bluuebunny/crossref_metadata_2025 huggingface dataset:
Provenance of sandstones from the Wakino Subgroup of the Lower Cretaceous Kanmon Group, northern Kyushu, Japan
Authors: Asiedu Daniel K. , Suzuki Shigeyuki , Shibata Tsugio
Published: March 2003

Abstract The Wakino Subgroup is a lower stratigraphic unit of the Lower Cretaceous Kanmon Group. Previous studies on provenance of Wakino sediments have mainly concentrated on either petrography of major framework grains or bulk rock geochemistry of shales. This study addresses the provenance of the Wakino sandstones by integrating the petrographic, bulk rock geochemistry, and mineral chemistry approaches. The proportions of framework grains of the Wakino sandstones suggest derivation from either a single geologically heterogeneous source terrane or multiple source areas. Major source lithologies are granitic rocks and high‐grade metamorphic rocks but notable amounts of detritus were also derived from felsic, intermediate and mafic volcanic rocks, older sedimentary rocks, and ophiolitic rocks. The heavy mineral assemblage include, in order of decreasing abundance: opaque minerals (ilmenite and magnetite with minor rutile), zircon, garnet, chromian spinel, aluminum silicate mineral (probably andalusite), rutile, epidote, tourmaline and pyroxene. Zircon morphology suggests its derivation from granitic rocks. Chemistry of chromian spinel indicates that the chromian spinel grains were derived from the ultramafic cumulate member of an ophiolite suite. Garnet and ilmenite chemistry suggests their derivation from metamorphic rocks of the epidote‐amphibolite to upper amphibolite facies though other source rocks cannot be discounted entirely. Major and trace element data for the Wakino sediments suggest their derivation from igneous and/or metamorphic rocks of felsic composition. The major element compositions suggest that the type of tectonic environment was of an active continental margin. The trace element data indicate that the sediments were derived from crustal rocks with a minor contribution from mantle‐derived rocks. The trace element data further suggest that recycled sedimentary rocks are not major contributors of detritus. It appears that the granitic and metamorphic rocks of the Precambrian Ryongnam Massif in South Korea were the major contributors of detritus to the Wakino basin. A minor but significant amount of detritus was derived from the basement rocks of the Akiyoshi and Sangun Terrane. The chromian spinel appears to have been derived from a missing terrane though the ultramafic rocks in the Ogcheon Belt cannot be discounted.
Prograde pressure–temperature records from inclusions in zircons from ultrahigh‐pressure–high‐pressure rocks of the Kokchetav Massif, northern Kazakhstan
Authors: Katayama I. , Zayachkovsky A. A. , Maruyama S.
Published: March 2003

Abstract In the first extensive, systematic study of inclusions in zircons from ultrahigh‐pressure (UHP) and high‐pressure (HP) metamorphic rocks of the Kokchetav Massif of Kazakhstan (separated from 232 rock samples from all representative lithologies and geographic regions), we identified graphite, quartz, garnet, phengite, phlogopite, rutile, albite, K‐feldspar, amphibole, zoisite, kyanite, calcite, dolomite, apatite, monazite, omphacite and jadeite, as well as the diagnostic UHP metamorphic minerals (i.e. microdiamond and coesite) by laser Raman spectroscopy. In some instances, coesite + quartz and diamond + graphite occur together in a single rock sample, and inclusion aggregates also comprise polycrystalline diamond crystals overgrowing graphite. Secondary electron microscope and cathodoluminescence studies reveal that many zircons display distinct zonation textures, which comprise core and wide mantle, each with distinctive inclusion microassemblages. Pre‐UHP metamorphic minerals such as graphite, quartz, phengite and apatite are common in the core, whereas diamond, coesite, garnet and jadeite occupy the mantle. The inclusions in core are irrelevant to the UHP metamorphism. The zircon core is of detrital or relatively low‐grade metamorphic origin, whereas the mantle is of HP to UHP metamorphic origin. The zonal arrangement of inclusions and the presence of coesite and diamond without back‐reaction imply that aqueous fluids were low to absent within the zircons during both prograde and retrograde metamorphism, and that the zircon preserves a prograde pressure–temperature record of the Kokchetav metamorphism which, elsewhere, has been more or less obliterated in the host rock.
Diamond growth during ultrahigh‐pressure metamorphism of the Kokchetav Massif, northern Kazakhstan
Authors: De Corte K. , Korsakov A. , Taylor W. R. , Cartigny P. , Ader M. , De Paepe P.
Published: March 2003

Abstract Characteristic features of in situ diamonds can be used to retrace diamond formation during ultrahigh pressure (UHP) metamorphism of the Kokchetav Massif, Kazakhstan. These features include the nitrogen aggregation state in diamond, dissolution features observed on diamond surfaces, and the carbon and nitrogen isotopic composition of the diamonds. The minerals in which the diamonds are included provide additional information and support the view that at least some of the Kokchetav microdiamonds are the products of prograde or peak UHP metamorphism. The coexistence of diamond and graphite is evaluated within this framework.
40Ar–39Ar analysis of phlogopite in the Horoman Peridotite Complex, Hokkaido, Japan and implications for its origin
Authors: Kaneoka Ichiro , Takahashi Natsuko , Arai Shoji
Published: March 2003

Abstract 40Ar–39Ar analysis of phlogopite separated from a plagioclase lherzolite of the Horoman Peridotite Complex, Hokkaido, Japan, has yielded a plateau age of 20.6 ± 0.5 Ma in an environment where the metamorphic fluid was characterized by an almost atmospheric Ar isotopic ratio. The age spectrum is slightly saddle‐shaped, implying some incorporation of excess 40Ar during the formation of the phlogopite at a depth. As the phlogopite has been inferred to have formed in veins and/or interstitials during exhumation of the peridotite body, metasomatic fluids, to which ground‐ and sea water might have contributed, were probably involved in the formation of phlogopite in the crustal environment. A total 40Ar–39Ar age of 129 Ma of a whole rock sample of the plagioclase lherzolite, from which the phlogopite was separated and is representative of the main lithology of the Horoman Peridotite Complex, indicates the occurrence of excess 40Ar. Hence, the age has no geological meaning.
High‐resolution seismic stratigraphy of the Yamato Basin, Japan Sea and its geological application
Authors: Thu Moe Kyaw , Tamaki Kensaku , Kuramoto Shin‐Ichi , Tada Ryuji , Saito Saneatsu
Published: March 2003

Abstract High‐resolution seismic stratigraphy of the Yamato Basin, Japan Sea, was successfully established using core‐log‐seismic data integration. The construction of synthetic seismograms by the combination of physical properties and well‐log data from the Ocean Drilling Program (ODP) Site 797 was the key to accomplishing the high‐resolution seismic stratigraphy. To achieve resolution comparable with well‐log data and core lithology, single channel seismic reflection data taken from ODP underway geophysics were reprocessed, and then carefully compared with synthetic seismogram, core and well log profiles to identify seismic units. Ten seismic stratigraphic units were identified at the site, and seismic stratigraphic interpretation was successfully extended from the site to the nearby area along the Yamato Basin margin. The opal‐A/opal‐CT (biogenic silica/metastable diagenetic silica) boundary has different appearances at places from strong to weak, and mostly discontinuous. One of the significant results achieved from this study is clear distinction of the opal‐A/CT boundary from a very strong reflector, which appears at 22 m below the opal‐A/CT boundary. Through well‐log and physical properties characterization of the different units, resistivity was found to be the best indicator of diatom content and with gamma‐ray it also is an indicator of chert layers in the opal‐CT zone. Velocity is not greatly effected by diatom ooze in the opal‐A zone, however, it shows strong peaks and has an indirect relationship with gamma‐ray in the opal‐CT zone. Finally, successful correlation of Gamma‐ray Attenuation Porosity Evaluator density and resistivity peaks with strong seismic reflectors from upper and lower stratified layers may provide new information on the late Neogene paleoceanography of the Japan Sea in high‐resolution scale.
Epidemiology and prophylaxis of viral hepatitis:A global perspective
Authors: POOVORAWAN YONG , CHATCHATEE PANTIPA , CHONGSRISAWAT VORANUSH
Published: March 2003

Background

Viral hepatitis with various forms of acute and chronic liver disease as potential and ultimately fatal sequelae presents a public health problem worldwide.

Methods

Recent published reports on the global epidemiology and prophylaxis of viral hepatitis were reviewed.

Results

With the advances in novel technologies, eight distinct types of hepatitis virus have been described: Hepatitis A, B, C, D, E, G, TT and SEN viruses. Hepatitis A and E viruses are transmitted by the fecal‐oral route and do not induce a chronic carrier state. Due to major changes in epidemiology of hepatitis A virus their significance is more pronounced in areas of intermediate endemicity. Since the available hepatitis A vaccine is rather expensive, cost‐benefit studies should be performed with emphasis on the area under consideration or specialized vulnerable groups. Parenterally transmitted hepatitis B and C viruses are major causes of chronic liver disease, including cirrhosis, hepatocellular carcinoma and end‐stage liver failure. Hepatitis D virus is unable to replicate on its own, it requires an established hepatitis B virus infection to be able to replicate. Since its introduction, hepatitis B vaccine has been widely used leading to a significant decrease in HBV infection in countries with universal vaccination. Hepatitis G and TT viruses have been characterized within the latter part of the past decade but their significance as to the causation of human liver disease has yet to be elucidated. Likewise, the precise impact of the most recently described SEN virus isolated from patients with post‐transfusion hepatitis awaits further studies.

Conclusions

In the course of this review, we present the situation and focus on research activities emphasizing epidemiology and prevention of the various forms of viral hepatitis.
Management of YMDD mutations during lamivudine therapy in patients with chronic hepatitis B
Authors: LIAW YUN‐FAN
Published: March 2003

Abstract  Lamivudine is a nuleoside analog with potent inhibitory effects on hepatitis B virus (HBV) replication. Prolonged therapy is required for sustained suppression. However, HBV species with mutations in the tyrosine‐methionine‐aspartate‐aspartate (YMDD) locus of the HBV‐RNA‐dependent DNA polymerase confering resistance to lamivudine may emerge after 6–9 months therapy with an incidence of 38% and 67% after 2 and 4 years of lamivudine therapy, respectively. During continued lamivudine therapy, patients with YMDD mutant HBV usually show serum alanine aminotransferase (ALT) and HBV‐DNA elevations at lower median levels than their baseline. Marked flare of serum ALT or acute exacerbation may occurred as the results of cytotoxic T lymphocyte mediated immune response directed against YMDD mutant. Although viral clearance with or without emergence of distinct lamivudine resistant mutants may occur after such exacerbations, 20% of the exacerbations are complicated with decompensation or even fatality. The exacerbations appear to be more severe than those occur during the natural course of wild type HBV chronic infection. The current practice of continuing lamivudine therapy, therefore, requires careful evaluation. Alternatives include interferon therapy but this seems ineffective. Adefovir dipivoxil and entecavir may effectively suppress the YMDD mutant but these treatments have not yet been available for use. Recent studies have shown no benefit to continuing lamivudine therapy in patients with YMDD mutantions. Before a rescue drug becomes available, the most cost‐effective strategy is to select patients with stronger endogenous anti‐HBV immunity to increase efficacy and to shorten the duration of lamivudine therapy to avoid the emergence of YMDD mutations.

© 2002 Blackwell Publishing Asia Pty Ltd
Evidence‐based medicine in the treatment of hepatocellular carcinoma
Authors: LLOVET JOSEP M
Published: March 2003

Abstract The incidence of hepatocellular carcinoma is increasing worldwide. Diagnosis at early stage is crucial to allow the application of curative treatments, that are the sole hope to increase their life expectancy. Surgical resection and liver transplantation are considered the first line options for early tumors, although there is no agreement on which is the best treatment approach. Resection achieves excellent results in patients with single tumors, absence of portal hypertension and normal bilirubin, but is limited by the high recurrence rate. Liver transplantation also achieves excellent results in patients with single tumors smaller than 5 cm or even three nodules smaller than 3 cm. However, this procedure is hampered by the shortage of donors and the increasing waiting times that have reduced their intention‐to‐treat outcomes. Treatment while waiting for a donor is controversial, but radical antitumoral therapies seem cost‐effective in long waiting times. Percutaneous therapies are reserved for patients with single non‐surgical tumors. More than 60 randomized clinical trials have been published to assess treatments for patients with advanced tumors, but there is no definitive evidence of survival benefits. A recent randomized trial reported that chemoembolization may benefit HCC patients in terms of survival, but additional studies to confirm this data are recommended.

© 2002 Blackwell Publishing Asia Pty Ltd
Molecular characterization of hepatitis B virus surface antigen mutants in Singapore patients with hepatocellular carcinoma and hepatitis B virus carriers negative for HBsAg but positive for anti‐HBs and anti‐HBc
Authors: OON *CHONG JIN , CHEN WEI NING , GOH KEE TAI , MESENAS STEVEN , NG HAN SEONG , CHIANG GILBERT , TAN CLARENCE , KOH SHIUAN , TENG SIAW WEI , TOH IVY , MOH MEI CHUNG , GOO KIAN SIM , TAN KAELING , LEONG AI LIN , TAN GEK SAN
Published: March 2003

Background

and Aims
: Mutations on the a‐determinant of hepatitis B virus surface antigen (HBsAg), capable of escaping detection and vaccination, are identified in HBsAg‐positive/anti‐HBs‐positive vaccinated infants. We studied the prevalence of these mutants in HBsAg‐negative/anti‐HBc‐positive chronic HBV carriers and patients with hepatocellular carcinoma (HCC).

Methods
: DNA sequence coding for the antigenic a‐determinant of HBsAg was amplified from either HCC genomic DNA or serum samples of the selected patients and sequenced. The replicative mutant genomes were reconstituted in vitro and their reactivity to commercial kits measured.

Results
: Mutations within and/or outside the a‐determinant were identified in patients seronegative for HBsAg. They were then reconstituted in vitro and transiently transfected into HepG2 cells. Culture medium containing secreted HBV viral particles was collected and assayed for their binding to commercial kits. Drastic decrease of reactivity to these kits was seen with most of the identified mutations, including those located outside the a‐determinant.

Conclusion
: The existence of a more complex antigenic structure of HBsAg is indicated by the decreased reactivity to detection of mutations, some of which are outside the a‐determinant, escape vaccination and may persist in seronegative patients. The high proportion of HBsAg mutants that are integrated in HCC genomes suggests a role of these mutants in hepatocarcinogenesis, possibly leading to mutant HBV‐related HCC.

© 2002 Blackwell Publishing Asia Pty Ltd
Comparing the treatment outcomes of endoscopic papillary dilation and endoscopic sphincterotomy for removal of bile duct stones
Authors: Ochi Yasuhide , Mukawa Kenji , Kiyosawa Kendo , Akamatsu Taiji
Published: March 2003

To compare the clinical usefulness of endoscopic papillary dilation (EPD) and endoscopic sphincterotomy (EST) for removal of bile duct stones, 110 patients with stones up to 15 mm in diameter and less than 10 in number were randomly treated with either EPD (55 patients) or EST (55 patients). The patients were followed up for a median period of 23 months and endoscopic manometry with the administration of morphine was carried out in 17 patients who were observed more than 12 months after the procedures to evaluate the post‐procedure papillary function. Duct clearance was achieved in 51 EPD (92.7%) and 54 EST patients (98.1%, not significantly different). Forty EPD (78.4%) and 51 EST patients (94.4%) achieved duct clearance in the initial procedure (P = 0.02). Early complications occurred in one EPD (2.0%) and in three EST patients (5.6%, P = 0.62). Complications during the follow‐up period occurred in two EPD and eight EST patients. Recurrence of bile duct stones was observed in two EPD and three EST patients (P = 0.98). Acute cholecystitis was observed in one EPD and five EST patients (P = 0.06) and among patients with gall‐bladder stones in situ, the rate of acute cholecystitis after EPD was significantly lower than that after EST (P = 0.03). Endoscopic manometry showed the existence of a choledochoduodenal pressure gradient only after EPD, while papillary contractile function was observed after both procedures. In conclusion, both EPD and EST are safe therapeutic modalities, although EPD is more clinically effective in decreasing the risk of acute cholecystitis in patients with gall‐bladder stones in situ and in preserving post‐procedure papillary function.
CASE REPORT: Reactive lymphoid hyperplasia of liver coexisting with chronic thyroiditis: Radiographical characteristics of the disorder
Authors: Nagano Kenichi , Fukuda Yoshihide , Nakano Isao , Katano Yoshiaki , Toyoda Hidenori , Nonami Toshiaki , Nagasaka Tetsurou , Hayakawa Tetsuo
Published: March 2003

Background: Reactive lymphoid hyperplasia of the liver is an extremely rare entity, with six cases reported so far.

Methods: We encountered a 47‐year‐old Japanese female with reactive lymphoid hyperplasia of the liver, which coexisted with chronic thyroiditis. The lesion was discovered incidentally as a hypo‐echoic mass with a hyper‐echoic rim at a routine ultrasonography examination. It increased from 12 to 17 mm diameter in 6 months. Radiological studies, such as contrast‐enhanced computerized tomography (CT) and angiography demonstrated a hypervascular lesion.

Results: It was consequently diagnosed as a neoplasm with malignant potentiality and she underwent partial hepatectomy. The lesion was composed of small mature lymphocytes which formed prominent lymphoid follicles with germinal centres, scattered plasma cells and stromal fibrosis. Immunohistochemical study revealed polyclonal origins of the involved lymphocytes. DNA analysis for the immunoglobulin heavy gene and the T cell receptor beta gene using Southern blot hybridization showed no monoclonality. The following features have characterized the images in past cases, as well as ours: hypo‐echoic mass, occasionally with a rim, in ultrasonography and hypervascularity, shown by angiography and enhanced CT.
Differential Helicobacter pylori infection rates in two contrasting gastric cancer risk regions of South China
Authors: Wong BCY , Lam SK , Ching CK , Hu WHC , Kwok E , Ho J , Yuen ST , Gao Z , Chen JS , Lai KC , Ong LY , Chen BW , Wang WH , Jiang XW , Hou XH , Lu JY ,   THE CHINA GASTRIC CANCER STUDY GROUP
Published: March 2003

Background: Carriers of Helicobacter pylori are believed to have a three‐ to six‐fold increased risk of developing gastric cancer. We have recently conducted a simultaneous cross‐sectional population study on the prevalence of H. pylori infection in a cohort of asymptomatic adult volunteers in two contrasting gastric cancer risk regions of South China, Hong Kong and Changle of Fujian. Their mean annual gastric cancer mortality has been approximately 7.5 and 75/100 000 population, respectively, since the beginning of the last decade. The aim of this study was to evaluate if H. pylori prevalence bears any relationship to gastric cancer mortality rates in these two southern regions of China.

Methods: Sera were obtained from 397 volunteers in Hong Kong. They were tested for anti‐H.pylori immunoglobulin (Ig) G antibody by using a commercial enzyme‐linked immunosorbent assay (ELISA) kit. Volunteers of Changle (1456) had upper endoscopy examination and were also tested for anti‐H. pylori IgG antibody by the same ELISA method.

Results: The overall H. pylori infection prevalence was significantly higher in Changle (80.4%) than in Hong Kong (58.4%; P < 0.01). The high prevalence is associated with more atrophic gastritis. The overall risk of gastric cancer in people of Changle is approximately five‐fold that of Hong Kong (adjusted odds ratio 4.9, 95% CI 2.5–9.8).

Conclusions: It is concluded that the prevalence of H. pylori infection rates bear a direct relationship to gastric cancer mortality rates in these two southern regions of China. Thus, H. pylori most likely plays a significant aetiopathogenetic role in gastric carcinogenesis in subjects living in Changle.
Interrelationships of alcohol and iron in liver disease with particular reference to the iron‐binding proteins, ferritin and transferrin
Authors: Fletcher Linda , Halliday June , Powell Lawrie
Published: March 2003

It is known that the regular consumption of alcohol is responsible for the disruption of normal iron metabolism in humans, resulting in the excess deposition of iron in the liver in approximately one‐third of alcoholic subjects. The mechanisms involved are largely unknown; however, it is likely that the two major proteins of iron metabolism, ferritin and transferrin are intimately involved in the process. Tissue damage in alcoholic liver disease and the inherited iron‐overload disease, haemochromatosis, are caused by excess alcohol and iron, respectively. The mechanisms of this damage are believed to be similar in both disease conditions and involve free radical‐mediated toxicity. A high proportion of haemochromatosis sufferers consume excessive amounts of alcohol and synergistic hepatotoxic events may occur leading to the earlier development of liver cirrhosis. This review describes briefly the role of ferritin and transferrin in normal iron metabolism and in iron overload disease and explores the possible involvement of these proteins in the pathophysiology of excess iron deposition in alcoholic subjects.
Analysis of adhesion molecules in patients with idiopathic portal hypertension
Authors: Yamaguchi Naoko , Tokushige Katsutoshi , Haruta Ikuko , Yamauchi Katsumi , Hayashi Naoaki
Published: March 2003

Background: The aetiology of idiopathic portal hypertension (IPH) is unknown. However, some evidence of immunological abnormalities in IPH patients has been reported.

Methods: As adhesion molecules are important in the interaction between lymphocytes and accessory and target cells, the expression and release of the soluble form of vascular cell adhesion molecule‐1 (VCAM‐1) and intercellular adhesion molecule (ICAM‐1) were examined in this study.

Results: In IPH patients, the serum level of soluble VCAM‐1 was found to be increased, compared with that of healthy subjects, fatty liver patients and chronic hepatitis patients. The level of soluble ICAM‐1 of IPH patients was found to be slightly increased, compared with that of healthy subjects; however, it was not different from the level in patients with other diseases. The expression of VCAM‐1 was observed in the sinusoidal lining cells and endothelial cells around the liver vessels of several IPH patients. In contrast, ICAM‐1 was weakly expressed in sinusoidal lining cells and hepatocytes in the liver tissue of only one of four IPH patients.

Conclusions: This differential pattern of VCAM‐1 and ICAM‐1 was found in IPH patients and it was suggested that VCAM‐1 might be an important molecule in the occurrence of IPH.
A sclerosant with astringent properties developed in China for oesophageal varices: Comparison with ethanolamine oleate and polidocanol
Authors: Nishida Ryuichi , Inoue Ryoichi , Takimoto Yukinobu , Kita Toru
Published: March 2003

Background: Xiao zhi ling (XZL), which consists of Chinese nutgalls and aluminium potassium sulphate, is used as a local injection for the treatment of internal haemorrhoids in China. It is also used for endoscopic sclerotherapy of oesophageal varices. To date, however, it has not been compared with other sclerosants with regard to its safety and efficacy.

Methods: In the present study, the effect on the endothelium and the haemolytic and thrombosing effects of XZL were compared with those of 5% ethanolamine oleate and 1% polidocanol, using an endothelial cell line and red blood cells taken from rats and the dorsal marginal ear vein of rabbits. In addition, XZL was injected into the area surrounding varices in rats and its efficacy was studied endoscopically and histologically.

Results: Xiao zhi ling reduced the size of varices in rats after causing severe damage in the injected region. Compared with the other two sclerosants, however, XZL had little effect on the endothelium and was the least haemolytic compound. Furthermore, XZL did not cause thrombosis in the injected vein of a rabbit.

Conclusions: These results suggest that XZL is another type of sclerosant with astringent rather than detergent properties. This compound should be used to treat oesophageal varices by paravariceal injection in smaller doses than 5% ethanolamine oleate and 1% polidocanol.
Relationship between asthma and gastro‐oesophageal reflux: Significance of endoscopic grade of reflux oesophagitis in adult asthmatics
Authors: Nakase Hiroshi , Itani Toshinao , Mimura Jun , Kawasaki Toshihiko , Komori Hideshi , Tomioka Hiromi , Chiba Tsutomu
Published: March 2003

Background: The association between asthma and gastro‐oesophageal reflux disease (GERD) is well known. The aim of this study was to elucidate the causal relationship between reflux oesophagitis (RE) and asthma.

Methods: Seventy‐two adult asthmatics were examined regarding their GERD symptoms, and each underwent an endoscopic examination. According to the Los Angeles classification, we divided the patients into three groups: group 1 (n = 52), no mucosal break; group 2 (n = 15), RE corresponding to grades A or B; group 3 (n = 5), RE corresponding to grades C or D. The asthmatics in groups 2 and 3 received anti‐reflux treatment for their GERD for 8 weeks. Their morning and evening peak expiratory flow rates (PEFR), daily variability of the PEFR and daily use of an inhalation bronchodilator were compared before and after this treatment.

Results: The percentage of severe asthma and postprandial exacerbation of asthma in group 3 were significantly higher than those in the other two groups. In contrast, the number of eosinophiles and the serum level of immunoglobulin E in group 3 were significantly lower than those in the other two groups. After the antireflux treatment, significant improvements of both PEFR and daily use of the inhalation bronchodilator were observed only in group 3.

Conclusions: The endoscopic severity of RE is associated with the characteristics of adult asthmatics and the treatment of severe RE improved the asthmatics’ condition.
Helicobacter pylori and extra‐digestive diseases
Authors: Tsang Kenneth W , Lam Shiu‐Kum
Published: March 2003

Helicobacter pylori is a recently rediscovered Gram‐negative bacteria that causes peptic ulcer disease, gastric lymphoma and gastric carcinoma. Helicobacter pylori achieves its pathogenetic role by triggering an intense leucocyte infiltration of the gastric submucosa which is mediated by proinflammatory cytokines. This pathogenetic mechanism is common to many other diseases and, therefore, Helicobacter pylori seroprevalence has also been investigated in other diseases. It is now known that H. pylori seropositivity is associated with an increasing number of cardiovascular, respiratory, extra‐gastroduodenal digestive, neurological, skin, autoimmune, growth and miscellaneous disorders. Although the precise role for H. pylori is unknown in these diseases, it is of tremendous interest to most clinicians and scientists as H. pylori is amenable to eradication therapy using simple and reliable drug regimens. The conditions associated with H. pylori seropositivity are highlighted in this concise article.
Peripheral cholangiocarcinoma (cholangiocellular carcinoma): Clinical features, diagnosis and treatment
Authors: Chen Miin‐Fu
Published: March 2003

Peripheral cholangiocarcinoma is a relatively rare cancer. However, it is known to have an unfavourable prognosis compared with that of hepatocellular carcinoma. Little is known about its aetiology, clinical or pathological features. Recently, with the development of imaging modalities, early staged cholangiocarcinoma has been diagnosed with relative ease. Surgery is the optimal therapy. Total hepatectomy does not provide survival benefit. Conventional surgery remains the only effective treatment, even for patients with advanced‐stage tumours. Factors influencing survival after hepatectomy were tumour‐free margin, lymphnodes metastasis and histopathology of tumour. Palliative intrahepatic tubing or percutaneous transhepatic biliary drainage and brachytherapy can alleviate jaundice and cholangitis, thereby prolonging survival in some cases.

© 1999 Blackwell Science Asia Pty Ltd
Medium‐chain triglycerides modulate ileitis induced by trinitrobenzene sulfonic acid
Authors: Tsujikawa Tomoyuki , Ohta Noriyasu , Nakamura Tsuyoshi , Satoh Jin , Uda Katsuhiro , Ihara Takashi , Okamoto Toshihiko , Araki Yoshio , Andoh Akira , Sasaki Masaya , Fujiyama Yoshihide , Bamba Tadao
Published: March 2003

Background
: It is important to develop an appropriate animal model for further investigation into inflammatory bowel disease (IBD). We therefore investigated a trinitrobenzene sulfonic acid (TNBS) ileitis model. Dietary fat in Crohn’s disease is still a controversial risk factor for IBD. We therefore also studied the effects of medium‐chain triglycerides (MCT) and long‐chain triglycerides (LCT) on TNBS ileitis.

Methods and Results
: An intraileal injection of TNBS induced ulceration and inflammation with thickening of the intestinal wall, which were characterized histologically by infiltration of polymorphic nuclear leucocytes and by granuloma formation. The mucosal damage score and serum sialic acid levels reached their highest 7 days after the TNBS injection and then gradually decreased. The mucosal damage series in the MCT group was significantly lower than in the LCT group, and levels of tumour necrosis factor‐α (TNF‐α) and leukotriene B4 (LTB4) tended to be lower in the MCT group.

Conclusions
: These results suggested that TNBS enteritis might be useful as an IBD animal model and that MCT modulates intestinal inflammation and is less damaging than LCT.

© 1999 Blackwell Science Asia Pty Ltd
Helicobacter pylori infection occurs via close contact with infected individuals in early childhood
Authors: Miyaji Hideki , Azuma Takeshi , Ito Shigeji , Abe Yoshimichi , Gejyo Fumitake , Hashimoto Norikazu , Sugimoto Hidehiro , Suto Hiroyuki , Ito Yoshiyuki , Yamazaki Yukinao , Kohli Yoshihiro , Kuriyama Masaru
Published: March 2003

Background
: The manner in which Helicobacter pylori is transmitted is of fundamental importance when considering strategies for its control, yet, to date, the exact mode of transmission remains uncertain.

Methods
: The seroprevalence of H. pylori in a relatively isolated rural town in Japan (A‐town) was examined to analyse the H. pylori infection route. The immunoglobulin G antibodies against H. pylori in 1684 subjects who had received public health examinations in A‐town were determined with an enzyme‐linked immunosorbent assay. The seroprevalence was compared in five areas according to the water source. The possibility and frequency of intrafamilial infection was analysed by comparing the seroprevalence among family members residing in the same home.

Results
: The seroprevalence of H. pylori did not differ significantly between the five areas examined. Seropositivity was significantly more common in the children whose mothers were seropositive (45.0%, 27/60) than in the children whose mothers were seronegative (10.0%, 2/20; odds ratio (OR) = 7.36, P = 0.0036, 95% confidence interval (CI) = 1.57–34.59). Seropositivity was significantly more common in the children whose older siblings were seropositive (55.0%, 22/40) than in the children whose older siblings were seronegative (23.5%, 20/85; OR = 3.97, P = 0.00051, 95% CI = 1.79–8.84). There was no significant relationship in seroprevalence between children and fathers, grandchildren and grandfathers, grandchildren and grandmothers, or within couples. Seropositivity was significantly more common in the adolescents who had attended a nursery school (44.4%, 20/45) than in the adolescents who had not attended a nursery school (25.6%, 109/426) (OR = 2.33, P = 0.0070, 95% CI = 1.24–4.36).

Conclusions
: The acquisition of H. pylori infection occurs by close contact with infected individuals in early childhood, especially via contact with infected mothers and other infected children.

© 2000 Blackwell Science Asia Pty Ltd
Prevalence of enteric pathogens among community based asymptomatic individuals
Authors: Hellard Margaret E , Sinclair Martha I , Hogg Geoffrey G , Fairley Christopher K
Published: March 2003

Background and Aims
: The objective of this study was to describe the prevalence of pathogenic microorganisms in asymptomatic individuals in a community study in Melbourne, Australia.

Methods
: The study population was a subset of 2803 individuals participating in the Water Quality Study; a community based randomized trial. Faecal specimens (1091) were collected over a 3‐month period from asymptomatic individuals. Specimens were tested for a range of bacteria including Salmonella, Shigella and Campylobacter species. Rotavirus and adenovirus were detected using a Rota‐Adeno latex kit, and protozoa were detected using a permanent stain (modified iron‐haemotoxylin).

Results
: Twenty‐eight known pathogens were identified from the 1091 faecal specimens, a total carriage rate of 2.6%. Giardia species were present in 18 specimens (1.6%), Salmonella in four (0.4%), Campylobacter in one (0.1%), Cryptosporidium in four (0.4%) and adenovirus in one (0.1%). Blastocystis hominis was found in 65 specimens. The median age of those without a pathogen was 12.5 years compared with 6.6 years for those with a pathogen (P = 0.02).

Conclusions
: Except for Giardia, pathogens were rarely found in asymptomatic individuals in the community. The prevalence of pathogens was higher in children than adults.

© 2000 Blackwell Science Asia Pty Ltd
Public health challenges in hepatitis C virus infection
Authors: Kaldor John M , Dore Gregory J , Correll Patricia Kl
Published: March 2003

The discovery a decade ago of the hepatitis C virus (HCV) led to control of post‐transfusion hepatitis in many countries, but raised a number of further questions about the transmission and epidemiological distribution of the newly discovered virus. In some countries, the diagnosis of HCV infection has been designated as a notifiable condition, with doctors (or laboratories, or both) required to send case reports to public health authorities. Such case reports of HCV diagnosis are inevitably biased towards people with symptomatic presentations or a known history of exposure, or those who undergo screening for other purposes, such as blood transfusion. Another approach has been the use of serological prevalence surveys either making use of blood that had been taken or tested for other purposes or recruiting specific population groups for the explicit purpose of measuring HCV prevalence. A limited number of surveys have either attempted to obtain true random samples of geographically defined populations, or recruited subjects, such as pregnant women, who may be considered to be broadly representative of the wider population. Injecting drug use is clearly the main mode of HCV transmission in countries that have established comprehensive blood screening, and it remains a major public health challenge. Although mother‐to‐child transmission is known to occur with a frequency of about 7% there is no proven means of prevention and very little is known about the long‐term consequences of maternally transmitted infection. The conclusion from a number of somewhat conflicting studies is probably that HCV infection should not be viewed as a sexually transmissible infection from the perspective of population health strategies. However, people with HCV infection and their sexual partners should minimize the extent of blood contact that may occur through sexual activity.
Sustained response to combination therapy in a patient with chronic hepatitis C and thrombocytopenia secondary to α‐interferon
Authors: Jiménez‐Sáenz Manuel , Rojas María , Piñar Angel , Salas Ernesto , Rebollo Jaime , Carmona Isabel , Herrerías‐Esteban Juan Manuel , Herrerías‐Gutiérrez Juan Manuel
Published: March 2003

Recent data suggest that hepatitis C viral (HCV) infection may induce a significant autoimmune reaction to platelets, but the mechanism is unknown. Many patients with chronic hepatitis C, in fact, have high levels of platelet‐associated immunoglobulin G (PAIgG) and HCV‐RNA is present in the platelets of 100% of those patients with thrombocytopenia and high PAIgG levels. Hepatitis C virus infection has been associated with the development of thrombocytopenic purpura, sometimes triggered during interferon (IFN) therapy. In such cases, the treatment of the underlying disease is a difficult problem to solve. We report the case of a patient with chronic hepatitis C, who developed life‐threatening thrombocytopenic purpura after a prolonged course of IFN‐α2b over a 4‐year period. Treatment with anti‐immunoglobulin gammaglobulin (Polyglobin®; Química Farmaceutica Bayer, Barcelona, Spain) had a transient effect on the platelet count, but prolonged therapy with prednisone was necessary for definitive relief of the haematological complication. Two years later, the patient was treated with combined therapy, including ribavirin (1200 mg/day) and IFN‐α2b (5 mU, t.i.w.) for 12 months. This therapy induced a sustained response, both biochemical and virological, without haematological complications. This observation suggests that ribavirin may be of benefit in the treatment of immune‐mediated thrombocytopenia in patients with chronic hepatitis C, preventing the harmful effect of IFN‐α but also allowing both drugs to be combined so as to increase the probability of sustained remission of the liver disease.
Surgery for gastric carcinoma in patients more than 85 years of age
Authors: Otani Yoshihide , Kubota Tetsuro , Kumai Koichiro , Ohgami Masahiro , Hayashi Noritaka , Ishikawa Yoichiro , Wada Norihito , Kitajima Masaki
Published: March 2003

Background
: The incidence of gastric carcinoma is increasing in elderly patients. It has not been determined whether surgery improves the quality of life or prolongs survival in patients older than 85 years. This study was designed to evaluate surgery as a treatment option in patients more than 85 years of age.

Methods
: The records of 18 patients aged 85 to 91 years (mean 87.3 years), who underwent surgery for gastric carcinoma between 1983 and 1997 were analysed.

Results
: Three patients had multiple lesions. A total of 21 lesions were examined. Operative procedures included distal gastrectomy (n = 12), total gastrectomy (n = 4), proximal gastrectomy (n = 1), and laparoscopic wedge resection (n = 1). Perigastric lymphadenectomy was performed in 15 patients. No lymph node dissection was performed in three patients. Postoperative complications, including delirium, respiratory dysfunction, cardiac dysfunction, anastomotic leakage, bleeding, and ileus, occurred in 11 patients. There were two hospital deaths in patients who underwent emergency surgery. Survival was neither shortened nor prolonged by surgery as determined by life table analysis.

Conclusions
: Surgical treatment should not be avoided based solely on the age of the patient, and quality of life in this population may be improved by surgery. Careful patient selection should include an assessment of the will to live.
Risk of gastric cancer is not increased after partial gastrectomy
Authors: Bassily R , Smallwood Ra , Crotty B
Published: March 2003

Background
: It has been suggested that there is an increased risk of gastric cancer following partial gastrectomy. This question has not been studied in an Australian population.

Methods
: The records of a total of 569 patients who had a partial gastrectomy for peptic ulcer disease at Repatriation General Hospital, Heidelberg, between 1957 and 1976 were reviewed. All were followed to date of death or 31 December 1996. The expected rate of gastric cancer for this population was estimated from published Australian age‐and sex‐specific gastric cancer mortality rates over this period, and a standardized incidence ratio was calculated.

Results
: The mean age at surgery was 53.5 years (range 27–83 years). There were 547 male (96.4%) and 22 female (3.6%) patients. Five hundred and seven (83.5%) had a Billroth II procedure. Thirty‐eight patients (6.3%) were lost to follow up and were not included in the analysis. From the records of the Department of Veterans’ Affairs, it was established that 125 (20.6%) were alive in December 1996, a mean survival after surgery of 18.8 years. The mean documented duration of follow up was 17.3 years (range 1–41 years). Nine patients developed cancer in the gastric remnant. The expected number of cancers in this population was 6.5. Assuming all survivors were free of gastric cancer, the standardized incidence ratio was 1.39 (95% confidence intervals 0.64–2.65, P = 0.313).

Conclusion
: The risk of gastric cancer was not increased after partial gastrectomy in this Australian population.
Racial differences in the prevalence of ulcerative colitis and Crohn’s disease in Singapore
Authors: Lee Ym , Fock Km , See Sj , Ng Tm , Khor C , Teo Ek
Published: March 2003

Background
: The aim of this study was to determine the prevalence rates of inflammatory bowel disease in the different races in Singapore.

Methods
: The patients studied consisted of 58 people with an established diagnosis of ulcerative colitis (UC) and Crohn’s disease (CD) as determined by a combination of clinical, radiological, endoscopic and histological criteria. The patients were residents of a well‐defined geographical area in the northern part of Singapore and had been referred to the single regional hospital. Epidemiological data including sex, age, ethnicity, family history and disease type and extent were collected from case records and patient interviews.

Results
: There were 37 UC and 21 CD patients. Of the patients with UC, 67.5% were Chinese, 13.5% were Malay and 19% were Indian. The CD group consisted of 81% Chinese, 9.5% Malay and 9.5% Indian patients. The study population from which the patients were drawn was approximately 0.5 million in size.

Conclusions
: The overall prevalence of UC was 6 per 100 000 and of CD was 3.6 per 100 000 in Singapore. There were disproportionately more Indians suffering from UC, with a prevalence of 16.2 per 100 000 in comparison with six per 100 000 for Chinese and seven per 100 000 for Malays. The relative risk of UC in Indians is 2.9‐fold greater than for the Chinese (CI = 1.25–6.7) which was statistically significant. This trend was not seen for CD.
Pancreatic cancer
Authors: Brennan Murray F
Published: March 2003

Abstract The incidence of pancreatic adenocarcinoma in the USA remains stable. Advances in management are confined to more accurate preoperative diagnosis and staging, and decreased operative mortality. Long‐term survival in the absence of resection remains poor.
Asian perspectives on viral hepatitis: Hepatitis C virus infection
Authors: Mccaughan Geoffrey W
Published: March 2003

Abstract Hepatitis C virus (HCV) infection is widespread throughout Asia. Unusual features of HCV in Asia include a novel genotype distribution with a significant representation of 3a. This is particularly important as genotype 3 is very sensitive to interferon‐based therapies. A major concern in the Asian region is the high prevalence of hepatocellular cancer complicating HCV‐associated cirrhosis, particularly in Japan. Finally, liver transplantation for advanced HCV infection with cirrhosis is an option via cadaveric and living donor programmes.
Clinical features and etiology of hepatocellular carcinoma arising in patients with membranous obstruction of the inferior vena cava: In reference to hepatitis viral infection
Authors: Matsui Shigeru , Ichida Takafumi , Watanabe Masashi , Sugitani Soichi , Suda Tsuyoshi , Takahashi Toru , Asakura Hitoshi
Published: March 2003

Abstract Background and Aims: Budd–Chiari syndrome (BCS) comprises hepatic vein thrombosis and inferior vena cava (IVC) obstruction known as membranous obstruction of the IVC (MOVC). The latter is frequently complicated by hepatocellular carcinoma (HCC). The etiology of MOVC‐associated HCC in relation to hepatitis viral infection is not known. In this study, we investigated the clinical features and etiology of HCC in MOVC.

Methods: Membranous obstruction of IVC and HCC were diagnosed and studied by using imaging techniques. Sera from patients with MOVC, complicated by HCC, were examined for hepatitis viral antigens and antibodies (hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti‐HBs), antibody to hepatitis B core antigen (anti‐HBc) and third generation antibody to hepatitis C virus (anti‐HCV)) and for hepatitis viral nucleic acids (hepatitis B virus (HBV)‐DNA, hepatitis C virus (HCV)‐RNA, hepatitis G virus (HGV)‐RNA and TT virus DNA).

Results: We studied 12 patients with BCS who were seen between April 1968 and February 1999. All of them had MOVC. Hepatocellular carcinoma developed in three (25%) of them. There were no obvious differences in the clinical features and imaging findings concerning MOVC between patients with and without HCC. Hepatocellular carcinoma in these three patients showed no clear trend in clinical features and imaging findings. Of the hepatitis viral markers examined, HBsAg, anti‐HBc and HBV‐DNA were positive in only one of three patients with HCC and all of the viral markers were negative in the other two patients.

Conclusions: Chronic congestion in the liver, caused by an outflow block of hepatic veins and subsequent histopathologic change, must have led to HCC in two patients without any hepatitis viral markers. Patients with MOVC should be followed closely as a high‐risk group for HCC.
Botulinum toxin for achalasia in children
Authors: Ip Kin Sing , Cameron Donald Js , Catto‐Smith Anthony G , Hardikar Winita
Published: March 2003

Abstract Background: Injection of botulinum toxin (BTx) into the lower esophageal sphincter (LES) of adult patients with achalasia results in the effective relief of symptoms. The aim of the present study was to examine the effectiveness of BTx in pediatric patients suffering from achalasia.

Methods: Seven patients suffering from achalasia with or without prior treatment were treated with intrasphincteric injection of BTx. The median duration of follow up was 15 months.

Results: All seven patients improved. The median interval before recurrence of symptoms was 4 months (range 1–14 months). There was an inverse relationship between the pretreatment LES pressure and the duration of response (r = –0.6). The mean pretreatment LES pressure in the subgroup with a response greater than 6 months was 38 ± 10 mmHg compared with 61 ± 12 mmHg in the other four patients (P = 0.05). All seven patients required retreatment.

Conclusion: Botulinum toxin is effective in relieving symptoms in pediatric patients suffering from achalasia, producing a sustained response beyond 6 months in 43% of patients.