Chronic Active Hepatitis B with COVID-19 in Pregnancy: A Case Report

Currently, infection with coronavirus disease 2019 (COV-ID-19), caused by severe acute respiratory syndrome cor-onavirus 2 (SARS-CoV-2), during pregnancy is a p...     

Chronic Active Hepatitis in Jerusalem

Forty-three patients with biopsy proven chronic active hepatitis (CAH) were studied with special reference to the presence or absence of HBsAg. Evidence of hepatitis B virus (HBV) infection (HBsAg and/or anti-HBs) was found in 26 cases (60.5%). Thus, HVB is probably the most important etiologic factor of CAH in the Jerusalem area. fifteen cases (35%) were HBsAg-positive. This group was characterized by a higher frequency of males of Sephardic origin, a relatively frequent acute hepatitis-like onset, early presence of cirrhosis and portal hypertension and relative rarity of skin rashes, thyroid involvement and cholelithiasis. L.E. cells, cryoglobulin, paraprotein and positive Kahn-Wassermann tests were not found and antimitochondrial antibodies were less common. The mean level of serum albumin was lower while lg-G and lg-A were higher. Mortality was 7% during a mean follow-up period of 4.4 years. The antigen-negative group was characterized by a higher prevalence of skin rashes, thyroid disease and cholelithiasis. Peripheral lymphomonocytosis, high Ig-M levels and antimitochondrial antibodies were also more common. All cases with L.E. cells, cryoglobulin, paraproteinemia and positive Kahn-Wassermann tests were in this group. Anti-HBs antibodies were present in 42% of the cases. Mortality was 29% during a mean follow-up period of 5.4 years. Linear discriminant analysis with ten variables (sex, mode of onset, skin rash, levels of serum albumin, Ig-A, Ig-M, degree of BSP retention, presence or absence of L.E. cells, antimitochondrial antibodies and positive Kahn-Wassermann tests) classified correctly 100% of the cases. Sex, ethnic origin (Ashkenazic or other) and presence or absence of thyroid disease classified correctly 85% of the cases, thereby permitting a bed-side classification with a high degree of credibility.     

Splenectomy in Active Chronic Hepatitis

Six patients with active chronic hepatitis and hypersplenism have been studied with regard to splenectomy and immunosuppressive treatment. All patients had pancytopenia and four of them had been given immunosuppressive treatment before splenectomy, but this had to be stopped because of severe pancytopenia. All patients tolerated splenectomy, and no serious side-effects were observed. After operation all six patients tolerated immunosuppressive medication, and at follow-up examination for an average period of 21 months improvement was demonstrated in most cases.     

Fibrinogen Metabolism in Acute Hepatitis and Active Chronic Hepatitis

Coagulation studies, including those of radioactive fibrinogen metabolism, were performed in seven patients with acute viral hepatitis and 12 patients with active chronic hepatitis. An increased fractional catabolic rate for fibrinogen was observed in four patients from the first group, and seven from the second. The catabolic rate was increased in those patients with the greatest degree of hepatic necrosis as demonstrated by the raised serum aminotransferase levels. There was no correlation between the rate of fibrinogen catabolism and the standard clotting tests, but the SDPS test (indicating the presence of fibrin monomers in the circulation) was consistently positive in those cases where the catabolic rate was increased.     

Neuropathic Arthropathy: A Report of Two Cases

Summary: The case histories of two patients suffering from neuropathic arthropathy are presented. One of them had Charcot"s disease of the lumbar spine secondary to a syphilitic infection. The second case, who was thought to have syringomyelia, gave a history of recurrent dislocation of the (R) shoulder. Clinical and radiological, examination of this joint suggested that it was of the neuropathic type. The pathophysiology and treatment of Charcbt's joints is briefly discussed.     

Idiopathic Chronic Active Hepatitis in Iceland

ABSTRACT. An epidemiological study of idiopathic chronic active hepatitis in Iceland during 1970-79 is described. Patients were identified by examining all request forms for surgical specimens (117 141) sent to the Department of Pathology in that period. The diagnosis was established by a review of clinical records and liver biopsies. The patients were interviewed if clinical or serological information was lacking. Although 33.9% of all deaths in Iceland were autopsied during this period, no previously undiagnosed case of idiopathic chronic active hepatitis was found among the deceased. Eighteen new cases were found, 17 females and one male. The mean age at the time of diagnosis established by liver biopsy was 53 years (range 3–79). The most common symptoms were fatigue and/or malaise (89%) and jaundice (61%) and the prevalence of immunological markers was high. The average annual incidence was 0.83/100000 and the prevalence 8/100000. Because of the ethnic origin of Icelanders, these figures might possibly apply to Norway and the British Isles.     

Chronic Active Hepatitis and Membraneous Glomerulonephritis

A 26-year old man with documented HBs antigenemia of five years' duration developed the nephrotic syndrome. Histologic patterns of chronic active hepatitis and membraneous glomerulonephritis were found. The glomeruli stained positively for Ig-G, complement and HBs Ag. The relationship of HBs Ag-positive chronic active hepatitis and membraneous glomerulonephritis is discussed.     

Chronic Active Hepatitis with Cholestatic Features

Twelve of 43 patients with chronic active hepatitis (CAH) (28%) manifested clinical and laboratory features of cholestasis. The criteria for selection of these patients included at least two of the following: chronic or recurrent pruritus, serum alkaline phosphatase levels of 300 mU./ml. and cholesterol of 300 mg./dl. or more. When compared with 31 control cases these patients were found to have a preponderance of Ashkenazi Jews of Roumanian origin, a higher prevalence of joint and thyroid involvement and higher serum Ig-M Levels. Mortality was similar in both groups but patients with cholestatic features tended to die earlier in the course of the disease. Retrospectively, it was found that they had been treated more intensively, attained complete remissions less frequently and developed cirrhosis more readily. There were no significant differences in the frequency of HBsAg and anti-HBs, the mode of onset, the frequency of hepatosplenomegaly and jaundice, the hematologic findings and the prevalence of autoantibodies. Like acute cholangiolitic viral hepatitis, CAH with cholestatic features emerges as a more serious disease than the classical form of CAH.     

Chronic Active Hepatitis with Cholestatic Features

A review of 25 liver biopsies from 12 patients with chronic active hepatitis (CAH) with cholestatic features (Group 1) and of 30 biopsies from 23 patients without such features (Group 2) revealed that in Group 1 the bile duct epithelium showed significantly more hyperplasis, atypia, swelling, vacuolization and inflammation. When present in patients of Group 2, these parameters, in general seemed to be less severe. The number of bile ducts per portal space was similar in both groups. Thus, on a cumulative basis, a correlation was found between the clinical and biochemical features of cholestasis and the histological signs of bile duct damage.