[Serological classification of post-transfusion hepatitis (author's transl)]

Post-transfusion hepatitis (PTH) remains to be a major hazard after massive blood transfusions. After 141 cardiac surgeries with massive blood transfusions the frequency of PTH reached 38%. The natural history of this type of hepatitis proved to be clinically mild but usually protracted. Icterus was found in one third. Serologically 46% of the PTH could be identified by HBs-Ag-testing as type B hepatitis. 39% revealed anti-HBs and 15% remained unclassified. HBs-Ag or anti-HBs were found in 40% patients without clinical or biochemical evidences of a hepatitis. The diagnosis of PTH still should rely on a synopsis of a typical clinical and biochemical hepatitis syndrome, characteristic serological findings and an adequate intervall between blood transfusion and outbreak of hepatitis.

[Chronic hepatitis--clinicopathological studies of 687 cases (author's transl)]

Chronic hepatitis is one of liver diseases with arguments from the clinical and histopathological aspects. Histopathological examinations were made on 687 biopsy cases clinically diagnosed as chronic hepatitis. Histopathological classification was based on our own criteria by referring to discussions in the series of Inuyama symposia on hepattis and others. The correlation between histological diagnosis and clinical data was also examined. Histopathological diagnoses made of the 687 cases were classified as follows; normal liver or liver with no pathognomonic changes of 77 cases (11.2%), non-specific reactive hepatitis of 56 cases (8.0%), viral hepatitis of 488 cases (71.0%), alcoholic hepatitis of 25 cases (3.6%), fatty liver of 23 cases (3.3%), massive liver necrosis of 3 cases, liver fibrosis of 2 cases, congestive liver of 1 case, and unclassified 12 cases due to inadequate specimens or other reasons. Among 488 viral hepatitis cases, histological stages were as follows; acute hepatitis (38 cases, 7.8%), persistent hepatitis (23 cases, 4.7%), chronic inactive hepatitis (142 cases, 29.1%), chronic active hepatitis (165 cases, 33.8%), chronic hepatitis with subloblar necrosis (33 cases, 6.8%), precirrhosis (51 cases, 10.5%), cirrhosis (27 cases, 5.5%). The relationship between histological aspects and clinical features was discussed by sex, age, and others. Of 41 follow up cases, significant values of histological type, presence of HB ag., or alcoholic were discussed as for the causative factors evolving liver cirrhosis.

Drug therapy reviews: chronic hepatitis

The classification, clinical course, etiology and treatment of chronic hepatitis are discussed. The clinical manifestations of chronic hepatitis are of limited diagnostic use. Diagnosis must be made by liver biopsy. The disease is classified as chronic persistent or chronic active hepatitis. The prognosis for chronic persistent hepatitis is excellent, and no treatment is required. Chronic active hepatitis may progress to cirrhosis and is associated with a poor prognosis if untreated. Recognized causes of chronic active hepatitis are hepatitis-B virus infection, post-transfusion hepatitis not associated with hepatitis-B virus, and certain drugs. For drug-induced hepatitis, discontinuation of the medication is indicated. For other types of chronic active hepatitis the recommended treatment is prednisone 10 mg and azathioprine 50 mg daily.

Liver biopsy in chronic hepatitis: 1968-78

The classification of chronic hepatitis introduced in 1968 is still current, but has been modified. The concept of bridging hepatic necrosis has been incorporated, and is recognised as an important feature of both acute and chronic aggressive (active) hepatitis (CAH). In the pathogenesis of the latter, piecemeal necrosis is, however, thought to be the more important factor. The histological picture of CAH varies widely. Several causes of CAH have been identified, including hepatitis B virus. Recognition of surface and core components of the virus in tissue sections has facilitated study of the relationship between host response and pathological lesion in chronic hepatitis. CAH and primary biliary cirrhosis share histological features, and a mixed form has been postulated. Staining for copper sometimes helps to distinguish the two lesions. A third histological category, chronic lobular hepatitis, comprises patients with histological lesions like those of acute hepatitis, but with a chronic or recurrent course.

The morphology of cirrhosis. Recommendations on definition, nomenclature, and classification by a working group sponsored by the World Health Organization

This memorandum provides guidelines on the definition, nomenclature, and classification of cirrhosis, chronic hepatitis, and hepatic fibrosis. These are considered according to morphological characteristics and aetiology. It is hoped that this system will serve as a standard for diagnostic, research, and epidemiological purposes. The relationship of cirrhosis to liver cell carcinoma is briefly discussed and the possible morphological markers of an increased risk of malignancy are defined.

[Diagnosis and therapy of chronic active hepatitis]

Chronic active hepatitis (CAH) as an entity covers a histologically, biochemically, and clinically heterogenous group of patients. Hence, there is no justification for treating all patients with this diagnosis with corticosteroids. On the basis of histological, biochemical, and clinical criteria, different degrees of severity of CAH can be distinguished. While corticosteroids appear to be indicated in severe CAH, they should, in general, not be administered in mild CAH. However, the course of disease must be carefully followed in these patients. In moderate CAH, the risk should be carefully weighed against the benefit of therapy in every individual patient, taking into account the severity of symptoms. In HBsAg-negative cases, a therapeutic trial of at least 6 months' duration is worthwhile. In HBsAg-positive patients, treatment with corticosteroids should be delayed and the course of the disease followed. Once the decision for corticosteroid therapy has been made, administration of 10 mg prednisolone and 50 mg azathioprine daily as a maintenance dose represents the therapy of choice. This combination is approximately as effective as 15--20 mg prednisolone alone, but is associated with a lower incidence of side effects.

Chronic hepatitis: a problem for the pathologist

The accepted histological categories of chronic hepatitis are chronic persistent hepatitis (CPH) and chronic active or aggressive hepatitis (CAH). A third form, chronic lobular hepatitis (CLH), encompasses those cases in which the lesion is predominantly within the lobules and in which portal and periportal inflammation are mild. CLH has many synonyms. International agreement on a reproducible and rational nomenclature of chronic hepatitis is still far from complete. CPH is characterized by portal inflammation. Histological definition is simple, but there are diagnostic pitfalls. The category may need subdivision on the basis of immunological studies. CAH should be regarded as a complex rather than a single disease, and it is important to specify the aetiology and pathological components in each instance. The concept of CAH must be altered to incorporate the lesion of bridging hepatic necrosis (BHN). Piecemeal necrosis, accompanied by inflammatory infiltration, is considered to be the most important of the various pathogenetic factors in CAH, but BHN probably plays a significant part in accelerating the development of cirrhosis. An excessive portal and periportal inflammatory reaction with or without BHN, in a liver biopsy taken during the course of an acute hepatitis, helps to predict a possible chronic course.