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Biliary bile acid have been analyzed in patients with various hepato-biliary diseases by thin-layer chromatography, and divided into 4 types of glycine- and taurine-conjugates. The composition of biliary bile acid was different according to the hepatic impairement, and the ratio of glycine-conjugate to taurine-conjugate was decreased in chronic liver diseases. The G/T ratio was 1.49 +/- 0.36 in the control group, but was 0.96 +/- 0.18 in severe liver cirrhosis, and 1.38 +/- 0.44 in chronic active hepatitis. In acute hepatitis, the G/T ratio was low on the initial stage of the diseases, and returned to a normal range upon recovery. There was also a dicrease in the ratio of dihydroxycholic to cholic acid of biliary bile acid in patients with chronic liver diseases. In conclusion, the measurement of bile acid in bile has a diagnostic value for chronic hepatic impairement.

The value of conventional gamma globulin in prophylaxis of hepatitis A has not been confirmed in recent years but there is no evidence that ineffectiveness has been encountered as a result of declining immune experience among antibody donors in open populations. Fortunately, specific tests for hepatitis A antibody are becoming available as a means of estimating effectiveness of currently manufactured gamma globin. Hepatis B prophylaxis by conventional gamma globlin is much more uncertain but the negative evidence must be considered in light of rising anti-HBs titers of globin manufactured more recently. The latter have appeared to be effective in pre-exposure prophylaxis when nonparenteral transmission was implicated. Post-exposure prophylaxis against massive inocula of hepatitis B, as in transfusions, would appear to require large amounts of HBs antibody. Protection against hepatitis from small inocula accompanying accidental punctures with contaminated needles is under controlled study to determine whether the anti-HBs titer of special globulin preparations is a predictive index of protection. Results are expected by midyear, 1975.

In summary, this critique has attempted to review the evidence of the occurrence of sequelae of acute viral hepatitis. Chronic disability does occur for periods of time not yet clearly defined as to duration and may occur as a continuation of the acute attack or after presumable recovery from the acute attack. The prognosis can not be definitely answered at present. The percentage of acute cases having chronic disability is small, but no definite numbers can be stated with assurance. That a still smaller group of the acute cases may terminate in cirrhosis seems supported by adequate evidence. Whether the group having chronic disability (the chronic hepatitis syndrome) or what percentage of it goes on to cirrhosis can not be answered at present.

UNDOUBTEDLY the most unsatisfactory situation in blood banking today is the inability to exercise any real control over the hazard of transmitting homologous serum jaundice by whole-blood transfusions. The risk is inherent in every bottle of blood issued. The problems of control are multiple: no donor's history is really reliable; any donor may be an innocent carrier; no laboratory test, or group of tests, is specific for the virus of hepatitis; there is no way of treating the blood to kill the virus without violating essential storage or safety requirements for whole blood; there is no susceptible laboratory test animal . . .

A known alcoholic with Laennec's cirrhosis (micronodular, portal, or septal) was awaiting elective portacaval shunt. During this period, he was observed to abstain from alcohol and maintain a good diet. Approximately 4 months after several transfusions of whole blood, he developed severe jaundice and died in hepatic coma 7 days thereafter.

SummaryHeterophile antibody agglutination, Kahn, and cold agglutinin tests were performed in 2 groups of patients with viral hepatitis. Sixteen out of 508 patients (3%) developed positive heterophile antibody tests with titers of 1:56 which were reduced to 1:7 or negative by absorption on boiled guinea pig kidney. A rise and/or fall in titer of antibody was demonstrable in serial weekly determinations. Out of 388 patients who were known not to have syphilis, 6 (1.5%) developed positive Kahn tests, and 10 others (2.5%) had doubtful tests. Two out of 323 patients had cold agglutinins present in a titer of 1:32.The relatively small number of positive heterophile antibody agglutination and Kahn tests is in contrast to reports of others25 who have found a considerably higher percentage of positive tests.

Summary1. Nitrogen mustard in a concentration of 500 mg per 1 failed to inactivate the Fort Bragg strain of serum hepatitis virus in whole blood. 2. Possible reasons for this failure are discussed. 3. The virus titer of the whole blood used was found to be at least 25000 infectious units/ml.

A progress report on the use of hepatic function tests in detecting the blood carrier of viral hepatitis by means of hepatic function tests is presented. In the case of 29 single donors suspected of being hepatitis carriers who gave blood and who were examined in this hospital, three-fourths had one or more abnormal tests and one-half had an abnormal thymol turbidity and/or thymol flocculation tests. This is virtually the same incidence of abnormality as in imprisoned narcotic addicts. In the case of 29 single donors giving blood in the local Red Cross center or in Red Cross or community centers at a distance from Philadelphia on whom hepatic function tests were also done in this hospital, abnormal tests were found in only one-quarter, and thymol turbidity and/or thymol flocculation tests were abnormal in only one-sixth of them. These rates of abnormality are similar to those of the general donor population. It is suggested that persons from the lower social and economic classes of the large metropolitan centers of the United States who donate blood for a fee are apt to be alcoholics and narcotic addicts and are, therefore, more likely to be chronic carriers of viral hepatitis than are more stable elements of the population. It is in this group that the use of the thymol turbidity and flocculation tests appears to be valuable in a screening regimen for the carrier state of viral hepatitis.

THE marked increase in drug addiction among adolescents has been amply documented,1 , 2 as has the transmission of malaria,3 tetanus,4 acute endocarditis5 and septicemia6 among drug addicts. To our...

Two immunologically distinct forms of hepatitis are generally recognized at present, although it is not known whether they represent different diseases or variant forms of a single disease. The relationship between them is obscure. An attack of infectious hepatitis confers homologous immunity, and this disease may be prevented by the administration of normal immune globulin. In contrast, the status of homologous immunity in serum hepatitis is equivocal, and attempts to prevent it by the administration of normal immune globulin have usually been unsuccessful. Epidemiologic and experimental evidence indicates that there is no cross immunity between the infections caused by viruses A and B. The prevention of infectious hepatitis is concerned with improvement in sanitation, the avoidance of fecal contamination of food and water, and the prohibition of persons who are potentially infected from acting as food handlers. Because of the carrier rate and the relative resistance of hepatitis virus to heat and other physical and chemical agents, it has been recommended that every parenteral penetration be performed with instruments sterilized by boiling in water for 30 minutes, or with steam under increased pressure (15 to 20 lb.) for 20 minutes, or with dry heat (180 C for one hour).

Morbidity and surveillance data on viral hepatitis cases in the United States since 1970 has revealed plateauing of case rate, continued failure to observe seasonal variation, more general geographic distribution of cases, and persistence, although at progressively lower levels, of highest rates in males 15-29 years of age. Based on results of HBS Ag testing, as much as 24 per cent of hepatitis B may be misdiagnosed by physicians and from 18 to 46 per cent of reported cases can be classified hepatitis B, thus suggesting that hepatitis B may account for up to one-half the recognized viral hepatitis in this country. HBS Ag-negative hepatitis still seems commonly acquired through close personal contact; hepatitis B patients 15-29 years of age also commonly have personal contact association. Parenteral drug abuse and transfusion of blood and blood products continue to play a role in dissemination of hepatitis B, but hepatitis B seems to account for only about one half of all reported transfusion-associated hepatitis. Case fatality rates for reported cases appear to increase with age but are not higher for HBS Ab positive patients than for negative patients.

"Nonparenteral" transmission of acute viral hepatitis was implicated in 50;5 per cent of 346 patients included in this study and in 67.5 per cent of 1,235 cases reviewed for the period 169-1973. Hepatitis B surface antigen (HBs Ag) was detected in 48.3 per cent of these patients. Of 476 family contacts of HBs Ag carriers 71 per cent had HBs Ag or anti-HBs, this being true for 88.8 per cent of siblings and for 67.7 per cent of offspring. Anti-HBs was detected in 10.4 per cent to 49.3 per cent of the populations tested, its frequency correlating with that of HBs Ag and increasing with age. Significant differences in the patterns of exposure to the hepatitis Bvirus (HBV) were seen between offspring and siblings of HBs Ag carries mainly determined by the observed HBs Ag prevalence in relation to their age. It was calculated that as many as 25 per cent of all Greeks may come into familial contact with HBs Ag carriers and acquire the infection mainly by nonparenteral mechanisms. It is concluded that in Greece there is already a wide exposure to HBV before vaccination programs.

Epidemiological data indicate that endemic hepatitis in Greenland is immunologically different from hepatitis type A occurring in large epidemics. The endemic type is characterized by sporadicity, a high incidence in urban areas, and predominance of adult cases indicative of a hepatitis B virus (hbv) etiology. The distribution of hepatitis B surface antigen (HBsAg) in the healthy population suggests the existence of a hyperendemicity of HBV in some rural areas showing few overt hepatitis cases but a HBs Ag carrier rate up to 25 per cent.

A serologic comparison was performed by immune electron microscopy between hepatitis A antigen (related to the MS-1 strain of hepatitis A virus) and a viral isolate, CR69(076), from the stool of a patient in Costa Rica with viral hepatitis. CR69(076) was not antigenically related to hepatitis A antigen but was related to echovirus 25. Thus, it is unrelated to the MS-1 strain of hepatitis A virus.

Two patients with agammaglobulinemia who died of complications of a disease presumed to be homologous serum hepatitis are described. The occurrence of acute atrophy in one patient and typical postnecrotic cirrhosis in the other has induced critical evaluation of the concept that an autoimmune mechanism is important in the pathogenesis of either of these complications of virus hepatitis.