The combined therapy is feasible and may be useful to reverse PVTT in patients with good hepatic function reserve.
Background-Although polypoid lesions ofthe gall bladder are frequently observed in asymptomatic subjects, the natural history of these lesions has never been studied using ultrasonography. Aim-The natural history of polypoid lesions ofthe gall bladder was investigated using ultrasonography. Subjects-Among 4343 patients who presented to the outpatient clinic of Tsuchiura Kyodo General Hospital in 1988, 111 subjects were diagnosed as having polypoid lesions of the gall bladder by ultrasonography. Among these patients, two had gall bladder carcinoma. The remaining 109 subjects (58 female; age: median 54, range 25-89) were enrolled in this study. Methods-The subjects were followed up by ultrasonography once or twice a year until 1994. Results-Four patients received cholecystectomy and two patients died of other causes during the observation period. In one patient, gall bladder carcinoma was found, but its location was different from that of the pre-existing polyp. The size of the lesions did not change in 88.3% of the other 130 patients during this period, even among those in whom the initial size ofthe lesion exceeded 10 mm. There was no apparent correlation between the change in the diameter ofthe polypoid lesions and patients' sex or age. Conclusion-Most polypoid lesions of the gall bladder detected by ultrasonography are benign. (Gut 1996; 39: 860-862) Keywords: gall bladder carcinoma, gall bladder polyp, prognosis, ultrasonography.Ultrasonography has been widely used in clinical medicine, and its usefulness has been reported in the diagnosis of calculous gall bladder disease.' Mass surveys for abdominal disease have recently been performed using ultrasonography, and polypoid lesions of the gall bladder have been one of the most common findings.There are several studies that describe the prevalence of gall bladder polyps.2A6 One epidemiological study in Japan shows that the prevalence of gall bladder polyps was 6.28% in men and 3.5% in women,2 and another showed 5.3%/o in men.3 In Denmark, the prevalence was 4.6% and 4.3% in men and women, respectively,4 and 5.9% and 5.8% in men and women, respectively, in a 70 year old population.5 The prevalence was as low as 1.3% in the United Kingdom.6 However, the only report on the prognosis ofpolypoid lesions of the gall bladder is an old study using cholecystography. Therefore, the natural history of patients with polypoid lesions of the gall bladder was studied in this study. MethodsUltrasonographic examinations were carried out on 4343 patients in the outpatient clinic of the Department of Internal Medicine, Tsuchiura Kyodo Hospital from 1 January to 31 December 1988. Among these patients, 1 1 1 were diagnosed as having polypoid lesions of the gall bladder. Two of them had gall bladder carcinoma. The remaining 109 subjects (58 females; age: median 54, range 25-89) were enrolled in this study. After an overnight fast, ultrasonographic examination was performed by a radiology licensed :echnician using an Aloka Echo Camera SSD-650CL equipped with a 3.5 MHz tran...
The activity of hepatitis varies in chronic hepatitis C virus (HCV) infection. Some patients show persistently normal serum alanine aminotransferase (ALT) values, whereas the others show high-ALT values and progress to liver cirrhosis or hepatocellular carcinoma. However, virological mechanisms causing hepatitis have not fully been elucidated. We analyzed serial changes in full-length HCV sequences in 10 patients with various profiles of hepatitis activity. In the nonstructural 5A (NS5A) and NS5B, the rate of amino acid changes, as well as the proportion of nonsilent ones, was low in patients with normal ALT values compared with those with abnormal ALT (for the rate of amino acid changes, 0 x 10(-3) vs 3.19 x 10(-3) changes/site/year (P = 0.037) in NS5A and 0 x 10(-3) vs 1.22 x 10(-3) changes/site/year (P = 0.023) for NS5B, for the proportion of nonsilent changes, 4 vs 22% (P = 0.017) in NS5A and 0 vs 16% (P = 0. 039) in NS5B). Also, the flare-up of hepatitis coincided with higher nucleotide/amino acid substitution rates in NS5B. In conclusion, the genomic structures of the NS5A and NS5B regions may correlate with hepatitis activity in chronic hepatitis C.
The extreme 5'-proximal sequences of the hepatitis C virus (HCV) genome including the 5'untranslated region (5'UTR) and the first 30 nucleotides of the core region are highly conserved, and serve as an internal ribosome entry site (IRES) that initiates the cap-independent translation of HCV polyprotein. Mutations in the IRES sequence have been shown to cause changes in the efficiency of protein translation in vitro. However, the significance of genetic variations in the IRES is not fully known in clinical settings. Pretreatment sera of 25 patients with HCV-1b infection who were treated with interferon were amplified by polymerase chain reaction (PCR), and the IRES sequence was directly sequenced. Correlation of interferon responses or other clinical features with IRES sequence variability was studied. Eleven of 25 patients were sustained responders (SR) of interferon treatment (negative serum HCV RNA and normal alanine transaminase levels for 6 months after the end of interferon treatment), and the other 14 patients were nonresponders ([NR], defined as any patient with positive serum HCV RNA within 6 months after the end of interferon therapy). In each patient, one to four nucleotide substitutions were found compared with the consensus sequence of HCV-1b genotype. There were no differences in the number of nucleotide substitutions between either SR and NR (mean, 1.8 in SR, 2.1 in NR; P = .30), and no specific variations associated with SR or NR were observed. Although NR had significantly higher serum levels of pretreatment HCV RNA than SR (median, 16 vs. <0.5 Meq/mL; P = .02), there was no correlation between the HCV-RNA level and the number of nucleotide substitutions in the IRES (mean, 1.9 nucleotide substitutions in 12 patients with HCV RNA <0.5 Meq/ mL vs. 2.1 nucleotide substitutions in 13 patients with HCV RNA >0.5 Meq/mL; P = .61). Sequence variability of the IRES has no influence on interferon efficacy or serum HCV-RNA concentrations in patients with chronic HCV-1b infection.
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