Epstein Barr virus hepatitis

Objectives

Epstein-Barr Virus (EBV) infection has the potential to establish life-long, benign infections in their hosts. Although biochemical evidence of hepatocellular damage is common, jaundice is uncommon and complete recovery is the rule. The present study describes clinical characteristics and changes of liver function tests during the course of infectious mononucleosis.

Patients and methods

All immunocompetent patients with hepatic dysfunction associated with acute EBV infection, cared for at the University Hospital of Heraklion, over a 6-year period, were identified and retrospectively studied.

Results

The study included 41 patients with a median age of 18.5 (15-51) years. Aspartate-aminotrasferase (AST) and alanine-aminotrasferase (ALT) were increased in an average maximum of 5-fold. Both transaminase levels started to rise 2 days after the clinical onset of the disease, and returned to normal after a period of 20 days. Alkaline-phosphatase (ALP), γ-glutamyltransferase (γ-GT) and bilirubin levels also increased above the normal values during the course of the disease and returned to normal after a period of 20, 30 and 22 days respectively. The changes of mean AST and ALT levels over time were statistically significant, while those of mean ALP, γ-GT and bilirubin levels over time were not. Anicteric cholestatic liver disease was observed in 24 patients (59%), while icteric only in 2 (6%).

Conclusion

Liver involvement in acute EBV infection represents mild and self-limited hepatitis with predominantly cholestatic features.     

Systematic review of health-related quality of life after esophagectomy for esophageal cancer

This study is aimed to assess the long-term health-related quality of life(HRQL) of patients after esopha-gectomy for esophageal cancer in comparison with es-tablished norms,and to evaluate changes in HRQL during the different stages of follow-up after esopha-geal resection. A systematic review was performed bysearching medical databases(Medline,Embase andthe Cochrane Library) for potentially relevant studiesthat appeared between January 1975 and March 2011.Studies were included if they addressed the questi...     

Unusual causes of intrahepatic cholestatic liver disease

We report five cases with unusual causes of intrahepatic cholestasis, including consumption of Teucrium polium （family Lamiaceae） in the form of tea, Stauffer＇s syndrome, treatment with tamoxifen citrate for breast cancer, infection with Coxiella Burnetii （acute Q fever）, and infection with Brucella rnelitensis （acute brucellosis）.     

The validity of the diagnosis of chronic obstructive pulmonary disease in general practice.

AIM: To determine the validity of the diagnosis of chronic obstructive pulmonary disease (COPD) in general practice in patients given a diagnosis of COPD and treated with bronchodilators. METHODS: From the medical records of eight Health Centres in Northern Greece, 319 subjects aged over 40 years and diagnosed as "COPD" were entered into the study. All filled in a special questionnaire and were subjected to spirometry, rhinomanometry and chest X-ray. RESULTS: One hundred and sixty patients (50.2%) met the GOLD criteria for COPD. Twenty-six of them were non-smokers and underwent further evaluation: blood eosinophil count, serum IgE assay, high resolution computed tomography (HRCT) scan of the chest, and echocardiography; 16 were given a different diagnosis. One hundred and fifty-nine subjects (49.8%) with an FEV1/ FVC ratio >0.7 did not meet the GOLD criteria for COPD; 71 suffered from nasal obstruction, 13 from asthma, six had restrictive pulmonary disease and 69 had no respiratory disease. CONCLUSION: Diagnostic errors in patients with respiratory symptoms in the primary healthcare setting are frequent. Patients suspected to have COPD should undergo spirometry testing after bronchodilation. An alternative diagnosis must be sought for non-smoking patients with irreversible airway obstruction.     

Early changes of CD4-positive lymphocytes and NK cells in patients with severe Gram-negative sepsis

Introduction  

Our aim was to define early changes of lymphocytes and of NK cells in severe sepsis and to correlate them with serum levels of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1).     

Epilepsy during the Middle Ages, the Renaissance and the Enlightenment

The purpose of this study was to pinpoint the views on epilepsy as a disease and symptom during medieval times and the Renaissance. A thorough study of texts, medical books and reports along with a review of the available literature in PubMed was undertaken. With the exception of some early Byzantine doctors in the East and some of the representatives of Arab medicine, scientific views and observations on epilepsy in the West were overrun by the domination of the Catholic Church. This led to the formulation of superstitious views of the disease; epileptics were considered possessed and, therefore, only religious methods could possibly cure it. Near the end of the fourteenth century, physicians were emancipated from Catholic intervention. The Renaissance is marked by a plethora of new treatises on epilepsy regarding the mechanisms of epileptic convulsions, the connection with various clinical conditions such as tumors and venereal diseases and the collection of interesting cases.