The state of hepatitis B and C in Europe: report from the hepatitis B and C summit conference*

Worldwide, the hepatitis B virus (HBV) and the hepatitis C virus (HCV) cause, respectively, 600,000 and 350,000 deaths each year. Viral hepatitis is the leading cause of cirrhosis and liver cancer, which in turn ranks as the third cause of cancer death worldwide. Within the WHO European region, approximately 14 million people are chronically infected with HBV, and nine million people are chronically infected with HCV. Lack of reliable epidemiological data on HBV and HCV is one of the biggest hurdles to advancing policy. Risk groups such as migrants and injecting drug users (IDU) tend to be under-represented in existing prevalence studies; thus, targeted surveillance is urgently needed to correctly estimate the burden of HBV and HCV. The most effective means of prevention against HBV is vaccination, and most European Union (EU) countries have universal vaccination programmes. For both HBV and HCV, screening of individuals who present a high risk of contracting the virus is critical given the asymptomatic, and thereby silent, nature of disease. Screening of migrants and IDUs has been shown to be effective and potentially cost-effective. There have been significant advances in the treatment of HCV and HBV in recent years, but health care professionals remain poorly aware of treatment options. Greater professional training is needed on the management of hepatitis including the treatment of liver cancer to encourage adherence to guidelines and offer patients the best possible outcomes. Viral hepatitis knows no borders. EU Member States, guided by the EU, need to work in a concerted manner to implement lasting, effective policies and programmes and make tackling viral hepatitis a public health priority.     

Staging Fibrosis in Chronic Viral Hepatitis

Staging fibrosis accurately has always been a challenge in viral hepatitis and other liver diseases. Liver biopsy is an imperfect gold standard due to its intra and interobserver agreement limitations and additional characteristics such as its safety and cost. Hence, non-invasive tests have been developed to stage liver fibrosis. In addition to serological biomarkers, physical tests with reasonable accuracy are available and adopted in the daily clinic regarding viral hepatitis fibrosis staging. In this review, we discuss the published data regarding the staging of liver fibrosis in chronic hepatitis B and C, emphasizing non-invasive markers of fibrosis, both serological and physical. Moreover, we also discuss a persistent central gap, the evaluation of liver fibrosis after HCV cure.     

Simultaneous development of lymphoma in recipients of renal transplants from a single donor: donor origin confirmed by human leukocyte antigen staining and microsatellite analysis

BACKGROUND: Posttransplant lymphoproliferative disorders (PTLD) occur in 0.5% to 2.5% of cases in renal-transplant recipients. Epstein-Barr virus (EBV) is usually detected in the tumor cells, suggesting a role for this virus as an agent of B-cell proliferation. It is unusual for patients receiving allografts from the same donor to develop PTLD simultaneously. METHODS: we describe two patients who received renal allografts from the same donor and developed PTLD simultaneously. The presence of EBV in both tumors was confirmed. In this report, the origin of tumor cells was determined by immunohistochemical human leukocyte antigen (HLA) typing and microsatellite analysis. Clonality was studied by immunoglobulin gene rearrangement analysis. RESULTS: Our results suggest that the tumor originated from donor cells in both patients but, because immunoglobulin gene rearrangements were different, this could mean that lymphoid cells proliferate independently in each recipient. CONCLUSIONS: We propose the following pathogenesis: immortalization of passenger B lymphocytes by EBV, proliferation of these cells, and development of PTLD by means of immunosuppression, antigenic stimulation, and HLA mismatch.     

Résultats à long terme d''une série de 89 patients suivis pour un sarcome des tissus mous traités par chirurgie conservatrice et trois modalités d''irradiation postopératoire

PURPOSE: To evaluate the outcome of patients treated for soft tissue sarcoma using three different post-operative radiotherapy schedules. METHODS AND MATERIALS: Between 1990 and 2003, 89 patients (median age 50.8 years) presenting with soft tissue sarcoma (located to the limbs for 66 of them) underwent post-conservative-surgery radiotherapy. Pathology was liposarcoma in 35 cases and 54 others tumors. Tumors grades (FNCLCC classification) were 1, 2, 3 or unknown in 29, 32, 19 and 9 cases, respectively. Surgery was considered as complete in 68 patients. Irradiation was normofractionated (NF) in 62 cases, hyperfractionated (BF) in 19 cases and hypofractionated (HF) in 8 cases. For all the patients, median delivered dose was 61 Gy [34-76 Gy]. RESULTS: Median follow-up of alive patients was 73,8 months [3-184]. Five-year local control (LC) and overall survival (OS) rates were 85.5 and 71.2% respectively. According to multifactorial analysis, favourable prognostic factors were for local control, complete surgery (P=0.0075) and for overall survival, complete surgery (P=0.0267), grade 1 tumor (P=0.012) and absence of distant recurrence (P=0.0488). There was no statistical evidence of difference for the five-year LC and OS rates between the patients who received NF, BF or HF. There were few complications and there were comparable in the three groups. CONCLUSIONS: This retrospective serie showed similar results for all the schedules. There is no evidence to recommend bifractionation. Hypofractionation should be used only in selected patients with poor performans status.     

Analysis and technical refinements of endoscopic treatment of vesico-ureteral reflux in children with a 40-month follow up

We report our experience with the endoscopic treatment of vesicoureteral reflux by submucosal injection of Teflon in children. During a period of 40 months, 450 children and a total of 678 ureters were treated; 606 ureters were available with a follow-up of more than 3 months and examined by cystography. The overall success rate was 84.2% after one injection and 94.3% after two injections; 96.2% of the primary refluxes disappeared after two injections. We believe that in duplicated ureters and grade IV and V refluxes only one injection should be tried. If this fails we undertake surgical reimplantation. The success rate in neurogenic bladders and failures of previous surgical reimplantations allows surgery to be avoid in these difficult cases. We found seven non-pathological Teflon granuloma calcifications that had no influence on the results. Offprint requests to: P. Sauvage     

Assessment of hepatitis C networks

AIMS: To assess the functioning of hepatitis networks.METHODOLOGY: A questionnaire was sent to all reference centers, to ten general hospitals and to twelve private hospitals working in hepatology. The main items included: participation and composition of networks, difficulties and positive or negative experiences, equal access to diagnostic and therapeutic means within the networks. Answers could be accompanied by personal remarks.RESULTS: The response rate was satisfactory: 75%, 70% and 100% respectively for the three groups. More than 80% of the questions were answered. Nearly all of the centers participate in a network. Two thirds of the reference centers have organized a therapeutic committee that includes private units and general hospitals. All groups actively participate in the networks. The positive experiences that were most often described were the success of training sessions especially in relation to equal access, and becoming acquainted with other participants. Most networks did not seem to be interested in screening. For reference centers the number of participating practitioners was too low. The main difficulty was felt to be overcentralization of the public hospital. Most networks are independent and meetings take place in the evening. Most responses were in favor of parity and equal access to diagnosis and therapeutic means within the networks. This only occurred in one third of the networks and if these measures were implemented it would increase network participation and effectiveness. Two thirds of the responses were also favourable to extending therapeutic trials to networks.CONCLUSION: Public and private hepatologists have similar opinions about hepatitis networks. Pooling of activities, responsibilities and means should be implemented and could improve participation in the networks.