Universal prenatal hepatitis B testing: is it cost-effective?

It was recently recommended that all pregnant women undergo prenatal hepatitis B screening. This change from previous policy (which advocated screening of only those individuals with recognized epidemiologic risk factors) is a very costly strategy to use in an effort to prevent the perinatal spread of hepatitis B in the "no-risk-factor" population. Inherent problems already exist in screening, related to the following: 1) the failure for disease transmission to occur in the majority of hepatitis B e antigen-negative pregnancies, 2) the lack of established efficacy of prophylaxis in the hepatitis B e antigen-negative pregnancy, 3) the preponderance of hepatitis B e antigen negativity in pregnant hepatitis B surface antigen carriers, and 4) the compliance of the mother to ensure that the prophylaxis program is accomplished.

Is endoscopy hazardous to your liver?

In a survey of a gastrointestinal endoscopy society, 92 members (84%) filled out a questionnaire and donated serum specimens for testing for hepatitis B markers and alanine aminotransferase. The frequency of serologic evidence of exposure to hepatitis B was only slightly higher than that seen in the general population and comparable to that reported in "low-risk" health-care workers. Overall, 12% had markers of previous hepatitis B exposure and 3% had an abnormal aminotransferase determination.

Diagnostic usefulness of testing for anti-HBc IgM in acute hepatitis B.

Numerous tests to detect anti-HBc IgM have been developed and shown to have different degrees of sensitivity and specificity. One of these assays, Corzyme-M (Abbott Laboratories, North Chicago, Ill.), recently became commercially available.

Nutritional support: how much for how much?

Although malnutrition is associated with poor clinical outcome, it cannot be inferred that better nutrition will improve clinical outcome. Efficacy of a proposed regimen is best established by prospective, randomised, controlled trials. Cost effectiveness is only an issue if efficacy exists.

Non-A, non-B posttransfusion hepatitis--a decade later.

We have followed up 69 patients who developed non-A, non-B posttransfusion hepatitis in 1972-1978. Chronic hepatitis, defined by biochemical criteria, was observed in 46 patients (67%), the majority of whom subsequently failed to resolve the abnormalities. Chronic hepatitis was a sequela of non-A, non-B posttransfusion hepatitis less often after the blood bank changed to a policy of all volunteer donors.

The pursuit of hepatitis in dialysis units.

Chronic hemodialysis patients were prospectively followed at monthly intervals with hepatitis B serologic (HBsAg, anti-HBs, and anti-HBc) and aminotransferase determinations. Over this 1 year, 53/176 (30%) had two or more abnormal aminotransferase values. In at least 34 of these 53 patients, viral liver disease appeared to be the responsible factor.

Recurrent ulcer after successful treatment with cimetidine or antacid.

This study was designed to compare the rates of duodenal ulcer healing and recurrence after treatment with cimetidine or antacid. Patients with endoscopically documented duodenal ulcer received cimetidine, 1200 mg daily, or Mylanta II, 7 oz daily, in a randomized, double-blind trial. For the 69 patients in each group who completed the healing phase of the trial, endoscopic ulcer healing was almost identical.

Clinical value of serum bile acid levels in chronic hepatitis.

A prospective study was undertaken to determine if individual serum bile acid (SBA) levels are clinically useful in differentiating patients with asymptomatic chronic active hepatitis (CAH) from patients with chronic persistent hepatitis (CPH). Fasting and postprandial SBA levels were obtained from 16 patients with CAH, 12 with CPH, and 18 control subjects. Levels of cholylglycine (CG) and total cholic acid conjugates (CCA) were determined by radioimmunoassay.

Hypouricemia--a transient biochemical phenomenon of total parenteral nutrition.

A retrospective chart review of total parenteral nutrition identified several patients who developed hypouricemia. In order to study this phenomenon, seven patients were prospectively investigated during courses of total parenteral nutrition with serum and 24-h urine determinations of uric acid. In all seven patients, the serum uric acid level decreased, with the average fall being 3 mg/100 ml, then began to rise again.

Multifocal eosinophilic granuloma involving the common bile duct: histologic and cholangiographic findings.

The multifocal eosinophilic granuloma syndrome (Hand-Schüller-Christian disease) is characterized histologically by focal accumulations of histiocytes and eosinophils. The clinical manifestations of this syndrome reflect the site and extent of these focal accumulations which are usually found in membranous bone, skin, and lung. Significant hepatobiliary disease due to this disorder has not been previously described.

The long-term course of non-A, non-B post-transfusion hepatitis.

Patients with non-A, non-B post-transfusion hepatitis were followed from the onset of their disease until their blood tests normalized, until they died, or until the present time. Of 66 patients, 30 had a spontaneous resolution of their biochemical disease. Ten patients died or were begun on immunosuppressive therapy with transaminases still abnormal.

Chronic active hepatitis. Who meets treatment criteria?

In order to ascertain the proportion of patients with biopsy-proven chronic active hepatitis who meet currently accepted criteria for immunosuppressive treatment, an analysis of 86 patients seen between 1973 and 1978 carrying this diagnosis was undertaken. Only 66 could be confirmed to have this lesion on blind histologic review. Nine of these 66 were on concomitant immunosuppressive therapy, four had inadequate documentation of chronicity, five consumed more than two ounces of alcohol daily, five had concurrent malignancy, two were prepubertal, and one had oxyphenisatin-induced disease.

Rapid development of cirrhosis secondary to squamous cell carcinoma of the common bile duct.

A 68-year-old male underwent cholecystectomy with a normal operative wedge liver biopsy. Five months later he presented with secondary biliary cirrhosis and signs of portal hypertension and hepatocellular failure. At autopsy, a squamous cell carcinoma of the bile duct was found.

Failure of endoscopic transmission of hepatitis B.

Emergency endoscopy was performed on two patients subsequently found to be hepatitis B surface antigen carriers. Before their carrier state was determined, nine other patients underwent endoscopy using the same instruments, which had been routinely cleaned between procedures. These patients were all notified within five days of the incident, given standard gamma globulin, and prospectively followed for the development of hepatitis.