[Effect of the prior influenza vaccination on serum antibody titer induction by subsequent inactivated influenza vaccine in the elderly]

In order to investigate the effects of prior influenza vaccination on subaequent annual influenza vaccination in the geriatric population, we analyzed serum hemagglutinine inhibition antibody tirers (HI titer) before and after vaccination with inactivated influenza vaccine in elderly inpatients. A total of 163 inpatients of 60 years or older were enrolled with informed consent. They were classified by vaccination status in the previous year, 53 patients had inactivated vaccine (inactivated). 52 patients had genetically assorted cold-adapted influenza live attenuated vaccine (cold-adapted), and 53 had no influenza vaccine history during the past year. The HI titer was higher in the inactivated group than in the cold-adapted and non-vaccinated groups, suggesting residual immunological effects of inactivated influenza vaccine from the previous year vaccination. The HI titer after the inactivated vaccine in 1993 was higher in both the inactivated and cold-adapted groups than in the non-vaccinated group. The number of patients with HI titers of 2(7) or higher, which is the putative protective HI titer level for influenza infection, was significantly higher in both the inactivated and cold-adapted groups than the non-vaccinated group. These results suggest that continuous annual influenza vaccination does not impair the effects of vaccination, and may actively promote elevated HI titers.

Cerebral aneurysms in the elderly in Yamaguchi, Japan. Analysis of the Yamaguchi Data Bank of Cerebral Aneurysm from 1985 to 1995

BACKGROUND AND PURPOSE

The number of elderly people is markedly increasing in Japan. We have investigated the epidemiology and management outcome of cerebral aneurysms in elderly patients aged > or = 70 years.

METHODS

A total of 3100 patients were enrolled in the Yamaguchi Data Bank of Cerebral Aneurysm between 1985 and 1995. Of these, 598 with ruptured cerebral aneurysms and 120 with unruptured cerebral aneurysms were elderly (ie, aged > or = 70 years).

RESULTS

The number of elderly patients with cerebral aneurysms has markedly increased since 1991, and in 1995 approximately 30% of all patients with cerebral aneurysms were elderly. In cases of ruptured cerebral aneurysms, the proportion of patients with severe neurological grade did not change and that with an unfavourable outcome did not decrease throughout the 11 years. The proportion of patients with severe neurological grade in the elderly group was higher than in the younger group (< 70 years), and the management outcome of elderly patients for each neurological grade on admission was worse than that of younger patients (P < .01). However, the incidence rate of symptomatic cerebral vasospasm and rebleeding was the same for the two age groups. Eventually, 60.4% of all elderly patients with ruptured cerebral aneurysms had an unfavorable outcome. In cases of unruptured cerebral aneurysms, 63.3% of the selected elderly patients were surgically treated, and the surgical morbidity and mortality rates were 26.3% and 4.0%, respectively. These rates were nonsignificantly higher than those for younger patients.

CONCLUSIONS

The number of elderly patients with cerebral aneurysms has markedly increased in Yamaguchi. Because of the unsatisfactory management outcome of ruptured cerebral aneurysms and surgical outcome of unruptured cerebral aneurysms in elderly patients during the 11-year period, we propose the treatment of unruptured cerebral aneurysms at a younger age and the use of a screening system to detect these subjects.

Hepatitis C virus-related liver damage is related to cold activation of complement

A high positivity of cold activation of complement has been reported in Japanese patients having hepatitis B virus-negative chronic hepatitis. Although the cause of cold activation of complement is unknown, the involvement of hepatitis C virus (HCV) has been suspected. We studied the positivity of cold activation of complement in 253 patients, including 93 patients with chronic hepatitis C infection who received 6MU natural interferon-alpha per day for 24 continuous weeks. Cold activation was positive in 38% of patients with chronic hepatitis C and in 46% of patients with liver cirrhosis C. We did not detect cold activation in asymptomatic HCV carriers; patients with chronic hepatitis B, liver cirrhosis B, or alcohol-related liver damage; or in the controls. Cold activation was also negative in HCV-RNA-negative patients who responded completely to interferon-alpha, and in HCV-RNA-positive patients who responded partially whose serum alanine transaminase levels were normalized after interferon treatment. In the patients who had a relapse of hepatitis C after interferon treatment, positivity of cold activation increased sharply. We conclude that HCV-associated liver damage is related to the development of cold activation of complement. Cold activation is useful for monitoring the response to interferon in patients with chronic hepatitis C infection.

[Efficacy and adverse reactions of influenza vaccine in the elderly]

Influenza virus infection is a serious problem in the elderly because of the high pneumonia complication rate and a significant increase in mortality. Influenza vaccine is a method for controlling influenza epidemics in the elderly. The vaccinated elderly showed lower influenza infection rate and had fewer incidences of febrile episodes than did non-vaccinees during epidemics. Significantly, decreased rates of mortality subsequent to influenza epidemics among vaccinated elderly inpatients were also found. The antibody response to influenza vaccine in the elderly is quite comparable to that of younger adults. Adverse reactions to influenza vaccination, including local reaction such as soreness, systemic reactions such as malaise and fever, and allergic reactions, are less frequent in the elderly than in children and younger adults. The currently used inactivated influenza virus vaccine is as safe or safer than other vaccines. Serious adverse effects are unknown in the elderly. The influenza vaccination rate is quite low in Japan when compared with that of other developed countries. To prevent influenza epidemics among the elderly, especially among those who have been institutionalized, influenza vaccine should be promoted more actively.

Revascularization with split duro-encephalo-synangiosis in the pediatric moyamoya disease--surgical result and clinical outcome

Dural arteries are potential donor arteries for cortical revascularization. In this report, a technique of indirect anastomosis using a split dura is presented. At surgery, the dura near the branches of the middle meningeal artery was split into outer and inner layers, and the split surface of the outer layer was attached to the cortical surface (split duro-encephalo-synangiosis; split DES). This procedure, combined with standard encephalo-duro-arterio-synangiosis, was applied to 25 hemispheres in 18 patients with pediatric Moyamoya disease (mean age, 6 years). Postoperative superselective angiograms demonstrated effective cortical revascularization through the dural arteries in addition to the supply from the scalp arteries. All the patients were symptom free by 1.5 years after surgery. Postoperative reversible ischemic neurological deficit and infarction were seen in three (12%) and one (4%), respectively. The follow-up period ranged from 1 to 12 years (mean, 6.5 years). Thirteen of 16 (81%) patients led normal lives and three were mildly handicapped due to mental retardation that existed preoperatively. The split DES is a useful technique to extend the area of revascularization of ischemic hemispheres in Moyamoya disease.

Hepatitis C virus infection in the elderly. Epidemiology, prophylaxis and optimal treatment

Chronic infection with the hepatitis C virus (HCV) occurs throughout the world and appears to be the main cause of hepatocellular carcinoma. Studies have shown that, in areas of high endemicity, the prevalence of HCV infection is low in children but high in people aged > 60 years. Medical interventions were found to play an important role in the spread of HCV infection, because elderly patients became infected via contaminated blood transfusions or when contaminated syringes and needles were used. Maternal and sexual transmission do not appear to be the main routes of HCV infection. Interferon treatment eliminates HCV in 20 to 30% of patients with chronic HCV infection. The response to interferon therapy is usually complete in 70 to 80% of people with low levels of HCV RNA, HCV of genotype 2 and young women, but poor in elderly patients. Because liver disease can be severe in elderly patients, more effective therapies are clearly needed.

[A case of an elderly patient with dementia and gait disturbance associated with influenza]

We report a case of progressive dementia and prolonged gait disturbance correlated with influenza A/H3N2 infection in 91-year-old female patient, admitted because of in ability to take care of herself due to aging and cerebral infarction. At admission, conversation and comprehension were not significantly impaired, and she was able to walk by herself. Flu symptoms such as high grade fever, chills, arthralgia, and cough appeared after a short stay at home. Influenza A/ H3N2 was confirmed serologically. Delirium occurred on the sixth day after influenza onset, persisted for three weeks, followed by recovery. Dementia symptoms such as memory defects and disorientation continued and did not improve. Due to this febrile episode, she was unable to walk unassisted. The results of computed tomography performed before and after the influenza episode were unremarkable for additional cellebro-vascular events during the observed period. Influenza infection may be an important risk factor for reducing the quality of life in the elderly. In geriatric cases, influenza should not be treated as a mere transient illness, but rather one which has important consequences for the elderly population, including the possibility of life threatening complications.

Heterosexual transmission of hepatitis C virus among married couples in southwestern Japan

The heterosexual transmission of hepatitis C virus (HCV) remains controversial, and data from general populations are scanty. In this cross-sectional study, we assessed the seroprevalence of antibodies to hepatitis C virus (anti-HCV) and the presence and genotype of HCV-RNA among 109 married couples within an endemic, community-based Japanese population. Overall, 25% of the husbands and 32% of the wives had anti-HCV. Spouses with anti-HCV-positive partners were around 2 times more likely to have anti-HCV than spouses with anti-HCV-negative partners (p = 0.01). Of 6 couples in which both spouses had HCV-RNA, however, 3 presented discordant HCV genotypes (type 1b vs. 2b). The couples' anti-HCV concordance status was not significantly influenced by the presence or absence of HCV-RNA among anti-HCV-positive partners (odds ratio [OR]: 0.8 for wives, 0.6 for husbands), nor by the length of marriage, the number of pregnancies or the use of contraceptives. No significant associations with anti-HCV were observed for serum markers of sexually transmitted agents, including human T-lymphotropic virus (OR = 1.1, 95% confidence interval [CI] 0.5-2.3), Treponema pallidum (OR = 0.7; CI 0.1-6.1) and hepatitis B virus (OR = 1.6; CI 0.9-3.0). Our results suggest that the clustering of HCV infection among specific couples within this endemic population may not be attributable to heterosexual transmission. Follow-up studies are necessary to determine the risk of heterosexual transmission of HCV in endemic areas.

Plasma levels of brain natriuretic peptide as an index for evaluation of cardiac function in female gene carriers of Duchenne muscular dystrophy

The level of plasma brain natriuretic peptide (BNP) was elevated in 8 of 15 female gene carriers of Duchenne muscular dystrophy (DMD), and the level correlated with indices of cardiac function. In one of these carriers, whose clinical course was followed for one year, the plasma BNP level was elevated before the development of cardiac symptoms, further increased with the evolution of cardiac symptoms, and then decreased after treatment for cardiac failure. These results suggest that the plasma BNP level may be useful for the early detection of cardiac dysfunction and for evaluating the efficacy of cardiac treatment in female DMD carriers.

Elevation of serum soluble interleukin-2 receptor levels in patients with hepatitis C virus infection

To determine serum soluble interleukin-2 receptor (sIL-2 R) levels in hepatitis C virus (HCV) infection, serum sIL-2 R was measured in 260 subjects with chronic HCV infection, including 100 patients who had previously been treated with natural interferon (IFN) alpha, and in 51 HCV RNA-negative controls. Serum sIL-2 R levels in asymptomatic HCV carriers, patients with chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC) were significantly higher than those of healthy controls and subjects who were positive for anti-HCV and negative for HCV RNA (P < 0.01, respectively). Moreover, serum sIL-2 R levels were also significantly higher in patients with HCC than in other HCV RNA-positive groups. There was some correlation between serum sIL-2 R levels and histological activity index scores (r = 0.287, P < 0.01) and serum alanine aminotransferase levels (r = 0.272, P < 0.01). In patients in whom HCV RNA was eliminated following IFN treatment, serum sIL-2 R levels decreased to those seen in healthy controls by one year post treatment. Serum sIL-2 R levels increase due to HCV infection, and the amount of increase corresponds to the degree of inflammation.

[Clinical significance of peak body temperature, white blood cell count, and C-reactive protein level in febrile episodes among geriatric inpatients]

To investigate the clinical implication of peak body temperature, peripheral blood white blood cell (WBC) count, and serum C-reactive protein (CRP) level in febrile symptoms among geriatric hospitalized patients, they were analyzed in 968 febrile episodes obtained from 433 hospitalized patients in the referred hospital. Episodes of one day duration were most frequent (41.6%). WBC count was elevated over 8000/microliters in 475 episodes (49.1%) and CRP exceeded 1.0 mg/dl in 770 episodes (79.5%). Frequency of WBC elevation decreased and frequency of CRP elevation increased according to the time course. The mean value of CRP increased significantly according to the time course. The frequency of WBC count increase and CRP elevation and their averages correlated to the peak body temperature. The peak body temperature displayed the most striking correlation to the length of febrile episodes among three clinical indicators, peak body temperature, WBC count, and CRP level. These results indicate that the elevation of WBC count and/or CRP level is frequent in geriatric patients with febrile symptoms. Peak body temperature may serve as a clinical indicator of the severy of the febrile disease occurring in geriatric patients.

Cloning of a cDNA encoding a putative metal-transporting P-type ATPase from Arabidopsis thaliana

Metal-transporting P-type ATPases were recently proposed to constitute a newly emerged sub-family of cation-transporting P-type ATPases, and are known to occur widely in prokaryotes and eukaryotes. However, no instance has been reported for higher plants. A cDNA clone encoding a metal-transporting P-type ATPase was thus searched for, if present, and was identified in Arabidopsis thaliana. The amino acid sequence, predicted from the determined nucleotide sequence for the cloned cDNA, shows all the critical features common to known metal-transporting P-type ATPases. This plant P-type ATPase has a typical metal-binding motif at its N-terminal portion. The newly isolated Arabidopsis gene, named PAA1, provides us with the first instance of putative metal-transporting P-type ATPases in higher plants. Some results of genomic analyses for this gene are also presented.

Usefulness of HCV-RNA assays in efficacy evaluation of interferon treatment for chronic hepatitis C: Amplicor HCV assay and branched DNA probe assay

We investigated the usefulness of Amplicor HCV assay and branched DNA probe assay in efficacy evaluation of interferon therapies for chronic hepatitis C. Subjects were 164 HCV-RNA positive chronic hepatitis C patients who received interferon-alpha (IFN-alpha, HLBI) 3-6 MU per day for 14-24 weeks. Their HCV-RNA levels were examined five times by using reverse transcription-polymerase chain reaction (RT-PCR) assay, Amplicor HCV assay, and branched DNA probe assay. Complete response rate in the low virus level patients was significantly higher than in the high virus level patients (P < 0.001). In complete responders, the rate of HCV-RNA disappearance 2 weeks after the initiation of IFN therapy was higher than in non-responders (P < 0.001). The HCV-RNA positive rates in RT-PCR assay and Amplicor HCV assay agreed by 98% or more. The HCV-RNA negative patients 6 months later were still negative 12 months later by Amplicor HCV assay. Before starting interferon therapy for chronic hepatitis C, it is advisable to make a prediction of treatment efficacy by using branched DNA probe assay. In addition, disappearance of HCV-RNA after 2 weeks of treatment could be a useful predictor of the therapeutic efficacy of IFN. Amplicor HCV assay is useful in detecting HCV-RNA and for efficacy evaluation during and after a given interferon therapy.

Duration of chronic HCV infection and efficacy of interferon in chronic hepatitis C patients with a history of blood transfusion. The Study Group for Treatment of Hepatitis in the Kyushu Area

To investigate correlations between the interval between blood transfusion and the start of IFN therapy, and IFN efficacy, we studied chronic hepatitis C patients with a history of blood transfusion. The subjects were 122 patients with chronic hepatitis C and a history of blood transfusion at 64 institutions. The patients were treated with high or low-dose IFN. High-dose therapy consisted of intramuscular injection of human lymphoblastoid interferon (HLBI), 6 x 10(6) IU daily for 2 weeks, then 3 times a week for 22 weeks, and low-dose interferon therapy of intramuscular injection of HLBI, 6 x 10(6) IU daily for 2 weeks, then 3 x 10(6) IU 3 times a week for 22 weeks. Normal serum ALT levels for 6 months or more after completing IFN (complete response) were found in 44/122 (36.2%) patients and HCV RNA was no longer detectable after completing IFN therapy in 19/68 (27.9%). Patients in whom the interval between blood transfusion and the start of IFN therapy was less than 20 years had significantly higher rates of HCV RNA-negative complete response than those in whom the interval was 20 years or more (p < 0.039). When chronic HCV infection is caused by blood transfusion, the efficacy of IFN depends on the duration of chronic HCV infection. Since the duration of HCV infection is a factor in predicting efficacy, early IFN therapy may be more effective.

[Ultrastructure of the mucous membrane of the human newborn vocal folds]

This study was carried out to determine the ultrastructure of the mucous membrane of vocal folds of human newborns. Excised larynges of newborns were observed with a transmission electron microscope. The results obtained are summarized as follows: 1) The epithelium of the edge of the vocal folds consisted of stratified squamous epithelium. It was thin but numerous desmosomes showed firm attachment between cells. 2) The basement membrane zone had the same structure as that of adults. 3) The lamina propria of the vocal fold mucosa was loose in structure and there was no vocal ligament. 4) Fibroblasts were sparse and in the resting phase. 5) Collagenous and elastic fibers were sparse in the lamina propria. Structures of the the collagenous fibers wee mature but those of elastic fibers, were immature morphologically. 6) Ground substance was abundant in the lamina propria. 7) The newborn vocal fold mucosa lacked not only a vocal ligament but also adequate viscoelasticity for vibration.

Electrophysiological characterization of cultured hepatic stellate cells in rats

This study aimed to examine electrophysiological properties of cultured rat hepatic stellate cells (HSCs) using the whole cell configuration of patch-clamp technique. At least three different current components were identified. First, when the membrane was depolarized to voltages more positive than -40 mV, a transient outward K+ current was evoked. Second, membrane hyperpolarization below -60 mV evoked a sustained and inward-rectifying K+ current. The third component was a current flowing outward, which was activated when the cell was depolarized more positively than 0 mV. The channel for this current allowed Na+, K+, and Cl- to pass nonspecifically, suggesting the presence of hemi gap-junctional channel. Furthermore, a laser photobleaching technique revealed the presence of gap junctions between adjacent HSCs. A voltage-gated Ca2+ current, which is known to occur in smooth muscle cells, was searched for but was not detectable. These results suggest that membrane potential of HSCs is determined specifically by the two distinct K+ channels and by an intercellular mechanism involving gap-junctional communication.

No significant changes in levels of hepatitis C virus (HCV) RNA by competitive polymerase chain reaction in blood samples from patients with chronic HCV infection

To determine if levels of hepatitis C virus (HCV) RNA change over a several-year period, we quantified the amount of HCV RNA by competitive polymerase chain reaction. The population studied included 44 residents of a rural area with chronic HCV infection, 39 had chronic hepatitis C and 37 were patients on hemodialysis. All these Japanese patients had HCV RNA of genotype II. Blood samples were collected once a year from 1992 to 1995. From 1993 to 1995 between the groups, there was no significant difference in change of HCV RNA levels of 44 residents with chronic HCV infection, with and without liver dysfunction, nor was there any change in the 31 hemodialysis patients from 1992 to 1995. The HCV RNA levels in the 25 with chronic hepatitis who did not respond to interferon-alpha during 1992-1993 returned to pretreatment levels after the cessation of interferon treatment. In two of six hemodialysis patients who were infected with HCV during this observation period, HCV RNA was eliminated within one year, and the remaining four became HCV carriers. HCV RNA levels in the latter rose rapidly after infection and were sustained at a high level throughout the study period. Thus, HCV RNA level did not change remarkably during a three-year period, a finding which supports that it does not correlate with deterioration of liver damage and aging of HCV carriers.

Hepatitis C viral quasispecies and liver damage in patients with chronic hepatitis C virus infection

To clarify the virological differences in patients with chronic hepatitis C virus (HCV) infection with and without liver damage, we assessed HCV markers in 306 patients from a rural area of Japan. Genotypes of HCV RNA were determined by polymerase chain reaction, and levels of RNA were determined by branched DNA signal-amplification assay. All patients had undergone annual tests for alanine aminotransferase (ALT) levels from 1986 to 1995. Patients were categorized into three groups: group A, 121 patients (39.5%) with normal ALT levels on all occasions for 10 years; group B, 127 patients (41.5%) with intermittently abnormal ALT levels; and group C, 58 patients (19.0%) with consistently abnormal ALT levels. There were no significant differences in serum RNA levels or distribution of genotypes among the three groups. We selected 10 patients from group A with normal ALT levels and 10 from group C with abnormal levels for sequence analysis of the HCV core region (nt 169-378) of five clones from each patient. More mutations were found in the 50 clones from the 10 patients from group C than in the 10 patients from group A. In group A, all mutations were synonymous so that the deduced amino acid sequences were identical among clones from each patient, whereas in group C 16 of 57 mutations were nonsynonymous so that the deduced amino acid sequences showed differences in the five clones of eight of 10 patients. In conclusion, the HCV core region was highly conserved in patients with normal liver biochemical test results but not in those with abnormal results. Our results suggest that abnormal liver biochemical test results in patients with chronic HCV infection may be associated with high degrees of virus quasispecies diversity.

[A case of hepatocellular carcinoma complicated with psoas abscess]

Psoas abscess is relatively rare and often difficult to make early diagnosis. We treated a patient suffering from hepatocellular carcinoma due to hepatitis C virus infection who was admitted to our hospital complaining of right inguinodynia and a high fever. Positive CRP test were seen. Staphylococcus aureus was detected from blood culture and he was treated for sepsis with antibiotic therapy. After starting treatment, his inguinodynia continued and abscesses were demonstrated in the right psoas muscle by pelvic computed tomography (CT). The abscesses were drained and a specimen yielded S. aureus on culture. After drainage, the symptoms improved and the abscesses disappeared on pelvic CT. Pelvic CT can be successfully used to diagnose psoas abscess and to monitor the efficiency of the treatment.

Correlation between human T cell lymphotropic virus type-1 and Strongyloides stercoralis infections and serum immunoglobulin E responses in residents of Okinawa, Japan

To clarify the relationship between Strongyloides stercoralis, infection with human T cell lymphotropic virus type-1 (HTLV-1), and serum immunoglobulin E (IgE) levels, epidemiologic investigations of these two infections were conducted in inhabitants of Okinawa, a subtropical zone in Japan. Blood and feces samples were taken from 1,347 healthy inhabitants (554 males and 793 females). Antibody to HTLV-1 was measured by particle agglutination, enzyme-linked immunosorbent assay, and Western blotting. The presence of Strongyloides was determined by direct detection of rhabditiform larvae in fresh stool on agar-plate cultures. Serum IgE levels in 127 inhabitants were measured by a fluoroenzyme immunoassay. Antibody to HTLV-1 was detected in 23.0% of the blood samples and was more frequent in females (25.1%) than in males (20.0%) (P < 0.05). Strongyloides were detected in 21.9% of the feces samples and were more frequent in males (31.9%) than in females (14.9%) (P < 0.001). The prevalence of both infections increased with age, especially in persons 50 years of age and older: The prevalence of Strongyloides infection was significantly higher in HTLV-1 carriers (31.6%) than in those without HTLV-1 infection (P < 0.001). The level of IgE was low in HTLV-1 carriers, and significantly lower in HTLV-1 carriers than in noncarriers among inhabitants with Strongyloides infection. Both HTLV-1 and Strongyloides infections are endemic in the area studied.

Electrophoretic demonstration of high molecular weight fibrin degradation products persisting in chronic subdural hematomas

Local hyperfibrinolysis plays an important role in the pathogenesis of chronic subdural hematoma (CSH). The purpose of this study is to elucidate the nature of the local hyperfibrinolysis in CSH, by comparing the pattern of fibrin/fibrinogen degradation product (FDP) of hematomas with that of purified fibrin clots digested by plasmin in vitro. Forty-seven hematoma samples were subjected to the analysis. FDPs of CSH and the purified fibrin clots digested by plasmin for different incubation times were identified using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immuno-blotting, and then quantified by densitometry. The effect of alpha-2 plasmin inhibitor (A2-PI) on the degradation process was also studied. The FDP pattern of CSH was similar to those of purified fibrin digested by plasmin for 0.75-2 h. The FDP composition of CSH was closest to that of purified fibrin digested for 1 h. By adding the physiological concentration of A2-PI at the second hour, further degradation of high molecular weight FDPs was inhibited and the early FDP pattern persisted after 24 h. Local hyperfibrinolysis in CSHs is characterized by incomplete fibrinolysis, which occurs only on the solid fibrin clot, and is arrested in the liquid hematoma. As a result, high molecular weight FDPs persist in CSHs for weeks or months in the hematoma. A2-PI seems to play an important role in producing this unique FDP pattern in CSH.

Long term survey of hepatitis C virus infection in hemodialysis units in Fukuoka, Japan

To examine prevalence of hepatitis C virus (HCV) infection and liver dysfunction in hemodialysis units, we surveyed markers for HCV infection and serum alanine aminotransferase (ALT) in hemodialysis patients. 204 hemodialysis patients (111 men and 93 women; mean age, 53 +/- 12 years) in four hemodialysis units in Fukuoka, Japan were investigated. All serum samples were tested for antibody to HCV (anti-HCV) by second-generation enzyme-linked immunosorbant assay (ELISA). HCV RNA was detected to identify present HCV infection in the anti-HCV-positive patients by polymerase chain reaction (PCR) using primers deduced from the 5'-noncoding region. Liver dysfunction was defined as an elevated concentration of serum ALT (above 36 IU/liter) tested by a multiple autoanalyser. 105 patients (51.5 percent) were initially positive for anti-HCV, 95 (90.5 percent) of whom were also positive for HCV RNA. Ten became positive for anti-HCV in hemodialysis units during the observation, eight (80 percent) of whom had sustained HCV viremia. The route of transmission of HCV was not clear, but two of these patients had received blood transfusions. Of 95 patients with HCV viremia, 43 (45.3 percent) had had liver dysfunction at least once. In conclusion, HCV infection continues to occur in hemodialysis units not through blood transfusion and many of them become HCV carriers. Liver dysfunction was found in about a half of HCV-infected hemodialysis patients during the observation.

[Serum albumin level as a predictor of incidence of febrile episodes and mortality in hospitalized geriatric patients]

To investigate the relationship between serum albumin level and incidence of febrile episodes and mortality in the elderly, we studied 748 patients hospitalized for over one year. The subjects included 123 males and 355 females with a mean age 81.2 years. The average serum albumin level was 3.79 g/dl and levels of serum albumin decreased with advancing age. The incidence of febrile episodes was 1.8 per year in patients with serum albumin levels over 4.1 g/dl, increasing with decline of serum albumin levels. The incidence of febrile episodes was 5.3 per year in patients with serum albumin levels under 3.0 g/dl. Patients with serum albumin levels under 3.0 g/dl displayed a high incidence of febrile episodes irrespective of age. Age adjusted in-hospital mortality was 40.4% during the observed period in patients with serum albumin levels under 3.0 g/dl, significantly higher than that of the patients with serum albumin levels over 3.1 g/dl. Relative risk of febrile episode and mortality calculated using the patients with serum albumin levels over 4.1 g/dl as a control was 2.9 and 2.1, respectively, in the patients with serum albumin levels under 3.0 g/dl. These results indicate that serum albumin level is a simple, but strong, predictor of susceptibility of febrile episode and death. Patients with serum albumin levels under 3.0 g/dl may constitute a high risk group for febrile episode and death.

Alcohol consumption and seroconversion from hepatitis B e antigen in the Okinawa Japanese

A total of 1,113 hepatitis B surface antigen (HBsAg) carriers of Yaeyama District in Okinawa, Japan, were investigated in attempts to elucidate effects of alcohol consumption on seroconversion from hepatitis B e antigen (HBeAg). All of HBsAg carriers were tested for HBeAg. The subjects over 20 years of age were asked about their habitual intake of alcohol and were ranked into three categories: nondrinkers, light drinkers (1-59 g/day), and heavy drinkers (> or = 60 g/day). The prevalence of HBeAg decreased with advancing age and did not differ between the sexes. Logistic regression analyses of the data revealed prevalence curves of HBeAg, depending on the age of subjects. The prevalence curves tended to be higher and decrease more slowly in heavy drinkers than in the nondrinkers. Thus, the possibility that heavy alcohol drinking prolongs seroconversion from HBeAg seems worthy of further consideration.

[A study on the concurrent validity of personality inventory from the view of the Five Factor Model concerning personality traits]

By using the Adjective Check List (ACL) in its Japanese version, the concurrent validity of a personality inventory is investigated through canonical correlation analysis and procrustes factor rotation from the view of the Five Factor Model concerning personality traits. After describing the objective of the present paper, the principles both of canonical correlation analysis and of incomplete orthogonal procrustes factor rotation to be used are explained. And, following the description concerning samples and data for analysis, the results both based on the scales and on the items of the personality inventory are presented. The important role of procrustes type of factor rotation in editing personality inventory is stressed before closing the discussion.

[Incidence and duration of febrile episodes in a hospitalized geriatric cohort]

Fever is a common and important clinical symptom observed among hospitalized geriatric patients. To investigate the frequency and duration of fever episodes, we surveyed fever episodes in a hospital where the frequency of patients over 60 years of age exceeds 90 per cent of the patients. Fever episodes with body temperature of over 37.5 degrees C were registered from May in 1991 to December in 1994, and 6809 episodes were subjected to analysis. The average incidences per month were 157.1, 165.3, 158.0, and 139.3 in 1991, 1992, 1993, and 1994, respectively. The numbers of episodes per month did not show any significant correlation with temperature or humidity. Average duration of the episodes were 8.0, 6.5, 7.6, and 6.7 days for 1991, 1992, 1993, and 1994, respectively. Episodes of one day duration were the most frequent in all months, and the frequencies of that ranged from 37.1% to 58.6% with a mean of 47.8%. The average duration of episodes and the frequency of one day episodes did not change significantly irrespective of a notable decrease in the total incidence. The high frequency of one day episodes and their consistency through the observed period suggest that fevers with one day duration are one of the characteristic features of the febrile symptoms in geriatric patients. Causality and prevention methods for these one day fever episodes should be investigated.

Prevalence of hepatitis C virus infection among female prostitutes in Fukuoka, Japan

To assess the risk of sexual transmission of hepatitis C virus (HCV), we surveyed female prostitutes to determine the prevalence of antibody to HCV (anti-HCV) and HCV RNA. Anti-HCV was examined with a second generation anti-HCV test employing a passive hemagglutination assay. HCV RNA was detected by two-stage polymerase chain reaction with primers deduced from the 5'-noncoding region of the HCV genome. All studies were performed in Fukuoka, Japan, from 1989 through 1992 and all subjects were Japanese and had no history of intravenous drug abuse. The prevalence of anti-HCV was significantly higher in the prostitutes (10.1%; 61/604) than in the controls (female blood donors; 0.8%; 52/6632) (P < 0.001). HCV RNA was found in 73.2% of the anti-HCV-positive prostitutes. The prevalence of anti-HCV among prostitutes increased with the number of years spent in prostitution (P < 0.05). Prostitutes with a history of syphilis had a higher prevalence of anti-HCV than those with no history of syphilis, irrespective of the number of years in prostitution. In a longitudinal study of 244 prostitutes, 2 of the 218 initially seronegative subjects showed anti-HCV and HCV RNA over the study period of 3 years. These two persons had no history of percutaneous exposure. Sexual transmission of HCV presents a risk for female prostitutes.

Predictive factors of a response to interferon therapy in chronic hepatitis C

To determine predictive factors of response to interferon (IFN) therapy in chronic hepatitis C patients, we administered IFN-alpha, 1 6 million U1 intramuscularly daily for 2 consecutive weeks, then three times a week, to 136 patients judged to have chronic hepatitis C virus (HCV) infection according to HCV-RNA positivity. We also investigated the most effective length of IFN-alpha treatment according to efficacy factors, i.e., histological activity index. HCV-RNA genotype, and HCV-RNA levels. patients were classified either into a short-term group (entire treatment period 16 weeks), standard-term group (24 weeks), and long-term group (40 weeks). Patients were assessed as complete responders (CR) if their HCV-RNA became negative and their alanine aminotransferase (ALT) decreased to < or = 39 IU/L after 18 months of treatment or nonresponders in other cases. Results showed that HCV-RNA levels and genotype were statistically significant predictive factors. CR rates in the standard- and long-term groups were significantly higher than in the short-term group (p < 0.05). In patients with low HAI scores, the long-term group showed the highest CR rate. In patients with low virus counts, the CR rate increased to 73% in the 24th week and 100% in the 40th week. CR rates in patients with HCV-RNA genotype 1b and 2a or 2b also increased as the treatment period became longer. For efficacy, a 24-week treatment period was necessary. In patients with mild liver tissue damage or low virus counts, 40 weeks of treatment proved highly useful.

Use of a split dura for revascularization of ischemic hemispheres in moyamoya disease

A new technique of indirect revascularization using the dural arterial supply to provide donor vessels is presented together with the results of an assay performed to determine the angiogenic activity of the dura. At surgery, a portion of the dura near the branches of the middle meningeal artery was split into outer and inner layers, and the split surface of the outer layer was attached to the cortical surface. This procedure, combined a with standard encephaloduroarteriosynangiosis, was applied to 25 hemispheres in 18 patients with pediatric moyamoya disease (mean age 6 years). All of the patients were symptom free by 1.5 years after surgery. The follow-up period ranged from 1 to 12 years (mean 6.5 years). Thirteen (81%) of 16 patients were able to lead normal lives and three were mildly handicapped due to mental retardation that existed preoperatively. Postoperative superselective angiograms demonstrated effective cortical revascularization through the dural arteries as well as from the scalp arteries. A histological study of the dura in cases of moyamoya disease showed an increased number of blood vessels in the outer layer. Angiogenic activity determined by chorioallantoic membrane assay was higher in the split surface of the dura than in the internal surface of the dura (the natural interface between the dura and cortex). The split duroencephalosynangiosis described in this report is a useful addition to indirect revascularization techniques, allowing extension of the area of revascularization in the ischemic hemispheres of patients with moyamoya disease.

Giant intracranial aneurysms in two sisters: case report

BACKGROUND

It is rare for intracranial aneurysms to present with cranial nerve palsy caused by the space-occupying effect of the lesion. Herein we discuss two sisters with familial intracranial aneurysms, both of whom presented with cranial nerve palsy.

CASE DESCRIPTION

Two female siblings presented with ocular movement and facial sensory disturbances caused by the space-occupying effect of giant aneurysms at the cavernous portion of the internal carotid arteries. The aneurysms were located at the identical site in both patients. Proximal occlusion of the internal carotid artery was effective in both cases, resulting in the promotion of thrombosis within the aneurysms in order to reduce their space-occupying effect.

CONCLUSION

This is considered to be the first known case of siblings, both suffering from giant internal carotid artery aneurysms.

[An outbreak of influenza A (H3N2) among hospitalized geriatric patients]

An outbreak of influenza A (H3N2) in a hospital where almost 90% of the inpatients are aged over 70 years is described. An increase of febrile episodes was seen during the period from January 29th to March 17th, 1992 in two of six wards paired sera, at the onset of fever and more than two weeks later, were obtained from patients in sixty-five episodes. Serum antibody titer to influenza A (H3N2) elevated over four times in 39 (60%) of 65. Influenza A (H3N2) virus was also isolated from seven patients. These results indicated an outbreak of influenza A (H3N2) in this population. Maximum body temperature was over 39 degrees C in 18 patients (46.2%) with influenza, and were significantly higher than that of the non-influenza patients. The duration of fever in 12 patients of 39 was longer than 8 days in 12 patients, and significantly longer than that of non-influenza cases. Bronchopneumonia was found in ten patients (25.6%). These results suggest that the influenza infection causes a high grade fever in geriatric patients and lasts longer than is commonly seen in patients with fever not associated with influenza. Influenza infection also frequently induces bronchopneumonia and may contribute to increase mortality in the elderly, especially in patients over 70 years old.

[Assay of specific anti-Chlamydia pneumoniae antibodies by ELISA method. 2. studies on clinical usefulness and serological diagnostic standards]

We measured anti-Chlamydia pneumoniae (C. pneumoniae) specific antibody titers by means of a newly-developed enzyme-linked immunosorbent assay (ELISA) method using an anti-C. pneumoniae specific antibody detection reagent. The clinical usefulness of this method was hereby evaluated. The IgG, IgA and IgM titers in 418 serum specimens obtained from patients with respiratory tract infections were measured by this new ELISA method, and the results were compared with the titers determined for the same specimens with the micro immunofluorescence (Micro-IF) method. The results showed good correlation coefficients for IgG, IgA and IgM. The two assay methods showed high agreement rates for positivity and for negativity. Specimens which did not yield the same results with the ELISA method and the Micro-IF method were subjected to analysis by the Western blot method, and the rates of agreement with the ELISA results were high. In addition, the child (0 approximately 15 yrs old; n = 122) and adult (16 approximately 90 yrs old; n = 133) cases were classified on the basis of being antigen-positive or antigen-negative at the initial examination, and their antibody-positive rates were determined. The adults showed no statistically significant differences in the antibody-positive rates for either IgG or IgA antibodies as a function of the pretreatment antigen status. However, the children showed statistically significant (p < 0.001) differences in the antibody-positive rates for both IgG and IgA antibodies as a function of the antigen status in the antigen-positive group compared with the rates in the antigen-negative group. Furthermore, the IgM-positive rates for the children were high in the antigen-positive group compared with the rates in the antigen-negative group, and the difference was statistically significant (p < 0.001). The IgM-positive rates in the adults were also significantly (p < 0.05) different between the antigen-positive group and the antigen-negative group. The Micro-IF method was applied to 34 specimens from antigen-positive patients, and 22 specimens were found to show an IgG titer of > or = 512 or an IgM titer of > or = 16. The diagnoses of these patients were acute respiratory disease in sixteen, pneumonia in four. Application of the ELISA-method to those 22 specimens showed all of them to exhibit IgG absorbance of > or = 0.6 and IgA absorbance of 0.2. The results described above indicate the clinical usefulness of our new ELISA method for the detection of antibodies specific for C. pneumoniae. The significance of this ELISA method for serological diagnosis of C. pneumoniae infections and the criteria for diagnosis of acute infections were also discussed.

The effect of sodium bicarbonate on CBF and intracellular pH in man: stable Xe-CT and 31P-MRS

The effects of sodium bicarbonate on cerebral blood flow (CBF) and intracellular pH were studied in five normal volunteers. CBF and intracellular pH were measured by stable xenon computed tomography and phosphorus-31 magnetic resonance spectroscopy (31P-MRS) respectively. Each patient received 7% sodium bicarbonate (3.5 ml/kg body weight) infused intravenously for 15 minutes. Before and after this injection, CBF intracellular pH and physiological parameters were measured. CBF and PaCO2 were significantly increased. On the other hand, hematocrit and intracellular pH were decreased. These result suggests that three factors are thought to contribute to increase CBF during administration of sodium bicarbonate in humans: 1) arterial dilatation in response to carbon dioxide 2) an decrease of hematocrit 3) intracellular acidosis.

Effective administration methods and dosages of interferon therapy for chronic hepatitis C

The efficacy of interferon alfa (IFN-alpha) was evaluated in 127 hepatitis C virus-ribonucleic acid (HCV-RNA)-positive patients with chronic hepatitis C in relation to HCV-RNA levels and genotype. Patients were assigned to one of three groups. Patients in group A received IFN-alpha daily for 8 weeks (total dose, 336 million units [MU]); patients in group B received IFN-alpha daily for 4 weeks and then intermittently for 20 weeks (total dose, 348 MU); and patients in group C received IFN-alpha daily for 2 weeks and then intermittently for 22 weeks (total dose, 480 MU). Complete response rates in groups B and C were significantly higher than those in group A, regardless of the virus level or genotype. Complete response rates in groups B and C were similar, but in patients with a high virus level or HCV-RNA genotype II, the partial response rate in group C was significantly higher than that in group B. In conclusion, IFN-alpha was more effective after daily and then intermittent administration than after daily administration only, and a higher daily dose was necessary to be more effective in patients with high virus levels or HCV-RNA genotype II.

Hemodynamics of hypertensive putaminal hemorrhage evaluated by Xenon-enhanced computed tomography and acetazolamide test

Cerebral blood flow (CBF) is usually decreased in patients with hypertensive putaminal hemorrhage (HPH). However, there are few reports concerning cerebrovascular reserve capacity (CRC) in these cases. This study evaluated cerebral hemodynamics in patients with HPH by measuring CBF and CRC. CBF and CRC were measured by stable xenon enhanced computed tomography (Xe-CT) in 11 patients with HPH (HPH group) and 11 patients with essential hypertension without intracerebral hematoma (non-HPH group). CBFs of the hemisphere and thalamus in the HPH group were lower than those in the non-HPH group. And the CBF of the hemisphere was increased transiently after the surgical evacuation of the hematoma. Thereafter, it fell gradually. The CRCs were also lower in acute stage of the HPH group. The CRC recovered during the chronic stage. Hemodynamics in patients with HPH can be modulated by surgical removal of hematoma. However, some adjunct therapies are necessary to prevent delayed neuronal inactivity, Stable Xe-CT with acetazolamide test is useful to evaluate hemodynamics in the HPH patients.

Surgical modulation of the natural course of collateral circulation in chronic ischemic patients

The purpose of this study was to evaluate hemodynamic compromise in terms of baseline CBF and CRC in patients with chronic cerebral occlusive lesions and its modulation by a superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis. The study subjects were 10 healthy volunteers and 49 chronic ischemic patients with stenosis or occlusion of the internal carotid artery (ICA) or middle cerebral artery (MCA). The hemodynamics were measured using stable xenon enhanced computed tomographic CBF measurement with the acetazolamide challenge. The compromised hemodynamics in patients with chronic steno-occlusive lesions did not improve during their natural course after two months. STA-MCA bypass modulated hemodynamic compromise in the ischemic patients. We recommend STA-MCA bypass for patients with reduced CRC, regardless of whether baseline CBF is reduced or normal. Hemodynamic classification using a combination of baseline CBF values and CRC values is useful for evaluating cerebral hemodynamics and for choosing the best treatment for cerebral ischemia with occlusive lesions.

Modulation of cerebral hemodynamics by surgical revascularization in patients with moyamoya disease

The purpose of this study was to evaluate hemodynamic compromise in the patients with moyamoya disease and surgical modulation of the hemodynamics using stable xenon enhanced computed tomographic CBF measurement with the acetazolamide challenge. The study group consisted of 15 preoperative cases and 17 postoperative cases. In the preoperative group, regional resting cerebral blood flow (rCBF) and regional cerebrovascular reserve capacity (rCRC) were reduced. The reduction was more prominent in the anterior circulation than in the posterior circulation. In the postoperative group, rCBF and rCRC were still low in the anterior circulation. Revascularization increased the resting CBF but did not change the CRC. Postoperative CBF did not increase in adults but increased in children. These findings suggest that the misery perfusion state may be present only in the child's brain. Measurement of CBF and CRC is useful to evaluate the hemodynamics of moyamoya disease.

Effect of angiotensin converting enzyme inhibitor on chronic ischemic patients

Most of patients with cerebrovascular disease are associated with hypertension. Hypertension induces progressive atheromatous changes in cerebral arteries, and often causes steno-occlusive lesions of cerebral arteries. Angiotensin converting enzyme (ACE) inhibitor cilazapril is one of the antihypertensive drugs. It was reported that cilazapril improved resting cerebral blood flow (CBF) and cerebrovascular reserve capacity (CRC) in experimental studies. In this clinical study, the authors investigated whether long-term treatment with cilazapril could improve CBF and CRC in patients with steno-occlusive lesions of the major cerebral arterial trunk, measured by stable xenon computerized tomography (Xe-CT) with acetazolamide challenge. On the other hand, CBF and CRC in the calcium blocker-treated patients were measured in the same way. CBF did not change after long-term treatment with both cilazapril and calcium blocker. In the cilazapril-treated group, CRC was increased significantly (p < 0.05). However, CRC did not change in the calcium blocker-treated group. It was recognized that long-term treatment with cilazapril did not decrease CBF and improved CRC in patients with occlusive lesions of the major cerebral arterial trunk.

Regression of moyamoya vessels and hemodynamic changes after successful revascularization in childhood moyamoya disease

Successful revascularization improves ischemic symptoms in the pediatric patients with moyamoya disease. However, it is not clear whether the revascularization prevents future intracranial hemorrhage from the residual moyamoya vessels. The purpose of this study is to investigate perioperative morphological and hemodynamic changes in the moyamoya vessels. Four pediatric patients (age < 15 years old) with bilateral moyamoya disease were selected for this study. To quantify the number of moyamoya vessels, T1-weighted transverse images at the level of the basal ganglia and the thalamus were selected and characteristic flow voids in the lentiform nucleus were counted. Resting CBF and cerebrovascular reserve capacity (CRC) were measured pre- and 1 year after surgery using Xenon-CT CBF method with acetazolamide test. The ratio of deep CBF/cortical CBF was calculated as an index of hemodynamic stress distribution. The one-year follow-up studies showed that 1) the number of moyamoya vessels decreased on the operative side, but did not change on the non-operative sides in all cases; 2) the ratio of deep CBF/cortical CBF decreased on the operative sides, but did not change in the non-operative sides; and 3) the CRC increased on both sides. This observation suggests the possibility that revascularization surgery may be effective for preventing the future risk intracranial hemorrhage.

Current status and controversies in the inhalation protocols for the Xenon CT CBF method

The historical background and current status of the inhalation protocols for the xenon CT CBF method are reviewed. A wash-in method has been established and widely accepted as a standard protocol. A wash-in/washout method is a useful alternative for a practical CBF study. The effect of flow activation with xenon gas can be minimized by shortening the inhalation time. Xe CT CBF method remains to be an indispensable technology for the clinical decision-making in various brain disorders.

Comparison of Xe-CT/CBF and quantitative ECD-SPECT

We compared stable xenon enhanced X-ray computed tomography (Xe-CT) with Technetium-99m ethylsteinate dimer single-photon emission computed tomography (ECD-SPECT) in 12 patients. We evaluated the cerebral blood flow (CBF) values in the territory of the anterior, middle and posterior cerebral artery, and in the thalamus. The CBF values were higher in ECD-SPECT than in Xe-CT except for the values of the thalamus. The posterior cerebral artery territory showed a lower correlation and the thalamus had no correlation between two methods. We discussed causes of these differences.

Hepatitis C virus infection and risk of hepatocellular carcinoma among Japanese: possible role of type 1b (II) infection

BACKGROUND

Although hepatitis C virus (HCV) infection is recognized as an important risk factor for hepatocellular carcinoma HCC), the strength of this association has been inconsistent. In addition, the role of specific HCV genotypes in HCC progression has not yet been determined.

PURPOSE

We conducted a case-control study to estimate the relative risk (RR) of HCC in relation to HCV infection among residents of the Fukuoka Prefecture, where HCC risk is among the highest in Japan, and to examine whether the risk differs according to HCV genotypes and/or HCV RNA titers.

METHODS

Stored serum samples obtained from 91 patients with HCC and 410 healthy control subjects, who had been frequency matched to the patients with regard to sex and age, were tested for antibodies to HCV by use of second-generation immunoradiometric and immunoblot assays. The presence of serum HCV RNA and of specific HCV genotypes was determined by use of polymerase chain reaction-based assays, and HCV RNA titers were measured by use of a branched DNA assay.

RESULTS

Antibodies to HCV were detected in 71 patients (78.0%) and in 30 control subjects (7.3%), of whom 57 patients and 25 control subjects had serum HCV RNA. One patient was positive for HCV RNA but not for antibodies to HCV. The sex- and age-adjusted RR of HCC among individuals positive for antibodies to HCV was estimated to be 53.7 (95% confidence interval [CI] = 27.1-106.2). Antibodies to HCV were much more prevalent among patients negative for serum, hepatitis B surface antigen (HBsAg) (69 of 72, 95.8 %) than among HBsAg-positive patients (two of 19, 10.5%); the RR increased to 339.6 (95% CI = 96.5-1195.8) in the separate analysis of HBsAg-negative subjects. The most frequent genotype among HCV RNA-positive subjects was type lb (also called type II) (found in 49 [86.0%] of 57 patients and in 15 [60.0%] of 25 control subjects); individuals with type 1b infection experienced a significantly elevated risk (RR = 3.8; 95% CI = 1.0-13.9) compared with the risk observed for individuals with type 2a (also called type III) infection. No statistically significant association between HCV RNA titers and HCC was evident.

CONCLUSIONS

HCV infection, particularly type 1b infection, plays an important role in the development of HCC among the study population. We estimated that approximately 78% (95% CI = 69%-86%) of the HCCs that occur in this high-risk area are attributable to HCV infection, if we assume that the patients in this study were representative population samples.

IMPLICATIONS

Further studies are needed to clarify potential risk factors, including specific HCV genotypes, for progression to HCC among HCV carriers.

[Efficiency of combination chemotherapy and interferon-alpha therapy in a patient with AIDS-related cutaneous and gastrointestinal Kaposi's sarcoma]

A 40-year-old male was admitted to the hospital with acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia (PCP). Two months before admission the patient had a high fever, general fatigue and mild epigastic tenderness. On admission, physical examination revealed numerous small tumors on the head, gingiva, neck, nasal ala, anterior forehead, anterior thoracic, bilateral sole and bilateral lower limbs. At that time, the CD4 cell count was 130/microliters. Upper GI endoscopy was performed because of sever epigastralgia and hematemesis. The gastric mucosa was diffusely nodular and erythematous with bleeding. This biopsy showed Kaposi's sarcoma, and the same findings were obtained from the duodenum, rectum and skin, AIDS with related cutaneous and gastrointestinal KS and PCP was diagnosed. We performed a combination of chemotherapy and Interferon-alpha therapy, and the KS almost completely disappeared within 3 months.

Regional differences in apoptosis in murine gliosarcoma (T9) induced by mild hyperthermia

There are several reports of apoptosis induced by mild hyperthermia both in vitro and in vivo. However, in tumour nodules, regional differences in apoptosis induced by hyperthermia have not been studied morphologically or quantified. In this study, apoptosis was identified on the basis of its characteristic morphology, and was quantified in different tumour regions (margin and centre) by light and electron microscopy and discussed the correlation with necrosis. Apoptosis was induced in solid nodules of gliosarcoma (T9) in vivo by heating for 30 min in a water bath at 43 degrees C. The gliosarcoma cells showed a rapid increase in the number of apoptotic cells following mild hyperthermia. There was a regional difference in the rate of apoptosis immediately after hyperthermia. Necrosis was markedly enhanced only in the centre of the tumour 3 and 6 h after hyperthermia. These combined responses of apoptosis and necrosis seem to be caused by the microenvironmental change in the intratumour location.

A case of large neonatal arteriovenous malformation with heart failure. Color Doppler sonography, MRI and MR angiography as early non-invasive diagnostic procedures

We report a case of a large arteriovenous malformation (AVM) of neonatal onset with heart failure. Transfontanel color Doppler sonography revealed abnormal vessels in the early stage of the investigation. Magnetic resonance imaging (MRI) revealed numerous flow voids suggesting abnormal vessels, and magnetic resonance angiography (MRA) disclosed numerous bizarre abnormal vessels. Color Doppler sonography is a convenient and appropriate procedure for the early bedside diagnosis of neonatal AVMs. MRI and MRA can replace cerebral angiography for the diagnosis of neonatal AVMs.

Identification of an epitope for T-cells correlated with antibody response to hepatitis B surface antigen in vaccinated humans

Two antigenic T-cell epitopes of HBsAg, designated HBs 16-31 and HBs 81-99, were identified using synthetic peptides and HBsAg-specific T-cell lines. HBs 16-31 was recognized by five HBsAg-specific T-cell lines from vaccinees with both high and low antibody titers, whereas HBs 81-99 was recognized by two T-cell lines derived from vaccinees with high antibody titers. The antibody titer against HBsAg was correlated significantly with the proliferation of vaccinee's PBLs in response to HBs 81-99 (r = 0.47) but not to HBs 16-31, suggesting that HBs 81-99 plays a critical role in anti-HBs antibody production in humans vaccinated with HBsAg.