The treatment of chronic hepatitis with adrenal cortical hormones
Identifieur interne : 001936 ( Istex/Corpus ); précédent : 001935; suivant : 001937The treatment of chronic hepatitis with adrenal cortical hormones
Auteurs : Fred Kern Jr. ; Irwin E. Vinnik ; John E. Struthers Jr. ; Rolla B. HillSource :
- The American Journal of Medicine [ 0002-9343 ] ; 1962.
Abstract
Fifteen patients with active chronic hepatitis and three with postnecrotic cirrhosis without active inflammation have been treated continuously with adrenocortical hormones for as long as eight years. They have been followed closely by means of serial chemical tests for liver function and, when possible, by serial liver biopsies. This experience is analyzed in an effort to determine the effects of the therapy, an appropriate therapeutic regimen, and the dangers and complication of therapy.For most patients the initial treatment consisted of a daily dose of steroids large enough to suppress disease activity. After apparent optimal improvement, the dose was cautiously reduced to the smallest amount that would maintain improvement.Based on the response to steroid therapy, the patients were divided into five groups. In group I two patients had complete biochemical and histologic remission; in one patient, steroid therapy was withdrawn without recurrences. The eight patients in group II had an excellent response to therapy. Even though there is still chemical and histologic evidence of liver disease, there has been no progression. A moderate response was seen in the two patients in group III; there was evidence of progressive hepatic disease, but the rate of progression has been retarded significantly. In group IV the initial response to steroid therapy in three patients was good but the unavoidably short duration of therapy did not permit clear interpretation. In group V, consisting of three patients, there was no response to steroid therapy. These patients had postnecrotic cirrhosis, without active chronic hepatitis.The complications of steroid therapy included peptic ulcer (two patients), osteoporosis with a pathologic fracture (one patient) and thrombophlebitis with pulmonary emboli (two patients). Abrupt discontinuance or too rapid decrease in steroid dosage frequently resulted in an exacerbation of the hepatitis.It is concluded from these observations that steroid therapy is effective in suppressing or retarding disease activity in most patients with active chronic hepatitis. Continued therapy with adequate doses is necessary to maintain this suppression for prolonged periods of time. No definite statement can be made about the effect of steroid therapy on the ultimate outcome of the disease, but no patient in this series has died while receiving steroid therapy. Further, it is concluded that the dosage of steroids should be reduced cautiously and slowly, with frequent observations of hepatic function.
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DOI: 10.1016/0002-9343(63)90174-8
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Hill</name><affiliation><mods:affiliation>Denver, Colorado USA</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:4B5A479652B1EF6C74BF674DB5510F9407C96AE8</idno><date when="1963" year="1963">1963</date><idno type="doi">10.1016/0002-9343(63)90174-8</idno><idno type="url">https://api.istex.fr/document/4B5A479652B1EF6C74BF674DB5510F9407C96AE8/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001936</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">The treatment of chronic hepatitis with adrenal cortical hormones</title><author><name sortKey="Kern Jr, Fred" sort="Kern Jr, Fred" uniqKey="Kern Jr F" first="Fred" last="Kern Jr.">Fred Kern Jr.</name><affiliation><mods:affiliation>Denver, Colorado USA</mods:affiliation></affiliation></author><author><name sortKey="Vinnik, Irwin E" sort="Vinnik, Irwin E" uniqKey="Vinnik I" first="Irwin E." last="Vinnik">Irwin E. Vinnik</name><affiliation><mods:affiliation>Denver, Colorado USA</mods:affiliation></affiliation></author><author><name sortKey="Struthers Jr, John E" sort="Struthers Jr, John E" uniqKey="Struthers Jr J" first="John E." last="Struthers Jr.">John E. Struthers Jr.</name><affiliation><mods:affiliation>Denver, Colorado USA</mods:affiliation></affiliation></author><author><name sortKey="Hill, Rolla B" sort="Hill, Rolla B" uniqKey="Hill R" first="Rolla B." last="Hill">Rolla B. Hill</name><affiliation><mods:affiliation>Denver, Colorado USA</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">The American Journal of Medicine</title><title level="j" type="abbrev">AJM</title><idno type="ISSN">0002-9343</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1962">1962</date><biblScope unit="volume">35</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="310">310</biblScope><biblScope unit="page" to="322">322</biblScope></imprint><idno type="ISSN">0002-9343</idno></series><idno type="istex">4B5A479652B1EF6C74BF674DB5510F9407C96AE8</idno><idno type="DOI">10.1016/0002-9343(63)90174-8</idno><idno type="PII">0002-9343(63)90174-8</idno><idno type="ArticleID">63901748</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0002-9343</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Fifteen patients with active chronic hepatitis and three with postnecrotic cirrhosis without active inflammation have been treated continuously with adrenocortical hormones for as long as eight years. They have been followed closely by means of serial chemical tests for liver function and, when possible, by serial liver biopsies. This experience is analyzed in an effort to determine the effects of the therapy, an appropriate therapeutic regimen, and the dangers and complication of therapy.For most patients the initial treatment consisted of a daily dose of steroids large enough to suppress disease activity. After apparent optimal improvement, the dose was cautiously reduced to the smallest amount that would maintain improvement.Based on the response to steroid therapy, the patients were divided into five groups. In group I two patients had complete biochemical and histologic remission; in one patient, steroid therapy was withdrawn without recurrences. The eight patients in group II had an excellent response to therapy. Even though there is still chemical and histologic evidence of liver disease, there has been no progression. A moderate response was seen in the two patients in group III; there was evidence of progressive hepatic disease, but the rate of progression has been retarded significantly. In group IV the initial response to steroid therapy in three patients was good but the unavoidably short duration of therapy did not permit clear interpretation. In group V, consisting of three patients, there was no response to steroid therapy. These patients had postnecrotic cirrhosis, without active chronic hepatitis.The complications of steroid therapy included peptic ulcer (two patients), osteoporosis with a pathologic fracture (one patient) and thrombophlebitis with pulmonary emboli (two patients). Abrupt discontinuance or too rapid decrease in steroid dosage frequently resulted in an exacerbation of the hepatitis.It is concluded from these observations that steroid therapy is effective in suppressing or retarding disease activity in most patients with active chronic hepatitis. Continued therapy with adequate doses is necessary to maintain this suppression for prolonged periods of time. No definite statement can be made about the effect of steroid therapy on the ultimate outcome of the disease, but no patient in this series has died while receiving steroid therapy. Further, it is concluded that the dosage of steroids should be reduced cautiously and slowly, with frequent observations of hepatic function.</div></front></TEI><istex><corpusName>elsevier</corpusName><author><json:item><name>Fred Kern, Jr. M.D.</name><affiliations><json:string>Denver, Colorado USA</json:string></affiliations></json:item><json:item><name>Irwin E. Vinnik M.D.</name><affiliations><json:string>Denver, Colorado USA</json:string></affiliations></json:item><json:item><name>John E. Struthers, Jr. M.D.</name><affiliations><json:string>Denver, Colorado USA</json:string></affiliations></json:item><json:item><name>Rolla B. Hill M.D.</name><affiliations><json:string>Denver, Colorado USA</json:string></affiliations></json:item></author><articleId><json:string>63901748</json:string></articleId><language><json:string>eng</json:string></language><abstract>Fifteen patients with active chronic hepatitis and three with postnecrotic cirrhosis without active inflammation have been treated continuously with adrenocortical hormones for as long as eight years. They have been followed closely by means of serial chemical tests for liver function and, when possible, by serial liver biopsies. This experience is analyzed in an effort to determine the effects of the therapy, an appropriate therapeutic regimen, and the dangers and complication of therapy.For most patients the initial treatment consisted of a daily dose of steroids large enough to suppress disease activity. After apparent optimal improvement, the dose was cautiously reduced to the smallest amount that would maintain improvement.Based on the response to steroid therapy, the patients were divided into five groups. In group I two patients had complete biochemical and histologic remission; in one patient, steroid therapy was withdrawn without recurrences. The eight patients in group II had an excellent response to therapy. Even though there is still chemical and histologic evidence of liver disease, there has been no progression. A moderate response was seen in the two patients in group III; there was evidence of progressive hepatic disease, but the rate of progression has been retarded significantly. In group IV the initial response to steroid therapy in three patients was good but the unavoidably short duration of therapy did not permit clear interpretation. In group V, consisting of three patients, there was no response to steroid therapy. These patients had postnecrotic cirrhosis, without active chronic hepatitis.The complications of steroid therapy included peptic ulcer (two patients), osteoporosis with a pathologic fracture (one patient) and thrombophlebitis with pulmonary emboli (two patients). Abrupt discontinuance or too rapid decrease in steroid dosage frequently resulted in an exacerbation of the hepatitis.It is concluded from these observations that steroid therapy is effective in suppressing or retarding disease activity in most patients with active chronic hepatitis. Continued therapy with adequate doses is necessary to maintain this suppression for prolonged periods of time. No definite statement can be made about the effect of steroid therapy on the ultimate outcome of the disease, but no patient in this series has died while receiving steroid therapy. 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Colorado.</note><affiliation>From the Department of Medicine and Pathology, University of Colorado Medical Center, Denver, Colorado.</affiliation><affiliation>Denver, Colorado USA</affiliation></author><author><persName><forename type="first">Irwin E.</forename><surname>Vinnik</surname></persName><roleName type="degree">M.D.</roleName><note type="biography">From the Department of Medicine and Pathology, University of Colorado Medical Center, Denver, Colorado.</note><affiliation>From the Department of Medicine and Pathology, University of Colorado Medical Center, Denver, Colorado.</affiliation><affiliation>Denver, Colorado USA</affiliation></author><author><persName><forename type="first">John E.</forename><surname>Struthers, Jr.</surname></persName><roleName type="degree">M.D.</roleName><note type="biography">From the Department of Medicine and Pathology, University of Colorado Medical Center, Denver, Colorado.</note><affiliation>From the Department of Medicine and Pathology, University of Colorado Medical Center, Denver, Colorado.</affiliation><affiliation>Denver, Colorado USA</affiliation></author><author><persName><forename type="first">Rolla B.</forename><surname>Hill</surname></persName><roleName type="degree">M.D.</roleName><note type="biography">From the Department of Medicine and Pathology, University of Colorado Medical Center, Denver, Colorado.</note><affiliation>From the Department of Medicine and Pathology, University of Colorado Medical Center, Denver, Colorado.</affiliation><affiliation>Denver, Colorado USA</affiliation></author></analytic><monogr><title level="j">The American Journal of Medicine</title><title level="j" type="abbrev">AJM</title><idno type="pISSN">0002-9343</idno><idno type="PII">S0002-9343(00)X0351-8</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1962"></date><biblScope unit="volume">35</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="310">310</biblScope><biblScope unit="page" to="322">322</biblScope></imprint></monogr><idno type="istex">4B5A479652B1EF6C74BF674DB5510F9407C96AE8</idno><idno type="DOI">10.1016/0002-9343(63)90174-8</idno><idno type="PII">0002-9343(63)90174-8</idno><idno type="ArticleID">63901748</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1963</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Fifteen patients with active chronic hepatitis and three with postnecrotic cirrhosis without active inflammation have been treated continuously with adrenocortical hormones for as long as eight years. They have been followed closely by means of serial chemical tests for liver function and, when possible, by serial liver biopsies. This experience is analyzed in an effort to determine the effects of the therapy, an appropriate therapeutic regimen, and the dangers and complication of therapy.For most patients the initial treatment consisted of a daily dose of steroids large enough to suppress disease activity. After apparent optimal improvement, the dose was cautiously reduced to the smallest amount that would maintain improvement.Based on the response to steroid therapy, the patients were divided into five groups. In group I two patients had complete biochemical and histologic remission; in one patient, steroid therapy was withdrawn without recurrences. The eight patients in group II had an excellent response to therapy. Even though there is still chemical and histologic evidence of liver disease, there has been no progression. A moderate response was seen in the two patients in group III; there was evidence of progressive hepatic disease, but the rate of progression has been retarded significantly. In group IV the initial response to steroid therapy in three patients was good but the unavoidably short duration of therapy did not permit clear interpretation. In group V, consisting of three patients, there was no response to steroid therapy. These patients had postnecrotic cirrhosis, without active chronic hepatitis.The complications of steroid therapy included peptic ulcer (two patients), osteoporosis with a pathologic fracture (one patient) and thrombophlebitis with pulmonary emboli (two patients). Abrupt discontinuance or too rapid decrease in steroid dosage frequently resulted in an exacerbation of the hepatitis.It is concluded from these observations that steroid therapy is effective in suppressing or retarding disease activity in most patients with active chronic hepatitis. Continued therapy with adequate doses is necessary to maintain this suppression for prolonged periods of time. No definite statement can be made about the effect of steroid therapy on the ultimate outcome of the disease, but no patient in this series has died while receiving steroid therapy. Further, it is concluded that the dosage of steroids should be reduced cautiously and slowly, with frequent observations of hepatic function.</p></abstract></profileDesc><revisionDesc><change when="1962-08-21">Received</change><change when="1962">Published</change></revisionDesc></teiHeader></istex:fulltextTEI></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: tail"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla" xml:lang="en"><item-info><jid>AJM</jid><aid>63901748</aid><ce:pii>0002-9343(63)90174-8</ce:pii><ce:doi>10.1016/0002-9343(63)90174-8</ce:doi><ce:copyright type="unknown" year="1963"></ce:copyright></item-info><head><ce:article-footnote><ce:label>☆</ce:label><ce:note-para>Supported in part by National Institutes of Health Training Grant 2A-5122.</ce:note-para></ce:article-footnote><ce:dochead><ce:textfn>Clinical study</ce:textfn></ce:dochead><ce:title>The treatment of chronic hepatitis with adrenal cortical hormones</ce:title><ce:author-group><ce:author><ce:given-name>Fred</ce:given-name><ce:surname>Kern</ce:surname><ce:suffix>Jr.</ce:suffix><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="FN1"><ce:sup loc="post">1</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Irwin E.</ce:given-name><ce:surname>Vinnik</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="FN1"><ce:sup loc="post">1</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>John E.</ce:given-name><ce:surname>Struthers</ce:surname><ce:suffix>Jr.</ce:suffix><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="FN1"><ce:sup loc="post">1</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Rolla B.</ce:given-name><ce:surname>Hill</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="FN1"><ce:sup loc="post">1</ce:sup></ce:cross-ref></ce:author><ce:affiliation><ce:textfn>Denver, Colorado USA</ce:textfn></ce:affiliation><ce:footnote id="FN1"><ce:label>1</ce:label><ce:note-para>From the Department of Medicine and Pathology, University of Colorado Medical Center, Denver, Colorado.</ce:note-para></ce:footnote></ce:author-group><ce:date-received day="21" month="8" year="1962"></ce:date-received><ce:abstract class="author"><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para view="all" id="simple-para.0010">Fifteen patients with active chronic hepatitis and three with postnecrotic cirrhosis without active inflammation have been treated continuously with adrenocortical hormones for as long as eight years. They have been followed closely by means of serial chemical tests for liver function and, when possible, by serial liver biopsies. This experience is analyzed in an effort to determine the effects of the therapy, an appropriate therapeutic regimen, and the dangers and complication of therapy.</ce:simple-para><ce:simple-para view="all" id="simple-para.0015">For most patients the initial treatment consisted of a daily dose of steroids large enough to suppress disease activity. After apparent optimal improvement, the dose was cautiously reduced to the smallest amount that would maintain improvement.</ce:simple-para><ce:simple-para view="all" id="simple-para.0020">Based on the response to steroid therapy, the patients were divided into five groups. In group I two patients had complete biochemical and histologic remission; in one patient, steroid therapy was withdrawn without recurrences. The eight patients in group II had an excellent response to therapy. Even though there is still chemical and histologic evidence of liver disease, there has been no progression. A moderate response was seen in the two patients in group III; there was evidence of progressive hepatic disease, but the rate of progression has been retarded significantly. In group IV the initial response to steroid therapy in three patients was good but the unavoidably short duration of therapy did not permit clear interpretation. In group V, consisting of three patients, there was no response to steroid therapy. These patients had postnecrotic cirrhosis, without active chronic hepatitis.</ce:simple-para><ce:simple-para view="all" id="simple-para.0025">The complications of steroid therapy included peptic ulcer (two patients), osteoporosis with a pathologic fracture (one patient) and thrombophlebitis with pulmonary emboli (two patients). Abrupt discontinuance or too rapid decrease in steroid dosage frequently resulted in an exacerbation of the hepatitis.</ce:simple-para><ce:simple-para view="all" id="simple-para.0030">It is concluded from these observations that steroid therapy is effective in suppressing or retarding disease activity in most patients with active chronic hepatitis. Continued therapy with adequate doses is necessary to maintain this suppression for prolonged periods of time. No definite statement can be made about the effect of steroid therapy on the ultimate outcome of the disease, but no patient in this series has died while receiving steroid therapy. Further, it is concluded that the dosage of steroids should be reduced cautiously and slowly, with frequent observations of hepatic function.</ce:simple-para></ce:abstract-sec></ce:abstract></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>The treatment of chronic hepatitis with adrenal cortical hormones</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>The treatment of chronic hepatitis with adrenal cortical hormones</title></titleInfo><name type="personal"><namePart type="given">Fred</namePart><namePart type="family">Kern, Jr.</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Denver, Colorado USA</affiliation><description>From the Department of Medicine and Pathology, University of Colorado Medical Center, Denver, Colorado.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Irwin E.</namePart><namePart type="family">Vinnik</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Denver, Colorado USA</affiliation><description>From the Department of Medicine and Pathology, University of Colorado Medical Center, Denver, Colorado.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">John E.</namePart><namePart type="family">Struthers, Jr.</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Denver, Colorado USA</affiliation><description>From the Department of Medicine and Pathology, University of Colorado Medical Center, Denver, Colorado.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Rolla B.</namePart><namePart type="family">Hill</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Denver, Colorado USA</affiliation><description>From the Department of Medicine and Pathology, University of Colorado Medical Center, Denver, Colorado.</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1962</dateIssued><dateCaptured encoding="w3cdtf">1962-08-21</dateCaptured><copyrightDate encoding="w3cdtf">1963</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Fifteen patients with active chronic hepatitis and three with postnecrotic cirrhosis without active inflammation have been treated continuously with adrenocortical hormones for as long as eight years. They have been followed closely by means of serial chemical tests for liver function and, when possible, by serial liver biopsies. This experience is analyzed in an effort to determine the effects of the therapy, an appropriate therapeutic regimen, and the dangers and complication of therapy.For most patients the initial treatment consisted of a daily dose of steroids large enough to suppress disease activity. After apparent optimal improvement, the dose was cautiously reduced to the smallest amount that would maintain improvement.Based on the response to steroid therapy, the patients were divided into five groups. In group I two patients had complete biochemical and histologic remission; in one patient, steroid therapy was withdrawn without recurrences. The eight patients in group II had an excellent response to therapy. Even though there is still chemical and histologic evidence of liver disease, there has been no progression. A moderate response was seen in the two patients in group III; there was evidence of progressive hepatic disease, but the rate of progression has been retarded significantly. In group IV the initial response to steroid therapy in three patients was good but the unavoidably short duration of therapy did not permit clear interpretation. In group V, consisting of three patients, there was no response to steroid therapy. These patients had postnecrotic cirrhosis, without active chronic hepatitis.The complications of steroid therapy included peptic ulcer (two patients), osteoporosis with a pathologic fracture (one patient) and thrombophlebitis with pulmonary emboli (two patients). Abrupt discontinuance or too rapid decrease in steroid dosage frequently resulted in an exacerbation of the hepatitis.It is concluded from these observations that steroid therapy is effective in suppressing or retarding disease activity in most patients with active chronic hepatitis. Continued therapy with adequate doses is necessary to maintain this suppression for prolonged periods of time. No definite statement can be made about the effect of steroid therapy on the ultimate outcome of the disease, but no patient in this series has died while receiving steroid therapy. Further, it is concluded that the dosage of steroids should be reduced cautiously and slowly, with frequent observations of hepatic function.</abstract><note>Supported in part by National Institutes of Health Training Grant 2A-5122.</note><note type="content">Section title: Clinical study</note><relatedItem type="host"><titleInfo><title>The American Journal of Medicine</title></titleInfo><titleInfo type="abbreviated"><title>AJM</title></titleInfo><genre type="Journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">196309</dateIssued></originInfo><identifier type="ISSN">0002-9343</identifier><identifier type="PII">S0002-9343(00)X0351-8</identifier><part><date>196309</date><detail type="volume"><number>35</number><caption>vol.</caption></detail><detail type="issue"><number>3</number><caption>no.</caption></detail><extent unit="issue pages"><start>2</start><end>442</end></extent><extent unit="pages"><start>310</start><end>322</end></extent></part></relatedItem><identifier type="istex">4B5A479652B1EF6C74BF674DB5510F9407C96AE8</identifier><identifier type="DOI">10.1016/0002-9343(63)90174-8</identifier><identifier type="PII">0002-9343(63)90174-8</identifier><identifier type="ArticleID">63901748</identifier><recordInfo><recordContentSource>ELSEVIER</recordContentSource></recordInfo></mods></metadata><enrichments><istex:refBibTEI uri="https://api.istex.fr/document/4B5A479652B1EF6C74BF674DB5510F9407C96AE8/enrichments/refBib"><teiHeader></teiHeader><text><front></front><body></body><back><listBibl><biblStruct><monogr><title level="m" type="main">Effect (of rorti-sane on chronic inflammatory disrases of the, liver. 7'r. 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