A Surgical Technique for Anterior Cruciate Ligament Reconstruction Using Semitendinosus Graft: An All-Inside Transfemoral Approach.

Given the paucity of reports on all-inside reconstruction procedures via the transfemoral approach, we describe a minimally invasive, all-inside transfemoral technique that enables creating femoral and tibial sockets from the intra-articular cavity. Our transfemoral approach makes it possible to sequentially create femoral and tibial sockets using the same reamer bit, while a single drilling guide is set in place. Our custom socket drilling guide was designed to integrate with a tibial tunnel guide, which helped locate the tunnel exit at an anatomically acceptable location. The advantages of this method include easy and precise positioning of the femoral tunnel, narrow tibial tunnel, minimal damage to the intramedullary trabecular bone integrity, and low postoperative risks of pain, bleeding, and infections.

Excellent short-term results of dome-shaped high tibial osteotomy combined with all-inside anterior cruciate ligament reconstruction.

PURPOSE: This study aimed to evaluate short-term outcomes at least 2 years after dome-shaped high tibial osteotomy (HTO) combined with all-inside anterior cruciate ligament reconstruction (ACL) in patients with persistent ACL insufficiency accompanied by pain due to varus deformity. METHODS: The study enrolled 19 knees of 18 patients. The mean age was 58.4 ± 13.4 years and the mean postoperative follow-up period was 31.4 ± 6.6 months (24-49 months). JOA(Japanese Orthopaedic Association)-OA(osteoarthritis) score, Lysholm score, radiographic outcomes such as femoro-tibia angle (FTA) in a standing position, side-to-side difference in KT-1000 measurements were evaluated at pre op. and post operative final follow up. And arthroscopic evaluation was evaluated at the time of the HTO plate-removal procedure. RESULTS: Before surgery, the mean JOA-OA score was 65.0 ± 13.5, the mean Lysholm score was 47.2 ± 16.2, the mean femoro-tibia angle (FTA) in a standing position was 183.8 ± 3.4° (range;180-190°), and the mean side-to-side difference in KT-1000 measurements was 4.1 ± 1.3 mm. After surgery, the mean JOA-OA score, Lysholm score, and side-to-side difference in KT-1000 measurements improved to 93.1 ± 6.0 (P < 0.00001), 94.2 ± 5.9 (P < 0.00001), and -0.2 ± 0.8 mm (P < 0.00001), respectively. The mean FTA decreased to 168.0 ± 3.3 (P < 0.00001), and the mean posterior tibial slope angle decreased to 5.0 ± 3.6° from 6.9 ± 2.6° preoperatively (P = 0.024). Arthroscopic evaluation during the HTO plate-removal procedure of 17 knees were performed at a mean of 16 months after the surgery. The reconstructed ACL graft in 13 knees were successful, a cyclops lesion in one knee, and looseness of the graft in three knees. CONCLUSIONS: Dome-shaped HTO allows for a relatively high degree of varus correction and decreases the steep posterior tibial slope that causes excessive load on the ACL. Therefore, its use in combination with ACL reconstruction seems to be effective.

Novel approach for chirp and output power compensation applied to a 40-Gbit/s EADFB laser integrated with a short SOA.

We propose a novel approach for simultaneously controlling the chirp and increasing the output power of an EADFB laser by monolithically integrating a short-cavity SOA. We achieved a 40-Gbit/s 5-km SMF transmission at a wavelength of 1.55 µm by using an EADFB SOA with a lower power consumption than a stand-alone EADFB laser.

Methicillin-resistant Staphylococcus aureus keratitis in a dog.

The purpose of this study is to report a case of methicillin-resistant Staphylococcus aureus (MRSA) keratitis in a dog. A 7-year-old intact male American cocker spaniel that had undergone removal of a nictitating gland was referred for severe ulcerative keratitis. Slit-lamp examination showed swelling of the eyelid, mucopurulent discharge, conjunctival injection and chemosis, diffuse corneal edema and opacity, and a deep ulcer in central cornea. Gram staining of discharge from the eye demonstrated Gram-positive cocci. Despite topical ofloxacin, oxytetracycline and polymyxin B ophthalmic solution and intravenous cefazolin, there was no improvement. Cultures revealed MRSA that was sensitive only to chloramphenicol, vancomycin, lincomycin, and clindamycin. The antibiotic regimen was changed to topical and systemic chloramphenicol. After 9 days of treatment, although inflammation started to be resolved, the dog developed nonregenerative anemia. The antimicrobial regimen was changed again to topical and systemic vancomycin. Inflammation continued to improve over the next week. MRSA should be considered a potential organism in infectious keratitis, especially when general antibiotics are not effective. Although topical and systemic chloramphenicol and/or vancomycin are effective for treating MRSA keratitis, vancomycin should only be used when culture and susceptibility results indicate it is appropriate and no other options are available. To our knowledge, this is the first detailed case report of MRSA keratitis in a dog.

Prevalence and risk factors for cerebral infarction and carotid artery stenosis in peripheral arterial disease.

OBJECTIVE: The purpose of the study was to examine the prevalence and risk factors for cerebral infarction (CI) and carotid artery stenosis (CAS) in patients with peripheral arterial disease (PAD) compared with normal controls. METHOD: A cross-sectional analysis was performed in 857 subjects (PAD: 543, controls: 314). CI and lacunar infarction (LI) were evaluated using brain computed tomography. Intima-media thickening (IMT) and CAS were measured with ultrasound. RESULTS: The prevalences of CI and LI were higher in patients with PAD than in controls (15.0% vs. 9.8%, 41.0% vs. 13.4%, respectively, p < 0.05). In multiple logistic analysis, CI was associated with diabetes mellitus, low HDL cholesterol and CAS ≥ 70% (p < 0.05). LI was associated with age, PAD, diabetes mellitus, and estimated glomerular filtration rate (p < 0.05). The prevalences of CAS ≥ 70% and CAS ≥ 50% were higher in patients with PAD than in controls (5.2% vs. 0.6%, 17.6% vs. 3.8%, respectively, p < 0.01). Mean and max IMT differed significantly between the two groups (PAD vs. controls: 1.01 ± 0.45 vs. 0.90 ± 0.28, 2.67 ± 2.00 vs. 1.73 ± 1.05 mm, respectively, p < 0.001). CAS ≥ 70% correlated with high LDL cholesterol, and CAS ≥ 50% with age and PAD. IMT was positively correlated with PAD, high LDL cholesterol, age, and hypertension (p < 0.05). CONCLUSIONS: Prevalences of CI and CAS were markedly higher in patients with PAD than in controls, indicating that PAD is a meaningful risk factor for CI, LI, and CAS. This suggests that screening for CI and CAS is important for managements in PAD, as with screening for PAD in patients with stroke.

Sex-related differences in Japanese patients with peripheral arterial disease.

OBJECTIVE: The goal of the study was to examine possible sex-related differences in the clinical characteristics and risk factors in Japanese patients with peripheral arterial disease (PAD). METHODS: Sex-related differences in clinical profiles, risk factors and treatments were examined in 730 consecutive patients with PAD (148 women (20.3%) and 582 men (79.7%)). RESULTS: The mean age of the women was higher than that of the men (73.6 ± 11.2 vs. 70.9 ± 9.1 years old, p = 0.002) and the proportion of subjects aged ≥ 75 years old was also higher in women (P=0.005). Women more frequently had critical limb ischemia (P < 0.001) and diabetes mellitus (P = 0.026), but less frequent smoking and alcohol intake, compared to men (P< 0.001). Total cholesterol (P < 0.001) and LDL cholesterol (P = 0.014) were higher in women. Fontaine stages were correlated with age, diabetes, cerebral infarction and women (p < 0.001). The prevalence of iliac artery lesions was higher in men (p< 0.001), whereas that for below the knee lesions was higher in women (p < 0.001). The number of affected below the knee arteries was also higher in women than in men (p < 0.001). The prevalence of medical treatment was higher in women (P = 0.009) and major amputation tended to be higher in women (p = 0.056). CONCLUSIONS: Women had more severe symptomatic states and uncontrolled risk factors. The prevalence of iliac artery lesions was lower, but below the knee lesions were more severe in women.

Typical atrial flutter with atypical flutter wave morphology due to abnormal interatrial conduction.

We report a case of typical counterclockwise atrial flutter (AFL) with conduction block from right to left atrium along the coronary sinus (CS) musculature, confirmed by discontinuous CS activation sequence during pacing near the ostium and differential right atrial pacing. AFL was associated with an atypical flutter wave morphology, due to the detour of the activation wavefront from right to left atrium via alternate interatrial electrical connections, such as Bachmann's bundle, the interatrial septum, or both.

Influence of four systems for dental bleaching on the bond strength of orthodontic brackets.

OBJECTIVE: To compare the influence of four systems for dental bleaching on the shear bond strength (SBS) of orthodontic brackets. MATERIALS AND METHODS: One-hundred and fifty freshly extracted bovine teeth were randomly divided into five groups. In group I the teeth were untreated (control). In the remaining groups the teeth were bleached, as follows: group II: 38% hydrogen peroxide; group III: 10% carbamide peroxide; group IV: resin-based coating material (RBCM), Beauty Coat; and group V: RBCM, White Coat. In all groups the enamel was conditioned with a self-etching primer and brackets were bonded with composite resin. Samples were stored (37°C, 24 hours), tested, and statistically analyzed, with significance predetermined at P ≤ .05. The adhesive remnant index (ARI) was also evaluated and analyzed. RESULTS: The SBS of group V (22.49 ± 5.34 MPa) was significantly higher than that of all other groups (I: 17.1 ± 5.11 MPa; II: 14.72 ± 5.42 MPa; III: 12.04 ± 5.29 MPa; and IV: 18.23 ± 5.58 MPa). In contrast, the SBS of group III was significantly lower than that of all groups (except group II). Significant differences in the ARI scores were present between groups. CONCLUSIONS: The use of RBCM for dental bleaching before bonding orthodontic brackets did not reduce the SBS. In contrast, hydrogen and carbamide peroxides negatively affected the SBS. The SBS yielded after bleaching with carbamide peroxide was significantly lower.

Detection of diastolic potentials around the mitral annulus of structurally normal human hearts.

To examine the electrophysiologic characteristics of the subvalvular mitral region, we retrospectively searched for the presence of subvalvular diastolic potentials (DP) in 91 patients (mean age, 46.9 ± 16.6 years) who underwent catheter ablation of left-sided accessory pathways (AP). We detected low-amplitude (0.19 ± 0.09 mV) DP in 14 patients (15.4%), including 8 with overt preexcitation and 6 patients with concealed AP. The mean interval between ventricular electrogram and DP was 383 ± 46 ms (range, 306-475). DP were detected in 4 of 20 patients with antero-lateral, 3 of 38 with lateral, 4 of 12 with postero-lateral, 2 of 14 with posterior, and 3 of 10 patients with postero-septal AP. In 6 of 14 patients, DP were detected before ablation. In 4 of 8 patients with overt preexcitation, DP were consistently recorded after elimination of the delta wave, suggesting that they were not associated with AP conduction. In 6 of 11 patients, DP were observed during both sinus rhythm and ventricular pacing, suggesting that they were not artifacts. The electrophysiologic characteristics of clinically relevant DP around the mitral annulus suggest that, in normal human hearts, an anatomical substrate may be present around the mitral annulus.

Increase in internal defibrillation threshold during acute myocardial infarction.

A 67-year-old man suffered an acute anteroseptal myocardial infarction complicated by multiple episodes of ventricular fibrillation, which were not systematically defibrillated by maximum, internal 35-J shocks delivered by an implanted cardioverter defibrillator (ICD). He had suffered from acute inferior myocardial infarction 6 years earlier, complicated with sustained polymorphic ventricular tachycardia (VT). Due to inducibility of sustained VT on an electrophysiologic study, an ICD was implanted. Defibrillation testing performed after healing of anteroseptal infarction was successful with a 10-J safety margin, suggesting that acute myocardial ischemia transiently elevated the internal defibrillation threshold.

Left-sided ICD implantation via right-sided venous access in a patient with left hemodialysis fistula.

A sufficient patency of the central vein ipsilateral to atriovenous fistula is the lifeline for hemodialysis patients. We describe a case with left dialysis fistula who underwent left-sided pectoral implantation of an implantable cardioverter defibrillator via right subclavicular venous access in order to avoid the possibility of development of left subclavian stenosis or occlusion and to achieve lower defibrillation thresholds. This approach may serve as an alternative choice in patients unsuitable for left-sided venous access and with higher defibrillation thresholds on right-positioned implantable cardioverter defibrillator.

Development of monoclonal antibodies for analyzing immune and hematopoietic systems of common marmoset.

OBJECTIVE: Common marmosets are considered experimental animals of primates useful for medical research. We developed several monoclonal antibodies (mAbs) directed to CD molecules to gain initial insight into the immune and hematopoietic systems of this organism, and analyzed the basic cellularity and characters of marmoset lymphocytes. MATERIALS AND METHODS: Anti-marmoset CD antigen mAbs were prepared using marmoset antigen-expressing transfectants and used for flow cytometric analyses and cell fractionation. Expression of T-cell-related cytokine gene transcripts was examined in response to T-cell receptor stimulation by reverse transcription polymerase chain reaction analyses. Hematopoietic progenitor activities of marmoset bone marrow cells were examined in fractionated cells by mAbs against CD117 (c-kit) and CD34. RESULTS: CD4 and CD8 expression profiles in T-cell subsets of marmoset were essentially similar to those in mouse and human. CD4(+) and CD8(+) subsets were isolated from marmoset spleens. Detected transcripts after stimulation of T cells included Th1-, Th2-, and Th17-related cytokines in CD4(+) cells and cytotoxic proteases in CD8(+) cells, respectively. Colony-forming abilities were detected mainly in CD117 (c-kit)(+) cells, irrespective of CD34 expression. CONCLUSIONS: Marmoset immune system was basically similar to human and mouse systems.

Cephalometric norms according to the Harvold´s analysis / Normas cefalométricas de acuerdo al análisis de Harvold

The purpose of this study was to establish cephalometric norms by age and gender of Harvold´s analysis for people living in the central region of Mexico and compare them with other populations to found morphologic craniofacial differences. One hundred sixteen males and 125 females were studied. The participants were divided into age groups. The parents and grandparents of the participants were born in Mexico. All participants had class I occlusion with normal growth, facial symmetry, no crowding and no previous orthodontic, orthopedic or maxillofacial surgery treatment. Lateral skull x-rays were obtained; each radiograph was analyzed on with a Harvold-like analysis. For statistical evaluation, the Student t´ test was used to compare the age groups between males and females. Significant gender differences were found in the following measurements: maxillary position, mandible position, and the anterior lower facial height in all age groups. Differences were found in the cranial and dental positions with other races respect to facial growth. Because every gender and race have their own characteristics, it is appropriate to use correct cephalometric norms in daily orthodontic practice. It is suggested to use the analysis of Harvold in a complementary way when in diagnosing a patient there is doubt on the alterations in the maxillae.

El propósito de este estudio fue establecer normas cefalométricas por edad y sexo de acuerdo al análisis de Harvold, para población de la región central de México y comparar estos patrones con otras poblaciones para encontrar diferencias en las características morfológicas craneofaciales. 116 hombres y 125 mujeres conformaron el estudio, divididos por grupos de edad. Los padres y abuelos de los participantes eran originarios de México. Todos los sujetos tenían clase I molar con un desarrollo normal, simetría facial, sin apiñamiento y sin previo tratamiento ortodóntico, ortopédico o cirugía maxilofacial. Se obtuvieron las radiografías laterales de cráneo; cada una se examinó de acuerdo al análisis cefalométrico de Harvold. Para el análisis estadístico, se aplicó la prueba t’ de Student para hacer la comparación entre grupos de edad y sexo. Se encontraron diferencias significativas entre hombres y mujeres en los siguientes parámetros: posición maxilar, posición mandibular y altura facial anteroinferior en todos los grupos de edad. Se demostraron diferencias en la posición dental y craneal con otras razas, respecto al crecimiento facial. Cada género y raza presenta sus características propias, por lo que es apropiado utilizar normas cefalométricas adecuadas en la práctica ortodóntica diaria. Se sugiere utilizar el análisis de Harvold como auxiliar o complemento cuando existe duda en el diagnóstico del paciente debido a alteraciones de los maxilares.

Dental arch morphology of Mazahua and mestizo teenagers from central Mexico

Aim: The aim of this study was to determine the morphologic characteristics of the dental arches in the ethnic group “Mazahua” and mestizo teenagers from central Mexico. Methods: A sample of 80 Mazahua and 80 mestizo teenagers with normal occlusion, divided into two age groups, were evaluated. A digital caliper was used to measure in cast models the intercanine width, intermolar width, length and perimeter of the arch, occlusal intermaxillary curve (of Spee), overjet, and overbite. A comparative analysis with Student’s t-test was applied between gender and population groups. Results: Comparison of the dental arches between Mazahua and mestizo teenagers revealed that statistically significant differences existed with respect to most of the measurements. In most cases, they were greater in males; the Mazahua teenagers had intercanine and intermolar widths greater than mestizo teenagers. Conclusions: Each group has a characteristic dental arch form. The ethnic group Mazahua has squared arches, whereas the mestizo teenagers have oval arches, which give them their particular facial characteristics. These findings indicate that population-specific standards are necessary for clinical assessments.

Discrimination between His-bundle and the right bundle branch during electrophysiologic studies.

BACKGROUND: The purpose of this study was to identify the His-bundle (HB) versus right bundle branch (RBB) during electrophysiologic studies, using the V3 phenomenon, and to compare the timing of HB versus RBB potentials of sinus cycles (His-ventricular [H-V] interval). METHODS: The study enrolled 16 patients without structural heart disease, who underwent electrophysiologic studies during which the H-V interval was within normal limits and the V3 phenomenon was induced during recordings of the HB and the RBB potentials by a multi-electrode catheter. The recording site of the earliest HB potential just before the V3 phenomenon was defined as the branching portion of His bundle (HBBP), the site immediately proximal to the HBBP as the HB, and the site immediately distal to the HBBP as the RBB. RESULTS: The HBBP was identified in all patients. In all cases but one patient, the H-V interval measured at the HB adjacent to the HBBP was > or =35 ms. However, in 12 patients, the H-V interval measured at the RBB adjacent to the HBBP was also > or =35 ms. CONCLUSIONS: The electrophysiologic identification of HB versus RBB by simultaneous recordings of HB and RBB potentials during induction of the V3 phenomenon was feasible. When the discrimination between HB and RBB was based on the measurement of the H-V interval, the proximal portion of the RBB was frequently misidentified as the HB.

Current status of chromosomal abnormalities in mouse embryonic stem cell lines used in Japan.

We performed chromosomal analysis on 540 mouse embryonic stem (ES) cell lines obtained during 2001 to 2004 from 20 institutions in Japan. Overall, 66.5% of the ES cell lines showed normal chromosomal numbers, but 15.9%, 9.1%, and 2.8% showed modal chromosomal numbers of 41, 42, and 39, respectively. When we karyotyped 88 ES cell lines selected arbitrarily from the 540 lines, 53 (60.2%) showed normal diploid karyotypes; the sex chromosome constitution of 52 lines was XY, with the remaining 1 being XX. Among 35 ES cell lines showing abnormal karyotypes, trisomy of chromosome 8 (41, XY, +8) was dominant (51.4%), 14.3% had trisomy 8 with loss of one sex chromosome (40, XO, +8), and 11.4% had trisomy 8 together with trisomy 11 (42, XY, +8, +11). Karyotypic abnormalities including trisomy 8 and trisomy 11 occurred in 88.6% and 17.1% of ES cell lines, respectively. The XO sex chromosome constitution was observed in 25.7% of all abnormal ES cell lines. Of the 88 selected ES cell lines, 60 lines were established from strain 129 animals, 17 from F1 progeny of C57BL/6J x CBA (called TT2 in this study), and 11 from C57BL/6J mice. Normal diploid karyotypes were observed in 58.3% of lines derived from 129, 58.8% of those from TT2, and 72.7% of C57BL/6J. The relatively high incidence of abnormalities in chromosomal number and karyotype in ES cell lines used in Japan suggests the importance of chromosomal analysis of ES cells for successful establishment of new animal models through germline transmission.

Coronary sinus recordings of double potentials associated with retrograde conduction through left atrioventricular accessory pathways.

INTRODUCTION: In some patients with left AV accessory pathway (AP), double potentials are recorded along the coronary sinus (CS) during retrograde AP conduction only. This electrophysiologic study was performed to clarify the origin and clinical significance of double potentials in 11 patients. METHODS AND RESULTS: The direction of activation of the first, relatively blunt component (DP1) was lateral to septal in 5 patients with anterior or anterolateral AP, centrifugal in 2 patients with posterior or posterolateral AP, and septal to lateral in 4 patients with posteroseptal AP, suggesting the earliest activation of DP1 was near the AP. The direction of activation of the second, sharper potentials (DP2) were septal to lateral in all patients. The double potentials were fused in the paraseptal CS region. Pacing from the lateral CS musculature or lateral left atrium reproduced the double potentials. The effective refractory period of the double potentials was reached by ventricular extrastimulation, and the left atrial deflection preceded the double potentials, excluding a ventricular or AP origin. CONCLUSION: In patients with connections between the paraseptal CS musculature and left atrium but no connections more laterally, retrograde left AP conduction is associated with double potentials in the CS recordings. The double potentials represent activation of the left atrial insertion of the AP (DP1) and later activation of the CS musculature (DP2) via connections between the paraseptal CS musculature and left atrium, respectively. The activation pattern of DP1 depends on AP location, thus providing important information for AP localization during CS mapping.

Myocardial bundles with slow conduction properties are present on the left interventricular septal surface of normal human hearts.

INTRODUCTION: The aim of this study was to examine the electrophysiologic characteristics of the normal left interventricular septum (LIVS). METHODS AND RESULTS: We explored the LIVS in search of endocardial potentials following ventricular electrograms during sinus rhythm in 28 patients without structural heart disease. In all patients, low-frequency (mean amplitude: 0.81 +/- 0.33 mV) systolic potentials (LA1) were detected in a basal-to-apical activation sequence (earliest to latest QRS-LA1 interval: 93.3 +/- 10.8 ms to 127.1 +/- 16.6 ms). Programmed stimulation demonstrated decremental conduction properties, and the effective refractory period of the tissue between the ventricular electrogram and LA1 at baseline (376.7 +/- 48.8 ms) was significantly prolonged by disopyramide (421.3 +/- 54.1 ms, P < 0.05 vs baseline). In 21 patients (75%), diastolic potentials (LA2) morphologically similar to LA1 (mean amplitude: 0.52 +/- 0.17 mV) were detected in an apical-to-basal activation sequence (earliest to latest QRS-LA2 interval: 368.9 +/- 32.4 ms to 440.7 +/- 45.8 ms). Para-Hisian pacing with capture of the His bundle showed shorter S-LA1 and S-LA2 intervals compared to the beats without His-bundle capture but with ventricular capture (156.3 +/- 11.2 ms vs 183.2 +/- 12.3 ms, and 385.7 +/- 21.6 ms vs 397.4 +/- 23.4 ms, respectively, P < 0.0001). At the same rate, the LA1-LA2 interval was significantly shorter during right ventricular apical than atrial overdrive pacing (220.4 +/- 23.1 ms vs 261.4 +/- 30.7 ms, P < 0.0001). CONCLUSION: Unique myocardial bundles with slow conduction properties and various electrical connections with the specialized conduction system may exist in the LIVS of normal human hearts.

Cleido cranial dysplasia: report of a family.

A family case of Cleidocranial Dysplasia is presented. A mother and two adolescent girls were examined. In all three cases, a radiological series was performed over the entire body. Generalized dysplasia in bones, prolonged retention of primary teeth, and delayed eruption of permanent, as well as supernumerary teeth was diagnosed. The citogenetic study with GTG band showed normal 46, XX. Bilateral audiometry in the mother demonstrated a mild to moderate hypoacustic condition. Radiological findings are presented and the importance of early diagnosis is discussed.

Effect of vitamin E on serum aminotransferase and thioredoxin levels in patients with viral hepatitis C.

OBJECTIVES: Oxidative stress induces cellular responses such as cell death, gene activation and cell proliferation, in the liver. Vitamin E (Vit. E) has been found to protect the liver against oxidative stress in animal experiments. Thioredoxin (TRX) is a stress inducible, multifunctional protein, secreted during oxidative stress. This study evaluated effects of Vit. E on serum TRX and aminotransferase levels in hepatitis C virus (HCV) patients, partly non-responsive to initial interferon (IFN), with higher than average level of serum alanine aminotransferase (ALT) after receiving anti-inflammatory drug treatment. METHODS: Seventeen HCV patients (male = 3; female = 14) of age 62 +/- 7.65 years receiving anti-inflammatory drug therapy, at least 6 months prior to Vit. E administration, were given d-alpha-tocopherol 500 mg/day, orally, for a period of 3 months. ALT, aspartate aminotransferase (AST), TRX and Vit. E were measured at 0, 1, 2 and 3 months and 1 month after end of treatment. As controls, the same patients biochemical data, 3 months from the start of therapy were used. Patients were divided into three categories: total patients "T", low ALT group "L" (ALT < 70 IU/l) and high ALT group "H" (ALT > 70 IU/l), respectively. RESULTS: The ALT level was lowered, significantly in group H, in the 1st, 2nd, 3rd and 1-month post therapy, compared to the initial value. But group L showed little or no change in ALT. Post Vit. E therapy, in groups T and H, the TRX level was elevated but remained below initial levels, whereas in group L, TRX level remained significantly lower than the pretreatment value. Groups T and L, showed significant reduction (p < 0.05) in serum TRX levels in the 2nd and 3rd month. Group H showed a tendency towards TRX reduction, but not significantly. Serum Vit. E levels increased significantly (p < 0.0001) from the 1st to 3rd month in all three T, H and L groups. CONCLUSION: Oxidative stress induced liver damage is reduced by Vit. E in patients with viral hepatitis C, particularly those with initial ALT levels > 70 IU/l. Vit. E treatment causes reduction of oxidative stress markers as TRX and ALT in sera. Therefore, Vit. E can act as a supportive therapy to combat liver damage caused by oxidative stress, in such patients with continuously high levels of ALT even after anti-viral and anti-inflammatory drug therapy.