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Is laparoscopy an advantage in the diagnosis of cirrhosis in chronic hepatitis C virus infection?

World Journal of Gastroenterology 2003年第4期9卷 745-750页

作者： perdita wietzke-braun Felix braun Peter Schott Giuliano Ramadori Department of Internal Medicine Division of Gastroenterology and EndocrinologyUniversity of GoettingenGermany

AIM:To evaluate the potential of laparoscopy in the diagnosis of cirrhosis and outcome of interferon treatment in HCV-infected patients. METHODS:In this retrospective study,diagnostic laparoscopy with laparoscopic liver biopsy was performed in 72 consecutive patients with chronic HCV *** presence or absence of drrhosis was analyzed macroscopically by laparoscopy and microscopically by liver biopsy *** and laboratory data and outcome of interferon-alfa treatment were compared between cirrhotic and noncirrhotic patients. RESULTS:Laparoscopically,cirrhosis was seen in 29.2 % (21/72)and non-cirrhosis in 70.8 %(51/72)of patients. Cirrhotic patients were significantly older with a significant longer duration of HCV infection than noncirrhotic patients. Laboratory parameters(AST,y-GT,y-globulin fraction)were measured significantly higher as well as significantly lower (prothrombin index,platelet count)in cirrhotic patients than in non-cirrhotic ***,cirrhosis was confirmed in 11.1%(8/72)and non cirrhosis in 88.9 %(64/72).Patients with macroscopically confirmed cirrhosis(n=21)showed histologically cirrhosis in 38.2 %(8/21)and histologically non- cirrhosis in 61.9 %(13/21).In contrast,patients with macroscopically non-cirrhosis(n=51)showed histologically non cirrhosis in all cases(51/51).Thirty-nine of 72 patients were treated with interferon-alfa,resulting in 35.9 %(14/39) patients with sustained response and 64.1%(25/39)with non ***-responders showed significantly more macroscopically cirrhosis than sustained *** contrast,there were no significant histological differences between non-responders and sustained responders. CONCLUSION:Diagnostic laparoscopy is more accurate than liver biopsy in recognizing cirrhosis in patients with chronic HCV *** biopsy is the best way to assess inflammatory grade and fibrotic *** invasive marker for staging,prognosis and management,and treatment outcome of chro

关键词： Adult Biopsy Comparative Study Female Genotype Hepacivirus purification Hepatitis C, Chronic Humans Interferon-alpha Laparoscopy Liver Cirrhosis Male Middle Aged RNA, Viral Reproducibility of Results Retrospective Studies Treatment Outcome

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Combination of "low-dose" ribavirin and interferon alfa-2a therapy followed by interferon alfa-2a monotherapy in chronic HCV-infected nonresponders and relapsers after interferon alfa-2a monotherapy

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World Journal of Gastroenterology 2001年第2期7卷 222-227页

作者： perdita wietzke-braun Volker Meier Felix braun Giuliano Ramadori Abteilung für Gastroenterologie und Endokrinologie Georg-August-UniversitatGottingenGermany

AIM To report on the efficacy, safety and tolerability of interferon alfa-2a combined with a "low dose" of ribavirin for relapsers and non responders to alpha interferon *** Thirty-four chronic hepatitis C virus-infected non-responders to interferon alfa2a monotherapy (a course of at least 3 months treatment) and 13 relapsers to interferon alfa 2a monotherapy (a dose of 3 to 6 million units three times per week for at least 20 weeks but not more than 18 months) were treated with the same dose of interferon alfa-2a used before (3 to 6 million units three times per week) and ribavirin (10 mg/ kg daily) for 6 months. In complete responders, interferon alfa-2a was administered for further 6 months at the same dose used before as *** Seven (20.6%) of 34 non-responders stopped the combined therapy due to adverse events, including two patients with histological and clinical Child A cirrhosis. In 17/27 (63%)non-responders, the combined therapy was stopped after three months because of non-response. Ten of the 27 non-responders completed the 1;2-month treatment course. At a mean follow up of 28 months (16- 37 months)after the treatment, 4/10 (15%) previous non-responders still remained complete responders,All 13 previous relapsers completed the 12-month treatment course. At a mean follow up of 22months (9 - 36 months) after treatment, 6/13(46%) the previous relapsers were stillsustained complete *** Our treatment schedule of the combined therapy for 6 months of interferon alfa2a with a low dose of ribavirin (10 mg/kg/day)followed by 6 months of interferon alfa-2amonotherapy is able to induce a sustainedcomplete response rate in 15% of non-responders and 46% of relapsers with chronic hepatitis C virus-related liver diseases comparable to those obtained with the standarddoses of ribavirin 1000 - 1200 mg/*** prospective controlled trials using lower total amounts of ribavirin in combination with interferon should be p

关键词： hepatitis C, chronic/drug therapy interferon alpha-2a/therapeutic use interferon alpha-2a/administration & dosage ribavirin/administration & dosage ribavirin/therapeutic use

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HCV-RNA positivity in peripheral blood mononuclear cells of patients with chronic HCV-infection: does it really mean viral replication?

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World Journal of Gastroenterology 2001年第2期7卷 228-234页

作者： Volker Meier Sabine Mihm perdita wietzke-braun Guliano Ramadori Georg-August-Universitat gottingen Zentrum innere medizinAbteilung Für Gastroenterologie Und EndokrinologieRobert-Koch-Straβe 4037075 GottingenGermany

AIM: To analyze the association of HCV-RNA with peripheral blood mononuclear cells (PBMC) and to answer the question whether HCV-RNA positivity in PBMC is due to viral replication. METHODS: HCV-RNA was monitored in serum and PBMC preparations from 15 patients with chronic HCV infection before, during and after an IFN-alpha therapy using a nested RT/PCR technique. In a second approach, PBMC from healthy donors were incubated in HCV positive plasma. RESULTS: In the IFN-alpha responding patients,HCV-RNA disappeared first from total RNA preparations of PBMC and then from serum. In contrast, in relapsing patients, HCV-RNA reappeared first in serum and then in PBMC. A quantitative analysis of the HCV-RNA concentration in serum was performed before and after transition from detectable to non detectable HCV-RNA in PBMC-RNA and vice versa. When HCV-RNA was detectable in PBMC preparations, the HCV concentration in serum was significantly higher than the serum HCV-RNA concentration when HCV-RNA in PBMC was not detectable. Furthermore, at no time during the observation period was HCV specific RNA observed in PBMC, if HCV-RNA in serum was under the detection limit. Incubation of PBMC from healthy donors with several dilutions of HCV positive plasma for two hours showed a concentration dependent PCR positivity for HCV-RNA in reisolated PBMC. CONCLUSION: The detectability of HCV-RNA in total RNA from PBMC seems to depend on the HCV concentration in serum. Contamination or passive adsorption by circulating virus could be the reason for detection of HCV-RNA in PBMC preparations of chronically infected patients.

关键词： Adult Aged Antiviral Agents Female Hepacivirus Hepatitis C, Chronic Humans Interferon-alpha Leukocytes, Mononuclear Male Middle Aged RNA, Viral Research Support, Non-U.S. Gov't Reverse Transcriptase Polymerase Chain Reaction Viral Load Virus Replication

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Initial steroid-free immunosuppression after liver transplantation in recipients with hepatitis c virus related cirrhosis

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World Journal of Gastroenterology 2004年第15期10卷 2213-2217页

作者： perdita wietzke-braun Felix braun Burckhart Sattler Giuliano Ramadori Burckhardt Ringe Abteilung for Gastroenterologie und Endokrinologie Georg-August-Universitt37075 GttingenGermany Georg-August-Universitt 37075 GttingenGermany Zentrum Pathologie Georg-August-Universitt37075 GttingenGermany

AIM:Steroids can increase hepatitis C virus(HCV) *** liver transplantation(LTx),steroids are commonly used for immunosuppression and acute rejection is usually treated by high steroid *** can worsen the outcome of recurrent HCV ***, we evaluated the outcome of HCV infected liver recipients receiving initial steroid-free immunosuppression. METHODS:Thirty patients undergoing LTx received initial steroid-free *** for LTx included 7 patients with HCV related *** immunosuppression consisted of tacrolimus 2×0.05mg/kg.d po and mycophenolate mofetil(MMF)2×15mg/kg.d *** tacrolimus dosage was adjusted to trough levels in the target range of 10-15μg/L during the first 3 mo and 5-10μg/L *** of acute rejection were verified histologically. RESULTS:Patient and graft survival of 30 patients receiving initial steroid-free immunosuppression was 86% and 83% at 1 and 2 *** rejection occurred in 8/30 patients, including 1 HCV infected *** HCV-infected patients had HCV genotype Ⅱ(lb).HCV seropositivity occurred within the first 4 mo after *** virus load was not remarkably increased during the first year after ***,grafts had no severe recurrent hepatitis. CONCLUSION:From our experience,initial steroid-free immunosuppression does not increase the risk of acute rejection in HCV infected liver ***,none of the HCV infected patients developed serious chronic liver *** suggests that it may be beneficial to avoid steroids in this particular group of patients after LTx.

关键词： Liver Transplantation Adult Drug Therapy, Combination Female Hepatitis C Humans Immunosuppressive Agents Liver Cirrhosis Male Middle Aged Mycophenolic Acid derivatives Postoperative Care Tacrolimus

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Adult-to-adult right lobe living donor liver transplantation:Comparison of endoscopic retrograde cholangiography with standard T2-weighted magnetic resonance cholangiography for evaluation of donor biliary anatomy

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World Journal of Gastroenterology 2006年第36期12卷 5820-5825页

作者： perdita wietzke-braun Felix braun Dieter Müller Thomas Lorf Burckhardt Ringe Giuliano Ramadori Abteilung für Gastroenterologie und Endokrinologie Georg-August-Universitt Gttingen Germany Klinik für Allgemeine Chirurgie und Thorax-chirurgie Universitt Schleswig-Holstein Campus Kiel Germany Abteilung für Diagnostische Radiologie Georg-August-Universitt Gttingen Germany Klinik für Allgemeine Chirurgie Georg-August-Universitt Gttingen Germany Center for Liver Pancreas and Biliary Disease Drexel University College of Medicine Philadelphia United States

AIM: To compare the value of endoscopic retrograde cholangiography (ERC) and standard T2-weighted magnetic resonance cholangiography (MRC) in the evaluation process as adult-to-adult right lobe living donor liver transplantation (LDLTx) demands a successful outcome, and exact knowledge of the biliary tree is implicated to avoid biliary complications, ***: After starting the LDLTx program, 18 liver transplant candidates were selected for LDLTx by a stepwise evaluation process. ERC and standard T2-weighted MRC were performed to evaluate the biliary system of the donor liver. The anatomical findings of ERC and MRC mapping were compared using the Ohkubo classification. RESULTS: ERC allowed mapping of the whole biliary system in 15/15 (100%) cases, including 14/15 (93.3%) with biliary variants while routine MRC was only accurate in 2/13 (15.4%) cases. MRC was limited in depicting the biliary system proximal of the hepatic bifurcation. Postoperative biliary complications occurred in 2 donors and 8 recipients. Biliary complications were associated with Ohkubo type C, E or G in 6/8 recipients, and 2/3 recipients with biliary leak received a graft with multiple (≥2) bile ducts. CONCLUSION: Pretransplant ERC is safe and superior over standard MRC for detection of biliary variations that occur with a high frequency. However, precise knowledge of biliary variants did not reduce the incidence of postoperative biliary complications.

关键词： Living donor liver transplantation Donors biliary tree Endoscopic retrograde cholangiography Magnetic resonance cholangiography

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Treatment of genotype 2 and 3 chronic hepatitis C virus-infected patients

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World Journal of Gastroenterology 2005年第39期11卷 6188-6192页

作者： perdita wietzke-braun Volker Meier Katrin Neubauer-Saile Sabine Mihm Giuliano Ramadori Abteilung für Gastroenterologie und Endokrinologie Georg-August-Universitt Gttingen Germany

AIM： Before pegylated interferon alpha （IFN） was introduced for the therapy of chronic hepatitis C virus （HCV）-induced hepatitis, conventional thrice weekly IFN therapy was supplemented by ribavirin. Also, at that time, higher and more frequent doses of IFN were expected to be more effective than the standard regimen of 3 MU thrice weekly. As ribavirin significantly increases side effects and negatively influences the quality of life particularly in young patients, we started a prospective non-randomized study with a daily IFN-2a monotherapy as an initial treatment for chronic hepatitis C. METHODS： Forty-six consecutive chronic HCV-infected patients received 3 MU IFN-2a per day as an initial treatment. Patients with genotype 2 or 3 （n = 12） were treated for 24 wk, and patients with genotypes other than 2 or 3 （n = 34） for 48 wk. Treatment outcome was followed up for 48 wk after the end of treatment （EOT）. Virological response was defined as the absence of detectable serum HCV-RNA. Patients without virological response at 12 wk after the start of treatment received low-dose ribavirin （10 mg（kg·d）） additionally. RESULTS： During treatment, three genotype 3 patients were excluded from the study due to incompliance. The remaining patients （n = 9） infected with genotype 2 or 3 showed an initial virological response rate of 100%. Six patients （66.7%） were still found to be virus-free at the end of follow-up period. In these patients, initial virological response was evident already after 2 wk of treatment. In contrast, initial virological response occurred first after 4 wk of treatment in the three patients who relapsed （33.3%）. In comparison, patients infected with genotypes other than 2 or 3 （n = 34） showed an initial virological response rate of only 23.5% （n = 8）, and even in combination with ribavirin a sustained virological response （SVR） rate of only 11.8% （n = 4） could be achieved. CONCLUSION： In chronic HCV-infected patients with genotype 2 or 3, a SVR can be expe

关键词： Chronic hepatitis C virus infection Genotype 2 and 3 Alpha interferon Daily dose interferon therapy

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Spontaneous elimination of hepatitis C virus infection: A retrospective study on demographic, clinical, and serological correlates

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World Journal of Gastroenterology 2007年第31期13卷 4224-4229页

作者： perdita wietzke-braun Larissa Bettina Mnhardt Albert Rosenberger Angela Uy Giuliano Ramadori Sabine Mihm Department of Gastroenterology and Endocrinology Robert-Koch-Str.40 37075 Gttingen Germany Department of Genetic Epidemiology Humboldtallee 32 Gttingen 37073 Germany Department of Microbiology Kreuzbergring 57 Gttingen Georg-August-Universitt Gttingen 37075 Germany

To find correlates to spontaneous clearance of hepatitis C virus （HCV） infection, this study compared individuals with self-limited and chronic infection with regard to clinical, demographic, and serological pa- rameters. METHODS： Sixty-seven anti-HCV positive and repeatedly HCV RNA negative individuals were considered to have resolved HCV infection spontaneously. To determine the viral genotype these patients had been infected with HCV serotyping was performed. For comparison reasons, 62 consecutive patients with chronic hepatitis C were enrolled. Cases and controls were compared stratified for age and sex. RESULTS： Retrospective analysis showed （1） a lower humoral reactivity to HCV in patients with self-limited compared to chronic HCV-infection and （2） that younger age, history of iv drug use, and acute/post-acute hepatitis A or B co-infections, but not viral genotypes, are independent correlates for spontaneous HCV clearance. CONCLUSION： The stronger humoral reactivity to HCV in patients with persistent infections and in those with a history of iv drug use is supposed to be due to continuous or repeated contact（s） to the antigen. Metachronous hepatitis A or hepatitis B infections might favor HCV clearance.

关键词： Hepatitis C virus Hepatitis Self-limitedinfection Anti-HCV antibodies Co-infection HCVserotype

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生命中那些短暂的友谊

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英语学习 2018年第6期 32-34页

作者： perdita Connolly 门椿林

人生旅途上，每个人都会收获各种形式的友谊。其中就有这么一种朋友，他们并没有长久地在我们身边，而只是在我们生命中或孤寂、或绝望、或烦闷、或迷茫的时刻出现，陪我们一起走过一段路，与我们一同见证一段道路的风景，然后便从我们... 详细信息

人生旅途上，每个人都会收获各种形式的友谊。其中就有这么一种朋友，他们并没有长久地在我们身边，而只是在我们生命中或孤寂、或绝望、或烦闷、或迷茫的时刻出现，陪我们一起走过一段路，与我们一同见证一段道路的风景，然后便从我们的生命中消失。而这种特殊的友谊，却会以记忆的形式，被储藏在内心那偶尔被唤起的深处。

关键词：友谊生命人生旅途个人朋友

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骑车记：飞一般的自由

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英语学习 2016年第10期 27-29页

作者： perdita Buchan 文玮北京教育科学研究院基础教育教学研究中心中小学外语教研室山东省教学研究室江西省教研室三亚市教育局教研室北京教育学院石景山分院广州市教育研究院高中教育教研室

著名主持人倪萍有本书叫做《自行车的日子》，里面有句话总结了人在自行车上的心境：当置身其中，你会感到这像是血脉在运行，热热闹闹、轰轰烈烈，蕴藏着不尽的潜能，仿佛自行车也有灵魂、有脉搏、有呼吸一样。如果说，自行车有灵魂，... 详细信息

著名主持人倪萍有本书叫做《自行车的日子》，里面有句话总结了人在自行车上的心境：当置身其中，你会感到这像是血脉在运行，热热闹闹、轰轰烈烈，蕴藏着不尽的潜能，仿佛自行车也有灵魂、有脉搏、有呼吸一样。如果说，自行车有灵魂，那也一定会是轮转不歇、自由不羁的灵魂吧!不然，怎能载着我在青山绿水、贫穷富贵、时间流转中肆意飞驰呢？

关键词：《自行车的日子》自由主持人灵魂

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摄影作品欣赏

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复印报刊资料（当代文萃） 2018年第10期 F0002-F0002页

作者： Espen Bergersen[挪威] perdita Petzl[奥地利] 不详

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