Ecological study of association between Helicobacter pylori infection and gastric cancer in Taiwan

The association between Helicobacter pylori infection and gastric cancer remains controversial. A community-based serosurvey was carried out in Taiwan to investigate the association. Serum IgG antibodies against Helicobacter pylori were examined in 728 subjects randomly selected from three townships with different gastric cancer mortality rates. The overall seropositivity of Helicobacter pylori was 54.7% (398/728) with no gender difference (males: 54.5%; females: 54.8%). The seroprevalence of Helicobacter pylori progressively increased with age in all three study townships. The age-specific seropositivity of Helicobacter pylori correlated well with age-adjusted gastric cancer mortality in the three townships. The difference in seropositivity was more profound in younger age groups. The ecological study in Taiwan suggests an association between Helicobacter pylori infection and gastric cancer. Helicobacter pylori infection in early childhood may be a key issue; in addition, a long induction time appears to be required for gastric carcinogenesis.

Preoperative mitomycin-C subconjunctival injection and glaucoma filtering surgery

Intraoperative mitomycin-C application has been well accepted recently as a useful adjunctive procedure to enhance the filtering effect in glaucoma surgery. However, the exact dose of mitomycin-C left after such a procedure in the ocular tissue is variable and unclear. It is important to determine such residual because of potential long-term toxicity of mitomycin-C to the eye. Based on previous successful experience using preoperative mitomycin-C subconjunctival injection in the THC-YAG laser sclerostomy on rabbits, the effect of intraocular pressure (IOP) control and its clinical observation was studied in six eyes of six refractory and high risk glaucoma patients by subconjunctival 1.2 micrograms to 3.6 micrograms mitomycin-C injection 24 to 72 hours prior to classic, routine, limbal-based trabeculectomy surgery. After 18 months of satisfactory clinical observation of the first eye for IOP, functioning bleb appearance and smooth clinical course, the same procedure was used on an additional five eyes, with a follow-up period of more than five months. Average IOP was reduced from 27.8 mm Hg (range 24 to 34 mm Hg) preoperatively to 9.5 mm Hg (range 5 to 14 mm Hg) postoperatively, with a smooth clinical course. The advantages of such preoperative subconjunctival mitomycin-C injection are emphasized here.

Evaluation of third-generation hepatitis C antibody assay in chronic hepatitis C and chronic non-B, non-C hepatitis

Second-generation hepatitis C virus (HCV) antibody assays are more sensitive and specific than first-generation assays in the detection of HCV infection; such tests are widely used. However, there are still HCV-infected patients who test seronegative for anti-HCV even by second-generation assays. In this study we evaluated the performance of the new third-generation HCV assay (HCV 3.0) in 230 individuals with different second-generation anti-HCV (HCV 2.0) and HCV RNA patterns. Our results showed the followings: only one healthy adult had a discrepant result in 200 subjects negative (group I) or positive (group II) for HCV 2.0 and HCV RNA; 7 of 13 (54%) HCV 2.0-negative but HCV RNA-positive patients (group III) were HCV 3.0-positive; two of 17 (12%) so-called chronic non-B, non-C hepatitis patients (group IV) were positive for HCV 3.0. We conclude that third-generation anti-HCV assays are more sensitive and specific than second-generation assays in the detection of chronic HCV infection; however false-positive results may be observed among low-risk healthy persons.

Mixed infections of hepatitis C virus as a factor in acute exacerbations of chronic type C hepatitis

Twenty patients with chronic hepatitis C virus (HCV) infection and acute exacerbations (group A) were studied by polymerase chain reaction with genotype-specific primers to explore the role of mixed infections of HCV in acute exacerbations of chronic type C hepatitis. Another 26 patients who did not have acute exacerbation were matched controls (group B). Eleven (55%) of the group A patients had heterologous HCV, and their mean age was significantly younger than that of the 9 without heterologous infection (55 vs. 67 years, P < .05). In contrast, only 2 group B patients (7.7%) had heterologous HCV infection. In 10 of 13 patients with heterologous HCV infection, type III/2a virus emerged on type II/1b HCV, and viral interference was observed in half of them. The results support that mixed infections of HCV may be important in acute exacerbations of chronic type C hepatitis.

Comparison of nucleolar organiser regions and DNA flow cytometry in the evaluation of pleural effusion

BACKGROUND

In conventional cytological diagnosis of pleural effusions the assessment of morphological features plays an important part. However, false negative and false positive results may occur. In this study conventional cytology was compared with flow cytometric DNA analysis and the argyrophil staining technique for nucleolar organiser regions (AgNOR) to characterise benign and malignant effusions.

METHODS

Pleural effusions from 71 patients (38 with benign lung disease, 33 with proven adenocarcinoma of lung) were studied by conventional cytology, flow cytometric DNA analysis, and the AgNOR technique. Tumour cell ploidy was determined by flow cytometry. In an attempt to detect the cell proliferative state, flow cytometric S phase fraction and the AgNOR technique were used. The correlations among conventional cytology, flow cytometric DNA ploidy, S phase fraction analysis, and nucleolar organiser regions were investigated.

RESULTS

All the 38 benign pleural effusions were diploid. There were 17 (52%) aneuploid and 16 (48%) diploid malignant pleural effusions. Based on these results this type of DNA analysis had a sensitivity of 52% and a specificity of 100%. The mean (SD) numbers of flow cytometric S phase fractions of benign and malignant cases were 5.32 (1.67)% and 12.45 (3.93)% respectively. The mean numbers of S phase fractions of diploid malignant cases were higher than diploid benign cases. In each case the number of AgNORs was counted in 100 cells. The mean number of AgNOR dots per nucleus was 12.57 (3.64) for malignant pleural effusion cells and 3.96 (1.39) for benign pleural effusion cells. The mean number of AgNOR dots was 14.45 (3.36) for aneuploid malignant pleural effusion cells and 10.57 (2.82) for diploid malignant pleural effusion cells. The AgNOR numbers were higher in diploid malignant cells than in diploid benign cells. There was a significant correlation between the S phase fraction determined by flow cytometry and the mean number of AgNORs per nucleus in malignant cases.

CONCLUSIONS

Both flow cytometry and the AgNOR methods provide comparable measurements in the diagnosis of pleural effusion. The study also indicates that the AgNOR method, which is rapid and easy to perform, may be a useful adjunct to flow cytometry, S phase fraction analysis and conventional cytology in the routine diagnosis of malignant pleural effusion.

[Gastric cancer in Taiwan]

The study of gastric cancer is important in clinical medicine as well as in public health. Environmental factors play an important role in gastric carcinogenesis and thus primary prevention is feasible after improvement of these factors. The 5-year survival rate of resected early gastric cancer is over 90% and this provides an excellent paradigm for secondary prevention. Though its mortality rate has declined since 1970, gastric cancer remains common and carries a high mortality in Taiwan where about 2,000 patients die of gastric cancer annually. The age-adjusted mortality is 16.54 and 8.16/100,000 for male and female, ranking the third and fourth cancer death respectively. Epidemiologic data disclose a positive association between gastric cancer and some dietary factors in Taiwan. However, the role of Helicobacter pylori infection and hereditary susceptibility should be elucidated in the future. Endoscopy with biopsy is an excellent method of the diagnosis of gastric cancer. However, its invasiveness makes it impractical as a screening tool and thus the proportion of early gastric cancer to gastric cancer remains as low as 30% in most reports. The value of lymph node dissection remains controversial although surgery is one of the most effective methods of eradicating gastric cancer. Overall, the 5 year survival rate is 24.5% to 54%. Laser therapy is usually reserved for patients with high operative risk and specific types of gastric cancer. To improve the survival results, development of a simple and economic screening program based on the epidemiologic results and utilization of noninvasive examinations such as serologic markers to diagnose and treat gastric cancer at its earliest stage deserves further study.

Laminin subtype distribution in the human ciliary body

PURPOSE

Laminin is a family of heterotrimeric molecules each consisting of a heavy chain (A or M chain), and two light chains (B1, B2, or S chains). In this study the distribution of these chains was determined in human ciliary body.

METHOD

Tissue slices from five postmortem eyes were incubated with monoclonal antibodies against the chains and with a fluorescent secondary antibody. After the tissues were embedded in Spurr's resin, 1-micron thick sections were obtained.

RESULTS

Uniform staining with A, S, and B2 laminin chains was observed in basement membrane surrounding muscle bundles. Inside the bundles, the basement membrane around individual fibers was evenly stained by S and B2; however, only some fibers had A-chain immunoreactivity. The basement membrane of blood vessels was also stained with A, S, and B2. Stromal connective tissue was not stained. Ciliary pigmented epithelium basement membrane demonstrated A, S, and B2 immunoreactivity, but not B1 immunoreactivity. Adjacent to the nerves, M, S, B1, and B2 immunoreactivity was detected.

CONCLUSION

The results indicate that A-S-B2 laminin is present in the basement membranes associated with smooth muscle bundles, blood vessels, and the nonpigmented and pigmented epithelia. A-B1-B2 laminin is also found in the pigmented epithelium basement membrane. M-B1-B2 and M-S-B2 are found in association with nerve tissue. This heterogeneity in the basement membranes of the ciliary body suggests that they mediate different cellular functions.

A clinicopathologic study of chronic non-A, non-B (type C) hepatitis in Taiwan: comparison between posttransfusion and sporadic patients

To elucidate the clinicopathological course and the role of hepatitis C virus in posttransfusion and sporadic chronic non-A, non-B hepatitis in Taiwan, we retrospectively studied 85 histologically confirmed patients with long-term follow up. Antibodies against hepatitis C virus (anti-HCV) by a second-generation assay were positive in 81% of the patients: 88% in the posttransfusion group and 76% in the sporadic group. Clinical manifestations were generally mild, and were noted in only half of the patients. During follow up, 33% (28 of 85 patients) had episodes of acute exacerbation of chronic liver disease and 24% (20 of 85) had normalized liver tests. Patients with normalized liver tests were usually anti-HCV negative (55% vs. 8%, p < 0.001). In 34 patients who had had blood transfusions, initial liver biopsies revealed chronic active hepatitis in 41%, active cirrhosis in 6%, and inactive cirrhosis in 9%. Follow-up biopsies in eight patients in this group showed histological progression in three after an average of 40.6 months. In the 51 sporadically infected patients, initial work-up revealed chronic active hepatitis in 37%, active cirrhosis in 4%, and inactive cirrhosis in 14%. Among the nine who underwent repeated biopsies, only one (11%) had progression. Patients above age 40 displayed more severe histologic activity than those below 40 (p < 0.005). Three patients, all with cirrhosis, died of hepatocellular carcinoma 7 to 12 years after follow up. Further genotyping study of hepatitis C virus in 28 patients showed that type II virus was most predominant in Taiwan and histologic severity was similar among patients infected with different genotypes.(ABSTRACT TRUNCATED AT 250 WORDS)

Transfusion-transmitted human T-cell lymphotropic virus type I infection in Taiwan: a true risk and occasional coinfection with hepatitis C virus shown in a prospective study

To study the incidence of human T-cell lymphotropic virus (HTLV) after blood transfusion in Taiwan, serum samples from 699 patients in a prospective study were examined for seroreactivity of anti-HTLV. By an enzyme immunoassay, 9 of the 699 recipients were repeatedly positive. Serial serum samples of these 9 patients were then confirmed with a Western blot analysis and with a polymerase chain reaction (PCR) assay for HTLV-I genome. Four were already positive for anti-HTLV before transfusion, 1 carried antibodies to HTLV-I transiently after transfusion, and only 4 cases had de nova seroconversions. These patients and their family members were called back and tested for HTLV-I genome in the peripheral blood mononuclear cell (PBMC) and plasma. All the serologically positive patients, except the "transient one," were positive for HTLV sequences in the PBMCs. Viral sequences could also be detected in several serum or plasma samples. In the family members, only the spouse of a pretransfusion-positive patient was infected. These results suggested that approximately 0.6% of the blood recipients were infected by HTLV-I through transfusion in Taiwan, and that the frequency of intrafamilial HTLV-I transmission is low. We also observed the unusual coinfection by both HTLV-I and hepatitis C virus in 2 patients, and superinfection of hepatitis C virus after blood transfusion in 1 HTLV-I carrier. Cases of coinfection suggest a prevalence of both viruses in blood donors and warrant further screening.

Clinicopathologic study of 208 patients with early gastric cancer in Taiwan: a comparison between Eastern and Western countries

To investigate whether there are any differences between the clinicopathologic characteristics of early gastric cancer (EGC) patients in Eastern and Western countries, 208 Taiwanese patients with EGC were reviewed between 1964 and 1992. The incidence of cancer has increased slightly over the 29-year period. Men were diagnosed with EGC frequently than women, and their mean age was 56 years. Epigastralgia (58.2%) was the most common symptom, whereas 5.8% of cancers were incidentally detected by endoscopy. Physical signs and laboratory tests were of limited value in making the diagnosis. Endoscopy was a better diagnostic aid than radiology. Tumours were frequently located in the lower third (53.2%) and middle third (43.3%) of the stomach. Cancers of the elevated type (17.8%) were less frequent than the depressed type (82.2%). Type IIc (31.2%) was the most common macroscopic type. The frequency of mucosal carcinoma (51.0%) was similar to submucosal carcinoma (49.0%). Mucosal carcinoma had less lymph node metastases (3.1%) than submucosal carcinoma (12.2%; P < 0.05), with an overall frequency of metastases of 7.5% (14/186). The 5-year survival rate was 90.8%. The clinicopathologic characteristics of EGC in Taiwan were similar to those of Western countries and other Eastern countries. Improvement of diagnostic examinations and endoscopic surveillance of asymptomatic subjects may lead to early diagnosis and thus ensure a more favourable outcome.

Prospective, randomized study of H2-blocker and triple therapy for duodenal ulcer treatment and the eradication of Helicobacter pylori

The efficacy of H2-blocker and triple therapy in curing duodenal ulcer was compared and the contribution of the eradication of Helicobacter pylori on ulcer remission was assessed. Forty-two duodenal ulcer patients infected with H. pylori were randomized to receive either H2-blocker therapy with famotidine (n = 21) or triple therapy with bismuth, amoxicillin, and metronidazole (n = 21). All patients received treatment for four weeks. Endoscopic evaluation of ulcer status and bacteriologic identification of H. pylori were performed at two, six and 12 months after therapy. Triple therapy had a similarly high healing rate to H2-blocker therapy (100% vs 90.5%) at two months of follow-up. However, at 12 months of follow-up, the ulcer remission rate in the triple therapy group (94.4%) was significantly higher than that of the H2-blocker therapy group (38.9%) (p < 0.05), resulting in the former therapy having a significantly lower rate of H. pylori infection compared to the latter (5.6% vs 100%, p < 0.005). Patients with persistent H. pylori infection at two months of follow-up had a significantly higher ulcer recurrence rate (64.7%) at 12 months than those without infection (5.3%) (p < 0.05). The success of triple therapy in ulcer remission may be attributed to the high eradication rate of H. pylori.

Biliary ascariasis: report of a case

A 64-year-old female aborigine presented with acute cholangitis and obstructive jaundice for three days. Abdominal ultrasonography showed dilatation of the common bile duct, intrahepatic ducts and a linear tubular structure in the common bile duct. Duodenoscopy showed a live Ascaris protruding through the papilla of Vater, which was retracted endoscopically. Cholangitis improved dramatically after worm extraction and nasobiliary drainage. Endoscopic retrograde cholangiography revealed another worm retained in the common bile duct. It disappeared spontaneously from the common bile duct one week later. The barium study of the intestine showed multiple filling defects in the terminal ileum. A total of five worms passed into the stool after treatment with pyrantel pamoate.

Terminal deletion of the long arm of chromosome 2 in a premature infant with karyotype: 46,XY,del(2)(q37)

We present a premature newborn boy with multiple congenital anomalies, including craniofacial anomalies, syndactyly, cardiac defects, and a horseshoe kidney associated with terminal deletion of 2q. The infant's karyotype was 46,XY,del(2)(q37). Clinical, cytogenetic, and autopsy findings are presented in this report. Clinical manifestations in this infant are compared with those four other known patients with terminal deletion of chromosome 2.

Seroprevalence study of Helicobacter pylori infection in patients with gastroduodenal diseases

To investigate Helicobacter pylori (H. pylori) infection in subjects with and without gastroduodenal diseases in Taiwan, IgG antibodies to H. pylori were examined in 136 healthy volunteers, 101 patients with non-ulcer dyspepsia, 122 gastric ulcers, 119 duodenal ulcers, and 161 gastric adenocarcinomas. The seropositivity was highest in duodenal ulcers (87.4%) (p < 0.001, as compared to healthy volunteers), followed by gastric ulcers (76.2%) (p < 0.01, as compared to healthy volunteers), but similar among gastric adenocarcinomas (60.3%), healthy volunteers (58.8%), and patients with non-ulcer dyspepsia (55.5%). Higher acquisition of H. pylori in younger patients with duodenal and gastric ulcers suggests a strong association with H. pylori. No ulcer characteristics, including number, location, and activity, were significantly statistically associated with the seropositivity of H. pylori in gastric and duodenal ulcers. Similarly, the location, extent of invasion, and histology of gastric adenocarcinoma was not significantly statistically associated with the seropositivity of H. pylori.

Serological, histological and polymerase chain reaction studies of Helicobacter pylori infection in patients with gastric adenocarcinoma

The association between Helicobacter pylori (H. pylori) and gastric adenocarcinoma remains controversial. However, the prevalence of H. pylori infection in gastric adenocarcinoma varies with the method of detection used, eg, serology, histology, culture, and polymerase chain reaction. However, studies on gastric adenocarcinoma by these methods remain inconclusive. We compared the results of serology, histology, and polymerase chain reaction for detection of H. pylori infection in 12 patients with gastric adenocarcinoma to investigate the actual status of H. pylori infection in gastric adenocarcinoma. IgG antibodies to H. pylori were examined in the sera, and histology and polymerase chain reaction were used for identification of H. pylori on the resected gastric tissues of 12 patients with gastric adenocarcinoma. Among them. H. pylori infection was verified by serology in eight, polymerase chain reaction in seven, and histology in five. In all positive cases, H. pylori was identified only in the non-tumorous part of the gastric tissue. In all four seronegative patients, H. pylori was not present in any of the tissues examined by histology and polymerase chain reaction. We conclude that: 1) polymerase chain reaction is more sensitive than histology; 2) a good correlation between serology and polymerase chain reaction is found; and 3) H. pylori infection is absent in a proportion of patients with gastric adenocarcinoma identified by these methods.

Five-drug combination chemotherapy (FAPEL) for advanced gastric cancer: a pilot study

To test if the incorporation of 5-fluorouracil (5-FU) and leucovorin in a modified etoposide, doxorubicin, cisplatin (EAP) regimen could diminish its toxicity and improve its efficacy, 18 patients with far-advanced, unresectable gastric cancer, diagnosed at National Taiwan University Hospital between January 1991 and December 1992, were treated with a FAPEL combination chemotherapy. The regimen consisted of doxorubicin 25 mg/m2 i.v. on day 1, cisplatin 60 mg/m2 i.v. infusion on day 1, etoposide 60 mg/m2/day i.v. infusion on days 1-3, 5-fluorouracil 500 mg/m2/day i.v. on days 1-3, and leucovorin 50 mg/day i.v. on days 1-3; repeated every three to four weeks. The patients included nine metastatic, six locally advanced and inoperable, and three post-gastrectomy recurrent cancer patients with median Karnofsky performance status of 60%. There were 11 men and seven women with a median age of 52.5 years. The patients tolerated the treatment toxicity relatively well and received an average of 4.3 courses of chemotherapy. Most patients completed the protocol therapy except one who refused and another who died of leucopenic sepsis. Myelosuppression was the limiting toxicity, with Eastern Cooperative Oncology Group (ECOG) grade 3-4 leucopenia developing in 35.9% and grade 3-4 thrombocytopenia developing in 11.5% of a total of 78 courses given. The overall objective response rate was 44.4% with 5.5% complete responses and 38.9% partial responses. The overall median survival was seven months (0.5-21 months). The median survival of responders and non-responders was 13 months (5-21 months) and three months (0.5-7 months), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Extracellular matrix of the human ciliary muscle

The ciliary muscle forms a major portion of the uveoscleral aqueous outflow pathway. To gain a better understanding of the extracellular matrix of the human ciliary muscle, human ciliary muscle cell cultures at various stages of confluency were immunocytochemically compared with sections of normal ciliary muscle for the presence of collagen types I, III, and IV, fibronectin, and laminin. A pre-embedding immunostaining protocol was employed to obtain good antigen conservation and histologically well-preserved tissue. In subconfluent cultured ciliary muscle cells, collagen types I, III, and IV, fibronectin, and laminin were found intracellularly in the endoplasmic reticulum or in granules surrounding the nucleus. In confluent cells, these matrix molecules each formed characteristic extracellular networks. In normal ciliary muscle, collagen type IV, fibronectin, and laminin were found in the basement membranes around the muscle fibers and blood vessels. Collagen types I and III and fibronectin were observed in the connective tissue among the muscle bundles. Collagen type I also formed a dense band of staining around blood vessels. The biosynthesis and turnover of these glycoproteins may have important roles both in the function of the nonconventional outflow pathway and in mediating the action of certain pharmacological agents.

Serum levels of pepsinogen I and gastrin in gastric carcinoma: the influence of Helicobacter pylori infection and tumor characteristics

The influence of Helicobacter pylori infection on serum levels of pepsinogen I and gastrin in gastric carcinoma was investigated by simultaneous determination of serum pepsinogen I, gastrin, and IgG antibodies against Helicobacter pylori in 100 patients with gastric carcinoma, and in another 100 age- and sex-matched healthy controls. Serum pepsinogen I level was significantly lower in gastric carcinoma than in controls (55.5 +/- 28.1 vs. 76.9 +/- 25.1 ng/ml, p < 0.005), but there was no difference in serum gastrin between them (63.2 +/- 30.2 vs. 57.4 +/- 28.5 pg/ml, p = 0.16). Helicobacter pylori infection caused a significant increase in serum PGI level in advanced, intestinal type, and non-cardia gastric carcinoma. The serum gastrin level was affected by neither Helicobacter pylori infection nor any of the tumor characteristics. It is concluded that pepsinogen I, rather than gastrin, in the serum is greatly influenced by Helicobacter pylori infection and tumor characteristics in gastric carcinoma.

Helicobacter pylori infection in early and advanced gastric adenocarcinoma: a seroprevalence study in 143 Taiwanese patients

The association between gastric adenocarcinoma and Helicobacter pylori infection remains controversial. A seroprevalence study of Helicobacter pylori infection in 143 patients with gastric adenocarcinoma and a control group of 823 subjects randomly selected from four areas in Taiwan, was carried out to elucidate the association. The overall seropositivity of Helicobacter pylori in gastric adenocarcinoma patients (62.9%) was higher than in controls (54.4%), but the difference was not statistically significant (p > 0.05). The seropositivity of early gastric adenocarcinoma (61.5%) was not significantly different from that of advanced gastric adenocarcinoma (63.2%). Various demographic factors such as sex, blood type, cigarette smoking, tumor histology and location were not associated with the seroprevalence of Helicobacter pylori. The age-specific seroprevalence of Helicobacter pylori tended to be higher in younger patients and decreased after the age of 60 years in gastric adenocarcinoma, in contrast to a stepwise increase of seropositivity in controls. This suggests that Helicobacter pylori infection in early life may be a contributory factor in gastric carcinogenesis.

Helicobacter pylori infection in a randomly selected population, healthy volunteers, and patients with gastric ulcer and gastric adenocarcinoma. A seroprevalence study in Taiwan

To investigate the association of Helicobacter pylori and gastric ulcer and adenocarcinoma, IgG antibodies against H. pylori were examined in 823 randomly selected subjects, 92 healthy volunteers, 117 patients with gastric ulcer, and 148 with gastric adenocarcinomas in Taiwan, where the prevalence of gastric adenocarcinoma is high. The seropositivity of this population in Taiwan was 54.4%. Gastric ulcer patients had a higher seropositivity (83.8%) than healthy volunteers (62.0%) and gastric adenocarcinoma patients (62.2%) (P < 0.001). Gender difference, blood type, and habit of smoking were not associated with the seroprevalence in any study groups. Gastric ulcer coexistent with duodenal ulcer had a higher seropositivity (94.7%) (P < 0.05). The seropositivity of H. pylori in gastric adenocarcinoma patients was higher than in healthy volunteers only in younger age and was not associated with histologic type, invasion, and location of major tumors. The results reemphasize the association of H. pylori infection with gastric ulcer but not with gastric adenocarcinoma in Taiwan.

Direct DNA amplification and restriction pattern analysis of Helicobacter pylori in patients with duodenal ulcer and their families

Sera from 14 patients with duodenal ulcer and their families were tested for IgG antibodies to Helicobacter pylori. Fourteen serologically negative patients and their families served as controls. Index patients and their family members who were serologically positive were advised to undergo endoscopic biopsy. Gastric biopsy tissues were subjected to HaeIII restriction analysis of nested polymerase chain reaction products of the urease gene. By serology, 28 (49.0%) of 57 in index families and 11 (27.5%) of 40 in control families tested positive. A higher prevalence rate was found in children of index patients (11/31, 35.5%) than in those of control patients (1/18, 5.6%; P < .05). On DNA analysis, 11 patterns were found in 13 patients, and 6 families underwent endoscopy. Children in 5 families exhibited identical patterns to those of their siblings and, in 3 of the 5 families, identical to the pattern of 1 of the parents. These results suggest that parent-to-child transmission and common infection source are probable causes of intrafamilial clustering of H. pylori.

Secular changes in the clinical manifestation and pathologic pattern of early gastric cancer in Taiwan

To investigate whether there has been a time trend change in the percentage of early gastric cancer to gastric cancer and the clinicopathologic features of early gastric cancer in Taiwan, we reviewed 208 patients diagnosed between 1964 and 1992. Patients were divided into group I from 1964-1980 (n = 106) and group II from 1981-1992 (n = 102). The percentage of early gastric cancer among total gastric resections in group II (14.7%) did not differ from group I (12.7%; p = 0.19). Epigastralgia (58.2%) was the most common complaint; 11.8% (12/102) of cancers in group II were incidentally detected by endoscopy. Endoscopy provided a better diagnostic aid than did radiology. Tumors were frequently located in the antrum (50.9%) with a mean diameter of 2.8 cm. Small cancers of less than 1 cm in diameter were more prevalent in group II (37.3%) than group I (10.4%; p < 0.001). Cancers of the elevated type (17.8%) were uncommon in contrast to depressed ones (82.2%; p < 0.001). The frequency of mucosal carcinoma (51.0%) was similar to submucosal carcinoma (49.0%). Mucosal carcinoma had less lymph node metastases (3.1%) than submucosal carcinoma (12.2%; p < 0.05) with an overall frequency of metastases of 7.5% (14/186). The five-year survival rate of group I (91.7%) was not statistically different from group II (94.6%). We concluded that, except for the symptomatology and the ability to diagnose, the clinicopathologic features of early gastric cancer were similar between these two time periods. Repeated investigation of suspicious lesions and endoscopic screening on asymptomatic subjects may increase the rate of detection and thus guarantee a favorable outcome.

Somatostatin-containing carcinoid tumor of the duodenum in neurofibromatosis: report of a case

We report a case of von-Recklinghausen's disease presenting with obstructive jaundice and found to have a somatostatin-containing carcinoid tumor in the papilla of Vater and a small neurofibroma in the duodenum. A 42-year-old woman with von-Recklinghausen's disease presented with intermittent jaundice, pruritus, and mild steatorrhea of a two-year duration. Abdominal ultrasonography and computed tomography showed dilated intrahepatic ducts, common bile duct and pancreatic ducts. Duodenoscopy showed a tumor at the papilla of Vater, but a preoperative biopsy failed to provide a definite diagnosis. Laparotomy revealed a yellowish tumor at the papilla of Vater and another nodule on the mesenteric side of the second section of the duodenum. Microscopically, the tumor at the papilla of Vater was found to be a somatostatin-containing carcinoid tumor. The small nodule on the mesenteric side was a neurofibroma. The jaundice, pruritus and steatorrhea disappeared after surgery.

Benign villous adenomas of the ampulla of Vater: report of two cases

Benign tumors of the ampulla of Vater are uncommon. We report on two patients with epigastralgia, jaundice and pancreatitis caused by villous adenoma of the ampulla of Vater, combined with biliary tract stones, who were treated at National Taiwan University Hospital. Definite diagnoses were made by endoscopic retrograde cholangiopancreatography and biopsy. Their medical unsuitability for radical pancreaticoduodenectomy led us to revive the procedure of wide local excision of these tumors with reimplantation of the pancreatic duct and double sphincteroplasty. Operative time and blood loss were substantially less, and postoperative recovery was relatively uncomplicated. Hepatic resection for intrahepatic stones was performed later in the first case. Postoperative follow-up at 2.5 years showed no tumor recurrence. We suggest that local resection of benign ampullary tumors with double sphincteroplasty is the procedure of choice in high-risk patients.

Serum levels of pepsinogen I in healthy volunteers and patients with gastric ulcers and gastric carcinoma in Taiwan

In order to investigate the clinical usefulness of human pepsinogen I (PGI) as a noninvasive diagnostic tool for gastric lesions, 92 healthy volunteers, 87 patients with a gastric ulcer and 94 patients with gastric carcinoma, verified by histologic examinations, were enrolled. The serum level of PGI in each patient was measured by radioimmunoassay. Mean serum PGI levels were 95.4 +/- 39.4 ng/mL in patients with gastric ulcers, 77.6 +/- 29.3 ng/mL in healthy volunteers, and 52.1 +/- 26.5 ng/mL in patients with gastric carcinoma. Statistically significant differences (p < 0.01) existed between the two groups. Various factors which affect serum PGI levels, including age, sex, smoking habit, blood type, and Helicobacter pylori (H. pylori) infection, were also analyzed in each group. The serum levels of PGI were not affected by gender or blood type in any of the three groups (p > 0.05). A negative correlation of serum PGI levels with age was observed in patients with carcinoma (r = -0.43, p < 0.01). Smokers in the gastric ulcer group had significantly higher levels of PGI than nonsmokers (106.2 +/- 35.9 ng/mL vs 83.2 +/- 32.3 ng/mL, p < 0.05). A significantly higher PGI concentration was found in both H. pylori infected asymptomatic volunteers and gastric carcinoma patients (82.9 +/- 29.8 ng/mL vs 67.6 +/- 26.0 ng/mL, and 56.5 +/- 26.7 ng/mL vs 43.6 +/- 24.3 ng/mL, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of Helicobacter pylori in gastric biopsy tissue by polymerase chain reaction

To evaluate the sensitivity of a polymerase chain reaction (PCR) assay using nested primers in detecting Helicobacter pylori, gastric tissue biopsy specimens were collected on endoscopy from 17 patients with a duodenal ulcer. DNA was extracted by phenol/chloroform treatment or boiling in water, and then subjected to a nested PCR using two primer pairs from the urease gene of Helicobacter pylori. Fourteen of the 17 patients were positive for Helicobacter pylori using DNA samples extracted by either method. The PCR results correlated well with the results of an enzyme immunoassay to detect IgG antibody. However, there were two culture negative patients. The three PCR negative patients were both culture negative and serologically negative. DNA from 9 of the 14 patients was randomly selected and subjected to semiquantification by serial dilutions, and then PCR. The results showed that phenol/chloroform extraction yielded 10-1000 times more DNA than the boiling method. It is concluded that the PCR assay is a rapid and sensitive method for detecting Helicobacter pylori, and that phenol/chloroform extraction is superior to simple boiling in obtaining DNA samples for PCR.

Effect of maternal aging on transgene heritability in transgenic founder mice derived from zygotes microinjected with retroviral long terminal repeat-containing recombinant deoxyribonucleic acid

To determine the stability of artificially introduced recombinant DNA in the mouse germline throughout the reproductive life, founder mice derived from fertilized eggs injected with retroviral long-terminal-repeat-containing recombinant DNAs were mated with congenic FVB/N mice. Tail DNA of all progeny were screened and restriction fragment patterns of the transgenes were examined. Litter size and percentage of transgene transmission at various reproductive age periods were analyzed. Microinjection of 1737 eggs with four different recombinant DNAs resulted in 12 female and 11 male transgenic mice; 2 males were sterile and the remaining 21 mice served as founders to produce 1087 F1 progeny. With increasing parental age, litter size decreased generally. The percentage of progeny inheriting the transgenes declined markedly with increasing aging of 4 female founders; this aging effect was not observed in male founders (p < 0.005). No apparent change in transgenes was detected in progeny from late reproductive stages.

Clinical study of Mycoplasma pneumoniae pneumonia

From 1982 to 1991, we experienced 76 patients with Mycoplasma pneumoniae pneumonia which were confirmed by serologic tests. There were 32 (42%) male and 44 (58%) female patients. One patient had underlying disease of diabetes mellitus while the other patients were in good health. The age ranged from 9 months old to 72 years old. All the patients complained of fever and coughing; 63% had dry cough and 37% had sputum production. Upper respiratory tract complaints such as rhinorrhea, sore throat, or earache were noted in 57% of the patients. Fifty-five percent of the patients had GI symptoms of anorexia, nausea, vomiting, or diarrhea. Other complaints included myalgia/arthralgia (29%), headache (30%), and general malaise (32%). Dyspnea (17%) and chest pain (20%) were occasional complaints. Seventy-one percent of the patients had WBC counts < 10000/cu mm and 29% > 10000/cu mm. The mean value of C-reactive protein (CRP) was 53.1 micrograms/ml, while 16% of the patients had a CRP value above 100 micrograms/ml. Thirty-one percent of the patients were noted to have a transient elevation of serum transaminase. Four different patterns of infiltration were seen in chest radiographic manifestation: 1) peribronchial and perivascular interstitial infiltrates (18.4%), 2) nonhomogeneous patchy consolidations (22.4%), 3) homogeneous acinar consolidations (27.6%), and 4) mixed interstitial and alveolar infiltrates (27.6%). Interstitial infiltration was more commonly seen in pediatric than adult patients (46% vs 20%). Other features of the radiologic manifestation were as follows: unilateral lesions in 80% of patients, single lobe lesions in 77%, lower lobe predominant in 69%, pleural effusion in 7%, and radiographic deterioration in 10%. Mycoplasmal pneumonia should be considered in the differential diagnosis of community-acquired pneumonias.

Hepatic lymphoma mimicking liver abscess: report of a case and review of the literature

Early detection of hepatic lymphoma involvement is of prime importance, as it affects the choice of treatment and the prognosis. However, clinical recognition of these lesions at the time of initial staging or during the course of the disease is difficult because infiltration by lymphoma is usually diffuse rather than focal. We describe a 64-year-old man with a previous history of peripheral T-cell lymphoma involving the lung, skin and inguinal lymph nodes. After six months of chemotherapy resulting in a complete clinical remission, he suffered from an intermittent fever and right upper quadrant pain one week prior to admission. Abdominal ultrasonography and computed tomography disclosed a 6.0 x 5.7 cm heterogeneous mass in the liver. The serum alfafetoprotein level was within the normal limits and an indirect hemagglutinin titer for ameba was negative. The patient was initially treated for a liver abscess until a liver biopsy showed malignant lymphoma. Chemotherapy was initiated and the tumor was remarkable reduced in size, with a final dimension of 2.3 x 2.2 cm before discharge. radiologic patterns of hepatic lymphoma and its differential diagnosis are discussed in this report.

Hepatitis C virus infection in volunteer blood donors in Taiwan. Evaluation by hepatitis C antibody assays and the polymerase chain reaction

A total of 2671 plasma samples that were selected from 22,500 volunteer blood donors in Taiwan were studied for hepatitis C virus (HCV) infection. The donors were stratified into three groups by serum alanine aminotransferase (ALT) levels. Of the donors, 20,768 (92.3%) had an ALT level less than 30 IU/L (group 1), 1080 (4.8%) had an ALT level between 31 and 45 IU/L (group 2), and 652 (2.9%) had an ALT level greater than 45 IU/L (group 3). To study anti-C100-3 hepatitis C antibody, 2023 plasma samples (10%) from group 1, 321 (30%) from group 2, and 327 (50%) from group 3 were randomly selected and tested. Twenty-one (1.04%) of group 1 donors, 13 (4.05%) of group 2 donors, and 26 (7.95%) of group 3 donors were positive for anti-C100-3, respectively. These seropositive samples were further tested by a recombinant immunoblot assay, by a polymerase chain reaction for HCV RNA, by a second-generation recombinant antigen-based immunoassay (r-HCV), and by a synthetic peptide-based immunoassay (EIA3) for HCV antibodies. By the polymerase chain reaction, 26 of the 60 donors were positive for HCV RNA. The HCV RNA was more frequently found in donors with an ALT level greater than 45 IU/L than in those with an ALT level less than 45 IU/L (15 of 26 vs nine of 34, respectively); in donors who were recombinant immunoblot assay reactive or indeterminate than in those who were recombinant immunoblot assay negative (17 of 21 or seven of 14 vs two of 25, respectively); and in donors who were EIA3 positive (25 of 33 vs one of 27) or r-HCV positive (25 of 35 vs one of 25). Based on these data, we anticipate that screening by anti-C100-3 in Taiwan will exclude approximately 3280 potentially infectious donations under the current screening policy but will result in the loss of 6860 donations that will be negative for HCV RNA per year. Because of its high sensitivity and specificity, EIA3 or r-HCV seems to be a potentially better screening method for HCV carriers.

Prevalence of hepatitis C viral infection in a community in Taiwan. Detection by synthetic peptide-based assay and polymerase chain reaction

The prevalence of antibodies to hepatitis C virus (anti-HCV) in a hepatitis B virus hyperendemic region was evaluated with a second-generation enzyme immunoassay. A general population of 1500 from Northern Taiwan was tested with this immunoassay which includes synthetic peptides from the capsid and non-structural protein region as the solid-phase antigen. A total of 37 subjects out of 1500 (2.5%) were positive, with no significant difference in distribution between hepatitis B antigenemic and non-antigenemic samples. The prevalence of anti-HCV was higher in subjects with abnormal than those with normal liver function tests (8.2% vs. 1.5%). Prevalence increased with age. By polymerase chain reaction, 43% of anti-HCV-positive samples were HCV-RNA-positive. However, only 1 (0.6%) of 150 anti-HCV-negative subjects had HCV-RNA. Comparison of the results with those from a conventional recombinant C100-3-based assay showed that the capsid/non-structural region synthetic antigen system provided more accurate sensitivity and specificity. The more sensitive assay revealed a high prevalence for HCV infection of 2.5% among this general population in Taiwan.

Carbon tetrachloride induction of rapid changes in liver nuclear protein factors capable of sequence-specific binding to regulatory elements in the long terminal repeat of polytropic-class endogenous murine leukemia virus-related proviruses

Treatment of mice with hepatic carcinogens, including CCl4, has been shown to rapidly enhance the transcription of endogenous murine leukemia virus-related proviral sequences in the liver. To understand the mechanism for this transcriptional stimulation, we used nuclear protein preparations from mouse livers to perform DNase I protection analyses and identified nuclear protein binding on approximately 20 individual sequences within the regulatory regions of the long terminal repeat (LTR) of a polytropic-class endogenous provirus clone. From 3 to 144 h after treatment with CCl4, the livers of FVB/N mice were analyzed for specific nuclear protein binding to the LTR DNA. Three to nine hours after CCl4 treatment, decreased protection was seen at potential regulatory cis-elements throughout the LTR, including specific sites within the putative negative regulatory element (located 5' of the consensus enhancer sequences) and the 3' terminal portion of the polytropic class-specific enhancer-like inserted sequence element and around the CCAA(C/T) box in the promoter region. In addition, by 3-6 h after treatment, a transient increase in protection activity for the transcription initiation site occurred. The loss of cis-element protection expanded to other binding sites and became most marked by 48 h after treatment. As the regenerating liver recovered, the nuclear protein binding activities for these LTR sequences also recovered, but protection at the TATAA and transcription initiation sites remained deprotected at 144 h after treatment. Nuclear protein protection of other sites, particularly in the conserved LTR enhancer sequences, was minimally affected by CCl4 treatment. Three nuclear protein binding sites that showed rapid CCl4-induced kinetic changes were homologous to the consensus sequence for the binding of the transcription factor families MEF-2, HNF-1, and C/EBP. The complex kinetic changes in factors that may contribute to the rapid and transient induction of endogenous retroviral gene expression in the liver after CCl4 exposure are discussed.

THC: YAG Laser Sclerostomy with Preoperative Mitomycin-C Subconjunctival Injection in Rabbits

Subconjunctival fibrosis is one of the major causes of most bleb failures. To inhibit the wound-healing process and to achieve a better intraocular pressure (IOP) lowering effect as well as bleb formation, we performed a sclerostomy using a THC:YAG laser (thulium, holmium, and chromium-doped yttrium-aluminum-garnet crystal) and a subconjunctival injection of mitomy-cin-C given 24 h or 5 days before a filtering operation or soon after the filtering process in rabbits. A 1-mm conjunctiva wound was made 12 mm away from the sclerostomy site to allow for entry of an optic probe for delivering energy. Forty-eight rabbits were divided into four groups. Group I received a subconjunctival injection of 0.2 ml of 0.2 mg/ml of mitomycin-C 24 h before the operation. The same dosage of mitomycin-C was given to Group II 5 days before the operation and to Group III immediately following the operation. Group IV served as a control, and only 0.2 ml of normal saline solution was given 24 h preoperatively. One eye of each rabbit was randomly selected for the experiment, while the other eye served as a control. The bleb lasted 30.9 $pM 15.7 days in Group I, 16.0 $pM 6.4 days in Group II, 15.5 $pM 6.5 days in Group III, and 2.3 $pM 0.7 days in Group IV. The IOP lowering effect was parallel to bleb formation. The results demonstrate that a subconjunctival mitomycin-C injection given 24 h before a filtering operation is more effective in prolonging the filtering effect produced by the THC:YAG laser than one given postoperatively.

Flow cytometric DNA analysis of pleural effusions

A total of 71 cases of pleural effusion in patients with and without cancer were analyzed by conventional cytology and flow cytometry (FCM) in order to detect cells with an abnormal DNA content (aneuploidy). For cytologic examination, the samples were prepared using standard techniques. Sample for FCM analysis were centrifuged and exposed to hypotonic solution containing detergent and propidium iodide. Thirty-eight patients had pleural effusion due to benign disease, whilst 33 patients had primary lung cancer. All 38 patients with benign pleural effusions showed FCM diploidy. There were 17 aneuploidy (52%) and 16 diploidy (48%) in the 33 patients with lung cancer by FCM analysis. Four of these 33 effusions were cytologically negative, however, FCM showed aneuploidy in 2 of these 4 patients. Based on these results, FCM analysis combined with conventional cytopathology yielded 100% specificity, 94% sensitivity and 100% predictive value of positive result. There were no false-positive results but 2 false-negative results. These findings suggest that FCM is a rapid and useful technique in the analysis of pleural effusion and can be a very useful adjunct to conventional cytopathology.

Double-blind comparison of omeprazole 20 mg OM and ranitidine 300 mg NOCTE in duodenal ulcer: a Taiwan multi-centre study

Two hundred and twenty-six patients with endoscopically confirmed duodenal ulcers > or = 5 mm in diameter entered a double-blind randomized trial comparing 20 mg omeprazole administered once daily in the morning with 300 mg ranitidine administered once daily at night. The patients were assessed endoscopically and symptomatically after 2 weeks, and those whose ulcers had healed terminated the study. Patients with unhealed ulcers continued treatment for a total of 4 weeks. Omeprazole produced significantly higher healing rates than ranitidine at both 2 weeks (57 vs 28%, P < 0.0001) and 4 weeks (93 vs 80%, P = 0.006). Similarly, significantly higher 'effective healing rates' (defined on the criteria established by the Japanese Society of Digestive Endoscopy) were observed with omeprazole compared with ranitidine at 2 and 4 weeks. After 2 weeks, there were significantly fewer reports of both day-time and night-time epigastric pain by omeprazole-treated patients compared with ranitidine-treated patients (22 vs 44%, P < 0.0001 for day-time pain; 24 vs 35%, P = 0.025 for night-time pain). Both drugs were well-tolerated and no major adverse effects were recorded during either treatment. In conclusion, 20 mg omeprazole administered once daily was superior to 300 mg ranitidine administered once daily for duodenal ulcer healing and symptom relief.

Detection of replicative form of hepatitis C virus RNA in peripheral blood mononuclear cells

Paired samples of plasma and peripheral blood mononuclear cells (PBMC) from 7 patients with posttransfusion hepatitis C were collected and studied for the presence of replicative forms of hepatitis C virus (HCV). RNA was extracted and tested for both positive and negative strands of HCV RNA by polymerase chain reaction. Positive-strand RNA of HCV was found in both plasma and PBMC of all 7 patients. However, negative-strand RNA was found in PBMC of 3 patients while none was found in the plasma. Levels of negative-strand RNA were about 10-100 times less than those of positive-strand RNA by semiquantification with serial dilution of viral cDNA. The results suggest that active infection and replication of HCV in PBMC is present in patients with posttransfusion hepatitis C and implicate the extrahepatic infection of HCV.

Intrafamilial transmission of hepatitis C virus: the important role of infections between spouses

To investigate the intrafamilial transmission of hepatitis C virus (HCV) and related risk factors, anti-HCV antibodies in 186 family members of 48 index patients were studied. The index patients were anti-HCV-positive and had chronic liver disease. Overall, 10 family members (5.4%) were positive for anti-HCV, indicating a higher prevalence of anti-HCV among family members than among the Taiwanese general population. Spouses had the highest prevalence (21%) of anti-HCV, with older age and longer duration of marriage of index patients the most evident risk factors. HCV RNA, recovered from the infected couples by reverse transcription-nested polymerase chain reaction and subsequently sequenced directly, was identical at the nucleotide level in 3 of the 4 couples studied, and the remaining couple had a homology of greater than 96%. These results strongly support that interspousal transmission may be the most important route of intrafamilial spreading of HCV, and thus sexual transmission, although with low efficiency, should be considered important in HCV infection.

Posttransfusion hepatitis revisited by hepatitis C antibody assays and polymerase chain reaction

Sera of 40 patients with posttransfusion non-A, non-B hepatitis were tested for hepatitis C and B viral genomes by polymerase chain reaction and for hepatitis C antibodies by synthetic peptide immunoassays. Five were then considered to have chronic hepatitis before transfusion. Six patients without hepatitis C markers and hepatitis B virus DNA recovered. In 29 recipients who became positive for hepatitis C virus RNA, posttransfusion hepatitis C was diagnosed. Of them, 5 were hepatitis B surface antigen carriers. Synthetic peptide immunoassays detected 28 whereas anti-C100 assay detected 23 of the 29 acute hepatitis C patients. Anticapsid antibody appeared earlier than the antinonstructural antibody in 10 seroconverters. They appeared simultaneously in 15 seroconverters but anticapsid antibody appeared later then the antinonstructural antibody in 3 hepatitis B carriers. Transient suppression of hepatitis B surface antigenemia was found in 2, whereas elevated hepatitis B virus DNA was found in 3 carriers during acute hepatitis C superinfection. In 2 carriers whose hepatitis C became chronic, both hepatitis B and C viral genomes persisted throughout 2 years of followup. Therefore these assays define posttransfusion hepatitis C more precisely, and there seems no significant interference between chronic hepatitis B and C virus infections.

Transient immunoglobulin M antibody response to hepatitis C virus capsid antigen in posttransfusion hepatitis C: putative serological marker for acute viral infection

The development of serological assays for hepatitis C virus (HCV) has made specific diagnosis possible. However, markers useful in indicating acute-phase HCV infection have not been identified. By an immunoblotting method, we characterized the IgM and IgG antibody response against HCV capsid antigen in patients with HCV infection. Among 88% of patients with acute posttransfusion hepatitis C recruited in a prospective study, there was a transient IgM antibody response. The IgM antibody appeared shortly after onset of hepatitis (average 3.7 weeks), persisted for several months (average 18 weeks), and then disappeared. In contrast, the IgG antibody persisted long-term once it appeared. Among patients with chronic hepatitis C with milder disease activities (serum aminotransferase increase above normal levels of less than 4-fold), the IgM antibody was negative in the majority (72%). In those with acute exacerbations (aminotransferase increase of greater than 10-fold), about 55% were negative for the IgM antibody. The reactivity of the IgM antibody in the rest was weaker or became negative upon further dilution of serum. The results suggest that IgM anti-capsid antibody may serve as a marker indicating acute or active HCV infection.

Prevalence of anti-HCV and HCV viremia in hemodialysis patients in Taiwan

Hepatitis C viral infection in 125 hemodialysis patients from Taiwan was studied using a second-generation anti-HCV immunoassay (EIA II) (Abbott HCV 2.0 EIA) and the polymerase chain reaction (PCR) to detect the HCV RNA in the serum. A total of 59 patients (47.2%) were positive by EIA II. In comparison, the conventional C100-3 anti-HCV assay was positive in 40 (32.0%). HCV RNA was found in 47 patients (37.6%). Patients with elevated serum transaminase level had a higher positive rate of anti-HCV and HCV RNA. The dialysis time was longer for those patients positive for anti-HCV than for those who were negative. A total of 57 of the 59 EIA II-positive cases had a history of blood transfusion. The HBsAg status did not influence the anti-HCV positivity. Among the 59 EIA II-positive patients, 66.1% were also positive for HCV RNA, and of the 47 HCV RNA-positive cases 83.0% were positive for EIA II. It is concluded that the high prevalence of specific HCV infection and HCV viremia was present in these patients. Prevention of cross-contamination during dialysis and blood screening before transfusion are important for the control of HCV infection in these patients.

Application of staining of nucleolar organizer regions in cytological smears of the bronchus

An argyrophil technique for the staining nucleolar organizer regions (AgNOR) was applied to cytological preparations obtained from bronchoscopic brushing materials. The number of AgNOR has been thought to be related to cellular activation. To differentiate malignant cells from non-malignant atypical cells, this study was carried out in 20 cases of adenocarcinoma of the lung (mean AgNOR: 18.34), 12 cases of pulmonary inflammatory diseases (mean AgNOR: 6.54) and 10 normal bronchial epithelial specimens for control (mean AgNOR: 2.07). On the basis of AgNOR number, we could differentiate between the three groups. The differences observed were statistically highly significant (p less than 0.0001). Moreover, the nucleolar organizer regions (NOR) in cancer cells were found the more irregularly distributed and more variable in sized than those in atypical and normal bronchial columnar cells. We suggest that the AgNOR technique will find increasing application as a complementary test in diagnostic cytopathology.

Effects of anticoagulants and storage of blood samples on efficacy of the polymerase chain reaction assay for hepatitis C virus

Blood samples from 11 patients with posttransfusion hepatitis C virus infection were collected. Each sample was divided into three fractions to obtain sera, sodium-citrated plasma, and heparinized plasma and then tested for HCV RNA by a nested polymerase chain reaction (PCR). Of them, eight sodium-citrated plasma samples, seven serum samples, and no heparinized plasma samples were PCR positive. Eight PCR-positive sodium-citrated plasma samples were exposed to different physical conditions and semiquantified for HCV RNA after serial dilutions. Samples stored at -70 degrees C showed the best preservation of HCV RNA, and storage at the other conditions resulted in only minimal loss of the PCR signal. Therefore, serum or sodium-citrated plasma specimens are satisfactory for detecting HCV RNA by PCR, but heparinized blood specimens are not.

Improved serodiagnosis of posttransfusion hepatitis C virus infection by a second-generation immunoassay based on multiple recombinant antigens

Serial serum samples from 35 patients with posttransfusion non-A, non-B hepatitis in a prospective study were tested for antibody to hepatitis C virus (HCV) by a multiple recombinant antigen based immunoassay [anti-HCV (2nd); Abbott]. Of them, 23 were positive for anti-C100, and 27 were positive for HCV RNA by polymerase chain reaction. By anti-HCV (2nd), 28 patients were positive, and all except 1 of the 28 patients were positive for HCV RNA. A total of 24 patients, who became HCV RNA positive at the acute stage and who were negative for both anti-C100 and anti-HCV (2nd) before transfusion, were considered to have posttransfusion hepatitis C. The mean time to seroconversion for anti-HCV (2nd) was 7.5 or 12.1 weeks after the onset of hepatitis or the date of transfusion, respectively, and was generally 6 weeks earlier than that detected by anti-C100. However, seroconversion was delayed in 2 hepatitis B surface antigen carriers as compared with anti-C100. The anti-C100 assay detected 20 (83%) and the anti-HCV (2nd) all 24 patients with documented posttransfusion hepatitis C. The second-generation test is, therefore, better than conventional anti-C100 for the early diagnosis of HCV infection.

Endoscopic approaches in the diagnosis of obstructive jaundice--with special reference to endoscopic retrograde cholangiopancreatography

Duodenofiberscopy with endoscopic retrograde cholangiopancreatography (ERCP) was performed in 102 patients with obstructive jaundice. Peritoneoscopy and peritoneoscopic cholecystocholangiography were done in patients whose ERCP was inconclusive. The causes of obstructive jaundice were carcinoma of the pancreas in 14 cases, carcinoma of the papilla of Vater in 12 cases, choledocholithiasis in 37 cases, carcinoma of the common bile duct in seven cases, hepatocellular carcinoma (HCC) in seven cases, intrahepatic cholestasis in three cases and miscellaneous causes in eight cases. No final diagnosis was made in 14 patients. The duodenofiberscopic examination with biopsy revealed the cause of obstructive jaundice directly in eight cases, when carcinoma of the pancreas or papilla of Vater extended to the duodenal mucosal surface. In 34 of the 37 patients with choledocholithiasis, ERCP alone was successful in making the diagnosis. Percutaneous transhepatic cholangiography and ERCP were used together to reach a diagnosis in the remaining three patients. We propose a classification for HCC on ERCP which may be useful for the study of icteric type HCC.

THC:YAG laser sclerostomy with mitomycin subconjunctival injection in rabbits

We performed sclerostomy using THC:YAG laser (thulium, holmium, chromium doped YAG crystal) and subconjunctival injection of mitomycin soon after the filtering process in rabbits to observe the lowering effect of intraocular pressure(IOP) and filtering bleb formation. A 1-mm conjunctiva wound was made 12 mm away from the sclerostomy site to allow the entry of the optic probe for delivering energy. Forty-eight rabbits were divided into 3 groups. After sclerostomy, Group I received 0.2 ml normal saline subconjunctival injection and Group II and III received 0.2 ml mitomycin injection of 0.1 and 0.2 mg/ml respectively. One eye of each rabbit was randomly selected for the experiment while the fellow eye served as control. The bleb lasted 1.4 +/- 0.5 days (or 1 to 2 days) in Group I, 8.5 +/- 4.5 days (or 4 to 17 days) in Group II and 15.4 +/- 10.9 days (or 4 to 37 days) in Group III. The IOP lowering effect was significantly enhanced in Group III. The postoperative complication was minimal corneal punctate erosion in the mitomycin group, but all of them, however, resolved within one week. The results demonstrated that mitomycin is effective in prolonging the filtering effect produced by the THC:YAG laser.