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Active chronic hepatitis: Part 2.

Ulster Medical Society
Publication Date
  • Research Article
  • Medicine


ACTIVE CHRONIC HEPATITIS: Part 2* by TERENCE FULTON, M.D., F.R.C.P. and VINCENT J. McCANN**, M.D., M.R.C.P. Royal Victoria Hospital ** Now Associate in Medicine, Royal Perth Hospital, Perth, Western Australia TREATMENT THE belief that an immunological mechanism is involved in the chronic inflam- matory process in the liver led to the use of corticotrophin and corticosteroid therapy for active chronic hepatitis as early as the 1950's (Waldenstrom 1950, Bearn, Kunkel and Slater 1956, Mackay, Taft and Cowling, 1956). However dis- agreement over the indications for treatment, doubts about its real value and con- cern about possible side-effects continued until the 1960's when gradually a con- sensus developed in favour of treatment (Page, Condie and Good 1964, Mackay, Weiden and Ungar 1964, Mistilis and Blackburn 1967). In a prospective trial the Copenhagen Study Group for Liver Diseases (1969) analysed the effects of pred- nisone in a dose of at least 10 mg daily given to 169 patients with cirrhosis and showed that the death rate in female patients without ascites was significantly lower than in the control group. It was assumed that prednisone exercised its bene- ficial effect in "patients with 'active' cirrhosis particularly at the early stages." This conclusion was confirmed in a second report (1974) on the effect of predni- sone in improving the survival of female patients with compensated non-alcoholic cirrhosis. The controlled prospective trial of corticosteroid therapy in active chronic hepatitis by Cook, Mulligan and Sherlock (1971) also clearly showed that corticosteroids were of value in improving life expectancy in the active phase of the disease, during the first two or three years. The realisation that the end result of continuing aggressive hepatitis was almost invariably cirrhosis and that many cases of cryptogenic cirrhosis probably represented the late stage of unrecognised active chronic hepatitis (Sherlock 1974) give hope for long-term benefits from effective treatment. Cri

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