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We performed patients survey for the liver disease patients including hepatitis B, hepatitis C and hepatocellular carcinoma. The results obtained from this patients survey indicated that the liver disease patients had a diversity of social, economical and mental troubles. The medical staffs should support liver disease patients based on the understanding for the difference of background of the patients.

A 47-year-old otherwise healthy woman, presented elevation of alpha fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) levels at a general health checkup. Both HCV antibody and hepatitis B surface antigen were negative. A screening abdominal CT revealed no abnormal change. An abdominal MRI and repeated CT, however, revealed a 20-mm tumor adjacent to the inferior vena cava and adjacent to or involving the liver. A surgical resection of the tumor was performed. The tumor was adjacent to, but distinct from, the liver. The Capsule of the tumor was connected to the liver but it was distinct from hepatic, renal, and adrenal tissue. A histological examination yielded a diagnosis of moderately differentiated hepatocellular carcinoma, with positive staining of hepatocyte-specific antigen and AFP.

A 52-year-old man was admitted to our hospital for fever, jaundice, and general malaise. Laboratory data revealed elevated serum liver enzyme levels (AST 2377IU/L, ALT 2756IU/L) and bilirubin (T-Bil 3.7 mg/dl). Blood count showed a marked decrease of platelets (2.0 x 10(4)/microl). Serological and virological analysis showed positive results for HEV IgM and HEV RNA, indicating a diagnosis of acute hepatitis E. The serum ferritin level was also markedly elevated (23200 ng/ml). A diagnosis of virus associated hemophagocytic syndrome (VAHS) was strongly suggested. This is the first report of hepatitis E most likely accompanied by VAHS.

Since the discovery of the hepatitis C virus(HCV), it has become evident that this infectious agent is a primary cause of posttransfusion and sporadic non-A, non-B hepatitis. Populations at risk for HCV infection include health care workers, infants born to HCV-infected mothers, hemodyalysis patients, and intravenous drug abusers. Because there currently is no HCV vaccine or specific immunoglobulin against HCV, prevention of exposure remains the only possibility for reducing HCV transmission and prevalence. However, the percentage of individuals who are positive for HCV antibody among health care workers is not significantly high, suggesting that health care workers are not at very high risk of HCV infection. Too much fear of HCV infection among the health care workers should be avoided.

After discovering HCV antibody in 1989, the new cases of posttransfusion hepatitis C has been rare. This HCV antibody screening system provided certainly the powerful preventive effect from HCV infection through blood products. But it was possible to infect HCV through the blood products without HCV antibody but with HCV-RNA. This phenomenon seemed to be observed in a window period between time at infection and antibody appearance. To detect the infectious source at a window period in blood products, NAT(nucleic acid amplification) method was adapted recently in Japanese red cross. For safe blood screening system, continuous efforts such as NAT will be needed forever.

We investigated clinical characteristics and incidence of patients with acute non-A-G hepatitis, who were all registered in 17 Japanese National Hospitals. Seven hundreds thirty-one (24.0%) of 3052 patients with sporadic acute hepatitis and 73 (21.2%) of 344 patients with posttransfusion acute hepatitis were diagnosed as acute non-ABC hepatitis. Patients with acute non-ABC hepatitis were older (Mean +/- SD, 44 +/- 15 years) and male/female ratio was 0.70. Although mean levels of liver function abnormality was generally mild, 4(1.8%) of 250 patients with acute non-ABC hepatitis were died of fulminant hepatitis.

Hepatitis viruses A, B, C, D and E are all well-characterized, molecularly defined agents with unequivocal disease association. Usual diagnosis for these virus infections are established by serological markers which are specific antigens or antibodies for these virus infections. But serological diagnosis occasionally shows pseudonegative results because this method is indirect diagnosis. In contrast, molecular diagnosis catches directly components of viral structure. Molecular diagnosis is also able to show the appearance and disappearance of these hepatitis viruses. Diagnostic criteria for Non-ABCDE hepatitis is the exclusion of hepatitis viruses A, B, C, D and E infections by using not only serological diagnosis but also molecular diagnosis.