The Effects of Rosiglitazone,Metformin, and Diet with Exercise in Nonalcoholic Fatty Liver Disease

Our aım was to evaluate effects of metformin, rosiglitazone, and diet with exercise in nonalcoholic fatty liver disease. Forty-seven patients (mean age, 44±10 years; 17 female) whose ALT levels had been high for at least 6 months and with hepatosteatosis detected by liver biopsy and/or USG were enrolled in this study. Of these, 12 were treated with 850 mg/day metformin (group 1), 11 with 4 mg/day rosiglitazone (group 2), and 24 with diet and exercise (group 3) for 1 year. ALT normalization at months 6 and 12 was accepted as treatment response. Liver biopsy was performed in all patients in groups 1 and 2 before treatment and 12 patients (4 in group 1, 8 in group 2) after treatment; but in group 3 it was performed only in patients who approved this procedure (12 patients). Body mass index did not change in groups 1 and 2, but it decreased significantly in group 3 (30±3 to 28±2 kg/m²) at month 12. Treatment response rate was 33.3, 54.5, and 54.2% in groups 1, 2, and 3, respectively, at month 6. This rate was 22.2, 37.5, and 41.2 in groups 1, 2, and 3, respectively, at month 12. Rate of steatosis and stage of fibrosis did not change after treatment. Diet with exercise seems to be superior to metformin and rosiglitazone. Decreasing treatment response at month 12 compared to month 6 may be due to fluctuations of ALT levels. Treatment response should be evalulated histologically.     

Intracranial symptomatic giant arachnoid cyst of the interhemispheric fissure presenting with frontal lobe syndrome

Symptomatic interhemispheric arachnoid cysts (ACs) are extremely rare lesions seen more frequently in the elderly. Only 13 cases of symptomatic interhemispheric ACs in the elderly have previously been reported. Herein, we describe a 70-year-old female with symptoms of vertigo, memory and behavior disturbances. Magnetic resonance imaging (MRI) revealed a giant arachnoid cyst (AC) on the interhemispheric fissure, which was exerting a mass effect and displacement on the corpus callosum and anterior cerebral vessels, with a massive midline shift. The patient was treated with a cysto-peritoneal shunt. Reports to date have reviewed the pathology, clinical presentation, radiology and surgical management of interhemispheric symptomatic arachnoid cysts in elderly patients.     

Lamivudine monotherapy and lamivudine plus interferon alpha combination therapy in HBeAg negative chronic hepatitis B not responding to previous interferon alpha monotherapy

BACKGROUND AND STUDY AIMS: To investigate the efficacy of the combined therapy of lamivudine (LAM) plus alpha interferon (IFN) and LAM monotherapy in HBeAg negative chronic hepatitis B (CHB) patients who were unresponsive to previous IFN monotherapy, and the incidence of YMDD mutations. PATIENTS-METHODS: Forty-five HBeAg negative patients were enrolled in this study. 24 of these were treated with LAM (100 mg/day, PO, for 24 months) alone (group 1) and 21 with combined therapy (IFN-alpha-2b, 10 MU, tiw, SC, for 6 months plus LAM 100 mg/day, PO, for 24 months) (group 2). Normal alanine aminotransferase values and negativity of HBV DNA (molecular hybridization; Digene, USA) were accepted as treatment response. YMDD variants were analyzed at the end of treatment or when clinical breakthrough was observed (Inno-Lipa Innogenetic kit, Belgium). RESULTS: End of follow-up response rate was 29.2%, by ITT in group 1, 19% in group 2 (p > 0.05). Histological activity index was statistically decreased by LAM monotherapy as compared to combination therapy. YMDD mutation rates were 59% in group 1, 62.5% in group 2 (p > 0.05). CONCLUSIONS: Additional IFN-alpha therapy to LAM in HBeAg negative CHB not responding to previous IFN-alpha monotherapy does not increase the response rate compared to LAM monotherapy and does not also decrease the incidence of YMDD mutations.     

An adult choledochal cyst—the magnetic resonance cholangiopancreatography findings: Report of a case

We herein report an unusual adult patient with a congenital choledochal cyst. A 28-year-old woman presented with recurrent episodes of abdominal pain in the right upper quadrant. Abdominal ultrasonography showed fusiform dilatation of the common bile duct without any obstruction. Endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) were performed to make a precise diagnosis. No abnormal pancreatobiliary junction was detected on ERCP. The MRCP images more clearly defined the type and extent of the choledochal cyst as observed at surgery. The cyst and gallbladder were excised and a Roux-en-Y hepaticojejunostomy was performed. We also reviewed the relevant English literature and concluded that MRCP offers diagnostic information that is equivalent or superior to that of ERCP for the evaluation of type I choledochal cysts in adults and because this modality is noninvasive, it should therefore be the preferred imaging technique for an examination of adult patients with choledochal cysts.     

FOXP3 mRNA expression analysis in the peripheral blood and allograft of heart transplant patients

Previously, we demonstrated in heart transplant patients that FOXP3, a gene required for the development and function of regulatory T cells, was highly expressed in the graft during an acute cellular rejection. In this study, we analyzed whether the FOXP3 gene expression in the peripheral blood also reflects anti-donor immune responses, and therefore may provide clues for non-invasive detection of non-responsiveness or acute rejection. We examined the FOXP3 expression patterns of peripheral blood mononuclear cells (PBMC; n=69) of 19 heart transplant patients during quiescence and rejection in comparison with those of endomyocardial biopsies (EMB; n=75) of 24 heart transplant patients. While the FOXP3 mRNA levels were abundantly expressed in rejecting EMB (ISHLT rejection grade>1R) compared with EMB without histological evidence of myocardial damage (ISHLT rejection grade 0R-1R; p=0.003), no association with rejection or non-responsiveness was found for the FOXP3 mRNA levels in the peripheral blood. Thus, in contrast to intragraft FOXP3 gene expression, the peripheral FOXP3 mRNA levels lack correlation with anti-donor immune responses in the graft, and, consequently, FOXP3 does not appear to be a potential candidate gene for non-invasive diagnosis of non-responsiveness or rejection.     

Changes in brain 11C–nicotine binding sites in patients with mild Alzheimer’s disease following rivastigmine treatment as assessed by PET

Rationale Marked reduction in the cortical nicotinic acetylcholine receptors is observed in the brain of patients suffering from Alzheimer’s disease (AD). Although cholinesterase inhibitors are used for symptomatic treatment of mild to moderate AD patients, numerous long-term treatment studies indicate that they might stabilize or halt the progression of the disease by restoring the central cholinergic neurotransmission. Thus, we used positron emission tomography (PET) technique as a sensitive approach to assess longitudinal changes in the nicotine binding sites in the brains of patients with AD. Objective To evaluate changes in brain nicotinic binding sites in relation to inhibition level of cholinesterases in cerebrospinal fluid (CSF) and plasma and changes in cognitive performance of the patients in different neuropsychological tests after rivastigmine treatment. Materials and methods Ten mild AD patients received rivastigmine for 12 months. A dual-tracer PET model with administration of ¹⁵O–water and (S)(–)¹¹C–nicotine was used to assess ¹¹C–nicotine binding sites in the brain at baseline and after 3 and 12 months of the treatment. Cholinesterase activities in CSF and plasma were assessed colorimetrically. Results The ¹¹C–nicotine binding sites were significantly increased 12–19% in several cortical brain regions after 3 months compared with baseline, while the increase was not significant after 12 months of the treatment. After 3 months treatment, low enzyme inhibition in CSF and plasma was correlated with higher cortical ¹¹C–nicotine binding. The ¹¹C–nicotine binding positively correlated with attentional task at the 12-month follow-up. Conclusion Changes in the ¹¹C–nicotine binding during rivastigmine treatment might represent remodeling of the cholinergic and related neuronal network.     

A comparative study of superoxide dismutase, catalase, and glutathione peroxidase activities and nitrate levels in vitiligo patients

BACKGROUND: Several groups have shown the involvement of oxidative stress in the pathophysiology of vitiligo. METHODS: In this study, we examined the erythrocyte and plasma activities of glutathione peroxidase and Cu/Zn superoxide dismutase, plasma nitrite/nitrate levels, and erythrocyte catalase activity in 23 vitiligo patients and 25 controls. RESULTS: The results show that erythrocyte superoxide dismutase activity and plasma nitrite/nitrate levels are high in vitiligo patients. CONCLUSIONS: Our study confirms that oxidative stress is involved in the pathophysiology of vitiligo, as indicated by the high levels of erythrocyte superoxide dismutase activity and plasma nitrite/nitrate.     

The study of simultaneous bilateral ocular trauma in Northern India: clinical presentation,epidemiology and patterns of injury

International Ophthalmology - This study is aimed to determine the frequency, sociodemographic profile, clinical presentation, patterns of injury, treatment and outcomes of cases of...