Adult Still's disease is characterized by typical spiking fever, oligopolyarthritis, neutrophilic leukocytosis and involvement of various organs. We report a case which illustrated typical digestive features of Still's disease as dysphagia, peritonitis and manifests the hitherto unreported complication of gastric ulcerations. Treatment with prednisone was started in order to control arthritis, resulting in improvement of both gastric ulcerations (partially resistant to omeprazole treatment) and arthralgia. After seven years of follow-up, the patient remains clinically and biochemically stable with steroid and methotrexate treatment.

OBJECTIVES AND METHODS:In France, the positive rate for unit-HCV antibodies in the sera of pregnant women is usually found to be between 0.7 and 3.9%. The aim of our prospective study was to determine the interactions between pregnancy and chronic viral hepatitis C in 12 pregnant women.RESULTS:In our study, chronic viral hepatitis C did not influence maternal or neonatal outcome. The mean gestational age was 38.4 +/- 3 weeks. During follow-up, mean serum ALT levels were significantly lower (36 +/- 17 mU/mL) during the last three months of pregnancy compared to before pregnancy (237 +/- 144 mU/mL, P < 0.002) and after pregnancy (141 +/- 62 mU/mL, P < 0.0005). During the third trimester, serum ALT levels were normal in 90% of the women. However, the persistence of viremia during pregnancy and a rebound in serum ALT during the post-partum period have been noticed.CONCLUSION:The normalization of serum ALT levels during pregnancy, the persistence of viremia, and a rebound in serum ALT during post-partum could be related to pregnancy-induced changes in the immune system.

Adult Still's disease is characterized by typical spiking fever, oligopolyarthritis, neutrophilic leukocytosis and involvement of various organs. We report a case which illustrated typical digestive features of Still's disease as dysphagia, peritonitis and manifests the hitherto unreported complication of gastric ulcerations. Treatment with prednisone was started in order to control arthritis, resulting in improvement of both gastric ulcerations (partially resistant to omeprazole treatment) and arthralgia. After seven years of follow-up, the patient remains clinically and biochemically stable with steroid and methotrexate treatment.

To determine the potential role of orthotopic liver transplantation (OLT) in cirrhotic patients surviving a first episode of spontaneous bacterial peritonitis (SEP), medical records of 79 patients presenting with a first episode of SEP were reviewed. Of these patients, 37 were selected as potential candidates for OLT using the following criteria: absence of hepatocellular carcinoma; no severe organ failure other than the liver; age less than or equal to 66 years; and survival after SEP > 60 days. Survival time was calculated from the day of SEP diagnosis. Prognostic value of clinical, biological and bacteriological data recorded at the time of SEP was determined using univariate and multivariate analysis (Cox's regression model).Survival rate of the potential candidates for OLT at 3 months, I year and 2 years was 94, 46 and 30%, respectively. Serum creatinine value (P=0.001) and Pugh score (P=0.005) were independently correlated with death. The 1 year survival rate was 80% for the 11 patients with a Pugh score <10, and 26% for the 26 patients with a Pugh score greater than or equal to 10.Our results suggest that after SEP, OLT should be considered in patients with severe liver disease. Survival of patients with a moderate liver disease (i.e. Pugh score <10) might be relatively high.

We tested the efficacy of maintenance treatment with alpha-2a interferon, 1 megaunit thrice weekly for 6 months, in preventing relapse of non-A, non-B/C hepatitis in remission after treatment with alpha interferon given thrice weekly according to the following dose schedule: 3 megaunits for 3 months, 2 megaunits for 2 months and 1 megaunit for 1 month. Fifty-three patients with hepatitis C in remission were randomly allocated to a treatment group (n=26) or a control group (n=27). A relapse (aminotransferase activity >1.5 times the upper limit of normal) occurred in 46% of the controls and 35% of the treated patients (NS). Maintenance treatment had no significant influence on histopathologic changes evaluated by three independent observers: in both groups the overall score for histologic lesions improved between the initiation of interferon therapy and the end of the study. We conclude that relapses in patients with non-A, non-B/C hepatitis in remission after treatment with alpha interferon at tapering doses are not prevented by maintenance therapy with low-dose alpha interferon. (C) Journal of Hepatology.

Based on the in vitro and in vivo potentiation of the cytotoxic activity of chemotherapeutic agents by the interferons, a pilot study combining human recombinant alpha-2b interferon (IFN) and doxorubicin was conducted for the treatment of unresectable, histologically proven hepatocellular carcinoma. Between March 1988 and May 1990, 21 patients (median age: 60 years, range: 29-76) entered the study. The dose of doxorubicin was fixed at 35 mg/m2, every 3 weeks. The dose of alpha-2b IFN was 6 million U/m2 per day, 5 days a week. 3 patients (14%) obtained a partial response lasting 11, 16 and 30 months, and 1 had a stable disease during 8 months. The other 17 patients died within a median survival time of 4 months. All patients experienced flu-like symptoms. 7 patients experienced WHO grade III-IV haematological toxicity. We conclude that the association of alpha-2b IFN and doxorubicin is feasible, with respect to the use of doxorubicin at an inferior dose level than the same agent used without IFN. The response rate is comparable to that observed with doxorubicin used alone. Further phase I studies and randomised trials are required to confirm the role of this regimen in the treatment of unresectable hepatocellular carcinoma.