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The surface antigen of hepatitis B virus (HBsAg) is the main serological marker of HBV infection since its discovery almost 50 years ago. Currently the quantification of HBsAg has acquired special relevance as there are commercial tests to measure its levels. Several studies have shown that in patients treated with pegylated interferon alfa the fall of HBsAg levels predicts the loss of HBsAg and persistent virologic response. The role of the quantification of HBsAg in the treatment with nucleoside analogues is still not well understood and requires further studies., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Background and Objective: The extended treatment with lamivudine in patients with chronic hepatitis B is associated with the emergence of resistances. Patients with resistance to lamivudine show a loss of biochemical and virological responses and a higher progression of their liver disease. Adefovir dipivoxil, an analogue of the nucleotides, is effective for the treatment of patients with resistance to lamivudine. The aim of this study was to evaluate the efficacy, safety and resistance of adefovir dipivoxil in patients with chronic hepatitis B refractory to treatment with lamivudine., Patients and Method: One hundred and twenty hepatits B virus patients refractory to lamivudine were treated with adefovir dipivoxil. Seventy-four patients were followed up during two years. In all cases, the hepatitis B virus-DNA was determined by polymerase chain reaction, and in those cases without response to treatment, the presence of resistances to adefovir and lavimudine were studied., Results: At the second year of treatment, we observed a biological response of 54.1%, a biochemical response of 62.2%, while an elimination of hepatitis B e antigen was seen in 21% cases. 20% patients developed resistance to adefovir dipivoxil, and the most frequent detected mutations were: A181V, A181T and N236T. Drug safety was excellent; in fact, only one adverse effect related to the drug was detected., Conclusions: Treatment with adefovir dipivoxil for 2 years in mono-therapy in patient who are previously non-responders to lavimudine is associated with a high biochemical and virologycal response with an excellent safety. At the second year of treatment, the adefovir dipivoxil resistance rate is 20%.

Background: Patients with chronic hepatitis are in risk to acquire a fulminant hepatitis associated with hepatitis A virus superinfection., Patients and Methods: Antibodies against hepatitis A were study in serum from 353 patients with chronic hepatitis B or C., Results: The prevalence of IgG-HAV antibodies was 81% in chronic hepatitis C patients, and 77% in chronic hepatitis B patients. The presence of anti-HAV antibodies was related to the patients' age. None case of acute hepatitis A in chronic hepatitis patients was detected., Conclusions: The prevalence of anti-HAV antibodies is high in patients with chronic viral hepatitis but the incidence of the disease is low. Hepatitis A vaccination should do with previously screening.

Background: Hepatocellular carcinoma (HCC) constitutes a frequent clinical problem in the follow up of patients with liver cirrhosis. The clinical features and diagnoses and survival in a group of 140 cases of HCC are reviewed., Methods: All the clinical histories of the patients diagnosed of HCC between 1987 and 1991 in the Unit of Hepatology of the General Hospital of the Vall d'Hebron were retrospectively reviewed. The clinical, analytical, diagnostic, therapeutic and evolutive data were collected., Results: One hundred forty patients (121 males and 19 females) were included. In 92% of the cases the HCC was established on liver cirrhosis in which alcohol was the most frequent etiologic factor. According to the Pugh-Child classification 31% of the patients were in group A, 32.5% in group B and 36.4% in group C. Clinically, diagnosis was carried out in the course of periodic out patient follow up in 21% of the cases. HBsAg was positive in 8.5% of the cases and anti HCV was 55% and in 78% by ELISA 1 and ELISA 2, respectively. Alphafetoprotein (AFP) was greater than 500 ng/dl in 37% of the cases. The treatment received was: surgical resection in 18 cases, liver transplantation in 3, intraarterial chemotherapy in 11 and intratumoral alcoholization in 8. Symptomatic treatment was administered in 71% of the cases. Global mean survival was 4.4 +/- 0.5 months. Mean survival was greater in patients with better liver function and smaller tumor size in the patients surgically treated and in those diagnosed in the periodic controls., Conclusions: Hepatocellular cancer is normally established in patients with liver cirrhosis. The high prevalence of infection by the hepatitis C virus and the low prevalence by hepatitis B virus is of note. The patients with greater survival were those surgically treated and those diagnosed in periodic controls.

The clinical case of a 56 year old patient who developed a grafted hepatic tumoration on a year after diagnosis of liver cirrhosis of alcoholic etiology is reported. Diagnosis of the mass was made by fine needle aspiration punction ecographically guided obtaining a cellular block which, upon anatomopathological study, revealed the presence of a malignant mesenchymal tumor; a leiomyosarcoma. Not only is this type of primary hepatic tumor rare but its appearance on a liver of alcoholic cirrhosis is also of interest. It is much more common to find primary hepatic tumors of epithelial origin, concretely hepatocarcinomas. The value of this finding is discussed with the importance of the ecographically guided punction enabling the establishment of a precise histological diagnosis being underlined. The prognosis of malignant hepatic mesenchymal tumors is commented upon as well as the long survival associated to the same, which, in this case, was longer than 18 months.

We have prospectively studied 158 cases of acute hepatitis delta observed during the last 7 years in a general hospital. Among them 136 were male and 22 female. The mean age was 22.7 years with a range between 16 and 61 years. The epidemiologic factors were drug addiction by parenteral route in 145 cases (92%), sexual transmission in 5 (3%), post transfusional in 2 (1%) and unknown in 6 (4%). With respect to the delta type infection, 105 cases (66%) were coinfections with type B and delta, and 53 patients had a type delta superinfection (34%). The clinical course was a fulminant hepatitis in three cases (two cases of coinfection B and delta an one case of delta superinfection), and an acute benign hepatitis in 155 patients. The follow-up of 118 patients revealed that 96% of coinfections by type B and delta evolved to the chronicity showing findings of active chronic hepatitis or hepatic cirrhosis. It should be noted that in 4 cases of superinfection delta type (11%) the HBsAg was negative after several months of positivity. In these patients the level of transaminases normalized and the hepatic histology evidenced alterations of chronic active hepatitis (2 cases) and hepatic cirrhosis (2 cases) without identification of tissular delta antigen.

A 50-year-old male without relevant past history was admitted because of fever lasting for 23 days. Physical examination showed hepatomegaly and splenomegaly without other findings. Laboratory studies only revealed mildly abnormal hepatic enzymes. The remaining investigations (markers, serologies, antinuclear antibodies, blood and urine cultures) were negative. Chest and abdomen X-ray films were normal. In abdominal echogram a homogeneous liver without space occupying lesions was seen, and computed tomography disclosed enlarged liver, spleen and lymph nodes. Needle hepatic biopsy was reported as showing reactive hepatitis. Although clinically meningeal antibody seroconversions were not found, DNA chains of cytomegalovirus, Epstein-Barr virus, hepatitis B virus and herpes virus simplex were investigated with the in situ hybridisation technique. Its result was a strongly positive hybridisation for herpes virus and negative for the other investigated viruses.

In 1972, Magnius and Espmark on confronting different sera containing the surface antigen of hepatitis B with each other, demonstrated a new antigenic item which they called e. In later works the presence of this new antigenic specificity was associated with a greater rate of incidence of chronic hepatic lesion and a greater contagiousness of B virus. In the present study the e system was determined in a group of HBsAG positive blood donors and in a group of patients carrying HBeAG who had been admitted to the hospital for different reasons. The results showed an elevated rate of anti-e antibodies in the asymptomatic donors, and this could be correlated with clinical and biochemical indemnity of the liver function. HBsAg carriers mainly presented renal insufficiency or hematologic disorders, probably related to a deficient immune response. Determination of the e system shows its usefulness in enabling HBsAg positive carriers to be classified according to whether they present or not present hepatic lesion. The presence of HBeAg could be correlated with hepatic lesion, while HBeAc seems to determine some type of protection on those patients who have it in their sera.

In the present work radioimmunoassay technique detecting antibodies have been used to diagnose viral hepatitis type A. Twenty-nine patients with sporadic acute hepatitis were studied. All of the cases were negative to surface antigen of viral hepatitis type B. Blood samples were obtained at the onset of clinical picture and on subsequent weeks. Antibody levels (anti-hepatitis virus A) showed a significant increase between the second and the sixth week in 21 cases (72.4 percent). An increased antibody titer in a single determination, however, is not sufficient for the diagnosis of hepatitis virus A, since antibodies against such virus are present in a large percentage of the normal population. At least two augmented titers in consecutive samples are necessary to diagnose viral hepatitis type A.