Pre-S1 proteins in sera of patients positive for HBsAg and antibodies to hepatitis delta virus.

Infection with the hepatitis Delta virus results in a reduction in hepatitis B virus replication. To study the question as to whether expression of large surface (pre-S1) protein is changed in patients with previous and chronic hepatitis Delta virus infection, sera of 25 HBsAg- and anti-HD-positive patients were analyzed by the Western blot technique using an antibody directed against a pre-S1 fusion protein. Pre-S1 proteins were present only in 3 of the 25 sera. This finding suggests that the expression of pre-S1 proteins and HBsAg is regulated independently, and that pre-S1 proteins are not necessarily required for the envelope of hepatitis Delta virus.

Prevalence of the hepatitis delta virus in Rumania.

Epidemiological data obtained to date show that the delta agent is spread all over the world. In Rumania hepatitis B virus infection is widespread and is associated with a high incidence of chronic liver disease. To determine the prevalence of delta infection, sera from 373 patients with chronic liver disease were tested for HBV markers; 228 were HBsAg positive. Anti-HD was present in 190 sera (83.33%), which reveals a very high incidence and shows a higher frequency of the active forms of the disease. However, in contrast to other studies, we found a high incidence of HDV infection in chronic persistent hepatitis and hepatocellular carcinoma.

[Cystic echinococcosis of the liver--problems of ultrasound diagnosis]. / Die zystische Echinokokkose der Leber--Probleme der Ultraschalldiagnostik.

The authors examined 100 patients with a total of 119 cysts of the liver. The diagnosis was subsequently confirmed via scintigraphy, radiology and laparotomy. This paper reports on a sonographic analysis of cystic echinococcosis of the liver, its sonographically demonstrable types, structures and complications and their differential diagnosis. In 58% of the cases the classical aspect of cystic echinococcosis was seen (Type A). 22.7% of the cases pointed toward a sediment within the cyst (Type B). 8.4% of the cysts were septated (Type C), whereas 6.7% had daughter cysts (Type D). However, only 4.2% of the cysts were important for differential diagnosis, since they had to be set off against other space-occupying growths on account of their solid tumorous structure.

Colchicine treatment effects on liver cirrhosis assessed by liver blood flow measurements.

Hepatic fibrosis is common in all chronic liver diseases. This fibrosis induces morphological, functional and hemodynamic changes. Among the antifibrotic drugs, colchicine gave the most encouraging results. In a group of 22 patients with liver cirrhosis, the hemodynamic changes were studied before and after 24 months of antifibrotic treatment with colchicine (1 mg daily, 5 days a week). The liver blood flow (LBF) was estimated every year by a noninvasive radioisotopic method. After colchicine therapy the determinations showed, an obvious improvement of the liver blood flow with an increase of K (from 0.159 to 0.1678) (p less than 0.001) and a per cent decrease of delta from 44 to 32 (p less than 0.001), thus showing an improvement of the liver blood supply. The simultaneous and favourable changes of the liver biochemical tests and of the sinusoidal hemodynamic parameters strongly suggest that the perfusion improvement, induced by a loss of liver collagen, might explain the tendency of the biochemical data to resume normal values.

Circulating immune complexes in chronic hepatitis as related to the presence of HBsAg.

The relationship between the presence of circulating immune complexes (CIC) and of HBsAg in the serum of patients with chronic liver diseases was studied in a group of 78 patients of whom: 16 with chronic persistent hepatitis (CPH), 39 with chronic active hepatitis (CAH) and 23 with liver cirrhosis (LC). The results showed a clear relationship between the incidence of CIC and the presence of HBsAg in the patients with persistent or active chronic hepatitis but not in those with liver cirrhosis. The presence of HBsAg was detected in the composition of CIC in only part of the cases (10/25 patients). This low incidence suggests that in chronic hepatitis other antigens can also participate in the formation of CIC.

[The rotor syndrome]. / Das Rotor-Syndrom.

Case reports of 4 patients with Rotor syndrome are given, including clinical chemistry values for liver function, BSP-test, histology, as well as sequential scintigraphy results with 131I-BSP. All results were normal, except serum bilirubin, which was increased, conjugated bilirubin making up for the largest part of the increase. The BSP-curve showed elevated 45-minute-values and liver scintigraphy disturbed hepatic uptake and storage of BSP. Therapy with phenobarbital led to a decrease of serum levels of bilirubin and BSP-retention.

Drug induced hepatitis.

During the last decade an increased incidence of the adverse reactions to drugs with liver involvement was found. The liver lesions produced by drugs constituted a constant concern. We followed the course of liver disease produced by tuberculostatics, cytostatics, antidepressive, antibiotics, narcotics, antirheumatics, by biochemical, immunological and morphological investigations (needle biopsy of the liver with optical and electronic microscopy). The pattern of the damage to the liver ranges from minimal functional changes to severe aspects with cytolysis and cholestasis. Hypersensitivity to drugs (cutaneous eruption, rash, fever, eosinophilia) were observed only in three cases. The cholestatic clinical form was the most frequently encountered, raising problems of differential diagnosis with acute viral hepatitis and obstructive jaundice. Clinical evolution of drug induced hepatic lesions is favourable as soon as the administration of drug is arrested. Chronic evolution, as reported in the literature when the administration of hepatotoxic drug is continued, was noted only in one patient who was using Chlorpromazine.

[Contribution of sequential scintigraphy with 131I-BSP to the differential diagnosis of jaundice (author's transl)]. / Der Beitrag der sequentiellen Szintigraphie mit 131J-BSP zur Ikterus-Differentialdiagnose.

Patients with constitutional hyperbilirubinemia and with extra intrahepatic cholestasis have been explored by means of sequential scintigraphy, with the following results: 1. in Gilbert's syndrome liver uptake and output of 131I-BSP were normal; 2. in the Dubin-Johnson syndrome liver uptake and plasma clearance of 131I-BSP were normal; the substance was retained for a long period (2 hrs) in the liver without any tendency to be excreted; 3. in the Rotor syndrome 131I-BSP uptake was delayed and liver clearance prolonged; 4. in total biliary obstruction no intestinal activity could be recorded even in the late registrations (the latest after 24 hrs); 5. in partial extrahepatic biliary obstruction there was a normal liver uptake with an abnormal retention in the choledochus and a delayed excretion (more than 2 hrs); and 6. in intrahepatic cholestasis 131I-BSP liver uptake, retention and excretion were delayed; differentiation of these cases from total biliary obstruction is difficult. Late determinations, the last 24 hrs after injection of the tracer, were performed in these cases, in order to exclude a total obstruction with parenchymal injuries, by assessing the enteral output.

Diagnostic value of serum bile acid determination in chronic hepatitis and liver cirrhosis.

Fasting and postprandial total bile acid measurements were performed by an enzymatic method in the serum of 12 patients with chronic persistent hepatitis, 8 with chronic active hepatitis, 14 with cirrhosis and 10 with cholestatic chronic hepatitis, as well as in that of 22 normal controls. The results indicated a rise of serum bile acid concentration concomitant with the degree of morphologic liver injury. A significant rise of the fasting concentration of bile acids as compared to the control started with chronic active hepatitis. As postprandial bile acid level was significantly higher in all types of chronic hepatitis and cirrhosis and correlated significantly with most of the usual biochemical liver tests, it could be considered as a test of major diagnostic significance for chronic liver diseases.

[The mechanism of action of phenobarbital on the metabolism of 131J-B.S.P. in cholestasis induced by ANIT in isolated and perfused rat liver (author's transl)]. / Die Wirkung von Phenobarbital auf die 131J-Bromsulfalein-Aufnahme bei isolierter Perfusion der durch alpha-Naphthylisothiozyanat cholostatischen Rattenleber.

In order to establish whether the increased B.S.P. secretion in the bile following phenobarbital administration is the consequence of change in the bile output or represents a consequence of the enzymatic induction, the dynamics of the elimination of 131J-B.S.P. was studied in animals treated with ANIT and Phenobarbital in the conditions of isolated perfused liver. At the same time the levels of the conjugation enzyme of B.S.P. were also determined. It was noted that after Phenobarbital the biliary elimination of 131J-B.S.P. is in correlation with the important increase of the output; in the animals treated with ANIT, on the other hand, the biliary excretion of B.S.P. is minimal. The biliary elimination is directly proportional to the increased of the bile output and reflects the changes found in the perfusate. Our findings allow us to assume that the increased of the bile output and in a smaller extent the result of the stimulation B.S.P. conjugation with Gluthation.