The effect of phlebotomy therapy on porphyrin metabolism was evaluated in five patients with porphyria cutanea tarda symptomatica (PCT-S). The removal of 2,500 to 4,500 cc over a three to four and one-half month period resulted in a marked reduction in urine and fecal uroporphyrin excretion in three of the subjects. Clinical improvement accompanied the chemical response in each case. In one patient, the induced chemical and clinical remission has persisted for six months without further treatment.

Adult↗

PubMedDate not supplied

Delayed HBsAg clearance in chronic hepatitis B viral infection.

Seven patients are described in whom HBsAg persisted for 13 to 98 months after acute viral hepatitis B and then became nondetectable. All patients subsequently developed anti-HBs. During the period of HBs-antigenemia, liver biopsies in five patients showed persistent viral hepatitis. Retrospectively, impending negativity of HBsAg was predictable in five patients by a decrease in HBsAg titer, and in four patients by persistent normalization of serum alanine aminotransferase. Although delayed clearance of HBsAg in patients with chronic hepatitis B virus infection is uncommon, it appears to be predictable.

Acute Disease↗

PubMedDate not supplied

The persistence of hepatitis A IgM antibody after acute clinical hepatitis A.

Hepatitis A IgM antibody (IgM anti-HAV), detected by commercially available solid-phase radioimmunoassay, is an accepted marker of acute viral hepatitis A infection. However, persistence of this serological marker far beyond the acute illness and immediate convalescent period has been reported. To determine the persistence of IgM anti-HAV following clinically manifest acute hepatitis A infection, 59 patients with this diagnosis were followed prospectively until this marker disappeared or persisted for greater than 60 days. Timed from the onset of jaundice, IgM anti-HAV persisted for less than 30 to greater than 420 days; most patients became seronegative by 120 days. These findings suggest that some patients may become seronegative early in the disease course while others (13.5%) remain positive for prolonged periods greater than 200 days. Awareness of this marked variability is important in the interpretation of IgM anti-HAV as a serologic marker of recent hepatitis A infection.

Adult↗

PubMedDate not supplied

Natural course of delta superinfection in chronic hepatitis B virus-infected patients: histopathologic study with multiple liver biopsies.

We evaluated the natural course of delta superinfection in patients with chronic B viral hepatitis by examining serial liver biopsy specimens from 23 patients. The mean follow-up period was 2.5 years, and the average number of liver biopsies per patient was 2.8. The striking features were: (i) the prolonged acute hepatitis-like necroinflammatory activity (mean = 15 months) following acute delta hepatitis and (ii) rapid progression to severe forms of liver disease within a mean interval of 24 months from the onset of delta superinfection. Although there was a high frequency of stainable delta antigen (90%) in these liver biopsy specimens, there was no correlation between the degree of positivity and the histopathological changes.

Antibodies, Viral↗

PubMedDate not supplied

Status of hepatitis B virus DNA in alcoholic liver disease: a study of a large urban population in the United States.

Two reports have shown hepatitis B virus DNA in serum and liver tissue in alcoholic liver disease with negative serum HBsAg, suggesting a pathogenetic role for hepatitis B virus. We studied hepatitis B virus DNA in serum and liver from three groups of alcoholic patients; (Group 1) 50 patients without liver disease, (Group 2) 108 patients with alcoholic liver disease and (Group 3) five patients with alcoholic liver disease and hepatocellular carcinoma. Serum was tested for HBsAg, anti-hepatitis B core and anti-hepatitis B surface by radioimmunoassay and hepatitis B virus DNA by direct spot hybridization. Liver tissue from Groups 2 and 3 (113 patients) was examined by Southern blot analysis using 32P-labeled hepatitis B virus DNA clone from pBR322. Controls were 21 patients with chronic hepatitis B virus (14 patients with chronic active hepatitis, seven patients with cirrhosis and hepatocellular carcinoma). Serum and tissue were analyzed for hepatitis B virus DNA. Hepatitis B virus DNA was not detected in either serum or liver tissue in any of the 163 patients (Groups 1 to 3). In contrast, among the controls, hepatitis B virus DNA was present in the serum of 15 of the 21. Tissue DNA in those with chronic active hepatitis revealed 10/14 with free hepatitis B virus DNA, two with integrated sequences and two with no viral sequences. All seven patients with hepatocellular carcinoma had integrated viral DNA sequences in the tumor tissues. From these results, it appears that hepatitis B virus does not play a role in the pathogenesis of alcoholic liver disease.

Adult↗

PubMedDate not supplied

Viral hepatitis: clinical aspects.

In the majority of instances acute viral hepatitis resolves totally without sequelae. Fulminant hepatitis is a highly lethal lesion but 20 to 25 per cent of patients, principally young patients, survive. Survivors do not appear to develop chronic liver disease. Persistent viral hepatitis follows acute icteric hepatitis, both type B and non-B, in 10 to 12 per cent of patients. Six long-term HBs Ag carriers demonstrated HBs Ag clearance after 14-73 months. Chronic active viral hepatitis often progresses to cirrhosis. This progressive hepatitis appeared as a sequelae of acute icteric type B hepatitis in 3 per cent of 429 patients. In patients with chronic active type B hepatitis, low titers of HBs Ag are common.

Acute Disease↗