bluuebunny/crossref_metadata_2025 huggingface dataset:
Duodenal tuberculosis with a choledocho‐duodenal fistula
Authors: Miyamoto Shin‐Ichi , Furuse Junji , Maru Yasushi , Tajiri Hisao , Muto Manabu , Yoshino Masahiro
Published: March 2003

Abstract A 22‐year‐old man visited our hospital (National Cancer Center Hospital East) complaining of fatigue and anorexia. A laboratory investigation demonstrated a biochemical ‘picture’ of obstructive jaundice. An abdominal CT showed a low density mass in the retropancreatic area with multiple enlarged periportal lymph nodes. Upper gastrointestinal endoscopy revealed active ulceration on the dorsal wall of the descending part of the duodenum, and histopathology of the biopsy specimen revealed an ulcer with reactive inflammatory cell infiltration; no tumor cells were detected. The possibility of neoplasm had been ruled out by the use of CT and angiography. The jaundice recovered spontaneously and the abdominal mass gradually decreased in size. Endoscopic retrograde pancreatography showed no evidence of pancreatic disease; however, endoscopic retrograde cholangiography showed a choledocho‐duodenal fistula. This patient showed hypersensitivity against the tuberculin skin test and Mycobacterium tuberculosis was successfully detected in gastric juice by using a polymerase chain reaction method and culture. Biopsy samples obtained from the duodenal ulcer at the second upper gastrointestinal endoscopy showed chronic inflammation with an epithelioid granuloma, suggesting tuberculosis. We thus diagnosed this case as a duodenal tuberculosis with a choledocho‐duodenal fistula. To the best of our knowledge, there has been no report available of duodenal tuberculosis being the cause of a choledocho‐duodenal fistula.

© 2001 Blackwell Science Asia Pty Ltd
Importance of achieving complete necrosis during the first treatment for hepatocellular carcinoma to prevent bone metastasis: A prospective study
Authors: Iwata Mitsuhiro , Kaneko Shuichi , Terasaki Shuichi , Matsushita Eiki , Urabe Takeshi , Kobayashi Kenichi , Matsui Osamu
Published: March 2003

Background and Aims: Recent advances in the treatment of hepatocellular carcinoma (HCC) have changed the importance of bone metastasis during the follow up of such patients. In the present study, we investigated risk factors for bone metastasis after treatment for HCC.

Methods: Two hundred and two patients with HCC were diagnosed as free of bone metastasis by technecium 99m‐methylene diphosphonate bone scintigraphy and were followed prospectively after treatment of the primary lesions (follow‐up period 2–146 months; median 20 months). We statistically analyzed the risk factors for bone metastasis using the clinical characteristics at the time of first treatment.

Results: Multiple tumors (P < 0.005), main tumor size > 5 cm in diameter (P < 0.005), the presence of distant metastasis (P < 0.005), elevation of serum α‐fetoprotein (> 100 ng/mL; P < 0.05), chemotherapy (P < 0.05) and insufficient therapeutic response (P < 0.0005) were identified as risk factors for bone metastasis by univariate analyses. Insufficient therapeutic response and main tumor size > 5 cm in diameter (both P < 0.05) were identified as independent predisposing factors for bone metastasis.

Conclusions: Complete necrosis of primary HCC during the first treatment is important to prevent subsequent bone metastasis.
Use of ursodeoxycholic acid in liver diseases
Authors: Kumar Dinesh , Tandon Rakesh K
Published: March 2003

Abstract Ursodeoxycholic acid is currently the only established drug for the treatment of chronic cholestatic liver diseases. It has cytoprotective, anti‐apoptotic, membrane stabilizing, anti‐oxidative and immunomodulatory effects. Prolonged administration of ursodeoxycholic acid in patients with primary biliary cirrhosis (PBC) is associated with survival benefit and a delaying of liver transplantation. There is evidence that it might even prevent progression of the histologic stage of PBC. It also has a beneficial effect on primary sclerosing cholangitis, intrahepatic cholestasis of pregnancy, liver disease associated with cystic fibrosis, chronic graft versus host disease, total parenteral nutrition associated cholestasis and various pediatric cholestatic liver diseases. In the present review the current knowledge about the mechanisms of the action and role of ursodeoxycholic acid in the treatment of various liver diseases has been discussed.
Kinetics of the hepatitis C virus during interferon therapy as a marker of therapeutic response
Authors: Nakamuta Makoto , Fukutomi Takayoshi , Shimohashi Naoya , Kinukawa Naoko , Uchimura Koutaro , Tada Seiya , Motomura Kenta , Enjoji Munechika , Kato Masaki , Iwamoto Hiroaki , Tanabe Yuichi , Imari Yasuhisa , Sakamoto Shigeru , Sakai Hironori , Nawata Hajime
Published: March 2003

Background: The viral load and subtype of hepatitis C virus (HCV) are predictors of the efficacy of interferon (IFN) therapy. The kinetics of HCV during IFN therapy have been described recently, suggesting that HCV infection is highly dynamic. These observations have raised the issue as to whether early monitoring of the viral load can help guide IFN therapy.

Methods: We measured HCV‐RNA levels at 0, 24 and 48 h after the start of IFN‐α treatment (10 MU daily for 2 weeks and then three times weekly for 22 weeks) or IFN‐β treatment (6 MU daily for 6 weeks). Then we analyzed the relationship between HCV kinetics and therapeutic response using stepwise multivariate logistic regression analysis.

Results: The exponential decay slope of the viral load during the first 24 h, not the first 48 h or the next 24 h, was a predictor of viral eradication at 6 months after completion of the treatment (sustained response; P = 0.0023). This decay slope was not affected by the HCV serotype or the type of IFN used. Initial viral load and HCV serotype were also predictors, as reported previously (P < 0.0001 and P = 0.0347, respectively). We also proposed a model using a prognostic index that predicted a sustained response with more than 80% sensitivity, specificity and efficacy in an independent and external group of patients.

Conclusion: This study demonstrated that the exponential decay slope of the viral load during the first 24 h was an important predictor of the response to IFN therapy as well as the initial viral load and HCV serotype. The model may also be useful for the clinical management of IFN therapy.
Basaloid‐squamous cell carcinoma of the esophagus: Diagnosis based on immunohistochemical analysis
Authors: Nishimura Wataru , Naomoto Yoshio , Hamaya Kazuo , Toda Satoshi , Miyagi Koji , Tanaka Noriaki
Published: March 2003

Abstract Basaloid‐squamous cell carcinoma of the esophagus (BSCC) is an extremely rare tumor. Histologically, this tumor should be differentiated from adenoid cystic carcinoma (ACC) and small cell undifferentiated carcinoma (SCUC). Biologically, this tumor is very aggressive, with a propensity for distant metastasis. We report a 64‐year‐old male with esophageal BSCC. The patient complained of dysphagia and was found to have a torous lesion in the esophagus on radiological examination. Upper gastrointestinal fiberscopy showed a localized ulcerative type tumor, which was diagnosed as squamous cell carcinoma (SCC) on biopsy. Surgery resulted in curative resection. A histological examination of the resected tumor showed features of BSCC. Immunohistochemical examination demonstrated AE3/1‐ and CAM 5.2‐positive tumor cells, and laminin‐positive cells in the periphery of the nests. These data were useful in differentiating this tumor from ACC and SCUC. Six months after surgery, the patient developed hepatic metastases, which were successfully treated by regional chemotherapy via the hepatic artery by using fluorouracil. The patient is currently being followed up at the outpatient clinic and shows no signs of any recurrence.
Fecal occult blood and flexible sigmoidoscopy screening for colorectal cancer: Modeling the impact on colonoscopy requirements and cancer detection rates
Authors: Olynyk John K , Platell Cameron F , Collett Judith A
Published: March 2003

Aim: The aim of this study was to estimate the colonoscopy requirements and the likely impact of fecal occult blood and flexible sigmoidoscopy screening on the detection of colorectal cancer by using previously published data.

Methods: Fecal occult blood and flexible sigmoidoscopy screening programs were applied to the 2.04 million subjects aged 50–65 years, at a participation rate of 40%. The following strategies were evaluated: Fecal occult blood testing with colonoscopy follow up of all positive tests; flexible sigmoidoscopy with colonoscopy follow up of all adenomatous polyps; and flexible sigmoidoscopy with colonoscopy follow up of all adenomatous polyps > 10 mm in size.

Results: The fecal occult blood program detected 5.6% of all colorectal cancer cases at a rate of 2914 colonoscopies/percentage of detection of colorectal cancer. The flexible sigmoidoscopy program detected 14% of all colorectal cancer cases at a rate of 8160 colonoscopies/percentage of detection of colorectal cancer. The flexible sigmoidoscopy program with follow up of adenomatous polyps > 10 mm in size detected 13% of all colorectal cancer cases at a rate of 1230 colonoscopies/percentage of detection of colorectal cancer.

Conclusions: Flexible sigmoidoscopy screening followed by colonoscopic follow up of adenomatous polyps > 10 mm in size is the most efficient screening strategy in terms of colonoscopies generated and cases of colorectal cancer detected.
Chronic narcotic use in inflammatory bowel disease patients: Prevalence and clinical characteristics
Authors: Edwards John T , Radford‐Smith Graham L , Florin Timothy HJ
Published: March 2003

Background:

Narcotic addiction can be a significant problem in inflammatory bowel disease (IBD). However, there are few published reports about this problem.

Methods:

All patients prescribed narcotics chronically in the absence of demonstrable organic pathology were identified on the computerized Brisbane IBD Research Group database (n = 332 patients with informative data as of 1 January 1999). Individual case records were reviewed with regard to clinical, psychiatric and social characteristics of these patients, and the prevalence of psychiatric disorders were compared with a control group of IBD patients.

Results:

Eleven patients were identified. Nine had complete datasets, eight with Crohn’s disease (CD), of which six had previous stricturing ileal disease, and one patient had ulcerative colitis, making a prevalence of 2.7% of IBD patients and 5.1% of CD patients. A 67% prevalence of a psychiatric disorder in narcotic users was significantly greater than the 8% prevalence in the control group of IBD patients (odds ratio 22, 95% CI 3.24–177).

Conclusions:

A significant proportion of IBD patients without demonstrable organic pathology were chronic narcotic users. Psychiatric disorders are common in this subgroup, as with chronic functional abdominal pain syndromes. It is suggested that inappropriate narcotic use in IBD patients can be reduced by appreciating that narcotics are a temporary therapy only for IBD patients, and awareness of pre‐existing social and psychiatric disorders, which not only impact on clinical presentation of pain, but also help define the subgroup of patients who are at risk of narcotic misuse.
Spatio‐temporal expression of trefoil peptide following severe gastric ulceration in the rat implicates it in late‐stage repair processes
Authors: Ulaganathan Meera , Familari Mary , Yeomans Neville D , Giraud Andrew S , Cook Gregory A
Published: March 2003

Background: The trefoil peptide (TFF1) is a member of a family of mucin‐associated regulatory peptides that are widely distributed in gastrointestinal tissues and have been implicated in the maintenance of the gastric mucosa. The role of TFF1 in gastric mucosal repair was examined by analysis of the spatio‐temporal expression of TFF1 following gastric ulceration in the rat.

Methods: Gastric ulcers were induced in rats by application of glacial acetic acid to the serosa of the fundus. At various time points post injury (0–28 days), macroscopic and microscopic examination of the gastric mucosa was performed. In addition, the spatio‐temporal expression of TFF1 protein and proliferating cell nuclear antigen were identified by immunohistochemistry, TFF1 message by in situ hybridization, and acidic/neutral secreting mucins by Alcian blue‐periodic acid–Schiff staining.

Results: In normal rat gastric tissue, TFF1 peptide and mRNA were expressed in mucosal cells of the superficial epithelium. Trefoil peptide and mRNA were significantly induced between 4 and 28 days post ulceration, with expression extending beyond the superficial epithelium and being localized to acidic mucin‐producing cells deep within the repairing mucosa.

Conclusions: Spatio‐temporal expression of TFF1 mRNA and peptide following macroscopic repair implicates TFF1 as a potential mediator of late stage‐repair processes. Whether this is through direct stimulation of cellular differentiation or the enhancement of mucosal protective properties through an interaction with gastric mucins remains to be elucidated.
Profile of hepatocellular carcinoma in India: An insight into the possible etiologic associations
Authors: Sarin Shiv Kumar , Thakur Varsha , Guptan Rajkumar C , Saigal Sanjeev , Malhotra Veena , Thyagarajan Sadras P , Das Bhudev C
Published: March 2003

Background:

Several etiologic factors including hepatitis viruses, alcohol and aflatoxin have been implicated in the pathogenesis of hepatocellular carcinoma (HCC). There is, however, limited information from the Indian subcontinent.

Methods:

Seventy‐four consecutive cases of HCC were studied. A detailed history, tests for hepatitis B virus (HBV; HBsAg, HBeAg, anti‐HBe, IgG anti‐HBc, anti‐HBs and HBV‐DNA), hepatitis C virus (HCV; anti‐HCV and HCV‐RNA) infection, liver histopathology and HBV‐DNA integration by using Southern blot hybridization were studied. A p53 gene mutation was also studied by using PCR and single‐strand conformation polymorphism.

Results:

Hepatocellular carcinoma patients were predominantly males (mean age 49.5 ± 14.0 years). Portal hypertension and cirrhosis were seen in 56 (76%) patients, more often (P < 0.05) in viral marker positive cases. Forty‐five percent of patients had features of hepatic decompensation at presentation. Evidence of HBV infection was present in 53 (71%) patients. Twenty‐six (49%) of these patients had either HBeAg + ve, HBV‐DNA + ve (n = 12), or HBsAg – ve, HBV‐DNA + ve (n = 14) forms of HBV infection. Hepatitis B virus DNA integration in the liver tissue was seen in 10 of 17 (59%) patients. Infection with HCV alone was detected in three (4%) and dual HBV and HCV infection in six (8%) patients. A majority (78.5%) of the chronic alcoholics had associated viral infection. The etiology of HCC remained undetermined in 15 (20%) patients. The p53 gene mutations were detected only in three of 21 (14%) liver tissues. Aflatoxin toxicity, oral contraceptive use or metabolic disorder were not seen.

Conclusions:

In India: (i) HBV infection is the predominant factor for the development of HCC, often related to mutant forms of HBV; (ii) a majority of the HCC patients have overt cirrhosis of the liver; and (iii) HCV and alcohol per se are uncommonly associated.
Relationship among gastric motility, autonomic activity, and portal hemodynamics in patients with liver cirrhosis
Authors: Miyajima Hitoshi , Nomura Masahiro , Muguruma Naoki , Okahisa Toshiya , Shibata Hiroshi , Okamura Seisuke , Honda Hirohito , Shimizu Ichiro , Harada Masafumi , Saito Ken , Nakaya Yutaka , Ito Susumu
Published: March 2003

Background and Aims:

We examined the effects of the autonomic nervous function and the volume of portal blood flow to clarify the mechanism of the abnormal gastric motility in patients with liver cirrhosis.

Methods:

Heart rate variability, electrogastrogram (EGG), and volume of portal blood flow were measured before and after a meal in 27 patients with liver cirrhosis (LC group) and in 20 normal subjects (N group). Autonomic nervous function was evaluated by using spectral analysis of heart rate variability. We used the cine phase‐contrast (PC) method, using magnetic resonance imaging (MRI) to measure the portal flow, while the peak frequency and spectral power of the EGG were measured at pre‐ and postprandial change.

Results:

The ratio of low frequency power to high frequency power (LF/HF) was significantly higher, and the HF power was significantly lower in the LC group than in the N group both before and after a meal. In both groups, the electrogastrographic peak power ratio before and after a meal showed a positive correlation with the HF ratio, and an inverse correlation with the LF/HF ratio. In addition, portal blood flow volume was significantly decreased in the LC group than in the N group. However, the increased rate of portal blood flow after a meal correlated positively with the increased rate of electrogastrographic peak power. Moreover, gastric motility was positively correlated with esophageal varices and coma scale with the use of multivariate analysis.

Conclusions:

Parasympathetic hypofunction, sympathetic hyperfunction and portal hemodynamics were closely related with gastric motility in cirrhotic patients. In addition, gastric motility was decreased, at least in part, by the ingestion of food in cirrhotic patients because of abnormalities in autonomic functions and portal blood flow following a meal.
Helicobacter pylori alters n‐6 fatty acid metabolism and prostaglandin E2 synthesis in rat gastric mucosal cells
Authors: Nakaya Atsuko , Wakabayashi Hiroyuki , Imamura Lisa , Fukuta Kanako , Makimoto Shinya , Naganuma Kotaro , Orihara Tadahiro , Minemura Masami , Shimizu Yukihiro , Nagasawa Tetsuro , Hamazaki Tomohito , Watanabe Akiharu
Published: March 2003

Background and Aims:

Little is known about whether Helicobacter pylori infection alters fatty acid metabolism in gastric mucosal cells. By using cultured rat gastric mucosal cells (RGM‐1), we investigated the effect of H. pylori broth culture filtrates on this point. Furthermore, our study aimed to find out whether n‐6 long chain polyunsaturated fatty acids from linoleic acid are formed in RGM‐1 cells.

Methods:

Rat gastric mucosal cells were incubated with 10, 20 and 40 μg/mL of linoleic acid or medium alone. Phosphatidylcholine content extracted from whole RGM‐1 cells was quantitated by using a densitometer, and its fatty acid composition was analyzed by using gas chromatography. Prostaglandin E2 concentration in the culture medium was measured by using radioimmunoassay. The expression of cyclooxygenase (COX)‐1 and COX‐2 was examined by using reverse transcription–polymerase chain reaction. In addition, after incubation with [1‐14C] linoleic acid, radioactivities of both linoleic acid and arachidonic acid components of the PC fraction were counted. The effects of H. pylori broth culture filtrates on PC content, its fatty acid composition and prostaglandin (PG)E2 synthesis were also assessed.

Results:

Linoleic acid addition caused an increase in the composition of arachidonic acid, as well as linoleic acid, and also in PGE2 concentration. Cyclo‐oxygenase‐2 expression was induced in RGM‐1 cells by the addition of linoleic acid. In addition, [1‐14C] linoleic acid added to the culture medium was converted to [1‐14C] arachidonic acid in RGM‐1 cells. Helicobacter pylori broth culture filtrates decreased linoleic acid composition and increased arachidonic acid composition. Moreover, after incubation with H. pylori broth culture filtrates, PGE2 concentrations were higher than that of the controls.

Conclusions:

These findings suggest the presence of fatty acid elongase and Δ5‐ and Δ6‐desaturases synthesize arachidonic acid from linoleic acid in RGM‐1 cells. Thus, H. pylori infection may enhance PGE2 synthesis and accelerate n‐6 fatty acid metabolism in gastric mucosal cells, which could make the gastric mucosal barrier more fragile.
Seroepidemiological study of Helicobacter pylori infection in asymptomatic people in South Korea
Authors: Kim Jin Ho , Kim Hak Yang , Kim Na Young , Kim Sang Woo , Kim Jae Gyu , Kim Jae Jun , Roe Im Hwan , Seo Jeong Kee , Sim Jae Geon , Ahn Hyoengsik , Yoon Byung Chul , Lee Sang Woo , Lee Yong Chan , Chung In Sik , Jung Hwoon Yong , Hong Weon Seon , Choi Kyoo Wan
Published: March 2003

Abstract Background: Helicobacter pylori infection occurs throughout the world and causes gastroduodenal diseases in all age groups. The prevalence of H. pylori infection varies between countries and races. The aim of this study was to evaluate the seroprevalence of H. pylori infection in asymptomatic healthy people in South Korea.

Methods: From March 1998 to October 1998, 5732 asymptomatic subjects who responded to the self‐assessment questionnaires from 54 hospitals in South Korea were enrolled in this study. The serum levels of antibodies for H. pylori immunoglobulinG were measured by using an ELISA test.

Results: The overall seroprevalence of H. pylori infection was 46.6% and there was no statistical difference between males (47.2%) and females (45.9%). In adults, a significant difference was observed between genders. According to the geographic areas, the high prevalent provinces were Kangwon (53.4%), Cheju (52.9%) and Cholla province (50.6%); Seoul (41.9%) was the lowest prevalent area. The seroprevalence increased with age and was highest when patients were aged in their 40s (78.5%). The characteristic feature of our study was that the infection rate was steeply increased in three age groups (10–12 year olds, 16–19 year olds and those aged in their 20s). In Seoul, there was no difference in the prevalence rate among the districts studied.

Conclusions: This nation‐wide seroprevalence of H. pylori infection in South Korea was 46.6%, which showed the transition from a developing country to a developed country. More studies on the epidemiological factors and the route of transmission of H. pylori infection should be warranted.
Novel murine autoimmune‐mediated liver disease model induced by graft‐versus‐host reaction and concanavalin A
Authors: Unno Rie , Matsuzaki Yasushi , Itoh Shinichi , Doy Mikio , Shoda Junichi , Tanaka Naomi
Published: March 2003

Background and Aims: We have previously reported that cluster of differentiation (CD)4+ T cells induced autoimmune liver diseases in mice with graft‐versus‐host reaction (GVHR) because of major histocompatibility complex (MHC) class II disparity. To analyze the progression of the autoimmune‐related mechanism in the liver, concanavalin A (Con A) was injected in mice undergoing GVHR. The aim of this study is to clarify whether Con A deteriorates murine hepatic lesions induced by GVHR, and to elucidate the participation of the cytokines of liver‐infiltrating CD4+ T cells.

Methods: Mice (F1; B6.C‐H‐2bm12× B6) were intravenously injected with B6 T spleen cells. Concanavalin A (15 mg/kg) was administrated 5 days after cell transfer. We examined serum transaminase, antimitochondrial antibodies (AMA), antinuclear antibodies (ANA) and histological changes. Liver‐infiltrating CD4+ T cells were sorted and their cytokine mRNA expression was examined by the use of reverse transcription–polymerase chain reaction (RT‐PCR).

Results: Graft‐versus‐host reaction + Con A mice revealed an elevated serum transaminase, elevated AMA and ANA titers, increased periportal cellular infiltration, piecemeal necrosis and bridging necrosis in the liver. In this group, interferon (IFN)‐γ mRNA expression was more elevated than it was in the GVHR mice. However, there was no difference in the expression of interleukin (IL)‐10 mRNA between the two groups.

Conclusion: The results suggest that Con A deteriorates the GVHR‐induced hepatic lesions, and IFN‐γ and IL‐10 of CD4+ T cells might be implicated in the progression of autoimmune‐related hepatic lesions. This model might offer an aspect for the investigation of progressive mechanisms in T‐cell‐ mediated hepatobiliary injury.
Analysis of hepatocellular carcinoma tumor growth detected in sustained responders to interferon in patients with chronic hepatitis C1
Authors: Toyoda Hidenori , Kumada Takashi , Honda Takashi , Hayashi Kazuhiko , Katano Yoshiaki , Nakano Isao , Hayakawa Tetsuo , Fukuda Yoshihide
Published: March 2003

Background: By analyzing a tumor growth of hepatocellular carcinoma (HCC) detected in sustained responders (SR) to interferon (IFN) therapy for chronic hepatitis C, we sought to determine the duration of follow up in SR that would be sufficient to detect HCC. In addition, we sought to elucidate the presence of HCC, which truly developed after the eradication of hepatitis C virus (de novo HCC development).

Methods: Tumor volume doubling time (DT) was calculated in a total of 46 cases of HCC detected in SR after IFN therapy. Based on DT, the annual growth rate was estimated for each tumor. Survival was compared between patients with HCC ≤ 30 mm and patients with HCC > 30 mm in diameter.

Results: Doubling time in SR was similar to the previously reported DT of HCC irrespective of IFN therapy. However, extensive DT was observed in three HCCs despite relatively poor differentiation, which may represent de novo HCC development. In the analysis of tumor growth, all HCCs grew to exceed 20 mm in estimated diameter between 6 months and 7 years after the end of IFN therapy. Better survival was observed in patients with HCC ≤ 30 mm in diameter compared with patients with HCC > 30 mm (P = 0.0107). In surviving patients, recurrences of HCC were very infrequent.

Conclusions: We may be able to detect most HCC in SR between 6 months and 7 years after IFN therapy. However, we cannot neglect the presence of de novo HCC development after the eradication of HCV, which makes it difficult to determine completely sufficient follow‐up duration after IFN therapy in this population.
Four response stages of capsaicin‐sensitive primary afferent neurons to capsaicin and its analog: Gastric acid secretion, gastric mucosal damage and protection
Authors: Mózsik Gyula , Vincze Áron , Szolcsányi János
Published: March 2003

Abstract Capsaicin is the active component of red hot peppers, which modifies specifically the capsaicin‐sensitive sensory afferent nerves. The action of capsaicin is an initial short‐lasting stimulation, which is followed by desensitization to capsaicin itself, and to other stimuli of afferent sensory nerves. Four response stages of capsaicin‐sensitive primary afferents exist to capsaicin, depending on the dose and duration of exposure to the drug. These are excitation, a sensory blocking effect, long‐term selective neurotoxic impairment, and irreversible cell destruction. The possible roles of four stages of capsaicin‐sensitive primary afferents can be evaluated in relation to gastric acid secretion, and to the details of the defensive side of gastric mucosa against different chemicals, physical agents, drugs and other pathological stress. Capsaicin inhibited the gastric acid secretion in pylorus‐ligated rats when it was given intragastrically at a dose of 0.4–1.8 μg/kg. Small doses of capsaicin (up to 800 μg, i.g.) produced a dose‐dependent inhibition (ID50 = 400 μg), and its inhibitory effect was exerted for 1 h in healthy human subjects. While a small dose (5 μg/kg) of capsaicin caused inhibition, a high dose (50–100 mg/kg) enhanced the gastric mucosal lesions productivity by causing hyperacidity in pylorus‐ligated animals. Capsaicin and its analog inhibited the development of different chemically induced gastric mucosal damage in various experimental models if they were given intragastric doses (μg/kg). The final effects of capsaicin depend on the dosage and timing. The different effects are excitation, a sensory‐blocking effect, long‐term selective neurotoxic impairment and irreversible cell destruction.
Alcoholic liver disease: A clinical series in an Australian private practice
Authors: Hourigan Kevin J , Bowling Francis G
Published: March 2003

Background and Aim: The published literature on alcoholic liver disease (ALD) in Australia lacks a large clinical series out of private practice as distinct from hospital‐based hepatology referral units. This series describes the presentation and clinical features of ALD in a consecutive series out of metropolitan private practice in Australia.

Methods: A retrospective descriptive study by case‐note review found 297 cases of ALD at a Brisbane practice over 20 years. The main outcome measures were: clinical features and stage at presentation, reasons for referral, and the predictive value of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio.

Results: Most patients (57.9%) had no symptoms of liver disease and 29 patients (9.8%) had neither symptoms nor signs. Cirrhosis was found in 41% of patients and hepatitis‐fibrosis was found in 26% of patients. The male to female (M : F) ratio was 4.7:1. The AST/ALT ratio was not reliably predictive of ALD stage. The average reported daily alcohol intake was 131 g. Females drank less on average and presented a more vigorous clinical picture.

Conclusions: This series presents the spectrum of ALD in a metropolitan Australian private practice. Many patients are asymptomatic on presentation. All heavy drinkers should be targeted for early investigation without waiting for volunteered symptoms or abnormal physical signs. The male to female ratio in ALD is higher than hitherto reported. The AST/ALT ratio is not generally applicable in the staging of ALD. The differences from hospital series data suggest the demography and epidemiology of ALD in Australia are incomplete, and further study is warranted.
Comparison of clinicopathological features of patients with hepatocellular carcinoma seropositive for α‐fetoprotein alone and those seropositive for des‐γ‐carboxy prothrombin alone1
Authors: Okuda Hiroaki , Nakanishi Toshimi , Takatsu Kazuko , Saito Akiko , Hayashi Naoaki , Yamamoto Masakazu , Takasaki Ken , Nakano Masayuki
Published: March 2003

Background:

There has been no comparative study of the clinicopathological features of HCC patients who are seropositive for α‐fetoprotein (AFP) alone and those who are seropositive for des‐γ‐carboxy prothrombin (DCP) alone. The authors, thus, performed this comparative study.

Methods:

The clinicopathological features of patients with solitary hepatocellular carcinoma (HCC), who underwent a hepatectomy were compared among the four below groups according to the seropositivity of AFP and DCP: group A, seronegative for both AFP below 20 ng/mL and DCP below 40 mAU/mL; group B, seropositive for AFP above 100 ng/mL and seronegative for DCP; group C, seronegative for AFP and seropositive for DCP above 100 mAU/mL; and group D, seropositive for both AFP and DCP.

Results:

Group B patients showed a higher incidence of HCC with an indistinct margin, and a somewhat higher incidence of small HCC less than 2 cm in greatest dimension compared with group C patients. By contrast, group C patients had a higher frequency of HCC with a distinct margin compared with that of an indistinct margin, large tumors more than 3 cm compared with that of small tumors less than 2 cm, and a somewhat higher frequency of moderately to poorly differentiated HCC compared with that of well‐differentiated HCC. Our HCC cases showed advanced clinicopathological features in the order of group C, group B and group A. Groups C and D patients showed similar characteristics.

Conclusions:

Hepatocellular carcinoma patients who were seropositive for AFP alone demonstrated clinicopathological features of less advanced HCC compared with those who were seropositive for DCP alone.
Long‐term outcome of autoimmune hepatitis in children
Authors: Saadah Omar I , Smith Arnold L , Hardikar Winita
Published: March 2003

Background and Aim:

Autoimmune hepatitis (AIH) is a chronic disease of unknown etiology, which usually progresses to cirrhosis if not diagnosed and treated promptly. Data on long‐term follow up in children with AIH are scant. The aim of this study is to assess the long‐term outcome of autoimmune hepatitis in children with respect to clinical and laboratory features at presentation.

Methods:

Data were extracted from the medical records of patients presenting over a 28‐year period (1972–2000) to the Royal Children’s Hospital, Melbourne, Australia. Additional information was obtained by interviewing patients, and their current physicians. Of the 30 patients (22 females, mean age 9 years) identified, 18 had type I, three had type II, four had autoimmune–polyendocrinopathy syndrome type 1, one had infantile giant‐cell hepatitis associated with Coomb’s‐positive hemolytic anemia, and four were seronegative (antinuclear antibody (ANA), smooth muscle antibody (SMA) and liver–kidney microsomal antibody (LKM)).

Results:

Clinical features at presentation included hepatomegaly (86%), jaundice (66%) and splenomegaly (50%). Initial investigations revealed a median serum bilirubin level of 55 μmol/L (range 6–425), median aspartate aminotransferase level of 678 IU (range 70–2548), and abnormal clotting in 33% of patients. Liver biopsies were performed on all patients at presentation and 11 showed cirrhosis (36%). The mean follow‐up period was 10.0 ± 7.8 years with 43% being followed for > 10 years. Only two patients died and one required transplantation. Fourteen (50%) patients continue to be on low dose prednisolone with azathioprine, two (7%) are on prednisolone alone, and six (21%) are on no therapy. When the cirrhotic and non‐cirrhotic patients were compared, the albumin level at presentation was significantly lower in the cirrhotic group (P = 0.01). Of the patients who were cirrhotic at presentation, six (54%) remain compensated with a mean follow‐up period of 8 years. All 24 patients currently under follow up are engaged in age‐appropriate activities including school, part‐ or full‐time work.

Conclusion:

Autoimmune hepatitis has a favorable long‐term outcome with a transplant‐free survival rate of 90% over a mean period of 10.0 ± 7.8 years (range: 0.5–23), and a normal or near‐normal lifestyle irrespective of presenting clinical, laboratory or histological features.
Predominant nocturnal acid reflux in patients with Los Angeles grade C and D reflux esophagitis
Authors: Adachi Kyoichi , Fujishiro Hirofumi , Katsube Tomoko , Yuki Mika , Ono Masahiro , Kawamura Akira , Rumi Mohammad Azharul Karim , Watanabe Makoto , Kinoshita Yoshikazu
Published: March 2003

Background and Aims:

Nocturnal gastric acid breakthrough (NAB) is defined as an intragastric pH < 4.0 lasting more than 1 h during the night in patients taking a proton pump inhibitor (PPI). Gastroesophageal reflux disease (GERD) patients with nocturnal gastroesophageal acid reflux accompanied by NAB are thought to be refractory to PPI treatment. The aim of this study was to endoscopically identify the patients with predominant nocturnal gastroesophageal acid reflux.

Methods:

The subjects were 37 patients with erosive reflux esophagitis (Los Angeles classification (LA) grade A, 12; B, 10; C, eight; and D, seven cases) and a control group of 20 patients without esophagitis. The results of ambulatory 24 h gastric and esophageal pH monitoring were compared among different grades of esophagitis.

Results:

Gastroesophageal reflux during 24 h in patients with high‐grade esophagitis was more frequent than for patients with low‐grade esophagitis or no esophagitis. Although the length of esophageal acid exposure (percentage time with pH < 4.0) in patients with grade A or without esophagitis was longer in the daytime, that in patients with grades C and D was longer during the night. The reason for the delayed nocturnal acid exposure was the longer nocturnal acid clearance in high‐grade reflux esophagitis.

Conclusions:

Nocturnal exposure of the esophagus to acid occurs frequently in patients with LA grades C and D esophagitis. Thus, the existence of NAB with resulting nocturnal acid reflux should be considered when the patient with high‐grade esophagitis shows resistance to PPI treatment.
Spatial distribution and histogenesis of colorectal Paneth cell metaplasia in idiopathic inflammatory bowel disease
Authors: Tanaka Masanori , Saito Hiroshi , Kusumi Tomomi , Fukuda Shinsaku , Shimoyama Tadashi , Sasaki Yoshihiro , Suto Koji , Munakata Akihiro , Kudo Hajime
Published: March 2003

Background and Aim: Colorectal Paneth cell metaplasia (PCM) is known to be a sign of idiopathic inflammatory bowel disease (IBD), although its distribution and histogenesis are not fully understood. Objectives of this research were to investigate the spatial distribution of PCM in IBD and other forms of colitis (non‐IBD), and to find stimuli causing PCM.

Methods: We studied multiple biopsy specimens from 181 patients with ulcerative colitis (UC), 159 with Crohn's disease (CD), 448 with non‐IBD, and 78 normal controls. Paneth cell metaplasia frequency, at each colorectal site, was evaluated to find possible differences among diseases, phases of activity, and extents of disease.

Results: In non‐IBD and controls, PCM was rarely (0–1.9%) seen at distal sites, but frequently (up to 48.7%) found at the ascending colon and cecum (P < 0.001). Paneth cell metaplasia frequency was significantly higher in IBD than in non‐IBD patients and controls at distal sites (P < 0.001), but did not differ significantly between UC and CD, or among active, resolving, and quiescent phases. In UC, proctitis and left‐sided colitis rarely displayed PCM at unaffected sites. Multiple logistic regression analysis revealed that PCM was positively associated with crypt distortion and mononuclear cell infiltration (P < 0.005), but negatively or not significantly associated with crypt atrophy, mucin depletion, acute inflammation, or phase of activity.

Conclusions: Paneth cell metaplasia is a non‐specific phenomenon in the proximal colon, but distal PCM, which occurs exclusively in affected mucosa, is a useful marker indicating IBD, even in the inactive phase. Regression analysis suggests that repair and regeneration may be the most potent stimuli causing PCM.
Higher seroprevalence of Helicobacter pylori infection in Korean adolescent athletes compared to age‐ and sex‐matched non‐athletes
Authors: CHOE YON HO , HWANG TAE SOOK , HONG YUN CHUL
Published: March 2003

Background Poor living conditions, such as overcrowding and bed‐sharing, are reported to be significant risk factors for Helicobacter pylori infection throughout childhood. We investigated the prevalence of H. pylori infection in Korean athletes who are obliged to live together in training camps for more than 6 months in a year.

Methods Blood sampling and surveying through questionnaire were performed on 440 students from a regular high school (228 boys and 212 girls) and 220 athletes (148 boys and 72 girls) of a physical education high school. We measured serum immunoglobulin G antibody (IgG Ab) to H. pylori in order to compare the prevalence of H. pylori infection between normal adolescents and athletes. In addition, we conducted a nutritional analysis and questionnaire survey for socioeconomic status in order to compare other risk factors that might influence H. pylori infection between groups.

Results The prevalence of H. pylori infection in athletes (43.2%) was higher than that in the controls (22.7%). No significant differences in the nutritional factors or socioeconomic status, such as Hollingshead index, type of house, number of siblings, and crowding index, were found between the groups. Multivariate analysis showed that crowding and the difference in school type were the significant predictors of H. pylori seropositivity after controlling for dietary and socioeconomic factors.

Conclusion The seroprevalence of H. pylori infection was higher in adolescent athletes than in age‐ and sex‐matched regular students. Further prospective study is needed to confirm the observation.
Serum gamma‐interferon‐inducing factor (IL‐18) and IL‐10 levels in patients with acute hepatitis and fulminant hepatic failure
Authors: YUMOTO EIICHIRO , HIGASHI TOSHIHIRO , NOUSO KAZUHIRO , NAKATSUKASA HARUSHIGE , FUJIWARA KEISHI , HANAFUSA TADASHI , YUMOTO YASUHIRO , TANIMOTO TADAO , KURIMOTO MASASHI , TANAKA NORIAKI , TSUJI TAKAO
Published: March 2003

Background and Aims: The aim was to determine the role of T‐helper (Th)1/Th2 cytokine responses in the clinical outcome of patients with acute liver injury.

Methods: The serum levels of the cytokines, interleukin (IL)‐18, gamma‐interferon (IFN‐γ), IL‐10 and IL‐4 were measured in 20 fulminant hepatic failure (FHF), 18 acute hepatitis (AH), 30 chronic viral hepatitis and 20 liver cirrhosis (LC) patients. Thirteen cases were from the intensive care unit (ICU) and there were 21 healthy volunteers. Immunohistochemical staining of liver biopsies for IL‐18 expression was also performed.

Results: Serum IL‐18 levels in patients with FHF were significantly
more elevated than in patients with other liver diseases, ICU cases and healthy volunteers.
Furthermore, serum IFN‐γ levels in patients with FHF were also significantly
higher than in patients with chronic viral hepatitis, LC and healthy volunteers.
We found a positive correlation between the levels of IL‐18 and IFN‐γ. However,
no relationship was observed between these and clinical outcome. In immunohistochemical
staining, CD68+ macrophage cells and IL‐18‐positive cells were observed in portal
zones. Elevated serum IL‐10 levels were restricted to patients presenting with FHF,
and were significantly higher in surviving cases (P < 0.01). Furthermore,
serum IL‐10 levels, but not IL‐4 levels, were inversely correlated with serum total
bilirubin concentrations (P = 0.045) and the death rate (p) outlined in Japan
(P = 0.030).

Conclusion: These results suggest that IL‐18 and IFN‐γ are involved in the pathogenesis of acute hepatic injury in humans, and that, in particular, elevated serum levels of IL‐10 may be predictive of improved outcomes for these patients.

© 2002 Blackwell Science Asia Pty Ltd
A survey of Australian general practice management of hepatitis C‐infected patients from non‐English‐speaking backgrounds
Authors: DEV ANOUK , SIEVERT WILLIAM
Published: March 2003

Background: Australia receives many migrants from countries with a high prevalence of hepatitis C infection. General practitioners, who are often the first health professionals consulted, need to be aware of risk factors and complications associated with hepatitis C in this group.

Methods: Four hundred and forty‐seven general practitioners, obtained from registries at two Melbourne teaching hospitals serving large non‐English‐speaking migrant populations, were sent a questionnaire. Two hundred and forty‐one returned a completed questionnaire. The survey attempted to assess knowledge of risk factors, complications, currently recommended antiviral therapy, referral practice to specialists and difficulties encountered by practitioners and patients in accessing information about HCV.

Results: Sexual and vertical transmission were listed as more common risk factors than iatrogenic causes or injecting drug use. Most respondents interpreted basic diagnostic tests correctly but there was a range of estimates regarding progression to cirrhosis and hepatocellular carcinoma with many seriously overestimating these aspects of natural history. Interferon and ribavirin were commonly listed as optimal therapy, but both interferon monotherapy and lamivudine, a treatment for hepatitis B, were stated as optimal therapy by 25% of respondents. Considerable frustration was expressed regarding access to reliable information about treatment outcomes and to linguistically and culturally appropriate patient information.

Conclusion: The wide response range regarding modes of acquisition of HCV in patients from non‐English‐speaking backgrounds, rates of progression to cirrhosis and hepatocellular carcinoma and optimal antiviral therapy suggests a need to improve provision of appropriate educational resources that will facilitate general practice management of a common and important public health problem.

© 2002 Blackwell Science Asia Pty Ltd
Natural history of hepatocellular carcinoma including fibrolamellar and hepato‐cholangiocarcinoma variants
Authors: Okuda Kunio
Published: March 2003

Abstract  The natural history of hepatocellular carcinoma (HCC) varies greatly with the global region, because the carcinogenic factors are not the same among countries. Besides the clinicopathological factors such as tumor characteristics, sex, and age, background liver disease is a major determinant of prognosis. Hepatocellular carcinoma, mainly associated with chemical carcinogens such as aflatoxin, does not have severe background cirrhosis, and grows quickly, whereas HCC developing in association with a virus in a cirrhotic liver generally grows more slowly, and the severity of cirrhosis is the major prognostic factor. The median survival of untreated sub‐Saharan African patients is less than 1 month from diagnosis, contrasted by an average survival of 4 months in virus‐induced HCC associated with cirrhosis. Tumor characteristics, such as size, number, and growth speed, which vary considerably from case to case, affect the prognosis. Vascular (portal) invasion portends a poor prognosis, and α‐fetoprotein levels also correlate with prognosis. Several distinct clinical types of HCC occur, namely diffuse‐type HCC caused by rapid portal spread of cancer cells, febrile‐type caused by poorly differentiated sarcomatoid cancer cells, and cholestatic HCC caused by intraductal invasion; all have a short survival. There are several histological variant forms: combined hepato‐cholangiocarcinoma behaves like HCC, with a poorer prognosis because of more frequent lymph node metastases; fibromellar carcinoma, which is relatively common in young Caucasian adults, has a good prognosis if diagnosed early, permitting resection; and cholangiolocellular carcinoma, which derives from the canalicular epithelium, is indistinguishable from HCC, with a similar prognosis.

© 2002 Blackwell Publishing Asia Pty Ltd
Clinicopathologic features of patients with hepatocellular carcinoma seropositive for α‐fetoprotein‐L3 and seronegative for des‐γ‐carboxy prothrombin in comparison with those seropositive for des‐γ‐carboxy prothrombin alone
Authors: OKUDA HIROAKI , NAKANISHI TOSHIMI , TAKATSU KAZUKO , SAITO AKIKO , HAYASHI NAOAKI , YAMAMOTO MASAKAZU , TAKASAKI KEN , NAKANO MASAYUKI
Published: March 2003

Abstract
Background
: There has been no study of the clinicopathologic features of patients with hepatocellular carcinoma (HCC) who are seropositive for lectin‐reactive α‐fetoprotein (AFP‐L3) alone, or seropositive for AFP‐L3 and seronegative for des‐γ‐carboxy prothrombin (DCP) in comparison with those who are seropositive for DCP alone. Thus, the present comparative study was performed.

Methods
: The clinicopathologic features of HCC patients with either one or two tumors who underwent a hepatectomy (n = 88) were compared among the following five groups according to the seropositivity of AFP, AFP‐L3 and DCP: (i) group A, seropositive for AFP above 100 ng/mL, AFP‐L3 above 15% and DCP above 100 mAU/mL; (ii) group B, seropositive for AFP‐L3 and seronegative for DCP below 40 mAU/mL; (iii) group C, seronegative for AFP below 20 ng/mL, AFP‐L3 below 15% and seropositive for DCP; (iv) group D, seropositive for AFP and seronegative for AFP‐L3 and DCP; and (v) group E, seronegative for AFP, AFP‐L3 and DCP.

Results
: Group B patients showed a higher incidence of infiltrative‐type HCC with an irregular margin (P < 0.05) and a higher frequency of poorly differentiated HCC (P < 0.01) compared with group C patients. Group A patients had larger tumors and more massive‐type tumors than group B patients. Our HCC cases showed that advanced clinicopathologic features were demonstrated in the order of group B, group C and group D. Group A and B patients and group D and E patients showed similar characteristics.

Conclusions
: Hepatocellular carcinoma patients who were seropositive for AFP‐L3 and seronegative for DCP demonstrated clinicopathologic features of more advanced HCC compared with those who were seropositive for DCP alone.

© 2002 Blackwell Publishing Asia Pty Ltd