Moderate alcohol use and health: a consensus document.

AIMS: The aim of this consensus paper is to review the available evidence on the association between moderate alcohol use, health and disease and to provide a working document to the scientific and health professional communities. DATA SYNTHESIS: In healthy adults and in the elderly, spontaneous consumption of alcoholic beverages within 30 g ethanol/d for men and 15 g/d for women is to be considered acceptable and do not deserve intervention by the primary care physician or the health professional in charge. Patients with increased risk for specific diseases, for example, women with familiar history of breast cancer, or subjects with familiar history of early cardiovascular disease, or cardiovascular patients should discuss with their physician their drinking habits. No abstainer should be advised to drink for health reasons. Alcohol use must be discouraged in specific physiological or personal situations or in selected age classes (children and adolescents, pregnant and lactating women and recovering alcoholics). Moreover, the possible interactions between alcohol and acute or chronic drug use must be discussed with the primary care physician. CONCLUSIONS: The choice to consume alcohol should be based on individual considerations, taking into account the influence on health and diet, the risk of alcoholism and abuse, the effect on behaviour and other factors that may vary with age and lifestyle. Moderation in drinking and development of an associated lifestyle culture should be fostered.

[Altered immunoregulation in chronic viral hepatitis. Deficiency of T-lymphocytes with membrane receptors for histamine]. / Alterata immunoregolazione nella epatite cronica virale. Deficit di linfociti T con recettore di membrana per l'istamina.

To further characterize the defect of immunoregulation in chronic active hepatitis (CAH), we measured circulating T cells with membrane receptors for histamine (H + TLy), cells endowed with cytotoxic and suppressor functions, in a group of patients with viral CAH, in patients with non-immune liver disorders and in healthy individuals. Patients with CAH showed significantly lower mean numbers and percentage of H + TLy (p less than 0,001) than controls, while patients with non-immune liver disorders had H + TLy values which did not differ significantly from those found in healthy individuals. The lymphocyte alterations in CAH patients were independent of serum HBsAg, cirrhosis or steroid therapy, but correlated inversely with an in vivo index of plasma cell activity, i.e., serum gammaglobulin levels, and with the histological parameter of hepatic inflammation, i.e. portal and periportal mononuclear infiltration. The normal values of H + TLy in patients with non-immune liver diseases suggest that in CAH the decrease in circulating H + TLy is not secondary to the liver damage. The alteration of immunoregulation associated with CAH may have pathogenetic implications, although it is unlikely to represent the sole mechanism for the perpetuation and worsening of the disease process.

Blood T and B cells in patients with acute viral hepatitis A, B and non-A non-B.

We studied the blood distribution of T and B cells in relation to the etiology and the course of the hepatitis process, in 61 consecutive patients with acute viral hepatitis (AVH). Patients with acute viral hepatitis B showed a significant increase in total T, active T and SmIg cells, lasting the first two weeks of disease. These alterations disappeared in patients with resolving hepatitis. SmIg cells remained persistently elevated in the blood of three patients, who developed chronic hepatitis B. In patients with other types of viral hepatitis, lymphocytes were unaltered, with the exception of a transitory increase in SmIg cells, during the convalescence phase of hepatitis A. The finding that lymphocytes were activated exclusively in patients with acute hepatitis B, but not in those with other types of hepatitis, suggests that the mechanisms of liver injury in hepatitis B may differ from those involved in the pathogenesis of hepatitis A and nAnB.

Long-term delta superinfection in hepatitis B surface antigen carriers and its relationship to the course of chronic hepatitis.

To assess the prevalence and clinical significance of delta-infection in chronic hepatitis B surface antigen carriers, we examined 326 liver biopsies from 192 retrospectively selected carriers by immunofluorescence. Delta antigen was detected in 102 specimens from 50 carriers (26.2%) with peak prevalence in patients with active cirrhosis (51.5%) and generally in close association with progressive liver disease (94%). The antigen was located in the nuclei of 2%-50% of the hepatocytes, without any disease-specific pattern of fluorescence. Patients with intrahepatic delta-antigen, however, had more severe liver disease than those without it. Histologic follow-up of 101 cases showed that the rates of worsening of the liver disease were similar in delta-antigen-positive and in delta-antigen-negative patients. It is concluded that delta-superinfection does play a role in worsening the histologic picture of hepatitis B surface antigen-positive chronic active hepatitis, possibly by liver injury induced acutely at the moment of infection.

Diagnostic value of serum cholylglycine radioimmunoassay in chronic asymptomatic HBsAg carriers.

The correlation between histological liver abnormalities and fasting serum cholylglycine levels was investigated in 75 chronic asymptomatic HBsAg carriers with normal conventional liver tests, to clarify whether serum CG radioimmunoassay could help in distinguishing the carriers with histological liver damage from those with normal histological findings. Mean (+/- SEM) fasting serum CG levels were 11.6 +/- 1.5 micrograms/dl in 56 carriers with normal liver histology, 14.6 +/- 4.2 micrograms/dl in 16 subjects with CPH and 95.6 +/- 54 micrograms/dl in three carriers with CAH. The incidence of abnormal values (greater than 40 micrograms/dl) among carriers with CAH (66%) was significantly higher than in the other two groups (1.8 and 12.5%, respectively). It is concluded that, among chronic asymptomatic HBsAg carriers with normal conventional liver tests, those who show abnormal serum CG levels are likely to have severe histological damage. This justifies the inclusion of CG radioimmunoassay in the routine follow-up of these subjects. The occurrence of false-positive and false-negative results must be considered if the test is used as an aid in the selection of patients for liver biopsy.