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. Alanine aminotransferase (ALT) levels were also obtained from each subject. There were no significant differences in the mean fasting and 3-hr postprandial CG or CCA levels between the CPH group and the control subjects. The mean fasting and 3-hr CG and CCA levels were significantly higher for the CAH group than the CPH group (P<0.05 for each comparison). A combination of the 3-hr postprandial CG and CCA levels with the ALT levels resulted in a better separation of the two groups. All patients with CAH had either a 3-hr CCA level of 200 μg/dl, a 3-hr CG level of 170 μg/dl, or an ALT level of 120 IU/liter. Using these values, only three patients with CPH were misclassified as having CAH, and no control subject reached any of these levels. Although the differences obtained were statistically significant, the separation based on a combination of CG, CCA, or ALT levels may have been fortuitous. Nevertheless, these data suggest that postprandial serum bile acid levels may have clinical utility in identifying patients with asymptomatic chronic hepatitis who are likely to have CAH.

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. None of the remaining 40 patients met the biochemical criteria for disease activity. The disease was predominantly seen in asymptomatic middle-aged males and was of viral etiology. A small subgroup of elderly female patients was also identified whose disease was apparently nonviral. In conclusion, the vast majority of chronic active hepatitis seen at a large university center occurs in individuals for whom treatment guidelines have not been established.

An unusual presentation of hepatic adenoma as an acute febrile illness with hepatomegaly, diarrhea, and metabolic acidosis has been discussed. Celiac angiography revealed a mass in the right heaptic lobe. Following a course of broad-spectrum antibiotics and amebacidal therapy, a right-hepatic lobectomy was performed. Pathological examination revealed a benign hepatic adenoma. Postoperatively, the patient had a complete recovery, with complete resolution of her symptoms. An etiology for the toxic state could not be determined. However, it was speculated that it might have represented a hypermetabolic or hypercatabolic state secondary to the tumor itself. Alternatively, the tumor may have secreted a substance giving rise to these symptoms.

To determine if a recently licensed radioimmunoassay (Ausria-125) would further reduce the incidence of type B hepatitis, 139 presumably susceptible recipients were prospectively studied after they had received blood negative for hepatitis B antigen by counterelectrophoresis. Fifteen cases of icteric or anicteric hepatitis occurred, but only four could be attributed to hepatitis B. No hepatitis B occurred in nine subjects who received radioimmunoassay-positive blood alone, and only one in 10 who had received radioimmunoassay-positive and hepatitis-B-antigen-positive blood. Type B hepatitis developed in three of 120 patients who received radioimmunoassay-negative blood, If serologic responses only are compared, exposure to hepatitis B or hepatitis B antigen occurred in six of 19 recipients (31.6 per cent) of radioimmunoassay-positive blood. Only eight of 120 (6.7 per cent) responded among the recipients of radioimmunoassay-negative blood. These findings do not support proposals for universal compu...