It was reported that steroid withdrawal therapy was beneficial in the management of patients with HBsAg-positive chronic active hepatitis and rarely led to fulminant hepatitis. We report a caseof chronic active hepatitis type B who developed severe liver dysfunction by steroid withdrawal therapy, and died one month later.
A 37-year-old man with HBsAg-and HBeAg-positive chronic hepatitis received steroid withdrawal therapy at the time of elevated transaminase (S-GOT 952u, S-GPT 877u).
The dosage of prednisolone was 40 mg/day at the first week, then decreased by 10 mg everyweek. Total doses were 700 mg in 4 weeks. A rebound S-GOT peak was observed at one week after the discontinuation of prednisolone. At this time, he complained of increasing general fatigue and loss of appetite. The laboratory data showed severe liver dysfunction (Prothrombin time 38%, Hepaplastin test 19%). Ascites was observed by the abdominal CT scanning. Then total bilirubin level increased gradually and urine volume decreased. Finally he died at one month after the discontinuation of prednisolone.

Hematological values were studied in cases of a thorough physical examination, chronic hepatitis and alcoholic liver injury. Cases of a thorough physical examination were a control group. Only thrombocyte count was decreased in cases of chronic hepatitis as compared with a control group. On the other hand a red blood cell count, MCV, MCH and neutrophils were changed significantly in cases of alcoholic liver injury. A red blood cell count was decreased, but MCV, MCH and neutrophils were increased. Correlation between MCV and each item of liver function tests was studied. No significantly correlated item was found in a control group and cases of chronic hepatitis, but GOT/GPT, LDH and CHE were significantly correlated in cases of alcoholic liver injury.

Patients with chronic liver diseases who were hospitalized into our clinic were studied. Chronic liver diseases consisted of three groups, namely chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. Patients with peptic ulcer were studied as a control group. The mean age was the difference of 8.4 years between a group of chronic hepatitis and that of liver cirrhosis, but only 3.0 years between a group of liver cirrhosis and that of hepatocellular carcinoma. HBs antigen positive ratio was almostly same between a group of chronic hepatitis and that of liver cirrhosis, but about twice in a group of hepatocellular carcinoma. Ratio of hard drinker was lowest in a group of hepatocellular carcinoma, and therefore we considered that the effects of alcohol upon carcinogenesis were little. HBs antibody positive ratio was no difference among groups of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma.

We gathered information of both drinking and smoking habits by questionnaires. Objects of our study were 246 male cases around Yanai City. These cases were divided into six groups. The 1st: less than 20 grams of ethyl alcohol daily and less than 10 cigarettes daily (56 cases). The 2nd: 20 grams and less than 10 cigarettes (39 cases). The 3rd: more than 40 grams daily and less than 10 cigarettes (36 cases). The 4th: less than 20 grams and more than 10 cigarettes (36 cases). The 5th: 20 grams and more than 10 cigarettes (23 cases). The 6th: more than 40 grams daily and more than 10 cigarettes (56 cases).
The 1st group was a control group, and was compared among the 4th, 5th and 6th group. Consequently obesity index and serum total protein level were decreased signifiacantly in the 5th and the 6th group. There were no significantly different items in the 4th group. It was thought that both drinking and smoking habits suppressed a nutritional state of a whole body.

The HCV antibody positive rates of blood donors were studied in Yamaguchi Prefecture. C100-3 antibody was examined by the method of the 1st generation. The subjects were 146, 792 people who donated blood from Nov. 1989 to Dec. 1990. The average positive rate was 1.01% in Yamaguchi Prefecture. The positive rates of more than 3% were registered in four towns. In one town out of these four, the average positive rate was 22.0% It was extremely higher than the other three towns. Further study will be required to elucidate such regional differences in the HCV positive rate in the prefecture.

During the past five years, 141 cases of liver cirrohosis were hospitalized intoour clinic. The mean age of these patients was 57.8 years old, and the ratio of male to female was 2.8 to 1. HBs antigen was positive in 16 cases, and among the patients without HBs antigen 49 cases of heavy alcoholic drinker were found. Seventy patients with liver cirrhosis were dividedinto a compensatory group and a decompensatory group according to three clinical findings, ascites, hepatic encephalopathy and bleeding from gastrointestinal tract. It was suggested that five items of biochemical data for liver function were very important on discriminating these two groups. The five items were cholinesterase, indocyanine green test, albumin, prothrombin time and erythrocyte count.
Next, we studied clinical findings of eight patients with minute hepatocellular carcinoma hospitalized into our clinic during the past five years. About a definition of minute hepatocellular carcinoma, we have defined that the tumor size should be less than 3 cm in diameter. Six of these patients were male, and average age was 56.7 years old. Of these patients, five were complicated by liver cirrhosis, and only one revealed positive HBs antigen in serum. The serum alpha-fetoprotein level showed more than 400 ng/ml in three patients. And we have thought that ultrasonographic examination is most effective to diagnose minute hepatocellular carcinoma in various diagnostic imaging methods. Most of patients exhibited a decreased functional reserve in the liver, but six patients underwent hepatic resection. After operation, one patient died of acutehepatic insufficiency on the 8th day, and one died of the recurrence of tumor on the 11th month. Otherfour patients have been alive now.

Patients with fatty liver diagnosed by computed tomography (CT) were studied clinically. Diagnostic criteria of fatty liver by CT was that the ratio of CT value of the liver to that of the spleen was less than 0.90. In cases of fatty liver, hepatic volume was significantly more increased (p<0.01) than normal controls, but volume of the spleen was not more increased. Fatty liver was diagnosed by CT in thirty eight cases. These cases were divided into four groups according to causes of fatty liver.The first was obesity group (fifteen cases), the second was alcohol group (fourteen cases), the third was DM group (four cases) and the fourth was group of unknown origin (five cases). Values of GOT/GPT (OP ratio), γ-GTP, CHE, LAP and ALB were significantly different (p<0.01) between obesity and alcohol group. Many cases of obesity group showed hypercholinesterasemia, but in many cases of alcohol group values of cholinesterase were lower than normal range.

Liver function influenced by drinking were studied in cases of a thorough physical examination. Objects of our study were 172 cases who entered in our clinic during past two years. 172 cases were divided into three groups. 1st group was 70 cases who had drunk less than 20 grams of ethyl alcohol a day, 2nd group was 49 cases who had drunk 20 grams a day and 3rd group was 53 cases who had drunk 40 grams a day.
GOT, GOT/GPT, γ-GTP, CHE and LAP were changed significantly with the increase of drinking as a result of study of these three groups. Especially it was thought that GOT/GPT, γ-GTP and LAP reflected most sharply the grade of alcoholic liver injury.

We have done the questionnaire about patients with hepatocellular carcinoma in Yamaguchi prefecture. The result was that 304 cases were answered. The mean age was 62.1 years old, and the ratio of male to female was 3.7 to 1. Abdominal ultrasonography was examined most frequently, and the next was computed tomography as the method of diagnosis. The serum α-fetoprotein level showed less than 400ng/ml in cases of 49.3%. HBs antigen was positive in cases of 15.9%. Positive cases were significantly lower in the mean age as compared with negative cases, and the ratio of male to female was 8.2 to 1. Liver cirrhosis was complicated in cases of 84%.

A first case is a 43-year-old male. He was admitted after hard drinking, and died two days later for hepatic coma. It is thought that this case applies to a diagnostic criteria of severe alcoholic hepatitis made by a Japanese reserch group about the relation of alcohol to liver. A second case is a 45-year-old male. He was also admitted after hard drinking, but he recovered rapidly. This case was diagnosed as Zieve's syndrome, because hyperlipemia and hemolytic anemia were found.
Volumes of liver and spleen in these two cases were examined by computed tomography. Volumes of liver were more increased and those of spleen were more decreased than those of controls. In a second case a volume of liver was decreased gradually, and that of spleen was increased with recovery from sickness. It is thought that a volume of liver is increased in a patient with alcoholic hepatitis, because liver cells fall into ballooning. But the cause is unknown as yet that a volume of spleen is decreased.