Manzillo G

Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies

This paper reviews the complications that arose after 68 276 percutaneous liver biopsies performed from 1973 to 1983. The complications are analyzed in relation to the underlying liver disease and to the type of needle used. Death was infrequent (9/100 000); it was always due to haemoperitoneum and occurred only in patients with malignant diseases or cirrhosis. Complications were less frequent in AVH (44/100 000) than in other liver diseases (from 125 to 278/100 000). Death, serious haemorrhagic complications, pneumothorax and biliary peritonitis were more frequent after biopsy with the Trucut needle than after biopsy with Menghinis needle (3/1000 against 1/1000). Sixty-one percent of complications were discovered within two hours of biopsy and 96% within one day. The data indicate a post biopsy observation period of at least 24 hours. The day-case procedure should be reserved for patients not presenting liver tumour or cirrhosis.

SERUM LEVELS OF HEPATITIS B SURFACE AND CORE ANTIGENS DURING IMMUNOSUPPRESSIVE TREATMENT OF HBsAg-POSITIVE CHRONIC ACTIVE HEPATITIS

One of the following treatments was randomly assigned to 101 consecutive patients with biopsy-proven chronic active hepatitis: prednisone 20 mg daily, azathioprine 100 mg daily, prednisone 20 mg and azathioprine 50 mg daily, or B vitamins 2 tablets daily (control group). Patients were observed at the beginning of the study, then at 2, 6, and 12 months after treatment. At each visit levels of HBsAg and Dane-particle-associated core-antigen (HBcAg) and their corresponding antibodies were determined. 42 patients were HBcAg positive at the beginning of the study. Of these 42 patients, the 34 who were under treatment remained HBcAg positive and showed a rise in HBcAg titre, while the 8 who were not treated had a fall in HBcAg titre (6 patients) or became HBcAg negative (2 patients) in 6 months. Among 59 patients who were HBcAg negative at the beginning of the study, this antigen became persistently detectable in 40% of the 42 patients who were treated, and was transiently present in 2 (12%) out of the 17 untreated patients (p < 0.05). Our data indicate that long-term prednisone and/or azathioprine treatments favour the replication of hepatitis-B virus in patients with HBsAg-positive chronic active hepatitis.

Chloramphenicol Combined with Ampicillin in Treatment of Typhoid

Fifty out of 100 patients with typhoid fever, matched for age, stage of illness, and degree of fever, were treated with chloramphenicol and the other 50 were treated with chloramphenicol combined with ampicillin. The febrile period was shortened by up to 29% in patients treated with the combined drugs compared with those given only chloramphenicol. Moreover, no patient on combined therapy had a febrile relapse, whereas two relapses occurred among patients treated with chloramphenicol only. We conclude that chloramphenicol and ampicillin together are better than chloramphenicol alone in the treatment of typhoid fever.

Familial clustering of hepatitis B Antigen and liver diseases in families with a high incidence of viral hepatitis

SummaryIn each of 23 families in which two or more cases of acute hepatitis-like jaundice (index cases) occurred, all family members were studied to evaluate HBAg clustering and the incidence of asymptomatic liver disease. There were 49 “index cases” of hepatitis-like jaundice: 38 cases of acute viral hepatitis, 5 of chronic agressive hepatitis and 6 of active cirrhosis. The overall number of members in these families (excluding index cases) was 170 and 155 of which were tested by clinical examination, laboratory tests and needle liver biopsy. In 27 out of the 155 subjects there was evidence of liver diseases (10 non icteric hepatitis cases, 12 CAH cases and 5 cirrhosis cases). HBAg was present in the serum of 19 of these patients, and two of the cirrhotic patients were positive. Furthermore, 33 of the 155 cases were healthy HBAg carriers showing no abnormality in liver function tests. In the majority of these carriers liver histology showed slight damage (pin-head necrosis or portitis) sometimes compatible with resolving viral hepatitis. A long-term follow-up of the HBAg carriers showed that three of these subjects progressed to acute viral hepatitis.ZusammenfassungIn jeder der 23 Familien mit zwei- oder mehrfachem Auftreten von hepatitisförmiger Gelbsucht (Indexfälle) wurden alle Familienmitglieder untersucht, um die HBAg-Anhäufung und das Vorkommen asymptomatischer Leberkrankheiten zu beurteilen. Die „Indexfälle“ von hepatitisförmiger Gelbsucht beliefen sich auf 49; ferner 38 Fälle von akuter Virushepatitis, 5 Fälle von chronisch aggressiver Hepatitis und 6 Fälle von akuter Zirrhose. Die Gesamtzahl der Mitglieder in diesen Familien (ausschließlich der Indexfälle) betrug 170, wovon 155 durch klinische Untersuchung, Labortests und bioptische Leberpunktion geprüft wurden. Bei 27 der 155 Personen fand sich der Nachweis von Leberkrankheiten (10 Fälle von antikterischer Hepatitis, 12 Fälle von chronisch aggressiver Hepatitis und 5 Fälle von Zirrhose). Bei 19 dieser Patienten war HBAg im Serum vorhanden, zwei der zirrhotischen Patienten waren positiv. Ferner waren 33 der 155 Fälle gesunde HBAg-Träger ohne Anomalie der Leberfunktionstests. Bei der Mehrzahl dieser Träger ergab der histologische Leberbefund eine leichte Schädigung (nadelkopfförmige Nekrose oder Portitis), die manchmal einer wiederauflösenden Virushepatitis entsprach. Eine longitudinale Nachbeobachtung der HBAg-Träger zeigte, daß drei dieser Personen akute Virushepatitis entwickelten.

An evaluation of urinaryd-glucaric acid excretion during acute hepatitis in man

The excretion of urinaryd-glucaric acid (d-GA), one of the final metabolites of glucuronic acid was determined in 49 patients with acute hepatitis. A 3.7-fold increase ofd-GA was found at an early stage of the disease (37.13 μmol/24hr±3.08se vs 9.91 μmol/24hr±1.18se in normal controls), when serum transaminases and bilirubin were very high (SGOT 589 I.U.±41se; SGPT 954 I.U.±61se; serum bilirubin 8.41 mg/100 ml±0.76se). A lower but significantly elevatedd-GA excretion was also found in the recovery phase of hepatitis at a time when both serum transaminases and bilirubin were considerably reduced (SGOT 89 I.U.±14se; SGPT 185 I.U.±30se; serum bilirubin 1.05 mg/100 ml±0.20se). Urinary glucuronides and free glucuronic acid, measured as total glucuronic acid, were also significantly increased in early hepatitis (1164 mg/24hr±54se vs 782 mg/24hr±84se in normal subjects), but no correlation was found withd-GA excretion. A short treatment with phenobarbital which led to a 3-fold increase ofd-glucaric acid in 12 normal subjects did not cause any further change in the patients with early acute hepatitis. While the mechanism of the urinaryd-GA increase in hepatitis still remains underfined, the findings of this study support the conclusion that its increase may not reflect an induction of liver microsomal enzymes.

Total body wash-out in patients with fulminant hepatitis

SummaryTwo patients with fulminant hepatic necrosis and in stage IV coma were treated with a rapid infusion of refrigerated buffered albumin electrolyte solution combined with simultaneous total body wash-out in order to remove the circulating neurotoxins and to provide additional time for liver regeneration. Both patients awoke from the coma following treatment. One patient recovered completely, the other died on the second day as a result of massive gastro-intestinal bleeding. The clinical value and the technical problems of the procedure are investigated.ZusammenfassungZwei Patienten mit einer fulminanten Lebernekrose, die sich im Koma Stadium IV befanden, wurden mit einer schnellen Infusion einer gekühlten, gepufferten Albumin-Elektrolytlösung und gleichzeitigen Ganzkörper-Spülung behandelt, um die zirkulierenden Neurotoxine zu entfernen und zusätzlich Zeit für die Leberregeneration zu gewinnen. Nach der Behandlung erwachten beide Patienten aus dem Koma. Ein Patient erholte sich vollständig, der andere starb am zweiten Tag an den Folgen einer massiven Magen-Darm-Blutung. Die klinische Bedeutung und die technischen Probleme des Verfahrens werden untersucht.

Treatment of HBsAg-Positive chronic active hepatitis with corticosteroids and/or azathioprine

Summary204 patients with biopsy-proven CAH were observed for at least one year with periodic examinations including a second liver biopsy for each patient. Patients were assigned at random to a group left untreated or treated with either azathioprine 100 mg daily, or prednisolone (Dutimelan 8 15*), or prednisolone plus azathioprine 50 mg daily. The outcome, assessed on clinical, biochemical and histological parameters, was correlated to the presence or absence of HBeAg and its antibody. No treatment was effective in HBeAg-positive patients whereas, among anti-HBe-positive patients, those who were treated with the association of steroids and azathioprine more frequently showed improvement and less frequently deteriorated (p<0.01) than untreated patients. Thus, HBsAg/anti-HBe-positive patients with CAH may be treated with the combination of these drugs, even though many side-effects may occur and there are frequent relapses after discontinuation of treatment.