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Total intravenous anesthesia (TIVA) with propofol combined with remifentanil or fentanyl has commonly been used to achieve general anesthesia. The purpose of this study was to examine recovery of psychomotor function, by use of the Trieger dot test, after TIVA with remifentanil–propofol or with fentanyl–propofol. Forty patients were randomly divided into two groups of 20, to receive TIVA with either remifentanil–propofol (group R) or fentanyl–propofol (group F). Anesthesia was induced by intravenous injection of propofol. In group R, remifentanil at 0.3 μg/kg/min was infused continuously during surgery. In group F, 3 μg/kg fentanyl was injected as an initial dose and 1 μg/kg fentanyl was administered intravenously every 30 min during surgery. Psychomotor function, as measured by the Trieger dot test, was evaluated before anesthesia and 30, 60, 90, 120, and 150 min after the end of TIVA. From assessment of the Trieger dot test, the number of dots missed in group R from 30 to 120 min after the end of TIVA was significantly lower than in group F. The maximum distance of dots missed in group R from 30 to 120 min after the end of TIVA was significantly shorter than in group F. The average distance of dots missed in group R from 30 to 120 min after the end of TIVA was significantly shorter than in group F. Recovery of psychomotor function in TIVA with remifentanil–propofol is faster than that in TIVA with fentanyl–propofol.

Randomly selected 50 asymptomatic hepatitis B virus (HBV) carrier residents who had been followed annually were enrolled in this study. The subject group comprised 25 males and 25 females with a mean age at the start of follow-up of 44.1+/-10.4 years. The mean follow-up period was 15.5+/-2.7 years. Genotyping revealed 27 (54%) of genotype B and 23 (46%) of genotype C. The prevalence of genotype B was clearly higher in asymptomatic HBV carrier redidents, which was contrary to the previous reports on chronic liver disease. At the start of follow-up, the ratio of carriers positive for anti-HBe was significantly higher in genotype B than genotype C (P0.001). Furthermore, the ratio of carriers with reduced HBV-DNA levels was significantly higher in genotype B than genotype C (P0.01), suggesting that most genotype B carriers had already undergone seroconversion from HBeAg to anti-HBe and were clinically stable at the start of follow-up. The subsequent follow-up observations demonstrated that levels of HBV-DNA and ALT were lower in genotype B than genotype C. Seroconversion from HBeAg to anti-HBe was less likely to occur in genotype C carriers, especially on 40-year-old generation, and these subjects were more likely to develop chronic liver disease.

A controlled trial was conducted to compare the efficacy of interferon (IFN) between two groups of patients with type C liver. Thirty-five patients were randomly assigned to group A (17 patients) or group B (18 patients). The former received 3 megaunits (MU) of human lymphoblastoid IFN six days per week for two weeks, followed by three days per week for 50 weeks; the latter group received 6 MU six days per week for two weeks followed by three days per week for 24 weeks. The percentages of biological sustained responders (B-SR) and virological sustained responders (V-SR) were 29.4 and 23.5%, respectively, in group B, and 17.6% for both in group A. The therapeutic effects were not different between two groups. HCV genotype 2 accounted for significantly higher percentage of B-SR and V-SR (both 57.1%, respectively). These findings indicate that IFN is effective in type C cirrhosis with genotype 2.

BACKGROUND The effectiveness of interferon against hepatitis C has been found to be greatly affected by viral factors. However, few controlled interferon trials have involved seemingly intractable cases of chronic hepatitis C. METHODS In 44 patients with high hepatitis C virus RNA levels (> or = 10(5) copies/mL), we carried out a prospective, controlled study of two natural interferon-alpha regimens, seeking predictors of therapeutic efficacy. Total natural interferon-alpha doses over 6 months in two groups were 780 and 840 million units, respectively. RESULTS High therapeutic efficacy was achieved with no significant outcome difference between the regimens. The virus eradication rate was 35% and the rate of sustained biochemical response was 45% for both regimens. Multivariate logistic regression analysis identified viral genotype as the only significant predictor of success in viral eradication. CONCLUSIONS Hepatitis C virus genotype 2 showed high sensitivity to interferon-alpha and this therapy can be recommended even for patients with a high viral load of this genotype. In contrast, with genotype 1b, cure was extremely difficult in cases with 10(7) or more copies/mL with a single 6-month course of interferon-alpha.

Hepatitis E is endemic in developing countries and may occur as imported hepatitis in industrialized countries. A 46-year-old Japanese man developed immunoserologically diagnosed acute hepatitis E in Japan 4 months after he had made a trip to China. He had bought a Chinese herbal medicine there, taking it occasionally until approximately 6 weeks prior to the onset of acute hepatitis. Nucleotide sequencing of the 3' terminal region of the viral cDNA amplified from the patient's serum by polymerase chain reaction revealed a high degree of homology (99.8% of 752 nucleotides) with the Chinese strain. Thus, the results of sequencing suggest that his hepatitis E was caused by infection with the Chinese strain, via the Chinese herbal medicine.

Background and Aim: The purpose of the present study was to investigate the influence of viral load on disease severity and analyze the possible relationship of the load of hepatitis A virus (HAV) with disease severity and laboratory findings. Methods: Fifty-eight patients diagnosed with acute hepatitis A were used in the current study, of whom 12 patients progressed to severe acute hepatitis (s-AH) defined on the basis of a prothrombin time (PT) of

One hundred and forty-one patients with chronic hepatitis C virus (HCV) infection treated with 6 MIU of interferon (IFN)-alpha2b for 24 weeks were studied to compare pretreatment viral dynamics during 1 month before the initiation of treatment (DeltaHCV) with other predictive factors. The patients were classified into three groups according to DeltaHCV: the Increase group (DeltaHCV0.20log copies/ml/month), the Stable group (-0.20/=DeltaHCV/=0.20log copies/ml/month) and the Decrease group (DeltaHCV-0.20log copies/ml/month). The sustained response (SR) rates were 0/40 (0%) in the Increase group, 6/54 (11.1%) in the Stable group and 25/47 (53.2%) in the Decrease group (P0.0001). Based on the HCV RNA level at baseline, the SR rates were lower in the Increase group than that in the Decrease group in less than 5.0log copies/ml (0% vs. 100.0%, P=0.0132) and at 5.00-5.49log copies/ml (0% vs. 81.8%, P=0.0270), respectively. The pretreatment HCV RNA decrease was determined as independent predictors of SR by multivariable logistic regression analysis (P0.0001). For serial assays of HCV RNA during treatment, there was not significant difference in mean HCV RNA level at baseline but was significantly different on day 14 between the Decrease and the Nondecrease groups (1.15 vs. 2.21log copies/ml, P=0.0417). These results suggest that DeltaHCV is independently associated with the IFN response and is useful for determining the indication of IFN treatment.

We evaluated the immunoreactivity to monoclonal antibody for hepatocyte (Hep Par 1) and determined the cellular distribution of the antigen in hepatocellular carcinoma (HCC), based on the histopathological grade and histological pattern. The pathological material included 100 areas selected at random in 61 tissue sections from 12 autopsy livers with HCC. Immunoreactivity was classified into four categories; strongly positive (90% of the area showed positive staining), moderately positive (5-90% of the area), weakly positive (5% of the area), and negative (completely negative). All 19 (100%) well-differentiated, trabecular type HCC areas were strongly positive for Hep Par 1. Among 11 well-differentiated, pseudoglandular type HCC areas, 2 (18%) were strongly positive, 5 (46%) were moderately positive, 2 (18%) were weakly positive, and 2 (18%) were negative. Among 36 moderately differentiated, trabecular type HCC areas, 6 (17%) were strongly positive, 17 (47%) were moderately positive, 9 (25%) were weakly positive, and 4 (11%) were negative. None of the four moderately differentiated, pseudoglandular type HCC areas were strongly positive, 3 (75%) were moderately positive, 0 was weakly positive, and 1 (25%) was negative. Among 25 poorly differentiated, compact or trabecular type HCC areas, 15 (60%) were weakly positive and 10 (40%) were negative. All 5 (100%) undifferentiated HCC areas were negative for Hep Par 1. Our results indicate that immunoreactivity to Hep Par 1 in HCC decreases with reduced differentiation of the tumor, suggesting that Hep Par 1 monoclonal antibody is useful as a marker for the diagnosis and differentiation of HCCs.

原発性胆汁性肝硬変(PBC) 23例の臨床像を,症候性例(s-PBC) 15例,無症候性例(a-PBC) 8例に分け比較検討した.年齢,観察期間,組織像には差が認められなかった.生化学的検討では,s-PBCはa-PBCに比し,GOT, γ-GTPが有意に高値であった(p

4人家族(父,母,兄,発端者)のうち, HB抗原陽性,慢性肝炎の発端者,および無症候性HB抗原キャリヤーの兄,および慢性肝障害を持つ母の3人にインドサイアニングリーン(以下ICGと略す)試験高度停滞を示す家族内集積を経験した.このうち,ブロ一ムスルホンフタレーン(以下BSPと略す)試験をなしえた兄と母にBSP (R45)軽度停滞が認められたが, ICGとの間に著明な解離がみられた.また, ICG血漿消失曲線を検討すると, 15分までは直線状に下降し, 20分において変曲点を持ち,一時平坦となり, 25分以後再び直線的に下降する特有な曲線をこれら3症例のいずれにも認められた.また, ICGと血清蛋白との結合様式をSephadex G-200によるゲル濾過法を用いて検討すると,本症例は,基本的に正常対照例と同じ結合パターンおよび結合比を示し,有意の差を認められなかつた.発端者の病態時の組織学的検索で,光顕では慢性肝炎活動型の像を呈し,電顕では慢性肝炎時に見られる変化以外に本症例に特異的所見は得られなかつた. ICG試験高度停滞の病態生理学的意義は現在の所不明であるが,われわれの以上の検討から, ICG試験高度停滞はICGと血清蛋白の結合異常によつて招来されるのではなく,肝細胞膜か,あるいは肝細胞内蛋白,もしくは何らかの転送機転における異常によるものと推定され,この質的異常は,肝障害による変化とは別に遺伝的背景を持つた異常であると考察される.

A 63-year-old female case of cancer of the colon who developed posttransfusion hepatitis A was presented. She became ill 49 days after receiving a single unit of concentrated red cells from a donor who also developed hepatitis A 10 days after donation.

Sjogren症候群(SjS)を合併した原発性胆汁性肝硬変症(PBC)において,肝,唾液腺とともに,膵を生検材料にて検索した.症例は55歳女性,黄疸と掻痒感を主訴とし,トランスアミナーゼの軽度上昇と,Al-P,γ-GTP, IgMの著明高値を認めた.抗ミトコンドリア抗体陽性であり,肝は,ckronic non-suppurative destructive cholangitisの組織像であった.乾燥症状を有し,唾液腺は,典型的SjSの像を呈した.経過中,膵型アイソザイム優位のアミラーゼ高値持続をみたため,外科的肝生検と同時に膵生検を行なった.膵には,び漫性に,小円形細胞の浸潤巣が認められ,同部の腺房細胞の退行性変化は著明であった.これらの像は,いずれも非特異的な変化とも考えられたが,同胞女性に無症候性PBCや高アミラーゼ血症が認められたことから,膵障害がPBCやSjSと病因の共通性を有する可能性も否定はできなかった.本例はPBCの膵を生検材料にて検索し得た初めての報告である.