[Morphological characteristics and pattern of hepatitis B antigen expression in liver tissue in acute and chronic forms of hepatitis (author's transl)]

Immunofluorescent and electron microscopic methods allow the localization of hepatitis virus B-components at the cytologic and histologic level. The acute and chronic forms of viral hepatitis are re-evaluated in the light of these new findings. In HB-Ag-positive hepatitis four types of correlation between the expression pattern of HG-Ag components and different forms of hepatitis are recognized which are of diagnostic and prognostic relevance (elimination type, immunosuppression type, aggression type, and carrier type). The correlation between antigen expression, persistence of infection and type of inflammation seems to reflect the specific immune state towards the hepatitis B virus.

[Hepatitis in drug addicts (follow-up study with biopsies) (author's transl)]

Viral hepatitis, proven by biopsy in 44 patients known to be drug addicts or confirmed drug takers had serial clinical, biochemical and (half of them) biopsy studies between 1971 and 1974. At the time of the first biopsy the period of addicition averaged 28.8 months. 30 of the 44 patients had had jaundice. At the time of the last biopsy, 20 of the 44 had chronic persisting and three had chronic active hepatitis, i.e. more than half had a chronic form. A further 12 patients had "hippie" hepatitis, a special form of acute viral hepatitis with piecemeal necrosis, histological evidence of possible change to a chronic state. There was no case of complete healing during the period of observation. The high rate of chronic hepatitis is thought to be due to partially insufficient immune response. The clinical and even biochemical course in most of the patients was remarkably mild. Severe clinical forms are rare and were not observed at all in the described group. It would therefore, seem that the prognosis is generally good, in contrast to chronic hepatitis in non-addicts.

Heart volume determination with phase synchronization in normal subjects and postinfarct patients

The authors investigated the influence of the systole-and-dyastole cycle upon the cardiac volume measured radiologically with ECG phase synchronization in prone subjects. Measurements were made in 30 healthy subjects and 27 patients with a history of myocardial infarction, all of them ambulatory. As expected, the mean cardiac volume relative to body surface was greater in postinfarct patients than in normal subjects to a high degree of statistical significance. Conversely, the differences between end-systolic and end-diastolic cardiac volumes fell short of statistical significance both in healthy subjects and in postinfarct patients. Accordingly, radiological measurements of cardiac volume without phase synchronization seem justified in the functional evaluation of postinfarct patients.

[Acute myeloid leukemia following treatment of IgA-paraproteinemia with alkeran]

Report on a 74-year-old patient who developed acute myeloid leukemia 16 months after diagnosis of IgA paraproteinemia. He had received a total dose of 1.4-1.5 g melphalan. The possible etiologic role of melphalan in the development of acute leukemia is discussed.

Pattern of core and surface expression in liver tissue reflects state of specific immune response in hepatitis B

A series of 67 liver biopsies (20 kidney transplant recipients and 47 outpatients with hepatitis) was investigated for the presence of hepatitis B antigen core (HBc) and surface (HBs) components by immunofluorescence and electron microscopy. The variable appearance of the core in liver cell nuclei and of the surface in the cytoplasm allowed the recognition of expression patterns which, together with histologic parameters, could be integrated into four reaction types of diagnostic and prognostic implications: Type I (Elimination Type). No components or only occasional expression of HBc; histologically, classic lobular hepatitis; clinically, acute, self-limited viral hepatitis. Type II (HBc Predominance, or Immunosuppression Type). Abundant core expression in each liver cell nucleus and moderate appearance of HBs; histologically, nonaggressive inflammation (nonspecific reactive or portal hepatitis); clinically, mild, chronic, persistent hepatitis in transplant patients. Type III (HBs Predominance, or Nonaggressive Type). Prominent HBs expression largely in the absence of HBc; histologically, nonaggressive inflammation (nonspecific reactive and portal hepatitis) or normal liver tissue, together with ground-glass hepatocytes in light microscopy, as a correlate of HBs-containing hepatocytes; clinically, hepatitis B antigen carrier, or chronic persistent hepatitis. Type IV (HBc+s Equivalence, or Aggressive Type). Spotty expression of both components, especially of core; histologically, periportal hepatitis; clinically, mainly corresponds to chronic aggressive hepatitis and to acute hepatitis with possible transition to chronicity. As a unifying concept for these types, it is suggested that immune responsiveness determines the reaction pattern, the key mechanism being immune elimination of affected cells. Between efficient elimination (type I) and effective immunosuppression (type II), a graded elimination insufficiency is found in chronic forms (types III and IV), explaining the persistence and probably also the aggressiveness of hepatitis B virus infection.