Hepatitis-B surface antigen and cirrhosis in Iraq

Incidence and significance of hepatitis B and A virus serologic markers in Greek cirrhotic patients

The incidence of serological markers of hepatitis B and A virus infection was studied by radioimmunoassay in 89 Greek cirrhotic patients. Controls consisted of 90 patients without liver disease. HBsAg was detected in 62 (69.5%) patients, anti-HBs in 35 (39.3%), anti-HBc in 60 (67.4%), HBeAg in 13 (14.6%), anti-HBe in 58 (65.1%), and the anti-HAV in 86 (96.6%). The corresponding figures for the control group were: HBsAg 4 (4.5%), anti-HBs 34 (37.7%), anti-HBc 41 (45.5%), HBeAg 3 (3.3%), anti-HBe 21 (23.3%), and anti-HAV 86 (95.5%). This high incidence of positive reactions in cirrhotic patients strongly suggests the possibility that HBV infection may be an important causative factor in the development of cirrhosis in Greece. No association could be established between hepatitis A virus infection and cirrhosis.

Immunological studies of ascitic fluid in patients with cirrhosis of the liver and hepatitis B surface antigen

Sixteen cirrhotic patients with ascites and HBs antigen (HBsAg), were chosen for this study. Serum and ascitic fluid samples were tested for Ag, total proteins, electrophoretic pattern and immunoglobulin IgG, IgA, IgM and IgE. Transmission of HBsAg through the peritoneal membrane was confirmed. All protein fractions and immunoglobulins were presented in the ascitic fluid. Seven patients with ascites due to intra-abdominal neoplasms were also studied as controls. Significant differences were observed and are discussed.

Hepatitis B virus (HBV) markers among patients with chronic liver disease in Kuwait

The prevalence of hepatitis B surface antigen (HBsAg), antibody to the hepatitis B core (anti-HBc) and to surface antigen (anti-HBs), was investigated, using sensitive radioimmunoassay (RIA) systems, among patients with different clinical entities of chronic liver disease in Kuwait, and compared to a control blood donor population. 81% of patients and 44% of the controls had at lease one HBV marker. 24% of patients, but non of the controls had both HBsAg and a high titre of anti-HBc in the absence of anti-HBs, suggesting a chronic infection. 31% of our patients with hepatosplenic schistosomiasis, 20% with cryptogenic cirrhosis and chronic active liver disease and 60% with hepatocellular carcinoma had these two markers. HBV antigenaemia was significantly more prevalent among male than among female patients and was particularly high among those less than 35 years old. The high prevalence of the various HBV markers among our patients suggests that HBV is a major factor in the development of chronic liver disease in our area. Furthermore, in view of a high prevalence of antigenaemia in patients with hepato-splenic schistosomiasis, HBV infection must play a concomitant role in the development of more serious form of chronic liver disease among such patients.

Clinicopathological studies of liver cirrhosis and hepatocellular carcinoma in a general hospital

Clinicopathological studies of 181 patients with liver cirrhosis undergoing autopsy in the pathology department of a municipal hospital between 1973 and 1976 are reported. The main etiological types were alcoholic (25.4 per cent), HBsAg positive (14.9 per cent), and cryptogenic cirrhosis (54.7 per cent). Four patients had multifactorial and secondary biliary cirrhosis and one patient had congestive cirrhosis. The morphological characteristics of the condition and the age and sex distribution of the patients were analyzed in each etiological group. Hepatocellular carcinoma occurred in 28.7 per cent of the cases, most frequently in association with HBsAg positive cirrhosis. Hepatocellular atypia was significantly more frequent in HBsAg positive than in other etiological types of cirrhosis and significantly more frequent in cases associated with hepatocellular carcinoma than in those not associated with it.

Hepatitis B antigen in black patients with hepatocellular carcinoma: correlation between orcein stained liver sections and serology

Formalin-fixed paraffin-embedded autopsy tissue of liver and tumor from 50 male black mineworkers with hepatocellular carcinoma were examined by orcein stain for the presence of cytoplasmic hepatitis B surface antigen. The results were correlated with the serum hepatitis B antigen (HBAg). In 72% serum HBAg was positive. Orcein staining of nontumor liver cell cytoplasm was present in 18 (36%). Sixteen (89%) of these orcein-positive cases were serum HBAg positive. The two false negative serum HBAg results were obtained by immunodiffusion, immunoelectrophoresis and complement fixation. Serum HBAg, measured by radio-immunoassay and hemagglutination, was positive in 14 orcein-negative cases. Six other negative orcein results appeared to be due to sampling error. Orcein staining was noted in tumor cells of three serum HBAg positive patients. Provided the limitations of the technique are realized, orcein staining of liver tissue from hepatocellular carcinoma patients may prove useful for retrospective screening surveys to assess the prevalence of HBAg positivity in these patients.

Aetiology of cirrhosis, hepatic fibrosis, and hepatocellular carcinoma

Histological study of 69 cases of cirrhosis, 9 of severe generalised hepatic fibrosis, and 19 of hepatocellular carcinoma showed an association with alcohol, hepatitis B surface antigen (HBsAg) or a1-antitrypsin bodies in, respectively, 41 (cirrhosis), 5 (fibrosis), and 9 (carcinoma). Eight of the cirrhotic cases and two of the carcinoma cases had double associations, HBsAg being present in all. Torcein and aldehyde fuchsin staining gave both false positive and false negative results when compared with immunofluorescence and immunoperoxidase methods for HBsAg. Large amounts of copper were found in four cirrhotic livers, and moderate amounts in 13: the diagnostic value of copper staining is questioned.