[Blood donors with positive HBsAg in Asturias: its current prevalence and significance]

BACKGROUND

The aim of the present study was to know the current prevalence of HBsAg positivity in Asturias blood donors and to carry out a clinical study of the carriers of the hepatitis B virus (HBV) accidentally detected in a blood donation program.

METHODS

A prospective study of incidence and prevalence of HBsAg positivity in blood donations performed in Asturias over two years from October 1989 and 1991 was carried out and the epidemiologic, clinical, and analytical characteristics, as well as histologic liver lesions in the HBsAg positive cases were determined.

RESULTS

Among the 42,789 blood donors during this above mentioned period in Asturias 119 cases of HBsAg positivity were found, representing a prevalence of 0.16% of the donations and 0.28% of the donors, generally new donors (95.8%) with a prevalence of 1.2% in this subgroup. No risk factors or known source of contagion were found in 43.6% of the cases and in most occasions the donors were asymptomatic HBsAg carriers (96.5%) with normal transaminases (87.3%) with 4.6% of the cases being HBeAg positive and 3.5% being mutant "e minus" carriers.

CONCLUSIONS

The prevalence of HBsAg was almost limited to new donors with a higher prevalence being observed with respect to other regions. Most of the cases may be considered as "apparently healthy" and in the group with positive replicative markers a similar number of positive HBeAg carriers and "e minus mutants" were present.

Mutation in a splice-donor site of the APC gene in a family with polyposis and late age of colonic cancer death

Adenomatous polyposis coli (APC) is an autosomal dominant disease characterized by the development of hundreds of colorectal adenomatous polyps during the first decades of life. The expression of the disease varies, as the age of onset of colonic cancer and the severity of extracolonic manifestations often differ between affected families. An attenuated form of APC has also been described in which a small number of polyps and a later age of onset of colonic cancer is observed. Cloning of the APC gene has allowed disease-causing mutations in APC families to be identified. Here, we report a novel splice site mutation (a G to T transversion at position +5 of the splice donor site in intron 9) in the APC gene of affected individuals in an Italian family. Characterization of the transcription products from this mutant APC allele revealed that normal splicing was disrupted: a shorter mRNA was expressed in which exon 8 was connected directly to exon 10. This created a shift in the reading frame and the introduction of a stop codon at position 1358. In addition, some normal APC transcript was produced from the mutant allele in lymphoblastoid cells. A comparison of the clinical features of affected members of this family with four unrelated Italian APC kindreds, in which the same AAAAG deletion at position 3926 has been found, showed a significant difference in the onset of disease symptoms and in the age of death attributable to colorectal cancer. Inefficient exon skipping may be, at least in part, responsible for the delay in the development of the disease in the reported family.

Persistent expansions of CD4+ CD8+ peripheral blood T cells

CD4+ CD8+ cells are present during T cell differentiation in the thymus. Less than 2% of normal T cells that coexpress CD4 and CD8 also are released in the circulation and are present in the peripheral blood. In this study, nine individuals are described that manifested persistent expansions (11% to 43%) of circulating CD4+ CD8+ T cells that in three cases had large granular lymphocyte (LGL) morphology in the absence of either lymphocytosis or overt lymphoproliferative disorders. Southern blot hybridization of enriched CD4+ CD8+ cells with T-cell receptor beta (TCR beta) and TCR gamma probes showed that most cases had the 12-kb Eco RI germinal band deleted or of decreased intensity. In several individuals new TCR beta-specific bands of different intensity and distinct from case to case suggested either monoclonal or oligoclonal and polyclonal expansions. Immunophenotypic analysis showed that in 7 out of 9 cases the CD4+ CD8+ T cells presented with CD8 dim expression. Furthermore, all the CD4+ CD8+ cells did not express many of the known activation antigens (low or absent CD25, CD38, CD71, HLA-DR), whereas they expressed high levels of CD2, CD29, CD56, and CD57. In addition, the CD4+ CD8+ cells of 5 out of 9 subjects coexpressed CD45RA and CD45RO suggesting that these cells might be "frozen" in an intermediate state between naive and memory T cells. In conclusion, the present CD4+ CD8+ cases fall within a larger spectrum of disorders ranging from apparently normal to reactive or proliferative situations and encompassing cells with LGL morphology or LGL-associated antigens expression either in the presence or in the absence of absolute lymphocytosis that deserve careful follow-up investigations.

Correlation between relatives for colorectal cancer mortality in familial adenomatous polyposis

It has long been realized that age-specific cancer mortality in Familial Adenomatous Polyposis (FAP) was bimodal, and a theory was proposed in which the involved locus was polymorphic in the general population. After the molecular cloning of the region 5q21, it has been suggested that the phenotypic variability in FAP may be due to the interaction of two loci, one of which is polymorphic. We show that these two hypotheses lead to different predictions of the correlation between relatives for a phenotypic trait, and use colorectal cancer mortality data from the Italian Polyposes Registry to verify them. We conclude that the first of the two is more likely and suggest that the same variation that we observe among the affected subjects is present in the general population, thus causing a significant difference between individuals for colon cancer susceptibility.

Simultaneous transplantation

1. Thoracic organ transplantation requires extensive preparation with little advance notice. 2. A single organ transplant requires a team of various staff members, and may include one or two circulating nurses, two scrub technologists or nurses, one perfusionist, one surgeon's assistant, two surgeons, and one anesthesiologist. 3. Timing is important in organ transplantation because thoracic organs ideally should be transplanted within four hours after cross-clamping the aorta of the donor. 4. The dedication, expertise, and thorough follow-up care provided by transplant surgeons, nurse transplant coordinators, organ procurement coordinators, and the CICU and coronary care nurses/departments directly relate to the success of a thoracic organ transplant program.

APC gene mutations in Italian familial polyposis coli patients

Adenomatous polyposis coli is an autosomal dominant disease characterized by the development of hundreds of colorectal adenomas in young adults. If prophylactic colectomy is not performed, colorectal cancer develops in virtually all affected individuals by the fifth decade of life. All at-risk relatives older than 10 years of age need to be screened regularly by endoscopy. Recently, the gene responsible for the disease, the APC gene, was cloned. The finding of inactivating mutations of the APC gene in Italian APC patients allowed us to offer DNA-based diagnostic tests to these families.

Congenital hypertrophy of retinal pigment epithelium (CHRPE) as a marker for familial adenomatous polyposis (FAP)

Seventy-eight patients from 26 families were examined to evaluate the potentiality of congenital hypertrophy of retinal pigment epithelium (CHRPE) as a phenotypic marker for familial adenomatous polyposis (FAP). The examined subjects were divided into three different groups: Group I, patients with FAP without extra colonic manifestations (ECM); Group II, patients with FAP and ECM (desmoids/osteomas/upper gastrointestinal adenomas); and Group III, individuals at risk without FAP. Of 24 Group I patients (median age 18 years) 16 had CHRPE compared with 14 out of 24 patients (median age 29 years) in Group II and only three out of 30 patients in Group III. The overall sensitivity of CHRPE for FAP was 70% (+/- 13%) without any difference related to ECM; the predictive value was 92%. The specificity calculated from Group III (median age 26 years) was 90%, but the results should not be considered as definitive because a longer follow-up to determine the appearance of adenomas is required. The data suggest that examination for CHRPE is an inexpensive, non-invasive test for FAP, but the absence of retinal lesions does not eliminate the necessity for adequate follow-up of individuals at risk.

Monoline argon laser (514 nm) treatment of benign pigmented lesions with long pulse lengths

A dichroic filter was adjusted in order to make use of the green line of an argon laser for the treatment of pigmented lesions (actinic and senile lentigo, ephelis, café-au-lait marks and spilus nevus). Using a power of 1.5 W, a spot size of 0.5 mm and pulse lengths of 200 or 300 ms, satisfactory elimination of 620 pigmented cutaneous lesions was achieved. Although the pulse lengths used were much longer than the thermal relaxation time of the melanosomes, the histology after treatment showed little damage of adjacent structures. Good restoration of the epidermis and a return of normal pigmentation led to excellent cosmetic results, with few complications.

Antibody to hepatitis C virus in acute, self-limited, type B hepatitis

Sera from 104 patients with self-limited, acute type B hepatitis were tested for the presence of anti-HCV antibodies. The results show that especially drug users with acute type B (and occasionally coinfected with type D) hepatitis commonly are infected with HCV. Furthermore, HCV infection may have preceded infection with the other agents and may be responsible for high ALT levels.

Prevalence of antibody to hepatitis C virus in chronic HBsAg carriers

The presence of the anti-HCV antibody was investigated in sera from 102 chronic HBsAg carriers. The subjects varied as to the characteristics of the clinical states. It was found that HCV coinfection was more common in HBsAg positive intravenous drug addicts than in other parenteral risk groups. It also appears that HCV may be the causative agent of chronic liver disease in HBsAg carriers with undetectable HBV (and possibly HDV) replication.

Sonographic appearance of primary retroperitoneal cysts

The sonographic findings observed in four patients with primary retroperitoneal cysts were reviewed. All lesions presented as fluid-filled masses with anechoic content and regular margins; all increased through transmission. Preoperative location of the cysts within the retroperitoneal space was possible in all cases by either real-time ultrasound (US) analysis of the different relationships of the kidneys and the cysts during respiratory movements or the anterior displacement of surrounding structures. A differential diagnosis among retroperitoneal lesions containing fluid is difficult and cannot be obtained with imaging methods alone. However, preoperative knowledge of both the retroperitoneal location of the disease process and its fluid content may help to narrow the diagnostic possibilities, thus allowing the surgeon to more accurately plan the therapeutic approach to the patient.

Immunochemical and structural characterization of an IgG1 heavy chain disease

The immunochemical and structural analysis of an IgG1 heavy chain disease is reported. The abnormal component is characterized by extensive deletion including the CH1 domain and most or all of the VH region.

Sensitivity of Hemoccult test for large bowel cancer in high-risk subjects

From 1979 to 1982, 1233 symptom-free subjects at high risk for colon cancer because of family history and/or personal history of bowel neoplasia (cancer or adenomatous polyp) were examined with a guaiac test (Hemoccult II) for occult blood in stools. The test was positive (H+) in 98 subjects (7.9%). Endoscopy was subsequently performed on 86% of the H+ and on 64% of the H- subjects. Of 20 in invasive cancers found, 15 had been H+ [75.0%; 95% confidence interval (CI), 54.3-91.0%]. Of 96 patients with adenoma(s), 23 were H+ (24%; 95% CI, 16.0-33.0%). However, the sensitivity for adenomas was higher in patients with multiple adenomas or with a single adenoma measuring 2 cm or more in its largest diameter (37.5%; 95% CI, 21.8-54.7%). Of 699 subjects free of neoplastic lesions at endoscopy, 47 had been H+, ie, false positive (6.7%; 95% CI, 5.0-8.7%). Adjusting for differential compliance of H+ and H- subjects to endoscopy, a corrected estimate for sensitivity would be 69% for cancer and 19% for adenomas; the corrected estimate for the false-positive rate would be 5%.