Biomedical subjects
Publications and source records attributed to T W Kiernan.
A 66-year-old man, with advanced alcoholic liver disease with Kaposi's sarcoma involving the stomach and the skin of the lower extremities, developed upper gastrointestinal hemorrhage. He was treated with radiation therapy to the stomach and the skin with rapid resolution of the gastric lesions, as demonstrated by serial endoscopy.
Ten patients designated as hepatitis B surface antigen (HBsAg) carriers were screened for inappropriate reactions to their disease. Assessment with a 32-item questionnaire showed three carriers to have underreacted to the risks of HBsAg transmission through misunderstandings or denial concerning the disease. One carrier, through severe social withdrawal, showed overreaction to the possibilities of disease transmission. Counseling was provided regarding the risks of HBsAg transmission. At a one-month follow-up, all carriers appeared appropriately aware of the risks of transmission, and one of two carriers referred for psychotherapy showed greatly improved social adjustment. We recommend that persons treating HBsAg carriers screen routinely for inappropriate reactions to risks of disease transmission and provide counseling as needed.
The recognition of viral hepatitis has been facilitated by the use of serologic studies for types A, B, and non-A, non-B. The course is best determined by serum enzyme determinations, followed by clearance studies of bile acids or dyes once the serum enzymes return to normal. In patients with persisting clinical or biochemical abnormalities and those in which the nature of the disease is not known, liver biopsy should be done.