Treatment of acute exacerbations in early multiple sclerosis: cyclosporin A or prednisolone?

Twenty-six acute exacerbations in 26 patients with early definite multiple sclerosis (MS) were treated with oral cyclosporin-A (CyA) or oral prednisolone in a double-blind, controlled and randomized trial. The duration of the treatment was 6 weeks. All of the patients showed improvement during the treatment. There were no differences in outcome between patients on CyA (7.5 mg/kg) or prednisolone (decreasing doses from 0.8 mg/kg) during the 6 week treatment. However, the improvement of clinical signs 3 months after the treatment was slightly greater in the prednisolone group. The drugs did not have significant side-effects. There was no fluctuation in the CD4/CD8 ratio during the follow-up. The two treatment groups did not differ from each other in respect to the number of CD3 (T3), CD4 (T4), CD8 (T8), CD14 (monocytes), CD20 (B cells) or CD25 (interleukin-2 receptor positive cells). The number of active T cells with the interleukin-2 receptor was high in the beginning of the exacerbation but it decreased during the treatment. To conclude, the effects of CyA and prednisolone were comparable in the treatment of acute MS relapses.

Ultrasound-guided fine-needle biopsy of focal liver lesions: techniques, diagnostic accuracy and complications. A retrospective study on 2091 biopsies

Two thousand and ninety-one ultrasound-guided fine-needle biopsies were performed in 1946 patients to diagnose focal liver lesions. The diagnostic accuracy of fine-needle biopsies is very high (only one false positive was observed), both for aspiration biopsy (93.4%) and for cutting biopsy (95.1%). The difference is not statistically significant. In cases of hepatocellular carcinoma (but not in cases of metastasis or hepatic lymphoma), double biopsy (aspiration and cutting) showed higher diagnostic sensitivity than single methods. A certain number of benign focal liver lesions were also diagnosed. In the present series, no case of death following liver puncture was observed. Intraperitoneal hemorrhage was the most common complication. The risk with a cutting needle being higher than with an aspirative needle.

[Diagnosis and course of small hepatocarcinoma in cirrhosis. 6 years' experience]

Diagnosis of hepatocellular carcinoma smaller than 3 cm in diameter was possible in 64 (27.7%) of 231 consecutive cases. Ultrasonography provided the highest diagnostic sensitivity which was further increased by combining this methodology with laparoscopy. Evolution of nodules was more often multicentric but sometimes unicentric with slow growth. Surgical treatment in selected patients (small resections) was associated with high operative mortality (37.5%). Survival of patients (Child C excluded) after percutaneous ethanol injection under ultrasound guidance was 100% at three years.

Low levels of mumps virus antigen induced interferon-alpha production in insulin-dependent diabetes

The in vitro production of interferon-alpha was studied in cultures of peripheral blood mononuclear cells from children with insulin-dependent diabetes. Significantly lower levels (p less than 0.01) of interferon (median 64 IU/ml) were found in mumps antigen stimulated cultures of IDDM patients compared to control children (median 256 IU/ml) whereas no differences between groups were found in the amount of interferon induced by Coxsackie B pool antigen or live Sendai virus.

[Ultrasound-guided percutaneous injection of alcohol. Is it an elective therapy in small diameter nodular hepatocarcinoma associated with cirrhosis?]

The authors discuss percutaneous alcohol injection as elective therapy for small hepatocellular carcinoma (less than 5 cm) in liver cirrhosis. Thirteen patients were classified as Child C cirrhosis. Thirty-six months actuarial survival is 60%. These results are similar in patients selected for surgical resection.

[Macronodular hepatic tuberculosis. Echographic diagnosis of 2 cases]

Two cases of macronodular hepatic tuberculosis are reported. In both cases primary or metastatic liver tumor had been suspected Hepatic tuberculosis was diagnosed by ultrasonically guided percutaneous fine-needle biopsy. Percutaneous needle biopsy of the liver appears to be a safe and valuable procedure for differentiating systemic or infiltrative diseases such as tuberculosis from primary or metastatic liver tumor.

Infection of human peripheral blood mononuclear cells with a temperature-sensitive mutant of measles virus

A stable temperature-sensitive mutant of measles virus (MV ts38) was used to study the mechanism of virus-mediated immune suppression of peripheral blood mononuclear cells in vitro. Both unstimulated and phytohemagglutinin-stimulated cultures released infectious virus at 32 degrees C, whereas no virus was released at 37 degrees C, although both viral RNA and viral proteins were synthesized. However, the response of the lymphoid cells to phytohemagglutinin, concanavalin A, and herpes simplex virus antigen was decreased in the presence of MV ts38 at 37 degrees C. The viability of infected cells was not diminished, therefore excluding cell death as a reason for immunosuppression. Interleukin 2 did not play a role in the inhibitory effect of MV ts38. Antibodies to alpha interferon partially reversed the inhibitory effect of the virus infection on lymphocyte mitogenesis, thus implying that alpha interferon plays a role in the immunosuppression. Depletion experiments indicated that adherent cells play a greater role in the measles virus-induced immunosuppression than nonadherent cells. However, monocyte maturation to macrophages had no effect on the degree of immunosuppression.

Small hepatocellular carcinoma: percutaneous alcohol injection--results in 23 patients

Twenty-three patients with hepatocellular carcinoma less than 4.5 cm in diameter (32 lesions) were treated with a percutaneous injection of ethyl alcohol performed with ultrasound (US) guidance. No complications or sequelae occurred after 271 treatments. All lesions were smaller after 6-27 months follow-up. No evidence of hepatocellular carcinoma was present at fine-needle biopsy or contrast material-enhanced computed tomography (CT). No viable tumor cells were detected in four patients who subsequently underwent surgery. The 1-year survival rate of 12 patients was 91.7%. From these data, it can be concluded that percutaneous alcohol injection (PAI) is an appropriate first-line treatment for patients with small hepatocellular carcinoma lesions who are poor surgical risks. Given the risk of new nodular lesions occurring on resected livers and the risk of perioperative mortality, PAI might even be considered an alternative to surgery.

Effect of viral infection on experimental allergic encephalomyelitis in mice

BALB/c mice were irradiated with 350 R and injected with mouse spinal cord homogenate (MSCH) in complete Freund's adjuvant. Only 15-30% of these animals developed signs of experimental allergic encephalomyelitis (EAE) at 21-28 days after inoculation. Intraperitoneal infection with the non-lethal A7 strain of Semliki forest virus (SFV) 7 days after sensitization reduced the mean appearance time of the EAE symptoms to 14 days and the number of animals with clinical EAE increased up to 70%. In contrast, virus inoculation 10 days before induction of EAE decreased significantly the incidence of clinical EAE in both BALB/c and SJL mice. Demyelination with increased cellularity, presence of macrophages, stripping of myelin from the axons and sparing of oligodendrocytes was observed in spinal cords of animals at days 13-16 after induction of EAE and subsequent virus infection. No demyelination was seen in specimens taken at the same time from mice inoculated with MSCH or SFV alone. Combined MSCH and virus inoculations induced changes in the general immune response which may be one of the major reasons for the increase or decrease in demyelination in this model.

Measles virus infection of unstimulated blood mononuclear cells in vitro: antigen expression and virus production preferentially in monocytes

Synthesis of measles virus antigens occurred only in a small percentage of peripheral blood mononuclear cells infected in vitro with measles virus without mitogenic stimulation. The infection cycle was restricted as only low amounts of infectious virus were released but all the major structural viral proteins were present as shown by immunofluorescence with monoclonal antibodies. Cells with viral antigen synthesis were characterized by double labelling and by infecting selectively depleted subpopulations. In 3-day cultures, up to 80% of the cells with measles virus antigen were shown to be monocytes by specific staining with anti-MMA and anti-Leu M3 monoclonal antibodies and up to 40% of the monocytes were infected. Less than 10% of the cells expressing virus antigens carried the lymphocyte marker OKT3, the majority of these cells belonging to the Leu3a (helper) population. Anti-alpha-interferon treatment increased the number of measles-positive cells and the release of infectious virus in preparations enriched for monocytes, but had no significant effect on infection of lymphocytes.

Measles virus strain-dependent variation in outcome of infection of human blood mononuclear cells

Eight measles virus strains including four subacute sclerosing panencephalitis (SSPE) isolates were compared on the basis of their growth characteristics in human peripheral blood mononuclear cells and effect on mitogen-stimulated lymphocyte proliferation. The Edmonston strain virus and some other strains of measles virus replicated in phytohaemagglutinin (PHA)-stimulated lymphocytes and released high titres of infectious virus into the culture medium. Inhibition of DNA synthesis was relatively low at the beginning of lymphocyte proliferation and could be detected only at high multiplicity of infection. Three to 4 days after initiation of proliferation a strong inhibition was seen also in cultures infected with low doses of virus, and was apparently related to the production of high titres of new infectious virus. Some virus strains originally isolated from SSPE patients produced only a small amount of infectious virus in lymphocytes at 37 degrees C but had a very strong inhibitory effect on lymphocyte proliferation leading to early cell death. The inhibitory effect was found over a wide range of virus concentrations, but was strictly dose-dependent and no increase in inhibition with low multiplicities of infection could be seen with longer culture times. The amount of interferon induced by different strains varied from 400 to 6400 international units/ml but the amount of interferon produced in the cultures did not correlate with the inhibitory effect on proliferation or with the amount of released new infectious virus. The Hallé measles strain, originally isolated from an SSPE patient, differed most from the Edmonston strain in its characteristics, and was studied in greater detail. Although only a small amount of infectious virus was produced, the Hallé strain had a very strong inhibiting effect on the proliferation of PHA-stimulated lymphocytes, and extensive syncytium formation was seen leading to cell death within 3 days.

Alpha-fetoprotein Monoclonal Assay: Preliminary Clinical Findings in a High Risk Population

A two-site solid phase immunoradiometric assay was developed for measurement of human alpha-fetoprotein, utilizing two high-affinity monoclonal antibodies directed against distinct and separate epitopes on the proteic structure. The analytical sensitivity of the assay is 0.5 ng/ml. The clinical sensitivity was evaluated by comparison of patients with cirrhosis and patients with hepatocellular carcinoma with cirrhosis. This assay gave good diagnostic discrimination. In a preliminary clinical trial, the specificity of the assay was 92.3%, the clinical sensitivity 88.2%. and predictive values were 78.9% in the clinically positive stage and 96.0% in the negative stage. The diagnostic efficacy of the assay was 91.3%.