http://www.expclinhep.comTable of contents Volume 7, 2011 Joint Issue 3-4.en-usCopyright 2012 by the Experimental & Clinical Hepatologyhttp://www.expclinhep.com/rssIndexCopernicus Journal Management System RSS GENERATORE-mail (Anna Boroń-Kaczmarskawebmaster@www.expclinhep.com (ADM)Thu, 15 Dec 2011 00:00:00 ESThttp://www.expclinhep.com/abstracted.php?level=5&ICID=970275Wilson disease (WD) is an autosomal recessive disease of a membranebound copper-transporting ATPase. Clinical manifewstations are caused by deposition of copper on brain and liver causing different clinical manifestations and radiologic findings. We report a case with atypical finding on CT scan of brain which showed presence of bilateral symmetrical hypodensity at thalamo-capsular and frontal areas,not found commonly in WD along with minimal involvement of the lentiform nucleus. Sreejita Bhowmik, Subhrajit Lahiri Case reporthttp://www.expclinhep.com/abstracted.php?level=5&ICID=970275http://www.expclinhep.com/abstracted.php?level=5&ICID=969168Background: Reactivation of Hepatitis B Virus (HBV) is well documented in HBV surface antigen (HBsAg) positive patients undergoing immunosuppressive treatment. Guidelines exist for identifying and treating such at-risk patients. The aims of reporting this case are to highlight the importance of screening all patients undergoing immunosuppressive therapy and to discuss the options for the type and duration of treatment. Case Report: We present a case of delayed de novo hepatitis B reactivation in a surface antigen negative patient with chronic lymphocytic leukaemia (CLL). The patient developed acute hepatitis B nine months after immunosuppressive treatment for CLL in 2009, having previously seroconverted after acute hepatitis B in 1994 (HBsAg-, HBcAB +). He was treated first with lamivudine in December 2009, adding tenofovir to treatment in January 2010 when further CLL treatment was planned and after showing signs of decompensated liver disease (abdominal ascites). We also include a review of the literature regarding delayed de novo hepatitis, factors to predict which patients might need treatment and also look at the use of nucleoside analogues and dual therapy in such patients. Results: He remains on both lamivudine and tenofovir with normal liver function tests, no signs of liver disease, and undetectable HBsAg. Conclusions: There are no other cases in the literature of a reverse seroconversion in a patient undergoing immunosuppressive chemotherapy for the second time. Sarah Hearnshaw, Geoffrey Summerfield, Ahmad Al-Rifai Case reporthttp://www.expclinhep.com/abstracted.php?level=5&ICID=969168http://www.expclinhep.com/abstracted.php?level=5&ICID=969154Background: Nonalcoholic fatty liver disease (NAFLD) is emerging as the most common chronic liver condition in the Western world and it is commonly associated with type 2 diabetes mellitus (DM). The aim of this study to determine the prevalence of NAFLD, and identify the predisposing factors in Type 2 DM patients with NAFLD. Material/Methods: A total of 258 patients of type 2 DM were included in the prospective study in a tertiary referral hospital. Patients with characteristic findings on ultrasonography were considered as having fatty Livers. They were divided into fatty liver (Group I) and non fatty liver group (Group II) and were further evaluated by measurement of body mass index, liver function tests and lipid profile. Results: Out of 258 type 2 diabetic patients, 167 (64.7%) patients had fatty liver on ultrasonography. BMI, Waist-hip ratio and triglyceride levels in the group I was significantly higher than Gp II. An increase in the levels of ALT, AST, total cholesterol, LDL and a decrease in HDL was observed in Gp I as compared to Gp II. Conclusions: The prevalence of NAFLD is common among in Type-2 diabetic patients and it increases with the rising incidence of obesity. Obesity as well as elevated liver enzymes, triglyceride and cholesterol are significantly raised in NAFLD patients with Type 2 DM. It highlights the importance of routine liver function test and lipid profile in subjects with type 2 DM and should be more closely observed for NAFLD and liver complications. Arunkumar Krishnan, Jayanthi Venkataraman Original articlehttp://www.expclinhep.com/abstracted.php?level=5&ICID=969154http://www.expclinhep.com/abstracted.php?level=5&ICID=969158Background: Portal hypertension (PH) constitutes the most frequent complication associated with chronic liver disease, like cirrhosis. This complication is frequently accompanied by severe bleeding, originated from the rupture of esophagogastric varices. This PH, created by a hyperdynamic circulation, is transmitted to the azygos vein due to the impossibility of blood to pass through the damaged liver. It has been recently described that there is a dynamic control of the microcirculation attributed to substances from the endothelial cells function (ECs): vasoconstrictor and vasodilator substances, creating a balance in normal tissue blood flow. Material/Methods: Nine patients (7 males and 2 females; mean age 50 years old) with alcoholic cirrhosis with non bleeding esophageal varices and (PH) (Group I) were studied and compared with nine control subjects (Group II). Cirrhosis was confirmed by percutaneous liver biopsy assessed by usual clinical and biochemical analysis. Upper fibroscopy was carried out with a video endoscope Fujinom EG 200HR. Esophageal biopsies were carefully obtained from the esophageal wall. 2 or 3 cm over the highest varix, fixed in glutaraldehyde and observed in electronic microscope Zeiss. Results: Electronic microscopy of the biopsies from group I evidenced capillary dilatation with aneurysmatic aspect in microcirculation. In some zones of the esophageal submucosa, the endothelial cells were hyperplasic and some protruded into the lumen, occasionally occlude it. Vacuolization, were capillary vasodilatation and thrombosis were also detected. Some biopsies showed a lacunar aspect with some cells floating inside this structure, some of them with necrotic characteristics. Conclusions: It is possible that prolonged PH causes anomalous local circulation, through the inverted blood flow direction in esophageal perforating veins. The finding of important morphological alterations in endothelial cells from esophageal veins can be the expression of this anomalous circulation. Abraham Lemberg, María P. Torres, Silvia Menendez, Alejandra Fernández, Néstor Lago, Carlos Brodersen Original articlehttp://www.expclinhep.com/abstracted.php?level=5&ICID=969158http://www.expclinhep.com/abstracted.php?level=5&ICID=969164Background: The analysis of viral productive replication sites including cells of the immune system is important for the understanding of HCV pathogenesis. The aim of the study was to search for the presence of NS3 HCV protein in PBMC with the simultaneous identification of the phenotype of the infected cell. Material/Methods: PBMC were collected in the Warsaw Hospital of Infectious Diseases, from 17 HCV-infected and 17 uninfected subjects. For the analysis of the nonstructural NS3 protein in PBMC, the immunocytochemical methods and flow cytometry were used. Monoclonal antibodies were used to analyse the HCV nonstructural protein NS3 in PBMC smears whereas flow cytometry was used to identify the phenotype of infected cells: CD3, CD14 and CD19. Results: The immunohistochemical analysis of HCV NS3 protein presence in PBMC showed positive results in the cytoplasm of the infected cells. The frequency of HCV proteins detection was highest in monocyte CD14+ (4–57%). Conclusions: The results of the immunocytochemical and flow cytometry analysis of the PBMC for the presence of NS3 protein showed that cells of the immune system are independent sites of HCV productive infection. Agnieszka Pawełczyk, Joanna Jabłońska, Anna Stelmaszczyk-Emmel, Katarzyna Popko, Kamila Caraballo Cortes, Iwona Bukowska-Ośko, Natalia Kubisa, Maria Fic, Marek Radkowski Original articlehttp://www.expclinhep.com/abstracted.php?level=5&ICID=969164http://www.expclinhep.com/abstracted.php?level=5&ICID=969167Background: Matrix metalloproteinases (MMP) play a crucial role in hepatic tissue remodeling. We investigated whether increased MMP expression in murine liver mediated by adenoviral gene transfer affects the expression of other genes involved in the hepatic extracellular matrix metabolism. Material/Methods: MMP-2, 3 and 9 cDNA using wild type (wt) as well as mutant (mut) sequences without protease activity was constructed and cloned into adenoviral expression vectors. Quantitative real time RT-PCR assays were established to determine tissue inhibitor of metalloproteases (TIMP)-1 and procollagen IV (proCOL IV) levels after adenoviral MMP overexpression in murine liver. Results: Overexpression of both wt and mut MMP in vivo caused increased TIMP-1 mRNA expression (10-fold). This effect was independent from catalytic MMP activity. In contrast, expression of proCOL IV mRNA decreased slightly after overexpression of MMP-2 wt/mut, whereas inactive MMP-3 and MMP-9 decreases COL IV expression up to 10-fold. Conclusions: The regulation of genes involved in the hepatic ECM metabolism like TIMP-1 and proCOL IV may be affected by Lutz Schwettmann, Daniela Rudowitz, Omnia el Bendary, Korbinian Brand, Matthias J. Bahr, Ralf Lichtinghagen Original articlehttp://www.expclinhep.com/abstracted.php?level=5&ICID=969167http://www.expclinhep.com/abstracted.php?level=5&ICID=969169Hepatocellular carcinoma (HCC) represents a major challenge in contemporary medicine, being one of the most common malignancy worldwide and a leading oncological cause of mortality. HCC incidence is increasing mainly due to the prevalence of chronic viral hepatitis leading to liver cirrhosis. HCC develops in a cirrhotic liver in a majority of cases, and the pre-neoplastic condition is the strongest predisposing factor. Emerging data indicate that mortality from non-HCC complications of cirrhosis is decreasing or stable, whereas mortality rate of HCC is rising, therefore becoming the main cause of liver-related death. Because the at-risk population can easily be identified, mass screening conducted as early as possible seems to be justified, as surgery interventions at an early stage can substantially increase survival chances. The present review focuses on two main aspects of the HCC problem according to the updated HCC recommendations: the epidemiological aspect with HCC prevalence and specification of characteristic HCC risk groups of patients, and the clinical aspect - with diagnostic difficulties and therapeutic dilemmas. Piotr Stefaniuk, Marta Dusza, Janusz Cianciara, Hanna Wasyluk, Alicja Wiercinska-Drapalo Review articlehttp://www.expclinhep.com/abstracted.php?level=5&ICID=969169