ANA-H and/or SMA-AA does not exclude AIH, the characterAntibodies to nuclei (ANA), smooth muscle (SMA), and ization of ANA and SMA may help to discriminate between liver/kidney microsomes type 1 (anti-LKM1) may occur in the two conditions. As compared with the seronegative counchronic hepatitis C. Distinct subspecificities, including ANA terpart, autoantibody-positive chronic hepatitis C is more with the homogeneous pattern (ANA-H) and SMA with anticommon in females and exhibits a more severe biochemical actin specificity (SMA-AA), are found in autoimmune hepatiand histological activity. The response to IFN therapy, howtis (AIH). This study was performed to characterize the hepaever, is similar. (HEPATOLOGY 1997;26:561-566.) titis C virus (HCV)-associated autoantibodies and to evaluate their influence on the profile of the disease. Two hundred ninety consecutive patients with chronic hepatitis C and 35A variety of immunological abnormalities has been decontrol cases with AIH were screened for autoantibodies by scribed in patients with chronic hepatitis C. In particular, indirect immunofluorescence (IFL) at 1:40 serum dilution. the occurrence of serum non-organ-specific autoantibodies The ANA pattern was defined by IFL on HEp-2 cells and the has been extensively studied: smooth muscle (SMA) and anti-SMA-AA identified by the presence of at least two of the nuclear (ANA) antibodies have been detected in approxifollowing elements: 1) SMA T or SMA G pattern by IFL on mately one third of the cases, 1,2 while antibodies to liver/ kidney sections; 2) XR 1 precipitating system by counterimmu-kidney microsomes type 1 (anti-LKM1) have been found noelectrophoresis; or 3) typical pattern by IFL on liver sec-more rarely (from 0% to 5%). [2][3][4] Variations in the autoantitions from phalloidin-intoxicated rats. ANA, SMA, and anti-body prevalence among the reports so far published 1-7 have LKM1 occurred in 9%, 20%, and 6% of chronic hepatitis C been attributed both to different experimental conditions in cases, respectively. The overall prevalence of autoantibodies the immunofluorescence (IFL) procedure and to ethnical and was 30% (87 of 290). Compared with AIH, HCV-associated geographical differences in the study populations. ANA and SMA exhibited ANA-H and SMA-AA at a lower Most reports agree that the autoantibody positivity does prevalence (38% vs. 71%, P Å .04 and 8% vs. 87%, P õ not influence either the clinical and biochemical profile of .000001, respectively) and had a lower median titer (1:80 vs. chronic hepatitis C or the response to interferon (IFN) alfa. 1:320, P õ .001 and 1:40 vs. 1:320, P õ .000001, respec-Some data, however, have been published on the occurrence tively). The concomitant positivity for ANA-H and SMA-AA of disease activity exacerbations in patients with serum autowas detected in none of the HCV cases, but in 46% of AIH antibodies during IFN treatment. 8-10 sera (P õ .000001). Two parameters were independently asThe major impact of the above autoantibodies in the hepasociated with the autoantibodie...

The incidence of tumor seeding after laparoscopic oncological surgery is rare and does not appear greater than what has been historically reported for open surgery. Tumor seeding seems to be most commonly related to the removal of high grade tumors and deviation from oncological surgical principles.

Zinc deficiency is common in cirrhosis and has been tent is common in patients with advanced cirrhosis, involved in the altered nitrogen metabolism. In this particularly of alcohol origin, 2 but the biochemical basis study, we measured the effects of zinc supplementation for zinc deficiency is still unknown. Several factors, on the dynamics of amino acid-derived urea synthesis such as poor dietary intake, impaired intestinal absorpin cirrhosis with mild or latent encephalopathy. The he-tion, and excessive urinary losses may be responsible patic conversion of amino acids into urea was studied in for reduced whole-body zinc content. rent hepatic encephalopathy, zinc levels after zinc for hepatocellular failure and encephalopathy, served as controls. Plasma zinc levels were reduced in all pa-supplementation and artificially induced zinc defitients and returned to normal after oral zinc. The ala-ciency correlated closely with mental state and electronine-stimulated urea nitrogen synthesis rate in relation encephalography tracings. 4 In a randomized doubleto a-amino-N concentration-the functional hepatic ni-blind trial, zinc sulfate oral supplements increased to trogen clearance-increased by 25% after zinc supple-normal plasma zinc levels of cirrhotic patients and sigmentation, i.e., more urea was produced at any a-amino-nificantly improved mild encephalopathy of the chronic N concentration. Basal and alanine-induced glucagon type.5 During treatment, ammonia levels decreased, decreased by 50%, and the ammonia response to alanine and plasma urea concentration increased. The results decreased by 30%. Psychometric tests improved, as did routine and dynamic liver function tests and the Child-were not confirmed in a short-term crossover study Pugh score. Also, the plasma concentration of lipid per-with zinc acetate supplements, which failed to normaloxides was reduced by zinc. No significant changes were ize plasma zinc levels. 6 Also episodes of acute encephaobserved in the control group. Our data indicate that lopathy after gastrointestinal hemorrhage have been long-term oral zinc speeds up the kinetics of urea forma-successfully treated with zinc. 7 In cirrhotic rats, zinc tion from amino acids and ammonia. Changes in the hor-supplementation was shown to increase the hepatic ac- be the biochemical basis for the beneficial effects of zinc on mental state in humans. Zinc is considered an essential trace element for sevThe liver plays a pivotal role in amino acid/protein eral metabolic processes, exerting a protective action disposition. Most of the amino acid nitrogen that is not on liver cell activity and possibly preventing cellular used for protein synthesis is converted by hepatocytes damage caused by oxidative stress.1 Reduced zinc con-into urea, which is irreversibly lost in the urine. The process may be quantified, after standardization for to study the effects of disease, hormone, drugs, and Received March 2, 1995; accepted December 11, 1995. dietary manipulations on the dynamics of amino acidSupported by a gr...