THE AIM OF THE STUDY: To evaluate the efficacy of combined antiviral treatment with pegylated interferon alpha plus ribavirin in patients with chronic HCV infection who have not yet been treated with antivirals (treatment-naive patients). To compare the treatment effect in patients with low (< 600,000 IU/ml) and high (> or = 600,000 IU/ml) initial viremia. METHODS AND TREATMENT REGIME: Treatment-naive patients with chronic HCV infection treated with the combination therapy of pegylated interferon-alpha2a plus ribavirin. Treatment response was evaluated at weeks 12, 24 and 48 when treatment was ongoing and at weeks 12, 24 and 48 after the treatment was finished. Commercially available sets from various manufacturers were used for serum and molecular genetic diagnostics of HCV infection. PATIENT SAMPLE: Antiviral treatment was initiated in 175 patients between 2001 and 2007. The complete data sets suitable for statistical analysis were available for 143 patients. End of treatment response and sustained viral response analyses were conducted separately for HCV genotype 1 (n = 124) and genotype 2 + 3 (n = 7). RESULTS: In the genotype 1 group, 76% of patients achieved end of treatment response and 59% of patients achieved sustained viral response. Both types of response were observed in 100% of the genotype 2 and 3 infected patients. When a correlation between initial viremia and sustained viral response was analysed, no statistically significant difference was observed between patients with low (< 600,000 IU/ml) and high (> or = 600,000 IU/ml) initial viremia. CONCLUSION: The results observed in the present study are generally slightly better than comparable results from large registration studies. In contrary to the published literature, the threshold of 600,000 IU/ml for initial viremia did not correlate statistically significantly with SVR.

• MeSH
• antivirové látky aplikace a dávkování   MeSH
• chronická hepatitida C farmakoterapie   virologie   MeSH
• dospělí MeSH
• genotyp MeSH
• Hepacivirus genetika   MeSH
• interferon alfa-2 MeSH
• interferon alfa aplikace a dávkování   MeSH
• kombinovaná farmakoterapie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• polyethylenglykoly aplikace a dávkování   MeSH
• rekombinantní proteiny MeSH
• ribavirin aplikace a dávkování   MeSH
• viremie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antivirové látky MeSH
• interferon alfa-2 MeSH
• interferon alfa MeSH
• peginterferon alfa-2a MeSH Prohlížeč
• polyethylenglykoly MeSH
• rekombinantní proteiny MeSH
• ribavirin MeSH

Cholestasis is a condition, where the bile flow into the intestine is defective. The causes may be extrahepatic (in large biliary ducts) or intrahepatic (at the level of hepatocytes or minor biliary ducts). The lack of bile in the intestine results in serious consequences, mainly malabsorption, malnutrition and skeletal changes. The compounds, which are normally excreted in the bile, accumulate and liver biliary cirrhosis ensues. Cholestatis is characterized by a typical laboratory picture, outlined in publications, which serves for differentiation of individual forms of cholestasis. There are various causes of cholestasis, listed in the survey. Extrahepatic cholestasis must be treated as early as possible (by endoscopy or surgery). The highest attention is devoted mainly to chronic intrahepatic cholestatis: primary biliary cirrhosis. It affects mainly women at middle age and is most frequently considered as an autoimmune disease. A survey of present therapeutic possibilities for cholestasis is given. Ursodeoxycholic acid became the main therapeutic drug. It must be administered as early as possible and for long period of time in all cases.

• MeSH
• cholestáza * diagnóza   etiologie   patofyziologie   terapie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

INTRODUCTION: The importance of liver biopsy and knowledge of the histological activity of liver les on in chronic hepatitis C virus (HCV) infections is widely discussed recently. There are attempts to find an alternative evaluation which will make it possible to avoid liver biopsy. The crucial question in patients with chronic HCV infection is to differentiate patients with already developed liver cirrhosis from those with chronic hepatitis. OBJECTIVES: 1. To evaluate the impact of the calculation of the discrimination score of liver cirrhosis (DSC) for prediction of liver cirrhosis in the histological assessment. 2. To assess the correlation of prediction of cirrhosis liver based on clinical signs and actual histological verification. 3. To evaluate the frequency of unexpected histological findings not correlating with the clinical picture. GROUP OF PATIENTS: The group was formed by 139 patients. In all patients during the baseline examination the patient's history data were analyzed as well as possible physical signs of liver cirrhosis. In all patients also, based on laboratory values before liver biopsy, the DSC according to Bonacini was calculated. Furthermore agreement between the histological finding of liver cirrhosis and chronic hepatitis with DSC values was assessed. RESULTS: 1. Based on calculation of DSC it is possible to predict accurately the existence of cirrhosis of the liver or chronic hepatitis only in 31% patients. In 69% patients even comprehensive evaluation of the type of DSC is not a sufficient guide for assessment of the hepatic lesion. 2. Even clinical signs of cirrhosis are not a quite reliable guide for its prediction. In 8% patients of our group the histological finding of liver cirrhosis was a surprise and in 3.5% patients cirrhosis of the liver was not confirmed despite the presence of clinical signs. 3. The frequency of other histological findings participating in the development of the hepatic lesion in chronic HCV infection was minimal. In the authors group as such only steatosis and toxic damage of hepatic tissue by alcohol were identified. These findings were, however, suspected already before biopsy. Steatosis can be however considered also a manifestation of HCV infection. CONCLUSION: The results of the trial support the view that liver biopsy is in the majority of cases irreplaceable for evaluation of the severity of the hepatic affection in chronic HCV infection.

• MeSH
• chronická hepatitida C komplikace   diagnóza   patologie   MeSH
• dospělí MeSH
• jaterní cirhóza diagnóza   virologie   MeSH
• játra patologie   MeSH
• jehlová biopsie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Recent reports from all over the world have repeatedly indicated a change in the incidence of individual risk factors for hepatitis C virus (HCV) infection transmission compared with the pattern in the late 1980s and early 1990s. In the Czech Republic, HCV is very often referred to as an addicts' disease, rare in the general population. To establish the incidence of individual risk factors for HCV infection transmission in a group of patients on follow-up at the Department of Internal Medicine I. General University Hospital in Prague 2. METHODS AND RESULTS: The group of patients included 216 individuals (127 men, 89 women) with documented HCV infection. The mean age of the patients was 40.2 years (10-81 years; SD 14.3). The risk factors were identified on the basis of evaluation of the patient's medical history, and/or their medical records if available. The presence of at least one of the following risk factors was regarded as the source of infection (the figure in brackets gives the incidence of the respective factor in the examined group in percent): blood product transmission (15%), intravenous drug injection (16%), inclusion into a regular dialysis program (12%), profession-related risk of transmission (10%), sexual contact with an infected individual (2%), surgery including dental surgery (14%), invasive examination (6%), and tattooing (1%). No risk factor for infection transmission was identified in 24% of cases. CONCLUSIONS: It has been shown a risk factor for infection transmission can be identified, through careful examination of medical history data, in the Czech population in as much as 76% of cases. An important finding is the fact the infection can be regarded as iatrogenic in as much as 57% of cases. Our data clearly show HCV infection is not exclusively a disease of intravenous drug addicts.

• MeSH
• dítě MeSH
• dospělí MeSH
• hepatitida C epidemiologie   přenos   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

Liver diseases are frequently associated with disorders of the carbohydrate metabolism--impaired glucose tolerance, hyperinsulinaemia, insulin resistance. Impaired glucose tolerance is due in particular to impaired glucose uptake in the splanchnic area and periphery. Glucose production by the liver is normal, similarly as insulin secretion. Its reduced clearance leads to hyperinsulinaemia with subsequent down regulation of insulin receptors and the development of insulin resistance. In diabetic subjects hepatomegaly is frequent, most frequently associated with steatosis of the liver. It correlates with the degree of obesity rather than the type of hepatic lesion. It is reversible for a long time and develops into cirrhosis only when combined with other factors, in particular alcoholism or infection with hepatotropic viruses. Cirrhosis of the liver is also more frequent in diabetic subjects. Treatment with antidiabetics is discussed, attention is drawn to new types of biguanides, which may have some advantages. Cholelithiasis is in diabetic subjects three times more frequent and leads more frequently to serious, in particular inflamatory, complications with an adverse course. Therefore cholecystectomy should be contemplated. According to contemporary views it seems that diabetic hepoatopathy proper does not exist. The authors draws practical conclusions for the everyday work of physicians.

• MeSH
• hyperinzulinismus komplikace   MeSH
• inzulinová rezistence MeSH
• komplikace diabetu * MeSH
• lidé MeSH
• nemoci jater * komplikace   diagnóza   metabolismus   MeSH
• porucha glukózové tolerance komplikace   metabolismus   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

Hepatic cysts are at the present time of widespread use of abdominal ultrasonography a frequent finding. The authors summarize contemporary diagnostic possibilities of liver cysts and submit variants of the therapeutic procedure in case of symptomatic liver cysts. They present their own experience with the treatment of hepatic cysts by the evaluation method combined with administration of 96% ethanol into the cyst. They compare this therapeutic procedure with the method of simple evaluation of the contents of the cyst. The method of evaluation of hepatic cysts under ultrasonographic control with subsequent administration of 96% alcohol appears to be more successful from the aspect of the long-term effect, manifested by the disappearance of clinical symptoms and non-refilling of the cyst.

• MeSH
• cysty * diagnostické zobrazování   terapie   MeSH
• diferenciální diagnóza MeSH
• drenáž MeSH
• ethanol aplikace a dávkování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci jater * diagnostické zobrazování   terapie   MeSH
• sklerotizující roztoky aplikace a dávkování   MeSH
• ultrasonografie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky kontrolované MeSH
• klinické zkoušky MeSH
• Názvy látek
• ethanol MeSH
• sklerotizující roztoky MeSH

Patients with Crigler-Najjar syndrome and Gunn rats cannot form bilirubin glucuronides owing to a lack of bilirubin UDP-glucuronosyltransferase activity. Because increased serum and tissue bilirubin levels remain constant, an alternative excretory route has to substitute for this deficiency. Gunn rats excrete in bile only 2-13% of the bilirubins eliminated in Wistar rats. In contrast, the biliary excretion rate of urobilinogen in Gunn and Wistar rats is comparable. The sum of bilirubins and urobilinogen excreted in the bile of Gunn rats amounts to 10-30% of pigments excreted in Wistar rats. Despite this low biliary excretion, the intestinal content and fecal excretion of bile pigments in Gunn and Wistar rats were similar. These data support an extrabiliary entrance of unconjugated bilirubin into the intestine. Additional proof for this was found in that the intestinal lumen of Gunn rats still contains a high amount of bilirubins and urobilinogen after 3 d of external biliary drainage. A similar procedure in Wistar rats resulted in the complete disappearance of bile pigments from the intestine. The direct transmural transport of bilirubin from blood to all parts of the intestinal lumen was demonstrated by injecting 14C-bilirubin i.v. into Gunn rats with isolated parts of small and large intestine. In Crigler-Najjar and Gilbert's syndrome patients, the biliary excretion of bile pigments has previously been shown to be strongly reduced. Their stools, however, contained approximately the same amount of bile pigments as in normal subjects. Although only traces of unconjugated bilirubin were detected in the stool of normal persons (4 +/- 3% of total bile pigments), higher amounts were found in patients with Crigler-Najjar disease (20 +/- 12&). These results suggest a direct intestinal permeation of unconjugated bilirubin in severe unconjugated hyperbilirubinemia both in man and rats.

• MeSH
• bilirubin metabolismus   MeSH
• Criglerův-Najjarův syndrom patofyziologie   MeSH
• familiární hyperbilirubinemie patofyziologie   MeSH
• Gilbertova nemoc patofyziologie   MeSH
• krysa rodu Rattus MeSH
• lidé MeSH
• potkani Gunn MeSH
• potkani Wistar MeSH
• střevní sliznice metabolismus   MeSH
• studie případů a kontrol MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• lidé MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• bilirubin MeSH

BACKGROUND: Pharmacotherapy of primary biliary cirrhosis (PBC) was not resolved unequivocally so far. During the last decade bile acids are used more widely. The objective of the submitted paper was to investigate under conditions of an open perspective study the influence of long-term administration of ursodeoxycholic acid on the clinical course and selected laboratory indicators. METHODS AND RESULTS: Ursodeoxycholic acid (Ursosan cps PRO.MED.CS) was administered to patients with PBC for a period of three years, 10-12 mg/kg/day. The investigation was completed by 13 women with a confirmed diagnosis of PBC which met clinical, laboratory and morphological criteria. During treatment marked improvement of itching was recorded, a significant drop of serum bilirubin, ALP and ALT. Changes of serum albumin levels were recorded only after three years treatment. The prothrombin time and galactose elimination capacity did not change significantly. Immunoglobulins M remained elevated and antimitochondrial antibodies were detected throughout treatment. The prognosis of the disease was evaluated by means of the Mayo score, the values of which declined significantly during the investigation. No serious side-effects were observed during treatment. CONCLUSIONS: Clinical evaluation proved beyond doubt a favourable effect of ursodeoxycholic acid on clinical and laboratory findings in PBC. Treatment should be started as soon as possible. Long-term continual administration is preferable.

• MeSH
• biliární cirhóza farmakoterapie   MeSH
• dospělí MeSH
• kyselina ursodeoxycholová terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• Názvy látek
• kyselina ursodeoxycholová MeSH

Hepatocellular carcinoma (HCC) is a highly malignant tumour with a poor prognosis. Its incidence is rising. The estimate incidence worldwide is 1 million cases. Most frequently it develops in livers already affected by cirrhotic transformation. How cirrhosis predisposes for the development of HCC is not clear. It is probably associated with the increased DNA synthesis in regeneration nodules. In micronodular transformation (most frequently alcoholic) the incidence is less frequent than in the macronodular from (mostly posthepatitic). The relationship of HCC and viral hepatitis is beyond doubt-this applies in particular to hepatitis B and C. Chronic alcoholism must not be either. There the risk of development of HCC is four times higher than non-alcoholics. Toxins can be also important for the development of HCC (in particular aflatoxins, chlorinated hydrocarbons, pesticides). As to drugs, in particular anabolics and contraceptives are suspected. Smoking is also a risk factor. HCC is encountered also more frequently in some liver diseases caused by metabolic disorders. It is probable than the development of HCC is a multifactorial process with a marked component of liver transformation.

• MeSH
• hepatocelulární karcinom epidemiologie   etiologie   MeSH
• incidence MeSH
• lidé MeSH
• nádory jater epidemiologie   etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Portal hypertension is a condition with a permanently raised pressure in the portal area. The most frequent cause is restricted blood flow through some part of the circulation. Depending on the site of obstruction, we classify portal hypertension into prohepatic, hepatic and posthepatic. In adult age the most frequent form is the hepatic one associated with cirrhosis of the liver, in childhood prehepatic hypertension associated with thrombosis of the porta. The significance of portal hypertension is due in particular to its sequelaes. Among the most serious ones is the development of a collateral circulation with subsequent gastroesophageal varicosities. The latter involve the risk of rupture and massive haemorrhage into the gastrointestinal tract. The patient develops posthaemorrhagic shock. The author mentions the most important metabolic and cellular changes caused by shock. The importance of complications is emphasised. Haemorrhage is frequently followed by hepatic failure, which even nowadays is usually fatal. The author mentions also the risks of hypersplenism and emphasizes their participation in haemorrhage. In the introduction the author points out why wo much attention should be paid so portal hypertension and procedures influencing it.

• MeSH
• lidé MeSH
• portální hypertenze * komplikace   etiologie   patofyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH