[Treatment response in chronic hepatitis C. Content of virus in serum is decisive for the outcome]
Weiland O. Danielsson A. Loof L.
Infektionskliniken, Huddinge sjukhus.
The article consists in a brief review of pre-treatment evaluation and antiviral treatment of chronic hepatitis C (HCV) infection. Patients with viraemia (i.e. HCV RNA seropositive with the PCR technique) should be evaluated historically if they lack contraindications for interferon alpha (IFN-alpha) treatment. Patients with depression, autoimmune and thyroid disorders, decompensated cirrhosis, or solid organ transplants, are ineligible for-IFN-alpha treatment. If the histological evaluation shows moderate to severe chronic hepatitis, and the HCV RNA level is < 3 million Eq/mL serum as measured by bDNA, naive (i.e. formerly untreated) patients should be given an initial 12-week course of IFN-alpha to evaluate treatment response. Those who become HCV-negative should continue the treatment for 48 weeks to increase the likelihood of sustained virological response after treatment cessation. Treatment should be discontinued in the case of patients still HCV-positive at 12 weeks, as the chances of obtaining sustained response are remote. Patients with higher pre-treatment HCV RNA levels (> or = 3 million Eq/mL) and patients manifesting unsustained response to earlier IFN treatment should receive combination treatment with ribavirin and IFN-alpha, as treatment with IFN alone is associated with poor chances of sustained response. This treatment approach is associated with an estimated sustained response rate in naive patients of 40-50 per cent.
[Certain immune-genes may affect Crohn disease. Advances in diagnosis, pathogenesis and treatment]
Befrits R. Hultcrantz R.
Kliniken for gastroenterologi och hepatologi, Karolinska sjukhuset, Stockholm.
Despite extensive research, the cause of Crohn's disease remains unknown. No specific infectious agent has been identified, though interest has been focused on the possible involvement of mycobacteria, and recently on child hood measles as a possible aetiological factor. Both hereditary and environmental factors seem to contribute to development of the disease. The clinical picture may be dependent upon individual HLA subtypes, as they appear to differ from each other regarding the secretion of inflammatory cytokines. Non-invasive scintigraphy and computerised tomography are used to determine the extent of disease, and to localise such complications as abscesses and fistulas. Endoscopic ultrasonography and magnetic resonance imaging have proved particularly valuable in diagnosing rectal and rectovaginal fistulas. New 5-ASA (5-aminosalicylic acid) preparations, steroids with fewer systemic side effects, and azathioprine-induced immunosuppression constitute the cornerstones of medical treatment, further developments in pharmacological immunoregulation being a future treatment possibility.
[Leukocyte scintigraphy, endoscopy, airway x-ray. New methods for the diagnosis of colitis and Crohn disease]
Almer S. Smedh K.
Universitetssjukhuset, Linkopinpings universitet.
In inflammatory bowel disease, the use of various diagnostic techniques to visualise the extent and severity of inflammation is of vital importance at the onset of disease, in the event of subsequent relapse, and when complications are suspected. Medical treatment and surgery can thus be optimised and limited operations performed, especially in Crohn's disease. The article consists in a summary of published reports from a single centre, representing 10 years' experience of three new techniques for assessing inflammatory bowel disease. Leucocyte scintigraphy is a non-invasive and well-tolerated method whereby the small and large bowels are assessed on the same occasion, and complications such as abscesses and possibly fistulas can be visualised. Intraoperative enteroscopy yields more accurate information than previous methods for deciding the extent of small bowel resections, and often permitting gut to be saved. Air enema radiography is a convenient and safe means of obtaining reliable information about the presence and depth of ulceration in ulcerative colitis. These methods facilitate the care of patients with inflammatory bowel disease, and should be made available at centres where such patients are treated.
[Vaccination against cancer soon a therapeutic possibility. B-cell tumors, colonic cancer and melanoma may be suitable for this treatment]
Mellstedt H. Fagerberg J. Osterborg A.
The theoretical basis of cancer vaccination having been well established during the past two decades, the translation of this knowledge into clinically applicable immunisation procedures is now an urgent need. Numerous antigenic preparations are available that are capable of inducing specific anti-tumour immunity which can be augmented by appropriate cytokines. Promising tumour vaccination results have been obtained in B-cell malignancies, colorectal carcinoma, and melanoma; tumour regression has been noted in myeloma, non-Hodgkin lymphoma, colorectal carcinoma, and melanoma patients, and significantly prolonged disease-freed survival in non-Hodgkin lymphoma and colorectal carcinoma patients. The presence of only minimal residual disease would seem to be a clinical prerequisite for tumour vaccination.
[Minilaparotomy is a careful method in right colon tumor surgery]
Furstenberg S. Goldman S. Machado M. Jarhult J.
mag-tarmcentrum, Ersta sjukhus, Stockholm.
In a series of 47 patients, right colon tumours were treated surgically with a minilaparotomy approach, entailing a skin incision of less than 10 centimetres. The procedure allows appropriate oncological management of the tumour, and is associated with a mild postoperative course and a rapid recovery and resumption of normal life. The short-term outcome in this series has been promising, and the minilaparotomy approach would thus appear to be an attractive alternative to traditional open surgery of the right colon.
[Proposed criteria for diagnosis of celiac disease in children]
Danielsson L. Stenhammar L. Ascher H. Cavell B. Dannaeus A. Hernell O. Ivarsson A. Lindberg T. Lindquist B.
Barn-och ungdomsmedicinska mottagningen, Norrtalje sjukhus.
At a seminar arranged in September 1997 by the Swedish Paediatric Working Group for Coeliac Disease, a diagnostic protocol proposed by the working group was approved by a majority of the paediatricians present, representing almost all paediatric units in Sweden. Briefly, a small bowel biopsy is called for in all children, both at presentation and as a control during gluten-free dieting. Subsequent gluten challenge and biopsy are mandatory only in cases of atypical presentation or if the diagnosis is questioned at some future date. Serum antigliadin and anti-endomysial antibody tests are complementary tools. Agreement was also reached regarding the institution of a national coeliac disease registry.