High rate of mixed genotypes of hepatitis C virus in patients of an epidemic area in Japan

The subjects of this study were 151 patients (69 males and 82 females) who underwent examination and liver biopsy owing to liver dysfunction in an epidemic area with hepatitis C. Second generation hepatitis C virus antibody (HCV Ab) was positive in 116 (76.8%) of 151 cases. HCV-RNA was detected in 120 (79.5%) by polymerase chain reaction (PCR). In 7 (4.6%) cases, HCV Ab could not be found, but HCV-RNA was detected. Three (2.0%) cases were positive for HCV Ab but negative for HCV-RNA. On the basis of variation in nucleotide sequence within a restricted region in the putative core gene of HCV, HCV genotypes were classed into four types of I, II, III and IV by PCR. The genotypes were identified in 120 cases. Ninety-eight (81.7%) cases carried one of the four types. Type II was found in 76 (63.3%) cases and type III in 22 (18.3%). The other 22 (18.3%) carried simultaneously two different genotypes (mixed type): 21 (17.5%) cases with type II + III and one (0.8%) case with type II + IV. In comparison with the incidence of HCV mixed types in cases with hepatitits C in a non-epidemic area, carriers of mixed types were found at a significantly higher rate in the epidemic area. Liver biopsy of 120 cases with identified HCV genotypes in the epidemic area showed 93 cases of chronic active hepatitis, nine of chronic lobular hepatitis, 10 of chronic persistent hepatitis and eight of liver cirrhosis. No significant correlation could be detected between liver histology and HCV genotypes. Of the 120 cases, 63 (52.5%), 54 (45.0%) and 12 (10.0%) cases had past histories of folk remedies accompanying bleeding, operation and transfusion, respectively. The repetition of these medications may have caused a high ratio of carriers of the mixed genotypes of HCV.     

A Case of Massive Hepatic Necrosis (Scarred Liver) with Elevated α-Fetoprotein and Seroconversion from HBe Ag to HBe Ab

A 39-year-old male with general malaise visited our clinic with high levels of aminotransferases (AST 776 IU/1, ALT 1,069 IU/I) and a prolonged prothrombin time. Serum-fetoprotein (AFP) level was markedly elevated (2,214 ng/ml) and human hepatocyte growth factor (hHGF)was also high (0.81 ng/ml). Hepatocellular carcinoma was found to be negative from imaging techniques. AFP bands separated by lectin affinity electrophoresis had a benign pattern. Laparoscopic diagnosis was scarred liver and histologically massive hepatic necrosis with a strongly positive AFP stain. Levels of hHGF and AFP fell into a normal range after treatments with glucagon-insulin and prostaglandin Ei. At second laparoscopy, regenerated nodules were confirmed by improved staining with Indocyanine Green. Hepatocyte regeneration was also histologically proven with a weakly positive AFP stain. The proliferating cell nuclear antigen (PCNA) was stained, and hepatocytes with PCNA positive nuclei were not seen at the time of the first laparoscopy, whereas hepatocytes with PCNA positive nuclei were found to be many at the time of the second laparoscopy. Seroconversion from HBe Ag to HBe Ab was observed 4 months after the maximum rise of AFP (6,341 ng/ml), when levels of ALT and DNA polymerase were within normal ranges. This is a patient with a marked rise in his serum level of AFP in association with seroconversion from HBe Ag to HBe Ab, and the elevation of AFP in the present case was thought to reflect severe liver injury with concomitant regenerative activities of injured hepatocytes rather than simple hepatocyte regeneration after hepatic necrosis was resolved.     

Oesophageal hiatal hernia-induced hydropneumothorax

The patient presented with acute and constant abdominal pain. He had had a lobectomy of the left lung three months before. On the 4th day in hospital the pain increased and he went into temporary shock. The next day a hydropneumothorax and incarcerated stomach were revealed by chest X-ray and computed tomography. He was transferred to the University Hospital immediately and underwent an operation. The diagnosis was an incarcerated para-oesophageal hernia with hydropneumothorax and perforation of the stomach. As a para-oesophageal hernia may be fatal, is important to diagnose and treat it early.     

Transurethral fulguration for empyema of ectopic ureteral stump

A 55-year-old woman who had undergone left nephrectomy 7 years prior because of pyonephrosis, suffered from refractory cystitis and was diagnosed with empyema of the left ureteral stump associated with ectopic ureter. Although removal of the stump is a popular treatment for this disease, transurethral fulguration of the stump lumen was performed in the patient described here. The procedure was technically easy and safe, resulting in the disappearance of the dilated stump and cessation of recurring cystitis.     

The peritoneal equilibration test variables in pediatric CAPD patients

The peritoneal equilibration test (PET) is generally accepted as a valuable tool in individualizing continuous ambulatory peritoneal dialysis (CAPD) treatment schedules in adults. However, the classification of peritoneal permeability as described by Twardowski is not available for children due to differences in peritoneal transport abilities. In this paper, we report the results of the PET for 20 patients aged from 1.5 to 24 years (mean 10.3 years), who started CAPD therapy at age 0–15 years, using Twardowski's standardized technique. D/P creatinine (dialysate to plasma ratio of creatinine at 4 h), D/D₀ glucose (the ratio of dialysate glucose at 4 h dwell time to dialysate glucose at 0 dwell time), and the residual volume (RV) in the abdominal cavity were calculated. The mean and standard deviation values for D/P creatinine and D/D₀ glucose were of a higher permeability level than those reported in Twardowski's data. Furthermore, a significant correlation of creatinine and glucose with fluid drainage ability of the peritoneum were observed. A large amount of RV (425±125 mL/m²) was detected in the patients' peritoneal cavity and this had a significant correlation with dialysate leak occurrences. The authors suggest that the RV would be an indicator for leaks and especially latent leaks. The cause of a large RV is unknown, but there is a probability that drainage volume and transport rates of metabolites decrease because the concentration of the instilled dialysate is immediately diluted by a large RV within the peritoneum.