Role of Liv.52 and Steroids in the Management of Viral Hepatitis in Children

Table XIII: Illustrates serum alkaline phosphatase levels on admission (a) and 15 days after treatment (d)
Serum alkaline phosphatase levels		Group ‘A’ %		Group ‘B’ %		Group ‘C’ %		Group ‘D’ %
Liv.52				Prednisone		Liv.52 + Pred.		Supportive
(a)		(d)	(a)	(d)	(a)	(d)	(a)	(d)
10–15		26.1	52.2	12.5	100	25	50	33.3	83.3
15–20		69.6	47.8	75.0	–	50	50	66.7	16.7
20–25		4.3	–	12.5	–	25	–	–	–
(a) — On admission; (b) — 15 days later.

Table XIV: Shows thymol turbidity levels of the present series at the time of admission (a) and 15 days after treatment (d)
Thymol turbidity test units/ml		Group ‘A’ %		Group ‘B’ %		Group ‘C’ %		Group ‘D’ %
Liv.52				Prednisone		Liv.52 + Pred.		Supportive
(a)		(d)	(a)	(d)	(a)	(d)	(a)	(d)
0–5		91.7	100	85.7	100	100	100	89.2	100
5–10		8.3	–	14.3	–	–	–	30.8	–

Table XV: Shows rise in proteins 2–4 weeks after treatment
Rise in proteins in g%	Group ‘A’	Group ‘B’	Group ‘C’	Group ‘D’
Liv.52		Prednisone	Liv.52 + Pred.	Supportive
0.1–0.5 g	43.5	–	–	11.1
0.5–1g	39.1	57.1	66.7	44.4
Stationary	8.7	14.3	–	22.2
Fall	8.7	28.6	33.3	22.2

Histopathological Studies of the Liver Biopsy Material
In the present study liver biopsy was done for 47 out of 60 cases and repeat biopsy for 15 cases. Initially all cases showed vacuolation of varying degrees of hepatocytes with scanty and granular cytoplasm. The portal tracts were infiltrated with mononuclear cells and segmented leucocytes. The lobular parenchyma was found as muralium duplex in all cases.

In most of the cases biliary canaliculi and Kupffer cells were prominent. Focal areas of liver cell necrosis were noted in few of them. The limiting plate was destroyed in some of them. Cholestasis was appreciable only occasionally and in such cases bile pigment could be seen in hepatocytes and also in biliary canaliculi. By and large the glycogen content of the liver cells was found to be reduced in sections stained with PAS. A striking feature was an intact lobular architecture in all cases. The reticulin framework was not disturbed.

Table XVI: Shows the repeat biopsy studies
Group	Case No.	Particulars
A Liv.52	2	Second biopsy after 6 weeks showed incomplete recovery but third biopsy after 4 months revealed complete recovery.
A Liv.52	3	Second biopsy after 6 weeks revealed persistence of the lesion but third biopsy after 1 year showed normal architecture of the liver.
A Liv.52	4	Second biopsy after 6 weeks showed complete recovery. Third and fourth biopsies repeated after 8 and 10 months also showed normal architecture of the liver.
A Liv.52	7	Second biopsy after 3 weeks showed only minimal vacuolation of the cells and mononuclear infiltration of the portal tracts. Third biopsy repeated after 3 months and fourth biopsy 1 year 9 months later both revealed normal architecture of the liver.
A Liv.52	11	Repeat biopsy after 4 weeks revealed only minimal vacuolation of the hepatocytes. Otherwise essentially negative.
A Liv.52	13	Repeat biopsy after 3 weeks showed minimal mononuclear infiltration within the portal tracts.
A Liv.52	29	Repeat biopsy after 3 months revealed normal architecture of the liver.
A Liv.52	10	Incomplete recovery after 1 month.
B Prednisone	27	Repeat biopsy after 8 weeks revealed persistence of mononuclear infiltration of the portal tracts vacuolation of hepatocytes and focal areas of liver cell necrosis.
B Prednisone	28	Repeat biopsy after 6 weeks showed persistence of mononuclear infiltration, vacuolation of liver cells and fibroblastic reaction.
C Liv.52 + Prednisone	9	Repeat biopsy after 4 weeks showed persistence of activity of the lesion.
C Liv.52 + Prednisone	23	Liver was essentially negative even at the time of admission though clinical and biochemical findings were strongly suggestive of viral hepatitis —repeat biopsy also revealed normal liver.
D Supportive	39	Repeat biopsy after 9 months revealed persistence of the activity of the lesion.
D Supportive	49	Repeat biopsy after 4 weeks revealed persistence of the activity of the lesion.
D Supportive	57	Repeat biopsy after 8 weeks revealed incomplete recovery of the histological lesion.