Acute hepatitis in elderly patients.
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Acute Disease↗
Biomedical subjects
A Floreani
Publications and source records attributed to A Floreani.
Hepatitis B virus infection in homes for the aged.
A seroepidemiological study was carried out in three different institutions for the aged. Serological evidence of HBV infection and the HBsAg carrier rate were found to be significantly increased in all three institutions with respect to the control group (noninstitutionalized aged). Of the 24 HBsAg asymptomatic chronic carriers 62% were positive for HBeAg. Among 15 patients with acute viral hepatitis, none had a severe course and in three HBsAg was not cleared 4-18 months after transaminase levels became normal. During 12-18 months of followup, two asymptomatic seroconversions to HBsAg were observed. Although no single HBV transmission route was identified, the close cohabitation with this high number of HBsAg/HBeAg-positive asymptomatic subjects could lead to an increased risk of spread of HBV within such institutions. Failure to clear HBsAg and the mild, often subclinical, HBV infection observed in these subjects, may be due to immunological abnormalities present in the elderly.
Aged↗
Hepatitis B virus infection in prisons. A seroepidemiological survey in prisoners and attending staff.
Prisoners and attending staff from six houses of detention were screened for serum HBsAg, anti HBs, antiHBc and transaminases. Both prisoners and warders showed an increased prevalence of HBV serum markers with respect to age- and sex-matched general population control groups. The HBsAg carrier rate was 6.7% in prisoners and 6.6% in staff. Sixty-five per cent of the HBsAg-positive subjects were antiHBe-positive. When the blood samples were taken, all the HBsAg-positive subjects were asymptomatic; transaminases were normal in 80% and only slightly elevated in 20%. Illicit drug abuse was found to be a relevant risk factor for HBV infection among prisoners under 35 yearts of age, but not in the older group, whereas no correlation emerged between presence of HBV serum markers and tattoos or admitted homosexuality. A high prevalance of HBV serum markers as also found among young warders who had been in service for a short time: most of them, however, come from areas of Italy with a particularly elevated HBV circulation. Although the results suggest that many of the HBV infections are not recently acquired within the institution, this survey confirms that prisons should be regarded as high risk areas for HBV infection, both for prisoners and warders.
Adult↗
Hepatitis B virus infection and cyclophosphamide.
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Cyclophosphamide↗
[Viral hepatitis B. Seroepidemiological study in Veneto].
Sera from 3160 subjects without overt liver disease were tested for the presence of HBsAg, anti-HBs, anti-HBc. This group corresponds to a 4%, sample of the population resident in Padova and the surrounding district, selected according to sex and age distribution (in 5 to 5 year classes). The overall prevalence of HBV infection was 23%. The prevalence of HBsAg+ subjects was 3.2% higher in males than in females (3.8% v.s. 2.7%). Children under 5 years of age showed the maximum HBsAg carrier rate (7.3%), which was found to decrease with advancing age. Prevalence of anti-HBs is similar in both sexes (M 15.8% v.s. F 14.2%) and increases with age. Anti-HBc without HBsAg or anti-HBs was found in 4.6%, higher in males than in females (5.8% v.s. 3.6%). These result stress the importance of anti-HBc detection in HBV seroepidemiological surveys and suggest that HBV transmission within the household (both vertical and horizontal) plays a relevant role in HBV spread in our population.
Adolescent↗
Hepatitis B virus serum markers (HBsAg, antiHBs, antiHBc): prevalence among drug addicts in north-east Italy.
Sera from 128 drug addicts without overt liver disease living in North-East Italy were tested for HBsAg, antiHBs, antiHBc. HBV infection serum evidence was present in 79.6% of the tested subjects: 14 (10.93%) were found to be HBsAG¿76 (59.3%) antiHBs+ and 12 (9.37%) had antiHBc alone. The overall prevalence of HBV infection was four fold higher than that observed in age matched controls. Our figures are essentially in agreement with those observed in low HBV prevalence countries, indicating that drug addicts are a peculiar group, highly exposed to HBV infection irrespective of the entity of HBV circulation in a given population. However, the risk of HBsAg chronicity is not enhanced in drug abusers.
Adolescent↗
Biochemical markers of hepatic fibrosis in primary biliary cirrhosis.
We studied the behavior of some biochemical markers of fibrosis, the aminoterminal propeptide of type III procollagen (P-III-P), laminin, hyaluronate and fibronectin, in the sera of patients with primary biliary cirrhosis (PBC). Significant increases were found in serum laminin, hyaluronate and P-III-P and, more important, a significant correlation was found between the histological stage of the disease and serum hyaluronate. This parameter seems to distinguish between early PBC (I and II stages) and advanced disease with fibrosis. Moreover, a correlation between the histological stage and serum levels of both laminin and P-III-P was observed. Serum laminin, however, increases particularly in advanced disease, whereas high levels of sP-III-P are already present in the early stage. Finally, no significant differences were found between the plasma fibronectin levels of patients with primary biliary cirrhosis and those of controls.
Adult↗
Chronic cholestasis associated with Turner's syndrome.
Liver abnormalities seem a very rare association in Turner's syndrome, only reported in a few anecdotal cases. We report the clinical and morphological findings in 3 patients who presented with cholestasis. One of them had a definite diagnosis of primary sclerosing cholangitis, in whom the natural history was complicated by the development of two distinct tumors. A review of the few cases described in the literature and our own case reports support the hypothesis that liver disease in Turner's syndrome may have a variety of expressions including cholestasis.
Adult↗
Prevalence of antibodies against hepatitis C virus in the elderly: a seroepidemiological study in a nursing home and in an open population. The Collaborative Group.
BACKGROUND: The prevalence of antibodies against hepatitis C virus (anti-HCV) increases in the general population with advancing age. Several discrepancies exist in the epidemiology of HCV, however, when selected elderly population groups are tested. OBJECTIVE: To evaluate the HCV prevalence in two groups of elderly people living in the same geopgraphical area of northeast Italy, i.e., one including residents of a nursing home, the other including subjects living at home. METHODS: The overall sample included 496 subjects (mean age 79.31 +/- 8.9 years); 288 were in a nursing home, and 208 were living at home. Enrollment in the latter group was based on all subjects over 65 years old listed under the public health service in the same district. The overall rate of adhesion to the study was 90%. Each subject was administered an anonymous questionnaire testing sociodemographic data and risk factors for HCV infection. Serological tests included: anti-HCV and hepatitis B virus serum markers. Multiple logistic regression analysis was performed to evaluate risk factors for anti-HCV positivity. RESULTS: Anti-HCV positivity was found in 34 of 288 (11.8%) elderly in the nursing home and in 23 of 208 (11.1%) in the open population. When the total population was considered, females exhibited a significantly a higher prevalence of anti-HCV than males (13.4 vs. 7.5%, p < 0.05). In both males and females, the highers rate of anti-HCV prevalence was found among the 75- to 79-year-old subjects. A decline in anti-HCV prevalence was observed in the very old subjects (over 80 years of age). None of the anti-HCV-positive subjects was found to be coinfected with hepatitis B surface antigen. However, multiple logistic regression analysis identified the age group between 70 and 79 years, female gender, and positivity for antihepatitis B surface antigen and/or antihepatitis B core antigen as independent variables significantly associated with HCV prevalence. CONCLUSIONS: The prevalence of anti-HCV proved identical among elderly people living in the nursing home or at home, suggesting that nursing homes do not represent a risk factor for HCV infections; the significant association between HCV prevalence and antihepatitis B surface antigen and/or antihepatitis B core antigen positivity supports a common route of transmission of the two viruses; these findings would suggest that there was an epidemic of HCV infection during the Second World War and in the years immediately afterwards.
Age Distribution↗
Tumour necrosis factor alpha and cellular proliferation in primary biliary cirrhosis.
AIMS: 1) To evaluate serum levels and tissue expression of Tumour necrosis factor alpha in primary biliary cirrhosis: 2) to correlate serum tumour necrosis factor alpha levels and cellular proliferation with the severity and prognosis of liver disease. METHODS: Twenty-nine primary biliary cirrhosis patients (6 stage I, 8 II, 8 III, and 7 IV) entered the study. Serum tumour necrosis factor alpha was measured by EIA (Innogenetics, Antwerp, Belgium). Tissue tumour necrosis factor alpha and Ki-67 were tested by indirect immunoperoxidase staining on liver sections. RESULTS: Serum tumour necrosis factor alpha increased with the severity of histological stage (from 10.8 +/- 11 pg/ml in stage II to 17.1 +/- 10 in stage III and 22.8 +/- 8.7 in stage IV, p < 0.036). A positive correlation was also found between tumour necrosis factor alpha serum levels and the Mayo score (p < 0.05). A weak and sporadic expression of tumour necrosis factor alpha was observed in the inflammatory infiltrate around the bile ducts. Tissue Ki-67 (expressed as the labelling index in the hepatocellular nuclei) was evaluated in all stages of the disease (1.09 +/- 0.6% in stage I, 1.14 +/- 0.6% in stage II, 2.11 +/- 1.9% in stage III, and 2.67 +/- 2.8% in stage IV; the labelling index was significantly lower in early stages (I/II) than in late stages (III/IV), p < 0.05. A strong correlation between Ki-67 and the Mayo score was observed (p < 0.0005). CONCLUSIONS: 1) tumour necrosis factor alpha production seems related to the severity and the prognosis of primary biliary cirrhosis; 2) liver mononuclear cells in the inflammatory infiltrate do not seem to be the major site of tumour necrosis factor alpha release; 3) cellular proliferation is correlated with the severity of liver disease.
Adult↗
Oxygen-derived free radical production by peripheral blood neutrophils in chronic cholestatic liver diseases.
BACKGROUND/AIMS: Patients with chronic cholestasis, particularly those with associated cirrhosis, are susceptible to infectious complications. From animal models it has been postulated that cholestasis affects systemic polymorphonuclear leukocyte (PMNL) function by impeding chemotaxis, phagocytosis and superoxide release, which are necessary for an adequate immune response. The aim of this study was to evaluate neutrophil activity in the production of oxygen-derived free radicals in chronic cholestatic liver diseases. METHODOLOGY: The following groups were included in the study: 27 primary biliary cirrhosis (PBC) patients, 12 primary sclerosing cholangitis (PSC) patients, and 3 control groups (29 healthy subjects, 19 patients with HCV-related cirrhosis and 23 ulcerative colitis (UC) patients). Peripheral neutrophils were isolated from heparinized blood samples and PMNL activity was measured by free radical production, using a chemiluminometer, after stimulation with fMLP, PMA and Zymosan. The effect of liver disease severity and degree of cholestasis on PMNL function was also evaluated. RESULTS: Both PBC and PSC patients exhibited a normal PMNL activity compared to healthy subjects after the three stimuli used. In PBC patients only (but not in PSC patients), the histological stage of the disease seems to positively influence ROS production. Stage IV PBC patients showed a significantly higher PMNL activity compared to HCV-related cirrhotic patients. PSC patients failed to show any difference according to the association with UC. CONCLUSIONS: The increased susceptibility to bacterial infections in patients with chronic cholestatic liver disease is not related to an impaired PMNL activity. However, our findings may support the influence of biohumoral factors (cytokines?) on PMNL activation.
Adult↗
[Hepatitis B virus infection in open and closed communities].
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Adolescent↗
Incidence of hepatic and extra-hepatic malignancies in primary biliary cirrhosis (PBC).
The aim of this study was to analyze the incidence of malignancies in a large series of PBC patients from Italy. The overall sample included 178 patients (10 M, 168 F). The mean age at presentation was 52 yrs (range 29-74); 17 patients had histological stage I, 52 stage II, 66 stage III, 44 stage IV. The follow-up period ranged from 1 to 16 years (mean 5 years). During the follow-up, extra-hepatic malignancies developed in 6 cases (3.3%), and hepatocellular carcinoma (HCC) in a further 4 patients, all associated with cirrhosis (2.2%). Breast cancer developed only in one patient, resulting in a crude incidence rate of 130/100.000 person years among females. The calculated crude incidence of HCC was 492.4/100.000 person years. Three of the four patients with HCC had a superinfection with HCV. In conclusion, the incidence of breast cancer is not significantly increased. HCC has a relatively high prevalence in PBC and HCV superinfection may play an important role in favouring HCC.
Adult↗