The genome of hepatitis C virus (HCV) associated with hepatocellular carcinoma (HCC) may have some characteristics which would barely be found in those of HCV from asymptomatic carriers (ASC). We ...analyzed 15 HCC patients who were infected with HCV genotype 1b (HCV-1b) for complete nucleotide sequences of the viral genomes. Of the 15 isolates, three were sequenced up to the first nucleotide of the 5′UTR, and six were sequenced to encompass the X-tail at the 3′ end: sequencing of at least three-quarters of the 5′UTR and entire polyprotein-ORF was accomplished in all 15 isolates. Analyses of these sequences together with those reported previously by Nagayama et al. Hepatology; 31 (2000) 745 suggested that nine residues (nt 119 of 5′UTR and aa 90, 434, 938, 962, 1176, 1412, 2143, and 2774 of polyprotein) might be useful to discriminate HCC-type sequences from ASC-type ones. The ‘progression score’ was 1.4±0.9 in ASC versus 3.7±1.5 in HCC (
P=3.87E-07) when calculated with the Nagayama et al.'s seven residues, but was 1.4±0.6 versus 4.6±1.9 (
P=1.33E-09) with our nine residues: a greater difference between HCC and ASC was achieved in the latter system. Further analyses, by increasing the sample size and/or by extending the comparison to include entire 5′UTR and 3′UTR/X-tail, may thus contribute to define the ‘progression score’ more appropriately.
The so-called interferon sensitivity determining region (ISDR) in the NS5A protein of hepatitis C virus (HCV) undergoes mutational changes in chronically infected hosts, but its mechanism remains ...obscure. We analyzed the ISDR by direct sequencing and/or restriction fragment length polymorphism in serial sera from two patients with chronic hepatitis C. Patient 1 showed a change in the ISDR quasispecies from wild type to mutant type, while in patient 2 the situation was vice-versa, during a period where interferon was not administered. The emerging mutant in patient 1 was detected in IgG-unbound HCV fraction, while the fading-out mutant in patient 2 was IgG-bound. These results suggest that an immune pressure against virion surface epitope(s) plays an insidious role for the apparent selection of HCV ISDR quasispecies. Of note, the ISDR mutants found in the two patients, irrespective of IgG-bound or -unbound, disappeared promptly by interferon therapy.
A 70-year-old woman with myeloproliferative disorder and massive splenomegaly presented with hematemesis. Emergency endoscopy demonstrated bleeding from esophageal varices. Management of variceal ...hemorrhage by endoscopic injection sclerotherapy, using 5% ethanolamine oleate, was successful. Following the control of variceal bleeding, she was treated with hydroxyurea, a myelosuppressive agent. The spleen size markedly decreased and she was discharged 3 months later. Variceal hemorrhage in myeloproliferative disorder has been reported to be fatal on many occasions, despite different therapeutic approaches, including surgery. In this report, we demonstrated that endoscopic injection sclerotherapy followed by treatment with a myelosuppressive agent was effective in a patient with myeloproliferative disorder and variceal hemorrhage.
A CASE OF GASTROINTESTINAL STROMAL TUMOR OF THE DUODENUM MARUO, Hirotoshi; KUME, Shinichiro; KANAI, Koichi ...
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association),
2000, Letnik:
61, Številka:
10
Journal Article
Odprti dostop
The term “gastrointestinal stromal tumor (GIST)” is used to describe gastrointestinal non-epithelial tumors composed of spindle cells, although diagnostic criteria for GIST have not been established ...yet. We recently experienced a case of GIST of the duodenum. This case is herein reported and discussed with reference to previous cases reported in Japan. A 62-year-old woman was admitted to the hospital because of melena and anemia. Gastric endoscopy detected a submucosal tumor with central ulcer in the second portion of the duodenum, On CT, the tumor measured 4cm in diameter and was solid with a well-delineated border. Angiography showed a hypervascular tumor. Leiomyosarcoma was suggested and a pylorus-preserving pancreatoduodenectomy was performed. Histopathologically, the tumor was composed of spindle cells, and there was no mitosis. Immunohistochemical study revealed that the tumor was positive for vimentin, CD-34 and c-kit protein, and partially positive for S-100 protein while it was negative for desmin, SMA, HHF-35, and NSE. Therefore, this tumor was diagnosed as uncomitted type of GIST.
We studied the clinical features of culture-positive, previously untreated patients with pulmonary tuberculosis (77 in females and 200 in males), with special reference on the gender differences in ...clinical features. The mean age was 50.8 y.o. for female and 54.4 y.o. for male, and the age distribution was almost similar to that of newly-registered patients of whole Japan in 1993, namely, small peak in 20s decade and large peaks in the age group over 50 in female, and gradual increase up to 50 years and get to plateau in male. Thirty-nine % in female and fifty-four % in male had various past histories and/or complications which might affect to the deterioration of tuberculosis, such as diabetes mellitus, liver function distress, respiratory failure, malignancy, stomach resection and so on. The rates with each complication were, in general, higher in male than in female. The positive rate to Mantoux reaction was higher in female than in male, and stronger reactions were observed in female than in male. According to the classificaion of pulmonary tuberculosis designed by the Japanese Society for Tuberculosis (GAKKAI classification), the site (s) of affected lung, the stage and the extent of lesions were more advanced in male than in female, and the positive rate and the amount of bacilli on smear were higher in male than in famale. The most marked difference was the location of the main lesions, 80% in the apical and posterior segments of upper lobe (S1, 2) and 8% in the superior segments of lower lobe (S6) in male, while 60% in S1, 2 and 25% in S6 in female. The rate of complete resistance against to anti-tuberculosis agents was higher in male than in female, but the combination chemotherapy of isoniasid and refampicin with streptomycin or ethambutol was almost equally effective both in males and females, and almost all patients converted to bacilli negative within three months after the initiation of the chemotherapy, except in a few male patients.
Efficacy of 50-week administration of interferon-alfa 2a to 159 chronic hepatitis B patients with or without HBe-antigen was investigated. Patients received 1 to 9 MU/injection of interferon for 26 ...to 50 weeks. 24.7% (23/93) of HBe-antigen-positive patients became HBe-antigen-negative after 24-week treatment with interferon. Those who remained HBe-antigen-positive after 24-week interferon therapy received additional 26-week of interferon and 35.1% (13/37) turned to HBe-antigen-negative. Nornal serum ALT at 12 month after interferon therapy was observed in 56.6% (25/44) of HBe-antigen-negative patients, althouth sustained clearance of serum HBV DNA was obtained in only 4 cases. 18.9% (30/159) dropped out mainly due to adverse effects of interferon. Fifty-week interferon therapy seems to increase the response rate of CH-B, althouth the high prevalence of adverse effects should be considered especially among those who received high-dose interferon.
Efficacy of 24-week administration of recombinant interferon alfa 2a to 100 patients with chronic hepatitis B was investigated. 9 MU of Interferon was injected daily for 2 weeks followed by 22 week ...af 9 MU interferon thrice weekly. Among 52 HBeAg-positive patients who completed interferon therapy, e antigen became negative in 27 (52%) and ALT turned normal in 25 (48%) at 24 weeks after discontinuation of interferon. Serum HBVDNA decreased in all cases during therapy, although none of the patients persistently cleared serum HBVDNA. Of 39 HBeAgnegative patients, normalization of ALT was retained in 23 (59%) at 24 week after therapy. In this group, serum HBVDNA became negative during interferon therapy in 9 (23%) cases. Twenty four week administration of interferon seems to be an effective therapeutic approach for chronic hepatitis B, with or without serum HBe-antigen.
We measured the portal and splenic venous flow volume (PV and SV), congestion index (CI) and SV/PV% in various stages of the liver diseases {chronic inactive hepatitis (CIH), chronic active hepatitis ...(CAH), liver cirrhosis without esophageal varices (LCvarix(-)), and liver cirrhosis with esophageal varices (LCvarix(+))}, and normal volunteers (NC). The results were as follows: PV was 869.4±184.0ml/min in NC, 920.4±242.5ml/min in CIH, 900.0±216.9ml/min in CAH, 841.8±253.0ml/min in LCvarix(-) and 909.7±430.7ml/min in LCvarix(+). SV was 241.0± 80.0ml/min in NC, 289.4±131.6ml/min in CIH, 286.4±108.8ml/min in CAH, 272.7±135.7 ml/min in LCvarix(-), 398.0±280.5ml/min in LCvarix(+). SV/PV% was 28.1±10.1 in NC, 31.4±14.0 in CIH, 32.1±9.6 in CAH, 32.4±16.0 in LCvarix(-), 43.1±23.7 in LCvarix(+). CI was 0.06±0.019 in NC, 0.07±0.028 in CIH, 0.09±0.05 in CAH, 0.11±0.03 in LCvarix(-), 0.145±0.047 in LCvarix(+). These results suggested that: (1) From the measurement of CI, portal venous pressure is begun to increase at the stage of chronic active hepatitis. (2) Increasing of splenic venous flow volume is begun at the stage of chronic hepatitis and it effects to the portal hypertension of liver cirrhosis. (3) The change of component of intrahepatic portal venous blood flow and decreasing of liver function tests was affected by increasing of splenic venous flow volume. (4) SV/PV% may be useful parameter to evaluate the decreasing of liver function tests and to estimate the complication of esophageal varices at the liver cirrhosis.
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