bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic resonance imaging (MRI) and diseases of the liver and biliary tract. Part 1. Basic principles, MRI in the assessment of diffuse and focal hepatic disease
Authors: Macdonald Graeme A , Peduto Anthony J
Published: March 2003

Abstract Magnetic resonance imaging (MRI) relies on the physical properties of unpaired protons in tissues to generate images. Unpaired protons behave like tiny bar magnets and will align themselves in a magnetic field. Radiofrequency pulses will excite these aligned protons to higher energy states. As they return to their original state, they will release this energy as radio waves. The frequency of the radio waves depends on the local magnetic field and by varying this over a subject, it is possible to build the images we are familiar with. In general, MRI has not been sufficiently sensitive or specific in the assessment of diffuse liver disease for clinical use. However, because of the specific characteristics of fat and iron, it may be useful in the assessment of hepatic steatosis and iron overload. Magnetic resonance imaging is useful in the assessment of focal liver disease, particularly in conjunction with contrast agents. Haemangiomas have a characteristic bright appearance on T2 weighted images because of the slow flowing blood in dilated sinusoids. Focal nodular hyperplasia (FNH) has a homogenous appearance, and enhances early in the arterial phase after gadolinium injection, while the central scar typically enhances late. Hepatic adenomas have a more heterogenous appearance and also enhance in the arterial phase, but less briskly than FNH. Hepatocellular carcinoma is similar to an adenoma, but typically occurs in a cirrhotic liver and has earlier washout of contrast. The appearance of metastases depends on the underlying primary malignancy. Overall, MRI appears more sensitive and specific than computed tomography with contrast for the detection and evaluation of malignant lesions.
Seroprevalence of GB virus C/hepatitis G virus–RNA and anti‐envelope antibody in high‐risk populations in Taiwan
Authors: Hwang Shinn‐Jang , Chu Chen‐Wei , Lu Rei‐Hwa , Lan Keng‐Hsin , Wu Jaw‐Ching , Wang Yuan‐Jan , Chang Full‐Young , Lee Shou‐Dong
Published: March 2003

Abstract Background: GB Virus C (GBV‐C)/hepatitis G virus (HGV) was identified in 1995–1996 as a transfusion‐transmissible virus. The diagnosis of GBV‐C/HGV infection is based on the detection of GBV‐C/HGV‐RNA by using polymerase chain reaction. Recently, an enzyme immunoassay detecting the antibodies to the viral protein, E2 envelope protein (anti‐envelope) of GBV‐C/HGV, has been developed.

Methods: Serum GBV‐C/HGV‐RNA and anti‐envelope antibody were determined in 76 cases of intravenous drug users (IVDU), 76 patients with regular hemodialysis and in 80 prostitutes to evaluate the GBV‐C/HGV infection rate among high‐risk populations in Taiwan. Seventy‐six healthy blood donors were randomly selected and were used as a control group.

Results: The prevalence of GBV‐C/HGV‐RNA in high‐risk populations was 33% for IVDU, 16% for patients with hemodialysis and 13% for prostitutes, which was significantly higher than the 3% obtained in the control group (P < 0.05 for all groups). The prevalence of anti‐envelope antibody was 13% for IVDU, 21% for patients with hemodialysis and 23% for prostitutes, which was not significantly different from the control group (11%). Among the 99 subjects who had positive GBV‐C/HGV markers, 97 were tested for exclusive positivity for either GBV‐C/HGV‐RNA or anti‐envelope antibody.

Conclusions: The presence of serum anti‐envelope antibody usually indicates the clearance of serum GBV‐C/HGV‐RNA in patients infected with GBV‐C/HGV. GB Virus‐C/HGV infection in high‐risk populations, determined by the presence of serum GBV‐C/HGV‐RNA, may underestimate the true level of past and present infection.
Chronic hepatitis C is mild in menstruating women
Authors: Sartori Massimo , Andorno Silvano , Rigamonti Cristina , Grossini Elena , Nicosia Gabriella , Boldorini Renzo
Published: March 2003

Background and Aims

Women with chronic hepatitis C may have a slower rate of disease progression than men. We have previously demonstrated a relationship between hepatic iron concentration and liver fibrosis in patients with chronic hepatitis C. Our aim was to compare hepatic histologic findings, iron status and other factors putatively capable of determining the severity of chronic hepatitis between menstruating women and men of comparable age.

Methods

We studied 21 consecutive hepatitis C virus (HCV)‐RNA positive menstruating women and 24 consecutive HCV‐RNA positive men of comparable age, who underwent liver biopsy for chronic hepatitis C. Alcohol intake was recorded and blood tests, HCV genotyping, serum iron, unsaturated iron binding capacity, serum ferritin, hepatic iron concentration, and liver histology were evaluated.

Results

Menstruating women showed lower grading (2.7 ± 1.5 vs 3.6 ± 2, P = 0.09) and significantly lower staging (1.38 ± 1.11 vs 2.42 ± 1.64, P = 0.037) scores than men of comparable age. Among the factors putatively capable of determining the severity of chronic hepatitis, only the hepatic iron concentration correlated with the hepatic histologic staging in a multivariate analysis. Iron‐depleted women (transferrin saturation < 20% and/or serum ferritin < 9 μg/L) showed significant lower hepatic histologic grading (1.75 ± 0.7 vs 3.23 ± 1.55, P = 0.027) and staging (0.75 ± 1.03 vs 1.77 ± 1.01, P = 0.026) scores than women with normal iron status.

Conclusions

Menstruating women with chronic hepatitis C may have a milder disease compared to men of comparable age, possibly because of menstrual blood loss and lower hepatic iron concentration. Women with chronic hepatitis C and iron deficiency have a milder disease compared to women with normal iron status, suggesting that iron deficiency results in a slower rate of disease progression.
Autoimmune hepatitis with membranous glomerulonephritis
Authors: Takahashi Kazuhiro , Takasaki Satoko , Morita Chie , Hayashida Kazuhiro , Matsui Mieko , Tamechika Yoshio , Ishibashi Hiromi
Published: March 2003

Abstract We report on a case of autoimmune hepatitis (AIH) associated with membranous glomerulonephritis. A 61‐year‐old woman was admitted because of peripheral edema, proteinuria and abnormal liver function test findings. A diagnosis of AIH was made on the basis of an elevation of aminotransferase and serum IgG levels, the presence of positive antinuclear antibody and the characteristic histological features of chronic active hepatitis. Histological examination of a renal biopsy specimen disclosed membranous glomerulonephritis with granular deposits of IgG, IgM, C3 and C1q along the capillary walls. This condition is rare in AIH and should be carefully distinguished from systemic lupus erythematosus.
Improved survival with oral administration of enteric‐coated tegafur/uracil for advanced stage IV‐A hepatocellular carcinoma
Authors: Ishikawa Toru , Ichida Takafumi , Sugitani Soichi , Tsuboi Yasunori , Genda Takuya , Sugahara Satoshi , Uehara Kazuhiro , Inayoshi Jun , Yokoyama Junji , Ishimoto Yuiko , Asakura Hitoshi
Published: March 2003

Background and Aims: There is currently no proven chemotherapy regimen for hepatocellular carcinoma (HCC). The principal chemotherapeutic approach in most cases is infusion therapy into the hepatic arteries feeding the tumors. However, the clinical effects of chemotherapy are extremely poor. Therefore, in the present study, we conducted a prospective randomized trial of the efficacy of oral administration of enteric‐coated tegafur/uracil for advanced HCC.

Methods: From 1994 to 1999, a total of 56 consecutive patients with unresectable stage IV‐A HCC were studied prospectively to examine the efficacy of enteric‐coated tegafur/uracil in HCC and to determine the significant prognostic factors. Twenty‐eight patients were treated only with enteric‐coated tegafur/uracil without other anticancer treatment. Another 20 patients were given conservative management only. The remaining eight patients withdrew from the study.

Results: In the group treated only with enteric‐coated tegafur/uracil, the median survival time and 1 and 2 year survival rates were 12.13 months and 55.3 and 36.9%, respectively. In the control group, the median survival time and 1 year survival rate were 6.20 months and 5.5%, respectively. By both univariate analysis and multivariate analysis using Cox's proportional hazards model, treatment with enteric‐coated tegafur/uracil was shown to be the factor most significantly favoring a better prognosis.

Conclusions: Although the prognosis of most patients with stage IV‐A HCC is poor, administration of enteric‐coated tegafur/uracil induces long‐term survival and is an effective treatment for stage IV‐A HCC.
Survival of conditionally immortalized hepatocytes in the spleen of syngeneic rats
Authors: Kim Byung‐Ho , Sung Se‐Ra , Park Jai‐Kyung , Kim Young‐Il , Kim Kyeong‐Jin , Dong Seok‐Ho , Kim Hyo‐Jong , Chang Young‐Woon , Lee Joung‐Il , Chang Rin
Published: March 2003

Background: Hepatocyte transplantation has been shown to be effective in the treatment of liver failure; however, the shortage of donor organs limits its clinical application. Several reports have suggested that conditionally immortalized hepatocytes (CIH) could be an alternative to primary hepatocytes. However, CIH are known to undergo apoptosis in vitro at a non‐permissive temperature, which is similar to body temperature.

Methods: To investigate the duration of survival and in vivo apoptosis of CIH in the syngeneic host, the L2A2 cells (a kind of CIH) that were established from hepatocytes of a Lewis rat with a gene for a temperature‐sensitive Simian Virus 40 (SV40) large T antigen were transplanted into the spleen. Cells were isolated from the spleen that was removed periodically up to 6 months, and used to detect the presence of the L2A2 cells among them with the selective culture for CIH and T‐antigen PCR. In situ apoptosis of L2A2 cells was also examined. In order to improve the survival of transplanted L2A2 cells in the host, a group of rats were partially hepatectomized 1 day before transplantation was performed.

Results: The L2A2 cells secreted albumin at a rate of 1.17 ± 0.18 μg/24 h per 106 cells in vitro. After transplantation, L2A2 cell colonies and PCR amplification bands appeared up to 14 and 7 days, respectively, but this duration was not prolonged by a partial hepatectomy. The spleen showed a large number of hepatocytes that were in the process of dying on the 5th day, and only a number of ghost hepatocytes were present on the 7th day of transplantation. No tumors were found during the 6‐month observation period.

Conclusions: Conditionally immortalized hepatocytes can survive in the spleen for a limited period, in spite of the growth stimulation, most likely because they undergo apoptosis in vivo as well as in vitro at a non‐permissive temperature. These data suggest that the use of these cells in hepatocyte transplantation be limited to temporary hepatic support.
Repeated intestinal perforation caused by an incomplete form of Behçet's syndrome
Authors: Ng Fook‐Hong , Cheung Tak‐Cheong , Chow Kai‐Chiu , Wong Siu‐Yin , Ng Wing‐Fung , Chan Hok‐Chin , Chau Wai‐Keung , Chang Chee‐My
Published: March 2003

Abstract Behçet's disease, as initially described, is a triad of recurrent oral and genital ulcers and relapsing uveitis. The incomplete form, in which there is no ocular involvement, has been described in Japan and Korea, but this is not commonly recognized in the southern Chinese. We reported herein a rare case of repeated intestinal perforations caused by an incomplete form of Behçet's syndrome in a southern Chinese man.
Binding sites for progastrin‐derived peptides in colonic crypts
Authors: Karelina Yulia , Baldwin Graham S
Published: March 2003

Background and Aims: Gastrin17gly acts as a growth factor for the colonic mucosa. Studies on the binding properties of the receptor involved in transducing the proliferative effects have generally been confined to colorectal carcinoma cell lines, and no investigation of gastrin17gly receptors on normal colonocytes has yet been reported. The aim of this study was to investigate the binding of 125I‐[Met15]‐gastrin17gly to normal colonic crypts.

Methods: Crypts were released from normal rat and rabbit colonic mucosa by treatment with EDTA and isolated by centrifugation. The binding of 125I‐[Met15]‐gastrin17gly was measured in displacement experiments with increasing concentrations of either gastrin17gly, gastrin17 or gastrin receptor antagonists. The concentrations required for 50% inhibition were determined by the use of curve fitting.

Results: 125I‐[Met15]‐Gastrin17gly bound to both rat and rabbit crypts, and displacement experiments with unlabeled gastrin17gly revealed that the IC50 values were 1.0 ± 0.6 and 0.6 ± 0.2 μmol/L, respectively. Binding was also competed by gastrin17, with IC50 values of 2.4 ± 1.7 and 2.4 ± 0.7 μmol/L, respectively. Binding was inhibited by the non‐selective gastrin/CCK receptor antagonists proglumide and benzotript, but not by the cholecystokinin (CCK)‐A receptor antagonist L364 718, or the gastrin/CCK‐B receptor antagonist L365 260.

Conclusion: We conclude that the gastrin17gly binding site on normal colonic crypts has properties consistent with the gastrin/CCK‐C receptor.
Biliary cancer growth factor pathways, cyclo‐oxygenase‐2 and potential therapeutic strategies
Authors: Sirica Alphonse E , Lai Guan‐Hua , Zhang Zichen
Published: March 2003

Abstract Cholangiocarcinoma is a hepatic biliary cancer of high morbidity and mortality, whose molecular pathogenesis is unknown. However, there is increasing evidence to suggest that alterations in selected growth factor pathways, including an overexpression of the growth factor receptor tyrosine kinases c‐ErbB‐2/c‐Neu and c‐Met, together with possible aberrant autocrine expression of hepatocyte growth factor/scatter factor, the ligand for c‐Met, may be playing important roles associated with the development of cholangiocarcinoma in both the human liver and in the furan rat model of cholangiocarcinogenesis. Cyclo‐oxygenase‐2, whose regulation has been experimentally related to c‐ErbB‐2/c‐Neu as well as to hepatocyte growth factor/scatter factor, and which has been demonstrated to be overexpressed in other cancers of the gastrointestinal tract, has also been observed in preliminary studies to be upregulated in human biliary cancers and in cholangiocarcinoma induced in the furan rat model. Moreover, new data from our laboratory have demonstrated the cyclo‐oxygenase‐2 inhibitor NS‐398 to produce a significant dose‐dependent growth inhibition of rat cholangiocarcinoma cells in vitro, as well as to suppress anchorage‐independent growth of these cells in soft agar. Based on the data reviewed, we propose that the selective therapeutic targeting of aberrant growth factor receptor tyrosine kinase signaling and of cyclo‐oxygenase‐2, alone or in combination, has potential to become a useful new approach for the treatment and/or chemoprevention of cholangiocarcinoma. We further propose that the furan rat model may serve as a powerful preclinical model for testing therapeutic and chemopreventative strategies that selectively target c‐ErbB‐2/c‐Neu, cyclo‐oxygenase‐2, and/or autocrine hepatocyte growth factor/c‐Met, aberrantly expressed in cholangiocarcinogenesis.
Prevalence of functional dyspepsia and its relationship with Helicobacter pylori infection in a Japanese population
Authors: Kawamura Akira , Adachi Kyoichi , Takashima Toshiharu , Murao Mitsuyoshi , Katsube Tomoko , Yuki Mika , Watanabe Makoto , Kinoshita Yoshikazu
Published: March 2003

Aim: To investigate the prevalence of functional dyspepsia and Helicobacter pylori infection and their relationship in a Japanese population.

Methods: Two thousand five hundred people who visited Shimane Institute of Health Science for their annual medical check‐up from September 1998 to August 1999 were prospectively enrolled in the study. After routine medical examination, including an upper gastrointestinal study and an ultrasonographic examination, all subjects were asked standard questions to check for the presence of any symptoms that suggested dyspepsia. Helicobacter pylori infection was determined by using a serum IgG antibody concentration with an ELISA.

Results: Of the 2500 persons investigated, 2263 showed no abnormal finding in any medical examination. The presence or absence of symptoms and H. pylori infection was investigated in these 2263 cases. Of these, 201 people (8.9%) experienced nausea, fullness and/or early satiety and were diagnosed as having dysmotility‐like dyspepsia, while 118 people (5.2%) experienced pain localized to the epigastrium and were diagnosed as having ulcer‐like dyspepsia. The frequency of these symptoms had a tendency to decline with age, although this was not statistically significant. In contrast, the rate of H. pylori infection increased with age. There was no significant relationship between H. pylori infection and any type of functional dyspepsia.

Conclusions: Helicobacter pylori infection does not influence the prevalence of the dysmotility‐like and ulcer‐like dyspeptic symptoms.
Liver gene regulation in rats following both 70 or 90% hepatectomy and endotoxin treatment
Authors: Jensen Søren Astrup
Published: March 2003

Background: The metabolic state effect of liver failure on liver gene regulation was evaluated in a rat model.

Methods: Following 70 or 90% hepatectomy and lipopolysaccharide or vehicle treatment at intervals up to 24 h, the liver remnants were analyzed for mRNA levels for acute‐phase, liver‐specific and growth‐related proteins.

Results: After 70% hepatectomy mRNA for alpha 1‐acid glycoprotein, alpha 2‐macroglobulin, thiostatin and fibrinogen, haptoglobin increased three‐ to sevenfold (P < 0.05), and mRNA for cyclin D and histone 3 increased seven‐ and 15‐fold (P < 0.05), respectively. After lipopolysaccharide injection and 70% hepatectomy were done, mRNA for acute‐phase proteins raised significantly (P < 0.05), more to five to 20‐fold, while mRNA for growth‐related proteins raised significantly (P < 0.05) less to three‐ to fourfold. After 90% hepatectomy, acute‐phase protein mRNA increased five‐ to ninefold (P < 0.05) more than after 70% hepatectomy, while mRNA for histone 3 and cyclin D did not increase within 24 h, which indicates a delayed growth after 90% hepatectomy. In 90% of hepatectomized rats treated with lipopolysaccharide, acute‐phase protein mRNA raised three‐ to sixfold (P < 0.05) less than after vehicle treatment.

Conclusion: In endotoxemia from liver failure, the synthesis of acute‐phase proteins is upregulated by gene regulation at the expense of that for regeneration, which may be an appropriate response for immediate survival. In severe liver failure, endotoxin may interfere with the appropriate gene regulation.
Dietary factors in relation to the distribution of duodenal ulcer in India as assessed by studies in rats
Authors: Jayaraj A Paul , Tovey Frank I , Clark1 Charles G , Hobsley Michael
Published: March 2003

Background: The prevalence of duodenal ulcer is less in the northern wheat‐eating regions of India and China than in the southern rice‐eating areas.

Methods and Results: Experiments were conducted on rat peptic ulcer models in which controls were fed on either known ulcerogenic rice or rice plus tapioca diets or on non‐ulcerogenic stock diet. By using an ulcerogenic diet and pyloric ligation, unrefined wheat, wheat bran and their respective oils were protective against ulceration. Refined wheat, wheat germ and its oil were not protective. Freshly milled rice and unmilled rice were protective, but stored rice bran and its oil increased the ulceration. Fresh rice bran oil was not ulcerogenic, but on storage, it became ulcerogenic. By using stock diet and alcohol‐induced ulceration, the findings with whole wheat oil, wheat bran and wheat germ oil were confirmed. Rats fed on the stock diet subjected to pyloric ligation developed ulcers following intragastric injection of stored rice bran oil. This ulcerogenicity was counteracted by whole wheat oil.

Conclusion: These results suggest that the factor of diet may well explain the regional differences in the prevalence of duodenal ulceration between North and South India and China where other etiologic factors are similar.
Antibodies to neutrophil cytoplasma in patients with ulcerative colitis and their first‐degree relatives in Thailand
Authors: Osangthamnont Charkaphan , Manatsathit Sathaporn , Pongprasopchai Supot , Viriyataveekul Ronnachai , Chaihirunkarn Supaporn , Leelakusolvong Somchai , Boonyapisit Sasiprapa
Published: March 2003

Background: The prevalence of perinuclear antineutrophil cytoplasmic antibodies (p‐ANCA) does not significantly vary in ethnically diverse populations. The prevalence of p‐ANCA is high in ulcerative colitis and primary sclerosing cholangitis. While the prevalence of ulcerative colitis in Asian populations is low, it is interesting to know the prevalence of p‐ANCA in such a population.

Methods: Sera from 33 cases of ulcerative colitis diagnosed during the last 10 years at the diarrhea clinic, Division of Gastroenterology, Siriraj Hospital, were prospectively compared with case controls consisting of 15 cases of diarrhea from non‐inflammatory bowel diseases and 25 non‐diarrheic patients. Indirect immunofluorescence assay was used to detect p‐ANCA in all the sera.

Results: Positive p‐ANCA tests were found in 13 of the 33 patients with ulcerative colitis and in one of the 40 controls. Sensitivity of the test was 39.4% and the specificity was 97.5%. The one patient with positive p‐ANCA in the control group was the patient with irritable bowel syndrome. Of the 13 p‐ANCA‐positive ulcerative colitis patients, two cases were found to have proctosigmoiditis, seven cases had left‐sided colitis, and four cases had pancolitis. Perinuclear antineutrophil cytoplasmic antibodies was one of the 22 cases of first‐degree relatives of ulcerative colitis patients (22 relatives from 12 index ulcerative colitis cases). There was no correlation between the positivity of p‐ANCA and disease activity, and extent of the disease.

Conclusion: The prevalence of p‐ANCA in Thai patients with ulcerative colitis (39.4%) is lower than that in the Western population. Although the prevalence of p‐ANCA is low in the Thai population, it should serve as a useful tool in diagnosing ulcerative colitis in this part of the world where the disease is uncommon and difficult to diagnose. The negativity of p‐ANCA in almost all first‐degree relatives of Thai ulcerative colitis patients should be further elucidated.
New approaches to immunosuppression in liver transplantation
Authors: GODDARD SARAH , ADAMS DAVID H
Published: March 2003

AbstractWith the continued improvements in outcome following liver transplantation, the drawbacks associated with conventional immunosuppression regimens become increasingly apparent. Although up to 70% of patients develop a histological infiltrate of the graft (acute rejection), many of these will resolve spontaneously, and chronic rejection is rare. If a robust form of allograft acceptance or tolerance can be established, then immunosuppression can be withdrawn along with all the accompanying risks. The liver is already known to be associated with downregulated immune responses; the mechanism for this is unclear, but may be related to a number of mechanisms known to be involved in peripheral tolerance. There are many strategies being studied for achieving allograft tolerance, including the use of modern immunosuppressants, antibodies that target key molecules in the immune response, and recruitment of leukocytes to allografts. In the interim, it is necessary to look for safe protocols that allow trials of tolerance strategies without putting patients at increased risk.
When is molecular genetic testing for colorectal cancer indicated?
Authors: BARBARA LEGGETT
Published: March 2003

Abstract  The genetic mutations causing many of the syndromes which confer a high inherited risk of colorectal cancer have now been identified. These include familial adenomatous polyposis, hereditary non‐polyposis colorectal cancer, Peutz‐Jeghers syndrome, Cowden’s syndrome and juvenile polyposis. In all these diseases, the precise mutation is nearly always unique to a particular family; there are few mutation hot spots. This means that mutation detection is technically demanding. Nonetheless, genetic testing can now be used clinically to confirm the diagnosis in affected individuals, and to predict whether an ‘at risk’ family member has inherited the disease and should therefore have endoscopic screening. Because current technology does not detect all mutations, a negative result in a definitely affected individual is diagnostically unhelpful and does not allow predictive testing of other family members. When a mutation can be detected, it is diagnostically very useful, and allows better management of all family members.

© 2002 Blackwell Publishing Asia Pty Ltd
Chronic liver disease mortality attributable to hepatitis B and C in New Zealand
Authors: WEIR ROBERT P , BRUNTON CHERYL R , BLAKELY TONY A
Published: March 2003

Abstract

Background:
This research aimed to estimate the prevalence and population attributable risk percent (PAR%) of hepatitis B (HBV) and C (HCV) infection among chronic liver disease (CLD) deaths in New Zealand. The PAR% is the percentage of CLD cases attributable to either HBV or HCV. Within New Zealand, there are large differences in HBV prevalence by ethnic group, so prevalence and PAR% estimates were made separately for the three major ethnic groups.

Methods:
The study sample was selected from CLD deaths between 1992 and 1997. Data were extracted from hospital records and coroners’ reports. The prevalence and PAR% of HBV and HCV were estimated.

Results:
Data were extracted for 303 of 359 decedents selected for inclusion. Hepatitis B virus and HCV test results were identified in 67 and 43%, respectively. Among those cases tested, the prevalence (and estimated PAR%) of HBV infection was 68% (PAR% 66%) for Pacific people, 54% (PAR% 52%) for Maori and 10% (PAR% 10%) for European New Zealanders. The prevalence (and estimated PAR%) of past or present HCV infection ranged between 8 and 15% (PAR% 8–14%) for the three major ethnic groups.

Conclusions:
The present study has demonstrated that HBV and HCV infections are important contributors to CLD mortality in New Zealand. With the introduction of universal hepatitis B vaccination in the late 1980s, we would expect the burden of CLD deaths attributable to HBV to decrease in the future. However, the burden of CLD deaths due to HCV is likely to increase.

© 2002 Blackwell Publishing Asia Pty Ltd
Prognostic factors in patients with small hepatocellular carcinoma treated by percutaneous ethanol injection
Authors: Kuriyama Hitoshi , Okada Shuichi , Okusaka Takuji , Ueno Hideki , Ikeda Masafumi
Published: March 2003

Background:Percutaneous ethanol injection (PEI) has been widely performed and is now accepted as a viable alternative to hepatic resection in patients with small hepatocellular carcinomas (HCC). However, only a few extensive investigations have been conducted regarding the prognostic factors for HCC patients treated with PEI.

Methods:We investigated the prognostic factors in 100 patients with small HCC who had undergone PEI. Univariate analysis and multivariate analysis with Cox's proportional hazards model were used to determine the factors potentially related to survival. For clinical application, a prognostic index was calculated based on the regression coefficients of the independent variables identified from the multivariate analysis.

Results:Median survival time and 1, 3 and 5 year survival rates were 71 months and 100, 84 and 62%, respectively. Among the 15 potential prognostic variables investigated, only three variables, namely a serum albumin level ≤ 3.5 g/dL, the presence of tumor stain and a serum glutamic oxaloacetic transaminase level> 66 IU/L, were identified as factors independently associated with a shorter survival. A prognostic index based on the regression coefficients of these three factors was proposed to classify patients into three groups, those with a good (5 year survival rate 91%), intermediate (64%) and poor prognosis (22%).

Conclusions:The results of the present study may be useful in predicting the survival of HCC patients treated with PEI and in the design and analysis of future clinical trials of PEI for HCC.

© 2002 Blackwell Publishing Asia Pty Ltd
Fatty liver in non‐alcoholic non‐overweight Japanese adults: Incidence and clinical characteristics
Authors: Omagari Katsuhisa , Kadokawa Yoshiko , Masuda Jun‐Ichi , Egawa Ichiei , Sawa Takafumi , Hazama Hiroaki , Ohba Kazuo , Isomoto Hajime , Mizuta Yohei , Hayashida Kenji , Murase Kunihiko , Kadota Takehiko , Murata Ikuo , Kohno Shigeru
Published: March 2003

Background and Aims: Fatty liver is not uncommon in many countries, including Japan, and is mainly caused by alcohol usage and obesity. The aim of this study was to determine the incidence and causative factors of fatty liver in Japanese adults.

Methods: The clinical characteristics of 3432 Japanese adults who visited our hospital between January and December 2000 for thorough medical examinations were recorded including sex, age, body mass index (BMI), percentage body fat measurement using a bipedal bioimpedance instrument, history of alcohol intake, blood pressure, serum levels of aspartate aminotransferase, alanine aminotransferase (ALT), γ‐glutamyl transpeptidase, total cholesterol, triglyceride, uric acid, fasting blood glucose (FBG), and liver status by ultrasonography (USG).

Results: Of 3432 participants, 747 (21.8%) were diagnosed as having fatty liver by USG, 1873 (54.6%) were ‘daily alcohol drinkers’, and 698 (20.3%) were overweight (BMI ≥ 25 kg/m2). Fatty liver was more frequent in men and overweight subjects (P < 0.01), whereas there was no significant difference in the proportion of the ‘daily alcohol drinker’ between fatty liver and non‐fatty liver participants. The logistic regression analysis showed that BMI, ALT, and triglyceride were independent predictors of fatty liver in both sexes, and FBG, uric acid, percentage body fat, and total cholesterol were independent predictors of fatty liver only in men. It was noted that 319 (9.3%) were non‐alcoholic individuals with fatty liver, and 141 (4.1%) were non‐alcoholic and non‐overweight individuals with fatty liver. The logistic regression analysis showed that percentage body fat was an independent predictor of fatty liver in non‐alcoholic and non‐overweight participants in both sexes, although non‐significant in women in the whole group.

Conclusions: In our study population, 21.8% had fatty liver diagnosed by USG, 9.3% were non‐alcoholic with fatty liver, and 4.1% were non‐alcoholic and non‐overweight with fatty liver. Our results suggest that central body fat distribution can correlate with the development of fatty liver, and that measurement of percentage body fat is useful to assess the etiology of fatty liver in non‐alcoholic and non‐overweight participants, particularly women.
Clinical characteristics and distribution of genotypes of TT virus infection in a hepatitis C virus‐hyperendemic township of a hepatitis B virus‐endemic country (Taiwan)
Authors: Dai Chia‐Yen , Yu Ming‐Lung , Hou Cheng , Lu Sheng‐Nan , Wang Jing‐Houng , Huang Jee‐Fu , Chen Shinn‐Cherng , Lin Zu‐Yau , Hsieh Ming‐Yuh , Tsai Jung‐Fa , Wang Liang‐Yen , Chuang Wan‐Long , Chang Wen‐Yu
Published: March 2003

Background:
The prevalence of TT virus (TTV) viremia, without definite clinical significance, has been reported to be higher among chronic hepatitis C patients. The status and clinical characteristics of TT virus (TTV) infection and distribution of TTV genotypes in a hepatitis C virus (HCV) hyperendemic township (Masago community) in a hepatitis B virus (HBV) endemic country (Taiwan) were investigated.

Methods:
Sera from 100 Masago residents were tested for alanine aminotransferase (ALT) and markers of HBV, HCV and GB virus C/hepatitis G virus (GBV‐C/HGV) and TTV‐DNA. Sera of 250 blood donors as a control group were tested for TTV‐DNA. Sera of Masago residents and blood donors with positive TTV‐DNA were directly sequenced, and phylogenetic analyses were performed subsequently.

Results:
The prevalences of TTV viremia in different age groups among individuals from Masago were significantly higher than that among blood donors. In regard to the subtypes of TTV, 23, seven, two, eight, one, six and one isolate were related to the genotypes 1a, 1b, 2a, 2b, 3, 4 and 5, respectively, from Masago and 21, 14, one, nine and three isolates were related to the genotypes 1a, 1b, 2a, 2b, and 4, respectively, from donors. No clinical or virological factor was associated with TTV viremia or TTV genotypes.

Conclusions:
TT Virus prevalence was higher among HCV hyperendemic township residents than blood donors with similar genotype distributions (genotype 1 was the most prevalent) in Taiwan. Neither TTV viremia nor a particular genotype was associated with HBV, HCV or GBV‐C/HGV infection and abnormal ALT levels.

© 2002 Blackwell Publishing Asia Pty Ltd
Infrared spectrometry based 13C‐octanoic acid breath test in measuring human solid gastric emptying
Authors: CHEN CHIH‐PING , CHEN CHIH‐YEN , LU CHING‐LIANG , CHANG FULL‐YOUNG , LEE SHOU‐DONG , CHU LEE‐SHING , LIU REN‐SHYAN , WU HAN‐CHANG
Published: March 2003

Background and Aims: Because of the convenience of non‐dispersive infrared spectrometry (NDIRS), we attempted to validate the usefulness of NDIRS compared with scintigraphy in human solid gastric emptying (GE) measurement, and tried to establish the normal range of solid GE based on NDIRS.

Methods: Twelve healthy volunteers (three men, nine women) were recruited for simultaneous scintigraphy and 13C‐octanoic acid breath test (13C‐OABT) studies. Stomach half‐emptying time (t1/2) and lag phase (tlag) were the two main GE parameters measured and correlated. The breath samples were analyzed using NDIRS every 10–15 min for a total of 6 h, while scintigraphy was taken minute by minute for the first 30 min, then hourly for 4 h. Another 32 healthy volunteers (19 men, 13 women) received only the 13C‐OABT to measure their solid GE.

Results: A significant correlation for t1/2 was found between the breath test and scintigraphy (r = 0.85, P = 0.001), while tlag was also positively correlated (r = 0.73, P = 0.007). The reference range of t1/2B based on all 44 subjects was 89.4–185.1 min (135.9 ± 21.1 min (mean ± SD)), while the range for tlagB was 37.1–117.8 min (81.9 ± 17.4 min). No demographic characteristics were found to influence the GE parameters.

Conclusions: 13C‐octanoic acid breath test determined by NDIRS is a simple, non‐invasive and reliable measurement, which may provide an ‘office‐based’ tool to detect solid GE.

© 2003 Blackwell Publishing Asia Pty Ltd
Establishment of a normal range of penile length in preterm infants
Authors: TULADHAR R , DAVIS PG , BATCH J , DOYLE LW
Published: March 2003

Rationale:

Recognition of micropenis is important because it may be the only obvious manifestation of pituitary or hypothalamic hormone deficiencies. Alternatively it may indicate the presence of dysgenetic testicular tissue with malignant potential. Previously published normal ranges for premature males are based on small sample sizes, with few infants <30 weeks and none <28 weeks.

Setting:

Intensive and Special Care Nurseries, Royal Women’s Hospital, Melbourne, Victoria.

Subjects:

188 consecutive male infants, inborn and outborn, with gestational age <37 completed weeks were examined in the first week of life. They included multiple births (n=51) and small for gestational age infants (n=16). Infants with hypospadias (n=3) or an endocrine disorder (n=1) were excluded from the study.

Manoeuvre:

Stretched penile length was determined by a single examiner (RT) using a standardized measure.

Results:

A mean penile length with associated 95% confidence intervals is described for infants between 24 and 36 weeks inclusive. The relationship between penile length (PL, cm) and gestational age (GA, weeks) was: PL=2.27+0.16 GA.

Conclusion:

This study confirms the normal range for penile length of premature male infants 30–36 weeks and defines the normal range <30 weeks. This should prove useful to paediatricians, paediatric surgeons and endocrinologists dealing with the increasing number of surviving male infants <30 weeks in whom penile size is questioned.
Post‐extubation prophylactic nasal continuous positive airway pressure in preterm infants: Systematic review and meta‐analysis
Authors: Davis PG , Henderson‐Smart DJ
Published: March 2003

Objectives: To determine whether management with nasal continuous positive airway pressure (NCPAP) in preterm infants having their endotracheal tube removed following a period of intermittent positive pressure ventilation (IPPV), leads to an increased proportion remaining free of additional ventilatory support, compared to extubation directly to headbox oxygen.

Methodology:
Search Strategy– Searches were made of the Oxford Database of Perinatal Trials, Medline, abstracts of conferences and symposia proceedings, expert informants, journal hand searching mainly in the English language and expert informant searches in the Japanese language. Selection criteria– All trials utilising random or quasi‐random patient allocation, in which NCPAP (delivered by any method) was compared with headbox oxygen for postextubation care were included. Methodological quality was assessed independently by the two authors. Data collection and analysis– Data were extracted independently by the two authors. Meta‐analysis using event rate ratios (ERRs) and event rate differences (ERDs) was performed using Revman 3.0 statistical software. Prespecified subgroup analysis to determine the impact of different levels of NCPAP and use of aminophylline were also performed using the same package. Similar analysis to investigate the effect of postnatal age on outcomes of interest was also undertaken.

Results: Nasal CPAP, when applied to preterm infants being extubated following IPPV, reduces the incidence of adverse clinical events (apnoea, respiratory acidosis and increased oxygen requirements) indicating the need for additional ventilatory support. This result is both statistically significant and clinically important; ERR, 0.62 (0.49, 0.79) and ERD, – 0.175 (– 0.256, – 0.095). A trend towards reduction in the incidence of oxygen dependency at 28 days of age is also seen in the group extubated to NCPAP; ERR, 0.86 (0.67, 1.10) and ERD, – 0.069 (– 0.177, 0.039).

Conclusions: Nasal CPAP is effective in preventing failure of extubation in preterm infants following a period of endotracheal intubation and IPPV. Further definition of the patient gestational age and weight groups to whom these results apply is required. Optimal levels of NCPAP as well as methods of administration remain to be determined.
Subglottic haemangioma: Controversies in management
Authors: Walker PJ , Cooper D , Macdonald D
Published: March 2003

Objective: To discuss treatment modalities for subglottic haemangioma (SGH).

Methodology: Case report of two children definitively managed by different modalities.

Results: Management by CO2 laser vaporization in one child, and laser followed by interferon 2‐alpha in the second child were both successful in controlling the SGH without the need for tracheostomy.

Conclusions: The stepped‐care approach at John Hunter Children’s Hospital, Newcastle, New South Wales, is presented. Both laser surgery and interferon can help control SGH. Careful surveillance and interdisciplinary cooperation are essential to achieve a good outcome.
Repeated adverse fetal outcome in pregnancy complicated by uncontrolled maternal phenylketonuria
Authors: Kesby GJ
Published: March 2003

Abstract: Phenylketonuria in pregnancy carries with it an increased risk of spontaneous abortion and development of a fetus that is affected by the maternal phenylketonuria syndrome. This syndrome is characterized by low birthweight, congenital heart disease, microcephaly, childhood growth failure, and cognitive impairment. It is the result of the hyperphenylalaninemia that accompanies the phenylketonuric state, and may therefore be avoided by maintaining maternal serum phenylalanine levels within the normal range. Phenylalanine is an essential amino acid and may be controlled by dietary manipulation. Presented here is a case history of a woman with phenylketonuria who was unable to satisfactorily control her serum phenylalanine levels in each of her three pregnancies. All three children were adversely affected by the fetopathy of the maternal phenylketonuria syndrome, each with evidence of growth failure and impaired neurodevelopment. This patient illustrates the difficulties that may be encountered when providing obstetric care to the woman with phenylketonuria who is not able or not willing to restrict her dietary intake of phenylalanine. The discussion includes consideration of management strategies, including dietary therapy and legal intervention.
Sepsis, severe sepsis and septic shock in paediatric multiple organ dysfunction syndrome
Authors: Goh AYT , Chan PWK , Lum LCS
Published: March 2003

Objectives: To determine the association between severity of sepsis with outcome and severity of illness in children with multiple organ dysfunction syndrome (MODS).

Materials: Four hundred and ninety‐five consecutive paediatric intensive care unit (PICU) admissions were analysed. multiple organ dysfunction syndrome was defined as simultaneous dysfunction of ≥ 2 organ system and sepsis by the American College of Chest Physicians and Society of Critical Care Medicine Consensus Conference definition.

Results: Eighty‐four patients developed MODS. The incidence of sepsis, severe sepsis and septic shock in these patients was 10.7%, 23.8% and 17.9%, respectively. Worsening categories of sepsis were associated with: (1) a higher mean admission Paediatric Risk of Mortality (PRISM II): 36.6 Â± 25.9, 56.8 Â± 32.1 and 73.6 Â± 28.5%, respectively (P = 0.005), (2) a larger number of organ dysfunctions: mean MODS index of 37%, 46% and 58%, respectively (P = 0.007), and (3) a higher mortality: 22.2%, 65% and 80%, respectively (P = 0.03).

Conclusion: Presence of sepsis, severe sepsis and septic shock was associated with an increasing severity of illness, increased number of organ dysfunctions and a distinct risk of mortality among critically ill children.
Clinical rhabdomyolysis
Authors: Ng Y‐T , Johnston Hm
Published: March 2003

Abstract: Although rhabdomyolysis is an uncommon disorder, especially in children, it can present as a severe, life‐threatening event. Paediatricians need to be aware of this important, probably underdiagnosed disorder in order to implement appropriate early treatment. In this report, seven children with rhabdomyolysis of both forms, endogenous and exogenous, are presented. Despite comprehensive ‘up‐to‐date’ investigations being performed on paediatric patients with endogenous (often recurrent) rhabdomyolysis, the majority of these patients’ underlying disorders will remain undiagnosed. Overall, these patients usually have a very good prognosis even if repeated, severe life‐threatening episodes occur. It is recommended that a regimen of early therapy with fluids and sodium bicarbonate be instituted in all patients with rhabdomyolysis.
An infant with seizure‐related bradycardia and asystole
Authors: Venugopalan P , Nair PMC , Koul RL
Published: March 2003

Abstract: We describe an infant girl with ictal bradycardia and asystole who died during an episode of seizure, despite anti‐epileptic therapy and permanent cardiac pacemaker implantation. The mechanism of ictal bradycardia and the need to recognize it are therefore discussed. Timely cardiac intervention and adequate anticonvulsant therapy are essential for successful management.
Ethnic comparisons of disease severity in children hospitalized with pneumonia in New Zealand
Authors: Grant CC , Pati A , Tan D , Vogel S , Aickin R , Scragg R
Published: March 2003

Objective: To determine if there are ethnic differences in disease severity in children hospitalized with pneumonia in New Zealand.

Methodology: A population based audit of children hospitalized in Auckland with pneumonia over 12 months from 1 November 1994 to 31 October 1995. The study population was children aged from 0 to 14 years with a discharge diagnosis of pneumonia. The sample was stratified by ethnicity and included 151 Pacific, 85 Mäori and 151 European children. Measurements were made of demographics and prehospital care; vital signs and therapy received in the emergency department and inpatient wards and laboratory investigations performed. Comparisons between the three ethnic groups were adjusted for age, weight, gender, socio‐economic status and relationship with primary care.

Results: A larger proportion of Pacific (15%) and Mäori (22%) children than European children (8%) had a respiratory rate elevated for ≥ 2 days, odds ratio (OR) (95% CI): Pacific versus European 2.7 (1.1, 6.8), Mäori versus European 4.3 (1.7, 11.6). A larger proportion of Pacific (15%) and Mäori (15%) children than European children (< 1%) had a heart rate elevated for ≥ 2 days, OR Pacific versus European 17.2 (3.2, 320), Mäori versus European 26.1 (4.4, 508). Compared with European children, a larger proportion of Pacific and Mäori children received intravenous fluids and antibiotics. A larger proportion of Pacific (29%) and Mäori (27%) children than European children (11%) received oxygen for ≥ 2 days, OR Pacific versus European 3.2 (1.6, 6.6), Mäori versus Europeans 2.6 (1.2, 6.2).

Conclusions: Based on the comparisons of vital signs and intensity of therapy, Pacific and Mäori children hospitalized with pneumonia have more severe pneumonia than European children.
Post‐transfusion white cell count in the sick preterm neonate
Authors: Wright IMR , Skinner AM
Published: March 2003

Objective: A previous report demonstrated post‐transfusion leucocytosis as a potential confounding factor in the diagnosis of sepsis in critically ill adult patients. In We wished to establish if the same phenomenon occurred in the sick preterm neonate and whether this significantly altered the indices considered for potential neonatal infection.

Methodology: Transfusion and full blood count data in a level 3 neonatal intensive care unit were prospectively recorded for 3 months.

Results: One hundred and fourteen transfusion events were recorded from 37 infants. Median white blood cell count increased 0.9 × 109/L (confidence interval (CI) 0.4–2.4) in the first 8 h following transfusion (P = 0.032). Median neutrophil count increased by 0.4 × 109/L (CI 0.1–1.7) in the same 8 h (P = 0.05). Median neutrophil left shift decreased 1.2% (CI 1.1–5.8%) over the 24 h post‐transfusion. No change in band count was observed.

Conclusions: A mild post‐transfusion white cell increase occurs in sick neonates. Because of the magnitude of effect, it is unlikely that this interesting physiological response would interfere with the diagnosis of sepsis in this population.