Mary Ashcavai

Determinants of Serum Bile Acids in Chronic Liver Disease

In normal subjects intestinal input of bile acids into the portal vein is the major determinant of peripheral bile-acid concentrations. In the present study some aspects of enterohepatic circulation of bile acids were analyzed for total bile acids, cholylglycine, and sulfolithocholylglycine in 8 patients with alcoholic liver disease. At the time of combined hepatic vein catheterization and transhepatic portal vein pressure measurement, simultaneous samples of blood were obtained for measurement of bile acids from portal vein, hepatic vein, and peripheral vein, both in the fasting state and during a 90-min period after injection of cholecystokinin. For all bile acids, concentrations were significantly lower in the hepatic vein than in the portal vein. No correlation was found between peripheral vein concentrations of bile acids and any of the liver status tests. Also, the ratio of hepatic vein to portal vein bile acids, an estimate of hepatic extraction of bile acids, did not correlate with peripheral vein levels, while it did with the prothrombin time, (r = -0.68, P

Evidence for clustering of hepatitis B virus infection in families of patients with primary hepatocellular carcinoma

Family members of 13 patients with hepatitis B surface antigen (HBsAg) positive primary hepatocellular carcinoma (PHC) were tested for the presence of hepatitis B virus‐associated antigens and antibodies. Of the 122 members examined, circulating HBsAg was detected in 47 (39%), antibody to HBsAg (anti‐HBs) was found in 37 (30%), and antibody to hepatitis B core antigen (anti‐HBc) alone was present in 13 (11%). The relatives with the highest frequency of HBsAg positivity were the offspring of the propositus, followed by the nieces and nephews and the grandchildren. Anti‐HBs and anti‐HBc were detected most often in the spouses and non‐blood relatives. Evidence for past and present hepatitis B virus (HBV) infection was more frequently found in the Asian family members when compared to the non‐Asians. The e antigen (HBeAg) was present in 38% of the HBsAg positive individuals, including four with PHC; antibody to HBeAg (anti‐HBe) was rarely detected. These results indicate that clustering of HBV infection was commonly present in family members of patients with PHC. The HBsAg positive individuals may be major contributors to the endemic pool of the virus, and may themselves be potential cases of chronic active type B hepatitis, cirrhosis, and PHC.

HBsAg clearance in chronic active hepatitis B. A possible cause of cryptogenic cirrhosis

Three patients with chronic hepatitis B infection, two with chronic active hepatitis and cirrhosis, and the third with quiescent cirrhosis, cleared HBsAg from their serum and eventually developed anti-HBs. All three were asymptomatic and had nearly normal serum aminotransferases following loss of HBsAg. Liver biopsy revealed cirrhosis in each patient. With the development of anti-HBs, these patients became serologically indistinguishable from patients with a cryptogenic cirrhosis who had prior unrelated exposure to hepatitis B. Remote chronic hepatitis B infection may be a more common cause of cryptogenic cirrhosis than is commonly appreciated.