TTV positivity and transfusion history in non-B, non-C hepatocellular carcinoma compared with HBV- and HCV-positive cases

The prevalence of TT virus (TTV) and its rate of transmission through transfusion were investigated to determine its possible hepatocarcinogenic role in non-B, non-C hepatocellular carcinoma (HCC) as compared with that in hepatitis B virus (HBV)- and hepatitis C virus (HCV)-positive HCC. Its transfection route in TTV-positive cases was also studied. Serum was positive for TTV in 77.8% (7/9) of HBV-positive, 36.4% (12/33) of HCV-positive, and 63. 6% (7/11) of non-B, non-C cases of HCC. The rate of transmission through transfusion was 52.4% (11/21) in HBV-positive, 40.1% (61/152) in HCV-positive, 33.3% (2/6) in HBV+HCV-positive, and 40% (8/20) in non-B, non-C HCCs, while it was 48.3% (14/29) in TTV-positive and 39.3% (11/28) in TTV-negative cases. The association between TTV and HCC was limited, and the main route of infection of TTV was not through transfusion.     

Incidence of cerebral palsy in Himeji City in 1983-1997

We retrospectively investigated the incidence, neuroimaging findings, and motor and intellectual disability of infants with cerebral palsy (CP) who were born between 1983 and 1997. The incidence of CP was found to have increased gradually and the major cause was periventricular leukomalacia. The prognosis of preterm infants was better than that of term infants. These findings suggest that the increase in the incidence of CP has been due mainly to changes in medical care for neonates.     

Primary sclerosing cholangitis and hepatitis C virus infection

Two cases of primary sclerosing cholangitis with hepatic C virus infection in a 62-year-old man and a 60-year-old woman are presented. The infection in the man was eradicated with interferon therapy in 1992. Seven years thereafter, endoscopic retrograde cholangiography revealed a diffuse 2.5-cm-long stenotic lesion in the common bile duct which was consequently resected. Histological examination of the resected specimen revealed proliferation of epithelial cells, plasma cell infiltration, and fibrosis in the submucosal layer of the common bile duct. The human leukocyte antigen DR loci were 2 and 9. In the woman, a 6-month course of interferon therapy in 1992 failed to eradicate the infection. Cholangiography in 1999 revealed multiple narrowings and dilatations of intra- and extrahepatic bile ducts. Ultrasound guided biopsy of the liver in 1992 had revealed onionskin lesions around the bile duct epithelium in the portal tract. The human leukocyte antigen DR locus was 2. From these findings, the 2 cases were diagnosed as primary sclerosing cholangitis. Further studies may provide insights into the relation between the pathogenesis of the disease and the infection.     

Multiple hypervascular liver nodules in a heavy drinker of alcohol

A case of hypervascular nodules in the liver, but without hepatitis B or C virus infection in a 38-year-old woman with a history of alcohol abuse is presented. An ultrasound disclosed 1-2-cm hypoechoic tumors in the right and left lobes. Magnetic resonance imaging showed high-intensity tumors at both the T1-weighted and T2-weighted sequences. Incremental dynamic computed tomography and hepatic angiography revealed hypervascular tumors. Ultrasound-guided needle biopsy revealed no evidence of hepatocellular carcinoma, metastatic liver cancer, hemangioendothelioma, inflammatory pseudotumors or pseudolymphoma, but demonstrated stellate-scar fibrosis septa, which contained small unpaired arteries without hyperplasia dividing the nodule. Moreover, marked pericellular fibrosis, neutrophilic infiltration and Mallory bodies were observed in the cytoplasm. There was no evidence of bile duct proliferation. From these findings, the diagnosis of alcohol-induced fibrosis, distinctly different from focal nodular hyperplasia, was tenable. Further studies may provide insights into the pathogenesis of nodule formation and hypervascularity in heavy drinkers of alcohol.     

A power spectral analysis of the EEG in the newborns. II. The power spectral changes of the infants with neonatal asphyxia

Power spectral analysis of the EEG at the neonatal period was performed in 33 babies with an Apgar score of 6 or less 1 minute after delivery. Their gestational ages ranged from 27 to 40 weeks, and birth weight from 1,013 g to 4,416 g. They were followed up until 18 months of age. All EEGs were recorded when the babies reached to 37-41 weeks of conceptional age, and analyzed using fast Fourier transformation. The percent power in active sleep was evaluated in this study. The abnormal EEG patterns in infants with neurological damage was classified into the following groups: (1) Increase of the percent power of the delta 1 band, (2) Decrease of the percent of the power of the delta 1. On the other hand, the EEG patterns at the neonatal period in infants with normal development who suffered from neonatal asphyxia were similar to those of age-matched controls. These results suggest one of the most important factors deciding the prognosis of the brain damage is the presence of a normal percent pattern. In conclusion, power spectral analysis of EEG at the neonatal period is useful in predicting the outcome of brain damage if it is used with visual inspection.     

Effect of the intra-aortic balloon pumping on renal function

The effect of IABP on renal function were studied in 41 patients who underwent cardiac operation. Eight of the 41 patients were acute myocardial infarction (AMI), 4 were unstable angina, and 29 were postoperative low cardiac output syndrome (LOS). In 12 patients with AMI and unstable angina, an IABP was inserted preoperatively. Urinary N-acetyl-beta-D-glucosaminidase (U-NAG) and fractional excretion of beta 2-microglobulin (FE beta 2M) in addition to conventional renal parameters such as creatinine clearance (Ccr) and free water clearance (CH2O) were measured before and during IABP. Patients were divided into three groups according to its responses within 6 to 12 hours of IABP. In Group I (25 cases) which showed the significant improvement of renal and cardiac function, the values of Ccr, CH2O improved to normal range within 6 hours after initiation of IABP. In Group II (4 cases) which showed improved renal functions in spite of insufficient improvement of cardiac functions, renal functions improved 12 hours late, showing 6 hours delay from Group I. In Group III (8 cases) both the renal functions as well as cardiac functions did show no improvement. Retrospective study demonstrated that the patients whose Ccr improved above 50 ml/min/1.48 m2 and CH2O reduced below -0.55 ml/min/1.48 m2 and within 12 hours after initiation of IABP were able to wean from IABP. However, the patients whose Ccr reduced less than 50 ml/min/1.48 m2 and CH2O grown worse above -0.55 ml/min/1.48 m2 for longer than 12 hours could not wean from IABP. And the patients whose U-NAG and FE beta 2M reduced less than 20 U/l and 3.0% during IABP support were able to wean from IABP. In conclusion, IABP was effective therapy for the patients with cardiogenic shock, LOS, and renal dysfunction.     

Inflammatory pseudotumor of the liver in a patient with chronic hepatitis C: Difficulty in differentiating it from hepatocellular carcinoma

A case of an inflammatory pseudotumor of the liver in a 75-year-old female with chronic hepatitis C whose radiologic features simulated that of hepatocellular carcinoma (HCC) is presented. On imaging studies, hypervascularity by CO2 ultrasound (US) angiography, enhancement at an early phase and isodensity at a late phase by incremental dynamic computed tomography (CT), perfusion defect by CT during arteriography (CTAP), and clinical background of hepatitis C virus (HCV) infection strongly suggested HCC. A US-guided needle biopsy revealed a mainly diffuse and polyclonal proliferation of lymphocytes positive for leukocyte common antigen (pan-lymphocyte cells), L-26 (B cell lymphocytes), and UCHL-1 (T cell lymphocytes), negative for both kappa and lambda light chains and sparsely distributed neutrophils and histiocytes. No lymphoid follicles were observed. The liver tissue around this tumor showed chronic hepatitis with mild activity and mild fibrosis. These histopathologic findings suggested that the diagnosis of inflammatory pseudotumor of the liver was tenable. As it is difficult to differentiate between inflammatory pseudotumor of the liver and HCC by imaging studies alone, supplemental biopsy, where possible, should be obtained when diagnostic imaging of tumors suggesting HCC is carried out. We emphasize that histopathology is a true gold standard in the diagnosis of this disease.     

Correction to: Retinoic acid receptor γ activation promotes differentiation of human induced pluripotent stem cells into esophageal epithelium

Journal of Gastroenterology - In the original publication of the article, the following errors were noted and corrected in this correction.     

Left ventricular diverticulum with hypertrophy of the left ventricular apex.

A surgical case of diverticulum in the left ventricular apex is presented. A two-dimensional echocardiogram and magnetic resonance image showed a calcified tumor buried in the marked hypertrophied apex of the left ventricle. Enucleation of the oval and hard tumor (4 x 2.5 x 2.5 cm) was performed through the apex, and the defect was anastomosed by buttress sutures. Histologic examination demonstrated that the tumor cavity was filled with a thrombus encapsulated by thickened and calcified endocardium that extended to the left ventricular cavity. In this report, the etiology of the diverticulum with a hypertrophied myocardium is discussed.