Preferential activation of CD4+V beta 5.2/5.3+ intestinal intraepithelial lymphocytes in the inflamed lesions of Crohn's disease

To analyze the nature of intestinal intraepithelial lymphocytes (iIELs) in inflammatory intestinal disease, we established T cell lines of iIELs isolated from endoscopic biopsied ileal and colonic mucosa of Crohn's disease patients. Seven T cell lines from the inflamed terminal ileum of 13 patients, but none of 16 T cell lines from normal terminal ileum, have shown a deviation of T cell receptor variable region gene usage and were enriched in the proportion of CD4+V beta 5.2/5.3+ cells. CD4+V beta 5.2/5.3+ cells in the T cell lines were not increased after stimulation with purified protein derivatives or 65-kDa heat-shock protein but significantly increased after stimulation with staphylococcal enterotoxins C1 and D. Those cells showed increased cytolytic activity against target cells cross-linked by anti-V beta 5.2/5.3 and produced a large amount of interferon-gamma. These results indicated that CD4+V beta 5.2/5.3+ iIELs were preferentially activated in the inflamed lesions of Crohn's disease and may play a possible role in the triggering and progression of human inflammatory intestinal disease.

Ascorbic acid reduces tropoelastin levels in culture medium of chick skin fibroblasts

Ascorbic acid reduced tropoelastin levels in the culture medium of embryonic chick skin fibroblasts to one-third or one-fourth of their original value in a dose- and exposure time-dependent manner under conditions in which collagen synthesis was stimulated 1.8-fold. The steady-state level of elastin mRNA remained essentially constant, whereas the collagen mRNA content increased in proportion to the increase in collagen synthesis with ascorbic acid treatment. These results suggest that the reduction of tropoelastin levels is not controlled by the elastin mRNA level but, rather, is related to the posttranslational modification of the tropoelastin molecule.

[Compliance with long-term home oxygen therapy]

Long-term home oxygen therapy has been shown to benefit patients with hypoxemic chronic obstructive pulmonary disease. However, to obtain the expected maximal benefit it is important for the oxygen to be used correctly and for a sufficient length of time. We examined compliance with home oxygen therapy in patients with chronic obstructive pulmonary disease, pulmonary fibrosis, late sequelae of pulmonary tuberculosis, and pulmonary hypertension who used oxygen concentrations. Compliance was defined as the ratio of the amount of oxygen used to the amount prescribed. The average daily length of time the concentrator actually ran was measured from the concentrator meters. These were read every 6 months by an engineer from the company that installed the concentrator. Factors thought to affect compliance were studied. These factors included age, the degree of dyspnea, arterial blood gases, and pulmonary function. Weak positive correlations were found between compliance and age and between compliance and PaCO2. A weak negative correlation was observed between compliance and PaO2. Compliance in patients with chronic obstructive pulmonary disease was higher than in patients with pulmonary fibrosis or pulmonary hypertension. Among those given prescriptions for 24-hr oxygen therapy, compliant patients had more severe dyspnea on excertion than did noncompliant patients. These data suggest that the compliant patients had more severe gas exchange problems.

Accumulation of tropoelastin by a short-term ascorbic acid treatment in the culture medium of aortic smooth muscle cells in vitro

Treatment of cultured smooth muscle cells with ascorbic acid resulted in an accumulation of tropoelastin in the culture medium in dose-dependent and exposure time-dependent manner under the condition in which collagen synthesis was stimulated 2-fold. The steady-state level of elastin mRNA was essentially unchanged, whereas collagen mRNA content increased 2-fold by ascorbic acid treatment. Newly synthesized tropoelastin was hydroxylated in the presence of ascorbic acid but was underhydroxylated in a scorbutic condition. Short pulse experiments showed that the secretion rate of tropoelastin was unaltered by ascorbic acid treatment. Pulse-chase experiment demonstrated that the level of fully hydroxylated tropoelastin in the medium of ascorbate-treated cells was greater than that of under-hydroxylated tropoelastin. These results indicate that accumulation of tropoelastin in the medium by ascorbic acid is related to an increased stability of hydroxylated tropoelastin and/or its impaired incorporation into insoluble elastin.

Prolongation of the QT interval observed in a Japanese patient with vivax malaria following treatment with halofantrine

In 1992, some 90 countries or territories where 42% of the world's population resided were considered malarious and estimation of deaths from malaria worldwide per year were in the order of 1.4 of 2.8 million. The higher the number of Japanese who go abroad becomes (the total number in 1994 was 13,578,934: Records of Statistical Division of the Ministry of Justice), the greater is the risk of their contracting malaria. Indeed, the reported annual number of imported malaria cases increased to not less than 100. Now, malaria should first be presumed if a patient complains of a higher fever after a visit to a tropical country. And the importance of instituting prompt diagnosis and proper treatment should also be stressed. One of the antimalarials which has been highlighted for its effectiveness is halofantrine. This drug has been used for treatment of human malaria since 1984, and to date clinical trials have involved about 3.4 million patients in more than 30 countries (personal communication). Several patients successfully treated with halofantrine without any treatment failure have also been documented in Japan. However, in 1993, a clinical study involving 400 patients on the Thai-Burmese border revealed cardiac effects of antimalarial treatment with halofantrine, including one sudden death after the treatment. There have also been some spontaneous reports of serious ventricular dysrythmiasis with prolongation of the QT intervals, rarely associated with death. The pharmaceutical company producing Halfan has reported 8 cardiac arrests, leading to 6 deaths, when a higher dose than recommended was used, there was recent or concomitant treatment with mefloquine, there was pre-existing prolongation of the QT interval or the patient had a thiamine deficiency. Finally, the World Health Organization (WHO) announced a "drug alert" on halofantrine advising a change in recommendations for its use. In the present paper, we discuss the first Japanese vivax malaria patient whose QT interval was prolonged after treatment with halofantrine.

Studies of temporomandibular joint sounds Part 3. The clinical usefulness of TMJ Doppler

Doppler auscultation as applied to internal derangements of the TMJ has been developed in recent years. Possible clinical use of TMJ Doppler auscultation was examined by separating the signals into their spectral components, and comparing the results with those of the conventional sound amplification system (CSAS). Observing frequency component changes with time, similar observations were made using CSAS and TMJ Doppler. However, noises found in TMJ Doppler sonograms were markedly reduced in comparison with those found using CSAS. Ultrasonic waves have high directivity, and pass through soft tissue and fluid; however they have difficulty passing through air, and this may decrease the recording noise. TMJ Doppler can be applied to record movements of the condyle because changes in the receiving frequency indicate the movement of an observed object with precision.

Left partial anomalous pulmonary venous connection found during a lobectomy for lung cancer: report of a case

We report herein the case of a 68-year-old man in whom a partial anomalous pulmonary venous connection (PAPVC) was found during an operation for primary lung cancer. The preoperative clinical findings did not suggest a vascular shunt, and intraoperatively the anomalous vein was seen to drain only from the left upper lobe into the left innominate vein. The lower pulmonary vein connected normally, and there was no atrial septal defect nor any other anomalous condition. A left upper lobectomy with ligation of the anomalous connected vein was performed uneventfully. This type of PAPVC is extremely rare, and is especially noteworthy because there were no clinical signs.

Case report: thyrotropin-releasing hormone-induced myoclonus and tremor in a patient with Hashimoto's encephalopathy

The authors investigated the possibility of a thyrotropin-releasing hormone-related mechanism in a 43-year-old Japanese woman with Hashimoto's encephalopathy who experienced three relapses closely associated with the menstrual cycle. Her symptoms began at ovulation, worsened during the luteal phase, and improved during the menstruation phase. No abnormalities were found by brain magnetic resonance imaging and cerebral angiography. Intravenous administration of thyrotropin-releasing hormone induced symptoms of myoclonus and tremor similar to those observed during an exacerbation. The intensity and duration of involuntary movements induced by thyrotropin-releasing hormone were dose-dependent. The patient's symptoms were controlled effectively by thyroxine replacement therapy. On the basis of these findings, thyrotropin-releasing hormone may have an important role in Hashimoto's encephalopathy.

Establishment of an enzyme-linked immunosorbent assay (ELISA) for measuring cellular MAGE-4 protein on human cancers

The MAGE genes encoding tumor-rejection antigens are expressed on various human cancers. An enzyme-linked immunosorbent assay (ELISA) was established for measuring cellular MAGE-4 protein (MAGE-4a and/or -4b) expressed on human tumor cells using a monoclonal antibody (mAb) and polyclonal Ab to recombinant MAGE-4b protein. Both the R5 mAb (IgG1) and the polyclonal Ab recognized a 45 kDa protein in extracts of MAGE-4 mRNA positive cancers, and showed no apparent cross-reactivity to the other MAGE gene products (MAGE-1, -2, -3, -6, and -12) by the immunoblot analyses. The R5 mAb and the polyclonal Ab primarily recognized one (the position 119-133) and two oligopeptides (the positions 119-133 and 259-273), respectively, among a series of 31 different MAGE-4b oligopeptides. The amino acid sequences of these two peptides were identical to those of MAGE-4a and -4b, but differed from those of all the other MAGE proteins (MAGE-1, -2, -3, -6, and -12). Substitution of glycine for amino acid in position 123 (arginine, R), 124 (lysine, K), 126 (R) or 128 (K) in a MAGE-4b oligopeptide of the position 119-132 severely decreased the reactivity of the R5 mAb to the oligopeptide. This ELISA also showed no apparent cross-reactivity with the other MAGE gene products (MAGE-1, -2, -3, -6, and -12). The minimum detectable level of MAGE-4 protein was determined to be 10 pg/well (100 pg/ml). The results suggest that this ELISA is a reliable and quantitative method to measure cellular MAGE-4 protein that is a potential target molecule for specific immunotherapy of human cancers.

Alteration of the hypothalamus-pituitary-testis axis in oligozoospermic men with normal gonadotropin levels

BACKGROUND

Serum basal hormone levels such as lutenizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone, which is important to regulate testicular function, do not necessarily indicate the normal integrity of the hypothalamic-pituitary-testicular axis and the static measurement is not enough to detect the endocrine disorder. The dynamic measurement of gonadal hormone by GnRH test is considered to be more helpful to understanding the endocrine regulation of spermatogenesis. In this study, we performed GnRH test in oligozoospermic patients with normal levels of LH and FSH to examine the subtle alteration of hypothalamic-pituitary-testis axis.

METHODS

GnRH test was performed in 41 patients with oligozoospermia and normal gonadal hormone levels.

RESULTS

The responses of LH and/or FSH were excessive in most patients in spite of their normal gonadotropin levels. The patients with sperm concentration < 10 x 10(6)/ml had significantly higher peak levels of both LH and FSH than did those with sperm concentration > 10 x 10(6)/ml. In the patients with normal peak levels of both LH and FSH, sperm concentration was significantly higher than those with exceeded peak levels of FSH and/or LH after GnRH test. No significant differences were observed in estradiol, testosterone, free testosterone, or prolactin (PRL) levels between patients with normal responses and abnormal responses of LH and/or FSH.

CONCLUSIONS

The feedback control of gonadotropin release from testis was worse in more severely oligozoospermic patients, although the precise mechanism of feed back still remains unknown.

Listener adaptive characteristics of vowel devoicing in Japanese dialogue

Listener adapative characteristics of Japanese vowel devoicing were investigated by analyzing (i) dialogues between professional teachers and hearing-impaired (HI) or normal-hearing (NH) children, and (ii) speech samples read by the teachers as fast and clearly as possible (RD). The teachers reduced the devoicing rate and lengthened the moras more in the HI vs NH samples, and even more in the HI vs RD samples. A logistic regression analysis of the devoicing rate suggests that the speech rate dependency of the devoicing rate is different among the HI, NH, and RD samples. When moras are lengthened, the predicted devoicing rate decreases more for the HI vs NH samples, and even more in the HI vs RD samples, suggesting that not only rate-dependent adjustments but also rate-independent adjustments significantly affect devoicing reduction. These results suggest the following: (1) Professional teachers of hearing-impaired children reduce their devoicing not only by lengthening the interval of successive voicing/devoicing gestures, but also by resizing component gestures to some extent, probably to improve the listener's comprehension; (2) vowel devoicing should be represented in terms of parameters of speech motor control; (3) it may be possible to develop an optimized communication method for hearing-impaired children by simulating such listener-adaptive adjustments in speech production.

[Marked clinical improvement by plasmapheresis in a patient with stiff-man syndrome: a case with a negative anti-GAD antibody]

We described a 56-year-old man with stiff-man syndrome, who was markedly improved after plasmapheresis therapy. He had a 12-year history of progressive painful stiffness of his back and limbs, muscle cramps and difficulty in walking. He had been taking oral diazepam and prednisolone. On examination the abdominal and paraspinal muscles and limbs were continuously contracting, confirmed by surface and needle electromyography. Antibodies against glutamic acid decarboxylase (GAD) and pancreatic islet cells in the serum were negative, but antinuclear antibody and anti-smooth-muscle antibody were present. The patient underwent a course of 4 double filtration plasma exchanges of 3,000 ml each in an 8-day period. Plasmapheresis resulted in marked clinical improvement. The disappearance of muscular cramps and a reduction of stiffness occurred within 24 hours after the first plasmapheresis, and he was able to walk unassisted. The patient's subjective improvement continued over 4 months after the plasma exchange. This case provides additional evidence of the autoimmune mechanism of stiff-man syndrome. Plasmapheresis is one choice in the management for stiff-man syndrome.

Hypertrophic cranial pachymeningitis with spinal epidural granulomatous lesion

A 67-year-old woman with a one-year history of tinnitus and headache had multiple cranial nerve palsies of V, VII, VIII, IX, X, XI and spastic paraparesis. She also had a secretory otitis media. Gd-DTPA-enhanced magnetic resonance imaging (MRI) revealed hypertrophy of the dura of the posterior fossa and spinal epidural mass which extended from C7 to T10. A biopsy of the epidural mass showed chronic granulomatous change. These lesions were completely cured with administration of antibiotics. We believe this case of double-lesion of hypertrophic cranial pachymeningitis and spinal epidural granulomatous lesion originated from a bacterial infection secondary to the secretory otitis media.

Surgical treatment for patients with pulmonary metastases after resection of primary colorectal carcinoma

BACKGROUND

The optimum treatment for patients with pulmonary metastases from colorectal carcinoma is still controversial.

METHODS

To evaluate the results of pulmonary resection in 22 patients with pulmonary metastases after resection of primary colorectal carcinoma, patients' characteristics were examined retrospectively. Eighteen patients had a solitary metastatic lesion and four had two lesions.

RESULTS

Postthoracotomy recurrence occurred in 17 of the 22 patients (77.3%), and showed no correlation with the type of pulmonary resection. In 11 patients with a solitary lesion of less than 3.0 cm in greatest dimension, the 3- and 5-year postthoracotomy survival rates (PTSR) were 71.6% and 36.8%, respectively. Six of these patients received two or more thoracotomies for pulmonary recurrence. The 3-year PTSR for seven patients with a solitary lesion greater than or equal to 3.0 cm was 19.0%, and for the four patients with two lesions, 25.0%. A significant difference was noted in the survival rate according to both number and size of the metastatic lesions (P < 0.05).

CONCLUSIONS

The number and size of metastatic lesions appear to be important prognostic determinants. Repeated thoracotomy can prolong survival for selected patients.

The human gene encoding the largest subunit of RNA polymerase II

The nucleotide sequence of a large portion of the human RNA polymerase II large subunit (RpII LS)-encoding gene and its whole gene structure were determined. The RpIILS gene consists of 29 exons. The sequence of the 5' flanking region is highly conserved as compared with that of the mouse RpIILS and contains several SP1-binding sites, a CCAAT sequence and a sequence homologous to a heat-shock element. In addition, several inverted repeats and palindrome sequences were involved in the 5' upstream region. Those suggest that the 5' flanking domain of RpIILS would be highly structured which may be responsible for transcriptional regulation.

[A case of HLA-DR2, DQw1 negative post-traumatic narcolepsy]

We reported a case of a 24-year-old man who had frequent sleep attacks beginning 4 years after a head trauma. He showed frequent episodes of excessive daytime sleepiness and cataplexy which were triggered by emotional excitement. He also complained of sleep paralysis and hypnagogic hallucination. An overnight polysomnography revealed the sleep onset REM stage as typically observed in narcoleptic patients. The HLA typing was negative for DR2 and DQw1. He was diagnosed as having HLA-DR2 and DQw1 negative-post-traumatic narcolepsy. Peroral pemoline suppressed excessive daytime sleepiness, sleep paralysis and hypnagogic hallucination with dramatic relief of cataplectic attacks by the addition of imipramine. It has been reported that more than 90% of narcoleptic patients are HLA-DR2 and-DQw1 positive. About 10% of the narcolepsy patients were regarded as symptomatic due to brain tumors, cerebrovascular disorders, head trauma, multiple sclerosis, encephalitis and so on, which mainly affect the brainstem or diencephalon. Thus far, narcolepsy is considered to develop depending on both the genetic background including HLA types, and exogenous factors. According to reported cases with narcolepsy, sporadic cases were HLA-DR2 positive even more frequently than familial cases. To date, however, there have been only three previous reports of a symptomatic narcolepsy patient without association of HLA-DR2 and DQw1. In conclusion, the present report suggests that typical symptomatic narcolepsy could be HLA-DR2 or DQw1 negative.

Detection of MAGE-4 protein in lung cancers

Expression of genes of the MAGE family, which encode tumor-rejection antigens recognized on HLA-AI and -Cw1601 by cytotoxic T lymphocytes (CTL), was investigated in lung cancers at the mRNA [MAGE-1, -2, -3/-6, and -4 (4a and/or 4b)] and protein (MAGE-4) levels. MAGE-1, -2, -3/-6 and -4 genes were expressed, respectively, at the mRNA level in 6, 7, 20 and 7 of 53 lung cancers (50 non-small-cell lung cancers and 3 small-cell lung cancers) by the reverse transcription-polymerase chain reaction (RT-PCR) method. Polyclonal antibody (Ab) and monoclonal antibody (MAb) against recombinant MAGE-4b protein were developed to detect MAGE-4 protein. Both the polyclonal Ab and the R5 MAb recognized a 45-kDa protein in extracts of MAGE-4 mRNA-positive lung cancers, and showed no apparent cross-reactivity with the other MAGE gene products except with MAGE-4a by immunoblot analyses and transfection experiments. MAGE-4 protein was detected on 13 of 44 (30%) lung cancers (18 to 55,989 pg/mg) by ELISA with the polyclonal Ab and R5 MAb. These 13 lung cancers consisted of 6 of 6 MAGE-4 mRNA-detectable and 7 of 38 MAGE-4 mRNA-undetectable lung cancers. Histologically, these comprised 7 of 10 squamous-cell carcinomas, 4 of 30 adenocarcinomas and 2 of 3 small-cell lung cancers. The proportions of MAGE gene-positive samples, at both the mRNA and protein levels, correlated with the size of the primary tumors and with regional node involvement. These results should provide important information on specific immunotherapy of lung cancers using MAGE gene products.

Presence of elastin-related 45-kDa fragment in culture medium: specific cleavage product of tropoelastin in vascular smooth muscle cell culture

Significant amount of 45-kDa polypeptide was found to be present in the cultured medium of chick aortic smooth muscle cells. The polypeptide as well as tropoelastin (65-kDa) reacted with monoclonal antibody for tropoelastin. Pulse-chase experiments revealed that the relative density of the 45-kDa polypeptide to tropoelastin increased with chase periods. Partially purified radioactive tropoelastin (65-kDa) was converted to a 45-kDa polypeptide fragment in the test tube. The processing from the 65- to the 45-kDa polypeptide in the test tube was inhibited by ethylenediaminetetraacetic acid but not by N-ethylmaleimide and aminophenylmethylsulfonyl fluoride. These results indicate that the 45-kDa fragment is a degradation product of tropoelastin and that processing is mediated by enzymatic cleavages with metal proteinase. Fully hydroxylated tropoelastin treated with ascorbic acid was more resistant to the enzymes than underhydroxylated tropoelastin with scorbutic condition, suggesting that the structural stability of tropoelastin is also involved in the processing rate.

Three-dimensional display of the pelvic structure of anorectal malformations based on CT and MR images

Three-dimensional images of the pelvic structure of patients with anorectal malformation (ARM) were constructed by computer graphics based on radiographic computerized tomography (CT) and magnetic resonance (MR) images. Organ contour data from CT images and raw MR image data were transferred to a personal computer and to a graphic workstation respectively. On MR image processing, organs were extracted semiautomatically by thresholding enclosed areas. After several steps of image processing, three-dimensional anatomy of each anomaly was visualized with emphasis on position and shape of the muscle complex. In control patients without an anomaly, images showed that the rectum is supported by the levator muscle from behind and descends along with the urethra. In the male patient, the anal canal separates from the urethra and penetrates through the middle of the sphincter complex to reach the orifice. In those with low-type anomaly with a fistula opening to the perineum or the vestibule, images showed the fistula descending through the anterior portion of the sphincter complex. Images of those with a rectourethral fistula could show the muscle complex behind the rectum and at the region where the external sphincter should be. In those with cloacal anomalies, anatomical position and the shape of three different viscera were easily recognized, and the muscle complex was shown like that of rectourethral-type anomalies. This study is a new approach to the anomaly to facilitate understanding it and can assist a surgeon in planning a procedure. This kind of application would make it possible for a surgeon to consider the strategy on a display screen before the real surgery.

Stimulation of elastin expression by minoxidil in chick skin fibroblasts

Minoxidil inhibited the proliferation of embryonic skin fibroblasts during the growth phase but not during the stationary phase. Minoxidil stimulated elastin synthesis two-fold in a dose-dependent manner at a concentration of 1 mM during the stationary phase. The stimulation of elastin synthesis paralleled a comparable increase in elastin mRNA level. These results suggest that the stimulation of elastin expression by minoxidil in skin fibroblasts was controlled at the elastin mRNA level and also suggest that its elastin-stimulating effect is not related to the suppressive effect on cell proliferation. Minoxidil appears to be a potent stimulator for elastin expression in skin fibroblasts.

Immunoglobulin G subclass distribution of human anticolon antibodies in ulcerative colitis

Immunoglobulin G (IgG) subclasses of anticolon antibodies were studied in patients with ulcerative colitis (UC) using enzyme-linked immunosorbent assay (ELISA). The concentrations of total serum IgG subclasses were also measured by ELISA. The values for total serum IgG subclasses in patients with UC were not significantly different from those in normal controls, while the ratio of IgG1 to IgG2 in the patients was significantly higher than that in normal controls. All four IgG subclasses of autoantibodies were demonstrated in the sera of the patients. IgG4 anticolon antibodies were detected most frequently (15 out of 18 patients, 83%). IgG2 was the next most prevalent (9 of 18 patients, 50%). The activity of anticolon antibodies in each subclass did not correlate with the concentration of the corresponding serum IgG subclass. Seven cell lines producing anticolon antibodies were obtained from the colonic mucosa of the patients by Epstein-Barr virus (EBV) transformation. IgG subclasses of anticolon antibodies secreted by these cell lines were also varied. IgG4 subclass was secreted by three EBV transformed cell lines, all of which produced IgG4 anticolon antibodies. These results suggest that all four different IgG subclasses could respond to the colon antigens and that various antigens in colonic mucosa or lumen may contribute to the induction of those autoantibodies. In addition, the prominence of IgG4 anticolon antibodies may support the pathogenic role of this subclass in UC as in other autoimmune diseases.

A rapid method for isolation of retinal pigment epithelial cells from rat eyeballs

A new, simple method for isolating retinal pigment epithelial (RPE) cells from rat eyeballs was developed: incubation of the eyeballs in 0.1% proteinase K solution. This method yielded an average of 4 x 10(4) viable RPE cells from each Sprague-Dawley rat eyeball in 1 h. These RPE cells were hexagonal and had cytokeratin in their cytoplasm and numerous microvilli on their surface, similar to RPE cells evaluated in vivo. The results of this study thus show that our method for incubating eyeballs in proteinase K can provide good-quality RPE cells in sufficient quantities for study in a short time.

Concentric fibrosis and cellular infiltration around bile ducts induced by graft-versus-host reaction in mice: a role of CD8+ cells

We report in this paper on obvious fibrotic lesions in the liver of mice undergoing specified graft-versus-host reaction (GVHR). B6 CD8+ splenocytes were transferred into (bm 12 x bm 1)F1 mice to induce GVHR. Recipient mice had been thymectomized and administrated with anti-CD8 monoclonal antibody (mAb) to deplete CD8+ cells from the hosts. Two weeks after the mAb administration, recipient mice were injected with B6 CD8+ cells and sacrificed further two or four weeks later for analyzing hepatic lesions histopathologically. Light microscopic analyses revealed the presence of concentric fibrosis around both small and large duct levels and the infiltration of mononuclear cells into portal areas. Focal necrosis of hepatocytes was also detected electron-microscopically. These findings suggest that CD8+ T lymphocytes might play an important role in the induction of fibrotic lesions in the liver.