[Epidemiology and clinical aspects of non-A, non-B hepatitis (author's transl)]. / Epidemilogie und Klinik der Non-A-Non-B-Hepatitis. Eine retorspektive Studie aus den Jahren 1970--1976.

Among 288 patients with acute viral hepatitis investigated between 1970 and 1976 29 (10%) had non-A, non-B hepatitis. In 9 of these 29 patients posttransfusion hepatitis was proven, the remaining 20 patients had sporadic infections. The incubation period of posttransfusion hepatitis was 2--8 weeks in 7 patients and 12 and 16 weeks in the two other patients. Transaminases changed monophasically in 22 patients, bi- or multiphasic in 7. The disease took a subicteric course in a quarter of all cases. Out of the 29 patients 17 were followed up for 2 to 7 years, one or more recurrence occurred in 9 patients, usually within the first two years after onset of the disease. Five of these 9 patients had a biphasic rise of transaminases during the acute stage. The almost complete absence of autoantibodies in the course of the acute phase might be evidence of increased suppressor cell activity favouring a chronic course. Non-organ-specific autoantibodies were only rarely observed and were completely absent in patients with posttransfusion hepatitis.

[A case of benign recurring intrahepatic cholestasis (Tygstrup-Summerskill and Walshe syndrome)]. / Uber einen Fall von benigner rezidivierender intrahepatischer Cholestase (Tygstrup-Summerskill- und Walshe-Syndrom).

The case of a 23-year-old male patient with benign intrahepatic recurrent cholestasis of Summerskill-Tygstrup and Walshe type is presented. The patient had suffered 9 attacks up to 1974. The clinical and histological data of this patient were compared with those in the 65 cases described previously. The most characteristic signs were that the disease began before puberty and the attacks of jaundice with direct hyper bilirubmemia were induced by infections. Histology obtained in acute phase of the disease revealed intrahepatic cholestasis, and there were signs of a non-specific mesenchymal reaction of the liver tissue while the patients were asymptomatic. The serum activity of alkaline phosphatase was increased, gamma-glutamyltranspeptidase and transaminases being normal or close to normal. The pattern of the biochemical findings was characteristic and the patient was recognized among 19,035 other patients hospitalized from 1972-1975 by means of a special computer program. This program may be helpful in detecting patients with this disease from computerized data of hospitalized patients and avoiding unnecessary surgical intervention.

[Liver damage following intestinal by-pass surgery for weight reduction]. / Leberschäden nach intestinaler Kurzschlussoperation zur Gewichtsreduktion

The jejuno-ileal bypass for weight reduction can hardly be considered a non-specific treatment: 3-4% of the patients develop chronic hepatic damage, 1-2% suffer hepatic failure due to massive fatty liver, rapidly progressing liver cirrhosis or hepatic fibrosis. Fatty liver is an invariable sequel of this operation. Once the above-mentioned symptoms set in or an incipient cirrhosis or fibrosis is diagnosed, immediate restoration of normal passage is required. The intestinal bypass syndrome observed in the patient (fem.) (viz. table 1) does not wholly coincide with the enteral bile acid loss syndrome occurring in extensive ileum resection (56) where usually there is no evidence of fatty liver, icterus, cholestasis or encephalopathy. Animal experiments seem to confirm that the blind loop in the broadest sense of the term is responsible for the sometimes fatal hepatic damage. Possibly we are confronted here with a pattern of hepatic damage due to toxic nutritive effects similar to cirrhosis as a sequel of low-protein and low-calorie intake or to the phenomenon observed in animal experiments. The cholestasis confirmed by biopsy and chemical methods is a manifestation of these hepatic disorders. The clinical aspects resemble the Reye syndrome that we know in pediatrics. Patients have to be carefully selected and informed about possible postoperative damage; a continuous clinical follow-up with biopsy of the hepatic tissue is also indicated.