Serafino Recchia

Chronic Hepatitis in Carriers of Hepatitis B Surface Antigen, with Intrahepatic Expression of the Delta Antigen: An Active and Progressive Disease Unresponsive to Immunosuppressive Treatment

To assess the characteristics of chronic hepatitis in hepatitis B surface antigen (HBsAg) carriers with intrahepatic delta antigen, the hepatic histologic findings of 137 patients were reviewed; 101 patients were followed for 2 to 6 years. The predominant liver disease was chronic active hepatitis in 93 patients or cirrhosis in 32; minor forms of chronic persistent or lobular hepatitis were seen in 12 patients. Eight of the 26 patients with an initial diagnosis of cirrhosis died during the follow-up period. Cirrhosis developed in 31 of 75 patients (41%) without nodular regeneration seen in the first biopsy specimen; 5 of these patients died. Treatment with prednisone or azathioprine did not induce histologic amelioration of delta hepatitis or prevent cirrhosis. Chronic HBsAg hepatitis with intrahepatic expression of the delta antigen is an active, progressive disease unresponsive to conventional immunosuppressive treatment.

Patterns of hepatitis delta virus reinfection and disease in liver transplantation.

Twenty-seven carriers of the hepatitis B surface antigen who underwent liver transplantation in Italy and Belgium for terminal Hepatitis delta virus (HDV) cirrhosis were investigated. In 22 of the patients, HDV infection recurred. Two patients died of coexisting HDV and hepatitis B virus (HBV) reactivation. Four patients who died of unrelated causes were found to have HDV without signs of HBV reactivation. Five patients (18%) cleared both HBV and HDV after transplantation with no evidence of hepatitis (mean follow-up, 29 months). In many surviving patients. HDV infection recurred early without signs of HBV reactivation. Disease returned in the 11 HDV-infected patients in whom HBV also recurred. Histological hepatitis did not recur during an interim of 12-33 months in the 5 HDV-infected patients in whom HBV did not return. The overall medium-term survival in patients with HDV who underwent transplantation was 77.7%. Liver transplantation offers patients with HDV a hope of cure from disease despite a high risk of reinfection. In the transplantation setting. HDV can cause subclinical infections without any apparent assistance from HBV; these infections become symptomatic only if and when HBV reactivates. Thus, HDV may not be in itself pathogenic but requires cooperation from HBV to cause the appearance of the disease.

Gastroduodenal fistula complicating a prepyloric ulcer

tion of heterotopic gastric mucosa in the duodenum (English abstract). Z Gesamte Inn Med 1977; 32:371. 12. Trier JS, Moxey PC, Fordtran JS, MacDermott RP. Ectopic gastric mucosa in celiac sprue. Gastroenterology 1973; 65:712. 13. Ming SC, Simon M, Tandon BN. Gross gastric metaplasia of ileum after regional enteritis. Gastroenterology 1963; 44:63. 14. King ESJ, MacCallum P. Cholecystitis glandularis proliferans (Aptica). Br J Surg 1931; 19:310. 15. Sfakianakis GN, Conway JJ. Detection ofectopic gastric mucosa in Meckels diverticulum and in other aberrations by scintig-

Survival of Patients with Early Gastric Cancer Operated on for Cure

Prognosis of early gastric cancer is far better than all other forms of gastric cancers with survival figures up to 90% at 5 years in Japan. Between 1982 and 1986, 31 cases of early gastric cancers were diagnosed at our institution and operated on for cure. Macro—scopically, 79% of lesions were ulcerating tumors, and 80% were located in the antrum with a maximal diameter of 2 cm in the majority of tumors. Histologically, 58% of cancers were of the intestinal type and 19 out of 31 had spread to the submucosa.

The e antigen and antibody in the serum of patients with HBsAg-positive liver disease and in asymptomatic carriers.

SummarySerum samples from 103 HBsAg positive and 69 negative patients were examined in Ouchterlony double diffusion in agarose for the presence ofe antigen and anti-e antibody.e antigen was found in 66 % of the cases of active chronic hepatitis, 18 % of those of active cirrhosis, and 12 % of those of acute hepatitis. Anti-e antibody was found only in asymptomatic chronic carriers; it occurred in 56 % of HBsAg-positive individuals with normal livers at biopsy. Noe reactivity was found in 6 subjects with inactive disease and in 3 with chronic persistent hepatitis. Thee system seems a valuable diagnostic tool utilizing the presence of the antigen to differentiate patients with chronic progressive disease from healthy carriers who, in contrast, often have circulating anti-e antibodies; its clinical value, however, is at present limited by the low sensitivity of the technique used for antigen detection. A significant association betweene antigen and the intrahepatic expression of the core determinant of the HB virus was observed in this study, suggesting they have a similar role in pathogenicity and infectivity; the association between anti-e antibody and HBsAg appeared uncertain, HBsAg being present in the liver irrespective ofe reactivity.