Biomedical subjects
R Esteban
Publications and source records attributed to R Esteban.
Hepatitis E infection in acute sporadic hepatitis in Spain.
Explore the source record for details and available documents.
[Hepatocellular carcinoma: clinical aspects, diagnosis, and survival in 140 cases].
BACKGROUND: Hepatocellular carcinoma (HCC) constitutes a frequent clinical problem in the follow up of patients with liver cirrhosis. The clinical features and diagnoses and survival in a group of 140 cases of HCC are reviewed. METHODS: All the clinical histories of the patients diagnosed of HCC between 1987 and 1991 in the Unit of Hepatology of the General Hospital of the Vall d'Hebron were retrospectively reviewed. The clinical, analytical, diagnostic, therapeutic and evolutive data were collected. RESULTS: One hundred forty patients (121 males and 19 females) were included. In 92% of the cases the HCC was established on liver cirrhosis in which alcohol was the most frequent etiologic factor. According to the Pugh-Child classification 31% of the patients were in group A, 32.5% in group B and 36.4% in group C. Clinically, diagnosis was carried out in the course of periodic out patient follow up in 21% of the cases. HBsAg was positive in 8.5% of the cases and anti HCV was 55% and in 78% by ELISA 1 and ELISA 2, respectively. Alphafetoprotein (AFP) was greater than 500 ng/dl in 37% of the cases. The treatment received was: surgical resection in 18 cases, liver transplantation in 3, intraarterial chemotherapy in 11 and intratumoral alcoholization in 8. Symptomatic treatment was administered in 71% of the cases. Global mean survival was 4.4 +/- 0.5 months. Mean survival was greater in patients with better liver function and smaller tumor size in the patients surgically treated and in those diagnosed in the periodic controls. CONCLUSIONS: Hepatocellular cancer is normally established in patients with liver cirrhosis. The high prevalence of infection by the hepatitis C virus and the low prevalence by hepatitis B virus is of note. The patients with greater survival were those surgically treated and those diagnosed in periodic controls.
Genomic organization of T and W, a new family of double-stranded RNAs from Saccharomyces cerevisiae.
Explore the source record for details and available documents.
Detection of hepatitis delta virus RNA in human liver tissue by non-radioactive in situ hybridization.
Several studies have demonstrated the presence of serum HDV-RNA by molecular hybridization in patients with chronic D infection, but there is scarce information about the presence of HDV-RNA in hepatic tissue. The presence of HDV-RNA by in situ hybridization (ISH) with a non-radioactive probe in paraffin-embedded hepatic tissue was studied in 29 patients with chronic delta hepatitis (20 with and 9 without intrahepatic delta antigen) and correlate their presence with the expression of hepatic delta antigen and serum HDV-RNA by dot-blot hybridization. HDV-RNA was detected by in situ hybridization in 18 cases: 16 of the 20 (80%) biopsies with intrahepatic delta antigen and 2 of the 9 (22%) without. HDV-RNA was not detected in any of the control cases. Serum HDV-RNA was found in 19 cases: 18 (90%) of 20 chronic delta hepatitis cases with tissular delta antigen and one of the 9 without intrahepatic delta antigen. All patients except one, who was positive for intrahepatic HDV-RNA, showed serum HDV-RNA. However, in two cases ISH detected hepatic HDV-RNA without tissular HDAg; one of these also had serum HDV-RNA and in the other positivity for hepatic HDV-RNA by ISH was the only marker of viral delta replication. In conclusion, detection of HDV-RNA in hepatic tissue by in situ hybridization with a digoxygenin-labelled probe is a rapid and sensitive method that could be a useful tool for diagnosis of HDV infection in clinical laboratories.
Epidemiology of hepatitis C virus infection.
The availability of the anti-HCV assay has confirmed most of the suspicions and predictions regarding the epidemiology of NANB hepatitis virus made before the discovery of HCV. It is now clear that HCV is responsible for the majority of cases of post-transfusion and sporadic NANB hepatitis, as well as of most cases of unidentified chronic liver disease. It seems plausible that HCV may act as a negative co-factor in other chronic liver diseases, especially those caused by alcohol, other hepatitis viruses, and so-called 'autoimmune hepatitis'. The issue of perinatal and sexual transmission of HCV has not yet been clarified, and further studies are urgently needed. Finally, the high prevalence of anti-HCV detected in HCC suggests that HCV is a major co-factor in the development of HCC and again raises the issue of viral persistence and neoplastic transformation, an issue that for HBV has not yet been elucidated.
Ribavirin therapy in chronic delta hepatitis.
Explore the source record for details and available documents.
Disappearance of serum hepatitis B virus DNA by polymerase chain reaction after adenine arabinoside 5'-monophosphate therapy in chronic hepatitis B.
The aim of antiviral therapy in chronic hepatitis B is the cessation of viral replication, which may be demonstrated by the loss of hepatitis B "e" antigen (HBeAg) and serum hepatitis B virus DNA (HBV-DNA) detected by dot-blot hybridization. With the development of the sensitive polymerase chain reaction (PCR) technique for detecting HBV-DNA, it has become apparent that many HBeAg negative patients may still have small amounts of circulating viral DNA. We assessed 19 of 25 patients with chronic hepatitis B who seroconverted from HBeAg to anti-HBe after adenine arabinoside 5'-monophosphate therapy (5 mg.kg-1.day-1 for 7 weeks) to determine whether serum HBV-DNA became undetectable. Sixteen of the 19 HBeAg negative patients remained hepatitis B surface antigen (HBsAg) positive, and the other three lost HBsAg during follow-up. All of them were HBV-DNA negative by dot-blot hybridization. Using the PCR technique, HBV-DNA became negative in 13 (81.2%) of the 16 patients who seroconverted to anti-HBe without losing HBsAg, and in all the patients who lost HBsAg. These data suggest that the majority of patients who respond to adenine arabinoside 5'-monophosphate show a complete inhibition of hepatitis B virus replication, as demonstrated by the absence of viral DNA by PCR. This inhibition was present in all patients who, at the same time, lost HBsAg.
Role of screening in prevention and treatment.
Since viral hepatitis may be the most common form of chronic viral disease in the world, strenuous attempts are being made to reduce the incidence. To achieve this, strategies are being developed by various national and international bodies involving both the immunisation and screening of certain groups of the population. These strategies are by no means universal, and the value of screening specific groups is the subject of much debate. This paper will address a number of the issues related specifically to the question of screening for hepatitis B virus and hepatitis C virus (HBV and HCV, respectively) namely (a) what is screening?; (b) why should we consider screening?; (c) who should we consider screening?; (d) what are the benefits and liabilities of screening?; (e) what constitutes an acceptable screening test?; (f) should we be screening for HBV or HCV?
Hepatitis C virus markers in patients with acute post-transfusion hepatitis treated with interferon alfa-2b.
This trial was undertaken to establish the long term biochemical and serological outcome of patients with acute post-transfusion hepatitis C virus infection after treatment with interferon alfa-2b. After 12 months, 12 patients (eight treated, four controls) had self limited disease and 16 patients (seven treated, nine controls) had chronic disease. After a total mean 31 months of follow up in 23 patients, nine (six treated, three controls) had self limited disease while 14 (five treated, nine controls) developed chronic liver disease; all patients with spontaneous or self limited hepatitis C (HCV) infection maintained normal serum alanine amino-transferase activity and absence of HCV-RNA, and tended to lose anti-HCV antibodies.
Is there a role for interferon in acute viral hepatitis?
Acute hepatitis B is a self limiting disease that resolves spontaneously in 95% of patients who acquire the infection in adulthood. Patients with acute hepatitis B, however, usually take between four and 12 weeks to recover; the personal, social, and sanitary costs associated with this are high. Also, 5-10% of patients with acute hepatitis B go on to develop chronic liver disease. Hepatitis C, by comparison, is an asymptomatic disease associated with a high progression to the chronic stage. At least 50% of patients with post-transfusion hepatitis C develop chronic liver disease or cirrhosis. While the efficacy of alpha interferon in chronic hepatitis B and C is now well established, only preliminary evidence for use in the acute phase exists. This paper reviews the preliminary evidence and concludes that, given the high risk of progression to the chronic stage, the use of interferon in acute hepatitis C should be recommended.
Drug-induced lupus-like reaction and captopril.
Explore the source record for details and available documents.
Serological diagnosis of chronic delta infection: correlation between serological markers and hepatitis delta virus RNA in hepatic tissue.
Explore the source record for details and available documents.
[Hepatitis A. An eradicable disease?].
Explore the source record for details and available documents.
Both yeast W double-stranded RNA and its single-stranded form 20S RNA are linear.
Most yeast strains carry a cytoplasmic double-stranded RNA (dsRNA) molecule called W, of 2.5 kb in size. We have cloned and sequenced most of W genome (1), and we proposed that W (+) strands were identical to 20S RNA, a single-stranded RNA (ssRNA) species, whose copy number is highly induced under stress conditions. Recently it was proposed that 20S RNA was circular (2). In this paper, however, we demonstrate that both W dsRNA and 20S RNA are linear. Linearity of W dsRNA is shown by the stoichiometric labelling of both strands of W with 32P-pCp and T4 RNA ligase. The last 3' end nucleotide of both strands is about 70 to 80% C and 20 to 30% A. Linearity of 20S RNA is directly demonstrated by a site-specific cleavage of 20S RNA with RNase H, using an oligodeoxynucleotide complementary to an internal site of 20S RNA. The cleavage produced not one but two RNA fragments expected from the linearity of 20S RNA.
T double-stranded RNA (dsRNA) sequence reveals that T and W dsRNAs form a new RNA family in Saccharomyces cerevisiae. Identification of 23 S RNA as the single-stranded form of T dsRNA.
Some strains of the yeast Saccharomyces cerevisiae harbor a double-stranded RNA (dsRNA) molecule, called T. We obtained T cDNA clones by random priming of denatured T dsRNA followed by reverse transcription. Sequence data of T show that only one strand ((+)-strand) has coding capacity for a protein with 940 amino acids which spans almost the entire length of the molecule (2.9 kilobases). Within this protein we found a sequence pattern characteristic of RNA-dependent RNA polymerases of (+)-strand and double-stranded RNA viruses. Although T has no homology with other dsRNAs found in S. cerevisiae, such as L-A, L-BC, M1, or W, the T-encoded protein shows a high degree of conservation with the W-encoded protein. This conservation extends beyond a region that contains the consensus sequences for RNA-dependent RNA polymerases, suggesting that both T and W are evolutionarily related. With a (+)-strand-specific probe for T we identified 23 S RNA, a new single-stranded RNA (ssRNA) species with a sedimentation coefficient of 23 S. T and 23 S RNA have the same mobility under denaturing conditions with glyoxal, suggesting that 23 S RNA is, in fact, the (+)-single-stranded RNA form of T dsRNA. 23 S RNA synthesis is induced under stress conditions such as heat shock and starvation. The relationship between T and 23 S RNA clearly resembles the one between W and its single-stranded derivative form, 20 S RNA. Thus T and W dsRNAs (and their respective single-stranded species) constitute a new RNA family in S. cerevisiae.
Interferon-alpha in acute posttransfusion hepatitis C: a randomized, controlled trial.
To assess the efficacy of interferon-alpha in acute hepatitis C, 28 patients with acute posttransfusion hepatitis were randomized to receive 3 million units of recombinant interferon-alpha three times weekly for 12 wk or no treatment. Biochemical, histological and serological parameters were monitored during 1 yr of follow-up. Serum ALT levels were normal at the end of therapy in 73% of treated patients and only in 38% of control patients (p = 0.06); these differences disappeared at 6 and 12 mo of follow-up. Anti-hepatitis C virus seroconversion occurred later and at a lower rate in the group of patients who received interferon-alpha. Treated patients had a trend toward less severe hepatic lesions with lower histological activity as compared with the control group, but no statistical differences were observed. No severe side effects of interferon-alpha were detected during the study. In summary, a 3-mo course of interferon-alpha in acute hepatitis C is safe and might have some effect in diminishing disease activity only during the treatment period; however, and probably because of a small sample size, no benefit of interferon-alpha in the long-term outcome of this disease was demonstrated.
Evaluation of anti-HCV positive blood donors identified during routine screening.
Of 30,231 donors tested, 368 (1.2%) were anti-HCV positive. Of these, 254 have been evaluated, with the following results: only 25% have a history of parenteral risk, seroprevalence increases with age and approximately 80% of those that are anti-HCV positive in our population are probably infected with HCV. In addition, an unexpectedly large number of these persons have chronic and/or severe liver disease and will require combined diagnostic approaches for accurate evaluation.