Acute hepatitis C transmitted by needlestick accident despite short duration interferon treatment

Hepatitis C virus (HCV) transmission by needlestick accidents involving hospital employees has become an important problem. The present report is of a case of acute hepatitis C that developed after a needlestick injury, despite short duration interferon treatment performed just after the accident in a trial effort to prevent HCV transmission. Nosocomial infection of HCV in medical employees is reviewed, and the current prospects for protecting them from HCV transmission after needlestick accident are discussed.     

Intrahepatic expression of HBsAg and HBcAg in asymptomatic HBsAg carriers and its follow-up

Intrahepatic expression of hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg) was investigated in 46 asymptomatic HBsAg carriers by a direct immuno-fluorescent method. In 21 HBeAg positive carriers, HBsAg was expressed diffusely on the membrane of hepatocytes, with associated cytoplasmic localization in a few scattered hepato-cytes. HBcAg was expressed in the nucleus of many hepatocytes and in the cytoplasm of a few scattered hepatocytes, but not on the cell membrane. In 25 anti-HBe positive carriers, HBsAg was expressed on the surface and in the cytoplasm of hepatocytes diffusely and/or focally, but neither intrahepatic HBcAg nor serum HBV-DNA was detected. Repeat liver biopsies were performed in 17 patients. In eight of 13 HBeAg-positive HBsAg carriers, who developed histologically proven chronic hepatitis and liver cirrhosis, the localization of HBsAg in liver had changed from a membranous to a mixed (membrane and cytoplasm) pattern, and localization of HBcAg in liver had changed from a predominantly nuclear to a predominantly membranous and cytoplasmic pattern. However, in two HBeAg and two anti-HBe positive cases who showed no biochemical and histologic change at follow-up, the intrahepatic expressions of HBsAg and HBcAg in the second biopsies remained unchanged. Thus, decrease in membranous expression of HBsAg and increase in membranous and cytoplasmic expression of HBcAg were associated with progression to chronic liver disease. This suggests that membranous HBcAg may represent the major target in the process of injury to hepatocytes.     

Evaluation of cases where the right kidney is higher than the left kidney

BACKGROUND: Finding the right kidney higher than the left kidney on excretory urography (EXU) is unusual. In the present study, the position of the kidneys was evaluated in patients, and the frequency, causes or attribution were investigated. METHODS: Kidney positions were evaluated in 1625 patients. Subsequent evaluations by computed tomography scan were performed for each case where the right kidney was higher than the left. If a patient had right hydronephrosis, bladder evaluations such as ultrasonography and/or cystoscopy were also conducted. Patients with a left contracted kidney were excluded. RESULTS: The right kidney was higher than the left in 81 (5%) of 1625 cases. In 30 cases (37%), the cause or attribution existed in the right urinary tract. Eleven of these cases were due to tumors or cysts in the right kidney, four were due to congenital anomalies, and 15 were due to hydronephrosis. In 10 (12.3%) of the cases, the cause or attribution existed in the left urinary tract. All of them were cysts or tumors of the left kidney. Of the other 13 (16.0%) cases, eight were caused by hepatatrophy and splenomegaly as a result of liver cirrhosis, two were caused by aortic aneurysm, one was caused by visceral inversion, one was caused by a right ovarian tumor, and one was caused by pneumonectomy. Malignancies, including two renal cell carcinomas and three bladder cancers at the right ureteral orifice, were found in five cases (6%). CONCLUSION: The above results suggest that the right kidney is higher than the left in five percent of all cases undergoing EXU. In cases where the right kidney is higher than the left, and a left contracted kidney cannot be found, further evaluation is recommend.     

A review: The active peptide of lactoferrin

A potent antimicrobial peptide, ‘lactoferricin’, was found to be generated upon gastric pepsin cleavage of lactoferrin. The active peptide consists mainly of a loop of 18 amino acid residues, derived from the N-terminal region of the lactoferrin molecule. Like various other antimicrobial peptides that display membrane-disruptive properties, it contains a high proportion of basic amino acid residues. A physiologically diverse range of micro-organisms was tested and found to be susceptible to inhibition by this natural peptide including Gram-negative and Gram-positive bacteria, yeasts and filamentous fungi. Its antimicrobial effect against sensitive micro-organisms was lethal. Electron microscopy studies revealed that it induces a profound change in cell ultrastructural features and causes substantial cell damage in bacteria and fungi. These findings suggest the possibility that active peptides of lactoferrin may have a role in the host defense against microbial disease. If produced in substantial quantities in vivo such peptides could have important physiological significance, especially in nursing infants.     

A Case of Lymphangioma Coexistent with Tubular Adenoma in the Descending Colon and a Review of the Literature

Abstract: We recently encountered a case of lymphangioma of the colon which coexisted with a tubular adenoma. The patient was a 71-year-old male who was admitted for physical therapy for lumbago caused by osteoarthritis. He had no evident abdominal symptoms and no weight loss. Although mild anemia and hypoproteinenia were observed, his stool occult blood test was negative and tumor markers revealed no significant changes. A barium enema revealed two elevated lesions in the descending colon. The proximal lesion appeared to be semipedunculated and its form changed following postural changes. The distal lesion was pedunculated. When the patient changed his posture, the head and stalk of the lesion were identified, Both lesions were removed by endoscopic polypectomy. The proximal lesion was histologically diagnosed as being a cavernous lymphangioma, while the distal one was found to be a tubular adenoma. Lymphangioma of the colon is considered to be rare. In Japan, 102 cases including the present case have been reported to date. The coexistence of this disease with neoplasmic lesions of the colon has been reported in 20 cases, including 7 cancer cases and 16 adenoma cases; some cases had overlapping coexistence. The frequency of coexistence of a lymphangioma with cancer or adenoma seems to be rather high. The relationship between lymphangioma and these lesions is unknown. The coexistence of neoplasmic lesions may be accidental. The patients with this coexistence had no characteristic features, except for a high incidence of gastrointestinal bleeding. At least 43% of the coexisting cancers were found in the cecum, the vermiform appendix and the hepatic flexure, indicating the necessity of a detailed examination of the entire colon in cases where a lymphangioma is detected.     

Genotypes of hepatitis C virus in Guangxi Province, southern China

Abstract Hepatitis C virus (HCV) has been subdivided into at least four genotypes, and the prevalence of each genotype has been reported to differ widely in different countries. Of 304 patients with chronic liver diseases (68 with chronic hepatitis, 50 with liver cirrhosis and 186 with hepatocellular carcinoma) from Guangxi Province in southern China, only 9 (3.0%) had antibodies to HCV as determined by a second-generation enzyme immunoassay with a cut-off index of 2.0 or more. The HCV genotypes of these nine cases were examined using polymerase chain reaction with type-specific primers deduced from putative core gene. Seven of the nine cases had type II infection and the other two cases showed double infection with types II and IV. These findings indicate that the predominant HCV genotype in the Guangxi area is type II, as is the case in Japan, although the prevalence of HCV infection in patients with chronic liver diseases is much lower.     

CD-resolved secondary structure of bovine plasma albumin in acid-induced isomerization*

Bovine plasma albumin (BPA) showed the acid-induced two-step transition, the N-F transition and acid-expansion. Changes in fractions of α-helix (f_α), β-form (f_β) and unordered form (f_R) in the acid-induced isomerization of BPA were studied using the method of Chen et al. (1972) with two constraints: f_i = 1, 0 ± f_i ± 1. pH-profiles of f_α and f_R showed the two-step change, one corresponding to the N-F transition and the other to the acid-expansion in 0.10 m KCl and in 0.02 m NaClO₄. pH-profile of f_β showed one-step change, correlating to the later part (lower pH side) of the N-F transition. The N-F transition might thus involve the helix ± β and helix ± coil transitions.     

Serum Gastrin Levels in Patients with Pheochromocytoma

Serum gastrin in 11 patients with pheochromocytoma, 26 patientswith essential hypertension and 20 normal volunteers was measuredand the clinical significance of the gastrin was discussed.It was found that elevations in serum gastrin levels in mostpatients with pheochrornocytoma were brought about by increasedepinephrine secretion, while norepinephrine had less influenceon gastrin release. Patients with epinephrine-producing tumorswere found to have high serum gastrin levels, but normal gastrinwas observed frequently in patients with extra-adrenal tumors.From these findings, we believe that the assay of serum gastrinin patients with pheochromocytoma might be helpful in the preoperativesearch for the location of the tumor, although there were someexceptions.     

Double Adenocarcinoma in Barrett's Esophagus: A Case Report

At the National Cancer Center Hospital in Tokyo, a patient withBarrett's esophagus developed double adenocarcinoma of the esophagus.One carcinoma was located in the midesophagus and the otherjust above the anatomic cardia. Esophagoscopic examination withbiopsy revealed two carcinomas surrounded with columnar epitheliumand ectopic islets of gastric mucosa situated in the postcricoidregion. There was no ulcer or stricture in the esophagus. Thepatient received subtotal esophagectomy and survived the operation.Microscopically, depth of invasion of the proximal cancer wasto the proper muscle, and that of the distal one was to thesubmucosal layer. There was metastasis to two lymph nodes. Therewas no sign of inflammation or ulcer in the esophagus.