Antigenic and immunogenic changes due to mutation of sgene of HBV

AIM:To investigate the change of immunologicalcharacteristics of HBsAg caused by the mutation at codon145 of HBsAg using DNA-based immunization.METHODS:Plasmids expressing mutant and wild typeenvelope antigens were transfected into human hepatocellularcarcinoma cells via electrotransformation.The antigenicity ofHBsAg was studied with EIA and immunocytochemical staining.Then plasmids were used to immunize 5 C57BL/6 mice.Sera of mice were detected for anti-HBs and anti-preS2with ELISA.RESULTS:The mutant HBsAg could be detected by nativeantibody in EIA and immunocytochemical study.But theA(450 nm)value of the mutant HBsAg in the supernatant wasapparently lower than that of the wild-type.Both mutantand native HBsAg expression plasmid could stimulate astrong humoral immune response to HBsAg and preS2antigen in mice.Protective antibodies against HBsAg elicitedby the native HBsAg occurred earlier than that elicited bythe mutant HBsAg about one to two weeks.The occurrenceof protective antibodies against preS2 antigen was one totwo weeks earlier than that of anti-HBs.CONCLUSION:The amino acid substitution causes changesof the antigenicity and immunogenicity of HBsAg,but mutantHBsAg can still induce a protective humoral immune responsein mice.Ge JH,Uu HM,Sun J,Zhang LZ,He J,Li YL,Liu H,Xu Y,Yu HY,Hu YP.Antigenic and immunogenic changes due to mutationof s gene of HBV.World J Gastroenterol 2004;10(21):3137-3140http://www.wjgnet.com/1007-9327/10/3137.asp     

Clinical experience of Pseudo-Meigs＇ Syndrome due to colon cancer

We report a rare case of Pseudo-Meigs＇ Syndrome caused by ovarian metastasis from sigmoid colon cancer, which was accompanied by peritoneal dissemination. A 58-year-old female patient presented with massive right pleural effusion, ascites and a huge pelvic mass. Under the diagnosis of an advanced ovarian tumor, bilateral oophorectomy was performed and sigmoidectomy was also carried out after intraoperative diagnosis of peritoneal dissemination involving the sigmoid colon. How- ever, immunohistochemical staining revealed that the ovarian lesions were metastasis from the primary advanced colon cancer. Postoperatively, ascites and pleural effusion subsided, and the diagnosis of Pseudo-Meigs＇ Syndrome due to a metastatic ovarian tumor from colon cancer was determined. The patient is now undergoing a regimen of chemotherapy for colon cancer without recurrence of ascites or hydrothorax 10 mo after the surgery. Pseudo-Meigs＇ Syndrome due to a metastaticovarian tumor from colon cancer is rare but clinically important because long-term alleviation of symptoms can be achieved by surgical resection. This case report suggests that selected patients, even with peritoneal dissemination, may obtain palliation from surgical resection of metastatic ovarian tumors.     

Fatal liver failure due to reactivation of lamivudine-resistant HBV mutant

We report a case of fatal liver failure due to reactivation oflamivudine-resistant HBV.A 53-year-old man was followedsince 1998 for HBV-related chronic hepatitis.Serum HBV-DNA was 150 MEq/mL (branched DNA signal amplificationassay) and ALT levels fluctuated between 50-200 IU/L withno clinical signs of liver cirrhosis.Lamivudine (100mg/d)was started in May 2001 and serum HBV-DNA subsequentlydecreased below undetectable levels.In May 2002,serumHBV-DNA had increased to 410 MEq/mL,along with ALTflare (226 IU/L).The YMDD motif in the DNA polymerasegene had been replaced by YIDD.Lamivudine was continuedand ALT spontaneously decreased to the former levels.OnOct 3 the patient presenting with general fatigue,nauseaand jaundice was admitted to our hospital.The laboratorydata revealed HBV reactivation and liver failure (ALT:1828IU/L,total bilirubin:10mg/dL,and prothrombin INR:3.24).For religious reasons,the patient and his family refusedblood transfusion,plasma exchange and liver transplantation.The patient died 10 d after admission.The autopsy revealedremarkable liver atrophy.     

A case of atrioventricular complete block due to Behçet's disease

The cardiovascular system is involved in 5% of the cases of Beh?et's disease. Thrombophlebitis. aneurysm in arteries, pericarditis, myocarditis, valvular disease, ventricular arrhythmia, and conduction system disorders may occur. A case of Beh?et's disease with complete proximal atrioventricular block is presented.     

Spontaneous perirenal hematoma due to Wegener’s granulomatosis after initiation of immunosuppressant

Spontaneous perirenal hematoma (SPH) is a rare, life-threatening condition. We present a patient with Wegener’s granulomatosis (WG) who developed SPH soon after the initiation of immunosuppressant therapy. Few cases of SPH as a complication of WG have been reported, though a rupture of an aneurysm in patients with polyarteritis nodosa can lead to SPH. Though immunosuppressant therapy is considered to be the first-line therapy for SPH with vasculitis, SPH could still occur after the initiation of an adequate treatment regimen.     

Could attacks of abdominal pain in cases of acute intermittent porphyria be due to intestinal angina?

Abdominal pain is by far the most serious symptom in attacks of acute intermittent porphyria. Its cause is unknown. This case study suggests visceral ischaemia as a possible cause of the abdominal pain. A 31-year-old woman with recurrent bouts died during an attack; the autopsy revealed a 20-cm necrotic gangrene in the ileum. A protracted intestinal vasospasm could have been the immediate cause of death. It is discussed whether intestinal angina could be the cause of the abdominal pain in acute intermittent porphyria.     

Laparoscopic treatment of an upper gastrointestinal obstruction due to Bouveret’s syndrome

Bouveret’s syndrome is an extremely rare type of gallstone-induced ileus with atypical clinical manifestations,such as abdominal distension and pain,nausea and vomiting,fever or even gastrointestinal bleeding,which may easily be misdiagnosed. In the present case,a 55-year-old male was admitted to the hospital with upper gastrointestinal obstructive symptoms but without pain,fever,jaundice or melena. At first,gastrolithiasis and peptic ulcer combined with pyloric obstruction were suspected after gastroscopy revealed a large,hard stone in the duodenal bulb. A revised diagnosis of Bouveret’s syndrome was made following abdominal computed tomography. Subsequently,the patient exhibited a good postoperative recovery after laparoscopic duodenotomy for gallstone removal and subtotal cholecystectomy. The condition of the patient remained stable after being followed up for 6 mo. The successful application of laparoscopic therapy to treat Bouveret’s syndrome has seldom been reported. Laparoscopic enterolithotomy is safe and effective,with good patient tolerability,rapid postoperative recovery and few wound-related complications. The laparoscopic treatment of Bouveret’s syndrome is worth exploring.     

Might erectile dysfunction be due to the thermolabile variant of methylenetetrahydrofolate reductase?

Hyperhomocysteinemia is considered one of the most important cardiovascular risk factors increasing considerably the risk of stroke and myocardial infarction. With respect to endothelial function, direct effects of hyperhomocysteinemia on vascular endothelial cells have been demonstrated through the reduction of endothelial nitric oxide production. In this paper, we report the case of a young man with homozygote genotype mutated with 5-methylenetetrahydrofolate reductase (MTHFR) thermolabile variant who, in the absence of relational stress, developed an erectile dysfunction (ED) refractory to the vasoactive type-V phosphodiesterase (PDE5) inhibitor therapy. After one month of treatment with 5 mg/day folic acid and 1000 microg/day cyanocobalamin, the patient restarted the assumption of 50 mg sildenafil, obtaining satisfying erections during sexual intercourse. We suggest that hyperhomocysteinemia may interfere with penile blood supply and, thus, be responsible for ED. If this relationship is confirmed, plasma levels and urinary homocysteine (HCy) should be evaluated in selected young patients with vascular ED. Furthermore, careful attention should be given to the risk of ED when dealing with this metabolic disturbance.     

Prevention of hepatotoxicity due to anti tuberculosis treatment： A novel integrative approach

AIM： To evaluate the ability of Curcuma Ionga （CL） and Tinospora cordifolia （TC） formulation to prevent anti-tuberculosis （TB） treatment （ATT） induced hepatotoxicity. METHODS： Patients with active TB diagnosis were randomized to a drug control group and a trial group on drugs plus an herbal formulation. Isoniazid, rifampicin, pyrazinamide and ethambutol for first 2 mo followed by continuation phase therapy excluding Pyrazinamide for 4 mo comprised the anti-tuberculous treatment. Curcumin enriched （25%） CL and a hydro-ethanolic extract enriched （50%） TC 1 g each divided in two doses comprised the herbal adjuvant. Hemogram, bilirubin and liver enzymes were tested initially and monthly till the end of study to evaluate the result. RESULTS： Incidence and severity of hepatotoxicity was significantly lower in trial group （incidence： 27/192 vs 2/316, P 〈 0.0001）. Mean aspartate transaminase （AST） （195.93 ± 108.74 vs 85 ± 4.24, P 〈 0.0001）, alanine transaminase （ALT） （75.74 ± 26.54 vs 41 ± 1.41, P 〈 0.0001） and serum bilirubin （5.4 ±3.38 vs 1.5 ±0.42, P 〈 0.0001）. A lesser sputum positivity ratio at the end of 4 wk （10/67 vs 4/137, P = 0.0068） and decreased incidence of poorly resolved parenchymal lesion at the end of the treatment （9/152 vs 2/278, P = 0.0037） was observed. Improved patient compliance was indicated by nil drop-out in trial vs 10/192 in control group （P 〈 0.0001）. CONCLUSION： The herbal formulation prevented hepatotoxicity significantly and improved the disease outcome as well as patient compliance without any toxicity or side effects.     

Space-occupying lesion of the pancreas--how frequently not due to a suspected ductal adenocarcinoma?

In patients with a space-occupying lesion of the pancreas at first a primary ductal adenocarcinoma is considered as the cause. Other tumours or metastases are assumed to occur very rarely. Therapy and prognosis of other pancreas tumours differ from therapy and prognosis of a primary ductal adenocarcinoma. We therefore examined the question of how frequently a space-occupying lesion of the pancreas was not due to a ductal adenocarcinoma in our case materials. Retrospectively 70 patients who had undergone a percutaneous puncture of a space-occupying mass of the pancreas under ultrasonographic control were included in the study (34 women, 36 men). In 62 patients a clear histological diagnosis was possible on the basis of the biopsy. In 53 cases (76 %) a primary adenocarcinoma of the pancreas could be diagnosed. In 5 patients (7 %) these masses turned out to be metastases of a previously known malignant tumour disease (2 x mammary carcinoma, 2 x gastric carcinoma, 1 x sigmoid carcinoma). Other tumours could be detected in 4 cases (6 %) including a tuberculoma, an endocrine tumour, a fusocellular sarcoma with partial neurogenic differentiation and a large-cell and pleomorphic-cell anaplastic, partly sarcomatoid carcinoma. In patients with a space-occupying lesion of the pancreas, tumours other than a ductal adenocarcinoma are not rare. In particular, in cases of a previously known malignant tumour disease a space-occupying lesion of the pancreas can also turn out to be a metastasis. Every other individual tumour entity is rare. Other tumour entities at large, however, are found in daily routine. The preoperative biopsy of space-occupying lesions of the pancreas, therefore, still has a clinical importance for the further therapy planning.     

Nosocomial Mycobacterium bovis-bacille Calmette-Guérin infections due to contamination of chemotherapeutics: case finding and route of transmission

We studied nosocomial infections due to Mycobacterium bovis bacille Calmette-Guérin (BCG) Onco-TICE bacteria, transmitted by contamination of medication prepared in BCG Onco-TICE-contaminated hoods in the pharmacy, in 5 immunocompromised patients at 3 hospitals. The BCG strains cultured from the patients had the same DNA profile as the BCG Onco-TICE strain used for bladder instillation. To prevent these infections, a change from open to closed preparation was made; strictly separated preparation in time of BCG Onco-TICE instillation and chemotherapy was enforced, the biological safety cabinet was disinfected between preparations, and gloves were changed between preparations.     

An indeterminate result of QuantiFERON-TB Gold In-Tube for miliary tuberculosis due to a high level of IFN-γ production

The QuantiFERON-TB Gold In-Tube^® test has excellent specificity for Mycobacterium tuberculosis. However, diagnosis of miliary tuberculosis remains challenging, and the interpretation of QuantiFERON^® results in immunocompromised individuals has not been fully established. Here, we present a patient with military tuberculosis who showed an indeterminate QuantiFERON^® result. A 76-year-old male presented with fever and pancytopenia. Radiological tests did not show the classical miliary pattern. Acid-fast staining and polymerase chain reaction of several specimens were negative for M. tuberculosis. The QuantiFERON^® responses were indeterminate on two separate tests, as interferon-γ (IFN-γ) concentration was high in the negative control. The patient did not respond to anti-microbiological therapy, and developed sepsis and disseminated intravascular coagulation, leading to lethal intracranial hemorrhage. An autopsy showed miliary tuberculosis and aplastic anemia. A literature review suggests a tendency towards indeterminate or false-negative QuantiFERON^® results in immunocompromised individuals or patients with miliary tuberculosis due to low production of IFN-γ. Our patient, however, showed substantial amounts of IFN-γ despite lymphocytopenia, which has not been reported in the literature. The present case suggests that indeterminate results of QuantiFERON^® should be interpreted with caution, as IFN-γ production in patients with miliary tuberculosis can vary significantly, even with sustained lymphocytopenia.     

A case of successful management with splenectomy of intractable ascites due to congenital dyserythropoietic anemia type Ⅱ-induced cirrhosis

The congenital dyserythropoietic anemias comprise a group of rare hereditary disorders of erythropoiesis, characterized by ineffective erythropoiesis as the predominant mechanism of anemia and by characteristic morphological aberrations of the majority of erythroblasts in the bone marrow. Congenital dyserythropoietic anemia type II is the most frequent type. All types of congenital dyserythropoietic anemias distinctly share a high incidence of iron loading. Iron accumulation occurs even in untransfused patients and can result in heart failure and liver cirrhosis. We have reported about a patient who presented with liver cirrhosis and intractable ascites caused by congenital dyserythropoietic anemia type II. Her clinical course was further complicated by the development of autoimmune hemolytic anemia. Splenectomy was eventually performed which achieved complete resolution of ascites, increase of hemoglobin concentration and abrogation of transfusion requirements.