Clinical significance of serum hyaluronic acid as a fibrosis marker in chronic hepatitis C patients treated with interferon-α: Histological evaluation by a modified histological activity index scoring system

Abstract The aim of the present study was to investigate the histological changes effected by interferon (IFN) treatment and to evaluate the clinical significance of serum hyaluronic acid (HA) as a marker of fibrosis. Forty-nine patients with chronic hepatitis C treated with IFN-α were divided into three groups according to the existence of viraemia: sustained complete responders (CR), complete responders with relapse (PR) and non-responders (NR). Needle biopsy sections of the liver taken before and at the end of IFN treatment were assessed according to the modified histological activitindex (HAI) scoring system. Serum fibrosis markers, including HA, were measured at needle biopsies. Biopsies of CR at the end of treatment showed a significant improvement in fibrosis and necroinflammatory scores. More significant correlation was observed between fibrosis scores and serum levels of HA before IFN treatment (r= 0.607, P < 0.0001) than those between fibrosis scores, on the one hand, and pepride of type III procollagen (PIIIP; r= 0.531, P= 0.0004) or type IV collagen 7S domain (type IV-C; r= 0.241, P= 0.1062) on the other. Moreover, serum HA levels fell significantly in patients in whom fibrosis improved (P= 0.011). This is the first paper describing the advantages of the modified HAI scoring system over others in estimating the effect of IFN-α; the results also indicate that serum HA can be useful in monitoring liver fibrosis in chronic hepatitis C patients treated with IFN-α.     

A Clinico-Pathological Study of Surgical Treatment for Small Cell Carcinoma of the Lung

Thirty-seven patients with histologically confirmed small cellcarcinoma (SCLC), who underwent surgical resection at the NationalCancer Center Hospital between 1963 and 1983, were reviewed.They were divided into two groups, 25 patients who were operatedon between 1963 to 1979 and 12 who were operated on between1980 and 1983. When these two groups were compared, a significantdifference in 5-year survival was found (8% vs 50%). An accumulationof various factors including adjuvant chemotherapy was consideredto contribute to the improvement in survival. After carefullyanalyzing these factors, we have come to the conclusion thatadjuvant chemotherapy was the most important factor among them.An additional six patients with SCLC, who were operated on in1984 and 1985, were also studied. They were either those whowere given an adequate dose of combination chemotherapy beforesurgical resection or those whose local carcinoma which recurredafter complete response was achieved by chemotherapy and/orchest radiation was surgically removed. In two cases, a tumor-likemass which was clearly visible on X-ray film- and in the surgeon'shand at the time of thoracotomy revealed a histo pathological"cure." In another two cases, tissue diagnosis of SCLC whichwas obtained without thoracotomy before chemotherapy and/orradiation was started was reported as NSCLC after the resectedspecimen was histo-pathologically examined. In both of them,the cancer tissue was made up of NSCLC of small cell type. Adiscrepancy between clinical TNM after treatment and pathologicalTNM was noted in two cases. Microinvasion and micrometastases,which were the reasons for the discrepancy, are considered tobe a core of eventual recur rence following induction of completeresponse.     

Endoscopic Diagnosis of Colorectal Villous Adenoma

Villous adenoma or adenoma with a predominant villous componentshowed a characteristic finding on macroscopic or endoscopicobservation. The fundamental elements which constitute thisfinding were reddish sulcus and whitish ramified relief similarto the villous pattern normally seen on the mucosa of the smallbowel. We called this feature "V (villous) pattern." A comparativestudy of the endoscopy and pathology of 70 polypoid lesionsof the large intestine was conducted, with the following results:The frequency of the V pattern in the endoscopic picture increasedin proportion to the population of the villous component inhistological picture of the polypoid lesions. However, evenin small polyps the V pattern could be observed when the lesionhad a villous component. Careful and close endoscopic observationmay allow the diagnosis of villous component (which means ahigh frequency of malignancy) of the colorectal polyp even withoutbiopsy. Dr. Makino's present address: Av. Ceará, 335, Belém—Pará,Brasil.     

X‐ray Radiation Causes Electromagnetic Interference in Implantable Cardiac Pacemakers

Background: X‐rays are not thought to cause electromagnetic interference (EMI) in implantable cardiac pacemakers. However, x‐ray radiation during computed tomography (CT) scanning has been reported to cause EMI in some implantable cardiac pacemakers. The objectives of this study were to identify the location within the pacemakers where x‐ray radiation causes EMI and to investigate the association of EMI with the x‐ray radiation conditions. Methods: We verified the location where x‐ray radiation caused EMI using a CT scanner and conventional radiographic x‐ray equipment. An inhibition test and an asynchronous test were performed using five types of implantable cardiac pacemakers. Results: X‐ray radiation inhibited the pacing pulses of four types of implantable cardiac pacemakers when the body of each implantable cardiac pacemaker, containing a complementary metal‐oxide semiconductor (CMOS), was scanned using a CT scanner. We confirmed that x‐ray‐induced EMI depends on the x‐ray radiation conditions, that is, the tube voltage, tube current, x‐ray dose, and direction of x‐ray radiation, as well as the sensing thresholds of the implantable cardiac pacemakers. Conclusions: X‐ray radiation caused EMI in some implantable cardiac pacemakers, probably because the CMOS component was irradiated. The occurrence of EMI depended on the pacemaker model, sensing threshold of the pacemaker, and x‐ray radiation conditions. (PACE 2010; 33:1174–1181)     

Promoting the effects of intravesical instillation of saline on bladder lesion development in rats pre-treated with BBN

BACKGROUND: At present, immunotherapeutic agents such as bacillus Calmette-Guerin (BCG) and anti-tumor chemotherapeutic agents in saline are used intravesically in patients with bladder carcinoma. However, of greater significance is the possibility that the saline vehicle may itself promote carcinoma development in the bladder. METHODS: The potential promoting effects of intravesical instillation of saline were assessed in female F344 rats. The animals were divided into 3 groups, all of which received 0.05% N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN) in their drinking water for the first 10 weeks. They were then maintained without further treatment (group 1) or received intravesical instillations of 0.3 mL of saline or distilled water once a week for 6 weeks, 15 weeks after the end of the BBN treatment (groups 2 and 3). At 32 weeks, all the animals were killed and examined immunohistochemically with proliferating cell nuclear antigen (PCNA) antibody, as well as by routine histopathologic examination. RESULTS: Both the incidence and the number of bladder carcinomas were higher in the animals that received instillations of saline than in those who did not receive the instillations. Significant increases in tumor size were also noted for the saline-treated groups, although this was not linked with the PCNA labeling index. CONCLUSIONS: The results indicate that saline is a promoter of urinary bladder carcinogenesis either because of the catheterization or the fluid itself.     

Economic evaluation of Helicobacter pylori eradication for the treatment of duodenal ulcer disease in Japan: A decision analysis to assess eradication strategy in comparison with a conventional strategy

To evaluate the socio-economic effects of Helicobacter pylori eradication in the treatment of duodenal ulcer disease in Japan, a clinical decision analysis was performed to assess H. pylori eradication therapy compared with the conventional strategy of maintenance with histamine-2 receptor antagonists. A decision tree-based state transition model (Markov chain approach) implemented to simulate a 5 year period of follow up was constructed. The H. pylori eradication strategy was found to be superior to the conventional maintenance strategy with regard to clinical effectiveness and other dimensions of a patient’s outcome. Furthermore, in a long-term perspective, the eradication strategy was less costly than the maintenance strategy. Helicobacter pylori eradication should be recommended as the ?rst choice treatment of H. pylori-positive duodenal ulcer patients. The clinical implication of H. pylori eradication entails an improvement in clinical effectiveness and other dimensions of a patient’s outcome and a signi?cant reduction in the costs of duodenal ulcer treatment. The long-term total costs do not depend on the initial drug cost of an eradication regimen. Pursuing a high eradication rate of H. pylori is essential in improving the patient’s outcome and the cost-effectiveness of treatment.     

Two Cases of Bladder Carcinoma with Similar Initial Features That Exhibited Completely Different Clinical Courses

Two cases of bladder carcinoma are described. The patients wereof similar age, were both smokers and were treated for the sameperiod, but exhibited completely different later clinical courses.Initially, both had a single, papillary, pedunculate tumor,identified as a transitional cell carcinoma, grade 2. pTa. Onepatient, six years later, had multiple papillary tumors coveringalmost all the mucosal surface and underwent simple cystectomy.Histologically the tumors were identified as transitional cellcarcinomas, grade 2, pT1. The other patient, nine years later,had a single nodular invasive tumor with a concomitant, verytiny papillary tumor and underwent radical cystectomy. Histologicallythe tumor was transitional cell carcinoma, grade 2>3, pT4.Many of the questions raised by these cases are unanswered,but comparison of such cases should provide sonic cities tothe natural history of bladder carcinoma.