Hepatitis B virus in patients undergoing hemodialysis: transmission risks and psychosocial reactions.

Thirteen patients undergoing hemodialysis who were carriers of hepatitis B virus (HBV) were screened for inappropriate reactions to HBV transmission risks and for emotional reactions to their renal and viral diseases. Four patients underreacted to HBV transmission risks through denial or misunderstanding. The nine remaining patients reported that their HBV, as compared with their renal disease, resulted in substantially greater restrictions in interpersonal relations and significantly greater feelings of not being accepted by others. In contrast, the nine patients reported that their renal disease, as compared with their HBV, resulted in substantially greater restrictions in leisure and work activities. Thirteen control patients undergoing hemodialysis but not having HBV did not differ from the patients with HBV in psychosocial reactions to renal disease. As shown in a one-month follow-up, counseling was effective in enhancing awareness of HBV transmission risks and in improving emotional adjustments to the renal and viral diseases.

Hepatic microsomal induction in rat liver: heterogeneity of response.

The concept that urinary 6-hydroxycortisol excretion patterns reflect all microsomal enzyme activities remains a subject of controversy. Three different microsomal hydroxylase activities were therefore studied in rat liver after the animals were intoxicated with alcohol, phenobarbital, or a combination thereof. The activities of pentobarbital hydroxylase, aniline hydroxylase, and cortisol 6-hydroxylase (the enzyme metabolizing cortisol to 6-hydroxycortisol) were assayed simultaneously after each treatment. A heterogeneity of enzyme activities was noted. Cortisol 6-hydroxylase activity did not parallel the activity patterns of the two other hydroxylases. The data suggest that before urinary 6-hydroxycortisol excretion patterns can be utilized as an index of microsomal enzyme induction, the effect of the specific drug on individual cytochrome P-450 hydroxylases is required.

Viral hepatitis: progress and problems.

The recognition of viral hepatitis has been facilitated by the use of serologic studies for types A, B, and non-A, non-B. The course is best determined by serum enzyme determinations, followed by clearance studies of bile acids or dyes once the serum enzymes return to normal. In patients with persisting clinical or biochemical abnormalities and those in which the nature of the disease is not known, liver biopsy should be done.

Gastric hemorrhage and Kaposi's sarcoma treated with radiotherapy.

A 66-year-old man, with advanced alcoholic liver disease with Kaposi's sarcoma involving the stomach and the skin of the lower extremities, developed upper gastrointestinal hemorrhage. He was treated with radiation therapy to the stomach and the skin with rapid resolution of the gastric lesions, as demonstrated by serial endoscopy.

Hepatitis B virus. Inappropriate reactions to transmission risks.

Ten patients designated as hepatitis B surface antigen (HBsAg) carriers were screened for inappropriate reactions to their disease. Assessment with a 32-item questionnaire showed three carriers to have underreacted to the risks of HBsAg transmission through misunderstandings or denial concerning the disease. One carrier, through severe social withdrawal, showed overreaction to the possibilities of disease transmission. Counseling was provided regarding the risks of HBsAg transmission. At a one-month follow-up, all carriers appeared appropriately aware of the risks of transmission, and one of two carriers referred for psychotherapy showed greatly improved social adjustment. We recommend that persons treating HBsAg carriers screen routinely for inappropriate reactions to risks of disease transmission and provide counseling as needed.

Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis.

A Histology Activity Index has been developed which generates a numerical score for liver biopsy specimens obtained from patients with asymptomatic chronic active hepatitis. Biopsies are graded in four categories: periportal necrosis, intralobular necrosis, portal inflammation, and fibrosis. Under code, three pathologists and three hepatologists evaluated 14 liver biopsy specimens obtained from five patients with asymptomatic chronic active hepatitis. Good correlation was seen between severity of liver biopsy lesions as judged by conventional histological descriptions and Histology Activity Index scores. Significant differences in Histology Activity Index score occurred in only 2 or 28 duplicate scorings of biopsy specimens by two observers. This system provides definitive endpoints for statistical analysis of serial changes in liver histology and offers an alternative to the use of conventional pathological descriptions in following the natural history and treatment responses of asymptomatic chronic active hepatitis.