoenzymes (A and B) in saliva after acute alcohol intoxication.

MATERIALS AND METHODS: Biological material was saliva of eight healthy (20-30 years old) volunteer-social drinkers, before acute ethanol ingestion (120-160g) and 2-5 days after. The activity of HEX isoenzymes (pkat/ml) was determined with colorimetric method of Chatteriee et al. modified by Zwierz et al.

The results were processed with statistical program. p<0.05 was considered statistically significant.

RESULTS AND CONCLUSION: The activity of HEX B in the saliva was significantly lower on second (p<0.05) and on fifth day (p<0.05) after acute ethanol intoxication in comparison to control group. The proportion of isoenzyme B to A after acute alcohol intoxication was significantly lower than in control group.

 Isoenzyme A of N-Acetyl-b-hexosaminidase can be more sensitive marker of acute ethanol intoxication and acute liver injury than isoenzyme B.

PI_14

SERUM AND URINARY a-MANNOSIDASE AS A MARKER OF LIVER-CELL DAMAGE IN ACUTE ETHANOL INTOXICATION

Waszkiewicz N², Szajda SD¹, Zwierz P¹, Dobryniewski J³, Zaniewska A¹, Zwierz K¹

¹Department of Pharmaceutical Biochemistry, Medical Academy in Białystok, ul.Mickiewicza 2a, 15-222 Białystok,

²Department of Psychiatry, Medical Academy in Białystok, ul. Plac Brodowicza 1, 16-070 Choroszcz,

³SPP ZOZ in Choroszcz ul. Plac Brodowicza 1, 16-070 Choroszcz.

Alpha-mannosidase is a glycosidase involved in the catabolism of N-linked glycoproteins through the sequential degradation of high-mannose oligosaccharides. Liver cell contains a-mannosidases in lysosomes, Golgi membranes, and cytosol.

Chronic alcohol consumption increases level of at least one of liver-cell a-mannosidase isoenzymes (a-mannosidase has one acid and two intermediate pH optimum isoenzymes).

There are no studies on the effect of acute alcohol consumption on this enzyme. The objective of this study was determination serum and urinary activity of a-mannosidase in acute ethanol intoxication.

AIM: The aim of our study was to check applicability of serum and urinary alpha-mannosidase determination to the early diagnosis of damage to liver-cells after acute alcohol intoxication.

MATERIALS AND METHODS: Biological material was serum and urine of eight healthy (20-30 years old) volunteer men-social drinkers, taken  before acute ethanol ingestion (120-160g) and 2-5 days after. The activity of  a-mannosidase was determined in pkat/ml. The results were processed with statistical program. p<0,05 was considered statistically significant.

RESULTS AND CONCLUSION: In eight ethanol intoxicated men level of serum a-mannosidase activity increased significantly (p<0,05) after 2 days, whereas urinary a-mannosidase activity significantly decreased (p<0.05) in comparison to control. On 5-th day, level of serum a-mannosidase decreased (p<0.05), but urinary a-mannosidase activity had tendency to increase, in comparison to control. Increased a-mannosidase activity in the serum can be a sensitive marker of acute damage to the liver-cells, caused by acute ethanol intoxication.

PI_15

INSULIN RESISTANCE, LIPID METABOLISM AND ANTIOXIDANTS IN OBESE AND NON-OBESE CHILDREN WITH NON-ALCOHOLIC FATTY LIVER DISEASE
Wierzbicka A, Socha P, Skorupa E, Dądalski M, Dzik E, Litwin M,  Socha J,
Zakład Diagnostyki Laboratoryjnej,  Klinika Gastroenterologii, Hepatologii i Immunologii, Instytut Pomnik Centrum Zdrowia Dziecka
 
Aim: Obesity seems to be the major risk factor responsible for non-alcoholic fatty liver disease (NAFLD), which usually is associated with other risk factors like insulin resistance, lipid metabolism disturbances and increased free radical injury. However, the role of other risk factors in non-obese children is not well established. The aim of the study was to compare fatty liver risk factors in obese and non-obese children with NAFLD.
Methods: We studied 61 children aged 12.4&#61617;4.1 y with NAFLD diagnosed by ultrasound and increased ALAT activity (metabolic and infectious diseases excluded). 31 patients had BMI< 97 centile (aged 12.1&#61617;4.41y) and 30 children  aged 12.6&#61617;3.65y presented with BMI> 97 centile (obesity). We compared major NAFLD risk factors in obese and non-obese children, and related the results to normal values obtained in 63 healthy  children.
Results: No difference was found between obese and non-obese children in  serum/plasma total cholesterol-TC (146.7-178.3 mg/dl vs. 170.1-198.2- 95% conf. inter.), TG (75.3- 152.9 mg/dl vs. 108.0- 151.6), LDL-C (89.8-112.6 mg/dl vs. 103.9- 129.4), HDL-C (34.1- 44.2 mg/dl vs. 37.1- 47.9), Apo A1 (0.96- 1.28 g/l vs. 1.05- 1.31) , vit E (10.3- 17.4 &#61549;g/ml vs. 11.1-17.7), glutathione (GSH) (594.0- 692.8 mcmol/ml vs. 651.0- 735.9), GPx activity (27.3- 31.9 gHb/l vs. 28.7- 33.5 vs. 30.6-34.5), TBARS (lipid peroxide) conc.( 0.455- 0.690 nmol/ml vs. 0.466-607.7)  and HOMA-IR (insulin resistance indicator) (1.8-3.6 vs. 1.4-3.1),. Significant differences was found only for vit A (377.2-504.4 ng/ml vs. 492.7-607.7) and VLDL-C (14.5- 29.5 mg/dl vs. 21.5-29.1). Children with NAFLD had higher (p<0.05) HOMA IR TBARS (lipid peroxide) serum c., ApoE, VLDL-C and  lower Vit. A, HDL, GSH, lower LCAT and GPx activity compared  to controls.
Summary: There is no significant difference in the major risk factors between obese and non-obese children with NAFLD.
Conclusion: Insulin resistance, lipid metabolism disturbances and free radical injury appear to be independent from obesity risk factors responsible for NAFLD.

PI_16

Influence of Neoglandyna on activity of N-acetyl-β-hexosaminidase (HEX) and its isoenzymes (HEX A, HEX B) in serum of alcohol dependent people hospitalized after a long-lasting drinking period.

Zaniewska A¹, Szajda SD¹, Waszkiewicz N², Zwierz P¹, Borzym-Kluczyk M¹, Knaś M¹, Sadowski M³, Zwierz K¹

¹Department of Pharmaceutical Biochemistry, Medical University, .Mickiewicza 2a Str.,

15-222 Białystok,

²Department of Psychiatry, Medical University ,Plac Brodowicza 1 Str., 16-070 Choroszcz,

³Department of General and Vascular Surgery, District Hospital , Żołnierska 18 Str.,

10-561 Olsztyn.

N-acetyl-β-hexosaminidase (HEX) is the most active lysosomal exoglycosidase. The presence of N-acetyl-β-hexosaminidase has been detected in liver, kidney, mucous membrane of stomach, intestine as well as in serum and urine of alcohol dependent people. HEX appears in several molecular forms from which the most active are isoenzymes A and B (HEX A and HEX B). There are no reports concerning influence of Neoglandyna on the activity of HEX and its isoenzymes during the abstinence period.

Aim: The aim of our study was the estimation HEX, HEX A and HEX B activity in serum.

Materials and methods: Biological material was collected on the 1^st, 4^th, 7^th, 10^th, 14^th and 30^th day from alcohol dependent people hospitalized after a long-lasting drinking period treated with Neoglandyna - medicine containing Borago officinalis oil and vitamin E. The control was group of alcohol dependent people hospitalized after a long-lasting drinking period not treated with Neoglandyna. The activity of enzymes was detemined with colorimetric Chatteriee et al. method as modified by Zwierz et al.

Results: The activity of HEX and HEX B in serum increases under the treatment with Neoglandyna, in comparison to control.

Conclusion: Increasing activity of HEX and HEX B in serum suggests intensification of immunoreactions caused by administration of Neoglandyna.

PI_17

SEARCH FOR AN OPTIMUM DOSAGE REGIMEN OF THE SUBSTRATE FOR THE 13C-METHACETIN BREATH TEST
Kasicka-Jonderko A, Jonderko K, Budniok M, Krusiec-Świdergoł B, Błońska-Fajfrowska B
Dept of Basic Biomedical Science, School of Pharmacy, Medical University of Silesia, 3 Kasztanowa street, PL-41-205 Sosnowiec, Poland
 
Background/Aims: 13C-methacetin breath test proved to be a valuable diagnostic tool in hepatology. We decided to compare two currently used dosage regimens of 13C-methacetin: fixed vs body mass-adjusted dose.
Methods: Two groups of healthy volunteers of different body mass were created: (i) <55 kg (8 women) and (ii) >95 kg (8 men). Every subject underwent two breath tests on separate days, taking 200 ml unsweetened black tea containing 13C-methacetin (Euriso-Top S.A., Saint-Aubin, France) either at a fixed 75 mg dose, or at a 1 mg/kg body mass-adjusted dose. Samples of expiratory air for 13CO2 measurement were collected 3, 6, 9, 12, 15, 18, 21, 24, 27, 30, 40, 50, 60, 75, 90, 105, 120, 150 and 180 min after intake of the substrate. The order of the dosage regimens was randomized.
Results: Compared to the standard 75 mg dose, the body mass-adjusted dose was lower by 24.06 mg (range 20.30-31.00) in "light" women, and higher by 27.98 mg (range 20.60-37.00) in "heavy" men. The time to peak 13C recovery in breath amounted to 14.6?1.0 min after the reduced dose and to 21.5?3.2 min following the augmented 13C-methacetin dose (p=0.078). Compared to the fixed 13C-methacetin dose, the maximum momentary 13C recovery after the body mass-adjusted dose increased in men (38.5?2.9 vs 32.3?2.5 %dose/h) and also (paradoxically) in women (41.9&#61617;2.9 vs 36.6?3.6 %dose/h). For the 3-h cumulative 13C recovery the difference between "light" and "heavy" subjects was greater with the fixed 75 mg dose (43.57?3.09 vs 39.51?1.97 %dose) than with the body mass-adjusted dose (41.85?3.08 vs 43.27?1.36 %dose).
Conclusion: The dosage regimen of the substrate may affect some results of the 13C-methacetin breath test, particularly the time to peak and the maximum momentary 13C recovery. The body mass-adjusted dosage is helpful for "normalization" of results from subjects of greatly differing body frame.

 

PI_18

CLINICAL COURSE OF LIVER DISEASE IN 14 CASES OF WILSON DISEASE

Jabłońska J., Nazzal K., Stańczak W

Department of Hepatology and AIDS, Warsaw Medical University, 01-201 Warsaw,  37 Wolska St

Head of the Department: Prof . Janusz Cianciara

INTRODUCTION

Wilson disease is autosomal recessive genetic disease resulting from copper deposition in brain and liver. Mutation in ATP7B gene causes failure of biliary excretion of copper. Neurological symptoms are: movement disorders, dysarthria, tremor, dystonia, behavioral abnormalities. Liver disease may present as hepatitis (acute or reccurent, cirrosi or liver failure.

AIM

We present clinical course and outcome of  14 cases of liver disease in patients with Wilson disease diagnosed in Department of hepatology

RESULTS

Fourteen  patients (10 female, 4 male) with Wilson disease were hospitalized in Department of Hepatology and AIDS in years 1995-2005. Mean age was 27 years (range 17-49). Seven patients had acute liver failure, with low aminotransferases level and hemolysis. In 5 cases clinical picture was similar to acute hepatitis with ALT > 1000 U/l. Two patients had liver cirrhosis. In all cases copper urinary excretion was significantly elevated. Ceruloplasmin level was decreased in 13 cases. None patient had neurologic symptoms before hospitalization.

Three  patients, all with “hepatitis like” model of disease,  are successfully treated with penicylamine and/or zinc. In 7 cases liver transplantation was successfully performed. Five patients  died -  3 because of liver failure, 1 – paralytic ileus, 1 – fungaemia.

CONCLUSIONS

Each patient with liver disease younger than 40 years should be tested for Wilson disease

Clinical manifestations of hepatic damage in Wilson disease are variable

In cases with liver failure only one successful treatment is liver transplantation

PI_19

ALCOHOLIC LIVER DISEASE IN WOMEN – ARISING PROBLEM IN POLAND

Jabłońska J., Mikuła T., Kozłowska J

Department of Hepatology and AIDS, Warsaw Medical University, 01-201 Warsaw,  37 Wolska

Head of the Department: Prof . Janusz Cianciara

INTRODUCTION

Alcohol consumption leads to broad spectrum of liver disease: hepatic steatosis, acute hepatitis and cirrhosis. The severity of liver damage varies among individuals. Women are more susceptible to alcohol toxicity than man. Clinical picture and treatment of alcoholic liver disease is presented and discussed. The number of women with alcoholic liver disease has increased in Poland.

AIM

Analysis of clinical course and outcome of alcoholic liver disease in male and female patients was performed.

PATIENTS

Data of 210 patients  (129 males and 81 females)with alcoholic liver disease hospitalized in Department of Hepatology and AIDS in years 1995-2005 were analysed.

RESULTS

Mean age of patients was 45,02 years (44,8 in females; 45,2 in males). Liver cirrhosis was diagnosed in 42 women and 45 men. Clinical outcome was more severe in women and mortality rate was higher. 14 women (17%) and 5 men (4%) died. Taking medical history was more difficult in women - 50% of women denied consumption of alcohol.

CONCLUSION

Alcoholic liver disease in women is arising problem in Poland. Diagnosis is difficult in this group of patients and clinical outcome is more severe.

PI_20

Liver damage in acute inhalation poisoning with chloroform

Piotr Rusiński, Zbigniew Kołaciński

Clinical Toxicology Dept.

Nofer Institute of Occupational Medicine

8, Teresy St., 91-348 Lodz, Poland

Head of Dept.: Prof. Zbigniew Kołaciński, MD, PhD

Case history

A 21-year-old patient was admitted to the Clinical Toxicology Dept. with malaise and vomiting. The symptoms appeared two days after he had inhaled chloroform for an hour to in the aim of stupefying himself.

Immediately after inhalation, halucinations occurred, followed by drowsiness. On the next day, he developed vomiting, dryness turned up at the mouth, upper abdominal pain and general weakness.

In the course of treatment, increased ALT activity, to 2928 IU, and AST activity, to 3797 IU, and prolonged PT (65.7%) were noted. The CPK and CPK- MB values remained normal. Serologic testing revealed no type A, B or C hepatitis.

Conservative hepatoprotective treatment was applied: Ornithyne (Hepa- Merz – iniections), phospholipids (Essentiale forte), glycocorticosteroids, cocarboxylase, vitamin B compositum, vitamin C, and a protective diet.

During the treatment, the biochemical indicators of liver damage gradually returned to normal and the patient’s general condition improved. He was discharged on day 13 of treatment in a good health condition. On discharge, AST and ALT activities were 60 IU and 171 IU, respectively, and PT was 105%.

Ambulatory treatment, using internal procedures, was continued. Laboratory testing on day 46 after poisoning revealed normalization of biochemical parameters: AST 28 IU, ALT 27 IU, PT 102%, and bilirubin 0.59 mg%. The patient reported no symptoms.

Conclusions

1.      Inhalation exposure to chlorophorm produces severe liver function impairment

2.      The clinical picture and treatment is similar as for other impairments of toxic aetiology and viral hepatitis

3.      Normalization of the liver function proceeds slowly, which requires long-lasting treatment and monitoring of the biochemical parameters

4.      In view of the chloroform potency to generate free radicals, it would be advisable to supplement the therapy with antioxidative drugs to enhance normalization of the liver function.

13.05.06- sobota (sesje popołudniowe) II Sesja plenarna

OII_1

Determination of Hepatitis Delta Virus RNA by Polymerase Chain Reaction among chronically infected hepatitis B patients from Northern Poland

¹Bielawski KP, ¹Ziętkowski D, ¹Charmuszko U, ²Stalke P, ¹Podhajska AJ

¹ Department of Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk., Poland

² Department of Infectious Disease, Medical University of Gdansk

Introduction:

HDV/HBV coinfection and superinfection may be associated with a higher rate of fulminant hepatitis as a consequence of more progressive infection. The objective of this study was to estimate the presence of hepatitis delta virus RNA in chronically infected HBV patieents. To our knowledge, these are the first such studies of HDV infection in Poland performed by PCR based method.

Methods:

A total group of 40 patients randomly selected from the group of 120 chronically infected hepatits B patients (32 men, 8 women, age: 11-77 years) were enrolled into this study. At entry, age, sex, mode of transmission, duration of infection, serum biochemical markers and HBV DNA were evaluated. Virus RNA from patients’ serum was isolated using QIAamp Ultrasens Virus Kit and than reverse transcribed by Omniscript Reverse Transcription Kit. cDNA was amplified by “home-made” nested PCR method.

Results:

Forty HBV positive patients’ serum samples were examined. Of them 3 samples (7.5%) were HDV-RNA-positive. All three patients were men, one was HCV co-infected. One was treated with interferon, none of them with nucleoside analogs. In all 3 HDV-RNA+ patients serum HBsAg was present and HBeAg absent. Those HDV carriers had high levels of serum ALT (72-281 IU/l). Their HBV viremia level was relatively low (940-28,000 cp/ml).

Discussion / Conclusion:

HDV RNA detected in this study by RT-PCR is relatively high in comparison to results obtained in other laboratories using serological methods of HDV detection.

Acknowledgements:

This study was supported by the VIRGIL European Network of Excellence (LSHM-CT-2004-503359).

OII_2

HISTOLOGICAL CHANGES SUGGEST NECESSITY OF TREATMENT IN A NUMBER OF CHILDREN WITH CHRONIC HEPATITIS C
Kowalik-Mikołajewska B, Aniszewska M, Pokorska-Lis M
Department of Children's Infectious Diseases, The Medical University of Warsaw, 01-201 Warsaw, 37 Wolska Str.
 
Aim: The study was designed to determine the histological changes in the liver in children with chronic hepatitis C.
Patients and methods: 35 liver biopsy specimens from 31 pediatric patients with chronic hepatitis C were examined. The studied group consisted of 23 boys and 8 girls, whose age ranged from 6 to 17 years old (mean age 12 years). ALT  level was elevated mean 3 x N. All patients were seropositive for HCV antibody and the presence of HCV-RNA in their sera was confirmed by PCR. Genotyping was performed in 12 children. In 8 cases we recognized coinfection with HBV. Each biopsy specimen was evaluated based on a numerical scoring Knodell system for the stage of fibrosis (0-4) and the grade of necroinflammation (0-18).
Results: The mean duration of HCV infection until liver biopsy was 11 years. The genotype of HCV was 1  in 10 children, 3a in 1 child. No child had liver cirrhosis. Seventeen biopses (51 %) were stage 0-1, 12 (36%)  stage 2  and 4 (12%)  stage 3 in fibrosis.
The grade of inflammation was: G = 9-12 in 3 biopses (9%), 4-8 in 22 (67%), 0-3 in 8 (24%). There was no child with more than 12 score points. Histological changes such as lymphadenoplasia portalis were observed in 11 children, fatty changes in 3. Bridging-fibrosis (porto-portalis) was found in 13 cases (38%), piecemeal necrosis in 5 (14%). In one patient with ten-year-history of chronic HCV hepatitis, treated ineffectively with interferon and ribavirin, during 18 months progression of inflammatory process (from 3 to 12 score) and fibrosis (from 2 to 3 score) was observed.
Conclusions: Histological changes in liver in pediatric patients with chronic hepatitis C might be severe. Progressive fibrosis suggests that the course of HCV infection in childhood may lead to significant morbidity in young adults. In these patients indications to treatment should be considered.

OII_3

HEPATITIS C VIRUS INFECTION IN SWIETOKRZYSKI REGION (SOUTH-EASTERN POLAND)

Kryczka W^1,2, Chrapek M³

¹Department of Infectious Diseases, Provincial Hospital, Kielce, Poland

²Institute of Medical Education and ³Institute of Mathematics, Swietokrzyska Academy, Kielce, Poland

BACKGROUND/AIMS: The epidemiological picture of hepatitis C virus (HCV) infection in the general population is largely unknown, even in developed countries. Seroprevalence of HCV in Poland was estimated from 1.4% (blood donors; Gloskowska-Moraczewska Z et al., 1993) to 1.9% (unselected population of northern Poland; Bielawski K et al., 2000). The aim of this study was to estimate seroprevalence of HCV infection in general adult (over 15 years) population of Swietokrzyskie voivodeship.

MATERIAL AND METHODS: Since 2000 year all patients with unknown HCV status were tested in our department with commercial ELISA kits for anti-HCV. We analyzed retrospectively the results of anti-HCV tests of consecutive 3223 inpatients (male-48.6%; age: 15-93, median-46 years; urban dwellers: 55.8%). All of them have fulfilled inclusion (previously had never been tested to HCV infection) and exclusion criteria (ivdu history, HIV- or HBsAg-positive, hemodialysis, diagnosis of acute hepatitis C as well as clinical symptoms of HCV-related decompensated cirrhosis). The prevalence of HCV was analyzed according to gender, age and place of living (urban, rural). Statistical analyses were performed using the Newcombe-Wilson method (Newcombe RG, 1998) as well as the method presented by Vollset SE (1993).

RESULTS: Antibodies to hepatitis C virus were found in 51 cases (1.58% [95%CI:1.21%-2.07%]). The differences between the seroprevalence of HCV according to gender (male: 1.72%, female: 1.45%), age (ys) groups (15-19: 1.80%; 20-29: 1.30%; 30-39: 1.01%; 40-49: 1.84%; 50-59: 1.83%; 60-69: 1.73% and 70 or older: 1.62%) and the place of living (urban:1.78%; rural:1.33%) were not statistically significant. The presence of HCV-RNA (Cobas Amplicor HCV) was detected in 70.5% [95%CI: 55.8%-81.8%] of 44 anti-HCV–positive cases tested, with no significant relationship to neither age nor gender. The gender distribution in patients’ group and voivodeship society was almost identical but patients were on average older. Taking into the account the age groups mentioned earlier, the overall similarity in age distribution between patients and voivodeship society was moderate and described as high as 88% (84% for women and 88% for men). Nevertheless, because of the lack of statistically significant differences between HCV prevalence in age-strata groups, it is possible to accept that the seroprevalence of HCV in Swietokrzyskie voivodeship is similar to seroprevalence observed among  participants in our study.

CONCLUSIONS: The overall prevalence of anti-HCV in Swietokrzyskie voivodeship was 1.58 percent, corresponding to an estimated 17,000 persons ³ 15 yrs. old and 12,000 chronically HCV infected. Our study showed no statistically significant tendency of higher seroprevalence of HCV in men and urban dwellers as well as in persons ³ 40 yrs. excluding the youngest age group.

OII_4

Adefovir dipivoxil (ADV) in the management of particular difficult problems in patients with chronic HBV infection
Cianciara J, Krygier R, Świętek K
Department of Hepatology and Acquired Immunodeficiences, Medical University of Warsaw, Poland
Infectious Diseases and Observation Ward of the Konin Specialists Hospital, Konin, Poland
Department of Infectious Diseases, Medical University of Poznań, Poland

Prolonged lamivudine therapy for chronic hepatitis B may induce mutations in the tyrosine-methionine-aspartate-aspartate (YMDD) locus of the HBV DNA polymerase gene in both immunosuppressed and immunocompetent patients, often leading to exacerbation of disease. This could be responsible for liver decompensation, especially in patients with advanced liver diseases (cirrhosis). Patients with HBV-related cirrhosis should be treated to improve fibrosis, prevent decompensation, and suppress HBV replication in the pretransplant setting. It is well confirmed that some patients with lamivudine resistance awaiting for liver transplantation treated with ADV were stable or improved and were not transplanted. Therapy with ADV resulted in a delay of hepatic decompensation and liver transplantation as final treatment. Thus, in patients with pre-existing liver cirrhosis an early switch to ADV appears to be indicated after emergence of lamivudine resistance. In majority of cirrhotic patients IFN alfa therapy is contraindicated. Failure of prophylaxis for hepatitis B virus (HBV) recurrence in liver transplant patients with HBV immunoglobulin (HBIG) or lamivudine or both can be associated with rapid development of liver failure. ADV should be considered to be a safe and effective choice for prophylaxis recurrent HBV infections in liver transplant patients.
It is confirmed that cccDNA persists throughout the natural history of chronic hepatitis B, even in patients with serologic evidence of viral clearance. Long-term ADV therapy significantly decreased cccDNA levels by a primarily noncytolytic mechanism, diminishing possibility of reactivation. In the absence of prophylaxis with LAM or ADV, the reactivation of HBV infection in oncology patients who are HBsAg carriers is a well-known and often serious complication of chemotherapy. The current recommendations of antiviral prophylaxis prior to chemotherapy in the USA are patients who are positive for HBsAg. Patients who are negative for HBsAg but positive for antibodies anti-HBc are still at risk for reactivation of latent HBV infection during and after chemotherapy and may be considered for prophylaxis. Successful treatment of fibrosing cholestatic hepatitis (FCH) using ADV in a patient with cirrhosis and renal insufficiency where observed.
  Moreover ADV can be safe and effective treatment of renal transplant patients with lamivudine-resistant hepatitis B. 10 mg daily ADV is well tolerated and active against lamivudine-resistant HBV in HIV-1/HBV co-infected patients. Adefovir does not share cross-resistance with nucleoside compounds such as lamivudine, emtricitabine, telbivudine, and entecavir.

 

13.05.06- sobota (sesje popołudniowe) II Sesja plakatowa

PII_1

THE IRON DISORDERS IN END-STAGE RENAL DISEASE PATIENTS WITH HEPATITIS C

¹Lakomy EA, ²Biedunkiewicz B, ¹Sikorska K, ¹Stalke P, ¹Michalska Z, ³Romanowski T ⁴Jaśkiewicz K

¹ Department of Infectious Diseases, Medical University of Gdansk, Poland

² Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Poland

³ Department of Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk, Poland

⁴ Department of Pathology, Medical University of Gdansk, Poland

Background:

Hepatitis C virus (HCV) infection is the most common cause of chronic liver disease in patients with end-stage renal disease (ESRD). The aim of the study was an assessment of HFE gene mutations C282Y and H63D in patients with chronic hepatitis C and ESRD.

Methods:

We excluded patients with HBV infection and alcohol abuse from the analysis. Among 36 ESRD patients with HCV-Ab(+), HCVRNA was detectable in 28 patients. Furthermore, liver function biochemical tests, iron metabolism tests and histopathological examination of liver biopsy specimens were performed in the group of 28 ESRD patients and 25 control subjects with chronic hepatitis C and without renal disease. The C282Y and H63D mutations of HFE gene were detected by PCR-RFLP methods.

Results:

Aminotransferases (ALT,AST) and bilirubin levels were significantly lower in the patients with ESRD. Patients with ESRD had less inflammatory activity but increased hepatic iron deposition in histopathological examination of the liver. There were no significant differences in GGT levels, fibrosis stage and steatosis in histopathological examination between patients with ESRD and control group. Distribution of C282Y and H63D mutations in patients with ESRD and control group was similar without statistical significance. We did not find any C282Y HFE gene mutation in both groups, H63D was only in heterozygotes in few cases.

Conclusions:

The distribution of HFE gene mutations in patients with ESRD is similar to control group and disturbances in iron metabolism in ESRD patients seem do not relate to HFE gene mutations. Moreover, we found that patients with ESRD had less severe hepatitis C than control subjects.

PII_2

THE CONCENTRATIONS OF SFAS AND SFASL AS INDICATORS OF PROGRAMMED CELL DEATH AMONG HIV AND HCV COINFECTED PATIENTS.
Łapiński TW. (1), Jaroszewicz J. (1), Kovalczuk O. (2), Wiercińska - Drapało A. (1)
1. Department of Infectious Diseases, Medical University of Bialystok
2. Department of Molecular Biology, Medical University of Bialystok

HCV and HIV coinfections can affect mechanisms of programmed cell death, therefore influence on AIDS progression as well as chronic hepatitis C course. The aim of study was to asses sFas and sFasL concentrations in HIV and HCV coinfected patients. Moreover to establish their relationships with HIV viral load, CD4 T-lymphocyte count, as well as liver function tests.
Patients and methods. 78 patients were included into study, among them 30 HIV and HCV coinfected, 10 HIV-infected and 38 HCV-infected without HIV infection. HIV infection was confirmed by use of Western-blot analysis (Cambridge Biotech Corporation, USA), HIV-viral load was measured by RT-PCR method (Cobas Amplicor HIS 1.5, Ultra Sensitive,USA) and CD3+, CD4+ and CD8+ T-lymphocyte counts by use of flow cytometry (Becton Dickinson). HCV infection was confirmed by HCV-RNA isolation by RT-PCR method. sFas and sFasL concentration was measured in duplicate by ELIS method (Bender MedSystems, Austria).
Results. The mean CD4+ T-lymphocyte count was decreased in HIV and HCV coinfected patients vs. HIV infected individuals (429/ml vs. 279/ml). sFasL protein was principally detectable in in HIV-infected individuals without HCV infection (90%), while in HCV-infection only it occurred in only 11% of cases. The highest sFas concentration was observed in HCV-infected patients (25,9 ng/ml) as well as in HIV-HCV coinfected individuals (20,3 ng/ml). This concentration was negatively proportional to the sFasL prevalence.
Conclusions. HCV infection among HIV-positive individuals may suppress processes of programmed cell death. There were no correlation between sFas sFasL and HIV-1 viral load. On the contrary sFas concentration and sFal occurrence were associated with  CD4+ T-lymphocyte count.
 

PII_3

HCV- RNA PERSISTENCE IN PERIPHERAL BLOOD MONONUCLEAR CELLS AFTER ANTIVIRAL TREATMENT: THE DIFFERENCE BETWEEN CHILDREN'S AND ADULT'S TREATMENT RESPONSE.
E.Majda-Stanislawska1, B.Jóźwiak2, M. Sidorkiewicz2, E. Berkan1, A. Piekarska1. 
1 Department of Infectious Diseases and Hepatology, Medical University of Lodz, Poland
2 Department of Biochemistry, Medical University of Lodz, Poland

Background: In patients with chronic hepatitis C the virus may be detected in blood serum and in peripheral blood mononuclear cells (PBMC). The aim was to estimate the frequency of HCV-RNA persistence in patients who responded to antiviral therapy with elimination of HCV-RNA from serum.
Material and methods: We investigated the persistence of HCV-RNA in PBMC obtained from 45 patients, aged 8-50 years (mean 27 ?16) suffering from chronic hepatitis C, who had no detectable serum HCV-RNA after antiviral treatment with: 1. IFN-a monotherapy for 6 months (14 patients), 2. IFN-a + ribavirine or 12 months (22 patients) or 3. both courses administered with at least one year interval (9 patients).
Results: HCV-RNA was present in PBMC in 11/45 (24%), more often in young patients (mean age in years 13.6 ? 2.4 vs. 32.0 ? 16.2; p<0.001), in patients resistant to initial IFN-a monotherapy (5/11 vs. 4/34 p= 0.02). The frequency of HCV RNA persistence did not decrease in time (mean time after treatment 1.9 years in positive vs. 1.4 years in negative patients, p=0.2).
Conclusion: Children and adolescents with chronic hepatitis C and patients with a history of previous unsuccessful treatment, when they eliminate HCV-RNA from serum, require follow-up in the respect of its persistence in PBMC.

PII_4

Expression of Ki67, TGF-β1, and Bcl-2 in liver tissue of patients with chronic liver diseases

Anna Piekarska¹, Janusz Piekarski², Wiesław Szymczak³, Robert Kubiak ⁴ 

¹Department of Infectious Diseases and Hepatology, Chair of Infectious Diseases, Medical University of Lodz, Poland

² Department of Surgical Oncology, Chair of Oncology, Medical University of Lodz, Poland

³Institute of Psychology, University of Lodz

⁴ Department of Tumor Pathology, Chair of Oncology, Medical University of Lodz, Poland

This work is supported by Medical University of Lodz, grant nr.: 502-11-172

Objective: Assessment of expression of proliferation, fibrosis and apoptosis markers in different phases of chronic liver diseases.

Material and methods: Sixty six adults with chronic liver diseases: chronic hepatitis C (48 cases), chronic hepatitis B (10 cases) or alcohol chronic liver disease (8 cases), treated in our Department of Infectious Diseases and Hepatology from 1999 to 2001, composed the study group. Liver biopsy specimens were used for immunohistochemical assessment of expression of Ki67, TGF-β1 and Bcl-2. Grade of liver inflammation and stage of fibrosis were evaluated according to Scheuer scale.

Results: Expression of Ki67 in hepatocytes was most intensive in patients with grade-2 and -3 of inflammation. The expression in patients with grade-4 inflammation was low. The expression of Ki67 in lymphocytes was most intensive in patients with grade-2 of inflammation. Expression of TGF-β1 in hepatocytes reached maximum in patients with grade 2 and 3 of inflammation and dropped in patients with grade-4 inflammation. There was statistically significant correlation between the stage of fibrosis and the expression of TGF-β1 in liver stromal cells. Very strong correlation was found between the expression of Bcl-2 in bile ductules epithelium and the grade of inflammation (P=0.006). The expression of Bcl-2 in hepatocytes was observed only in patients with very intense liver inflammation (grade 3) and in patients with stage 3 and 4 of fibrosis.Conclusion: Processes of proliferation, fibrosis and apoptosis are not directly correlated to progression of the liver disease. Expression of studied markers can be used for analysis of dynamics of these processes.  

PII_5

THYROID DYSFUNCTION IN PEGYLATED INTERFERON (Peg- IFN&#945;)  TREATED PATIENTS WITH CHRONIC HEPATITIS C-A SINGLE CENTER
RETROSPECTIVE STUDY
Smoliński P, Serafińska S,  Simon K,  Rotter K
Klinika Chorób Zakaźnych, Hepatologii i Nabytych Niedoborów Odpornościowych AM, ul.Koszarowa 5, 51-149 Wrocław. Ten adres e-mail jest ukrywany przed spamerami, włącz obsługę JavaScript w przeglądarce, by go zobaczyć
 
Introduction:
Large  prospective analyses showed thyroid dysfunction in both natural and treated chronic  hepatitis C patients. The ranges of any induced thyroid dysfunction comes up to 40% in certain  studies regardless of its further consequences.  Therefore TSH, autoantibodies and thyroid hormone measurement is a standard of care in the patients. However, in our practice
rare incidents of IFN discontinuation or disqualifications due to thyroid dysfunction  are observed in those with induced abnormalities.
Methods:
- a retrospective thyroid dysfunction study of chronic  hepatitis C patients treated with Peg- IFN&#945; (one weekly dose) and IFN&#945;  (three time weekly dose) -  130 vs. 50 persons respectively-according to the approved Polish standard of care
-all  patients with thyroid dysfunction in the interview or present  at baseline were excluded from the study even though they had started IFN&#945;-therapy
- statistical analysis was done by use of  t-student test and p<0,05 regarded as statistically essential
Objectives:
- analysis of  TSH level dynamics in course of Peg- IFN&#945;  therapy
-comparison  of IFN&#945;   and Peg- IFN&#945; treated groups as for percentage of abnormal  TSH levels (thyroid hormones and autoanibody measurement performed if indicated)
-implications for hepatitis C therapy efficacy  in patients with induced thyroid dysfunctions (ETR- end of treatment response, SVR-sustained viral response)
Results:
1.we didn`t find any thyroid dysfunction in all  IFN&#945; treated patients (TSH levels both at baseline and 6 month of treatment ranged within normal)
2. there were 17 patients (13 %) treated with Peg- IFN&#945; with subclinical thyroid dysfunction (TSH level abnormal, free thyroid hormones within normal, no clinical manifestation)  ; 1 (0,7%) and 16 (12,3%) patients  were attributed respectively  to hypo- and hyperthyreosis. Thyroid dysfunction were relatively more prevalent in female than male sex (14 vs 11,5%).
3. none of the treated patients discontinued Peg-IFN&#945; treatment due to thyroid dysfunction
4. in 4 patients (23,5%) with thyroid dysfunction  compared to 42 patients (37%) with no such abnormalities the Peg-IFN &#945; therapy revealed no viral efficacy (HCV RNA positive as ETR/SVR).
Conclusions:
Our study showed that thyroid dysfunctions of any kind more frequently happen in course of Peg- IFN&#945; than IFN&#945; treatement. Usually the dysfunctions seem to appear in female than male and  those who respond to IFN&#945; -therapy estimated as ETR/SVR (no statistical difference in our analysis was achieved). Predominantly the abnormalities  have no clinical manifestation. In the study there was   no general  need to start thyroid treatment as the observed TSH level changes were cursory and isolated. Much attention however must be paid to  its further follow-up specially if clinical manifestation are present. Peg-IFN&#945; treatment efficacy- though not determined by- may be correlated with thyroid dysfunction.
 

PII_6

sPECAM-1 AS A MARKER OF INFLAMMATORY ACTIVITY, FIBROSIS STAGE AND RESPONSE TO ANTIVIRAL THERAPY IN CHRONIC HEPATITIS C
Żwirska-Korczala Krystyna1, Kukla Michał1, Janczewska-Kazek Ewa2, Ziółkowski Adam3, Berdowska Agnieszka1, Rybus-Kalinowska Barbara1, Gabriel Andrzej3, Król Wojciech4
1 Department of Physiology, Zabrze, Medical University of Silesia, Katowice, Poland
2 Department of Infectious Diseases, Chorzów, Medical University of Silesia, Katowice, Poland
3 Department of Patomorphology, Zabrze, Medical University of Silesia, Katowice, Poland
4 Department of Microbiology, Zabrze, Medical University of Silesia, Katowice, Poland

Background: Passage of leukocytes across the endothelial lining into sites of inflammation has been shown to be regulated largely by platelet/endothelial cell adhesion molecule-1 (PECAM-1). PECAM-1 is expressed on the surfaces of transmigrating leukocytes and concentrated at the borders of endothelial cell. Its soluble form (sPECAM-1) reflects its expression intensity in the tissue. The study was performed to answer the question if sPECAM-1 serum levels correlate with fibrosis stage and inflammatory activity in chronic hepatitis C (CHC) patients.
Material and methods: Our study group encompassed 50 CHC patients (25 males and 25 females, age 52.0±11.2 years, main body mass index 25.2±1.3 kg/m2. First control group included 15 HCV Ab-positive patients with normal aminotransferases levels, without fibrosis and second one - 12 healthy volunteers similar in age and BMI. Modified Scheuer’s scale was used for  histological assessment. Measurement of serum sPECAM-1 levels were made using commercially methods.
Results: sPECAM-1 concentration in study group patients was significantly higher than in both control groups (252.7 vs. 166.1, p<0.001; vs. 86.4 ng/ml, p<0.001). sPECAM-1 levels were significantly lower when inflammatory grade 1 than grade 2 or grade 3 (166.1 vs. 253.1 vs. 252.1 ng/ml, p=0.03). In patients with fibrosis stage 3 sPECAM-1 concentration was significantly higher than in stage 2 (280.0 vs. 224.1, p=0.01). sPECAM-1 was positively associated with inflammatory activity (r=0.35, p=0.02), fibrosis stage (r=0.53, p<0.001) and AlAT activity (r=0.31, p=0.049).
Conclusions: We found a positive association between sPECAM-1 concentration and intensity of inflammatory activity.  Levels of sPECAM-1 can be a predictor of fibrosis progression.
 

PII_7

USEFULNESS OF sVCAM-1 IN THE ASSESSMENT OF LIVER FIBROSIS AND INFLAMMATORY ACTIVITY IN PATIENTS WITH CHRONIC HEPATITIS C
Żwirska-Korczala Krystyna1, Kukla Michał1, Janczewska-Kazek Ewa2, Ziółkowski Adam3, Berdowska Agnieszka1, Rybus-Kalinowska Barbara1, Korzonek-Szlacheta Ilona1, Król Wojciech4, Gabriel Andrzej3
1 Department of Physiology, Zabrze, Medical University of Silesia, Katowice, Poland
2 Department of Infectious Diseases, Chorzów, Medical University of Silesia, Katowice, Poland
3 Department of Patomorphology, Zabrze, Medical University of Silesia, Katowice, Poland
4 Department of Microbiology, Zabrze, Medical University of Silesia, Katowice, Poland

Background: During chronic hepatitis C (CHC) vascular cell adhesion molecule (VCAM-1) is expressed on hepatocytes infected by hepatitis C virus and on endothelial cells from sinusoidal vessels. VCAM-1 plays an integral role in infiltration, activation and binding of effector cells to tissues. A soluble form (sVCAM-1) reflects its level of expression in the tissue. The aim of the study was to investigate if sVCAM-1 levels correlate with fibrosis stage and inflammatory activity.
Material and methods: Study group included 50 patients (25 males/25 females) with CHC, age 52.0±11.2 years, BMI 25.2±1,3 kg/m2. First control group consisted of 15 HCVAb positive patients with normal aminotransferases levels, without fibrosis and the second one consisted of 11 healthy men, similar in age and BMI. Liver biopsies were assessed with modified Scheuer’s scale. sVCAM-1 levels were measured by immunoenzymatic method.
Results: sVCAM-1 level in the study group was significantly higher in comparison with healthy subjects but not with group with CHC without fibrosis (2197.2 vs.1144.9 ng/ml, p<0.001 vs. 2358.8, p-NS). sVCAM-1 levels was significantly lower in patients with inflammatory grade 1 than  with grade 2 or 3 (166.1 vs. 253.0 vs. 252.1 ng/ml, p=0.03). There was no significant difference in sVCAM-1 level between groups with fibrosis stage 1 or 2 and stage 3 (2070.7 vs. 2308.0 ng/ml). sVCAM-1 level was positively associated with CHC duration (r=0.34, p=0.049).
Conclusions: An estimation of sVCAM-1 levels in serum of CHC patients has limited diagnostic value in the assessment and prediction of inflammatory activity and fibrosis stage.

 

PII_8

HCV AS AN INDEPENDENT FACTOR OF MILD HEPATIC STEATOSIS IN COMPARISON WITH PATIENTS INFECTED WITH HBV.

K.Jurczyk, M.Wawrzynowicz-Syczewska, E.Karpińska, I.Morańska, M.Abramowicz, A.Barabasz, A.Brzeska, E.Budzinska, A.Boron-Kaczmarska, Department of Infectious Diseases, Pomeranian Medical University, Arkońska 4 str, 71-455 Szczecin , tel .(+48  91431 62 42) , e- mail: Ten adres e-mail jest ukrywany przed spamerami, włącz obsługę JavaScript w przeglądarce, by go zobaczyć

Aim: To define whether there is any relation between the type of chronic viral hepatitis B or C ( genotype) and the extent of liver steatosis in histopathology specimens.

Patients, methods: Liver biopsy specimens from altogether 106 patients ( 41 women, 65 men 18-89 years of age were analysed histologically; degree of steatosis was expressed using semiquantitative scoring system (in range 0-3 grade). Additionally standard biochemical tests were performed (AST,ALT,GT, serum glucose concentration). Patients were divided into comparable (age, sex, BMI) groups accordingly to the etiology of liver damage: HBV ( n=59), HCV (n=47), HCV- genotype 1b (n=33), HCV-genotype 3a (n=14). Statistical analysis was made by using Chi square test ( correction by Yates), V-test, exact Fischer and Mann-Whitney tests.

Results: 1. There were no significant differences with regard to ALT, AST and glucose,  independently on etiology (HBV or HCV), but steatosis was significantly higher in patients with HCV (p<0,011) despite GT higher in HBV patients (p<0,0052).

2. In HCV group we showed significant differences in liver steatosis but only with grade 1 (p<0,034) in comparison with HBV patients where most of patients had no steatosis - grade 0 ( p<0,021). We did not observe such relationships in patients  with steatosis grade 2 or 3. 

3. There were  more HCV patients with mild steatosis  (grade 1) in the group of patients with genotype 3a  ( p<0,05) in comparison with genotype 1b. In the letter one  we observed more frequently patients without steatosis but it was not significant ( p=0,054).  There were no differences in grade 2 and 3 of steatosis between both genotypes.

Conclusions: There is possibility that HCV can be an independent factor of mild steatosis in patients with chronic viral hepatitis. In HCV patients mild steatosis ( grade 1) was more common in patients with genotype 3a in comparison with 1b.

PII_9

PROGRESSION OF LIVER FIBROSIS IN HCV INFECTED PATIENTS – RESPONDERS AND NON-RESPONDERS TO THE THERAPY

Kozłowska J., Mikuła T., Stańczak W., Jabłońska J.

Department of Hepatology and AIDS, Warsaw Medical University. 01-201 Warsaw,  37 Wolska

Head of the Department: Prof . Janusz Cianciara

.

 The liver biopsies were performed twice in at least 5 years intervals in 51 patients with confirmed chronic HCV infection. All patients were hospitalized in Department of Hepatology and AIDS, Warsaw Medical University.

All patients were divided into three groups:

Group 1 - 13 patients (4 women and 9 men) were not enrolled to treatment:

-   8 patients because of very slight - according past Polish recommendations advancement of

       HCV infection (low grade of inflammation and stage of fibrosis)

-   5 patients because of contraindications.

Group 2 - 13 (3 women and 10 men) sustained viral responders (SVR) for treatment IFN

      or  IFN+RIBA

Group 3  - 25 (9 women and 16 men) non - responders (NR)

Medium age of the patients was 37 years - comparable in all groups.

Fibrosis was evaluated according Scheuer Schedule from 0 to 4.

Medium staging results in the first and last biopsies in all patients - see Table 1.

Table 1. Medium staging in the first and last biopsy

Medium staging                First biopsy        Last biopsy

Group 1 (not-treated)          1,3                     1,4

Group 2 (SVR)                   1,4                     0,8

Group 3 (NR)                     1,6                     2,1

In the Group 1 - in 5/13 patients there was no progression in fibrosis, in 4/13 patients regression and in only 4/13 progress in fibrosis. 

In the Group 2 - in 5/13 patients there was no progression in fibrosis, in 7/13 patients regression and in only 1/13 progress in fibrosis. 

In the Group 3  - in 11/25 patient there was no progression in fibrosis, in 2/25 patients regression and in 12/25 progress in fibrosis – see Table 2. 

Table 2. Changing in fibrosis in all groups.

Fibrosis           Regression        Stable              Progression

Group 1           4                      5                      4

Group 2           7                      5                      1

Group 3           2                      11                    12

Conclusions: Surprisingly in not treated patients we found only slight progression of fibrosis and among non-responders - advanced progression.

PII_10

LONG-TERM OBSERVATION OF CHILDREN WITH CHRONIC HEPATITIS B AFTER SPONTANEOUS HBeAg/HBeAb SEROCONVERSION

Szczygielska I, Hernik E

Institute of Rheumatology, Warsaw, Spartańska 1

Objectives: Despite increasing knowledge concerning chronic hepatitis B infection, it is one of the most important epidemiological problems nowadays and there are still difficulties with the diagnosis of HBV infection, the disease treatment and long-term outcome. Hepatitis Be antigen clearance and production of anty-HBe antibodies is usually associated with clinical, biochemical and histopathological improvement.

The aim of this study was to analyze whether spontaneous HBeAg seroconversion in children persistently infected with hepatitis B correlated with the remission of the disease. We have also analyzed the frequency of disease progression despite HBeAg seroconversion.

Material and methods: Fifty children (39 males and 11 females, mean age 14.1 years) with confirmed chronic hepatitis B infection after spontaneous HBeAg seroconversion were included in the study. Patients presenting infection with other hepatitis viruses or other liver diseases were excluded from our analysis. Children with chronic HBV infection were followed up for 1 to 10 years (median 7.5 years). The following parameters were analyzed: serum ALT activity and bilirubin level, serum HBV-DNA level by PCR as well as ultrasonography and histopathological examination of the liver obtained by needle biopsy.

Results: In eighteen patients (36%) HBV-DNA in serum was negative. The complete disease remission was observed in 10 children (20%), the hiperbilirubinemia was found in 4 patients (8%) and the result of USG analysis was improper in remaining 4 children (8%). One child (2%) had clinical and histological evidence of cirrhosis.

The serum HBV DNA was found in 32 patients (64%), although the viremia levels ranged from <10³ to >10⁵ copies per ml. Ten children (20%) had active hepatitis and 9 (18%) were qualified to antiviral therapy.

Moreover, children with other coexisting diseases, showed higher viremia levels (>10⁵ copies/ml) despite normal ALT level and mild inflammation activity in liver biopsy.

Conclusions:

1.      The HBV DNA was still present in 32 patients despite spontaneous HBeAg seroconversion

2.      Spontaneous HBeAg seroconversion not always leads to disease remission

3.      Patients after spontaneous seroconversion should be treated as a possible source of infection

4.      This patients should be followed up by specialistic outpatient clinic and eventually qualified to antiviral therapy.

PII_11

THERAPY WITH NATURAL LEUKOCYTE INTERFERON AND RIBAVIRINE IN “DIFFICULT TO TREAT” PATIENTS INFECTED WITH HCV

Ewa Janczewska-Kazek¹, Beata Logiewa-Bazger², Dorota Meier², Michał Kukla³,

Marek Beniowski¹

      1. Department of Infectious Diseases, Medical University of Silesia, Chorzow, Poland

2.  Hepatology Outpatient Clinic, Chorzow, Poland

3. Department of Physiology, Medical University of Silesia, Zabrze, Poland

Introduction: Combination of pegylated interferon and ribavirin is the standard treatment of chronic hepatitis C; however in special groups of patients pegylated interferon may cause severe, even life-threatening side effects. The “natural” interferon appears to be immunologically indistinguishable from interferon produced by the human immune system, is better tolerated, induces less adverse events and lower  bone marrow suppression.

Aim: To evaluate safety, tolerability and efficacy of treatment with natural leukocyte interferon-alpha and ribavirine in “difficult to treat” patients infected with HCV (patients  with thrombocytopenia, patients with hypersensitivity to recombinant interferon,  non-responders to standard PEG-interferon + ribavirine therapy).

Methods: Twenty five subjects infected with HCV were included: 15 with liver cirrhosis (Child-Pugh score A) and coexistent thrombocytopenia (initial thrombocytes level 30-55 G/l; average 39 G/l), 3 with history of hypersensitivity to recombinant interferon (skin rash) and 7 non-responders to PEG-Interferon + ribavirine therapy with histologically confirmed liver cirrhosis. The patients were treated with natural leukocyte interferon-alpha (Alfaferone®) 3 MU tiw and ribavirine (Ribalfa®) 1000-1200 mg/day depending on body weight for 48 weeks. The patients were monitored at 1, 2, 3 and 4 week of therapy, then once monthly. HCV RNA was assessed at week 24 of the treatment. Treatment was being continued for 48 weeks independently from HCV RNA result.

Results: Drugs were well tolerated and we didn’t observe any serious adverse events. One patient prematurely discontinued the treatment at week 24 due to recurrent epistaxis. We didn’t notice any signs of hemorrhagic diathesis in remaining 14 thrombocytopenic patients. Platelets levels during the treatment were stable in these subjects with lowest values 52 to 28 G/l (average 37 G/L). We didn’t observe any allergic reaction to the natural interferon in 2 patients with history of hypersensitivity to recombinant interferon. One patient from this group developed mild allergic dermatitis which disappeared after administration of antihistaminic drugs without stopping the antiviral treatment. HCV RNA at week 24 was negative in 11 patients (44%). Sustained viral response was achieved in 3 patients (12%): 2 patients from thrombocytopenic group and 1 patient from the allergic group. No one from the non-responders group achieved sustained viral response.

Anemia requiring ribavirine dose reduction occurred in 10 patients.

Conclusions:

1. Natural leukocyte interferon-alpha and ribavirine in patients with contraindications to pegylated infection seems to be a safe alternative to standard therapy.

2. Efficacy of the treatment of studied group is relatively low; however it is supposed that in patient with advanced fibrosis and cirrhosis treatment with interferon may be beneficial because of its antifibrotic effect, independently from antiviral efficacy.

3. Treatment with natural leukocyte interferon-alpha and ribavirine is not effective in non-responders to standard PEG-interferon + ribavirine therapy.

14.05.06- niedziela (sesje poranne) III Sesja plenarna

OIII_1

RADICAL LIVER RESECTION AFTER NEOADJUVANT CHEMOTHERAPY IN CASE OF AN ORIGINALLY UNRESECTABLE, DISSEMINATED CHOLANGIOCELLULAR CANCER WITH METASTASES TO LUNGS - CASE REPORT
SŁUPSKI M, SZCZYLIK C, JASINSKI M
DEPARTMENT OF TRANSPLANTOLOGY AND GENERAL SURGERY UNIVERSITY HOSPITAL BYDGOSZCZ, 85-094, UL. M. SKŁODOWSKIEJ-CURIE 9,  DEPARTMENT OF ONCOLOGY CSK WAM WARSAW, UL. SZASEROW 4
 
Cholangiocellular cancers are about 20% of primary liver cancers. Prognosis is poor, less than 5% five-year survival. The case described shows remission of a disseminated cholangiocellular carcinoma (focal changes in liver, metastases to lungs) after neoadjuvant chemotherapy.
The initial diagnosis was based on ultrasound examination and confirmed with computer tomography. Tumour biopsy and histopathological examination revealed cholangiocellular carcinoma. The patient underwent chemotherapy in the Department of Oncology CSK WAM in Warsaw. After remission of lesions in lungs and reduction/regression of tumours in liver to one focal change, right lobe liver resection was performed in the Department of Transplantology and General Surgery CM UMK in Bydgoszcz. The
histopathological examination did not reveal any carcinoma cells, only necrotic tissues in place of the primary tumour as well as in local portal vein branches. 18 months after the operation the patient is in a good overall condition and no recurrence has been observed.
Conclusion:
Appropriate neoadjuvant chemotherapy may allow radical resection in a previously unresectable cholangiocellular cancer.

 

OIII_2

SPECTRUM OF CT FINDINGS ASSOCIATED WITH SPONTANEOUS
PRIMARY HEPATIC TUMOR RUPTURE
Maciej Michalak*, Ryszard Pacho*, Magdalena Huba*, Piotr Palczewski*, Leopold Bakoń*, Piotr Hevelke**, Krzysztof Zieniewicz**, Marek Krawczyk**
II Department of Radiology, The Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland.
**Department and Clinic of General Surgery and Liver Diseases, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland.

Background:
Spontaneous hepatic bleeding associated with primary hepatic tumor rupture is rarely encountered in clinical practice. Most often, hepatic hemorrhage is due to ruptured hepatocellular carcinoma and hepatic adenoma. Sporadically, the source of bleeding is FNH, angiomyolipoma or hemangioma, and, extremly rarely hepatoblastoma, hepatic sarcoma, or cholangiocarcinoma. The bleeding originates from rupture of tumor capsule, damage of feeding arteries, or thrombosis of draining veins. Proper and prompt clinical diagnosis is often challenging. In patients without prior symptoms clinical history is nonspecific- it does not confirm abdominal trauma or anticoagulant therapy. The clinical manifestation can be diverse: from nonspecific RUQ pain to hypovolemic shock. Therefore helical CT plays a significant role in the early diagnosis and management of bleeding from primary hepatic tumors.
Purpose:
The purpose of this work is to present the spectrum of  imaging findings which can be observed in emergency helical CT in primary hepatic tumor rupture.
Material/Methods:
The study included 5 cases of hemorrhagic primary hepatic tumors: 2 hepatocellular carcinomas and 3 hepatic adenomas. Triple phase helical CT of the liver was performed in all cases. MIP and VR postprocessing algorithms were used for the evaluation of tumor
vasculature.
Results:
CT findings included intrahepatic bleeding, subcapsular hematoma and intraperitonal hemorrhage. Particularly predisposed for rupture are large tumors, located  at the periphery of the liver. However, small tumors which are not very well seen on images, can be a source of massive bleeding as well. The identification of  damaged tumor capsule can be difficult.
In our material there was no evidence of  active bleeding after iv contrast injection.
It is noteworthy that when ascites is present, active intraperitoneal bleeding can be missed because of  dilution of  blood resulting in decreased density.
Conclusions:
Helical CT of the abdomen, especially MDCT, performed in the emergency setting is a method of choice in diagnosis of spontaneous hepatic bleeding associated with primary hepatic tumor rupture providing crucial information for further management of the patient and qualification to treatment: hepatectomy, interventional radiology procedures, or conservative therapy.
 

OIII_3

RESULTS OF SYNCHRONIC AND METACHRONIC LIVER RESECTIONS IN PATIENTS WITH COLONIC CANCER METASTASES
SŁUPSKI M, WŁODARCZYK Z, MASZTALERZ M, PACHOLSKA M, PIOTROWIAK I.
DEPARTMENT OF TRANSPLANTOLOGY AND GENERAL SURGERY UNIVERSITY HOSPITAL BYDGOSZCZ, 85-094, UL. M. SKŁODOWSKIEJ-CURIE 9

 

Background: Retrospective study of results of colonic cancer liver metastases surgical treatment.
Material and methods:
During the years 1997-1999 in the General and Vascular Surgery Department and 1999-2005 in the Transplantology and General Surgery Department, Collegium Medicum Nicolaus Copernicus University 75 liver resections were conducted in patients with colonic cancer metastases. The studied group consisted of 43 men at the average age of 57,9 and 32 women at the average age of 59,1. 61 metachronic and 14 synchronic liver resections have been conducted. Short and long term results have undergone
statistical analysis and have been compared in patients with metachronic and synchronic resections.
Results:
No statistical difference has been shown in the postoperative complications ratio in both groups whereas there have been some in the duration of operation (p&#8805;0,01), blood loss (p&#8805;0,05) and hospitalization period (p&#8805;0,05). Adjuvant chemotherapy has been introduced in both groups and prolonged hospitalization period in the patients after synchronic resections has not delayed the beginning of the chemotherapy. Cumulated survival rate according to Kaplan- Meier has been 56% in
the synchronic and 28% in the metachronic liver resections. Such surprising results may be due to the different patient number in the groups as well as colon resection having been conducted in different surgical centres in the metachronic resection group.
Conclusions: Proper qualification of patients with colonic cancer to the synchronic liver resection enables good long term results.

 

OIII_4

Long term results of liver transplantation for HCC-single centre experience.

¹Pacholczyk M., ¹Łągiewska B., ¹Chmura A., ¹Adadyński L., ¹Małkowski P., ¹Wasiak D., ²Nowacka-Cieciura E.

¹University  Department of General & Transplant Surgery, Medical University of Warsaw.

²University Department of Transplant Medicine and Nephrology, Institut of Transplantology, Medical University of Warsaw

Introduction. In view of the current literature liver transplantation is the best treatment modality for primary liver tumors within cirrhotic organ. The five year patient survival and low morbidity advocating the choice of transplantation for all patients meeting the extended Milan Criteria.

Aim of the study. The main aim of this study was to analyze the results of a recent series of liver transplant cirrhotic patients with  HCC, treated in our department.

Patients and method. During a period between 2000 and 2005 we performed 140 liver transplantations with a final diagnosis of HCC in cirrhotic liver in 6 patients. In 5 out of these patients the diagnosis of HCC was established before transplantation. In the remaining one case the presence of the tumor was found accidentaly in explanted native liver. The tumor diameter in these cases vary from 1 to 9 cm and the number of tumors from 1 to 5. One of the patients did not meet the Milan criteria (summarized tumor diameter 9 cm, 5 HCC lesions).

Results. Five patients (5 / 6 ) are still alieve and followed from 17 to 43 months after liver transplantation. Among them only in one case the recurrent liver tumor was diagnosed ( mixed form – HCC/CCC) at 25 months post OLT. One patient died at 13 months following surgery (diagnosed recurrence at 6^th month). This was the case who did not meet the Milan criteria.

14.05.06- niedziela (sesje poranne) III Sesja plakatowa

PIII_1

ELECTROFOCUSING OF N-ACETYL-&#914;-HEXOSAMINIDASE (HEX) ISOENZYMES FROM LIVER CARCINOMA
Borzym-Kluczyk M Radziejewska I Knaś  M Szajda S Dudzik  D Zaniewska  A Gołaszewska Z Zwierz K
Department of Pharmaceutical Biochemistry and Medical Chemistry, Medical University of Bialystok, Poland
 
Introduction: Primary hepatic carcinoma (about 0.7% of neoplasms) causes annually 2560 death in Poland and 548 000 in the world. Only &#188; of patients may be treated surgically, as diagnosis is usually to late and tumor to big.
N-acetyl-&#946;-hexosaminidase ( HEX) is a lysosomal exoglycosidase involved in the breakdown of oligosaccharide chains of glycoproteins, glycolipids and glycosaminoglycans. Determination of HEX activity was initially used for diagnosis of hereditary Tay-Sachs and Sandhoff's diseases. Recently the activity of HEX was used for diagnosis joint and liver diseases. HEX in majority tissues and body fluids exists as two isoenzymes i.e. HEX A and HEX B. The aim of our work is the evaluation of isoforms of HEX A and HEX B isoenzymes in human liver
Materials and Methods: Specimens from control and cancerous human liver were taken at operation. Tissue was homogenized in 0.05 M citrate-phosphate buffer, and centrifuged for 60min at 12,000x g. For electrofocusing supernatants were concentrated and electrofocused in Multiphor II ( Pharmacia) with ampholines 3,5-9.0 ( 2%). After separation, enzymatic activities were detected with &#945;-naphthyl-AS-AB- N-acetyl-&#946;-glucosaminide. The stained gels were dried and evaluated densitometrically.
Results : After electrofocusing we detected clearly separated two group of isoenzyme bands from human liver. One group of bands migrated near the anode with a pI of 5.0 and the other one at a pI of 7.3. These two isoenzyme group of bands were identified as HEX A (pI 5.0) and HEX B (pI 7.3).
 
 PIII_2

THE ANALYSIS OF FINAL RESULTS OF TREATMENT THE COLORECTAL METASTASES TO LIVER.

Musiewicz M., Olakowski M., Grabarczyk A., Mrowiec S., Ciosek J., Lampe P.

Katedra i Klinika Chirurgii Przewodu Pokarmowego Samodzielny Publiczny Centralny
Szpital Kliniczny Śląskiej Akademii Medycznej ul. Medyków 14 40-752
Katowice

INTRODUCTION: Liver resection is still the standard method of radical treatment of metastases of colorectal carcinoma. In last years, there has been an observed increase of interest in the ablation technique of treatment of non-resectable metastatic tumors. AIM OF STUDY: Analysis of results of treatment of patients which underwent hemihepatectomy, segmentectomy or cone hepatic resection, based on our own material.

MATERIAL AND METHOD:  From January 1990 through June 2005, 528 patients with diagnosed liver tumors have been treated. In the 379 persons (72%) a diagnosis of a malignant neoplasm was made and 170[45%] patients were treated because of colorectal cancer metastases. We performed: hemihepatectomy in 48 [28,2%] patients, segmentectomy or cone resection in 80 patients (47,1%), ablation in 12 patients (7,1%), hepatic artery cannulation for
arterial chemotherapy in 13 persons (7,6%) and explorative laparotomy in 17 patients (10%). In 12 patients we performed hemihepatectomy with cone resection of metastases in the remain lobe. Final results of resection or ablation of colorectal hepatic metastases in 134 patients [67 women, 67 men] were submitted to a retrospective analysis. The average patient age was 60 years [range 32-83]. The first group [I] inc1uded 48 patients after hemihepatectomy . The second group [II] inc1uded 80 patients after segmentectomy or cone resection. The third group [III] included 12 patients treated with the ablation technique. Synchronous resections
were performed in 36 patients (27%), while metachronous resections were performed in 98 cases (73%).

RESULTS: Mean intraoperative blood loss in I group was 725 ml (range: 300-3600 ml), II – 280 ml (range: 150-2500 mI), III-150ml [range:0-400]. Post-operative complications appeared in 42% patients after HH[I], in 30% patients after segmentectomy or cone resection [II] and in 8% patients after ablation [III]. Perioperative mortality was 8.3% [4 patients] in group I , 3,75% in group II, III-8% [1 patient]. Mean hospitalization time after surgery was 23 days in group I , 16 days in group II and 8 days in group III. 3-year survival
rate was 37% in group I and 31 % in group II; 5-year survival rate was 21 % in group I and 25% in group II.

CONCLUSIONS: The results of surgical treatment of colorectal metastases depends on extent of the resection procedure. The ablation technique is a safer alternative method of treatment for the selected group of patients who disqualified from the resection procedure.

PIII_3

HAEMANGIOMA IN THE LIVER HILUS AS A RARE CAUSE OF PORTAL HYPERTENSION
Pazgan- Simon M.,Szymczak A, Simon K
Klinika Chorób Zakażnych, Wątroby i Nabytych Niedoborów Odpornościowych we Wrocławiu
 
Introduction: liver haemangioma is the most common focal lesion. Most often, it is discovered incidentally by abdominal USG.  Haemangiomas are usually benign and therefore  not removed surgically, except for large surface  lesions which carry a risk of laceration.

Materials and methods: a case report of a 39-year old woman hospitalized with a portal vein thrombosis of unknown origin, portal hypertension and bleeding from upper gastrintestinal tract  at the Clinic of Infectious Diseases, Liver Diseases and Acquired Immune Deficiency (Clinic) in Wrocław.

Results: In January 2005, a 39-year old woman was admitted to  hospital in Ząbkowice Śląskie with a massive hemorrhage from the upper gastrintestinal tract. Initially, a conservative treatment was applied  without any further diagnostic. In May 2005, the patient was admitted to the surgical ward , from where - after a consultation and a gastroscopy which revealed advanced oesophageal varices - she was referred to the Clinic in Wrocław for endoscopic variceal ligation with nylon endominiloops. 10 endominiloops  were applied. Additional examinations of liver metabolic functions and possible causes of liver disorder excluded  the cirrhosis of the liver as the cause of the observed portal hypertension. An angio CT of the abdominal cavity  revealed  a homogeneous soft lesion with an equal contrast augmentation in the liver hilus, portal thrombosis  and splenic vein  thrombosis with a  well-developed collateral circulation in area  of pancreas and spleen.
In July, the patient was admitted again to the Clinic for ligation treatment - with  10 endominiloops applied. Due to vague results of the angio CT, the observed thrombosis of the portal vein  and normal blood test results,   the patient was referred to the  Clinic of Angiosurgery and Transplantology. Treatment included a laparotomy that revealed  a haemangioma in the liver hilus, which modeled  the pancreas and covered liver vessels. Neither a resection nor a vessel anastomosis was possible due to the lesion's location and anatomical condition.   In October, the patient was admitted again to  the Clinic in Wrocław. She was in a good condition and her blood test results were normal. Gastroduodenoscopy showed recurrent oesophageal varices and also gastric varices   with hemorrhagic parts. In view of limited funds, the varices were injected with  ethoxysclerol. The patient in still under clinic observation.

Conclusions:
1.Haemangioma located in a  liver hilus may lead to complications which suggest an advanced liver disorder  such as   portal hypertension or oesophageal varices.
2. "Malignant" location of a benign lesion may trigger  pathologies which resemble the cancer process, for example  the portal thrombosis.

 

PIII_4

FOCAL NODULAR HYPERPLASIA IN THE LIVER- ANALYSIS OF MULTIPHASE SPIRAL COMPUTER TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING
Edyta Szurowska, *Anna Lakomy, **Ewa Iżycka-Świeszewska, **Robert Rzepko, Joanna Pieńkowska, Mirosława Dubaniewicz-Wybieralska,   ***Paweł Szurowski, Adam Zapaśnik, Michał Studniarek, Arkadiusz Szarmach

Department of Radiology, Medical University, 80-211 Gdańsk, ul. Dębinki 7, Poland
* Department of Infectious Diseases, Medical University, Gdańsk, Poland
** Department of Pathology, Medical University, Gdańsk, Poland
*** Department of General Surgery, St. Adalbert Hospital, Gdańsk, Poland

The purpose of this study was to compare mulitiphase spiral CT and MR imaging to characterize FNH.
Material and method
The authors prospectively studied 30 FNH in 23 patients who underwent spiral CT and MR imaging. Multiphase spiral CT (sCT) included noncontrast scans (NC), hepatic arterial- (HAP), portal venous- (PVP) and equilibrium phase (EP). MRI was performed in all cases. T1- and T2- weighted images with SE, TSE sequences were used, along with dynamic study after i.v. administration Gd-DTPA. All lesions were confirmed pathologically. Each case was reviewed for the number of detectable lesions, density and signal intensity, type of enhancement in sCT an MR images and presence of central scar.
Results
The signal intensity in T1- and T2-weighted images was similar to surrounding parenchyma in 15/30 cases. Combined Tl- and T2-weighted images showed 6/30 lesions hypointense on Tl and hyperintense on T2. In 9 cases the lesion was hypointense in T1- and isointense in T2-weighted images. In 21 cases, the enhancement profile was characterized by intensive homogeneous enhancement in arterial phase and rapidly decreased enhancement in portal phase. Seven lesions presented homogenous enhancement in arterial and portal phase. The central scar was visualized in 17 lesions in sCT scans and 23 foci in MR images. For FNH with diameter <2 cm the central scar was undetectable in MR and CT studies.
Conclusion
Dynamic MR and sCT images demonstrate characteristic features that enable to confirm diagnosis of FNH in most of cases. MR imaging is superior to sCT in visualization of central scar.

 

 PIII_5

USEFULNESS OF MULTIPHASE SPIRAL COMPUTER TOMOGRAPHY  AND MAGNETIC RESONANCE  IMAGING IN CHARACTERIZATION OF FOCAL LIVER NON SPECIFIC IN ULTRASONOGRAPHY
Szurowska E, Studniarek M., *Rzepko R., **Witczak-Malinowska K., *Iżycka-Świeszewska E., Dubaniewicz-Wybieralska M., ***Szurowski Paweł, Szarmach A.

Department of Radiology, Medical University, Gdańsk, Poland
*Department of Pathology, Medical University, Gdańsk, Poland
** Department of Infectious Diseases, Medical University, Gdańsk, Poland
*** Department of General Surgery, St. Adalbert Hospital, Gdańsk, Poland

Purpose
The purpose of the study was the evaluation of utility of sCT and MR imaging in the characterization of HCC, metastases and hemangioma.
Materials and methods
Multiphase sCT and MRI was performed in 230 patients suspected (after ultrasongraphy) of hepatic tumor. 178 patients with hepatic mass (confirmed pathologically or by clinical and radiological follow-up) were included in this study. Nonenhanced scans were performed in all cases along with HAP, PVP and EP. The following sequences MRI were used: SE, TSE, TFE T1- and T2-weighted images, STIR and dynamic study with administration Gd-DTPA. In statistycal analysis, the sensitivity and accuracy of the methods were compared concerning the characterization of HCCs, metastases, hepatic hemangioma(HH) and FNH.
Results
98 HCC foci, 316 liver metastases and 77 hemangiomas were detected in 178 patients. The lesions ranged in size from 5 to 140 mm(median value 20 mm). The sensitivity of MR imaging versus sCT for characterization HH was 0,99 vs 0,78 (significant difference). For HCC mean sensitivity of MR imaging (82%) was significantly higher than that of sCT study (66%). In characterization of metastases the sensitivity of bouth methods was 0,79 vs 0,82.
Conclusion
The sensitivity of MR imaging seems similar to multiphase sCT study in the characterization of metastases, but MR imaging is the most sensitive in characterization of hemagiomas and HCCs. MR imaging is superior to the routinely used methods (US and sCT) in differentiation of focal liver lesion.
 

PIII_6

THE ACTIVITY OF a-MANNOSIDASE AND a-FUCOSIDASE

IN LIVER CANCEROUS TISSUE

Zwierz K¹, Snarska J², Szajda SD¹, Kamiński F², Knaś M¹, Zawadzki P¹, Borzym-Kluczyk M¹, Dudzik D¹, Zwierz P¹.

¹Department of Pharmaceutical Biochemistry, Medical University in Białystok,  Mickiewicza 2a Str. Białystok,

²I^stDepartament of General and Endocrinological Surgery, Medical University in Białystok, M.C. Skłodowskiej 24A Str. Białystok.

INTRODUCTION Cancerous transformation of tissue is accompanied by release of metabolites and variety of proteins (hormones, enzymes, receptors) from cancer and surrounding tissues to circulation. The substances used to detection cancer and its localization are called tumor markers. There are some data pointing at lysosomal exoglycosidases as tumor markers. The lysosomal exoglycosidases degrade oligosaccharide chains of glycoconjugates (glycoproteins, glycosaminoglycans and glycolipids).

THE AIM The aim of our study was to asses the activity of lysosomal exoglycosidases: a-mannosidase (a MAN) and a-fucosidase (a FUC) in human liver cancerous tissue.

MATERIALS AND METHODS Analysed group was consisted of metastases of adenocarcinoma to the liver (n=7), primary liver cancer – adenocarcinoma (n=1). Control group were liver tissue segments where cancer was histopatologicaly excluded (n=2). All specimens were obtained during surgery in I^st Department of General Surgery, Medical University in Bialystok, Poland. One gram specimens of liver cancerous and control tissue were homogenized with 9 ml of 1,54M KCl. Homogenates were centrifuged at 4⁰ C for 20 min at 12,000 x g. The activity of a MAN and a FUC in supernatants was determined by colorimetric method according to Chatteriee et al. as modified by Zwierz et al. The activity of exoglycosidases was expressed as amount of p-nitrophenol released from p-nitrophenyl derivatives of a-mannose and a-fucose, respectively.

RESULTS The preliminary results indicate on decrease in activity of α MAN and α FUC in cancerous tissue in comparison to control.

PIII_7

Water dissector HELIX HYDRO-JET IN LIVER RESECTION – initial self experiences

T. Okniński , P. Lesiuk, L. Gruszeczki, J. Pawlak
Department of General Surgery, Western Hospital, Grodzisk Mazowiecki

                                                                                                                                                      The aim of this article is presentation of new device for liver resection. The  blood losing, the duration of the operation and the early postoperative complications were estimated.

From  03.2005 to 01.2006 at our Ward was realized 20  liver resections, 8  segmentectomy and 12 hemihepatektomy. Indications for those operations were primary liver tumours, metastatic tumours of colon and liver hemangiomas.The dimension of the resection in each case was depended on lesion location and largeness.

Surgical intervencions were executed with water dissector  HELIX HYDRO-JET made by “ERBE”. This device permit to precision dissection tissues withouth damage nearly lying structures and single out (select) vessels and nerves. Also  provide simultaneous suction of dissected material  causes better view in operation area.

Above features directly  prevails to minimalize traumatism of the surrounding tissues, reduction of blood loss and reduction time procedure.

Preliminary results of  water dissector  HELIX HYDRO-JET use  are encouraging and we could ascertain that this device will apply in liver surgery.

PIII_8

EBAR – EUROPEAN BILIARY ATRESIA REGISTRY – POLISH PATIENTS

Joanna Pawłowska, Irena Jankowska, Piotr Czubkowski, Piotr Kaliciński, Magdalena Szabuńko*, Karolina Ratajczyk-Pekrul*, Diana Kamińska*, Jerzy Socha

The Children’s Memorial Hospital, Warsaw

Medical student, Warsaw Medical University

The European Biliary Atresia Registry (EBAR) was founded in 2001 in order to raise awareness of the biliary atresia (BA) and to reinforce international and interdisciplinary cooperation. In 2005 year 89 centers from 22 countries reports their data of BA patients to EBAR. The coordination of the whole programm is done in Medical School Hannover, Germany. The Children’s Memorial Health Institute, as a leading center of treating patients with biliary atresia, reports all their own patients as well as patients after Kasai operated elswhere in Poland and later send for futher treatment.

The aim of the study was to evaluate patients with biliary atresia operated during the last five years accoding their age at the operation, survival rate and timing of the transplantation.

Material: Between January 2001 and December 2005 a total number of 62 children (39 girls – 62%) with biliary atresia had hepatoportoenterostomy. The operation had been performed from 5 to 17 weeks of life (mean 9,5 weeks).

Results: Fifty eight children (93,5%) are still alive. One child with coexisting cystic fibrosis died at the forth day after operation, one with genetically  proven chromosomal aberration and severe cardiac anomaly died  four month after operation and one of a foregin orgin died six month after operation. Twenty six children (41%) had been transplanted. The age at the transplantation ranged from four month to four years and two month (mean 15 month). Only one child died few days after a retranplantation. All rest are alive and well. Six children are acctualy on a waiting list for transplantation.

Conclusion:

1.      The survival rate in children with biliary atresia is exelent.

2.      A great majority of children after hepatoportoenterostomy needs liver transplantation in the first two years of live.

P III 9

BILE DUCT PROTHESIS AND RADIOFREQUENCY THERMAL ABLATION : INFLUENCE AND RELATIONS."
Folwarski M., Zadrożny D., Adamonis W., Gross M.
Klinika Chirurgii Ogólnej, Endokrynologicznej i Transplantacyjnej Akademii Medycznej w Gdańsku, Dębinki 7, 80-211 Gdańsk

Katedra Patomorfologii Akademii Medycznej w Gdańsku, Dębinki 7, 80-211 Gdańsk
STN Akademii Medycznej w Gdańsku,

 

Background
The main purpose of the study was to asses the influence of the prothesis, inserted into the hepatic duct, on the process of liver radiofrequency thermal ablation. There were three main aims: 1) Estimating whether the bile duct prothesis modifies the spherical shape of the tissue coagulation range 2) Microscopic analysis of lesions in the hepatic duct wall and enclosing hepatic tissue 3) Observing the impact of the RF thermal ablation on the physical features of the prosthesis.
Material/Methods
Fresh porcine liver was used to perform the experiment. The hepatic duct was dissected and a bile duct prosthesis was introduced.  Radiofrequency ablation was conducted with Radionics Cool-Tip device. The liver was sliced and the coagulation zone was measured and photographed. A specimen including a fragment of the hepatic duct was taken for the histopathological examination. 
Results
A spherical range of coagulation was achieved and photographed. Its diameter was 4,5 cm. Prosthesis placed in the hepatic duct did not modify the shape of the ablation zone. Microscopic examination of the liver fragment exposed hepatic duct deprived of superficial epithelium, with features of its coagulation. The depth of coagulation along the bile duct was not regular- in the margin closer to the ablating electrode, the lesions depth reached 1mm and  in the opposite side of the bile duct only the epithelium was denatured.
Conclusions
Inserting a prothesis in the bile duct does not change the shape of the ablation zone. The depth of the bile duct lesions depends on the distance from the active electrode. High temperatures of the surrounding tissue does not alternate the physical features of the prothesis (flexibility, shape- remain the same)


 

PIII_10

Does hyperinsulinism exert a carcinogenic effect in cirrhosis type C?

Grzegorz Kulig¹, Marta Wawrzynowicz-Syczewska², Krzysztof Jurczyk², Ewa Karpińska², Anna Boroń-Kaczmarska²

¹Endocrinology Department of the Pomeranian Medical University, Szczecin

²Chair and Department of Infectious Diseases and Hepatology of the Pomeranian Medical University, Szczecin

Background: Insulin resistance (IR) frequently accompanies chronic viral hepatitis and liver cirrhosis of various etiology, but this effect as well as glucose intolerance are more common in hepatitis C virus (HCV) infection than in the other forms of chronic liver disease. Pathological mechanisms of this phenomenon are largely unknown. It seems, however, that biological properties of HCV may be of importance. It was shown in vitro studies that insulin can stimulate HCV replication. It was also proven that insulin is a mitogenic factor and takes part in transcription activity having a possible role in carcinogenesis processes.

Aim of the study was to look for the possible relationship between IR and hepatocellular carcinoma (HCC) by measuring insulin concentration and calculating insulin resistance  in cirrhotic patients with HCC, in patients with chronic viral hepatitis and in healthy controls.

Patients and methods: The study assessed 228 subjects divided into five groups. Group I comprised of 36 patients with HCC and cirrhosis type C; group II consisted of 18 patients with HCC and cirrhosis type B. Groups III and IV were composed of patients with chronic hepatitis: in group III there were 84 patients with chronic hepatitis type C (CHC) and group IV comprised of 58 patients with chronic hepatitis B (CHB). There were 32 healthy controls in group V. Fasting serum insulin and glucose were measured in every subject, and IR was determined using HOMA-IR and Quicki-IR equations. Statistical analysis was performed using licensed Statistica (Statsoft) 6.0 program.

Results: The highest insulin concentration was noted in group I (mean 27,68 mmol/L). Mean insulin level was lower in patients with HCC and cirrhosis type B (group II), but in comparison with group I this difference did not reach statistical significance, probably due to a small number of patients in group II (27,68 vs. 19,6 mmol/L, p=0.05). In group III mean insulin concentration was significantly higher than in group IV (24,7 vs. 13,8 mmol/L, p<0,05), but significantly lower in comparison with group I (24,7 vs. 27,68 mmol/L, p<0,001). Mean insulin concentration was the lowest in healthy controls, but only in comparison with group IV the difference was not statistically significant (10,15 vs. 13,8 mmol/l). Mean values of HOMA-IR and Quicki-IR showed similar differences as insulin concentration in all studied groups.

Conclusions: Our study confirms that IR seems to be a feature of chronic viral hepatitis and is especially prominent in chronic HCV infection. Insulin resistance increases in the advanced forms of liver disease and may contribute to the carcinogenic process in the liver.

PIII_12

A case report of extrahepatic hemangioma.

Nosek R^1,2, Kosieradzki M¹, Pacholczyk M¹, Łagiewka B¹, Adadynski L¹,Wasiak D¹, Kwiatkowski A¹, Czerwiński A¹, Małkowski P¹, Rybińska J³

1. Department of General and Transplantation Surgery, 2. Department of Anatomy, 3. Student of Health Scientes Faculty, Medical University of Warsaw

A 48-year-old woman was referred to our Department due to asymptomatic liver tumor, which was incidentally found on abdominal ultrasound. Diagnosis was confirmed with computed tomography (CT) and magnetic resonance (MR). CT showed  9 cm, clearly-bordered  tumor localized in the 6-th segment of the liver. The tumor was visible as extra-hepatic lesion, which disfigured liver margin and protruded to the right iliac fossa and was compressing the kidney and ascending colon. As in CT scan, MRI visualized pathologic lesion 8.5x9 cm originating from VI segment of the liver, hyper-intensive in T1 and hypo-intensive in T2 phase, with contrast enhancement from tumor border. CT and MRI were both suggestive of hepatic hemangioma. Tumor markers blood levels (AFP, CEA, CA 19-9) were within normal range. Patient was scheduled for laparotomy and resection of the lesion. On the procedure, 10-cm in diameter, pedunculated, protruding to iliac fossa, mobile liver tumor originating from the VI segment was found. Flat, 5 cm-wide tumor peduncle extended from the inferior border of the right lobe. Resection was performed. Microscopic study revealed liver hemangioma.

14.05.06- niedziela (sesje ranne). IV Sesja: prezentacja wybranych plakatów z sesji PI, PII, PIII

O/PIV_1

ANALYSIS OF INDICATIONS FOR LIVER TRANSPLANTATIONS IN PATIENTS WITH WILSON'S DISEASE ACCORDING TO NEW KING'S COLLEGE SCORING SYSTEM
Socha P1, Pawłowska J1, Dądalski M1, Jankowska J1, Schmidt H2, Dhawan A3
1-Departament of Gastroenterology, Hepatology and Immunology, Children's Memorial Health Institute, Warsaw
2-Charite Mitte, Berlin
3-King's College, Londyn

Background: King's College has lately proposed new scoring system to be used to assess clinical course and indications for liver transplantation (LTx) in patients with Wilson's disease (WD) (A. Dhawan et al. Liver Transplantation 2005, 11: 441-448). Scoring (based on bilirubin and albumin concentrations, INR, leucocytosis and AspAT activity) over 11 corresponds to poor outcome without LTx.
Patients and Methods: Indications for LTx in patients with WD in our centre within last two years were analyzed.
Results: Two patients with WD were qualified for LTx. In the first of them the clinical onset (jaundice, liver and spleen enlargement, ascites, coagulopathy) of the disease was at the age of 8. Normal aminotranspherases, elevated bilirubin 4,7/2,7 mg/dl, INR 2,16, albumin concentration 38,75 g/l, leucocytosis 7,7 were found in laboratory tests. Basing on molecular analysis, decreased serum ceruloplazmin concentration (13 mcg/dl) and increased 24h urinary copper excretion (152 mcg) WD was diagnosed. Treatment with penicyllamine was started. King's College scoring equals 5. Because after one month of therapy no improvement was observed, patent was qualified for LTx (PELD 11), but it was not performed. After nine months of therapy ascites, hepatomegaly and cholestasis recovered and INR returned to normal ranges - 1,12.
The second patent had clinical onset of the disease (cholestasis, encephalopathy, hepatomegaly and ascites) At the age of 13. Slightly elevated AspAT (130), bilirubin (2,1/0,8) and leucocytosis (13,7), increased INR (3,3) and albumin concentration 36,05 g/l were found in laboratory tests. Due to serious clinical course patient was qualified for LTx (MELD 23) before final diagnosis was established. WD was later diagnosed according to molecular analysis, increased liver copper (759 mcg/g), decreased serum ceruloplazmin concentration (13 mcg/dl) and increased 24h urinary copper (357 mcg). King's College scoring equals 9. Treatment with penicyllamine was started. After nine months of therapy ascites, hepatomegaly and cholestasis recovered and INR improved to 1,36.
Conclusion: The case reports analysis supports King's College opinion that clinical outcome without LTx in case of WD is better than in other liver diseases and standard indications for LTx ought to be replaced with those corresponding to WD.

O/PIV_2

THE ANALYSIS OF FINAL RESULTS OF TREATMENT THE COLORECTAL METASTASES TO LIVER.

Musiewicz M., Olakowski M., Grabarczyk A., Mrowiec S., Ciosek J., Lampe P.

Katedra i Klinika Chirurgii Przewodu Pokarmowego Samodzielny Publiczny Centralny
Szpital Kliniczny Śląskiej Akademii Medycznej ul. Medyków 14 40-752
Katowice

INTRODUCTION: Liver resection is still the standard method of radical treatment of metastases of colorectal carcinoma. In last years, there has been an observed increase of interest in the ablation technique of treatment of non-resectable metastatic tumors. AIM OF STUDY: Analysis of results of treatment of patients which underwent hemihepatectomy, segmentectomy or cone hepatic resection, based on our own material.

MATERIAL AND METHOD:  From January 1990 through June 2005, 528 patients with diagnosed liver tumors have been treated. In the 379 persons (72%) a diagnosis of a malignant neoplasm was made and 170[45%] patients were treated because of colorectal cancer metastases. We performed: hemihepatectomy in 48 [28,2%] patients, segmentectomy or cone resection in 80 patients (47,1%), ablation in 12 patients (7,1%), hepatic artery cannulation for
arterial chemotherapy in 13 persons (7,6%) and explorative laparotomy in 17 patients (10%). In 12 patients we performed hemihepatectomy with cone resection of metastases in the remain lobe. Final results of resection or ablation of colorectal hepatic metastases in 134 patients [67 women, 67 men] were submitted to a retrospective analysis. The average patient age was 60 years [range 32-83]. The first group [I] inc1uded 48 patients after hemihepatectomy . The second group [II] inc1uded 80 patients after segmentectomy or cone resection. The third group [III] included 12 patients treated with the ablation technique. Synchronous resections
were performed in 36 patients (27%), while metachronous resections were performed in 98 cases (73%).

RESULTS: Mean intraoperative blood loss in I group was 725 ml (range: 300-3600 ml), II – 280 ml (range: 150-2500 mI), III-150ml [range:0-400]. Post-operative complications appeared in 42% patients after HH[I], in 30% patients after segmentectomy or cone resection [II] and in 8% patients after ablation [III]. Perioperative mortality was 8.3% [4 patients] in group I , 3,75% in group II, III-8% [1 patient]. Mean hospitalization time after surgery was 23 days in group I , 16 days in group II and 8 days in group III. 3-year survival
rate was 37% in group I and 31 % in group II; 5-year survival rate was 21 % in group I and 25% in group II.

CONCLUSIONS: The results of surgical treatment of colorectal metastases depends on extent of the resection procedure. The ablation technique is a safer alternative method of treatment for the selected group of patients who disqualified from the resection procedure.

O/PIV_3

USEFULNESS OF MULTIPHASE SPIRAL COMPUTER TOMOGRAPHY  AND MAGNETIC RESONANCE  IMAGING IN CHARACTERIZATION OF FOCAL LIVER NON SPECIFIC IN ULTRASONOGRAPHY
Szurowska E, Studniarek M., *Rzepko R., **Witczak-Malinowska K., *Iżycka-Świeszewska E., Dubaniewicz-Wybieralska M., ***Szurowski Paweł, Szarmach A.

Department of Radiology, Medical University, Gdańsk, Poland
*Department of Pathology, Medical University, Gdańsk, Poland
** Department of Infectious Diseases, Medical University, Gdańsk, Poland
*** Department of General Surgery, St. Adalbert Hospital, Gdańsk, Poland

Purpose
The purpose of the study was the evaluation of utility of sCT and MR imaging in the characterization of HCC, metastases and hemangioma.
Materials and methods
Multiphase sCT and MRI was performed in 230 patients suspected (after ultrasongraphy) of hepatic tumor. 178 patients with hepatic mass (confirmed pathologically or by clinical and radiological follow-up) were included in this study. Nonenhanced scans were performed in all cases along with HAP, PVP and EP. The following sequences MRI were used: SE, TSE, TFE T1- and T2-weighted images, STIR and dynamic study with administration Gd-DTPA. In statistycal analysis, the sensitivity and accuracy of the methods were compared concerning the characterization of HCCs, metastases, hepatic hemangioma(HH) and FNH.
Results
98 HCC foci, 316 liver metastases and 77 hemangiomas were detected in 178 patients. The lesions ranged in size from 5 to 140 mm(median value 20 mm). The sensitivity of MR imaging versus sCT for characterization HH was 0,99 vs 0,78 (significant difference). For HCC mean sensitivity of MR imaging (82%) was significantly higher than that of sCT study (66%). In characterization of metastases the sensitivity of bouth methods was 0,79 vs 0,82.
Conclusion
The sensitivity of MR imaging seems similar to multiphase sCT study in the characterization of metastases, but MR imaging is the most sensitive in characterization of hemagiomas and HCCs. MR imaging is superior to the routinely used methods (US and sCT) in differentiation of focal liver lesion.

 

O/PIV_4

CLINICAL COURSE OF LIVER DISEASE IN 14 CASES OF WILSON DISEASE

Jabłońska J., Nazzal K., Stańczak W

Department of Hepatology and AIDS, Warsaw Medical University, 01-201 Warsaw,  37 Wolska St

Head of the Department: Prof . Janusz Cianciara

INTRODUCTION

Wilson disease is autosomal recessive genetic disease resulting from copper deposition in brain and liver. Mutation in ATP7B gene causes failure of biliary excretion of copper. Neurological symptoms are: movement disorders, dysarthria, tremor, dystonia, behavioral abnormalities. Liver disease may present as hepatitis (acute or reccurent, cirrosi or liver failure.

AIM

We present clinical course and outcome of  14 cases of liver disease in patients with Wilson disease diagnosed in Department of hepatology

RESULTS

Fourteen  patients (10 female, 4 male) with Wilson disease were hospitalized in Department of Hepatology and AIDS in years 1995-2005. Mean age was 27 years (range 17-49). Seven patients had acute liver failure, with low aminotransferases level and hemolysis. In 5 cases clinical picture was similar to acute hepatitis with ALT > 1000 U/l. Two patients had liver cirrhosis. In all cases copper urinary excretion was significantly elevated. Ceruloplasmin level was decreased in 13 cases. None patient had neurologic symptoms before hospitalization.

Three  patients, all with “hepatitis like” model of disease,  are successfully treated with penicylamine and/or zinc. In 7 cases liver transplantation was successfully performed. Five patients  died -  3 because of liver failure, 1 – paralytic ileus, 1 – fungaemia.

CONCLUSIONS

Each patient with liver disease younger than 40 years should be tested for Wilson disease

Clinical manifestations of hepatic damage in Wilson disease are variable

In cases with liver failure only one successful treatment is liver transplantation

O/PIV_5

Does hyperinsulinism exert a carcinogenic effect in cirrhosis type C?

Grzegorz Kulig¹, Marta Wawrzynowicz-Syczewska², Krzysztof Jurczyk², Ewa Karpińska², Anna Boroń-Kaczmarska²

¹Endocrinology Department of the Pomeranian Medical University, Szczecin

²Chair and Department of Infectious Diseases and Hepatology of the Pomeranian Medical University, Szczecin

Background: Insulin resistance (IR) frequently accompanies chronic viral hepatitis and liver cirrhosis of various etiology, but this effect as well as glucose intolerance are more common in hepatitis C virus (HCV) infection than in the other forms of chronic liver disease. Pathological mechanisms of this phenomenon are largely unknown. It seems, however, that biological properties of HCV may be of importance. It was shown in vitro studies that insulin can stimulate HCV replication. It was also proven that insulin is a mitogenic factor and takes part in transcription activity having a possible role in carcinogenesis processes.

Aim of the study was to look for the possible relationship between IR and hepatocellular carcinoma (HCC) by measuring insulin concentration and calculating insulin resistance  in cirrhotic patients with HCC, in patients with chronic viral hepatitis and in healthy controls.

Patients and methods: The study assessed 228 subjects divided into five groups. Group I comprised of 36 patients with HCC and cirrhosis type C; group II consisted of 18 patients with HCC and cirrhosis type B. Groups III and IV were composed of patients with chronic hepatitis: in group III there were 84 patients with chronic hepatitis type C (CHC) and group IV comprised of 58 patients with chronic hepatitis B (CHB). There were 32 healthy controls in group V. Fasting serum insulin and glucose were measured in every subject, and IR was determined using HOMA-IR and Quicki-IR equations. Statistical analysis was performed using licensed Statistica (Statsoft) 6.0 program.

Results: The highest insulin concentration was noted in group I (mean 27,68 mmol/L). Mean insulin level was lower in patients with HCC and cirrhosis type B (group II), but in comparison with group I this difference did not reach statistical significance, probably due to a small number of patients in group II (27,68 vs. 19,6 mmol/L, p=0.05). In group III mean insulin concentration was significantly higher than in group IV (24,7 vs. 13,8 mmol/L, p<0,05), but significantly lower in comparison with group I (24,7 vs. 27,68 mmol/L, p<0,001). Mean insulin concentration was the lowest in healthy controls, but only in comparison with group IV the difference was not statistically significant (10,15 vs. 13,8 mmol/l). Mean values of HOMA-IR and Quicki-IR showed similar differences as insulin concentration in all studied groups.

Conclusions: Our study confirms that IR seems to be a feature of chronic viral hepatitis and is especially prominent in chronic HCV infection. Insulin resistance increases in the advanced forms of liver disease and may contribute to the carcinogenic process in the liver.