Prevention of hepatitis B virus transmission by the gastrointestinal fibrescope. Successful disinfection with an aldehyde liquid

In a prospective study we examined the efficacy of a standardized disinfection method in preventing the transmission of hepatitis B virus by the gastrointestinal fibrescope. Four HBSAg- and Dane particle-positive patients who have been endoscoped served as possible sources of hepatitis B virus infection. We cleaned the instrument with a 10% aldehyde liquid and used it immediately thereafter in 10 HBSAg-negative patients. Eight of them were followed-up for 7 months after the endoscopic procedure. None of them showed serological evidence of an endoscopically transmitted hepatitis B virus infection. It is concluded that disinfection with an aldehyde liquid is effective in preventing the transmission of hepatitis B virus by the fibrescope.

Evolution of muntjac DNA

The extent of nuclear single-copy DNA divergence between Muntiacus reevesi and Muntiacus muntjak vaginalis (Cervidae), a species pair showing extreme karyotype differences but striking morphological similarity, is 2%, as judged from the thermal stability of interspecific DNA-DNA hybrids. A comparison of the total nuclear DNA reassociation kinetics of the two species indicates a reduction of lowly repetitive sequences in M. m. vaginalis.

[Contraceptives and the liver]

Among the typical complications of oral contraceptive use are intrahepatic cholestasis, occurring in women with a special and probably genetical predisposition only, and a thrombotic diathesis secondary to increased hepatocellular synthesis of coagulation factors, both effects induced by the estrogens. This state of hypercoagulability may lead to thrombosis of the hepatic veins and may thus cause the Budd-Chiari syndrome. A tendency to gallstone formation is explained by a derangement in the synthesis of bile acids and by changes in the permeability of liver cell membranes and of epithelial cells of the gallbladder, an effect again due to the estrogen component of the contraceptives. After long-term use, an increased incidence of benign liver cell adenomas is observed; malignant liver tumors do occur very rarely. A causal relationship with focal nodular hyperplasia, however, is unlikely. Only the typical vascular changes of this entity are probably due to the effects of the contraceptives.

Acute viral hepatitis B with bridging necrosis: a follow-up study

Forty patients with bridging necrosis (BN) on biopsies taken during the course of acute viral hepatitis B were included in a prospective study to assess the prognostic significance of this lesion. Of the 22 patients with complete clinical, biochemical and histological follow-up (histological follow-up 5-33 months), only two failed to eliminate HBs- and HBe-antigen in serum, a finding paralleled by transition to chronic active hepatitis and by the persistence of focal HBc- and HBs-antigen expression in liver tissue. Nineteen of 22 patients showed complete histological healing; one developed inactive cirrhosis. It is concluded that, in the setting of acute viral hepatitis B, the histological lesion of BN is of no particular prognostic significance, and that transition to chronic liver disease is much less frequent than has been assumed from previous studies of etiologically heterogeneous patient populations. Markers of poor prognosis are the failure of serological elimination of HBs- and HBe-antigen and the persistence of spotty expression of HBc- and HBs-antigen on immunofluorescence histology.

An improved method for Y-body identification and confirmation of a high incidence of YY sperm nuclei

The fluorescence of Y-bodies and brightly fluorescing autosomal heterochromatin in quinacrine mustard stained interphase nuclei treated with distamycin A is more brilliant than in nuclei stained only with quinacrine and mustard. In the present study examinations with the aid of this method in several probands and different tissues are described. The effect of distamycin A is demonstrated to depend on its dose and the time of exposure to it. An exceptionally high frequency of YY sperm nuclei, previously also described by other studies, is confirmed in the present work. A hypothesis explaining the effect of distamycin A in interphase nuclei is discussed.

Chromosome banding in Amphibia. VI. BrdU-replication patterns in anura and demonstration of XX/XY sex chromosomes in Rana esculenta

A modified BrdU-Hoechst-Giemsa technique permitted the demonstration of easily reproducible replication patterns in the somatic chromosomes of Amphibia. These banding patterns allow for the first time a precise identification of all chromosomes and the analysis of the patterns of replication in the various stages of S-phase in Amphibia. Several possibilities for the use of this technique were demonstrated on three frog species of the family Ranidae, all differing greatly in their DNA-content. With this method, the homomorphic chromosome pair No. 4 in Rana esculenta could be identified as sex-specific chromosomes of the XX/XY-type. All male animals exhibit an extremely late replicating region in the Y-chromosome, which is lacking in the X-chromosome in the female animals, both X-chromosomes replicate synchronously. These sex-specific chromosomes cannot be distinguished by other banding techniques. In the highly heteromorphic ZZ/ZW-sex chromosome system of Pyxicephalus adspersus a synchronous replication of the two Z-chromosomes of male animals and a very late replication of the short arm of the W-chromosomes of male animals was demonstrated. These results support the assumption that there is no dosage compensation for Z-linked or X-linked genes by the sex chromosome inactivation mechanism in the sex chromosomes of Amphibia.

[Non-A, non-B viral hepatitis: occurrence, epidemiology and prognosis]

Out of 117 cases with acute viral hepatitis, 37 (32%) were classified as hepatitis A, 50 (43%) as hepatitis B and 30 (25%) as hepatitis non-A-non-B (NANB). In 21 of the 30 patients with hepatitis NANB, a possible mode of parenteral transmission could be found. The mean incubation period was 53 days. Only 3 patients had had blood transfusions. 14 (52%) of the 27 patients with sporadic hepatitis (without transfusions) had a mild course of the acute illness without, or with only mild, jaundice and transaminase values below 500 IU. The remaining 13 patients had a more severe form of acute hepatitis (bilirubin above 5 mg/dl, GPT above 500 IU), and in 11 of these 13 cases confluent necrosis was demonstrable on liver biopsy. 10 (37%) of the sporadic cases, of whom 8 had a mild form of acute hepatitis, and the 3 cases of posttransfusion hepatitis, were followed by a chronic course.

Fatal lymphoproliferation and acute monocytic leukemia-like disease following infectious mononucleosis in the elderly

Three elderly patients are reported, in whom serologically confirmed recent infectious mononucleosis is followed by fatal lymphoproliferation (case 1), by acute monocytic leukemia (case 2), and by acute probably monocytic leukemia (case 3).

delta Antigen in hepatitis B: immunohistology of frozen and paraffin-embedded liver biopsies and relation to HBV infection

The finding that the recently described hepatitis B (HB)-associated delta antigen (delta Ag) is preserved in pronase-treated, formalin-fixed paraffin sections allowed a combined prospective and retrospective immunohistological study of its occurrence in 571 liver biopsies. Among 116 frozen biopsies (69 HBAg seropositive, 47 HBAg seronegative) and 455 paraffin-embedded biopsies (296 HBAg seropositive, 159 HBAg-negative), delta Ag was found in 10 HBAg seropositive patients. With the exception of 1 patient with chronic persistent HB, all had chronic-active HB and none had acute HB; 5 patients were i.v. drug abusers. In follow-up biopsies, the delta Ag persisted with HBsAg for as long as 6 years. The expression of delta Ag showed similarities to the HBcAg system including nuclear localization, mixed nuclear cytoplasmic expression, and coexistence with anti-delta in blood. The findings are compatible with the hypothesis that delta Ag represents a transmissible, defective viral agent which requires HBV as a helper and may modulate, but not terminate, ongoing HBV infection.

Heptacarpo-octatarso-dactyly combined with multiple malformation

A case of heptacarpo-octatarso-dactyly combined with cheilo-gnatho-palato-schisis, hypertelorism, macroglossia, complex malformations of heart and great vessels, horse-shoe-kidney, micro-penis, and penis palmatus is described. To our knowledge, this syndrome has not yet been described in the literature. Some of the features of the case reported overlap with syndromes such as Grauhan syndrome and Meckel syndrome.

A frog with highly evolved sex chromosomes

Highly differentiated ZZ/ZW sex chromosomes and an exceptionally low genome size were found in the karyotypes of Pyxicephalus adspersus (Anura, Ranidae). The W-chromosome is considerably smaller than the Z-chromosome and consists to a very great proportion of constitutive heterochromatin. The DNA content of this species and the chromosome length have the lowest values determined in the Ranidae to date.

Somatic pairings of the Y heterochromatin in human XYY and XYqi cells

In human interphase nuclei containing Yq isochromosomes or two Y chromosomes, there are conspicuous somatic pairings between the brightly fluorescing Y-heterochromatin regions. These somatic pairings cannot be demonstrated in metaphases from conventional cell cultures because they are disrupted at the mitotic prophase. However, in lymphocytes cultivated in a medium containing distamycin A, the somatic pairing between Y-heterochromatin is preserved to metaphase. The present findings are compared with earlier observations of somatically paired heterochromatin. An explanation for the highly disparate frequency of somatic pairing between the Y-heterochromatin regions in Yq isochromosomes and YY chromosomes is proposed.

Diagnostic value of the fecal chymotrypsin test in pancreatic insufficiency, particularly chronic pancreatitis: correlation with the pancreozymin-secretin test, fecal fat excretion and final clinical diagnosis

The diagnostic value of the fecal chymotrypsin test (FCT) was reevaluated with regard to (a) proved pancreatic hypofunction of different severity (183 pancreozymin-secretin tests); (b) the final clinical diagnosis, and (c) fecal fat excretion (208 patients with chronic pancreatitis; CP). Progressive pancreatic disease (cancer, CP) was mainly associated with moderate or severe pancreatic hypofunction (119/138; 86.2%) and a low incidence of false-normal FCT values (14/138; 10.1%). Miscellaneous disorders (mainly reversible pancreatic hypofunction) were mainly associated with slight pancreatic hypofunction and a high incidence of false-normal FCT values (17/45; 37.8%). Pancreatic steatorrhea (greater than 10 g/day) was found only in patients with markedly depressed FCT values. Progressive deterioration of pancreatic function was demonstrated by repeated FCT in CP (n = 220).

H-Y antigen as a tool for the determination of the heterogametic sex in Amphibia

H-Y antigen was investigated in three amphibian species with different degrees of sex-chromosome differentiation: Bufo bufo, Triturus vulgaris, and Pyxicephalus adspersus. No heteromorphic sex chromosomes were found in B. bufo, but an examination of the progeny of hermaphrodites (Ponse, 1942) indicated that the female of this species was heterogametic (ZW). Sex chromosomes differing only by a very small heterochromatic region at their telomeres were found in the male of T. vulgaris (XY). Pyxicephalus adspersus revealed high differentiated ZW sex chromosomes. The results of the H-Y antigen studies on these three species indicate that H-Y antigen is expressed only in the heterogametic sex, irrespective of differences in morphological differentiation of the sex chromosomes. Therefore, H-Y antigen could be a valuable tool in determining the heterogametic sex, not only in Amphibia but possibly also in other vertebrate species that have either evolved no heteromorphic sex chromosomes or where sex-reversal experiments are not possible.

The effects of distamycin A on gorilla-, chimpanzee- and orangutan lymphocyte cultures

Lymphocyte cultures from the gorilla, chimpanzee, and orangutan were treated with the oligopeptide antibiotic distamycin A. This AT-specific DNA-ligand induces a distinct undercondensation in the quinacrine-bright heterochromatin of the gorilla and chimpanzee. This is also the case in human lymphocyte cultures. Distamycin A further causes an undercondensation in the nonheterochromatic bands 17q21 of the gorilla and 16q22 of man. No visible distamycin A-sensitive chromosome regions are determined in the orangutan. The in vitro treatment with distamycin A preserves the somatic pairings between the quinacrine-bright heterochromatic regions existing in the interphase nucleus until the succeeding metaphase stage. The phylogenetic origin of the quinacrine-bright and distamycin A-sensitive heterochromatin in the ancestor of man, the gorilla, and the chimpanzee is discussed.

[Management of liver cell adenoma and focal nodular hyperplasia]

Since 1975 six cases with hepatic adenoma (5 females, 1 male) and five cases with focal nodular hyperplasia (3 females, 2 males) have been treated at our hospital. Four of the five women with hepatic adenoma took oral contraceptive pills before the diagnosis was made, only one patient took the pills in the group with focal nodular hyperplasia. Hepatic adenomas were resected electively in three patients; one patient underwent operation because of ruptureed adenoma with intraabdominal hemorrhage. In the other two cases with hepatic adenoma resections were not possible, but both tumors have regressed after the cessation of oral contraceptives. One patient in the group with focal nodular hyperplasia underwent liver resection because of intratumoral hemorrhage with recurrent pain; in the other four cases no treatment was done as symptoms were absent. We recommend elective resection for hepatic adenoma because of the high risk of spontaneous ruptur. Embolization or ligation of the hepatic artery are alternative procedures when resection is not possible and tumors do not regress after the cessation of oral contraceptives. On the other hand a more conservative attitude is suggested for focal nodular hyperplasia because those patients do not frequently bleed; resection is indicated in case of symptoms or growth of tumor.

[Therapy of chronic hepatitis]

Treatment with glucocorticosteroids alone or in combination with azathioprine can be considered the most successful therapy in "chronic active hepatitis" of the "autoimmune" type. Immunosuppressive treatment of HBs+ chronic active hepatitis remains controversial and should be confined exclusively to severe cases. Caution is even more indicated in chronic active hepatitis of the non-A-non-B type. Antiviral therapy in chronic active hepatitis is still controverted. Relatively little experience has been gained of the enormously expensive interferon treatment.

[Iodine deficiency is still endemic in Switzerland]

To obtain information on the present state of iodine supply in Switzerland random urine samples have been collected from 770 individuals for the purpose of measuring iodine and creatinine excretion. As a first step the widely used method of measuring iodine concentration per gram creatinine in casual urine samples was validated by quantitatively collecting urines for 6 consecutive 4 h periods in 11 healthy volunteers. True ioduria could thereby be compared with that calculated from random samples. 83% of all values were found to be within +/- 30% of the true mean value. The mean iodine content of all 770 samples collected in the field study was 93.3 microgram per gram creatinine (I/Cr). This mean value is slightly below the adequate iodine supply. Of even more concern is the fact that less than 60 microgram I/g Cr was found in 20% of all samples. Therefore, in the population sample as a whole the mean ioduria is still clearly below that indicating a sufficient iodine supply, and in one out of five individuals iodine excretion was typical of marked iodine deficiency. Low ioduria correlated significantly with low natriuria in both male and female subjects. This finding indicates that iodized table salt is an important though inadequate source of alimentary iodine. The increase in iodine admixture to table salt already agreed upon appears to be an appropriate means of improving nutritional iodine availability. Iodine deficiency may still be an important cofactor in the high prevalence of goiter in Switzerland. The long established goiter prophylaxis by iodine admixture to table salt may have lost part of its efficiency due to the sharp decrease in per capita consumption of salt.

HLA genotype studies in juvenile insulin-dependent diabetes

HLA genotypes were ascertained in 53 French Caucasian families, comprising 68 juvenile onset insulin-dependent diabetic siblings. Among the 49 alleles detected at different loci in the HLA complex (A, C, B, Bf, DR) 4 appeared to occur at a significantly higher frequency among the 53 index cases than in a control series of 116 healthy individuals: HLA-B18 (p < 10(-3)), DRw3, DRw4 and BfF1 (p < 10(-6)). The excess of HLA identical affected siblings confirms genotype disequilibrium and supports the hypothesis of an HLA-linked gene(s) conferring susceptibility. There was no increase of homozygosity for HLA DRw3 and DRw4 whereas there was a marked excess heterozygosity for HLA DRw3/DRw4 in diabetic patients (32% versus 0% in the control series, p < 0.001). These data provide evidence for the existence of two cooperating genes, linked to each of the HLA DR alleles.

Regional assignment of a 2.1-kb repetitive sequence to the distal part of the human Y heterochromatin

Variants in structure and content of the human Y chromosome were investigated by cytogenetic methods and by restriction endonuclease analysis. It is shown that most or all of the 2.1-kb male-specific reiterated sequence is located in the distal part of the brightly fluorescing heterochromatin.