atitis activity index scoring system 14 and others, [15][16][17] have To clarify the characteristics of fibrosis developed in been used in the assessment of the degree of fibrosis, howthe process from chronic hepatitis C to cirrhosis, a morever, these methods cannot completely avoid the observer's phometric analysis of liver biopsy samples was conbias. In the present study, we selected chronic hepatitis C ducted on 25 chronic hepatitis C patients and 20 chronic patients who developed cirrhosis and underwent multiple hepatitis B patients (controls). Hepatitis C patients were liver biopsy procedures; and conducted a quantitative analyfollowed up for 3 to 23 years. The mean number of liver sis using morphometry to determine chronological changes biopsies performed on these patients was 3.8. Each biof fibrosis in the course from chronic hepatitis to cirrhosis. opsy was evaluated for the degree of fibrosis by usingThe result of the initial biopsy was also assessed as to two methods: a semiquantitative method with a staging whether it could be a predictive factor for the development scoring system, and morphometry using a computed imof cirrhosis from chronic hepatitis C. age analysis system. A significant correlation was observed between the Stage and the area of fibrosis (AF Å PATIENTS AND METHODSthe ratio of the area of fibrosis to that of the entire tissue specimen). The AF in cirrhosis was significantly higherWe examined 25 patients with chronic hepatitis C who were positive for hepatitis C virus antibodies by a second generation assay, in hepatitis C patients than in hepatitis B patients. The negative to hepatitis B surface antigen, and eventually developed ratio of AF in the last biopsy sample to AF in the initial cirrhosis during clinical observation. They were selected from apbiopsy sample was significantly higher in hepatitis C proximately 1,000 patients with chronic liver diseases seen at Napatients than in hepatitis B patients. Evolution from tional Nagasaki Chuo Hospital, Ohmura, Japan during the period chronic hepatitis C to cirrhosis occurred more fre-from 1967 to 1994. They were willing to undergo biopsy procedures quently in patients aged ¢50 years, and this time period and to be followed up at a regular interval because of fluctuations was 1.8 times shorter than that in patients aged õ50 in their serum alanine aminotransferase levels. The initial biopsy years. AF in the initial biopsy related significantly to the was usually undertaken within 6 months after the disease onset. period of evolution from chronic hepatitis C to cirrhosis. Patients, whose initial biopsy showed cirrhosis, were excluded from the study. Ten of the 25 patients had received blood transfusions, AF in the initial biopsy might be a predictive factor for and three of them were followed up after having developed acute In some cases, chronic hepatitis progresses to cirrhosis and positive for serum hepatitis B surface antigen, and negative for hepathen to hepatocellular carcinoma within 20 to 30 years. 7,12,13 titis C virus antibody...

Extensive studies on hepatitis C have been conducted since Limited information is available regarding the histology of the specific serological test for hepatitis C virus (HCV) infechepatitis C virus infection in children. The aim of this study tion was developed, and the characteristics of this disease was to determine the histological pattern of chronic hepatitis have been established. [1][2][3][4] Recent pathological studies have C (CHC) in children, and liver biopsy specimens from 109 clearly defined the histological characteristics of chronic heppediatric patients with CHC were examined. Each biopsy atitis C (CHC), e.g., lymphoid aggregates in the portal tract, specimen was evaluated based on a numerical scoring system bile duct damage, and large-droplet fatty changes, in comparfor the stage of fibrosis (1-4), the grade of portal/periportal ison to chronic hepatitis B (CHB). [5][6][7] However, in-depth studnecroinflammation (0-4), the grade of lobular necroinflammaies of CHC in children have not been conducted, and the tion (0-4), and their sum (final grade). The histological lesions histological characteristics of this disease in pediatric patients considered to be characteristic of chronic hepatitis were also remained to be identified, although it is well known that evaluated. None of the children had liver cirrhosis, and 105 even pediatric patients with CHB have various degrees of cases (97%) were stage 1 or 2. Only 4 children were stage 3.hepatic lesions ranging from mild fibrosis to liver cirrhosis. 8 Two of these 4 cases showed hemosiderosis. A significant Some studies have reported histopathology of CHC in pediatcorrelation was observed between the staging score and the ric patients, 9-13 but they examined only a small number of final grade in the pediatric patients (r Å .59; P õ .0001). The liver biopsy specimens, and their histological evaluation histological characteristics of adult CHC, such as lymphoid methods differed. For example, Inui et al. 9 examined the aggregate, bile duct injury, and fatty changes, were also obliver biopsy specimens of 25 pediatric patients with CHC served in the children. In conclusion, the majority of children who were all transfusion associated, but the investigators did with CHC presented with mild fibrosis, but a few showed not find liver cirrhosis. In contrast, Lai et al. 10 followed up CHC with lobular distortion and hemosiderosis. Frequent 46 thalassemic children who were treated with blood transfublood transfusion may aggravate hepatic lesions in pediatric sions and found that 5 patients (11%) developed liver cirrho-CHC. (HEPATOLOGY 1997;26:771-775.) sis during the following 8 years.The present study was designed to clarify the histological changes in the liver of pediatric patients with CHC. PATIENTS AND METHODSAbbreviations: HCV, hepatitis C virus; CHC, chronic hepatitis C; CHB, chronic hepatitis B.Patients. We collected 109 biopsy specimens from 109 pediatric men and 62 women who ranged in age from 23 to 95 years old Received September 27, 1996; accept...

Context.—Cirrhosis is widely regarded as being irreversible. Recent studies have demonstrated that fibrosis may decrease with time in humans and experimental animals if the disease activity becomes quiescent. The histologic appearance of regressing cirrhosis in the human has not been described in detail. Objectives.—To define histologic parameters that indicate regression of cirrhosis and to provide an interpretation of how regression occurs from a histologic point of view. Design.—A patient who underwent a series of biopsies that showed apparent regression of hepatitis B cirrhosis is presented. In addition, 52 livers removed at transplantation having cirrhosis or incomplete septal cirrhosis were graded for histologic parameters that suggest progression or regression of fibrosis. Progression parameters were steatohepatitis, inflammation, bridging necrosis, and piecemeal necrosis. The regression parameters (collectively called the hepatic repair complex) were delicate perforated septa, isolated thick collagen fibers, delicate periportal fibrous spikes, portal tract remnants, hepatic vein remnants with prolapsed hepatocytes, hepatocytes within portal tracts or splitting septa, minute regenerative nodules, and aberrant parenchymal veins. Results and Conclusions.—Regression parameters were found in all livers and were prominent in the majority. Livers with micronodular cirrhosis, macronodular cirrhosis, and incomplete septal cirrhosis demonstrate a histologic continuum. A continuum of regressive changes was also seen within individual livers. These appearances allow one to understand visually how fibrous regions of hepatic parenchyma can be returned toward a normal appearance. Many examples of incomplete septal cirrhosis could be the product of regressed cirrhosis.

Hypoxic events may play a crucial aetiologic role in the pathogenesis of late-onset neonatal intussusception.

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