Analysis of hepatitis B virus DNA, liver disease and influence of antibody to hepatitis C virus in anti-HBe chronic carriers

Hepatitis B virus DNA (HBV-DNA) in serum was studied in 67 anti-HBe patients using dot-blot hybridization, a modified technique and polymerase chain reaction (PCR). All patients had abnormal aminotransferase (ALT) levels. Serum HBV-DNA was detected in 14/67 cases by dot-blot and in 39/67 (DNA probe) and 45/67 (RNA probe) using the modified technique. The RNA probe was more sensitive than the DNA probe when they were compared, using serial dilutions of HBV-DNA of known concentration (0.1 pg vs 1 pg, respectively). HBV-DNA was found by PCR in 57/67 patients. Ten patients were negative to serum HBV-DNA. The ALT level was significantly higher in patients with serum HBV-DNA by dot-blot as compared to those who had serum HBV-DNA by the modified technique and PCR. With respect to the presence of anti-HCV, 6/67 had anti-HCV confirmed by RIBA test. These 6 patients had serum HBV-DNA. The route of acquisition of HBV infection in anti-HCV positive patients was by parenteral exposure in 67% of the cases and 15% in HCV negative (p less than 0.05). All patients were negative to nonorganic specific autoantibodies. In summary, most of the anti-HBe patients (85%) had viral replication. HCV superinfection plays a minor role in the activity of liver disease.

Prospective, randomized controlled trial of interferon-alpha in children with chronic hepatitis B

Thirty-six children with chronic hepatitis B were entered into a randomized controlled trial of recombinant human interferon-alpha. All patients had hepatitis B virus DNA and increased levels of aminotransferases in serum for at least 1 yr. Twelve children received 10 MU of interferon-alpha 2b/m2 body surface area three times a week (group I); 12 children received 5 MU/m2 under the same conditions (group II); and 12 children served as controls (group III). During 6 mo of therapy, 12 of 24 (50%) treated patients (7 from group I, 58%, and 5 from group II, 42%) and 2 of 12 (17%) controls lost hepatitis B virus DNA from serum and subsequently remained negative. Comparison of the rate of response in group I vs. controls showed a statistically significant difference (p less than 0.05). Eleven of 12 (92%) treated patients who cleared hepatitis B virus DNA from serum lost HBeAg, seroconverted to anti-HBe and had improvement in liver histological findings with loss of hepatitis B virus DNA from liver. In 10, serum ALT levels became normal. Interferon-alpha was well tolerated and all children finished therapy. These findings indicate that a 6-mo course of interferon-alpha is effective in inducing a serological, biochemical and histological remission of disease in approximately 50% of children with chronic hepatitis B.

[Surgical treatment of supraventricular tachycardias (Wolff Parkinson White and Occult Kent). Experience at the "Ignacio Chávez" National Institute of cardiology]

We report our initial experience in the surgical section of the accessory pathway in thirteen patients: eight patients with Wolff Parkinson White syndrome and five with accessory pathway functioning only in direction ventricle to atrium (Kent concealed), with recurrent episodes of paroxysmal supraventricular tachycardia with no response to medical treatment. Three of these patients had episodes of auricular fibrillation with interval RR lower than 250 msec and one patient presented syncope. A total of fifteen accessory pathways were sectioned: 7 left lateral, 5 left posterior, one left posterolateral, one right lateral, and another one right anteroseptal. In the same procedure two patients had correction of another heart malformation: one with patent ductus arteriosus and another with and another with atrial septal defect. All patients had successful outcome, one of them needed a second surgery for persistent accessory pathway. We had two post-operatory complications: one mediastinitis and one patient with ectopic auricular tachycardia.

[Doppler color transesophageal echocardiography. Report of the first 110 studies carried out at the Ignacio Chávez National Institute of Cardiology]

Transesophageal echocardiography allows views of the posterior structures of the heart. This approach provides additional and complementary information to the transthoracic study, it is also an alternative in those patients with technical limitations for optimal precordial imaging. This study analysis the first 110 cases studied with transesophageal echocardiography in the National Institute of Cardiology Ignacio Chávez. They correspond to patients with valvular heart disease, prosthesis, acute and chronic ischemic heart disease, dissecting aortic aneurysm, cardiomyopathies, thrombus, tumors and masses. As well as paediatric and adult with complex congenital heart disease. The advantages of the transesophageal technique compared with the precordial approach are described.

[Barrett's esophagus does not revert after medical or surgical therapy for gastroesophageal reflux]

An evaluation was made of 34 patients having Barrett's oesophagus. Medical therapy consisted of antacids, H2 blockers, orthopramides, and postural measures (20 cases, mean follow-up 2.9 years). A Nissen fundoplication was done in 14 cases (mean follow-up 2.5 years). Clinical, endoscopic and histologic evaluation was done in all patients and pH measurements also done in all operated cases. Clinical results have been excellent in 70% of medically treated patients and in 100% of surgically treated ones, pH measurements were between normal limits in all operated patients. However, recovery of the normal epithelium did not occur in any case, except for some partial improvement in one patient treated surgically.

Hepatitis B virus DNA in liver and peripheral blood mononuclear cells during reduction in virus replication

Changes in hepatitis B virus DNA in blood cells and liver were studied in 34 patients (12 controls, 22 under therapy). There were no basal differences in the presence of the viral genome in blood cells between treated and control patients. A significant decrease in the percentage of patients with viral genome in blood cells was observed in patients who lost this marker in serum. Replicative intermediates of the viral genome were observed in the basal liver samples from all patients. In patients who lost the viral DNA in serum, hepatitis B virus genome became undetectable in the second liver sample in all but two patients who had viral sequences integrated in the host genome. Replicative intermediates were found in all patients with serum viral DNA. The results of this study suggest that there may be a relation between the disappearance of hepatitis B virus DNA in liver and blood cells.

[Transesophageal echocardiography. General principles and applications]

A new echocardiographic technique is described, which allows cardiovascular ultrasonic exploration by means of a transducer mounted on the distal tip of a gastroscope. The transducer is moved along the esophagus and from time to time into the stomach, which permits real-time visualization of the different cardiac segments and the great arteries. This technique is of special utility in the exploration of posterior structures as are the left atrium and its appendage, the pulmonary veins, etc. The most important views in the transverse plane are described, as well as the technical aspects, the limitations and the possible complications.

Choroid plexus tumours in children. Review of 24 cases

24 cases of choroid plexus tumours (16 papillomas and 8 carcinomas) were observed in the Department of Paediatric Neurosurgery, Hôpital des Enfants de la Timone, Marseille France between 1975 and 1989. The case records were reviewed and the clinical, surgical, and pathological results are presented here. 14 (58%) were infants and 10 (42%) of these were aged less than 1 year at presentation. In 11 (46%) the tumour arose in the lateral ventricle, in 7 (29%) it was located in the IIId ventricle, and in 6 (25%) the tumour was found in the IVth ventricle. 5 of the 8 carcinomas had their origin in the IVth ventricle. 17 cases (75%) required ventriculo-peritoneal shunt procedures before surgery of the tumour and in all these it was left in place post-operatively. One child required shunting de novo after removal of the tumour. A total excision was achieved in 20 children (83%) out of 23 operated upon. The operative mortality (mortality within one month of surgery) was 8%, the overall mortality was 25%. One child with a IIId ventricle papilloma died before surgery from a large gastro-intestinal haemorrhage. 5 children under the age of 3 years with carcinomas on the IVth ventricle died. The 3 children with supratentorial carcinomas are alive respectively 2 months, 8 years, and 13 years after treatment. Among 15 children with papillomas alive, 10 (67%) are neurologically intact and 5 (33%) have sequelae.

Prevalence of liver disease and infection by hepatitis B, delta virus, and human immunodeficiency virus in two Spanish penitentiaries

We studied the prevalence of liver disease and the carrier state for hepatitis B (HBV), delta virus (HDV) and HIV-1 infection in two Valencian penitentiaries, one for males and the other for females. Serological results were correlated with history of intravenous drug addiction, alcohol abuse, homosexuality or prostitution (high-risk groups), and duration and number of internments. A high prevalence of increased transaminase levels (52.2%) and serological markers for HBV infection (66.5%) was observed amongst the inmates, figures being higher amongst high-risk individuals and inmates confined for more than 6 months. No signs of HDV or HIV-1 infection were found amongst the prison staff. Anti-HIV-1 positivity was observed most frequently amongst individuals combining both drug abuse and homosexuality/and prostitution.

Acute nonlymphocytic leukemia (M7 subtype) with erythrocytic internalization

A case of acute nonlymphocytic leukemia of megakaryocytic lineage or M7 with a conspicuous phenomenon of erythrocytic internalization present in nearly 3% of the leukemic megakaryocytic precursors (LMP) is reported. The phagocytosis was detected at light microscopy and ultrastructural levels. The erythrocyte might have reached the interior of the LMP through cytoplasmic vacuoles that are connected with the extracellular space and that can be considered rudimentary equivalents of the demarcation membrane system (DMS). Erythrocytic internalization is not a specific feature of the mononuclear phagocytic system and can be misleading in the classification of undifferentiated blast cells.

What is the role of violence in the therapeutic community?

The violence inherent in the world of substance abuse is conspicuously absent as a research issue in published studies in this area. Computer searches surfaced articles dealing with mental health/mental retardation. A synthesis of these articles indicates that the setting, therapy, and staff identified as most effective in the treatment of violent patients coincide with those found in drug and alcohol therapeutic communities. (The use by some drug and alcohol clinicians of radical confrontation therapy was the only practice seemingly counterindicated on treatment effectiveness and ethical and legal grounds). We emphasize the need for a drug and alcohol research focus on violence.

Non-Hodgkin's lymphoma in systemic lupus erythematosus: report of 4 cases with ultrastructural studies in 2

Four patients with systemic lupus erythematosus (SLE) and non-Hodgkin's lymphoma are described. Except for low dose prednisone therapy in 1 patient, none of these patients had received immunosuppressive therapy prior to the lymphoma. This present series and literature review suggests an increased incidence of non-Hodgkin's lymphoma in SLE.

[Neurofibromatosis associated with perianal rhabdomyosarcoma (author's transl)]

The authors report one case of perianal rhabdomyosarcoma observed in a 12-month old girl with neurofibromatosis. The way in which both entities can be related is discussed, and the management of the patient is described.

[Mesenterial lipoma in a child (author's transl)]

A rare case of a 16-month old infant with a mesenteric lipoma is presented. Symptomatology, diagnosis and surgical approach are discussed. Authors make a review of previously reported cases in the infant age.

[Short rib-polydactyly (author's transl)]

A new case of short rib-polydoctyly, Saldino-Noonan type is described. The authors make a differential diagnosis between another forms of neonatal chondrodysplasias and point-out principal features of this entity.

Mutations affecting pigmentation in man: I. Neuroectodermal melanolysosomal disease

We describe a syndrome identified in three consanguineous families who had two and probably four common ancestors five generations ago. The syndrome is characterized by profound dysfunction of the central nervous system, silver-leaden colored hair, abnormal melanosomes and melanocytes, and abnormal inclusion bodies in fibroblasts, bone marrow histiocytes and lymphocytes which appear to represent abnormal lysosomal bodies. Because of the biochemical relationships between melanin-melanosomes and neuromelanin, we think that all the manifestations of the condition are related to and represent pleiotropic effects of a newly identified gene in man in its homozygous state. Biochemical reactions of the cells of these patients indicate presence of tyrosinase in the melanosomes.and show that the substance accumulated in cultured fibroblasts and in the bone marrow histiocytes is a PAS and Oil-red-O positive material but is Oil-red-O negative after extraction; it has the typical reactions of melanin withe the Masson and Fontana stain, but cannot be considered typical melanin, since without stain it is colorless. The ultrastructural studies showed round granules with variable matrix, similar in fibroblast and bone marrow, and with variable intensity of reaction to osmium. This mutation principally affects the neuroectoderm, but also the mesoderm.

[Neurological alterations due to metoclopramide in children (author's transl)]

Some clinicals and epidemiological considerations are made on the base of eleven children affected by ingestion on this drug.

[Specific protection by sulfhydryl groups against inhibition of urease by hypoglycaemic drugs (author's transl)]

The effect of oral hypoglycaemic drugs, derivatives of sulphonylurea, upon urease has been studied. These compounds, structurally connected to urea, produce a competitive inhibition of enzyme activity with respect to substrate. Glutathioné (reduced form) and cysteine prevent inactivation of enzyme by sulphonylurea, whereas-oxidated glutathione and cysteine do not. The same phenomenon occurs in enzyme preparations inhibited by p-hydroxymercuribenzoate. The role of sulfhydryl groups in the formation of enzyme-substrate complex is discussed.

[Mucocutaneous lymph node syndrome (author's transl)]

Authors present the case of a two year old spanish girls with mucocutaneous lymph node syndrome such as described by Kawasaki.

[Inhibition of urease by hypoglycaemic drugs (author's transl)]

The effect of oral hypoglycaemic drugs (derived from sulphonylurea) on urease activity in the quantitative determination of urea has been studied. These compounds have been found to produce a competitive inhibition of enzyme activity with respect to substrate. Possible interference of these antidiabetic agents upon urea analysis is discussed.

[Beckwith's syndrome. Pathological aspects (author's transl)]

A new observation of Becwith's syndrome is presented. Being a still birth a pathological study could be accomplished. Pathologycal findings are commented.

Giant esophageal leiomyoma with secondary megaesophagus

A 25-year-old woman presented with a giant leiomyoma in the lower third of the esophagus. She had no digestive symptoms, although there was a severe esophageal dilation. Such a megaesophagus secondary to a leiomyoma has not been described previously. Esophagogastric resection was performed, followed by an uneventful recovery period. The literature on esophageal leiomyoma is reviewed.