Problems, goals and solutions reported by cancer patients participating in group problem-solving therapy.

BACKGROUND: The purpose of the present study was to categorize and develop lists of contents of problems, goals, solution plans generated through the brainstorming work in therapy, and selected solutions for execution, that treated in problem-solving therapy (PST) for cancer patients in clinical settings, and to describe their characteristics. Additionally, examining the associations of problem domains with characteristics of participants, was also aimed. METHODS: We conducted content analysis using records of thirty-one cancer patients (M = 62.6 years old; SD = 10.5) who participated in PST program. RESULTS: Problems were categorized into four domains (e.g. psychological and existential problems; physical problems; social relations; social living environment). Participants under treatment at baseline reported psychological and existential problems most often (P < 0.05). Goals were categorized into four domains (e.g. improving mental health; improving physical functions; improving social relations and improving one's social living environment). Solution plans generated through the brainstorming work in therapy were categorized into four domains (e.g. emotion regulation/cognitive adjustment; health behaviors; adjustment of social relationships and adjusting one's social living environment). Selected solutions for execution were categorized into four domains (e.g. emotion regulation/cognitive adjustment; health behaviors; adjustment of social relationships and adjusting one's social living environment). CONCLUSIONS: We found that various problems, goals and solutions were treated in PST of realistic clinical setting. Creating lists based on our study and making use of it for the materials as aids while implementing the PST or being shared with patients and medical staff would be expected.

Successful treatment of pulmonary aspiration due to brain stem infarction by using cough exercise based on swallowing scintigraphy: preliminary observations.

Although dysphagia in stroke may result in lethal chest infection, it can be prevented by coughing. We report on a patient with dysphagia and aspiration who regained oral ingestion by swallowing with voluntary cough. A 54-year-old man with subarachnoidal hemorrhage underwent endovascular coiling and developed brain stem infarction. Scintigraphy showed pulmonary aspiration just after swallowing, but no radioactivity was detected in the lungs 10 min after swallowing with voluntary cough. Swallowing exercise with voluntary cough resulted in a safe swallow without enteral feeding. Even if laryngeal penetration and pulmonary aspiration are observed, chest infection could be prevented by swallowing exercise combined with voluntary cough.

[Different types of aphasia caused by cerebral hemorrhage in the left frontal lobe: Broca's aphasia and Broca area's aphasia].

We reported two cases of aphasia that exhibited different characteristics of aphasia following cerebral hemorrhage in the left frontal lobe involving the Broca's area. Case 1 is a 74-year-old right-handed woman. She was hospitalized with speech disturbance. Spontanoues speech was fluent and articulation was normal, but she showed verbal paraphasia and speech perseveration. She demonstrated a preserved ability to repeat short sentences and was able to read words aloud. This type of aphasia is called "Broca area's aphasia". MRI and CT showed hematoma involving the left inferior frontal lobe, operculum and insula cortex. Single-photon emission computed tomography (SPECT) showed low perfusion in the frontal lobe without involvement of the postcentral gyrus. Case 2 is a 76-year-old right-handed man. He was also hospitalized with speech disturbance. Spontanoues speech was non-fluent and articulation was poor. He sometimes showed phonemic paraphasia with anarthria, but he demonstrated a preserved ability to repeat short sentences. He was able to read words aloud in a manner comparatively similar to. This type of aphasia is called "Broca's aphasia". MRI and CT showed hematoma involving the left inferior frontal lobe, operculum and precentral cortex. SPECT revealed low perfusion in the frontal lobe extending to the postcentral gyrus. We supposed that the different characteristics of aphasia in those cases were due to extended lesion in the frontal lobe.

Different antibody responses against hepatitis B surface antigen among mouse strains transfected with mutant viral DNA.

BACKGROUND: Rapid seroconversion from hepatitis B surface antigen (HBsAg) to anti-HBs antibody is seen in most patients with fulminant hepatitis B. It is unclear whether viral mutation or host immune background is responsible for such enhanced host reaction to hepatitis B virus (HBV). To investigate interaction between virus mutation and host immune background, we established a mouse model of hepatitis B using liposome-mediated gene transfer. METHODS: A mixture of liposomes and full-length viral DNA derived from hepatitis B patients was injected into three strains of purebred mice intrahepatically. After injection, HBsAg and antibody in liver and serum were serially measured. RESULTS: Three days after transfection, viral transcript and antigen were detected in the liver and serum. Ten days after transfection with wild-type DNA, hepatitis B surface antibody was detectable in two of the three strains. Mice that did not produce antibody after transfection with wild-type DNA produced a high amount of serum antibody against surface antigen when transfected with fulminant hepatitis-associated DNA. CONCLUSIONS: The present results are consistent with previous clinical observations of rapid HBsAg seroconversion in patients with fulminant hepatitis B. Further studies are needed to determine which mutations are responsible for differences in immunogenicity between HBV strains.

Prevalence of herpesviridae and hepatitis virus sequences in the livers of patients with fulminant hepatitis of unknown etiology in Japan.

BACKGROUND: Fulminant non-A, non-B, non-C hepatitis has a high mortality rate, making the identification of its causative agent imperative. Cytomegalovirus, Epstein-Barr virus, human herpesvirus-6, and herpes simplex virus are all members of the herpesviridae family that are associated with fatal hepatic failure. We investigated the involvement of herpesviridae and hepatitis virus in the pathogenesis of fulminant hepatitis. METHODS: The study participants consisted of 11 patients with fulminant hepatitis and 11 with acute hepatitis negative for known hepatitis viral markers and any other liver diseases. Viral DNA was extracted from liver tissues and amplified. In situ hybridization was then performed for 1 patient to detect viral DNA and RNA, and viral protein was localized by monoclonal antibodies. RESULTS: Human herpesvirus-6 was detected in liver tissues from seven patients, (five children and two adults) with fulminant hepatitis and two patients with acute hepatitis. Two patients with fulminant hepatitis also had cytomegalovirus in the liver. Although Epstein-Barr virus and herpes simplex virus were detected in the patients with fulminant hepatitis, they were not specific to these patients. In situ hybridization in one of the patients localized DNA and RNA of human herpesvirus-6 in hepatocyte nuclei, and an envelope antigen of this virus was detected in hepatocyte cytoplasm. CONCLUSIONS: Human herpesvirus-6 was frequently detected in Japanese pediatric patients with fulminant non-A, non-B, non-C hepatitis. Although the significance of human herpesvirus-6 in liver pathogenesis remains unclear, this virus may replicate in hepatocytes in some patients with acute onset hepatitis.

Molecular analysis of antigenicity and immunogenicity of a vaccine-induced escape mutant of hepatitis B virus.

BACKGROUND: To analyze the mechanisms of mutant escape, we established a murine model of hepatitis B virus (HBV) infection and studied the interaction of the envelope protein of the virion with various kinds of anti-hepatitis B antibody. METHODS: Mutation from glycine to arginine at aa145 was introduced into replication-competent DNA of HBV. The resulting mutant HBV DNA was transfected into cultured hepatoma cells and livers of mice using liposome-mediated gene transfer. Then, interactions between the antigenic envelope protein (in culture or in circulation) and anti-hepatitis B antibody were examined. RESULTS: Mutant envelope protein escaped human hepatitis B immunoglobulin, rabbit polyclonal anti-hepatitis B surface antigen (HBsAg) antibody, and monoclonal anti-a antibody in vitro and in vivo. There was a difference in the degree of inhibition between hepatitis B immunoglobulin and the other two antibody types in vitro. Transfection with an HBV construct containing a mutation in the a-loop resulted in levels of HBsAg in circulation and seroconversion to anti-HBs antibody that were similar to those produced by a wild-type construct. CONCLUSIONS: The degree of escape by the mutant envelope protein differed according to antibody type. Of the three types of antibody used in this study, HBV immunoglobulin was least affected by mutation in the a-loop. There appears to be no correlation between antigenicity and immunogenicity of the escape mutant, and the a-loop mutant may cause hepatitis with the usual serum viral markers.

Small-bowel hemorrhage caused by cytomegalovirus vasculitis following fulminant hepatitis.

We describe life-threatening vasculitis of the small bowel following fulminant hepatitis. A 35-year-old man was admitted to our hospital due to consciousness disturbance and jaundice. He was diagnosed with fulminant hepatitis, and recovered after intensive medical care that included corticosteroid administration and artificial liver support. During reduction of the dosage of steroid, massive gastrointestinal hemorrhage occurred from the upper jejunum, revealed by arteriography. The hemorrhage could not be stopped, so a portion of the ileum, including the bleeding point, was excised. However, the intestinal hemorrhage continued from several small ulcers remaining outside the resected area. Pathological findings revealed an ulcerative region that was diagnosed as cytomegalovirus (CMV) vasculitis. His serum level of CMV (measured by real-time-detection polymerase chain reaction [PCR]) was high. Ganciclovir therapy was started, and manifestations of the CMV infection improved. In addition to CMV, PCR assay for hepatitis A virus (HAV), HBV, HCV, Epstein-Barr virus (EBV), human herpes virus-6 (HHV-6), and herpes simplex virus (HSV) was performed, but no viruses other than CMV were detected. We are the first to report such a case. We conclude that the possibility of CMV enteritis should be considered when patients present with unexplained fever and gastrointestinal hemorrhage following fulminant hepatitis, and we conclude that the early administration of ganciclovir should be considered.

Lamivudine treatment for acute exacerbation of hepatitis B in patients undergoing immunosuppressive therapy.

Lamivudine was administrated to six patients with acute exacerbation of hepatitis B who were undergoing immunosuppressive therapy. All patients had chronic hepatitis B and were receiving immunosuppressive therapy for other primary diseases (hematologic malignancies, collagen diseases, renal transplantation) when the hepatitis flared up. Only one patient tested positive for the hepatitis B virus e (HBe) antigen. All patients had normal ALT levels and were anti-HBe-positive before immunosuppressive therapy. The patients were treated with 150 mg of lamivudine daily. Lamivudine was well tolerated and showed no effect on the primary disease. In all patients, hepatitis B virus (HBV) DNA levels decreased in response to lamivudine administration. Four patients recovered from exacerbation, but two patients died from complications. Molecular analysis revealed that, regardless of whether patients had the wild HBV genotype or mutations within the core promoter or precore HBV regions, the effectiveness of lamivudine therapy was the same. These results demonstrated that lamivudine is very effective for treating acute exacerbation of chronic hepatitis B that occurs while a patient is undergoing immunosuppressive therapy, regardless of the phenotype of the virus.

Genotypic analysis of hepatitis B virus from patients with fulminant hepatitis: comparison with acute self-limited hepatitis.

AIM/BACKGROUND: There is an increasing evidence that certain hepatitis B virus (HBV) strains may contribute to the pathogenesis of fulminant hepatitis B (FHB). Recently, we reported that genotypes of HBV influence the clinical course of acute self-limited hepatitis B (AHB). In this study, we compared clinical features of FHB between different HBV genotypes and compared the prevalence of each genotype between FHB and AHB patients. METHODS: The subjects consisted of seven patients with FHB and 25 patients with AHB. The core promoter and precore region were directly sequenced following polymerase chain reaction, and genotype was determined by restriction fragment length polymorphism analysis of the S gene. RESULTS: Of the seven FHB patients, one had genotype A, one had genotype B, four had genotype C, and one had genotype D. Six of the seven FHB patients were infected by heterosexual contact; one FHB patient who was not infected by heterosexual contact had genotype C. All four FHB patients with genotype C had a short duration clinical course. In one patient with genotype A, the time from onset of hepatitis to hepatic coma was 30 days. These results are similar to those of the patients with AHB, in which clinical course was longer in patients with genotype A than in patients with genotype C. CONCLUSION: Viral genotype can be used to predict the clinical course of both FHB and AHB.

Repeated jaundice due to YMDD mutant in a patient with prolonged lamivudine therapy for chronic hepatitis B under prednisolone treatment for Still's disease.

A 50-year-old woman patient began receiving lamivudine because of acute exacerbation of chronic hepatitis B. She also suffered from adult-onset Still's disease and had received prednisolone for 5 years. Lamivudine was effective for treatment of the first flare. Fifteen months after lamivudine treatment was started, a breakthrough due to lamivudine-resistant strain M5521 occurred. Between 10 and 12 months after the breakthrough, flare with jaundice occurred 3 times. We decided interferon would not be suitable, because it could induce activation of Still's disease. Prolonged lamivudine therapy is only recommended in cases of hepatitis B in which there is no alternative treatment.

[Case of conduction aphasia due to right hemispheric lesion].

We report the case of conduction aphasia due to injury of the right hemisphere of the brain. The patient was a right-handed male in his fifties with moyamoya disease. T2-weighted MRI showed an extensive high intensity area in the right temporal-parietal-occipital lobes. In the case of language-related symptoms, comprehension was preserved, but phonemic paraphasias were frequent, and kana paragraphias were also observed. Despite the extensive injury of the right hemisphere, these language-related symptoms were consistent with the clinical features of conduction aphasia. Therefore, this patient was diagnosed with atypical crossed aphasia. Improvement in the phonemic paraphasia differed between words and nonsense words, suggesting that the improvement was dependent on the level of meaning of the words.