The object of this study is to assess whether aneurysm surgery can be performed in patients with ruptured cerebral aneurysms by using three-dimensional computerized tomography angiography (3D-CTA) alone, without conventional catheter angiography (CCA). Between May 1994 and November 1996, a consecutive series of 60 cases of ruptured cerebral aneurysms was evaluated by both 3D-CT A and CCA prospectively and compared the detectability of cerebral aneurysms. Both 3D-CTA and CCA demonstrated a 100% diagnostic accuracy of ruptured cerebral aneurysms. In the associated unruptured cerebral aneurysms, the diagnostic accuracies of 3D-CTA and CCA were 96% and 92%, respectively. Based on the results, we have operated on 128 consecutive patients with ruptured aneurysms in the acute stage based on 3D-CTA findings since December 1996. One hundred twenty eight ruptured aneurysms including 50 associated unruptured aneurysms were detected by 3D-CTA. In seven of 128 ruptured aneurysms, which included four dissecting vertebral artery aneurysms, two basilar artery (BA) tip aneurysms, and one BA-superior cerebellar artery (SCA) aneurysm, 3D-CTA was followed by CCA to obtain diagnostic confirmation or information concerning the vein of Labbé, which was needed to guide the surgical approach for BA tip aneurysms. All of the ruptured aneurysms were confirmed at surgery and treated successfully. One hundred twenty one patients who underwent surgery with 3D-CTA findings only had no complications related to the lack of information of CCA. The authors considered that 3D-CTA could replace CCA in the diagnosis of ruptured aneurysms and that surgery could be performed in almost all acutely ruptured aneurysms by using only 3D-CTA without CCA.
Background and Aims: Hepatitis C virus (HCV)-specific cytotoxic T lymphocytes (CTL) may contribute to viral clearance and liver cell injury in patients with chronic hepatitis C. In the present study, we attempted to determine the serial HCV-specific CTL activity during interferon-beta (IFN-β) therapy in patients with chronic hepatitis C and whether there is any relationship between the CTL response and clinical response to IFN-β therapy. Methods: Eight HLA-A2-positive patients with chronic hepatitis C were treated initially with 6 million U/ml of IFN-β every day for 8 weeks and then 3 times weekly for the subsequent 16 weeks. Peripheral blood mononuclear cells (PBMC) were collected before the start, 4 weeks after the start, and after the end of IFN treatment and were stimulated with 2 peptides corresponding to core sequences, which were previously reported to have an HLA-A2 restricted-CTL epitopes. Cytolytic activity was determined by a standard 51Cr-release assay using allogenic HLA-matched EBV-transformed B lymphoblastoid cell lines (B-LCL). Results: HCV-specific CTL responses were detected in 2 of the 8 patients before treatment with IFN-β. One of 2 patients was not observed HCV-specific CTL responses after 4 weeks of IFN-β treatment, however these two patients showed CTL responses at the end of IFN-β treatment, and finally HCV-RNA was negative. In addition, HCV-specific CTL responses were observed in 4 patients after 4 weeks of IFN-β treatment. Three of these 4 patients showed CTL responses only at 4 weeks after IFN-β treatment. However, there were no differences between clinical parameters or between IFN efficacy in HCV-specific CTL response- positive (n=4) and -negative (n=4) patients at 4 weeks after the start of IFN-β treatment. Conclusions: These findings suggest that there are few relations between peripheral HCV-specific CTL response and clinical response to IFN therapy in patients with chronic hepatitis C, although IFN enhances the host immune response against HCV synergistically with antiviral activities.
Sera from 93 patients with connective tissue disease, 36 rheumatoid arthritis, 41 systemic lupus erythematosus, 12 polymyositis/dermatomyositis and 4 systemic sclerosis and sera from 12 patients with liver disease, along with sera of 10 healthy subjects, were tested for antikeratin antibodies using enzyme-linked immunosorbent assay in which the wells were coated with human epidermal keratin. Values above the mean+SD of the 10 healthy subjects were found in 8.3% of rheumatoid arthritis, 29.3% of systemic lupus erythematosus, 33.3% of polymyositis/dermatomyositis, 50% of systemic sclerosis, 16.7% of liver disease patients, and 20% of healthy subjects. The results indicated a character of naturally occurring antibody of antikeratin antibodies in human sera.
Background/Purpose. Most patients with hepatocellular carcinoma in Japan also have liver cirrhosis. Therefore, reliable information about liver function is essential before undertaking liver resection. Occasionally preoperative estimates and intraoperative findings are disparate. This study used rats with liver fibrosis and a new tactile sensor to determine whether quantification of liver hardness intraoperatively can be used to validate the preoperative assessment of liver function prior to hepatectomy. Methods. Liver fibrosis was induced by administration of thioacetamide to rats. Laparotomy was performed. In some rats, blood samples were taken for examination, and liver stiffness and tactile values were measured by a new tactile sensor. A biopsy specimen from each removed liver was taken, and the hepatic fibrosis index was measured by computed color image analysis after Azan blue staining. The other rats underwent partial hepatectomy, and the bromodeoxyuridine labeling index was calculated in them. Correlations between stiffness, tactile values, and other data were calculated. Results. A strong correlation existed between stiffness and both the hepatic fibrosis index and the bromodeoxyuridine labeling index, and between tactile values and both the hepatic fibrosis index and the bromodeoxyuridine labeling index. Conclusions. Liver hardness proved to be a function of hepatic fibrosis. The tactile sensor proved to be an easy and reliable way to evaluate the hepatic fibrosis index. Quantification of liver hardness by tactile sensor predicted liver regenerative activity.
Two patients with amyopathic dermatomyositis complicated by interstitial lung lesions were effectively treated with a combination of corticosteroids and cyclosporine and/or cyclophosphamide. A 48-year-old female patient was treated with pulse methylprednisolone and cyclosporine 2 months after onset of dermal symptoms. A 45-year-old male patient was treated with oral prednisolone and pulse cyclophosphamide 2 1/2 months after onset of dermal symptoms. Early evaluation of interstitial lung lesions and early extensive therapy may improve prognosis of interstitial lung lesions in patients with amyopathic dermatomyositis.