Letter: Intranuclear particles in hepatocytes of HBAg-positive blood-donors.
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Biomedical subjects
Publications and source records attributed to I L Woolf.
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The clinical syndrome of active chronic hepatitis occurs characteristically in young people. In this report we describe three elderly patients with the syndrome. All three presented in a different manner and in two this was atypical. The diagnosis was suspected from the clinical finding of hepatomegaly or the presence of abnormal liver function tests. All three responded to treatment with corticosteroids.
Thirty-four healthy blood donors, found to be persistent HBAg carriers, have been investigated by means of serial liver function tests, bromsulphthalein (BSP) retention, and liver biopsy. Thirty-one of the donors had histological abnormalities including one with cirrhosis, three with chronic aggressive hepatitis, and 11 with chronic persistent hepatitis. In 13 biopsies there were focal areas of necrosis in the liver parenchyma. Serial liver function tests revealed abnormalities in each of the donors with cirrhosis or with chronic aggressive hepatitis, in seven of the 11 donors with chronic persistent hepatitis, and in seven of the 13 with focal parenchymal necrosis. The degree of BSP retention was greatest (>11%) in the donors with chronic aggressive hepatitis. The severity of the histological changes was related neither to the titre of the antigen in the serum nor to the presence of autoantibodies.
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58 patients with acute hepatitis type B, including 13 with fulminant hepatitis, were tested on presentation for HBeAg. Positive results were obtained in 24%. The frequency was highest in those with fulminant hepatitis (46% positive), and this was probably related to the earlier presentation of patients with this condition. Patients with acute hepatitis who were HBeAg-positive had had a significantly shorter duration of symptoms than those who were HBeAg-negative at presentation. HBeAg was still detectable more than 3 weeks after the onset of symptoms in only 2 patients, both of whom progressed to chronic active hepatitis. The early detection of HBeAg in patients with acute hepatitis is of no prognostic significance, but its persistence may provide the earliest evidence of potential chronicity.
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