The pathology of viral hepatitis types A and B in chimpanzees. A comparison

The histologic manifestations in the livers of chimpanzees inoculated with hepatitis A and B virus were compared with each other and correlated with biochemical, serologic, and virologic observations. Both types of hepatitis reveal alterations similar to those seen in human hepatitis, but the lesions--particularly the hepatocellular necrosis--are far milder. Hepatitis Type A in chimpanzees is a disease of short incubation period and duration. The hepatocytic alterations are mainly restricted to the periportal areas, and the parenchymal changes are less severe than the portal inflammation. The lesions correlated well with biochemical changes, the presence of virus in the liver, and its shedding in the stool. In contrast, experimental Type B hepatitis has a long incubation period and longer duration, involves the entire lobular parenchyma, and is, if anything, more severe in the lobular centers while portal inflammation is less conspicuous. Biochemical alterations and presence of virus in the liver correlate with these lesions, and the antibody response is similar to that seen in man. The chimpanzee is a useful model for studying the pathogenesis of viral hepatitis; additional study of serial morphologic events may contribute to our understanding of the clinical differences between hepatitis Type A and Type B.     

Alcoholism, hepatitis B and C viral infections, and impaired liver function among Taiwanese aboriginal groups

Viral hepatitis and alcoholism prevail in four major Taiwanese aboriginal groups. To study the relative importance of the acquisition of hepatitis B virus or hepatitis C virus infection and alcoholism to the presence of impaired liver function in these groups, the authors conducted a semistructured clinical interview for alcoholism and test for seromarkers for viral hepatitis among 993 cohort members enrolled in 1990-1992 in an ongoing prospective study (Taiwan Aboriginal Study Project). The subjects' blood specimens were tested for serum alanine aminotransferase/aspartate aminotransferase levels and for the presence of hepatitis B surface antigen and anti-hepatitis C virus antibody. The prevalence of a combination of an alanine aminotransferase level of > 35 IU/liter and an aspartate aminotransferase level of > 40 IU/liter, implying impaired liver function or advanced liver disease, was 4.3% overall. Univariate and multiple logistic regression analysis showed that, rather than chronic hepatitis B virus infection, hepatitis C virus infection and alcoholism were the two dominant risk factors that signalled the risk of liver damage among these Taiwanese aborigines. In addition, these two contributing factors were able to act synergistically to cause impaired liver function.     

Histologic distribution of hepatitis A, B, C, D, E, and G with concomitant cytokine response in liver tissue

BACKGROUND: Studies focusing on the economic impact of cancer on families have emphasized that costs of chronic disease are substantial for patients and their families. However, little effort has been devoted to measuring the costs of care for families of patients hospitalized with stroke. METHODS: A total of 215 stroke patients and their families from four teaching hospitals in the Taipei metropolitan area were monitored from the date of the patient's admission to hospital until the date of discharge. The value of labor contributed by families was estimated by assigning the current monetary market rate of providing health aide to the time families spent caring for patients in hospital. Lost earnings of patients and families, expenditure for medical care, and expenses for food, clothes, adult diapers, transportation and other miscellaneous items were determined and summed to arrive at the total family cost of providing care. RESULTS: The average cost of care for one family per inpatient day was NT$4,358.20. A total of 98.6% of the families incurred labor costs, which accounted for about half of family costs for providing care. Hospital bills accounted for almost 19% of total family costs. The income loss for families and patients accounted for about 25% of total family costs. Expenses for food, clothes, transportation, diapers and other illness-related miscellaneous items accounted for about 12% of total family costs. Multiple regression analyses demonstrated that the number of family members involved in giving care and the length of stay are important predictors for the total cost of care. Average total family costs per day increased by 24.3% when an additional family member was involved in providing care. Total family costs increased 2.5% for each hospital day. CONCLUSIONS: If direct and indirect nonmedical costs are not included in the total cost calculation for providing hospital care to stroke patients, the economic impact of care on families is likely to be underestimated.     

The functional activity of anti-endotoxin factors in viral hepatitis A and B

Bacterial endotoxins (BE) that are lipopolysaccharide complexes (LPS) are a structural component of the external membrane of gram-negative bacteria. In normalcy, BE interact with many types of cells in the mammals. In terms of the concentration, BE may cause cell damage or stimulate the production of many biological mediators, such as interleukins, prostaglandinds, alpha-TNF. Many gastrointestinal bacteria in humans are gram-negative and BE constantly enter the blood. In health, the absence of a toxic response to BE is explained by the presence of natural humoral and cellular antiendotoxic systems and the hepatic absorption of LPS. In patients with hepatitis A and B, the following indices of the blood antiendotoxic systems were determined: the level of antiendotoxic antibodies to Re-chemotype glycolipids was assessed by the passive hemagglutination reaction in the "Antiendotox-1-test"; the count of polymorphonuclear leukocyte (PMNL) fixating LPS on their own surface and endotoxin binding function of PMNL was in vitro measured by the strain ELISA and sandwich ELISA with Re-glycolipids, respectively (LPS-test); the endotoxin fixation function of serum high density lipoproteins (HDL) was also assessed. The humoral and cellular antiendotoxic systems in patients with mild advanced hepatitis A and B was studied when the disease was most clinically significant, at an early convalescence, and at convalescence itself. Finally, the findings indicate that there is a significant decrease in Re-antibody levels and there is a greater absorption ability of HDL than that in the control. Six different types of an antiendotoxic fixation reaction of PMNL were identified in patients with viral hepatitis in the different periods of the disease. The alterations observed may play an important role in the pathogenesis of toxemia in patients with viral hepatitis.     

Immunohistochemical characterization of hepatic lymphocytes in acute hepatitis A, B, and C

Mechanically evoked cerebral potentials (MECP) were studied in humans standing on a movable platform with three different stance widths. A sudden platform tilt of 4 degrees produced ankle dorsiflexion and resulted in scalp potentials of five distinct components, the earliest being a positive deflection at 35/60 ms. Their latencies have shown fairly consistent values among the three stance widths, while the amplitudes underwent some significant changes under the wide stance condition as compared with tightly close feet. These findings were interpreted as purporting evidence of altered somaesthetic afferent input from lower limbs during standing with widely apart support surface.     

Hb, C, D and E hemoglobinopathies

The four commonest beta chain variants of human hemoglobin (Hb), i.e. Hbs C, D, E, and S were absent or quite infrequent in Japanese. They are occasionally found in visitors and immigrants to Japan recently. Geographical distribution, clinical expression, pathophysiology and diagnosis of Hbs C, D and E are briefly reviewed.     

Use of polymerase chain reaction in clinical diagnostic laboratories in viral hepatitis B and C]

alpha 1-Antitrypsin deficiency has been associated with a variety of vascular disorders including arterial aneurysms, spontaneous extracranial arterial dissections, and arterial fibromuscular dysplasia. We determined the distribution of alpha 1-antitrypsin phenotypes in patients with intracranial arterial dissections, a rare cause of subarachnoid hemorrhage. The study population consisted of 4 consecutive patients with subarachnoid hemorrhage due to spontaneous intracranial arterial dissections. The vertebral artery was involved in 3 patients and the posterior inferior cerebellar artery in 1 patient. Three of these 4 patients were found to have a heterozygous alpha 1-antitrypsin deficiency (PiMZ or PiMS phenotypes). These data support previous studies suggesting that patients with alpha 1-antitrypsin deficiency may be at an increased risk of developing spontaneous arterial dissections.     

Seroprevalence of hepatitis B and C viral markers in patients with primary hepatocellular carcinoma in Singapore

This paper reviews studies on the basic principles of biostimulation of wound healing by various low-energy lasers. It looks at the mechanism of action of biostimulation as well as the laser's effect on cell proliferation, collagen synthesis, and would healing.     

Ethiopathogenesis of hepatitis B viral infection in chimpanzees

Oral glucose tolerance tests were performed on 16 addicts and 16 control subjects. A flat delayed glucose response was demonstrated, with hyperinsulinaemia, elevated plasma growth hormone and normal plasma cortisol in heroin addicts compared with control subjects. These studies suggest a relative insulin resistance in addicts which might be mediated by the elevated growth hormone or some other pharmacologic effect of the chronic opiate abuse.     

Occupational exposure to HIV, hepatitis B, hepatitis C, and tuberculosis

This article reviews risk of occupational exposure to bloodborne pathogens, specifically HIV, hepatitis B, and hepatitis C to healthcare workers. Information regarding assessing the risk of exposure, appropriate actions to take if an exposure occurs, the most recent recommendations for treatment and follow-up postexposure, and prevention strategies for avoiding exposure are presented. Additionally, current recommendations for the prevention of the transmission of tuberculosis in healthcare workers and the regulatory guidelines governing this topic are discussed.     

Epidemiological risk factors and clinico-pathological presentation in chronic hepatitis C

BACKGROUND/AIMS: To analyze the epidemiological risk factors related to clinical and pathological patterns on presentation in patients with chronic hepatitis C (CHC) without cirrhosis. METHODOLOGY: This prospective study, carried out in the Liver Unit of the Princesa University Hospital, includes a population of 253 patients with CHC without clinical features of cirrhosis evaluated for clinical, virological and histological assessment. A standardized questionnaire was used to identify the presence of risk factors for hepatitis C virus (HCV) infection. Anti-HCV was tested by ELISA-2 and RIBA-2 assays. HCV RNA was analyzed by nested PCR. Liver biopsies were obtained percutaneously or in some cases by laparoscopy. RESULTS: The mean age of patients was 43+/-15 years and 154 were males, being significantly younger than females (39+/-13 versus 50+/-14 years). A source of infection was ascertained in 204 (80.6%) patients and only 37 (14.6%) referred a history of acute hepatitis. Anti-HCV was ELISA-2 positive in all 253, and 133 were tested by RIBA-2 (131 positive, 1 negative, 1 indeterminate) and by nested PCR to detect HCV RNA, with positivity in all except 3, including both the RIBA-2 negative and indeterminate. No differences appeared in the histological activity index according to routes of infection, but in comparing sexes, females had a significantly higher total score as well as the inflammatory/hepatitic index and fibrosis. CONCLUSIONS: In CHC no epidemiological, clinical or biochemical patterns are indicative of pathological features. The more severe disease in females could be attributed to the fact that they were older and it could be assumed that viral infection progressed longer. This slow progression calls for a therapeutical option over many years.     

Serosurvey of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infection among hospital-based surgeons. Serosurvey Study Group

BACKGROUND: Because occupational blood contact places health-care workers at risk for infection with bloodborne pathogens, we wanted to estimate the prevalence of infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) among hospital-based surgeons and correlate the results with occupational and nonoccupational risk factors. STUDY DESIGN: All surgeons in training or in practice in general surgery, obstetrics and gynecology, or orthopedics at 21 hospitals in moderate to high AIDS incidence areas were eligible to participate in a voluntary, anonymous serosurvey. Serum samples were tested for HIV antibody, for HCV antibody, and for markers of HBV infection: hepatitis B surface antigen, total antibody to hepatitis B core antigen, and antibody to hepatitis B surface antigen. RESULTS: Of 2,887 eligible surgeons, 770 (27 percent) participated in the study. One of 740 surgeons not reporting nonoccupational risk factors was HIV seropositive (0.14 percent, upper limit 95 percent confidence interval [CI] equals 0.64 percent). None of 20 participants reporting nonoccupational HIV risk factors and none of ten not responding to the question on nonoccupational risk factors were HIV positive. Of 129 (17 percent) participants with past or current HBV infection, three (0.4 percent) had chronic HBV infection; all were negative for hepatitis B e antigen. Risk factors for HBV infection included not receiving hepatitis B vaccine (odds ratio [OR] 14.7, 95 percent CI 8.3 to 26.0) and practicing surgery at least ten years (OR 2.2, 95 percent CI 1.3 to 3.8). Seven (0.9 percent) participants had anti-HCV. CONCLUSIONS: Although not necessarily generalizable to all surgeons in moderate to high AIDS incidence areas, these results do not indicate a high rate of previously undetected HIV infection among surgeons who trained or practiced in these areas, or both. Hepatitis B virus posed the highest risk of infection with a bloodborne pathogen, followed by HCV and HIV.     

GB virus C RNA in serum, liver, and peripheral blood mononuclear cells from patients with chronic hepatitis B, C, and D

We examined fiber density, compound muscle action potential (CMAP) amplitude, and motor unit number estimate (MUNE) of the abductor digiti minimi and grip strength longitudinally. We sought to determine the effects of ALS on these measurements and to evaluate which of these tests may be more sensitive in evaluating progression of ALS and possibly predicting survival. Ten patients were examined at months 0, 3, and 6. A significant decrease in MUNE and increase in fiber density were observed at months 3 and 6 (p < 0.02) compared with baseline (month 0). Mean CMAP and grip strength declined, but not significantly. The decrease in MUNE over 6 months was significantly greater than that of CMAP and grip strength (p < 0.025). The significant changes in MUNE and fiber density over time suggest that they are more sensitive in measuring the rate of progression of ALS. To evaluate further the utility of these tests, we arbitrarily divided the patients into equal groups based on length of survival. MUNE declined significantly in the group with shorter survival (p < 0.01). Conversely, fiber density increased significantly in patients with longer survival (p < 0.01). With similar statistical analysis there were no significant differences in decline of CMAP or grip strength in either subgroup over 6 months. Our study suggests that MUNE and fiber density are more sensitive than CMAP and grip strength in detecting progression of ALS. Furthermore, we raise the hypotheses that a greater increase in fiber density identifies a group of patients with ALS who will have longer survival, and that a greater decline in MUNE identifies a group with a worse prognosis.