Ganciclovir is effective for prophylaxis and treatment of human herpesvirus-6 in allogeneic stem cell transplantation.

Human herpesvirus 6 (HHV-6) infection and disease are serious complications of allogeneic hematopoietic stem cell transplantation (allo-SCT). Ganciclovir (GCV) is effective against HHV-6 in vitro but the antiviral susceptibility of HHV-6 has not been well characterized in vivo. We retrospectively compared the HHV-6 reactivation rate in pediatric allo-SCT recipients with and without GCV prophylaxis. The HHV-6 reactivation rate at 3 weeks after allo-SCT in patients without prophylactic GCV administration was significantly higher than that in those receiving prophylactic GCV (11/28 vs 0/13, P < 0.01). Five of 36 patients without prophylactic GCV showed clinical manifestations including skin rash, interstitial pneumonitis, persistent thrombocytopenia, enterocolitis and thrombotic microangiopathy, respectively. HHV-6-associated symptoms were observed in one of the 13 patients receiving prophylactic GCV. This patient showed fever, diarrhea and graft rejection concomitantly with a sudden increase of HHV-6 DNA copy number. Patients who received GCV for treatment of HHV-6 infection showed an improvement in symptoms and/or decrease of HHV-6 copy number. Thus, GCV is effective for treating HHV-6 disease after allo-SCT in vivo.

Hepatocellular carcinoma: comparative study among precontrast, artery-dominant, and delayed-contrast phase images at ultrafast CT.

To evaluate the detectability of hepatocellular carcinoma (HCC) at artery-dominant phase and to compare it with that at precontrast and delayed-contrast phases, 34 patients with 109 HCCs were examined by ultrafast computed tomography (CT) using an incremental dynamic technique under single breath-holding. Images of three phases (precontrast, artery-dominant, and delayed) were compared with iodized-oil CT images. None of the lesions were detected only at precontrast phase. HCC detectability at the artery-dominant phase (87/109, 80%) was significantly superior to that at precontrast phase (32/109, 29%) (p < .01) and delayed-contrast phase (57/109, 52%) (p < .01). All 31 lesions missed at delayed-contrast phase were depicted at artery-dominant phase, while one lesion observed at delayed-contrast phase was missed at artery-dominant phase. Incremental dynamic CT at artery-dominant phase was suitable for the diagnosis of HCCs. Precontrast phase images were not necessary, although delayed-phase images were useful for the evaluation of tumor extension in some cases.

[Technetium-99m-pyrophosphate myocardial scintigraphy in polymyositis--a case report].

A patient with polymyositis who had cardiac involvement underwent myocardial scan with technetium-99m-pyrophosphate. We used Activity Index for evaluating myocardial uptake of technetium-99m-pyrophosphate, which correlated with the degree of serum creatine phosphokinase elevation. Our findings indicate that these examinations may be helpful for identifying patients who have cardiac involvement and evaluating their response to the treatment with corticosteroids or immunosuppressants.

[Experience in treating esophageal carcinoma with multiple fractions per day (MFD)].

We have experienced treating 29 patients of esophageal carcinoma with multiple fractions per day (MFD) examined the effectiveness of this method. A dose of 2.0 Gy was delivered to the conventional field and 1.1, 1.15, or 1.2 Gy to the gross disease at 4- to 6- hour interval for 20 days, 4 days per week. The total tumor doses were 62, 63 or 64 Gy/40 f/5 w. The following results were obtained: 1) CR rates were 44.8% on barium examination and 55.2% by endoscopic evaluation; 2) the two-year actuarial, loco-control, and disease-free survival were 49.7%, 75.5%, and 52.3%, respectively; and, 3) the acute complications were tolerable, though esophageal stricture was found to have increased in patients treated with 64 Gy.

[Serial CT during arterial portography and arteriography of the liver with a triple-lumen balloon catheter].

Serial computed tomography during arterial portography (CTP) and CT during arteriography (CTA) of the liver could be performed on nine of ten patients with hepatocellular carcinoma, using triple-lumen balloon catheters (3-B-C). The 3-B-C was inserted into the common hepatic artery, and the balloon was inflated. We have injected contrast medium into the splenic artery through the side hole of the 3-B-C to perform CTP, and then into the common hepatic artery through the tip hole to perform CTA.

Human herpesvirus 8-encoded interleukin-6 homologue (viral IL-6) induces endogenous human IL-6 secretion.

We found that human herpesvirus 8-encoded IL-6 (vIL-6) induced endogenous human IL-6 (huIL-6) secretion from various cell lines (MT-4, THP-1, U937, Raji, and CESS) including patients with multicentric Castleman's disease. Especially, in MT-4 cells, huIL-6 was enhanced with vIL-6 by 30-fold compared with that of control. In addition, reverse transcriptase-polymerase chain reaction confirmed that vIL-6 induced huIL-6 expression in MT-4 cells. Our novel finding of the huIL-6 induction by vIL-6 indicates that vIL-6 may play a significant role in the pathogenesis of HHV-8 associated diseases.

Sequential measurement of human herpesvirus 6 DNA with polymerase chain reaction method in pediatric living-related liver transplantation.

BACKGROUND: Human herpesvirus 6 (HHV-6), a causative virus of exanthem subitum, may occasionally present with a severe clinical form in immunosuppressed patients after transplantation. In this study, HHV-6 DNA was sequentially measured with a polymerase chain reaction (PCR) method, a quick and sensitive modality in pediatric living-related liver transplantation (LTx). METHODS: Subjects consisted of 5 post-operative biliary atresia patients undergoing living-related LTx at ages from 8 months to 4 yr. Immunosuppression was performed with Tacrolimus (blood trough level 8-18 within 1 month and 5-10 ng/mL thereafter) and low-dose steroid. Specimens were peripheral blood mononuclear cells (PBMC), plasma, and liver biopsy tissue. The amount of HHV-6 DNA was semiquantified as follows: 1+, 1-10; 2+, 10-100; 3+, 100-1000; 4+, over 1000 copies/105 PBMCs. RESULTS: A total of 69 blood samples and three liver biopsies were provided for the examination. HHV-6 DNA in PBMC was positive in 2 donors and 3 recipients before LTx. Two patients with negative DNA were converted to 3+ at 2-3 wk after LTx and 3 with positive DNA remained 2+ to 3+ throughout the post-LTx period. Only 1 patient developed clinical symptoms, such as fever, liver dysfunction, petechiae, idiopathic thrombocytopenic purpura, and finally bone marrow suppression. HHV-6 DNA in the liver biopsy tissue and plasma in this patient were 4+ and 2+, respectively. CONCLUSION: HHV-6 DNA in PBMC measured by the PCR method may be persistently high in pediatric recipients after living-related LTx. Although HHV-6 DNA in PBMC may be positive in case of evident infection, positivity in PBMC may not be always associated with the clinical symptoms.