We studied the clinical features of sixty-one patients with non-tuberculous pulmonary mycobacteriosis (NTM), who were newly diagnosed at five national hospitals in Kinki area during 1993. The study ...subjects were composed of 31 patients with M. avium complex (MAC) disease (20 males and 15 females), 21 with M. kansasii (MK) disease (19 males and 3 females), 2 males with M. szulgai (MS) disease and 2 females with M. chelonae (MC) disease. The rate of NTM to all culture proven mycobacteriosis was 20.2% and the rate of NTM to all culture proven, newly discovered mycobacteriosis was 18.2% and the rates were higher than Sakatani's report in 1994 (14.0% in 1991). The ratio of MK to MAC was 22: 35, and the ratio of MK was higher than the report of Sakatani.
Endoscopic intravariceal injection sclerotherapy (EIS) using sclerosant mixed with contrast medium was done in 100 patients without hepatocellular carcinoma. They were followed longer than 12 months ...(mean ; 58±29 months) after EIS. The recurrence rate of esophageal varices in cases with complete eradication (n=79) and cases with incomplete eradication of (n=21) was 8.9% and 85.7%, respectively (p<0.01). In 21 cases, complete eradication was achieved by intravariceal injection and additional therapy using paravariceal injection was not performed. The recurrence rate of this group was only 4.8%. Endoscopic varicealography during injection sclerotherapy were evaluated in 91 cases. At final session of EIS, narrowing of diameter (less than 1 mm) and irregularity of vessel walls were observed in small vessels (devastated vessels). Appearance rate of devasted vessel in 75 cases with completely eradicated esophageal varices was 65.3%. In contrast, among 16 cases with incomplete eradication of varices, devastated vessels were seen only in 6.3% (p<0.01). It is concluded that the important point in preventing the recurrence of esophageal varices after EIS was the complete eradication of esophageal varices by intravariceal injection sclerotherapy resulting in the eradication of the routes to esophageal varices from port-splenic venous system. For the sake of accomplishment of this treatment, appearance of devastated vessel is very useful.
Twenty-six patients with fulminant hepatic failure were treated with daily infusions of antithrombin III concentrate until recovery of consciousness or death. Seven patients were alive (group A), 7 ...survived 17 to 47 days after treatment (group B), and 12 died within 9 days (group C). Decreased plasma antithrombin III levels increased on the day after treatment, irrespective of the pretreatment levels in all patients. Continuous or temporary normalization was seen in all patients in groups A and B, but in only 5 in group C patients whose bleeding was extensive (p less than 0.05). An abrupt drop in peripheral platelet counts occurred when plasma antithrombin III levels were below normal. General bleeding accompanied this drop. These results suggest that maintained normal plasma antithrombin III levels are beneficial for prolonged survival time in fulminant hepatic failure, probably through controlling intravascular coagulation, and that antithrombin III infusion may be useful for such treatment.
A case of Japanese male patient with primary sclerosing cholangitis who had received a liver transplantation in the U.S.A. in 1988 (at age of 16) is reported. He experienced several clinical ...manifestations scinece he returned to Japan. He had severe back pain just after his return to Japan, and about 1 year later he had pain on walking due to osteonecrosis of the femoral condyle, which were assumed to be side effects of steroids. This patient has also shown a persistent abnormal liver function tests caused by an anastomotic stricutre at the site of choledochojejunostomy, and ulcerative colitis occurred to this patient 3 years after the transplantation. However, those problems have been successfully managed, and at present, he lives an ordinary life as an university student.
The endoscopic findings on and 1 year before admission were compared in 30 patients with esophageal variceal hemorrage. The deterioration of red color sign on varices was the most remarkable change ...which was found in 19 cases (63.3%) (P<0.01). Furthermore, in 3 cases with rapid deterioration of varices, the varices showed characteristic shape in which the appex of varix protruded into esophageal lumen forming "ridge-like" appear-ance. It was also elucidated by endoscopic varicealography during injection scierotherapy that "ridge-like" varices were consisted of a large number of tiny varices. In conclusion, "ridge-like" varices seem to be a sign of high risk of variceal bleeding and should be treated immediately.
Changes of liver functions associated with endoscopic injection sclerotherapy (EIS) were investigated in 143 patients with remarkable esophageal varices. The index used for evaluating hepatic reserve ...was the ratio between the increase of total bilirubin and the increase of LDH after EIS I.I. index=(ΔT.Bil./ΔLDH)×100 in cases treated by intravariceal injection of 5% ethanolamine oleate. I.I. index value caused by hemolysis was stable and always below 0.2, while the elevation of I.I. index above 0.2 was regarded as the reflection of the deterioration of liver function. After the entire sessions of EIS, the changes of liver function tests before and after EIS were estimated in 104 cases using 3 factors as follows ; (1) ΔT.Bil.; increase of total bilirubin more than 0.5mg/dl (2) ΔPT; decrease of prothrombin time more than 5% (3) ΔICG R15 ; increase of ICG R15 more than 5%. I.I. index of group I (without any changes of 3 factors mentioned above ; n=66) was 0.22±0.16, approximately within normal range. However, in group II (with 1 factor ; n=29), group III (with 2 factors ; n=5), group IV (with all factors ; n=4), I.I. index was elevated according to the severity of their liver dysfunction. The cases whose I.I. index value increased gradually during the course of EIS, were apt to deteriorate the liver functions and therefore, should be carefully observed. Also, I.I. index seems to reflect the prognosis of the patients treated by EIS for some extent, since the survival period of the cases treated by EIS were correlative with the value of I.I. index (r= -0.542, p<0.01), and I.I. index of 32 cases who survived for longer than 5 years after EIS was almost normal (0.22±0.15).
Incidence of muscle cramps in 80 patients with liver cirrhosis, 96 patients with chronic hepatitis, and 142 healthy subjects was evaluated with a standard questionnaire. Thrity one percent of the ...cirrhotics complained of muscle cramps more than once a week, while only 5% of the patients with chronic hepatitis and 7% of healthy subjects reported such a high frequency (p<0.01). The incidence of muscle cramps was higher in severe liver cirrhosis. Serum electrolytes, glucose tolerance test, and treatment by diuretics were not found to have any correlation with muscle cramps. When 18 cirrhotics complaining of muscle cramps more than once a week were treated with eperisone hydrochloride, an antispastic agent, in a dose of 150mg to 300mg per day for 8 weeks, muscle cramps completely disappeared in 11 (61%), and decreased in frequency in 6 (33%). These results suggest that muscle cramps in liver cirrhosis may have a neural component, since eperisone hydrochloride is known to inhibit the reflexes mainly in the spinal cord.
Mutations in the precore region are not always detected in hepatitis B virus (HBV) from patients with chronic hepatitis B who respond to interferon and lose hepatitis B e antigen (HBeAg) from serum. ...The other mutations may also be responsible for the loss of HBeAg and response.
Forty six consecutive patients with HBeAg-positive chronic hepatitis B received recombinant-alpha 2 a interferon (total dose: 702 MU). The mutation for stop codon 28 in the precore region was determined by restriction fragment length polymorphism, and mutations in the core promoter were searched for in five HBV DNA clones propagated from each patient.
HBeAg was cleared at 6 months after interferon in 11 (61%) of 18 patients with the precore mutation and in 12 (43%) of 28 without it. Of these 28 patients, 19 with mutations in the core promoter in all five HBV DNA clones lost HBeAg more frequently than the remaining nine who had at least one clone among the five that lacked such mutations (58 vs 11%, p < 0.05).
HBeAg-positive patients infected with HBV variants having mutations for an HBeAg-negative phenotype would respond better to interferon by clearing HBeAg from serum. Such mutations may not necessarily be in the precore region but also in the core promoter, which would interfere with the synthesis and secretion of HBeAg either at the translation or transcription level.
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