Anti-HBe-positive chronic hepatitis B with HBV-DNA in the serum response to a 6-month course of lymphoblastoid interferon.

Eighteen heterosexual HBsAg carriers with anti-HBe- and HBV-DNA-positive chronic hepatitis B (CHB) were randomly assigned to receive human lymphoblastoid interferon (ly-IFN) at a dose of 5 MU/m2 i.m. three times a week for 6 months (ten cases) or no treatment (eight cases). All patients were followed for 24 months after IFN discontinuation and received a second liver biopsy. During the 6 months of treatment all patients had a progressive reduction of serum HBV-DNA levels, and at the end of therapy nine out of ten were HBV-DNA-negative and had normal ALT values. None of the untreated patients became persistently HBV-DNA-negative or showed significant variations of ALT levels. During the post-treatment follow-up, from 1 to 17 months after ly-IFN discontinuation, eight of the nine responders (89%) had recurrent or persistent reappearance of HBV-DNA in the serum and reactivation of the liver disease activity, with an ALT peak in four of them. On the post-trial liver biopsy seven of the eight relapsed patients showed persistence of HBcAg reactivity with no significant difference in the percentage of positive cells with respect to the pre-treatment liver specimen. Histological features improved in four treated patients, worsened in one untreated case and were unchanged in the remaining patients. These results indicate that ly-IFN shows a transient antiviral effect in the therapy of anti-HBe- and HBV-DNA-positive CHB. The 6-month treatment regimen employed in this study seems insufficient for eradicating the replicating virus from the liver cells in the majority of patients and consequently does not appear to prevent HBV reactivation after IFN discontinuation.

Analbuminemia: report of a case and review of the literature.

Idiopathic analbuminemia was fortuitously detected in a 30-year-old Italian woman. No associated disease condition could be revealed in this patient, the only consistent finding being a slight tendency to develop ankle edema. Asthenia and a moderate hypotension were also recorded. Trace amounts (5.2 mg/100 ml) of serum albumin were determined by immunochemical methods. Laboratory features also included increased circulating levels of cholesterol and beta-lipoproteins, as well as elevation of acute phase reactants and immunoglobulins. Albumin turnover studies showed low albumin synthesis and abnormally slow albumin degradation rate. No consanguinity of the percentage could be traced in this patient and an autosomal recessive transmission of the trait was suggested. An extensive review of the literature disclosed 19 additional cases of this rare condition, their occurrence actually challenging the vital role of albumin in man. Compensatory mechanisms certainly play a role but are only partially understood.

Gastric abnormalities in cholera: epidemiological and clinical considerations.

The anatomofunctional status of the stomach was studied in cholera patients during the outbreak in Bari, Italy, in 1973. Of a total of 70 patients examined, 24 were found to have undergone gastric resection for ulcer in the past. Stomach secretions induced by fasting and histamine stimulation were studied in 30 patients, the majority of whom showed achlorhydria and other disturbances of gastric secretion. These abnormalities not only predisposed the patients to cholera infection but shortened the incubation period. The clinical course and severity of the disease were also related to the degree of gastric damage, the most serious cases occurring in gastrectomized patients.