Foscarnet therapy for ganciclovir-resistant cytomegalovirus retinitis after stem cell transplantation: effective monitoring of CMV infection by quantitative analysis of CMV mRNA.

We report three pediatric patients with ganciclovir-resistant cytomegalovirus (CMV) retinitis who were successfully treated with foscarnet. The patients were recipients of hematopoietic stem cell transplantation (SCT) from HLA-mismatched donors. Because these patients had developed or experienced progressive CMV retinitis during ganciclovir therapy, they received foscarnet therapy at 60 mg/kg every 8 h. Their retinitis resolved promptly after initiating foscarnet therapy, suggesting foscarnet's effectiveness in treating ganciclovir-resistant CMV infection. The amount of CMV mRNA was quantitatively measured using an NASBA technique, which amplified the beta2.7 transcripts specific for CMV replication. This technique was useful for monitoring disease activity in a more rapid and sensitive manner than the PCR assay for CMV DNA.

Epidemiological study of human herpesvirus-6 and human herpesvirus-7 in pityriasis rosea.

BACKGROUND: Pityriasis rosea (PR) is a common papulosquamous skin disorder that is suspected to have an infectious aetiology. OBJECTIVES: We aimed to study the role of human herpesvirus (HHV)-7 and HHV-6 in the pathogenesis of PR. METHODS: We performed seroepidemiological studies (indirect immunofluorescence test) and polymerase chain reaction (PCR) analysis for HHV-6 and HHV-7 in patients with PR. Seventy-two serum samples and 37 samples of peripheral blood mononuclear cells (PBMC) from 44 patients with PR were obtained. Twenty-five patients with other skin disorders such as drug eruption, urticaria or herpes zoster were studied as controls in the PCR analysis. RESULTS: HHV-7 DNA was detected in 13 of 30 (43%) samples of PBMC of the patients with PR and 14 of 25 (56%) samples of PBMC of controls. HHV-6 DNA was detected in six of 29 (21%) patients with PR and nine of 23 (39%) controls. Thus there was no difference in the prevalence of HHV-6 or HHV-7 in PBMC between patients with PR and those with other skin disorders. In the seroepidemiological study, two cases of at least a fourfold rise in titre and five cases of a fourfold decrease in titre to HHV-7 antibody, and two cases of a fourfold rise in titre and two cases of a fourfold decrease in titre to HHV-6 antibody, were observed in 24 patients with PR. This seroepidemiological study revealed antibody responses consistent with active infection in several PR patients, but the greater proportion of the patients had no definite increase in the antibody titres. CONCLUSIONS: We conclude that HHV-7 and HHV-6 may play a part in some patients with PR, but that other causative agents may exist. Further analyses are needed to determine the causative agents of PR.

[Infantile T cell acute lymphoblastic leukemia complicated by thrombotic microangiopathy and human herpes virus 6 infection after allogeneic peripheral blood stem cell transplantation using CD34-positive cells].

We report on a 19-month-old boy with refractory T-cell acute lymphoblastic leukemia who underwent allogeneic peripheral blood stem cell transplantation using positively selected CD34 cells from his HLA two-loci mismatched mother. The conditioning regimen consisted of busulfan (140 mg/m2/d for 2 days), total body irradiation (12 Gy) and melphalan (210 mg/m2). The patient received cyclosporin A for graft-versus-host disease (GVHD) prophylaxis. The CD34-positive cells were separated using an immunomagnetic cell-separation system (Isolex 50). The number of infused CD34-positive cells was 4.4 x 10(6)/kg. Successful engraftment was confirmed on day 14 by fluorescent in situ hybridization of X chromosomes. The patient experienced severe diarrhea due to thrombotic microangiopathy (TMA) following acute GVHD, and died on day 71 of human herpes virus type 6 pneumonitis. Stem cell transplantation using CD34 positively selected cells from HLA-mismatched related donors may be a useful treatment with low incidence of severe GVHD, but many problems remain to be overcome, including severe viral infections and TMA.

Pseudotumorous enlargement of the paracaval portion of the caudate lobe: a report of two cases with CT and MR appearance.

The computed tomographic (CT) and magnetic resonance appearance of pseudotumorous enlargement of the paracaval portion (PCP) of the caudate lobe of the liver are presented in two cirrhotic patients. The enlarged PCP was hyperattenuated on precontrast CT and hyperintense on T1-weighted images. The middle and right hepatic veins were displaced around the PCP. The presence of a portal vein branch penetrating the center of the enlarged PCP was important to distinguish it from other hepatic masses in the two patients.

High-resolution MR imaging evaluation of hepatocellular carcinoma.

PURPOSE: To determine the utility of high-resolution MR imaging for hepatocellular carcinoma. MATERIALS AND METHODS: High-resolution MR images with a 512 matrix in a right to left frequency encoding direction were obtained in 20 consecutive patients with known or suspected hepatocellular carcinoma (HCC). Six series of breath-hold images of the entire liver [T1- and T2-weighted fast spin echo sequences, T1-weighted fast low-angle shot gradient echo sequence and three-phased contrast-enhanced dynamic study using the latter) were obtained using a phased-array multicoil. RESULTS: HCC was depicted in 15 patients on the MR images, and the diagnosis was confirmed at pathology in 13 and at imaging in the other two. In the remaining five patients, HCC was correctly ruled out with MR imaging. CONCLUSION: High-resolution MR imaging is a promising method in the evaluation of HCC.

[Metabolism of 99mTc-ethyl cysteinate dimer (99mTc-ECD) in blood--mainly in vitro].

Metabolism of 99mTc-ethyl cysteinate dimer (99mTc-ECD) in blood was studied mainly in vitro. When 99mTc-ECD was mixed with blood taken from 12 subjects, the octanol extraction ratio of ECD (y) decreased rapidly and the octanol extraction ratio-time profile well fitted a monoexponential curve (y = Ae-kt/1000, A, k: constant, t: time after mixing). The k value and hematocrit (Ht) were significantly correlated (k = 0.376Ht-3.27, r = 0.897, p less than 0.001), therefore, it was suggested that the majority of the enzyme which dissolves ECD exists in red blood cells. When ECD was mixed with blood, there were more hydrophilic products of ECD in plasma than those generated by the enzyme in plasma. In vivo input function of 99mTc-ECD was calculated by arterial blood sampling and octanol extraction. The duration of effective input was relatively short, which was attributed to rapid decrease of octanol extraction ratio in vivo.

[67Ga scintigraphic study of a case of recurrent extra-abdominal desmoid tumor].

A case of extra-abdominal desmoid tumor was studied with 67Ga scintigraphy. Extra-abdominal desmoid tumors show an aggressive clinical course with tendency of recurrence in high percentage. On 67Ga scintigraphy, our case revealed a hot spot which is useful of recurrence. 67Ga scintigraphic study was useful in searching for local and recurrence after surgery.

[Clinical evaluation of serum CEA levels in uterine cervix cancer].

Serum CEA levels were measured in the blood of 98 patients with uterine cervix cancer before, during, and after treatment to investigate the relationship among the CEA level, the extent of the disease, and recovery. The CEA level rose as the disease progressed. Although there was no significant difference in the survival rates of patients with various CEA levels, those who returned to normal levels after treatment recuperated better. There was not clear evidence that CEA levels are clinically significant. However, it can be concluded that CEA levels at pre- and post-treatment times are helpful in the early detection of disease, prognosis, and in predicting recurrence or metastasis.