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Objective: This article aimed at evaluating the impact of HBV vaccination in population included and not listed in the National Immunization Programme (NIP) on hepatitis B incidence in Opolskie province in 2007 - 2011., Materialand Methods: Analysis was based on data provided by the Sanitary and Epidemiological Inspection under epidemiological surveillance conducted, i.e. MZ-56, MZ-57 reports (reports on cases of infectious diseases), MZ-54 reports (reports on vaccinations) and 'Questionnaires on hepatitis type B and C'. A total of 446 records of detected and confirmed hepatitis B cases, registered in 2007-2011 in district sanitary and epidemiological stations, were subject to analysis., Results: In 2007-2011, hepatitis B incidence in Opolskie province was higher compared to the average incidence in Poland and was increasing in the successive years (5.8; 6.6; 7.9; 11.8; 11.0 per 100,000 population). An increase of incidence resulted from increasing number of patients with chronic hepatitis B (chronic HBV), i.e. from 47 in 2007 to 119 in 2010 and 110 in 2011 compared to decreasing number of acute infections (acute HBV). In the analyzed period, no new infections were reported in the following age group 0-9 years in Opolskie province. Only 3 cases (chronic stage) were noted in the age group 10-14 years. Of 446 patients, diagnosed with hepatitis B, 309 (69.3%) were not vaccinated. The remaining cases of acute or chronic hepatitis B were vaccinated, including 124 (27.8%) and 13 individuals with complete and incomplete vaccination, respectively., Conclusions: This analysis suggests an important role of HBV vaccination in the prevention of HBV infections. In case of individuals at the age older than that specified in the NIP, especially adults, it is recommended to perform diagnostic tests for HBV infection prior to vaccination. Furthermore, it is required to undertake activities aimed at promoting HBV vaccination in populations which are not included in the NIP.

Aim: This longitudinal non-interventional study aims to describe the demographics data disease characteristics and clinical management of a cross-sectional CHB patient population in Poland treated in regional medical centers., Material and Methods: [corrected] Between March 2008 and December 2010 we observed patients with HBV related liver disease from 5 medical centers in Poland, both sexes, > 18 years old. At baseline, we used a case report form to extract data from patient charts, comprising: sociodemographic data; disease characteristics, HBeAg/ antiHBeAg status, genotype HBV; co-morbidities; viral load, liver biopsy and ALT levels in previous 12 months; treatment history in previous 12 months; current CHB treatment; changes in disease characteristics and CHB management; time from diagnosis to the therapy and resource utilization and any reasons for termination of follow-up. Written informed consent was obtained from all participants, Results: The analysis population included 253 patients (94 treated and 159 non-treated at baseline) mostly male (69.1 vs. 56.6). Patients in treated group compared with untreated group were: significantly older (mean 42.6 vs. 37.5 years respectively, p < 0.001), observed longer since diagnosis(3.9 vs.2.9 years), with higher rate of HBeAg(+)(42.6% vs.5.1%), lower ALT activity, and higher VL HBV DNA PCR. Of the 53% of treated patients, the most frequently prescribed anti-HBV drugs were: Lamivudine (53%), Entecavir (23.7%), Pegylated IFN-alfa2a (23.7%), Adefovir (11.1%). During 24 months of follow-up in treated group 13(36.1%) patients underwent a treatment switch to another nucleosi(-ti)de analogue, in one (2.8%) patient another analogue was added, and in 25 (69.4%)patients the therapy was stopped. The proportion of all patients treated with monotherapy at the end of follow-up was 99.4%, unfortunately mostly with Lamivudine-49.3%., Summary: 1. Despite the several methodological limitations usually associated with this type of observation, the collected data does characterize the demographics of polish patients chronically infected with HBV well, provides some insights into the determinants of treatment initiation and the clinical management of patients in real-word settings. 2. These results indicate that in clinical practice in 5 medical non-academic centers in Poland, European guidelines regarding the qualification to HBV treatment were followed, but there were discrepancies between the initial treatment decisions in real-life current clinical practice and guideline recommendations

Unlabelled: Available data on prevalence of HCV genotypes in Poland are insufficient. The aim of the study was the analysis of distribution of HCV genotypes in Poland over the period of recent 10 years regarding the age of patients and the regions of the country., Material and Methods: Analysis of HCV genotypes in Poland was carried out between 2003 and 2012, and included 14 651 patients from 22 centers where patients with chronic viral hepatitis C are diagnosed and treated. Genotypes were analyzed in age groups (< 20 years of age, 20-40 years of age, > 40 years of age) as well as in populations of HBV and HIV co-infections., Results: Genotype (G) 1 infection was demonstrated in 79.4%, G2 -0.1%, G3- 13.8%, G4- 4.9%, G6-0.09% and mixed infections in 1.6%. There was no infection with genotype 5. The highest prevalence of G1 was observed in the Łódzkie voivodship (89.2%) and the Slaskie voivodship (86.7%) while the lowest one in the Warmińsko-mazurskie (62.0%) and the Podlaskie voivodships (68.2%). Genotype 3 most commonly occurs in the Warmińsko-mazurskie (28.1%), and the Podlaskie voivodships (23.0%) and is least common in the Małopolskie (7.9%) and the Łódzkie voivodships (9.0%). Genotype 4 is more common in the Kujawsko-pomorskie (11.7%) and the Podlaskie voivodships (8.6%) and relatively less common in the Lubelskie (1.1%) and the Łódzkie voivodships (1.8%). Prevalence of G1 infection in 2003-2004 was 72% and increased up to 85.6% in 2011-2012, that was accompanied by decrease of G3 prevalence from 17% to 8% in this period. In HBV co-infected (n = 83), G1 infection was demonstrated in 85.5%, G3 - in 7.2%, G4 -4.8%, and mixed genotypes in 6%. Among HIV co-infected (n = 391), a much lower prevalence of G1 (33.0%) and a high of G3 (40.4%) as well as G4 (24.0%) were observed., Conclusions: There is a geographic variability of HCV genotypes prevalence in Poland. Increase of HCV G1 infections and decrease of G3 and G4 were observed in the last 10 years. Genotypes G3 and G4 occur more often in HCV/HIV co-infected than in HCV mono-infected patients.

The paper discusses epidemiology, aetiology and the most important predisposing factors associated with recurrent meningitis, as well as the possibilities to prevent this particularly challenging clinical problem. The frequency of recurrent meningitis is estimated to be 2-9%. However, the case fatality is lower compared to a single episode of meningitis. The main causes of recurrent meningitis are considered to be: head injury, congenital or acquired (post-traumatic or post-surgical) cranial or spinal defects, chronic intracranial inflammation, complement system dysfunction, as well as congenital and acquired humoral or cellular immunodeficiency.

The article describes the case of 34-years old man, who has used nasal drops with xylomethazoline for three years. Health consequence of uncontrolled use of the drops and treatment were prescribed. Described problem confirms the need of physicians and pharmacists cooperation to limit the problem of drug-addiction.

Large outbreak of bloody diarrhoea complicated by haemolytic uraemic sundrome (HUS) has been observed in north Germany since May 2011. Epidemy spreaded throughout Germany and other countries and ceased at the end of July 2011. The WHO and German authorities confirmed that this epidemy was related to infection by new, unusual enteroaggregative Shiga toxin/verotoxin-producing Escherichia coli 014:H4 strain.

Aim: Evaluation of colonization of Legionella sp. in water systems of hospitals and public facilities in Opole province in the years 2010-2011., Material and Methods: Evaluation was based on examinations of warm water in terms of Legionella and reports MZ-56 and MZ-57 concerning incidences of infectious diseases., Results: Examinations of warm water have shown that significantly proportion of public facilities in Opole province has colonized water systems by Legionella sp. In the group of examined facilities, the highest percentage of buildings with colonization of Legionella sp. in water systems are hospitals (2010--63%, 2011--57%). Despite of noticed colonization of Legionella sp. in water systems of hospitals and other public facilities any case of disease caused by this biological factor has not been recorded in analyzed period in Opole province.

About 70% of HCV infection fail to resolve spontaneously and progress to chronic hepatitis C, eventually to cirrhosis and HCC. Many studies have demonstrated that clinical manifestation and the outcome of HCV infection are negatively influenced by a variety of cofactors and comorbidities. Moreover many of these cofactors often reduce the chance of achieving a sustained virological response (SVR) with only available combination therapy with pegylated interferon-alpha2 (PEG-IFN) and ribavirine (RBV). Dose modification of both currently licensed drugs for treatment of HCV infection and variations of treatment duration are the most discussed strategies to optimized the therapy, particulary in patients infected by genotype 1 HCV. Tailoring the duration of peginterferon/ribavirine therapy to HCV kinetics is useful to optimize the results of therapy.

The drugs currently approved for treatment of HBV infections are: interferon alpha2a and alpha2b, pegylated interferon (PeglFN-al-pha2a) natural interferons and nucleos(t)ide analogues (NA): adefovir, entecavir, lamivudine, telbivudine (currently not available in Poland) and tenofovir. The following questions are described: the primary goal of antiviral treatment, criteria in therapeutic decision-making (including extrahepatic manifestations, compensated and decompensated cirrhosis of the liver), treatment failure (including: drug resistance), management of patients with HBV-positive markers, in whom chemotherapy or other immunosuppressive therapy is planned. In treatment-naive patients with chronic hepatitis B the first line therapy should be PeglFN-alpha2a monotherapy, and the first-line should be entecavir or tenofovir (highest potential for HBV replication suppression and high genetic barrier to resistance). In drug resistance the patient should be switched to another, preferably high-potency NA (entecavir or tenofovir) or start PeglFN-alpha2a therapy.

Objective: To evaluate usefulness of total fluorescence of advanced glycation end products (AGE) and haptoglobin (Hp) measurement in human serum as parameters in liver cirrhosis and hepatocellular carcinoma development among patients with anti-HCV antibodies., Materials and Methods: 43 patients (20 women and 23 men) with chronic hepatitis HCV were examined (14 individuals with liver cirrhosis and 9 with primary liver cancer). The control group numbers 20. As reflection of AGE concentration, total fluorescence in serum samples was measured with spectrofluorimetric method and haptoglobin with microplate guaiacol test., Results: We affirmed that total fluorescence in examined groups was higher than in healthy subjects, but increase was not statistically significant. Fluorescence of AGE in serum from patients with hepatocellular carcinoma was lower in comparison to patients with cirrhosis and anti-HCV carriers. Haptoglobin was significantly decreased in serum of cirrhosis patients as compared to HCV carriers of patients with hepatocellular carcinoma (p < 0.001)., Conclusions: The measurement of total fluorescence AGE is not differentiating for liver cirrhosis and hepatocellular carcinoma among anty-HCV carriers. We confirmed that haptoglobin, parameter included in fibrotest, is very useful, in detecting liver cirrhosis.

Thyroid disorders and diabetes mellitus t. II are the most common disorders observed among of endocrine extrahepatic manifestations of HCV infection. The mechanism of this disorders is still unclear. Two main hypothesis are considered: primary cytopathic effect of virus and secondary-induced autoimmunity. The ability of HCV to infect central nervous system cells seems to be significant in the hypothalamus--epiphysis--axis dysfunction. Further clinical researches are awaited in order to explain phenomenon mentioned above.

Fatty liver disease is one of most frequently diagnosed hepatopathies while detailed examination of potential causes of liver enzymes abnormalities is done. Despite its isolated nosology fatty liver disease often co-exists with other liver pathologies or - more often - it is their natural consequence. Liver steatosis is also more often found in primary hepatotropic viral infections. However, it's more prevalent among HCV (hepatitis C virus) infected persons than in those HBV (hepatitis B virus) infected. It is described in 30-70% routinely pursued liver biopsies in HCV infected individuals. Hitherto, there were many analyses concerning clinical and prognostic implications pursued of HCV influence upon inflammatory and fibrotic process of the liver. This article is an up-to-date review of current clinical and therapeutic implications of hepatosteatosis supported by referent study results.

Brucellosis is a rarely encountered zoonosis in Poland caused by Brucella species. Most of cases are imported from endemic areas. We reported 2 cases (married couple) oftypial brucellosis in patient returning from Azerbaijan, where both of them drunk non-pasteurized goat milk. The diagnosis was established by serological tests. Brucellosis should be suspected in patients with unexplained fever, especially in travelers to countries where non-pasteurized dairy products are common.

The current standard therapy in terms of treatment efficacy is the combination of peginterferon and ribavirin. Many factors affects response to this therapy: viral factors, host factors, factors related to therapy. The overall sustained virological response (SVR) is only 50%-61% among patients infected with genotype 1,4, following 48 weeks therapy and 78%-88% among patients infected with genotype 2,3, following 24 weeks therapy. Because there are some differences between the two brands of peginterferon clinicians are awaiting more information regarding the most effective anti-viral schedule for naive patients with chronic hepatitis C, particulary with genotype 1,4. IDEAL is the current ongoing trial comparing the effectiveness of these two form peginterferons approved for the treatment of chronic hepatitis C.

The GI endoscopy can be divided into upper GI tract endoscopy (oesophago-, gastro-, entero-, fistulo- and cholangioscopy) and lower GI tract endoscopy (recto-, sigmo-, colonoscopy) from practical point of view and the characteristic of used equipment. A lot of therapeutic methods for GI tract is associated with each of these procedures. GI tract endoscopy doesn't play significant part in diagnosis of acute and chronic hepatitis. Significance of endoscopy procedures decidedly increases in the case of progressive liver fibrosis and liver cirrhosis, where changes in GI tract are observed to 87% patients. These changes can be divided into: 1) not associated with portal hypertension, 2) these ones caused by portal hypertension. The most observed changes not associated with portal hypertension involve: reflux esophagitis, esophageal candidiasis; different variants of gastritis, gastric and duodenal ulcer. To the changes connected with portal hypertension, which are possible for endoscopy assessment, belongs esophageal and gastric varices, portal gastro-, entero-, colopathy, and gastric antral vascular ectasiae (GAVE). However to-day endoscopy has got not only diagnostic significance but also enables therapy of acute GI bleeding in this group of patients., the primary and secondary prophylaxis of bleedings from GI varices (particulary endoscopy band ligation-EBL) as well as estimation of pharmaco- and surgical therapy efficiency.

Hepatitis B virus (HBV) can be classified into eight major genotypes (A-H) that have mainly a geographic distribution. The HBV genotype may influence disease progression, HBeAg seroconversion rates, response to antiviral treatment. The aim of study was to analyze the distribution and frequency of genotypes in patients with chronic hepatitis B. Response to lamivudine 100 mg daily therapy was examined in respect to genotype. Sixty six patients (45 (68,2%) male, 21 (31,8%) female) with chronic hepatits B were enrolled. HBV genotypes were assigned before treatment with INNO-LiPA HBV Genotyping, Innogenetics, N. V., Ghent assay, which is a line probe test based on the reverse hybridization principle. In baseline and after 12 months of treatment serological markers of HBV infection, alanine aminotransferase (ALT) activities and HBV DNA serum levels were tested. Patients with chronic hepatitis B were infected predominantly with genotype A. HBV genotype distribution was: 78,8% for genotype A, 13,6% for genotype D, 1,5% for mixed infection with genotypes A and D. Distribution of genotypes A and D was asymmetrically regardless of sex, HBeAg status, ALT and HBV DNA levels. Four (6,1%) specimens had indeterminate A results by LiPA. There were no significant differences between patients with genotypes A and D regarding age and sex. There were also no significant differences between these two groups regarding rates of HBeAg and anti-HBe positivity, ALT activity and viral load. Twenty months of lamivudine (100 mg daily) therapy resulted in significant decreases in serum HBV DNA and ALT activities in patients with genotype A as well as with genotype D. After 12 months of treatment there were no statistical differences in HBeAg seroconversion rates, ALT activities, viral loads, frequency of HBeAg and anti-HBe between genotypes A and D.

Chronic hepatitis C remains the significant epidemiological and clinical problem. Its serious sequelae include cirrhosis, liver failure and hepatocellular carcinoma. The only approved treatment of chronic hepatitis C are interferon (IFN) alfa-based regimens. Pegylated IFN alfa in combination with ribavirin has been proved to be the most effective therapy with sustained virological response rate of 72%, regardless of HCV genotype. Qualifying for antiviral therapy needs careful initial assessment, regarding of contraindications and certain conditions, and then close monitoring during treatment. Despite the significant progress in hepatitis C management currently available therapies are often ineffective and unsuitable for certain patient populations. The results of molecular researches on HCV biology give rise to the new therapeutic approaches to HCV therapy.

The aim of the study was to determine an influence of HCV infection and combination therapy with interferon - alpha and ribavirin on the condition of oral mucosa and minor salivary glands in patients with chronic hepatitis C in comparison to subjects without liver pathology on 12-month follow-up. Patients with chronic hepatitis C more commonly develop pathological changes on the oral mucosa than patients without liver pathology. Combination therapy affects the amount of pathological lesions in the oral cavity of patients suffering from chronic hepatitis C and B. The occurrence of oral lichen planus on the oral mucosa may be associated with chronic hepatitis C as well as with concomitant alpha-interferon and antiviral therapy.

In this case report a rare adverse event (mild toxic epidermic necrolysis (Lyell)) was described. Incorrect a purified protein derivative (PPD) administration involves false negative tuberculin test (TT): BCG vaccine was injected even though high immunization to BCG. Mild, benign epidermic necrolysis, fever, mononucleosis-like syndrome, splenomegaly and lymphadenopathy were observed. Evaluation of white blood cells was done by automatic (simultaneously two analysers: Baker 900 plus and Technicon, Bayer) and by microscopic methods and revealed high lymphocyte activation (blastic transformation), lymphocytosis and high eosinophilia.. Wiener and coworkers describe interleukin-2-induced dermatotoxicity resembling toxic epidermal necrolysis. Further the most common side effects of IL-2 are skin eruptions and eosinophilia. Careful analysis yielded the conclusions that Lyell's syndrome may be fatal consequence of inappropriate revaccination, hyperergia--delayed type hypersensitivity and massive IL-2 release. Successful dexamethasone therapy confirms this observation.

We prospectively studied the serum zinc status and development of HIV infection in HIV infected ex-intravenous drug users (IDUS). It was prospective study of 75 persons (53 HIV infected persons, 22 controls). All patients in this group were observed and examined at baseline and every 3 months. We performed clinical examinations and completed blood counts, chemistry blood examinations, serum zinc level, LCD4 cells count. We found lower serum zinc level in HIV infected patients in comparison with control group. There was no significant difference among serum zinc level in male HIV positive patients in comparison with female HIV positive patients and in HIV infected patients with liver disease and in HIV infected patients without liver disease. In subgroups divided according to the degree of immunity deficiency (according to CDC classification) we do not show characteristic statistical differences in serum zinc level in comparison with control group.

According to UNAIDS data there are 40 millions of HIV infected people in the world. 7880 people are infected with HIV (official statistics) in Poland. Because of improvement of dialysis accessibility in Poland there is no limitations of qualification for dialysis for HIV infected patients. In this article authors present general information about HIV infection (epidemiology, diagnostic, clinical picture and treatment), post exposure management and prophylaxis in dialysis centers. We present also algorithms of management with patient with acute/chronic renal failure in dependence on result of HIV test.

The most common metabolic disorder of hem biosynthesis is porphyria cutanea tarda (PCT). PCT frequently is connected with liver disfunction. We have shown three cases of patients suffering from PCT and HCV infection, treated in Department of Infectious Diseases of Medical University in Wrocław. There is shown the pathway from the first disorders to the diagnosis and influence of treatment on the course of disease.

The human herpes virus (HHV) family (herpesviridae) are large DNA viruses containing eight important, ubiquitous human pathogens. This group of viruses encompasses: herpes simplex virus (HSV types 1 and 2), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), HHV-6, HHV-7 (cause roseola or exanthema subitum in children) and Kaposi sarcoma herpes virus--(KSHV). The outstanding property of herpes viruses is lifelong persistence of infection and potential periodic reactivation, particularly often among immunocompromised patients. Herpesvirus infections are associated with a wide spectrum of diseases ranging from local ulceration to serious systemic illnessess or malignancies. These infections are one of the major cause of morbidity and mortality in the immunocompromised patients.

Hepatitis B virus infection remains a major epidemiological health problem worldwide, due to the high prevalence (350 mln new cases per year) and clinical consequences of this infection including chronic hepatitis, liver cirrhosis and primary liver cancer. Two cases of patients with clinical symptoms of chronic hepatitis B without traditional serological markers, pointing to active hepatitis B viral replication, were presented. The diagnosis has been confirmed by molecular methods, typical histopathology of liver biopsy specimens, and biochemical improvement after lamivudine treatment.

The GI endoscopy can be divided into upper GI tract endoscopy (esophago-, gastro-, entero-, fistulo- and cholangioscopy) and lower GI tract endoscopy (recto-, sigmoido-, colonoscopy) from practical point of view and the characteristic of used equipment. A lot of therapeutic methods for GI tract is associated with each of these procedures. GI tract endoscopy doesn't play significant part in diagnosis of acute and chronic C hepatitis. Significance of endoscopy procedures decidedly increases in the case of progressive liver fibrosis and liver cirrhosis associated with HCV infection., where changes in GI tract are observed to 87% patients. These changes can be divided into: 1) not associated with portal hypertension, 2) these ones caused by portal hypertension. The most observed changes not associated with portal hypertension involve: reflux esophagitis, esophageal candidiasis; different variants of gastritis, gastric and duodenal ulcer. To the changes connected with portal hypertension, which are possible for endoscopy assessment, belongs esophageal and gastric varices, portal gastro-, entero-, colopathy, and gastric antral vascular ectasiae (GAVE). However to-day endoscopy has got not only diagnostic significance but also enables: estimation of pharmacotherapy efficiency, the primary and secondary prophylaxis of bleedings from GI varices as well as therapy of GI bleeding in this group of patients.

Central nervous system (CNS) becomes infected in early days of primary HIV infection. It is concerned to be one of the most important reservoirs of HIV in the human organism. It is also often affected by a number of conditions of different etiology, associated with HIV infection: opportunistic infections, neoplasms, disorders caused by HIV itself, adverse events of drugs, etc. These conditions appear in certain stages of HIV infection, connected with the state of the host's immunological system and degree of immunodeficiency. Unique physiological features of CNS cause that viral replication in CNS is to certain degree independent and different from systemic mechanisms of HIV infection. We overview the natural history of CNS HIV infection and common disorders of CNS associated with HIV regarding the stages of infection and possible mechanisms of viral entry to CNS and its progressive damage.

Sepsis is defined as systemic inflammatory response syndrome (SIRS) caused by infection. Massive activation of humoral and cellular mechanisms of host defense is present and can lead to a multiple organ dysfunction syndrome. Sepsis is good example, that inflammation binds with considerable energetic and metabolic effort of organism i.e. demand for oxygen, protein and microelements. The effort during SIRS exceeds compensatory abilities of organism, cause shock and death. The high mortality (40-70% in the case of septic shock) is a good illustration of the therapeutic problem. In the paper pathogenesis, diagnosis and therapy of sepsis was described. Pathogenetic importance of intoxication was explained--massive intoxication (for example by Staphylococcal enterotoxin) without infection cans lead to SIRS too. Precious advice in selection of antibiotic were given. Advantage penicillins and karbapenems over cephalosporins result from binding to PBP 2 or 1, considerably smaller release of free endotoxin and smaller induction Jarish-Heixhaimer's reaction. The side effect stimulates inflammation and deepens SIRS by release toxins and increase of TNF-alpha.

The aim of this study was the assessment the efficacy and safety of therapy with interferon alpha (Intron A) administered s.c. 3 MU x 3/week for 12 weeks for patients with HBV related liver cirrhosis (Child's class A). Fifteen patients completed therapy and 12 months follow-up. At the end of follow-up sustained response to the therapy, defined by clearance of HBV-DNA, normalization of ALAT activity in serum and improvement in the liver histology was achieved in 46.6% of treated patients. Moreover, among few patients from group of nonresponders (patients without sustained clearance of HBV-DNA) decrease of HBV-DNA level, ALAT activity in serum and improvement in the liver histology were observed. Adverse effects of IFN alpha therapy were typical, but in any case were no necessity terminate the therapy.

The determination of fibronectin (FN) concentration in plasma has been performed in the group of 77 patients (60-with various chronic liver diseases, 6-with AIDS IVc, 11-healthy patients). The purpose of this study was: evaluation of the value of plasma FN determination in assessment the degree of liver fibrosis and the degree of liver damage. The obtained results were compared with routine biochemical tests and histopathological picture of liver sections. Among patients with liver diseases, we observed that plasma FN concentration was significantly lower only in the group with decompensated liver cirrhosis, in relation to control group. Non significant lower values of FN was observed in the group of patients with chronic hepatitis, as well as non significant higher ones in the group with cholestasis and fibrosis. It has been concluded that determination of plasma FN concentration has not any importance in evaluation of degree of liver fibrosis and its only one from many functional liver tests.

In the paper the structure, place od synthesis and biological role of fibronectin in human organism are discussed, and the value of plasma fibronectin (FN) concentration determination in the diagnosis of chronic hepatic diseases, including hepatic fibrosis, was critically evaluated. Simultaneously, the view is presented that the determination of FN concentration in peritoneal fluid, as well the determination of amount and location of FN in the hepatic tissue should be a routine element of hepatological diagnosis.

Differential value of ACE activity and acid alpha 1-glycoprotein was evaluated in the selected liver and biliary tract diseases. The study involved 75 patients divided into 4 subgroups, according to the character of their disease: patients with the acute viral hepatitis, chronic viral hepatitis, liver cirrhosis, and cholelithiasis. It was found that ACE activity was significantly increased in all pathologies involving liver parenchyma, and normal in patients with extrahepatic cholestasis. It was also shown that simultaneous assays of ACE and acid < alpha 1-glycoprotein may serve as a sensitive test differentiating jaundice in parenchymal hepatic diseases from that in the course of extrahepatic pathology.

The present study was aimed to test the efficacy and safety of interferon alpha (Wellferon-Wellcome Foundation Ltd.) either alone, or in combination with short-term corticosteroid pretreatment in the therapy of chronic hepatitis B. 44 patients with documented chronic hepatitis type B (12 women and 32 men; mean age 37.5 years, range 23-59 years) and satisfying the entry criteria were subjects of the study. 30 patients had chronic active hepatitis on liver biopsy, while 14 had chronic persistent hepatitis. Consecutive patients were given either placebo or prednisone in a double-blinded manner for 4 weeks (0.6 mg/kg/day in the first two weeks, 0.45 mg/kg/day in the third week and 0.25 mg/kg/day in the last week), and then, after a 2 week pause, therapy with interferon was instituted for a total of 12 weeks. Interferon was given by intramuscular injection in a single daily dose of 10 x 10(6) IU for 5 days and three times weekly thereafter. However, because of side effects, the dose of interferon was occasionally reduced to 5 x 10(6) IU in most patients. Interferon induced a sustained cessation of HBV replication as judged by loss of DNA-polymerase activity in 26 (59%) patients, 20 (45%) patients seroconverted to anti-HBe. Additionally, 6 (14%) cases lost HBsAg and seroconverted to anti-HBs. Prednisone pretreatment did not seem to improve the efficacy of interferon therapy. The outcome of the treatment was unrelated to gender and pretreatment activity of transaminases, however, patients with low activity of HBV replication were more likely to respond to therapy than patients with high HBV replication.

Therapeutic plasmaphereses using CS 3000 Fenwal Cell Separator were performed in 4 women and 2 men, aged between 17 and 44 years, with hepatic coma complicating acute viral hepatitis type B. One to four plasma exchanges per patient were performed, usually at the volume of 3000 ml per procedure. Two patients at II and IVa period of the coma, according to Aboun classification, survived. Four patients at II, III and two at III/IV period of the coma died. The authors suggest that in some cases exchange of large volumes of plasma in the treatment of hepatic coma complicating acute viral hepatitis may be a lifesaving procedure.