[Primary biliary cirrhosis--analysis of clinical material]. / Pierwotna zólciowa marskosc watroby--analiza materiallu klinicznego.

The analysis is presented of 67 patients with primary biliary cirrhosis treated in the years 1971-1988. The group consisted of 60 women (89.5%) and seven men (10.5%). Presenting symptoms were mostly itching (66%) and jaundice (12%). The time between the onset of the first symptoms and the diagnosis was three years, on the average. Autoantibodies to mitochondria were present in 86% of patients. In 27% of cases markers of HB virus infection were found. Cholelithiasis was present in 19 patients (28%). Primary biliary cirrhosis was diagnosed with delay. Third degree of histological changes was observed in 38.8% of cases and in 18% of patients it was already fourth degree. Eighteen patients (27%) died after six years, on the average, from the onset of symptoms. The direct causes of death were, most frequently, liver failure and haemorrhage from oesophageal varices.

Cellular localization of hepatitis B virus antigens in patients with hepatocellular carcinoma coexisting with liver cirrhosis.

Specimens of liver tissue obtained by biopsy from five patients and at necropsy from seven patients with postnecrotic liver cirrhosis and hepatocellular carcinoma were examined for the presence of hepatitis B surface antigen (HBs Ag) and hepatitis B core antigen (HBc Ag) by direct immunofluorescence. In all cases, samples of serum were tested for HBs Ag and antibody to HBs Ag (anti-HBs) by immunoelectroosmophoresis and for antibody to HBc Ag (anti-HBc) by indirect immunofluorescence. Of these 12 representative cases of the main histological types of hepatocellular carcinoma, six were found to be seropositive for anti-HBc, and three of them were negative for HBs Ag. HBs Ag was detected in the cytoplasm of hepatocytes in the cirrhotic nodules in one seronegative patient and in three of the seropositive cases. In the latter cases, HBs Ag was identified in the cytoplasm of cells in well-differentiated hepatocellular carcinoma. HBc Ag was not found in any of the specimens examined.

Immunopathological aspects of hepatitis type B.

Tissue samples from 180 unselected necropsy cases of various forms of hepatitis were examined by histopathology and immunofluorescence. The hepatitis forms studied included acute fulminant hepatitis (28 patients), subacute hepatitis (48 patients), acute fatal hepatitis (24 patients), chronic aggressive hepatitis (26 patients), liver cirrhosis (49 patients), and "minimal" hepatitis (5 patients). Hepatitis B surface antigen and hepatitis B core antigen were detected in 101 patients (56.1 per cent). In these, lesion-bound immune complexes of hepatitis B surface antigen were found in the liver and extrahepatic locations in 77 patients (76.2 per cent). The latter included activated germinal centers of lymph nodes and spleen, focal hyaline lesions of splenic and renal arterioles, necrotic and/or proliferative lesions of small and medium-sized arteries, and kidney glomeruli with mild proliferative and degenerative lesions. There was an inverse relation of the approximate amounts of hepatitis B surface antigen in the liver and the liver damage, the latter being directly proportional to the amount of HBS Ag immune complexes in the liver and indirectly proportional to their amount in extrahepatic locations and to the severity of lesions at these sites.