No abstract

Minimal hepatic encephalopathy (HE) is a major cause of premature retirement in cirrhotics. The decision on the earning capability of a patient is usually based on clinical judgement, considering the patient's complaints and clinical findings such as nervousness and depression. In a comprehensive psychometric study we were able to show that cirrhotic patients, who are considered to be unable to earn their living, differ significantly from those who are working, in tests evaluating psychomotor function and in personality and subjective well-being scores representing nervousness, aggressiveness, depression. The latter scores are considered to represent the individual discrepancies between professional demands and cerebral performance. Since minimal HE affects psychomotor function but not verbal abilities this discrepancy exists predominantly in "blue collar workers." In accordance with this 60% of "blue collar" (in contrast to 20% of "white collar") workers of our patient group were considered unfit for work. Working ability is an essential element of quality of life in Western societies. Thus, an impairment of working capability is of major impact on quality of life in cirrhotics.

HBsAg was determined quantitatively by radioimmunoassay and by Laurell electrophoresis in sera of 90 patients with acute hepatitis B, 57 patients with chronic hepatitis B, and 154 HBsAg positive blood donors. Of 55 patients with clearance of HBsAg from the circulation within six months, 54 (98%) showed an at least 50% reduction in concentration within 16 days. All 55 patients had such a decrease within 20 days. No such decrease was found in seven patients with acute hepatitis B who became HBsAg carriers. Therefore, quantitative HBsAg concentration in paired sera seems to be a reliable and early prognostic marker in acute hepatitis B. In patients with clearance of HBsAg most of the antigen is already present in the circulation at hospitalization and is eliminated with a mean half-life of 8.8 days. Patients with chronic hepatitis exhibit on average nearly the same HBsAg concentration (about 40,000 ng/ml) as patients with acute hepatitis B at hospitalization (about 39,000 ng/ml) and HBsAg positive blood donors on average a lower HBsAg concentration (about 8,000 ng/ml).

An extensive psychometric test program was performed in 96 patients with proven liver cirrhosis and clinical signs of portal hypertension as well as in 20 patients with alcoholic pancreatitis, in 19 patients without cirrhosis but with alcoholic cerebral atrophy and in 163 normal controls. The study population comprised six groups of subjects as follows: Group 1. 27 patients with non-alcoholic cirrhosis and normal EEG pattern. Group 2. 48 patients with alcoholic cirrhosis and normal EEG pattern. Group 3. 21 patients with cirrhosis and minimal EEG changes. Group 4. 20 patients with alcoholic pancreatitis. Group 5. 19 patients without cirrhosis but with alcoholic cerebral atrophy. Group 6. 163 normal controls. A one way analysis of variances comparing asymptomatic patients (group 1, 2 and 4) with controls (group 6) revealed no significant differences between patients with alcoholic and non-alcoholic cirrhosis, both cirrhotic groups scoring significantly lower than patients with alcoholic pancreatitis and normal controls, who did not differ significantly. Comparing symptomatic patients (group 3 and 5) with normal controls both patient groups scored significantly lower than controls, the cirrhotic group (group 3) scoring significantly lower than patients with alcoholic cerebral atrophy. A two way analysis of variances revealed that in clinically asymptomatic patients cerebral functional defects revealed by psychometry are only due to cirrhosis and that in patients with clinical evidence of cerebral impairment the factors alcohol and cirrhosis are additive - not synergistic. A multiple group stepwise discriminant analysis revealed that tests evaluating psychomotor functions contributed most to the discrimination. Especially "line tracing " proved to be most sensitive and most specific followed by dexterity, steadiness, aiming, digit symbols in sensitivity and by reaction time, steadiness and dexterity in specificity. A test program for clinical use is proposed.