Search

Copyright of Journal of Wound Management is the property of Cambridge Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The necessity is emphasized to perform always a careful anamnesis and a clinical inspection of patients before achieving laboratory examinations (avoiding to demand to a "check up" the diagnosis). This is particularly important in those diseases, like viral hepatitis, which become even more frequent, so that such diagnosis may be supposed basing on unreliable laboratory findings. The possibility is mentioned that different hepato-colangiopathies (Wilson's disease, intolerance to fructose, hepatic congenital fibrosis, hepatic ductal hypoplasia, granulomatous hepatitis, bacterial, micotic and protozoarian cholangitis, liver sufference in onchologic diseases) may simulate viral hepatitis.

In 21 subjects HBsAg positive affected by different forms of chronic hepatitis and in one carrier we compared the presence in the liver of HBsAg, HBcAg and delta studied by means of I.F. and the presence of serological markers of hepatitis B virus infection. By the I.F. test, HBsAg was present in all cases, HBcAg in 15 cases (71%), delta in 8 cases (38%). These percentages are almost the same as those of other researches in chronic hepatitis in immunodepressive treatment. About the serological markers, HBsAg and HBcAb were present in 100% of cases, while, regarding the e-anti e system, HBeAg was present in 12 cases (57%) and HBeAb in 7 (33%). In the work effected there is no relation between delta and HBeAg because in 50% of the positive delta subjects there was HBeAb. On the contrary HBcAg and HBeAg are strictly correlated. Therefore the antigens core and delta are not interdependent. We wanted to verify the existence of relation between HBcAg and HBeAg and came to the conclusion that this relation exists in 17 out of 21 subjects (81%). In our researches is clear the long persistence of the hepatic antigens without any connection with the time of treatment and the course of the various chronic hepatitis. The change in the serum from HBeAg to HBeAb occurred in many improved cases but not in all of them. We presume that the long immunodepressive treatment (about 4 years) has influenced our results.

13 children with chronic HBsAg negative hepatitis were examined in this work with the I.F. method. Comparison can be made with a previous work on chronic HBsAg positive hepatitis. 8 of these patients were cases of ECP, 1 was a ECA-A and 4 were ECA-B. Research has been done to point out immunoglobulins and immunocomplexes in the liver and serum. On the whole, fluorescence was less both in liver and serum than fluorescence in chronic HBsAg positive hepatitis. Reasons of it can be: the absence of anti-virus B antibodies (HBcAb, delta-Ab, HBsAb), the relative lightness of our cases and, probably, a better answer of HBsAg negative hepatitis than of HBsAg positive one to immunodepressive treatment.

Chromosome aberrations of short and long-term cultured lymphocytes have been studied in 12 subjects with chronic hepatitis B. Short-term cultures show "stickiness", aneuploidy, and fragmentations. Long-term cultures show minor damages, made up almost totally of "lacunae" and sporadic fragmentations. Major size chromosomes appear to be more affected, among the latter those containing sites for the interferon. This latter findings would suggest that the interferon decrease in patients might be bound, even only partially to the virus-linked chromosome alterations.

On liver biopsies of 20 children with different forms of chronic HBsAg-positive hepatitis, submitted to immunodepressive treatment, the presence and the distribution of core and delta antigens and their correlation with the different clinical forms have been studied with the direct immunofluorescence technique. Core antigen was present in 11 patients, delta antigen in 4 patients: both antigens in 3 cases. The percent rate of positive nuclei varied from 5 to 80%. All subjects negative for both antigens showed a favourable course. Delta antigen seems to be associated to forms with unsatisfactory course notwithstanding therapy, particularly to relapses and recurrences of chronic hepatitis in such a way as to hypothesize the possible responsibility either of another hepatitic virus (non A, non B virus) or of a different virus. Core morphological expression frequent in chronic hepatitis submitted to immunodepressive treatment, corresponded approximately to the finding thus far reported for the adults. The interpretation of these results, though difficult, shows remarkable interest for the pathogenetic and therapeutic considerations which follow.

The results obtained in a study of liver biopsies from children affected by different forms of chronic hepatitis during an immunodepressive treatment, accomplished by means of immunofluorescence are summarized. The different antigens correlated to B virus, localized in the nuclei (core and delta), the immunological phenomena observed in the tissue (immunoglobulins and immunocomplexes) and in serum (autoantibodies) have been investigated. The presence of HBcAg, looking finely granular, has been found in 77% of cases of CAH, similar to that found in adults. Delta Ag has been found only in 29% of cases, in the nuclei, like core Ag, but nuclei were more large and not homogeneous. The 2 antigens could be found also in the same patient, differently from adults. The absence of the two antigens has a good prognostic significance; the presence of delta antigen has on the contrary a bad prognostic meaning; the persistence of core antigen under immunodepressive treatment may correspond to a tolerance against antigen. Immunoglobulins and/or immunocomplexes, binding complement, were found in 69% of cases. The fluorescence can be found in different patterns: nuclear, due to immunocomplexes of HBV and antibodies penetrated through impaired membranes; of hepatocyte membranes, linear, probably against auto-antigens (lipoproteins liver-specific) or neo-antigens induced by the virus; in inflammatory cells (K-cells or phagocytic monocytes); or scattered granular, may be from non-eliminated immunocomplexes. Autoantibodies in serum, tested on autologous substrates, were present in 97% of cases, in prevalence antinuclear or against hepatocytary membranes, but also against cytoplasmatic components. Important variations exist between the different forms, both as for what concerns the morphological patterns and the intensity of the reactions. A statement about the severity and the evolution of the disease, with prognostic implication could be hypothetically made in the future, after further studies.

Liver biopsies from patients (mostly children) affected by chronic hepatitis (persistent or active, HBsAg positive or negative forms), part of them treated by immunosuppressive therapy, have been studied by means of immunofluorescence techniques. A cytoplasmic localization of HBsAg and a nuclear localization of HBcAg have been demonstrated. Moreover, a nuclear localization of immunocomplexes was demonstrated, as well as the presence of immunoglobulins. Persistent forms showed a lesser fluorescence than active forms, and so did the treated patients, if compared with recent, not yet treated subjects.