61 coded sera from patients with primary biliary cirrhosis (24) and various other hepatic and nonhepatic diseases (37) were tested for hepatitis B antigen (H.B. Ag.) by electron microscopy and radioimmunoassay. Investigators were not aware of the diagnosis of any patient. Particles, morphologically indistinguishable from H.B. Ag., were observed in 40 sera, including 23 which were negative for H.B. Ag. by radioimmunoassay. Assuming that radioimmunoassay is both a sensitive and reliable method for detecting H.B. Ag., there were 23 false positives and 17 true positives by electron microscopy. Of 24 patients with primary biliary cirrhosis, 5 were positive for H.B. Ag. by both radioimmunoassay and electron microscopy. There were 8 false positives by electron microscopy. It was concluded that there are particles in sedimented serum that are morphologically similar but unrelated to H.B. Ag. Therefore electron microscopy alone is not a reliable way to detect H.B. Ag. in serum. There was no evidence to suggest that H.B. Ag. is a cause of primary biliary cirrhosis.

Dr. Rodolfo N. Perez, Jr., Senior Assistant Resident in Medicine, the Jewish Hospital of St. Louis, and Assistant in Medicine, Washington University School of Medicine: A 50-year-old black woman was admitted to Jewish Hospital for the first time in October 1968 with a history of jaundice and anorexia. The patient was not aware of exposure to infectious hepatitis, and denied intravenous injections or transfusions, recent surgery, exposure to hepatotoxic agents, or ingestion of any medication. On physical examination, she had scleral icterus and a soft abdomen without palpable organomegaly; Murphy's sign was not elicited. The remainder of her physical examination was within normal limits. The hematocrit reading was 39% and the white blood cell count (WBC), 4,500/cu mm with a normal differential cell count; the urine was positive for bile but was otherwise unremarkable. The total circulating alkaline phosphatase level was 307 international units (IU; normal, < 100 IU); lactic