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We catalog the 443 bright supernovae discovered by the All-Sky Automated Survey for Supernovae (ASAS-SN) in $2018-2020$ along with the 519 supernovae recovered by ASAS-SN and 516 additional $m_{peak}\leq18$ mag supernovae missed by ASAS-SN. Our statistical analysis focuses primarily on the 984 supernovae discovered or recovered in ASAS-SN $g$-band observations. The complete sample of 2427 ASAS-SN supernovae includes earlier $V$-band samples and unrecovered supernovae. For each supernova, we identify the host galaxy, its UV to mid-IR photometry, and the offset of the supernova from the center of the host. Updated light curves, redshifts, classifications, and host galaxy identifications supersede earlier results. With the increase of the limiting magnitude to $g\leq18$ mag, the ASAS-SN sample is roughly complete up to $m_{peak}=16.7$ mag and is $90\%$ complete for $m_{peak}\leq17.0$ mag. This is an increase from the $V$-band sample where it was roughly complete up to $m_{peak}=16.2$ mag and $70\%$ complete for $m_{peak}\leq17.0$ mag., Comment: 14 pages, 7 figures, 4 tables. Updated to reflect changes made in the published version. Tables containing the catalog data presented in this submission are included in machine-readable format as ancillary files

Families of asteroids generated by the collisional fragmentation of a common parent body have been identified using clustering methods of asteroids in their proper orbital element space. An alternative method has been developed in order to identify collisional families from the correlation between the asteroid fragment sizes and their proper semi-major axis distance from the family centre (V-shape). This method has been shown to be effective in the cases of the very diffuse families that formed billions of years ago. We obtained photometric observations of asteroids in order to construct their rotational light curves; we combine them with the literature light curves and sparse-in-time photometry; we input these data in the light curve inversion methods to determine the shape and the spin pole of the asteroids in order to assess whether an object is prograde or retrograde. The ultimate goal is to assess whether we find an excess of retrograde asteroids on the inward side of the V-shape of a 4 Gyr asteroid family identified via the V-shape method. This excess of retrograde rotators is predicted by the theory of asteroid family evolution. We obtained the spin poles for 55 asteroids claimed to belong to a 4 Gyr collisional family of the inner main belt that consists of low-albedo asteroids. After re-evaluating the albedo and spectroscopic information, we found that nine of these asteroids are interlopers in the 4 Gyr family. Of the 46 remaining asteroids, 31 are found to be retrograde and 15 prograde. We also found that these retrograde rotators have a very low probability (1.29%) of being due to random sampling from an underlying uniform distribution of spin poles. Our results constitute corroborating evidence that the asteroids identified as members of a 4 Gyr collisional family have a common origin, thus strengthening their family membership., 20 pages, 7 figures. A&A (2022)

Summary Background Viral hepatitis is the most common cause of liver disease in the world. In the past 25 years, vaccines have become available for two of the five hepatitis viruses, and, where implemented, vaccination has become a key component of hepatitis prevention. Aims To provide an update on recent advances in the use of current hepatitis vaccines and to examine progress in the development of vaccines for the remaining hepatitis viruses. Methods A Medline search was undertaken to identify the recent relevant literature. Search terms included hepatitis vaccines, hepatitis vaccination and hepatitis A–E vaccines. Results Dramatic vaccine-induced declines in the incidence of both hepatitis A and B have occurred in the USA. Strategies to integrate hepatitis A vaccine into universal childhood immunization are being adopted. Similarly, strategies with the goal of eliminating transmission of hepatitis B have been promulgated. A vaccine for hepatitis E has been reported to be effective and safe, but progress in the development of vaccines for hepatitis C and D has been limited. Conclusion During the next few decades, the goals of eliminating hepatitis A and B virus transmission may be reached in the USA and elsewhere.

International audience; Aims:We present physical models of ten asteroids obtained by means of lightcurve inversion. A substantial part of the photometric data was observed by amateur astronomers. We emphasize the importance of a coordinated network of observers that will be of extreme importance for future all-sky asteroid photometric surveys. Methods: The lightcurve inversion method was used to derive spin states and shape models of the asteroids. Results: We derived spin states and shape model for ten new asteroids: (110) Lydia, (125) Liberatrix, (130) Elektra, (165) Loreley, (196) Philomela, (218) Bianca, (306) Unitas, (423) Diotima, (776) Berbericia, and (944) Hidalgo. This increases the number of asteroid models up to nearly one hundred.

We present new observations and models of the shapes and rotational states of the eight near-Earth Asteroids (1580) Betulia, (1627) Ivar, (1980) Tezcatlipoca, (2100) Ra-Shalom, (3199) Nefertiti, (3908) Nyx, (4957) Brucemurray, and (5587) 1990 SB. We also outline some of their solar phase curves, corrected to common reference geometry with the models. Some of the targets may feature sizable global nonconvexities, but the observable solar phase angles were not sufficiently high for confirming these. None is likely to have a very densely cratered surface. We discuss the role of the intermediate topographic scale range in photometry, and surmise that this scale range is less important than large or small scale lengths.

We present an analysis of recently published photometry of OW Geminorum during its 2002 eclipse season. The photometric data are analyzed simultaneously with previously published radial velocities. The results show that OW Gem consists of an F2 Ib–II primary with M1 = 5.8 ± 0.2 M⊙, R1 = 30.1 ± 0.3 R⊙ and a G8 IIb secondary with M2 = 3.9 ± 0.1 M⊙, R2 = 31.7 ± 0.3 R⊙. We discuss the evolutionary implications of these results.

The aim of this study was to compare the clinical features of major upper gastrointestinal bleeding among patients exposed to nonsteroidal antiinflammatory drugs (NSAID) and those not taking these drugs.Using data from a multicenter international case-control study designed to evaluate the role of drugs in the etiology of major upper gastrointestinal bleeding (UGIB), patients with a confirmed first episode of major UGIB were divided into two groups: those exposed to NSAIDs during the week before the onset of bleeding, and those not exposed. The groups were compared according to age and sex, clinical appearance and site of the bleeding, preceding symptoms, and requirement for transfusion and acute surgery.The median age was significantly higher and the proportion of women was slightly higher among the NSAID users. There was no significant difference between users and nonusers according to the clinical presentation, the site of the bleeding, or the frequency of preceding symptoms. Forty percent in each group had no symptoms before the onset of bleeding. Slightly more NSAID users received blood transfusions, although the same median amount of blood per transfusion was given in both groups. There was no difference in the frequency of surgical intervention.There are no important differences in the clinical presentation of major UGIB according to whether or not an individual is an NSAID user. An important finding is the frequent absence of preceding symptoms in patients with major UGIB, regardless of NSAID use.

We studied the antiviral effectiveness and safety of interferon alfa-n3, a natural alpha interferon which contains multiple interferon species, in the treatment of previously untreated patients with chronic hepatitis C. Seventy-seven patients were randomized to receive either 1.0, 2.5, 5.0, or 10.0 million units (MU) of interferon alfa-n3 three times a week for 24 weeks and were then followed for an additional 24 weeks. At the end of therapy, 67% of patients in the 10 MU group normalized serum alanine transaminase (ALT) levels and 59% had no hepatitis C virus (HCV) RNA detected by polymerase chain reaction. At the end of the follow-up period, 44% of patients in the 10 MU group maintained normal ALT, and 24% had nondetectable HCV RNA. Lower doses were much less effective. Interferon alfa-n3 was well tolerated and no patient developed neutralizing anti-interferon antibodies during or after the treatment period. Interferon alfa-n3 appears to be effective against hepatitis C virus and deserves further study in larger randomized controlled trials.

SummaryBackground The treatment of chronic hepatitis C is changing rapidly. Aim To review clinical studies of the efficacy and safety of sofosbuvir-containing regimens in the treatment of chronic hepatitis C. Methods Using PubMed and search terms ‘sofosbuvir,’ ‘emerging HCV treatment,’ and ‘HCV polymerase inhibitor,’ literature on the clinical development of sofosbuvir, as well as abstracts presented at the November 2013 annual meeting of the American Association for the Study of Liver Diseases (AASLD), was reviewed. The last search was undertaken on 15 November 2014. Results In a dose of 400 mg once daily, the drug has been safe and generally well tolerated with most adverse reactions attributable to the concurrent use of ribavirin or peginterferon plus ribavirin. A high barrier to resistance has been demonstrated. In genotype 1 (G1) patients, the addition of sofosbuvir to peginterferon plus ribavirin yielded sustained virological response rates at week 12 after discontinuation of treatment (SVR12) of about 90% with slightly lower levels in G1b and in patients with cirrhosis, but with no major impact of IL28B genotype, high viral load, body mass index (BMI), alanine aminotransferase (ALT) or race/ethnicity. In genotype 2 (G2), sofosbuvir and ribavirin for 12 weeks also resulted in SVR12 of 90% or better with little effect from cirrhosis. In contrast, genotype 3 (G3) was less responsive to 12 weeks of sofosbuvir plus ribavirin, especially in the presence of cirrhosis. Conclusion The efficacy and safety of sofosbuvir-containing regimens with ribavirin alone or with peginterferon plus ribavirin signal a new era in treatment.

Current amount of ~500 asteroid models derived from the disk-integrated photometry by the lightcurve inversion method allows us to study not only the spin-vector properties of the whole population of MBAs, but also of several individual collisional families. We create a data set of 152 asteroids that were identified by the HCM method as members of ten collisional families, among them are 31 newly derived unique models and 24 new models with well-constrained pole-ecliptic latitudes of the spin axes. The remaining models are adopted from the DAMIT database or the literature. We revise the preliminary family membership identification by the HCM method according to several additional criteria - taxonomic type, color, albedo, maximum Yarkovsky semi-major axis drift and the consistency with the size-frequency distribution of each family, and consequently we remove interlopers. We then present the spin-vector distributions for eight asteroidal families. We use a combined orbital- and spin-evolution model to explain the observed spin-vector properties of objects among collisional families. In general, we observe for studied families similar trends in the (a_p, \beta) space: (i) larger asteroids are situated in the proximity of the center of the family; (ii) asteroids with \beta>0{\deg} are usually found to the right from the family center; (iii) on the other hand, asteroids with \beta0{\deg} or \beta, Comment: Accepted for publication in A&A (September 16, 2013)

The larger number of models of asteroid shapes and their rotational states derived by the lightcurve inversion give us better insight into both the nature of individual objects and the whole asteroid population. With a larger statistical sample we can study the physical properties of asteroid populations, such as main-belt asteroids or individual asteroid families, in more detail. Shape models can also be used in combination with other types of observational data (IR, adaptive optics images, stellar occultations), e.g., to determine sizes and thermal properties. We use all available photometric data of asteroids to derive their physical models by the lightcurve inversion method and compare the observed pole latitude distributions of all asteroids with known convex shape models with the simulated pole latitude distributions. We used classical dense photometric lightcurves from several sources and sparse-in-time photometry from the U.S. Naval Observatory in Flagstaff, Catalina Sky Survey, and La Palma surveys (IAU codes 689, 703, 950) in the lightcurve inversion method to determine asteroid convex models and their rotational states. We also extended a simple dynamical model for the spin evolution of asteroids used in our previous paper. We present 119 new asteroid models derived from combined dense and sparse-in-time photometry. We discuss the reliability of asteroid shape models derived only from Catalina Sky Survey data (IAU code 703) and present 20 such models. By using different values for a scaling parameter cYORP (corresponds to the magnitude of the YORP momentum) in the dynamical model for the spin evolution and by comparing synthetics and observed pole-latitude distributions, we were able to constrain the typical values of the cYORP parameter as between 0.05 and 0.6., Accepted for publication in A&A, January 15, 2013

F. Blaine Hollinger, Moderator, Theodore Eickhoff, Anne Gershon, Elaine C. Jong, and Raymond S. KofF* Department of Medicine, Virology, and Epidemiology, Baylor College of Medicine, Houston, Texas; Division of Infectious Disease, University of Colorado Medical Center, Denver; Department of Pediatrics, Columbia University, New York, New York; Department of Medicine, University of Washington, Seattle; Department of Medicine, University of Massachusetts Medical School, Metro West Medical Center, Framingham, Massachusetts

The spin rate distribution of main belt/Mars crossing (MB/MC) asteroids with diameters 3–15 km is uniform in the range from f = 1 to 9.5 d−1, and there is an excess of slow rotators with f 1 d−1. The observed distribution appears to be controlled by the Yarkovsky–O'Keefe–Radzievskii–Paddack (YORP) effect. The magnitude of the excess of slow rotators is related to the residence time of slowed down asteroids in the excess and the rate of spin rate change outside the excess. We estimated a median YORP spin rate change of ≈ 0.022 d −1 / Myr for asteroids in our sample (i.e., a median time in which the spin rate changes by 1 d−1 is ≈ 45 Myr ), thus the residence time of slowed down asteroids in the excess is ≈ 110 Myr . The spin rate distribution of near-Earth asteroids (NEAs) with sizes in the range 0.2–3 km (∼5 times smaller in median diameter than the MB/MC asteroids sample) shows a similar excess of slow rotators, but there is also a concentration of NEAs at fast spin rates with f = 9 – 10 d −1 . The concentration at fast spin rates is correlated with a narrower distribution of spin rates of primaries of binary systems among NEAs; the difference may be due to the apparently more evolved population of binaries among MB/MC asteroids.

We report the observation of the first gravitational microlensing event in a sparse stellar field, involving the brightest (V=11.4 mag) andclosest (~ 1 kpc) source star to date. This event was discovered by an amateurastronomer, A. Tago, on 2006 October 31 as a transient brightening, by ~4.5 mag during a ~15 day period, of a normal A-type star (GSC 3656-1328) in the Cassiopeia constellation. Analysis of both spectroscopic observations and the light curve indicates that this event was caused by gravitational microlensing rather than an intrinsically variable star. Discovery of this single event over a 30 year period is roughly consistent with the expected microlensing rate for the whole sky down to V = 12 mag stars. However, the probability for finding events with such a high magnification (~ 50) is much smaller, by a factor ~1/50, which implies that the true event rate may be higher than expected. This discovery indicates the potential of all sky variability surveys, employing frequent sampling by telescopes with small apertures and wide fields of view, for finding such rare transient events, and using the observations to explore galactic disk structure and search for exo-planets., 13 pages, 2 tables, 3 figures, accepted by ApJ

To review information on performance characteristics for tests that are commonly used to identify acute and chronic hepatic injury.A MEDLINE search was performed for key words related to hepatic tests, including quality specifications, aminotransferases, alkaline phosphatase, gamma-glutamyltransferase, bilirubin, albumin, ammonia, and viral markers. Abstracts were reviewed, and articles discussing performance of laboratory tests were selected for review. Additional articles were selected from the references. Guideline Preparation and Review: Drafts of the guidelines were posted on the Internet, presented at the AACC Annual Meeting in 1999, and reviewed by experts. Areas requiring further amplification or literature review were identified for further analysis. Specific recommendations were made based on analysis of published data and evaluated for strength of evidence and clinical impact. The drafts were also reviewed by the Practice Guidelines Committee of the American Association for the Study of Liver Diseases and approved by the committee and the Association's Council.Although many specific recommendations are made in the guidelines, some summary recommendations are discussed here. Alanine aminotransferase is the most important test for recognition of acute and chronic hepatic injury. Performance goals should aim for total error of10% at the upper reference limit to meet clinical needs in monitoring patients with chronic hepatic injury. Laboratories should have age-adjusted reference limits for enzymes in children, and gender-adjusted reference limits for aminotransferases, gamma-glutamyltransferase, and total bilirubin in adults. The international normalized ratio should not be the sole method for reporting results of prothrombin time in liver disease; additional research is needed to determine the reporting mechanism that best correlates with functional impairment. Harmonization is needed for alanine aminotransferase activity, and improved standardization for hepatitis C viral RNA measurements.

Interleukin-12 (IL-12) plays a central role in mounting an effective cellular immune response directed towards elimination of intracellular pathogens. The present open-label, multicenter, dose-escalation phase I/II study was designed to assess tolerability, pharmacokinetics, pharmacodynamics, and efficacy of subcutaneously administered recombinant human interleukin-12 (rHuIL-12) in the treatment of chronic hepatitis C. Sixty patients (42 men, 18 women, aged 24-60) were treated with 0.03 microgram/kg (n = 16), 0.1 microgram/kg (n = 14), 0.25 microgram/kg (n = 15), or 0.5 microgram/kg rHuIL-12 (n = 15) for 10 consecutive weeks. rHuIL-12 was generally well tolerated, with 2 patients (3.3%) being withdrawn from treatment for adverse events. Treatment was associated with temporary decreases in neutrophils and lymphocyte counts and with elevations in serum transaminases and bilirubin. Serum IL-12 levels observed were higher at 0.5 microgram/kg compared with 0.25 microgram/kg doses, suggesting a dose-related increase in systemic exposure of IL-12. Measurable levels of interferon gamma (IFN-gamma) were also observed at the highest dose of 0.5 microgram/kg. At the end of treatment hepatitis C virus (HCV) RNA was detectable in all patients. A more than 50% decrease in pretreatment HCV RNA levels was observed in 3 of 16 patients of the 0.03-microgram/kg dose group, in 3 of 14 of the 0.10-microgram/kg dose group, in 6 of 15 of the 0.25-microgram/kg dose group, and in 8 of 15 patients of the 0.5-microgram/kg dose group. Although in several cases serum alanine transaminase (ALT) levels decreased either during or after treatment, ALT normalization was observed in only 4 patients at the end of treatment and in 5 patients at the end of follow-up. Significant anti-rHuIL-12 antibody titers were not detectable in any patient. In conclusion, antiviral activity of rHuIL-12 in patients with chronic hepatitis C does not appear advantageous in comparison with other currently available treatments.

Development of colon cancer is now believed to result from a series of inherited or acquired mutations in DNA. Convincing evidence that colonoscopic polypectomy prevents colorectal cancer is now available. A consensus panel recommended that all patients with duodenal and gastric ulcers who are infected with H pylori on first presentation be treated with antimicrobial agents.

Hepatitis A virus (HAV) infection is a well-recognized cause of acute hepatitis with jaundice in adults. However, chronic sequelae of HAV infection are so rare and so poorly defined that their existence remains speculative. In this report we describe a middle-aged woman in whom serologically defined acute hepatitis A appeared to trigger the onset of autoimmune chronic active hepatitis. This and two previously reported cases suggest that in certain individuals, presumably with a genetic predisposition to the development of autoimmune hepatitis, HAV infection may be the precipitating event in the pathogenesis of this disorder.

The hepatitis B virus is a member of an unusual family of noncytopathogenic, hepatotropic DNA viruses--the hepadnaviruses. The complete virus comprises a lipoprotein coat, the hepatitis B surface antigen, enveloping a nucleocapsid core that contains a small, circular DNA molecule. Four open reading frames have been identified on the hepatitis B virus DNA genome. They encode seven proteins, including a hepatitis B virus DNA polymerase molecule with reverse transcriptase activity. The replication of the virus resembles that of retroviruses and occurs predominantly but not exclusively in hepatocytes. Virus variants involving genomic mutations have been identified. Testing for hepatitis B surface antigen permits detection of many but not all acutely infected patients. Diagnosis of acute infection rests on the identification of IgM antibodies to the hepatitis B core antigen. Antibody to hepatitis B surface antigen appears in serum during the convalescent phase of hepatitis B virus infection. It is the neutralizing, protective antibody largely responsible for immunity to reinfection. In persistent infection hepatitis B surface antigen is present, antibody to hepatitis B core antigen is predominantly an IgG antibody, antibody to hepatitis B surface antigen is not detectable or is present in very low titers and viral replication may be active. Persistent infection leads to an asymptomatic carrier state, chronic hepatitis, cirrhosis and hepatocellular carcinoma. No specific treatment exists for acute hepatitis B virus infection. Current data indicate that approximately 50% of adults who have chronic infection achieve virologic, biochemical and histologic remission from treatment with alpha-2b-interferon.

Nitrofurantoin-induced hepatic injury has been established unequivocally as an entity by rechallenge experiences. We reviewed 12 previously reported cases in which rechallenge was described. The longest reported interval between initial injury and rechallenge-provoked injury was 4 yr. We report a 56-yr-old woman who experienced severe hepatocellular injury with brief low-dose administration of nitrofurantoin 17 yr after an initial hepatitis-like illness associated with ingestion of the drug. Despite a temporal relationship to nitrofurantoin administration and histologic features compatible with drug-induced hepatitis, the initial bout of hepatitis had been termed "infectious." Our case appears remarkable for the long interval between initial injury and rechallenge-induced injury. The severity of the hepatic injury seen on rechallenge underscores the concept that the inadvertent rechallenge can be dangerous. Failure to identify the first bout of hepatitis as nitrofurantoin-related, and failure to inform the patient about the possible relationship to nitrofurantoin, raises important risk-management concerns, because hepatic memory of nitrofurantoin hypersensitivity appears to be of long duration.

SummaryIntraperitoneal administration of halothane, 1.7 to 14 mmoles/kg of body weight in rats, led to significant elevations in plasma levels of a number of enzymes (GOT, GPT, OCT, CPK, SDH, total LDH, and LDH isoenzyme V). This response was sharp and dose related. A similar but quantitatively lesser response was observed in rats treated intraperitoneally with ether. Normal plasma enzyme activity was found after injections of sodium pentobarbital or saline. These data suggest a direct, albeit transient, toxic effect of halothane on the liver and skeletal muscle of the rat.

Transfusion of a misidentified and mislabeled unit of hepatitis B surface antigen (HBsAg)-positive blood was recognized 18 hours after the transfusion episode. Within 24 hours of transfusion the recipient became HBsAg-positive, and antibody to the hepatitis B core antigen (anti-HBc) was detected. Despite hepatitis B immune globulin (HBIG) administration of 28 hours after transfusion, the serologic markers persisted for at least one month. Clinically apparent hepatitis developed about two months after transfusion. At this time HBsAg could not be detected, but antibody to HBsAg (anti-HBs) was present and anti- HBc persisted. The recipient recovered and became a plasmapheresis donor for several hepatitis B research programs.

As is apparent from the foregoing, there is only one etiologic variant of CAH for which specific therapy is available, namely, that associated with Wilson's disease. However, Wilson's disease is responsible for only a minute portion of the total cases of CAH. Drug-induced CAH also seems highly responsive to appropriate management--in this instance, removal of an offending agent rather than administration of a therapeutic drug. However, as stated, it too is an infrequent contributor to the CAH pool. Among the remaining forms of CAH, a reasonably consistent response to treatment can be expected only from patients with autoimmune CAH. This entity is a serious disorder with unequivocally high morbidity and mortality and thus clearly warrants treatment. Despite the considerable side effects that invariably result from the long-term use of corticosteroids--the only available, although nonspecific, form of treatment--corticosteroid use is justified and indeed recommended. Current evidence, derived from the Mayo Clinic data, suggests that the best therapeutic approach is to use both corticosteroids and azathioprine, a combination that offers the highest therapeutic index with the lowest rate of side effects. Using this regimen, complete remission is reported to result in 65% of cases within 2-3 years, although a considerable proportion of these individuals relapse and require retreatment. Much publicity has surrounded the Mayo Clinic and Royal Free Hospital treatment trials; however, it is probable that autoimmune CAH represents far less than 20% of all cases, and that severe disease requiring corticosteroid therapy comprises but a minor fraction of these. Thus, the bulk of cases of CAH in the United States occur in patients with either established or inferred viral-related disease, the group for which clearly effective therapy is not yet available. Most of these persons are asymptomatic, their disease having been detected through routine screening programs or at the time of evaluation of other disorders. Much interest is evoked, at present, by the new experimental forms of treatment, but none has proved to be consistently effective, and for some, toxicity is high. All appear to reduce levels of replicating virus, but none clearly affects HBsAg or disease activity. Research in this area continues, with highest expectations of success for the use of combination therapy.(ABSTRACT TRUNCATED AT 400 WORDS)

The liver is a major site of amyloid deposition. The spectrum of histopathologic changes in the liver was studied in 38 patients with systemic amyloidosis (25 with primary or myeloma-associated amyloidosis [AL] and 13 with secondary, reactive [AA] amyloidosis). Overall architectural distortion, alterations of portal triads, as well as predilection for topographic deposition in the parenchyma and/or blood vessel walls were noted. Significant histopathologic differences in AL or AA amyloid liver involvement included 1) portal fibrosis, seen in 7 of 25 (28%) AL patients and 8 of 13 (62%) AA patients (P = 0.05), 2) parenchymal amyloid deposition in 25 of 25 (100%) AL amyloid and 10 of 13 (77%) AA amyloid patients (P = 0.04), and 3) vascular amyloid deposition found in 17 of 25 (68%) with AL amyloid and 13 of 13 (100%) patients with AA amyloid (P = 0.02). These data vary from the widely held concept that deposition of amyloid is predominantly vascular in the AL form and parenchymal in amyloid AA. Clearly, however, in individual cases significant overlap occurred, and characterization of amyloid types based on morphologic distribution of amyloid deposits may be possible in only a minority of cases. In most cases, differentiation of amyloid AL and amyloid AA forms requires clinical, histochemical, immunochemical, and sometimes more elaborate laboratory amino acid sequence studies for accurate identification.

Wilson's disease presents as a classical hereditary syndrome of clinical and biochemical abnormalities. Life-long treatment with copper-chelating agents may dramatically alter the subsequent course and outcome. Hence, considerable attention has been drawn to early recognition and treatment. Since the presentation of Wilson's disease may simulate chronic active hepatitis of unknown etiology, it has been emphasized that the diagnosis of the genetic disorder should be suspected and excluded in this clinical setting. In this report we describe the difficulties encountered in the evaluation of a patient with non-Wilsonian chronic active hepatitis and low serum ceruloplasmin levels. This case illustrates that the distinction between the Wilson's disease homozygote and the hypoceruloplasminemic patient with idiopathic chronic active hepatitis may be difficult to establish and requires a critical evaluation of data to avoid diagnostic pitfalls.

Lactic acidosis has been described in patients with leukemia and lymphoma, but its occurrence in other malignant diseases is not documented. We treated two patients with oat cell carcinoma of the lung and extensive liver metastases in whom lactic acidosis developed. Tumor-induced hepatic dysfunction appeared to be a major factor in the pathogenesis of the lactic acidosis observed in these patients.

CEA levels were determined in blood specimens from 14 persons suffering from fulminant hepatitis. Values ranged from 1.9 to 21 ng/ml with a mean of 7.0 ng/ml. All except one patient had a CEA level greater than 2.5 ng/ml, but only three exceeded 10 ng/ml. There was no correlation between single CEA levels and prognosis, routine liver chemistries, or histopathologic characterization of hepatic tissue obtained at postmortem examination. These data show that patients with fulminant hepatitis commonly had increased circulating levels of CEA, but these elevations were far less than may be found in patients with hepatic metastases. In severe hepatic dysfunction reduced hepatic clearance of CEA may be responsible for the increased levels.

New information has prompted revision of the conceptual framework for considering the epidemiology and virology of viral hepatitis. The means are now at hand to identify infections due to either Hepatitis A or B, as well as to implicate other etiologic agents in hepatitis. Immunologic evidence of variation in the antigens associated with Hepatitis B, and possibly in Hepatitis A, may explain some well known epidemiologic phenomena and has important implications in immune serum globulin prophylaxis. The ambiguous relationship of antigenemia and viremia in Hepatitis B is explored in relation to the hepatitis hazard of blood products, to trials of immune serum globulin, and to the potential role of the carrier-health worker in hepatitis transmission. The emerging concept of non-parenteral transmission of Hepatitis B is reviewed and future developments in the production of hepatitis vaccines and in experimental viral hepatitis in non-human primates is briefly discussed.

Fulminant hepatic failure developed in a 24-year-old black woman who had been treated with propylthiouracil and propranolol for hyperthyroidism. Clinical and biochemical recovery followed discontinuation of drug therapy. Liver biopsy disclosed submassive hepatic necrosis. During the acute phase of the disease, lymphocyte transformation studies revealed sensitization of the patient's lymphocytes to propylthiouracil but not to propranolol. Sensitization remained demonstrable 2 months after cessation of the former drug. Lymphocytes obtained from a hyperthyroid patient treated with propylthiouracil without complications failed to show evidence of sensitization. These observations indicate that submassive hepatic necrosis may result from treatment with propylthiouracil and are consistent with the notion that sensitization mechanisms may be responsible for the hepatic injury induced by this drug.

Two patients with hematologic disease, one of whom had received androgenic steroids, had liver damage associated with peliosis hepatis. In one patient with spherocytic hemolytic anemia, peliosis hepatis was an incidental postmortem finding. In the other patient, who was treated with androgenic-anabolic steroids for aplastic anemia, hepatic failure associated with peliosis hepatis developed. Splenic involvement by peliosis was present in both patients. Peliosis hepatis should be considered in the differential diagnosis of hepatic disease in patients with hematologic disorders, especially if treatment has included androgenic-anabolic steroids.

The cholesterol-lowering effect of portacaval anastomosis in homozygous familial hypercholesterolemia suggested a study of lipid metabolism in cirrhotic patients after portasystemic anastomoses. Fasting serum cholesterol, triglycerides, insulin, and glucagon levels were obtained in 20 patients with alcoholic cirrhosis and portacaval anastomosis, and in 21 nonshunted subjects with cirrhosis. After 100 g of glucose, given orally, insulin and glucagon levels were measured. In the shunted patients serum cholesterol was higher than in the nonshunted subjects, 240 +/- 15 mg per 100 ml (mean +/- 1 SEM) versus 180 +/- 13 mg per 100 ml, P less than 0.01. Triglycerides were normal in both groups. Fasting insulin was elevated to a greater extent in the shunted patients with cirrhosis (36 +/- 5 muU per ml) than in the nonshunted patients (22 +/- 4 muU per ml), P less than 0.05. Two hours after glucose, insulin levels were also elevated to a greater extent in the shunted subjects (304 +/- 50 muU per ml) than in the nonshunted subjects (167 +/- 29 muU per ml), P less than 0.03. Fasting glucagon (corrected for interference factor) was elevated to a greater extent in the shunted subjects (204 +/- 35 pg per ml) than in the nonshunted subjects (80 +/- 19 pg per ml), P less than 0.01. The explanation for serum cholesterol elevation after surgical shunting in cirrhotics is unknown. Two possible hypotheses--the differential action of insulin and glucagon on cholesterol metabolism and the effects of shunting on the cirrhotic liver--are discussed.

A randomised, double-blind, controlled trial has been undertaken to compare the efficacy of hepatitis B immune globulin (H.B.I.G.) with that of immune serum globulin (I.S.G.) for the prophylaxis of viral hepatitis. Participants in the trial were individuals exposed accidentally to material infectious for hepatitis (primarily viral B hepatitis). Preliminary evaluation of the first 302 of the 561 individuals entered into the study indicates that H.B.I.G. significantly reduced the frequencies of both clinical and subclinical hepatitis during the first 3--4 months after the injection. Less than 10% of H.B.I.G. recipients had detectable anti-HBs at the sixth month after the injection, suggesting that H.B.I.G. might need to be given every 3--4 months to continually exposed individuals. Further long-term evaluation is required in order to define more clearly those most likely to benefit from H.B.I.G.