Evaluation of Laparoscopic Findings in Chronic Hepatitis C

Abstract: To elucidate the differences in the progression of liver cirrhosis of chronic hepatitis B and C, the laparoscopic appearance of the liver surface and the histological findings were carefully assessed in 65 patients with chronic hepatitis B and 58 patients with chronic hepatitis C. There was a difference noted in the distribution of periportal reddish markings between the two types of chronic hepatitis. Localized and irregular markings were found to be common in hepatitis C. While the markings were seen to be diffusely distributed over the liver surface in hepatitis B. In addition, localized and longitudinal depressions on the liver surface were observbed more frequently in the hepatitis C patients than in those with hepatitis B. Biopsy specimens obtained from the hepatitis C patients with the above-mentioned laparoscopic findings showed more advanced histological activity. These laparoscopic changes developed in accordance with the progression of histological activity in chronic hepatitis C. Lymphoid follicles or aggregates within the portal areas were observed more frequently in the patients with chronic hepatitis C than in the chronic hepatitis B patients. Although it is not yet clear how the laparoscopic and histological differences between these two types of chronic hepatitis come about, it appears that the progression of hepatocellular necrosis in chronic hepatitis C is different from that of chronic hepatitis B.     

Endoscopic Biliary Drainage without Endoscopic Sphincterotomy

Endoscopic biliary drainage (EBD) is usually performed after endoscopic sphincterotomy (EST). In some patients, however, EBD without EST, so-called nonEST-EBD, is also effective. Thirty-four patients treated from 1983 to the present, were investigated to estimate the usefulness, safety, and drawbacks of nonEST-EBD. First, the reasons for adopting nonEST-EBD were reviewed in each patient. The most common reason was to reduce jaundice so as to preserve the function of the papilla of Vater in patients with choledocholithiasis who were to undergo surgery. However, such patients were treated in the early period of the investigation, and most would have undergone EST just after endoscopic retrograde cholangiography (ERC), had they been treated more recently. The most important reason, at present, was, thus, to avoid bleeding in patients with general or local hemorrhagic diathesis, who accounted for 20.6% (7/34 of our subjects). Next, the effect of drainage was examined. Drainage in seven patients was judged to be excellent, while that in 15 patients was determined to be effective. In 10 patients without jaundice, nonEST-EBD was performed to prevent jaundice. Therefore, in 91.7% of patients (22/24), nonEST-EBD was considered to be useful. Changes in the serum amylase level were investigated to estimate the safety of nonEST-EBD. Twenty-seven patients with nonEST-EBD, in whom the serum amylase level was within normal limits before treatment, and 57 patients with EBD after EST were evaluated. No statistically significant difference was recognized between these two groups in the degree of serum amylase elevation after drainage. NonEST-EBD is concluded to be an effective and safe method of reducing jaundice, if appropriate patients are selected.     

A case of ureteral reflux identified by ultrasound

Reflux nephropathy is known to be a major cause of renal failure in children. Vesico-ureteral reflux is usually diagnosed by voiding cysto-urethrography (VCG). However, it has been observed that conventional VCG is not always reliable for the diagnosis of ureteral reflux. In the case of a 5 year old girl with recurrent febrile urinary tract infection, VCG showed no ureteral reflux. Urodynamic study revealed a large bladder capacity and significant residual urine. Renal scintigram delineated a right renal scar. Simple ultrasound examination with videotape recording during voiding definitely demonstrated the presence of significant ureteral reflux when she voided, that is, there was marked dilatation of the right distal ureter and ballooning of the right renal pelvis on voiding, and quick refilling of the bladder concomitantly with the disappearance of the pelvic ballooning. Therefore, an ultrasound during voiding may be useful for diagnosing ureteral reflux in patients where a VCG does not reveal reflux.     

Studies of peptide antibiotics. XLVI. Syntheses of gramicidin S analogs containing D-α, β-diaminopropionic acid or α,β-dehydroalanine*

A gramicidin S (GS) analog ([d -Dpr^4,4] GS) containing d -α,β-diaminopropionic acid (D-Dpr) in place of D-Phe at 4,4′ positions was derived from [l -Orn(δ-formyl)^2,2, d -Dpr(β-Z)^4,4′]GS, which was synthesized by conventional method in solution. An analog [ΔAla^4,4′]GS was synthesized from [l -Orn(δ-Boc)^2,2′, d -Dpr^4,4′]GS through Hofmann degradation of the d -Dpr residues. Antimicrobial activities of these analogs were tested; [d -Dpr(β-Z)^4,4′]GS and [ΔAla^4,4′]GS showed high antimicrobial activities against Gram-positive bacteria. [d -Dpr^4,4′]-GS showed an appreciable activity against Gram-negative bacteria such as Escherichia coli. Four semigramicidin S (semiGS) analogs such as [ΔAla⁴]semiGS were synthesized; these had no antimicrobial activity. Analogs containing ΔAla residues were hydrogenated, and the formation of l -Ala or d -Ala residues was determined. The ΔAla residues in [ΔAla^4,4′] GS were reduced to dl -Ala, and ΔAla in [ΔAla⁴]semiGS mostly to l -Ala. The relationships of the antimicrobial activity, CD curves and asymmetric hydrogenation to the structure were discussed.     

Osteopontin levels are elevated in patients with eosinophilic pneumonia

Background and objective: Osteopontin is a key cytokine involved in pro‐inflammatory T helper type 1 (Th1)‐associated immune responses, which has recently been implicated in allergic diseases. We investigated the pathogenic role of osteopontin in eosinophilic pneumonia. Methods: The concentrations of osteopontin and Th1‐ or Th2‐associated cytokines were measured in BAL fluid (BALF) from 41 patients with eosinophilic pneumonia, including those with acute (AEP, n = 12), chronic (CEP, n = 16), or drug‐induced eosinophilic pneumonia (DEP, n = 13). The results were compared with those from patients with other interstitial lung diseases. Immunocytochemistry and double immunofluorescence labelling were performed to determine the cellular source of osteopontin. Results: Osteopontin was significantly elevated in BALF from patients with eosinophilic pneumonia as compared with BALF from patients with drug‐induced interstitial pneumonia, hypersensitivity pneumonitis, idiopathic interstitial pneumonia, or sarcoidosis, and also compared with BALF from healthy volunteers. Osteopontin concentrations elevated at the time of exacerbation decreased during clinical improvement, either spontaneously or as a result of corticosteroid therapy. Elevated concentrations of CXCL10, CCL17 and IL‐10 were also detected in BALF from patients with eosinophilic pneumonia. Osteopontin concentrations in BALF of AEP patients were correlated with IL‐5, as well as IL‐10, CCL11, CCL17 and CXCL10 concentrations. In AEP and DEP patients, serum osteopontin concentrations were also elevated. Double immunofluorescence labelling showed that in patients with eosinophilic pneumonia, osteopontin was expressed in lung eosinophils. Conclusions: Osteopontin is likely to contribute to the development of inflammation in patients with eosinophilic pneumonia.     

TSUTSUGAMUSHI DISEASE (SCRUB TYPHUS)

Two patients with Tsutsugamushi disease (fever) were successfully treated with tetracycline derivatives after typical eschars were found, although one of the patients was initially misdiagnosed as having a drug reaction eruption. Prompt diagnosis and treatment are important because this disease can be associated with considerable morbidity and simple effective treatment is easily available.     

Predominant obligate anaerobes invading the deep layers of root canal dentine

This study was carried out to investigate the presence and types of bacteria invading the deep layers (0.5-2.0 mm from the surface of the root canal wall) of infected dentine of human root canals by sampling with an anaerobic glove box system the split surfaces of eight freshly extracted teeth. More bacteria were recovered after incubation in an anaerobic glove box than after aerobic incubation in air with 30 per cent CO2. Out of 256 predominant bacterial isolated, 205 isolates (80 per cent) were obligate anaerobes. These findings suggest that the environment of deep layers of endodontic dentinal lesions is anaerobic and favours the growth of anaerobes. Among the obligate anaerobic isolates, strains belonging to Lactobacillus (30 per cent) and Streptococcus (13 per cent) were predominant, followed by Propionibacterium (9 per cent). No strains of obligate anaerobic Gram-negative rods were isolated. The microflora of deep layers of infected root dentine is somewhat similar to that of the deep layers of carious lesions in coronal dentine.     

东北红豆杉愈伤组织中松香烷型二萜类成分的分离与鉴定

目的明确东北红豆杉(Taxus cuspidata)愈伤组织中的化学成分,为开发可持续利用的红豆杉资源提供物质基础。方法采用硅胶柱色谱、制备型HPLC等手段对愈伤组织的乙酸乙酯和甲醇提取物进行分离和纯化,根据化合物的理化性质和波谱数据并结合相关文献对化合物结构进行鉴定。结果从东北红豆杉愈伤组织中共分离得到7个松香烷型二萜化合物,分别鉴定为hinokiol(1)、美丽红豆杉素A(taxamairin A,2)、美丽红豆杉素C(taxamairin C,3)、taxayunnin(4)、margoci-lin(5)、3,20-epoxy-12-methoxy-8,11,13-abietatriene-3,7,11-triol(6)和brevitaxin(7)。结论化合物1~7均为首次从东北红豆杉植物中分离得到。     

ALTERATIONS IN CYTOKERATIN EXPRESSION BY THE ALVEOLAR LINING EPITHELIAL CELLS IN LUNG TISSUES FROM PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS

It is generally recognized that epithelial cytokeratins (CKs) are expressed in tissue-specific patterns and reflect differentiation, functional specialization, and pathological alterations of the cells. Differential epithelial cell types can thus be distinguished from each other by their selective expression of particular sets of CKs. To determine the characteristics of metaplastic and hyperplastic changes of alveolar-lining epithelial cells in the lungs of idiopathic pulmonary fibrosis (IPF), the expression of individual CKs was studied immunohistochemically using monospecific anti-CK monoclonal antibodies (anti-CKs 7, 8, 10, 13, 14, 16, 17, 18, 19). Biopsy specimens from 17 patients with IPF and normal lung tissues (NL) from seven patients with lung cancer were studied. In the IPF specimens, several kinds of altered epithelial cells were observed, which showed characteristic changes in CK expression compared with NL, especially CKs 8, 14, and 17. Hyperplastic type II cells expressed increased CKs 7, 8, and 19, but not CK 17; flattened or stratified squamous metaplastic cells expressed increased CKs 17 and 14, co-expressed with CKs 7, 8, and 19; bronchiolar metaplastic cells expressed increased CKs 7, 8, and 19, co-expressed with CKs 14 and 17; cuboidal metaplastic cells expressed increased CKs 7, 8, 17, and 19. The quantification of individual CKs in the tissues by enzyme-linked immunosorbent assay revealed increased expression of CKs 8, 14, and 17 in IPF lung tissues compared with NL. These results were consistent with the immunohistochemical observations. The hyperplastic and bronchiolar metaplastic phenotypes were characterized by their increased expression of simple CKs without CK alteration. The squamous metaplastic phenotype showed CK alterations, with the appearance of CKs 17 and 14. Epithelial cells are thus altered not only in shape, but possibly also in differentiation and function, with potential implications for the pathogenesis of IPF. © 1997 John Wiley & Sons, Ltd.