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Early-stage chronic active hepatitis treated with prednisolone and azathioprine has a good prognosis. In most of the 20 patients investigated improvement occurred already after 3 months of treatment, by 6 to 9 months the laboratory findings had become normal and after 12 months there was no definite evidence histologically for the initial aggressive form of liver disease. However, in the late stage of chronic active hepatitis the effect of immunosuppressive treatment seems questionable. The tendency for improvement of laboratory findings during immunosuppression was significantly worse than in early-stage disease. Histologically there was no real improvement in two thirds of the cases a year after onset of treatment.

Analysis of the enzyme pattern in 34 patients with liver histology indicating porto-periportal inflammation showed two statistically well differentiated groups: 20 patients with clinical suspicion of early chronic active hepatitis and 14 patients with suspected chronic destructive cholangitis. The course of the disease and the response to immunosuppressive treatment were quite different in the two groups. For differentiation of the early stages of chronic active hepatitis and chronic destructive cholangitis correct interpretation of the enzyme pattern is of great importance. It is also relevant for the decision to use long term immunosuppressive treatment.

Immunosuppressive treatment with prednisolone and azathioprine was administered to a small group of nine patients in the early stage of chronic active or inactive hepatitis about six months after onset of the disease. There occurred a relatively rapid improvement in the active liver process, including biochemical and histological findings, compared with ten patients in a control group who, with the same liver condition, were not given immunosuppressive treatment. There were no side-effects in the treated group.

A double-blind study was conducted in four hospitals to test the effect of (+)-cyanidanol-3 (Catergen) on the course of acute viral hepatitis. Activities of a number of enzymes, bilirubin levels and gamma-globulin concentrations, as well as elimination of HBs antigen in blood were measured serially in 73 patients with viral hepatitis, 37 being treated with the drug, 36 patients receiving a placebo. In addition, liver biopsies before and after treatment were compared (19 patients treated, 23 patients on placebo). There was no significant difference between the treatment and placebo groups with regards to morphological and biochemical changes.

Results of laparoscopy and scintigraphy were compared and contrasted with ultimate clinical diagnosis in 94 patients with chronic hepatitis or liver cirrhosis and 38 with liver tumours. The findings agreed in 77 cases of chronic hepatitis and cirrhosis and 33 of liver tumour. In the remainder either laparoscopy or scintigraphy gave the wrong results. In one case each of cirrhosis and liver metluded that (1) laparoscopy and scintigraphy are methods complementing but not replacing other clinical tests; (2) if diffuse liver disease is suspected clinically the diagnosis can essentially be done only by laparoscopy and selective biopsy or blind liver biopsy but not scintigraphy; (o) if a circumscribed condition is suspected, scintigraphy is among the most important screening tests, but cannot replace laparoscopy, biopsy or angiography for confirming the diagnosis; (4) liver scan is an important method, of little stress to the patient, in following the progress of chronic hepatitis and liver cirrhosis, additional to clinical examination, enzyme tests, laparoscopy and histology.