Lack of transmission of human immunodeficiency virus in chronic hemodialysis patients.

We carried out a prospective 2-year study on the transmission of human immunodeficiency virus (HIV) infection in a chronic dialysis unit with a high prevalence (11%) of the infection. Only 1 of 45 HIV-negative patients seroconverted, and this was related to the administration of contaminated blood. We conclude that current Centers for Disease Control criteria are sufficient to prevent transmission of HIV infection in dialysis units.

Hepatic encephalopathy and orotic aciduria associated with hepatocellular carcinoma in a noncirrhotic liver.

A 40-yr-old man presented with encephalopathy and was found to have hepatocellular carcinoma without cirrhosis. A large vascular hepatic mass was defined by CT scan and angiography; laparoscopy with biopsy confirmed the absence of chronic liver disease. A definitive tissue diagnosis of hepatocellular carcinoma was made at laparotomy; the tumor was unresectable.

Experience with diagnostic laparoscopy in a hepatology training program.

Laparoscopy is an underutilized endoscopic procedure in the United States even though it has proven to be an important diagnostic modality. Among factors that may account for the unpopularity of this procedure are lack of experience and proper training in many gastroenterology fellowship programs, a perceived notion that there is a relatively high complication rate, and the preference for radiologic imaging techniques for establishing a diagnosis. We reviewed, over an 11-month period, our experience with laparoscopy in a large teaching center to better assess its safety when performed by trainees.

Postoperative jaundice as a clue to unrecognized biliary tract obstruction.

Postoperative jaundice is often a complex clinical problem of multifactorial origin. If underlying liver disease is present preoperatively, there is a greater likelihood of jaundice after surgery. We describe two patients: one with intrabiliary hepatocellular carcinoma and the other with primary sclerosing cholangitis.

Failure of Centers for Disease Control criteria to identify hepatitis B infection in a large municipal obstetrical population.

The Centers for Disease Control (CDC) has recommended screening pregnant women from high-risk populations for hepatitis B surface antigen (HBsAg). To assess the adequacy of the risk criteria, all women presenting for delivery to a large municipal hospital were screened. Sera from 5356 women were tested, and questionnaires designed to identify women at high risk were completed by 78% of these patients.

The initial presentation of fatty liver of pregnancy mimicking acute viral hepatitis.

Acute fatty liver of pregnancy, a disease of the 3rd trimester of pregnancy, may have varied presentations. An unusual initial presentation of acute fatty liver of pregnancy mimicking an acute viral hepatitis is reported herein. Osmium tetroxide preparation of pathological specimen for the diagnosis of acute fatty liver of pregnancy is also discussed.

Reduction of redundant hospital stay through controlled intervention.

With the aim of reducing redundant hospital stay through controlled intervention, preset criteria for inpatient care were applied on a medical ward. The proportion of unjustified hospital stay days fell by 52.6% and the average length of stay on the experimental ward declined from 6.

A serologic follow-up of the 1942 epidemic of post-vaccination hepatitis in the United States Army.

An epidemic of icteric hepatitis in 1942 affected approximately 50,000 U.S. Army personnel.

Immunoprophylaxis of viral hepatitis: a practical guide.

There are presently available immune globulin preparations of proven efficacy and safety in the prophylaxis of type A and B viral hepatitis. Active vaccines for prevention of type B hepatitis are now available and are safe and effective. None of these preparations has been associated with the development of HTLV-III/LAV/HIV infection.

Resection of metachronous hepatocellular carcinomas.

We have described the rare case of a woman with no recognized predisposing factors for hepatocellular carcinoma in whom a second hepatic neoplasm was successfully resected nine years after a presumed "curative" partial hepatectomy. The importance of long-term measurements of available tumor markers as well as aggressive surgical management is emphasized.

Misdiagnosis of echinococcal cyst disease of the liver.

Echinococcosis is a disease which is commonly seen in certain parts of the world and uncommonly seen in the United States. Recognition of this disease is important for appropriate surgical management with the least amount of morbidity and mortality. Proper history taking and awareness of this disease will decrease the chance of misdiagnosis.

Veterans Administration cooperative study on hepatitis and dentistry.

Personnel in the VA dental facilities were screened for the detection of viral hepatitis and identification of factors implicating infectivity. A total of 963 personnel from 126 dental facilities throughout the United States voluntarily participated in the study. The rate of seroconversion for any hepatitis B markers was approximately 1% per year.