[Transaminases and histological activity in chronic hepatitis C]

The purpose of our study was to verify the correlation between biochemical and histological inflammatory activity in chronic hepatitis C. The histological activity index (HAI) of 42 patients with chronic hepatitis C was correlated with their transaminase activity. There was indeed a significant correlation between histological activity and the AST (r = 0.54, p = 0.0002) and ALT level (r = 0.36, p = 0.018) respectively. Due to considerable scatter of the results, transaminase activity did not allow reliable assessment of inflammatory activity in individual cases. In the majority, markedly elevated transaminase activity was associated with marked histological inflammatory activity, whereas normal or slightly elevated transaminase activity was found in all stages of inflammatory activity. To assess inflammatory activity in chronic hepatitis C, a liberal indication for liver biopsy should therefore be adopted.

[Significance of hepatitis C virus antibodies in asymptomatic blood donors]

The aim of the study was to determine the frequency and course of hepatitis C viremia in clinically healthy, anti-HCV positive test subjects, and to ascertain whether the HCV antibodies of the IgM type differed between viremia and immunity. In 21 anti-HCV positive blood donors (test subjects) with normal transaminase activity, two serum samples, taken at an interval of 25 +/- 10 months, have been investigated for HCV-RNA and HCV-IgM antibodies. In a total of 16 test subjects (76%) HCV-RNA was found during the first test and/or the follow-up: 14 of them were positive on both occasions, and one test subject each was HCV-RNA positive exclusively at the first test and the follow-up respectively. At the time of the follow-up the serum transaminase level was elevated in 4 test subjects. 3 of these 4 were HCV-RNA positive also. On the other hand, the results of the HCV-PCR were nonuniform in HCV-IgM antibody negative test subjects. The above results demonstrate that in the majority of clinically healthy, anti-HCV positive test subjects with normal transaminase activity, a viremia exists which persists and the course of which may include inflammatory phases. The proof of HCV-IgM antibodies correlates with a viremia. On the other hand, the lack of HCV-IgM antibodies does not exclude viremia.

Survival rates of hemisected teeth: an attempt to compare them with survival rates of alloplastic implants

Use of hemisection in an attempt to preserve multirooted teeth that have furcation involvement has increased in recent years. However, there are few long-term studies of the success of this treatment. Furthermore, it is difficult to compare results of different studies because of differences in the length of follow-up and the criteria for failure. Results of various studies were reduced to a common denominator to allow comparison. The compiled results of studies on hemisection revealed an average reported failure rate of 13.1%. This rate was compared with results of studies on implants; the failure rates of the two treatment alternatives are not substantially different. Thus, because hemisection is a relatively simple, inexpensive treatment with a good chance of success (given appropriate case selection), it should always be considered as an option before molar extraction.

Chronic viral hepatitis B and C: an argument against the conventional classification of chronic hepatitis

The classification of chronic hepatitis distinguishing benign chronic persistent hepatitis from severe chronic active hepatitis was constructed without knowledge of well-defined aetiological factors. Better understanding of the different hepatitis-viruses has shed new light on this subject. Chronic viral hepatitis B and C each show typical histological patterns. The validity of the conventional classification has been evaluated by a comparative study of chronic viral hepatitis B and C. 130 biopsies from 110 patients with chronic hepatitis C (CH-C) proven serologically by antibodies (second generation testing) were compared with 105 biopsies from 73 patients with chronic hepatitis B (CH-B). These were scored semi-quantatively. In CH-C, lymphoid follicles and/or aggregates were found in 88.5%, fatty degeneration in 51%, bile duct lesions in 46.2%, and Mallory body-like material in the hepatocytes in 9.2%. The portal lymphocytic infiltration generally predominated over the necro-inflammatory lesions of the parenchyma. Chronic persistent hepatitis (defined by the presence of portal hepatitis) was present exclusively in CH-C. Chronic lobular hepatitis was found exclusively in CH-B. We conclude that the histological criteria described for CH-C are highly suggestive of the diagnosis, that the artificial subdivision of chronic hepatitis into CPH and CAH is obsolete and that the histological assessment of chronic hepatitis should consist of a grading of inflammatory activity (minimal, mild, moderate, severe) and staging of fibrosis (extent of distortion of architecture). The final diagnosis should be based on the demonstration of the aetiological agent.

Extraoral root lengthening with titanium screws

The aim of the present study was to experimentally evaluate marginal and periapical healing in extracted and subsequently replanted teeth following extraoral cementing of apically exposed titanium root screws in the root canal. In 5 out of 6 replanted teeth, the periodontal tissues had healed with a normal periodontal membrane or healed surface resorptions indicating that only minor trauma had been inflicted during the extraoral procedure. In 3 out of 6 teeth, total or partial osseointegration of the titanium screws was seen, while a connective tissue capsule had formed around the remaining 3 screws. It was concluded that both of the healing results described in the present study, osseointegration and connective capsule formation, may be regarded as acceptable as long as inflammation is prevented, although it remains to be shown which one represents the end-point.

[The value of ERCP in the diagnosis and therapy of complications of laparoscopic cholecystectomy]

Biliary complications are more frequent in laparoscopic than in open cholecystectomy. The aim of the study was to evaluate the diagnostic and therapeutic value of endoscopic retrograde cholangiopancreatography (ERCP) in the management of complications of laparoscopic cholecystectomy. We therefore report on the result of 49 ERCP after laparoscopic cholecystectomy done at our department between January 1991 and March 1993. Patients were referred from 16 different surgical institutions. In 29 cases endoscopic sphincterotomy was performed without complications. Indications for ERCP were "persistent biliary pain" (n = 27), bile leakage (n = 7), pancreatitis (n = 5), abscess (n = 5), painless jaundice (n = 3) and asymptomatic bile duct stone in routine cholangiography (n = 2). In the group of patients with "persistent biliary pain" we found bile duct stones in 12 (80%) of 15 cases with cholestasis and in 3 (30%) of 10 without cholestasis. The stones were endoscopically removed after sphincterotomy. In 2 patients without cholestasis, cannulation of the bile duct failed. 7 patients showed biliary leakage, 4 from inadequate clipping of the cystic stump (2 in combination with a common bile duct stone), 2 from the hepatic duct and 1 from insufficient anastomosis after reconstruction of a common bile duct. After endoscopic sphincterotomy and, if necessary, stone extraction by Dormia basket, leakage from the cystic stump and hepatic duct healed. The insufficient common bile duct anastomosis required reconstruction by hepaticojejunostomy. Three of 5 patients with postoperative pancreatitis had common bile duct stones, while one with chronic pancreatitis had a concrement in the pancreatic duct which was endoscopically removed.(ABSTRACT TRUNCATED AT 250 WORDS)

Endogenous inhibitors of 11 beta-OHSD: existence and possible significance

Inhibition of 11 beta-hydroxysteroid dehydrogenase (11 beta-OHSD) by licorice-derived compounds and in cases of idiopathic impairment of this enzyme is known to result in hypermineralocorticoid syndromes, reflecting corticosteroid receptor activation by excess intracellular glucocorticoids. In this paper we address the question of whether or not endogenous inhibitors of 11 beta-OHSD exist that might cause pathological glucocorticoid metabolism. Using microsomal preparations we have demonstrated that bile acids are potent inhibitors of rat renal and human hepatic 11 beta-OHSD, with lithocholic acid exerting the strongest effect. The human renal enzyme is affected to a lesser extent. Serum of patients with cholestatic liver cirrhosis also inhibited 11 beta-OHSD activity, in parallel with total bile acid concentration. Cholesterol and its precursor lanosterol inhibited the enzymatic activity in microsomes from rat and human kidney cortex and human liver. We conclude that bile acids could contribute to the abnormalities of cortisol metabolism observed in cholestatic liver cirrhosis.

Gestational age dependence of 11 beta-hydroxysteroid dehydrogenase and its relationship to the enzymes of phosphatidylcholine synthesis in lung and liver of fetal rat

Increase in fetal surfactant synthesis and lung maturity is caused by the glucocorticoidal induction of enzymes required for phosphatidylcholine (PC) synthesis towards the end of gestation. The regulation of gestational age-dependent induction of PC synthesis by glucocorticoids is still unclear. Since 11-beta-hydroxysteroid dehydrogenase (11 beta-HSD) activity and its metabolising capacity for glucocorticoids have been suggested to play a central role in this regulation, we measured the gestational age-dependent changes in 11 beta-HSD and PC synthesizing enzymes in lung and liver of fetal rat. The activity of cholinephosphate cytidyltransferase (CCT; key enzyme in PC synthesis), choline phosphotransferase (CPT) and lysolecithin acyltransferase (LAT) were found to increase gradually in the lung towards the end of gestation, reached peak values at term followed by a decrease of activity reaching finally adult levels. Only CK activity exhibited constant levels until term followed by a slight increase after the birth. In comparison with the lung, the liver enzymes followed a similar pattern, but at a higher rate of activity except for CCT which was higher in the lung. The activity of 11 beta-HSD in fetal lung microsomes was detectable from day 20 and increased towards the end of gestation in the lung and liver of the rat. Oxidase activity was always found to exceed the reductase activity. The activity of 11 beta-HSD continued to increase after delivery and reached peak levels in adult animals in both organs. In order to test the hypothesis, whether 11 beta-HSD activity and PC synthesis are induced by increasing endogenous glucocorticoidal levels, we examined on day 19 of gestation the effect of dexamethasone (DEXA) on enzymatic activities (11 beta-HSD, CCT) and on [14C]choline incorporation in phosphatidylcholine in fetal lung organoid cultures. Additionally, changes in CCT activity in fetal lungs after maternal administration of DEXA were measured. DEXA accelerated 11 beta-HSD and CCT activities as well as [14C]choline incorporation. We conclude, that endogenous glucocorticoids induce PC synthesis as well as 11 beta-HSD activity in lung and liver of the fetal rat. Fetal PC synthesis is not altered by increasing 11 beta-HSD levels, because the increase of free serum corticosterone levels apparently exceeds the metabolising capacity of 11 beta-HSD towards term.

Low-dose interferon in chronic hepatitis non-A/non-B: effects on quantitative liver function and structure in a randomized, controlled multicenter trial

In this randomized, controlled multicenter trial we evaluated the effects of recombinant interferon-alpha 2b on galactose elimination capacity and histological activity index in 88 patients with chronic active hepatitis non-A/non-B. Forty-five patients were randomly assigned to treatment with interferon at 1.5 x 10(6) U three times per for 1 year; 43 patients were assigned to no treatment. A complete response (normalization of alanine aminotransferase) was observed, respectively, in 47% and 5% of the two groups (P < 0.006); 47% of these patients suffered a relapse. Thus 22% of patients had a sustained response. Histological activity decreased significantly in responders (P < 0.04) while the biopsy score did not change significantly in nonresponders. In contrast, galactose elimination capacity--a surrogate marker for survival in chronic active hepatitis--was not affected by response to treatment. None of the parameters evaluated, including hepatitis C virus RNA, was able to predict response or relapse. We conclude that low-dose interferon treatment for 1 year is as effective as the recommended treatment schedule.

[Fulminant hepatitis caused by disulfiram]

After undergoing withdrawal treatment for alcoholism as an in-patient for one year a 49-year-old woman was started on disulfiram, 250 mg daily, her liver function tests being normal. Except for vitamin B1 she received no further medication. Jaundice developed 13 days after onset of treatment and acute liver failure was diagnosed on the 18th day after a total disulfiram dose of 4.5 g (Quick value < 10%; bilirubin 460 mumol/l; GPT 5099 U/l; GOT 4142 U/l), as well as early renal failure (creatinine 300 mumol/l). An acute viral infection, autoimmune hepatitis and a metabolic liver disease were excluded by biochemical, serological and molecular biology tests. All toxicological tests were negative. The patient died 25 days after the onset of disulfiram treatment in hepatic coma due to a fulminant hepatitis with hepatorenal syndrome. Both a liver biopsy and the autopsy showed the signs of an acute hepatic dystrophy without cirrhosis. The temporal relationship between the disulfiram intake and onset of the illness, the exclusion of other causes of the fulminant hepatitis and the liver histology, which was compatible with a chemical-toxic hepatitis, indicate that this was a case of disulfiram-induced hepatitis. The hepatotoxicity of disulfiram is a very rare idiosyncratic reaction which is often fatal. Disulfiram administration must be discontinued at once if there is a rise in liver enzyme activity or jaundice occurs.

[Whipple's disease with reactive (AA) amyloidosis]

A 59-year-old man had been known for two years to have a clearly elevated blood sedimentation reaction and intermittent arthralgia in the hand. His general condition had progressively deteriorated over the last six months, with weight loss, recurrent vomiting and constipation. At first malignant lymphoma had been suspected because numerous lymph nodes were enlarged. But a lymph-node biopsy revealed massive macrophages with PAS-positive inclusion material, diagnosed as Whipple's disease. The patient died suddenly of a heart attack on the day of diagnosis. At necropsy generalized amyloidosis with marked cardiac involvement was found. Immunohistochemically the amyloid deposits gave a strongly positive reaction to anti-AA, while other amyloid syndromes were excluded using appropriate anti-sera. This was therefore a case of reactive (AA) amyloidosis in the presence of Whipple's disease.

[Mesenteric panniculitis]

A 70-year-old patient with a 6 x 6 x 12 cm mass involving the mesentery root is discussed. The pseudotumorous infiltration was detected by ultrasound done because of nonspecific abdominal symptoms and weight loss. Laparoscopic biopsy confirmed the diagnosis of mesenteric panniculitis. The primary histologic criterion is infiltration of the mesenterium by foamy lipid-laden macrophages, clusters of lymphocytes and fibrosis. The majority of cases follow a benign course and need no therapy, but co-existence of lymphoma has been reported. There have been few cases where panniculitis with progressive fibrosis changed into retractile mesenteritis with shortening of the mesenterium and compression of mesenteric vessels with partial or complete intestinal obstruction or ischemia requiring surgery. Few reported cases of severe and progressive disease have been treated with prednisone and azathioprine or cyclophosphamide.

[Polymerase chain reaction in hepatitis C: increased sensitivity via amplification of shorter cDNA fragments]

The aim of our study was to compare the sensitivity of hepatitis C virus polymerase chain reaction (HCV-PCR) by use of two different primer sets which amplify PCR products of different length. Serum samples of 70 patients with chronic hepatitis C were tested by "nested primer" PCR, using either "NCR primers" that amplify cDNA-fragments of 340 basepairs (bp), or by "PT primers" which amplify fragments of 59 bp only. HCV-RNA was detected in 40 patients (57%) by "NCR primers" and in 69 patients (90%) by "PT primers" (p < 0.001). 23 of 70 patients (33%), which were HCV-RNA negative by "NCR primers", were positive by "PT primers", but no patient negative by "PT primers" was found to be positive by "NCR primers". 20 healthy controls tested by both primer sets were all HCV-RNA negative. We conclude that the sensitivity of HCV-PCR is significantly improved by use of primers that amplify "short" PCR products and recommend the use of "PT primers" for HCV-PCR.

Upper gastrointestinal hemorrhage preceding development of Bouveret's syndrome

Gastric outlet obstruction by a gallstone is a very uncommon clinical entity; it was first reported by Bouveret in 1896. In the patient presented, we were able to show the development of formation of the bilioenteric fistula with massive arterial bleeding from the eroded cystic artery until duodenal occlusion. The process was endoscopically and radiologically observed and documented. Although the diagnosis was made immediately, the patient had to undergo surgery because the gallstone proved to be too large to be extracted endoscopically.

[HIV-associated Penicillium marneffei infection]

We report on an HIV positive patient with a disseminated Penicillium marneffei infection. A 35-year-old Swiss homosexual male with HIV-associated immunodeficiency with a CD4 cell count of 90/mm3 presented with a two-month history of malaise, intermittent fever, loss of weight, unproductive cough and widespread molluscum contagiosum-like skin lesions, mainly on the face. The patient had travelled extensively and had last visited Thailand 19 months before admission. The chest X-ray showed bilateral diffuse reticulonodular markings. The diagnosis was suspected in bronchoalveolar lavage, which showed round-to-oval intracellular yeast cells but also elongated sausage-shaped extracellular forms. The diagnosis was confirmed on culture. Penicillium marneffei was further isolated from the following specimens: blood cultures, bone marrow, stool, skin and tracheal mucosa biopsy. Intravenous amphotericin B therapy led to a complete subsidence of all symptoms and the skin lesions healed without leaving a scar. The infection, with its clinical presentation, epidemiology, diagnostic problems and therapy is reviewed. We stress that since Penicillium marneffei is an increasingly important pathogen in HIV positive patients in Southeast Asia, this fungus can also be imported to Europe by travellers. If immunocompromised patients have molluscum contagiosum-like skin lesions, pneumonitis and a history of travelling in Southeast Asia, disseminated Penicillium marneffei infection should be considered in differential diagnosis.

11-beta-Hydroxysteroid dehydrogenase of rat lung: enzyme kinetic, oxidase-reductase ratio, electrolyte and trace element dependence

The modulation of the intracellular glucocorticoidal effect on surfactant synthesis of the fetal lung by the metabolic capacity of 11 beta-hydroxysteroid dehydrogenase (11 beta-HSD) could be an important factor in lung maturation. The kinetic properties of microsomal 11 beta-HSD of the rat lung are characterized with respect to product inhibition, substrate specificity, effect of electrolytes or trace elements, and the dependence of the oxidase reductase (OR) ratio on incubation conditions. With NADP+ product inhibition of the reductase was demonstrated. The most common trace elements and electrolytes exhibited no effect on the activity of 11 beta-HSD. It is shown that the OR ratio was strongly dependent on assay conditions. With optimal assay conditions oxidase activity exceeds reductase activity in adult and fetal rat lung microsomes (OR ratio > 1). Thus, glucocorticoids are mainly metabolized to their inactive forms. The enzyme activity in the adult is about 10 times higher than in the fetal lung. The low enzyme activity in fetal lungs could be the reason why the glucocorticoidal effects on surfactant synthesis are not suppressed despite the predominance of oxidase activity.

Metabolism of dexamethasone: sites and activity in mammalian tissues

We have used in vitro techniques to study the metabolism of dexamethasone. Tissue slices, homogenates and microsomal fractions of various mammalian organs from rats and humans have been used. We focused particularly on the question of whether or not dexamethasone (Dexa) is oxidized at the C11-OH group by 11 beta-hydroxysteroid-dehydrogenase. High activities of this enzyme system for Dexa were localized in renal cortex and rectum. Material from both human and murine liver was ineffective. The main metabolite formed from Dexa in renal and intestinal systems was identified by different mass-spectrometric techniques including on line HPLC mass spectrometry as 11-dehydro-dexamethasone. This finding was corroborated by the observation that both corticosterone and glycyrrhetinic acid block the metabolic transformation of Dexa.

[Primary amyloidosis of the liver]

For 2 years a 72-year-old man had suffered from nonspecific upper abdominal discomfort and hepatomegaly. The gamma-glutamate transaminase concentration was increased to 121 U/l, the erythrocyte sedimentation rate was 80 mm in the first hour. Histological examination of tissue from the enlarged liver (22 cm in the midclavicular line) revealed the diagnosis of amyloidosis. The gastric mucosa, duodenum and rectum were not involved. Two years later ascites developed; six months after this he was again hospitalized in hepatic coma. Now, for the first time, a type IgA-lambda paraprotein was demonstrated by serum immunoelectrophoresis. The patient died of slowly progressing anicteric liver failure after having been ill for a total of 4 1/2 years. At autopsy there were extensive amyloid deposits throughout the liver and spleen so that the structure of these organs was hardly recognizable. The amyloid deposits in the liver were restricted to the glomerular region, while there was no amyloid in the heart. Histochemical tests showed that the deposits were strongly positive to the anti-lambda antibody. This was thus a case of primary (AL-lambda) amyloidosis of the liver and spleen which had taken an unusually prolonged course, because the heart was not involved at all and the kidneys only slightly.

[Heterosexual transmission of hepatitis-C virus]

Parenteral transmission of hepatitis C virus (HCV) through blood transfusions and intravenous drug misuse is well established. Since 50% of patients with hepatitis C have no history of parenteral exposure, other ways of transmission must exist. The purpose of this study was to examine the epidemiological importance of heterosexual intercourse for transmission of HCV infection. 29 heterosexual contacts (13 men, 16 women, mean age 47 years) of 29 index patients (16 men, 13 women, mean age 49 years) with histologically und serologically documented chronic hepatitis C were questioned about parenteral exposure and sexual behaviour. Their serum samples were examined for ALT activity and anti-HCV antibodies (first-generation Ortho-HCV-ELISA). Five contacts were using condoms to prevent infection. Five of 24 contacts (21%) practising unprotected sexual intercourse, but none of 5 contacts using condoms, showed evidence of heterosexual HCV transmission: 4 were anti-HCV positive (one with elevated ALT activity) and another showed elevated ALT activity with a negative anti-HCV test. None of these contacts had a history of parenteral exposure. Our results indicate that heterosexual transmission of HCV is epidemiologically important. The true rate of infection may be even higher, for two reasons: (1) not every HCV infection is detected by the anti-HCV test, and (2) the anti-HCV test may turn negative again in uncomplicated infection.

[Second generation hepatitis-C virus test and polymerase chain reaction in anti-C 100 negative patients with chronic non-A, non-B hepatitis]

The aim of our study was to evaluate whether a negative HCV test of the first generation (HCV-ELISA 1) using the antigen C100-3 excludes chronic HCV infection, or whether patients exist who are negative for antibodies to C100-3 in spite of chronic hepatitis C. 27 patients with histologically proven chronic non-A, non-B hepatitis, all of whom were HCV-ELISA 1 negative, were tested by the HCV test systems of the second generation (Ortho-HCV-ELISA 2 and Chiron-HCV-RIBA 2) based on the distinct HCV antigens 5-1-1, C100-3, C33c and C22-3. To determine the presence of viremia, serum samples were also tested for HCV-RNA with "nested" PCR. 10 of 27 patients proved to be persistently negative when tested with the second generation assays. One patient showed low grade reactivity by HCV-ELISA 2, but non-reactivity by HCV-RIBA 2. In none of these 11 patients was HCV-RNA detected. 16 (60%) of 27 patients negative with HCV-ELISA 1 were positive with HCV-ELISA 2. HCV-RIBA 2 detected antibodies to the structural core antigen C22-3 in all of these 16 patients and antibodies to the non-structural antigen C33c in 14 of them, while antibodies to 5-1-1 or C100-3 were not found in any of these cases. 10 (63%) of the 16 HCV-ELISA 1 negative, but HCV-ELISA 2 and HCV-RIBA 2 positive patients were positive for HCV-RNA by "nested" PCR.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hepatitis-C virus and hepatoma]

To clarify the relationship between hepatitis C virus (HCV) infection and hepatocellular carcinoma (HCC), frozen serum samples from 213 patients with histologically proven liver cirrhosis alone (96 alcoholics, 59 HBsAg positive, 29 non-A, non-B hepatitis, 29 cryptogenic) and 40 patients with liver cirrhosis and HCC (12 alcoholics, 7 HBsAg positive, 7 non-A, non-B hepatitis, 14 cryptogenic) were analyzed for antibodies to hepatitis C virus (anti-HCV) with the ortho-HCV-ELISA. The results were as follows. 50 of 253 (20%) patients were anti-HCV positive. The prevalence of anti-HCV was significantly higher in patients with HCC than in patients without HCC (14 of 40 [35%] vs 36 of 213 [17%]; p less than 0.001). In anti-HCV-positive patients HCC were significantly more frequent than in anti-HCV-negative patients (14 of 50 [28%] vs 26 of 203 [13%]; p less than 0.001). The significantly higher occurrence of HCC in anti-HCV-positive patients was not related to other known risk factors such as alcoholism or chronic hepatitis B virus (HBV) infection. Patients with HCV infection as the only risk factor also had a significantly higher occurrence of HCC (12 of 38 [32%] vs 26 of 203 [13%]; p less than 0.001). Our data suggest that chronic HCV infection plays an important role in the pathogenesis of HCC, in particular in patients with cirrhosis unrelated to alcohol or HBV infection.

[Anti-HCV test in patients with chronic non-A, non-B hepatitis]

Our study was designed to evaluate the clinical significance of the ELISA-anti-HCV test. 90 patients with histologically proven chronic non-A, non-B hepatitis (NANBH) and a control group consisting of 36 patients with primary biliary cirrhosis (PBC) were analyzed for antibodies to hepatitis C virus (anti-HCV). Frozen serum samples were tested with the ortho-HCV-ELISA. 67 of 90 (74%) patients with chronic NANBH showed antibodies to the hepatitis C virus. The prevalence of anti-HCV in patients with parenterally transmitted and sporadic chronic NANBH was 70% (23 of 33) and 77% (44 of 57) and in patients with chronic active and chronic persistent NANBH 73% (27 of 37) and 76% (40 of 53) respectively. No significant difference in the prevalence of anti-HCV in the 4 subgroups of patients with chronic NANBH was found. 2 of 36 patients (6%) with PBC were anti-HCV positive without evidence of previous HCV infection. Our results bear out the experience of other authors, that HCV is the commonest pathogen of chronic NANBH. The low prevalence of anti-HCV in patients with PBC suggests good specificity. There have been reports in the literature of "false positive results", particularly in autoimmune hepatitis, and it has been shown that borderline positive test results are often unspecific and therefore to be interpreted with care.

[The endoscopic treatment of malignant biliary tract stenoses with endoprostheses]

In 65 patients (36 men, 29 women; mean age 74 [43-90] years) obstructive jaundice caused by malignant biliary stenosis was treated by endoscopic retrograde insertion of a 10 or 12 F synthetic endoprosthesis. The rate of complications of the endoscopic intervention was 5% (n = 3), 30-day mortality rate was 11% (n = 7) and method-related mortality was 8% (n = 5). Good drainage was achieved in 39 of 41 patients (95%) with the 12 F endoprosthesis, and in 15 of 21 patients with a 10 F one (71%) (P less than 0.001). Renewed jaundice due to prosthesis occlusion occurred in 31 patients an average of 103 (11-350) days after placement. Interval until occlusion correlated with the site of the stenosis and the length of the endoprosthesis. Jaundice recurred earlier in patients with long prostheses and proximal biliary stenosis than in those with a short prosthesis and distal stenosis. In 20 patients with renewed jaundice the endoprosthesis was replaced endoscopically. At that time 13 of the patients had a cholangitis. Occlusion of the new endoprosthesis was more common in patients with cholangitis (9 of 13) than those without (2 of 7; P less than 0.05). These findings indicate that endoscopic biliary tract drainage should be performed with as short a 12 F endoprosthesis as possible. In view of the potential need for early change of endoprosthesis the biochemical parameters of cholestasis should be regularly monitored.

Polymerase chain reaction detects hepatitis B virus DNA in paraffin-embedded liver tissue from patients sero- and histo-negative for active hepatitis B

The polymerase chain reaction (PCR) was used to analyse tissues from paraffin blocks of liver needle biopsies retrospectively. Biopsies of 29 patients with proven HBsAg and HBcAg expression in liver tissue and of 8 healthy volunteers served as positive (group 1) and negative tissue controls (group 2), respectively. These were compared with 16 patients with proven HBsAg expression in liver but lack of HBcAg (group 3), with 23 patients with anti-HBc as the only hepatitis B virus (HBV)-related marker (group 4) and with 21 patients with liver disease and without HBV markers in tissue or serum (group 5). PCR detected HBV sequences in all cases of the positive control group and in 94% of group 3, in 65% of group 4, and in 71.4% of group 5, whereas all healthy volunteers were negative. Our data show that PCR is able to detect HBV-DNA sequences in virtually all patients with active viral antigen expression but also in a high proportion of hepatitic patients who are silent for active HB but may or may not show signs of a contact with the HBV. Thus, PCR for HBV-DNA in paraffin sections might become a useful tool for identifying patients carrying HBV-DNA but not expressing HBV antigens.