bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial differences in peptic ulcer frequency in Singapore
Authors: KANG J. Y. , LABROOY S. J. , YAP I. , GUAN R. , LIM K. P. , MATH V. , TAY H. H.
Published: March 2008

Several hospital series of peptic ulcer patients have suggested that ulcer prevalence may be different in the different races in Singapore. However, such studies may be biased because different races use hospital services differently and also because hospital catchment populations are difficult to define. In the present study the racial composition of a consecutive series of 1248 peptic ulcer patients seen in two medical units of a general hospital was compared to that of 2023 general medical patients attending the same units. For both sexes, the racial structure of the gastric ulcer as well as the duodenal ulcer patients was significantly different from that of the general medical group. There was an excess of Chinese patients of both sexes with gastric ulcer and duodenal ulcer. In contrast, the numbers of male Malay gastric ulcer, male Malay duodenal ulcer, female Malay duodenal ulcer as well as Indian gastric ulcer patients of both sexes were fewer than expected. These results cannot be accounted for by racial differences in either health‐seeking behaviour or analgesic and tobacco usage. These observations confirm the probable occurrence of racial differences in peptic ulcer frequency in Singapore.
Serum pancreatic secretory trypsin inhibitor in pancreatic diseases
Authors: HAYAKAWA TETSUO , MURASE TOSHIYUKI , KONDO TAKAHARU , SHIBATA TOKIMUNE , SUGIMOTO YOSHIYUKI , KITAGAWA MOTOJI
Published: March 2008

To elucidate the diagnostic significance of serum pancreatic secretory trypsin inhibitor (PSTI) in pancreatic diseases, organ distribution of PSTI and abnormalities in serum PSTI were studied. The pancreas showed the highest content of PSTI, which was five times that of the stomach and almost 40 times that of the other organs. Serum PSTI and amylase were elevated in eight patients with acute pancreatitis, 27 and 11 patients of 47 with chronic pancreatitis, 31 and 13 of 36 with pancreatic cancer, and 67 and 62 of 109 with non‐pancreatic disease, respectively. PSTI levels were more sensitive to the presence of pancreatic disease than were amylase levels. The specificities in serum of healthy controls and patients with non‐pancreatic disease were similar for PSTI and amylase (69% vs 71%). In chronic pancreatitis and pancreatic cancer patients the efficiency of the PSTI assay was higher (P < 0.02) than the amylase assay (67% vs 63% for pancreatitis and 71% vs 66% for cancer). The sensitivity and efficiency of serum PSTI assay in chronic pancreatic diseases were superior to those of amylase.
Liver cell adenoma: A case report and a review of 30 cases reported in Japan
Authors: KOGURE KIMITAKA , NAGAMACHI YUKIO , SASAMOTO KIYOSHI , OGAWA TERUO
Published: March 2008

A 38 year old man with a huge liver cell adenoma extending to the pelvis was treated by left lateral lobectomy. The tumour, which was well‐encapsulated by fibrous membrane, was 18 × 19 × 6 cm in size and weighed 1500g. Histopathologically, this tumour was composed of well‐differentiated liver cell trabeculae and a small number of pseudobiliary ducts, but no Glisson sheaths. For the past 4 years 8 months he has remained asymptomatic. Thirty cases of liver cell adenoma found in Japanese literature are reviewed here and possible pathogenic implications are discussed.
Endoscopic manometry of the sphincter of Oddi
Authors: TOOULI J. , ROBERTS‐THOMSON I. C.
Published: March 2008

Endoscopic manometry of the sphincter of Oddi is a new and invasive test which is currently being evaluated in patients with biliary‐type pain, particularly after cholecystectomy, and idiopathic recurrent pancreatitis. Technical aspects of the test appear to have been clarified, but data are incomplete on the potential effect on manometric records of variables such as patient anxiety, prolonged endoscopy and the injection of radiological contrast material prior to the procedure. Despite these considerations, abnormal manometric records are frequent in patients with post‐cholecystectomy pain and idiopathic recurrent pancreatitis, and minor abnormalities have been associated with choledocholithiasis. The term structural stenosis is currently being applied to those in whom the sphincter basal pressure is high while biliary dyskinesia describes a variety of manometric changes including rapid phasic contractions, an excess of waves oriented in a retrograde direction and an abnormal response to the intravenous infusion of cholecystokinin octapeptide. Reasons for the motility disorders remain unclear but may include histopathological changes in sphincter tissue, enteric nerve dysfunction, autonomic dysfunction, hormonal/metabolic changes and psychiatric disorders. Heterogeneity within the patient population needs to be carefully addressed in any prospective study of potential benefit from drugs or other procedures such as endoscopic sphincterotomy and operative sphincteroplasty.
Neurotensin and the exocrine pancreas
Authors: EAVES E. R. , LAMBERT J. R. , KORMAN M. G. , MERCURI J. , HANSKY J.
Published: March 2008

It has been postulated that neurotensin (NT) has a physiological role in the regulation of the exocrine pancreas, but this is controversial. Using the Thomas cannula canine model, the effect of intravenous NT, in physiological and pharmacological doses on exocrine pancreatic secretion, and on plasma pancreatic polypeptide, secretin and cholecystokinin (CCK) levels is reported. The infusion of physiological doses of NT alone (0.2 pmol/kg per min) did not stimulate pancreatic secretion; however, in conjunction with secretin, NT stimulated protein and bicarbonate output, the latter synergistically. Higher doses of NT (20 and 100 pmol/kg per min) resulted in a dose‐dependent stimulation of pancreatic volume, bicarbonate and protein secretion. Cholinergic blockade with atropine reduced pancreatic secretion stimulated by low doses of NT (2–20 pmol/kg per min), but at higher doses (100 pmol/kg per min) protein secretion was reduced whilst bicarbonate secretion was enhanced. The infusion of graded doses of NT had no effect on plasma secretin or CCK levels. In contrast, NT did release pancreatic polypeptide in a dose‐dependent manner, but only at pharmacological infusion levels. NT, acting synergistically with other hormones, may thus play a role in exocrine pancreatic stimulation.
Prophylaxis against ERCP sepsis with cefoperazone
Authors: PATTINSON NEIL R. , CHAPMAN BRUCE A.
Published: March 2008

Fifty patients were given cefoperazone (1 g) intravenously over 2–3 min immediately prior to endoscopic retrograde cholangiopancreatography (ERCP). In 16 of these subjects an aliquot of common duct bile was obtained via the ERCP cannula at the commencement of the procedure. Therapeutic biliary levels of cefoperazone were found in 10 subjects. Cholestasis and sampling distal to calculi may account for those in whom undetectable levels were found. Multiple samples from one patient showed that the biliary concentration increased with time. Therapeutic serum levels were detected in all patients and no side effects were observed.
Somatostatin and gastrin content of gastric antral mucosa in ulcer disease
Authors: HANSKY J. , SOVENY C. , MERCURI J.
Published: March 2008

Gastrin and somatostatin containing cells are abundant in the gastric antral mucosa suggesting a role for these peptides in gastric physiology, presumably acid secretion. The concentration of these peptides in antral mucosa in ulcer disease is controversial, some finding normal levels, others decreased somatostatin levels. Biopsies of antral mucosa from patients with ulcer disease and non‐ulcer dyspepsia were obtained at endoscopy, and somatostatin and gastrin concentration were measured by specific radioimmunoassay. Levels were similar in non‐ulcer, duodenal and gastric ulcer patients but prior treatment with H2‐receptor antagonists in duodenal ulcer patients led to a fall in somatostatin and a rise in gastrin mucosal levels. It is thus unlikely that a lack of somatostatin or an increase in gastrin are factors in the pathogenesis of duodenal ulcer, but the cells may behave abnormally in ulcer disease.
The effect of iron, iron‐binding proteins and iron‐overload on human natural killer cell activity
Authors: CHAPMAN D. E. , GOOD M. F. , POWELL L. W.
Published: March 2008

The in vitro natural killer (NK) activity of peripheral blood lymphocytes (PBL) was assessed in 13 patients with genetic haemochromatosis (HC) and 27 normal subjects, using a 51Cr‐release cytotoxicity assay against the target K‐562 leukaemic cell line. Mean NK function did not differ between these two groups. This conclusion differs from the reported deficit in NK activity in other diseases in which increased iron stores may occur, including alcoholic cirrhosis and β‐thalassaemia major.

The effect of ferric citrate (0.1–1.0 mmol/1), normal human liver ferritin (100–10 000 μg/1) and transferrin (2 g/1) on NK activity was also assessed for both groups. In neither group was NK activity affected by any of these additives.

These results suggest that peripheral blood NK function is not compromised in haemochromatosis, and that the diminished NK activity which has previously been reported in some patients with thalassaemia or alcoholic cirrhosis is due to factors other than to a direct effect of increased iron stores.
Hepatitis B in renal transplant recipients: An assessment of the relationship of viral replication to liver pathology
Authors: LAWSON M. J. , FOCK K. M. , GOWANS E. J. , MATHEW T. H. , BURRELL C. J.
Published: March 2008

To determine the natural history of hepatitis B virus (HBV) infection in renal transplant recipients, 16 recipients who remained chronic HBsAg carriers were followed for 2–15 years by assaying hepatitis Be antigen (HBeAg) and hepatitis B viral DNA (HBV DNA). The results were compared with sequential liver biochemistry and histology. Similarly, nine HBsAg‐negative renal transplant patients were studied for up to 10 years. It was found that different patterns of HBV replication were described in a majority of long‐term HBsAg‐positive renal transplant patients with intermittent virus replication being particularly common. A minority of patients with viral replication showed co‐existing elevated transaminases. Development of liver disease was more common among HBsAg‐positive patients, but when the various patterns of infection were correlated with long‐term outcome, no one pattern was clearly more predictive of an adverse outcome.
Treatment of severe peptic ulcer haemorrhage with the heat probe
Authors: LIN HWAI‐JENG , TSAI YANG‐TE , LEE SHOU‐DONG , LAI KWOK‐HUNG , NG WAI‐WAH , TAM TSENG‐NIP , CHANG FULL‐YOUNG , LEE CHEN‐HSEN
Published: March 2008

From September to December 1986, 30 cases of persistent upper gastrointestinal bleeding were collected and treated, via the endoscope, with a heat probe. All cases had either gastric or duodenal ulcers. Ten cases were in shock. After treatment, all bleeding episodes initially stopped, but six cases (20%) re‐bled. Five cases received repeat heat probe therapy and did not re‐bleed thereafter. Thus the ultimate success rate was 96.7% (29/30). Twenty of 21 ulcers (94.3%) were found to be healed with scars 2 months after therapy. During therapy and the follow‐up period, only one complication occurred and this was a mild aspiration pneumonia. The heat probe is an ideal haemostatic device for severe non‐variceal upper gastrointestinal bleeding.
Intra‐operative secretin test for the rapid evaluation of curative operation in a case of Zollinger‐Ellison syndrome
Authors: AZUMA TAKESHI , IMAMURA MASAYUKI , SHIMADA YUTAKA , INOKUCHI HIDETO , KAWA KEIICHI
Published: March 2008

The intra‐operative measurements of serum gastrin levels and an intra‐operative secretin test were carried out as the rapid evaluation of curative operation in a case of Zollinger‐Ellison syndrome (ZES). In this case, pre‐operative investigations suggested that the tumours were located in the head of the pancreas and the duodenal wall. The surgeon planned a pan‐creato‐duodenectomy. Serum gastrin levels were reduced after the resection of the head of the pancreas and duodenum, and the secretin test after resection was negative. The surgeon ensured that gastrinomas were resected completely during the operation. The secretin test carried out 1 month post operatively was also negative. The patient has experienced no further complications, to date. This case suggests that intra‐operative secretin test is useful for the rapid evaluation of curative operation in case of ZES.
The function in vitro of macrophages from the intestinal mucosa of patients with Crohn's disease: An association between chemotactic migration and granulomata
Authors: HERMANOWICZ A. , GIBSON P.R. , PALLONE F. , MASON C.H. , JEWELL D.P.
Published: March 2008

The chemotactic migration in vitro of intestinal macrophages and peripheral blood monocytes has been assessed in patients with Crohn's disease, ulcerative colitis, and miscellaneous intestinal diseases. In all groups, the chemotaxis of peripheral blood monocytes was similar to that of healthy subjects. Intestinal macrophages migrated similarly to autologous monocytes in patients with ulcerative colitis and in the miscellaneous group. In contrast, intestinal macrophages from patients with Crohn's disease exhibited a wide range of chemotaxis from markedly suppressed to normal. This variation was independent of drug treatment and the degree of inflammation present. However, patients in whom granulomata were not present exhibited a significant depression of chemotaxis compared with those with granulomata, with disease controls (ulcerative colitis patients), and with the miscellaneous group. Such a difference was not reflected in monocytes from autologous peripheral blood. These findings indicate the presence of local mucosal suppressive factors in some patients with Crohn's disease and could suggest that the diminished ability of macrophages to accumulate in a focus of inflammation may be an underlying mechanism for the failure to form granulomata in these patients.
Evidence of ongoing virus multiplication in type B fulminant hepatitis
Authors: GANDHI B.M. , IRSHAD M. , ACHARYA S.K. , JOSHI Y.K. , TANDON B.N.
Published: March 2008

The presence of HBeAg‐ and HBV‐specific DNA‐polymerase (DNA‐P) activity—regarded as markers of HBV multiplication—were studied in 40 patients with fulminant hepatitis B within 1‐5 days of the onset of hepatic encephalopathy. HBeAg and DNA‐P were detected in three (7 %) and 21 (51%) of the patients respectively. Only three (7%) were positive for anti‐HBs. DNA‐P activity was present in 38.1 % even 10 days after the appearance of icterus. Present findings confirm an ongoing HBV multiplication in about half of the patients of fulminant hepatitis B.
Vasoactive intestinal peptide immunoreactive nerve fibres are deficient in intestinal and nasal mucosa affected by cystic fibrosis
Authors: WATTCHOW DAVID A. , FURNESS JOHN B. , GIBBINS IAN L. , LITTLE KEN E. , CARTER RODNEY F.
Published: March 2008

Cystic fibrosis (CF) is the most common lethal or debilitating inherited disease amongst Caucasians, with estimates of its frequency of occurrence in this population ranging from 1: 2000 to 1: 15 000 live births. It is characterized by disorders of exocrine secretions, primarily of the skin, respiratory tract and digestive system. The secretory processes of these tissues are influenced by autonomic nerve fibres, many of which contain regulatory peptides. The innervation of the intestinal and respiratory mucosa of CF patients has been investigated in order to determine if there is any derangement of the peptide‐containing nerve fibres that supply these tissues. The present work demonstrates that, in CF, there is a deficiency of vasoactive intestinal peptide immunoreactivity (VIP‐IR) in nerve fibres in the nasal and intestinal mucosa. There is not a generalized loss of fibres that are immunoreactive for this peptide, however, since VIP‐IR fibres innervating the intestinal muscle are largely unaffected. Moreover, other types of nerve fibres innervating the nasal mucosa and the mucosa of the intestinal villi appear to be unaffected in CF patients. Physiological evidence indicates that vasoactive intestinal peptide is contained in secretomotor neurons and is a powerful stimulant of secretion; loss of function restricted to these neurons is consistent with the clinical manifestations of CF.
Influence of intraduodenal chenodeoxycholic acid on secretory and pressure activity of the stomach and duodenum
Authors: EYRE‐BROOK I. A. , READ N. W. , BROWNSON A. , JOHNSON A. G.
Published: March 2008

The influence of duodenal infusion of bile acid at a concentration similar to that in the common bile‐duct (50 mmol/1) on antroduodenal motility, duodenogastric reflux, gastric and duodenal secretion was studied in 10 healthy volunteers. Intraluminal pressures were recorded in the antrum and the first and second parts of the duodenum. Gastric and distal duodenal contents were collected by continuous low pressure sump aspiration during infusion of either saline or chenodeoxycholic acid (CDC) into the second part of the duodenum. Values for duodenogastric reflux and gastric and duodenal secretion were calculated with reference to the recovery of two non‐absorbable markers infused into the stomach and second part of the duodenum. Each volunteer received at least 3 h of saline infusion and 2 h of CDC infusion.

During saline infusion, duodenogastric reflux varied with the migrating motor complex (MMC), being statistically greater at the end of duodenal phase III activity than at other times (P<0.05). Infusion of CDC abolished the MMC and inhibited antral contractions but the amount of reflux was not increased compared with the saline period. Infusion of CDC also produced marked increases in measured bicarbonate (P<0.001), trypsin (P<0.001), phospholipase A2 (P<0.05) and endogenous total bile acid (P<0.05) in the duodenum, although gastric acid secretion was unaffected. These findings suggest that bile acid may regulate gastroduodenal motor activity and pancreaticobiliary secretion.
Nodular regenerative hyperplasia of the liver diagnosed by needle biopsy of the liver: Report of a case and review of the literature
Authors: TERANO AKIRA , HONDA ICHIRO , SHIGA JUNJI , KOHMOTO OSAMI , MATSUMOTO KAZUNORI , HIRAISHI HIDEYUKI , OTA ICHI , SUGIMOTO TSUNEAKI
Published: March 2008

The authors report the case of a 45 year old woman in whom the diagnosis of nodular regenerative hyperplasia of the liver was made by needle biopsy of the liver, laparoscopy and hepatic venography. The patient did not have any underlying disorders and had not ingested any of the many drugs and chemicals which may produce the lesion. Clinical manifestations were hepatosplenomegaly, portal hypertension and iron deficiency anaemia, and her condition remains unchanged 5 years after diagnosis.
Liver cancer in Thailand: Temporal and geographic variations
Authors: SRIVATANAKUL P. , SONTIPONG S. , CHOTIWAN P. , PARKIN D. M.
Published: March 2008

Liver cancer is the most common fatal neoplasm in Thailand, and is responsible for 16.3% of all new cancers in males, and 5.5% in females. In recent years, at least, these proportions have been constant. In males, hepatocellular cancer is the predominant subtype, with an incidence 3.6 times that in females. In females, however, cholangiocarcinoma is slightly more common, incidence exceeding that of hepatocellular carcinoma after the age of 45. Geographic variation in the frequency of hepatocellular carcinoma is quite small (less than twofold), whereas the frequency of cholangiocarcinoma varies more than 12‐fold between regions, and its occurrence relates to the endemic nature of the liver fluke Opisthorchis viverrini.
Anti‐HBs responses after combined injection of recombinant yeast and plasma‐derived hepatitis B vaccines
Authors: YOSHIDA KEN , FUJIYAMA SHIGETOSHI , SATO TATSUO , MIZUNO KYOSUKE
Published: March 2008

Anti‐HBs responses to a combined injection of recombinant yeast and plasma‐derived hepatitis B vaccines were evaluated in 119 healthy members of medical staff. They were divided into three age‐ and sex‐matched groups. Group I (YHB‐YHB‐YHB) were given recombinant yeast vaccine at 0, 1 and 6 months, group II (PHB‐YHB‐YHB) were given plasma‐derived vaccine at 0 month, and then recombinant yeast vaccine at 1 and 6 months, and group III (YHB‐YHB‐PHB) were given recombinant yeast vaccine at 0 and 1 month and then plasma‐derived vaccine at 6 months.

The seroconversion rate in each group at 7 months were similar (group I: 91.2%, group II: 88.5%, and group III: 94.1%). Acquired antibody titre (S/N ratio) was higher, however, in group II than in group I (group I: 37.6 ± 29.1 versus group II: 57.4 ± 44.9).

The present study indicated that in this combined injection method, cross antigenicity was observed between plasma‐derived vaccine and recombinant yeast vaccine and that high antibody titres could be obtained by a combined injection of a recombinant yeast vaccine and a plasma‐derived vaccine when compared with the recombinant vaccine alone. Accordingly, this combined vaccination method is recommended because of its easy availability.
Halothane hepatitis: Damage to peripheral blood mononuclear cells produced by electrophilic drug metabolites is Ca2+‐dependent
Authors: FROST LINDA , PRENDERGAST DEBRA , FARRELL GEOFFREY
Published: March 2008

Abstrat

Peripheral blood mononuclear (PBM) cells from patients with halothane hepatitis are unusually susceptible to damage from phenytoin metabolites generated by an in vitro drug metabolising system. In order to provide more information about the nature of this susceptibility factor, the effect of removing calcium ions (Ca2+) from the incubation medium of the test system was examined. Phenytoin metabolites were generated by incubating phenytoin with β‐naphthoflavone‐induced rat liver microsomes in the presence of 1,1,1‐trichloropropene oxide (TCPO), an epoxide hydrase inhibitor. When PBM cells from patients who had recovered from halothane hepatitis were incubated in this system and then maintained in Ca2+‐containing tissue culture medium (without α‐tocopherol) for 16 h, cell death, as measured by trypan blue exclusion, was greatly increased (53% and 78% at 0.06 mmol/1 and 0.12 mmol/1 phenytoin, respectively) compared with control incubations (TCPO omitted). Removal of Ca2+ from the tissue culture medium effectively abolished reactive metabolite‐induced cell death. Resting cytosolic free Ca2+ concentration in PBM cells was also measured using the quin‐2 fluorescence method and total Ca2+ content was measured by atomic absorption spectrometry. Although variability appeared greater among patients, mean values for these parameters among 12 patients with halothane hepatitis did not differ from controls. It is concluded that enhanced permeability of PBM cells to extracellular Ca2+ may be an important factor in the pathogenesis of drug metabolite‐induced cell death in patients susceptible to halothane hepatitis. Such permeability to Ca2+ is not evident in resting cells and presumably results from an interaction between electrophilic metabolites and the pumps which regulate cell calcium homeostasis.
Corrosive oesophageal strictures following acid ingestion: Clinical profile and results of endoscopic dilatation
Authors: BROOR S. L. , CHARI A. KUMAR. S. T. , SINGAL A. , MISRA S. P. , KUMAR N. , SARIN S. K. , VIJ J. C.
Published: March 2008

Abstrat

There are several reports on oesophageal strictures caused by alkali ingestion, but information on oesophageal strictures due to acid ingestion is scarce. Endoscopic dilatation, which has been found to be quite safe and effective in the treatment of benign oesophageal strictures of other aetiology, has also not been evaluated adequately in the treatment of these strictures. Over a period of 2 years, of 47 patients treated at this centre of benign oesophageal strictures, 17 (36.2%) patients had strictures following ingestion of corrosive agents. Thirteen patients had ingested acids and only four gave a history of alkali ingestion. The age range of these 13 patients was 14–50 years (mean = 25.5 years, s.d. = 2.6). The amount of acid ingested varied from 10 to 100 ml (median = 50 ml). The interval between acid ingestion and presentation to hospital ranged from 1 to 60 months (median = 2 months). Ten patients had multiple strictures, and the most common site of involvement was the upper third followed by the lower third of the oesophagus. Only five‐of these 13 patients had evidence of gastric involvement in the form of antral stricture (four) and hour glass deformity (one). Strictures were dilated using Eder‐Puestow metal olives passed over a guide wire. The total number of sittings required to achieve adequate dilation in this group ranged from 1 to 30 (median = 14). Most patients were managed successfully with dilatation (good response 63.6%, satisfactory response 18.2%). On follow‐up, recurrence of dysphagia was seen in a high number of patients (66%), but this could be managed easily with repeat dilatation. It is concluded that, in contrast to reports from the West, acid ingestion is a common cause of oesophageal strictures in India. These strictures are usually tight and multiple. The patients not only require several sittings to achieve adequate dilatation, but they also have a high recurrence rate.
Electronic endoscopy: Its present and future
Authors: TAKEMOTO TADAYOSHI , KARITA MIKIO , OKITA KIWAMU
Published: March 2008

As its image sensor, the electronic endoscope incorporates the so‐called charge‐coupled device (CCD) at its tip. The device was developed by the high technology of microelectronics, and it has a quite new construction, different from fibre‐optics. Two years after the electronic endoscope was produced first by Welch‐Allyn from the USA, the first Japanese electronic endoscope model was developed in 1985, and now an upper gastrointestinal model, a duodenoscope model, and a colonoscope model are available commercially from four companies worldwide.
Measurement of activity in Crohn's disease
Authors: BARTHOLOMEUSZ F. D. L. , SHEARMAN D. J. C.
Published: March 2008

Crohn's disease is a chronic inflammatory disorder of unknown aetiology affecting any part of the gastrointestinal tract. Recurrent exacerbations are common but some patients feel mildly unwell even when in remission which makes it difficult to confirm reactivation of the inflammation and to assess disease activity objectively. Yet this assessment is important if appropriate therapy is to be instituted and monitored. This paper reviews the clinical, laboratory and imaging methods used to measure the degree of activity in Crohn's disease.
Combined hepatocellular‐cholangiocarcinoma associated with dermatomyositis
Authors: HORIE YUTAKA , YAMADA MINORU , NAKAI KAZUHITO , KAWASAKI HIRONAKA , HIRAYAMA CHISATO , MATSUI KATSUAKI , KAMBE NAOTO , SHIMAO SHUUHEI
Published: March 2008

Abstrat

A 56 year old female developed combined hepatocellular cholangiocarcinoma associated with dermatomyositis. Serum tumour markers except for carbohydrate antigen (CA 19‐9; 6400 ng/ml) were within normal range. Despite extensive chemotherapy, no clinical response was obtained and the patient's course deteriorated after 4 months. Macroscopically, the liver was mainly occupied by hepatocellular carcinoma but cholangiocarcinoma was found in the hilum. This is the first case of a rare association of combined hepatocellular‐cholangiocarcinoma and dermatomyositis.
Radiolabelled unprocessed bran: Validation of a practical labelling technique and evaluation of gastrointestinal transit profiles in health
Authors: KERLIN PAUL , BYRNES OWEN , WONG LAWRENCE
Published: March 2008

Using a radiolabelled bran preparation, a large field of view gamma‐camera and a computer, a method has been developed to define and analyse the gastrointestinal transit profile of solids. Unprocessed bran, labelled with technetium (99mTc) sulphur colloid is incorporated into biscuits cooked in a microwave oven. With this preparation, less than 3.4% of the isotope dissociated from the bran in a gastric milieu, and more than 90% of recovered radionuclide activity, were retained with the solid phase during small intestinal transit in subjects with stable ileostomy function. A normal range for gastric emptying (GE), small intestinal transit (IT) and colonic filling (CF) was established in 15 healthy volunteers. Anterior and posterior images were taken until all isotope was present in the colon. Using regions of interest for the stomach and colon, decay corrected geometric mean curves for GE and CF were generated. GE was characterized by a lag phase followed by a linear emptying phase. The GE profile (mean and standard deviation) was described by ‘power exponential’ parameters of half‐emptying time (1.6 ± 0.4 h) and β(1.5 ± 0.2). The IT time was 3.9 ± 1.5 h. The onset of CF was determined visually (4.1 ± 1.5 h), and the time of 50% CF filling was determined from the colonic filling curve (5.5 ± 1.4 h). This technique should provide a useful, practical, clinical and research test to study the pathophysiology and pharmacology of intestinal motor disorders.
Causative effect of cow's milk protein and soy protein on progressive small bowel mucosal damage
Authors: IYNGKARAN N. , YADAV M. , BOEY C. G. , KAMATH K. R. , LAM K. L.
Published: March 2008

Some infants intolerant to cow's milk protein (CMP) are often also intolerant to other food proteins including soy protein (SP). The effect of CMP and SP in infants recovering from diarrhoeal disease was studied in 22 infants who were maintained on an hypo‐allergenic formula for 4–6 weeks. The infants were then challenged successively, initially with SP, followed 24 h later with CMP and then rechallenged with SP 24 h after CMP provocation. Three groups were recognized on the basis of clinical symptoms and mucosal changes following SP challenge.

Group 1 comprised four infants who developed clinical and histological reactions on SP challenge. The subsequent CMP challenge, 24 h after the initial SP challenge, resulted in clinical symptoms in three of the four infants, and they developed increased mucosal injury. Rechallenge with SP in the three infants caused development of severe clinical symptoms.

Group 2 comprised 12 infants who developed histological reaction but had no clinical symptoms to initial SP challenge. The subsequent CMP challenge caused further progression in mucosal pathology in 11 of the 12 infants and six also had associated clinical symptoms. Rechallenge with SP in the latter six infants resulted in development of clinical symptoms in three and tolerance to SP in three infants.

Group 3 comprised six infants who tolerated SP and CMP but one of these infants developed mild histological changes to CMP. The progression of mucosal injury following SP and CMP challenge was associated with a significant decrease in mucosal disaccharidases, alkaline phosphatase levels and presence of reducing sugar in the stools. The 1 h blood xylose level continued to decrease significantly following the pre‐SP, post‐SP, and post‐CMP challenge.

It appears that the small bowel mucosa of young infants recovering from diarrhoea1 disease remains sensitive not only to CMP but also to SP. The feeding of these proteins in rapid successive sequence to infants with mucosal damage might result in further progression of the mucosal injury. Thus, the exclusion for a variable period of time of antigenic food proteins like CMP and SP from the diet of young infants recovering from diarrhoea might reduce the risk of inducing mucosal sensitivity to these proteins in susceptible infants.
Fulminant viral hepatitis: Indian experience
Authors: RAJU G. S. , BROOR S. , SINGH V. , MEHTA S. K.
Published: March 2008

Thirty‐six patients with fulminant viral hepatitis were studied. Enzyme immunoassay was used to detect the presence of HBsAg, IgM anti‐HBc, and IgM anti‐HAV. Non‐A, non‐B virus was the most common aetiological agent (61.1%) followed by hepatitis B virus (HBV; 30.6%) and hepatitis A virus (8.3%). Presence of IgM anti‐HBc confirmed the diagnosis of HBV infection in three cases who were negative for HBsAg. Similarly, in one case who was positive for HBsAg, absence of IgM anti‐HBc suggested superinfection with some other agent. Survival was significantly higher (P < 0.01) in the hepatitis A virus (HAV) group (66.6%) compared with non‐A, non‐B (31.2%) and HBV groups (27.3%). Fever at the onset of illness was seen in all patients with HAV, 54.5% of patients with HBV and 38.88% of patients with non‐A, non‐B infection (P < 0.01). The median time interval between the first symptom and the onset of encephalopathy was 16, 13 and 8 days in HAV, HBV and non‐A, non‐B groups, respectively, but this difference was statistically not significant (P > 0.05).
Serum and urinary zinc in fulminant hepatic failure
Authors: NANDI S. S. , CHAWLA Y. K. , NATH R. , DILAWARI J. B.
Published: March 2008

Patients with chronic hepatic encephalopathy have been shown to have low serum zinc levels. Moreover, in a controlled study, significant improvement was seen in these patients on oral zinc supplementation. Information on zinc status in fulminant hepatic failure is insufficient. Serum and urinary zinc abnormalities were studied in 22 patients with fulminant hepatic failure (FHF) and they were compared with age‐ and sex‐matched controls. The mean serum zinc values were significantly less in patients with FHF (72.7 ± 3.7 μg/100 mL versus 107.9 ± 6.2 μg/100 mL) while the urinary zinc values were significantly higher compared with controls (603.5 ± 9.3 μg/24 h versus 334.4 ± 10 μg/24 h). The serum zinc levels significantly and progressively decreased, while urinary zinc significantly increased after admission in patients with FHF. The serum zinc values in the group that survived were significantly higher than those in the group of patients who died. Correspondingly, urinary zinc was lower in survivors than in the group that expired. This study indicates that serum and urinary zinc levels could be used as a prognostic indicator in FHF. A therapeutic trial with zinc supplementation is justified in this group of patients.
Natural/spontaneous shunts in non‐cirrhotic portal fibrosis
Authors: DILAWARI J. B. , CHAWLA Y. K. , CHARI S. T.
Published: March 2008

Large natural/spontaneous shunts on splenoportovenography were demonstrated in 10 of 93 patients with non‐cirrhotic portal fibrosis. There was significantly less bleeding in patients with spontaneous shunt than in those having no shunt. Large oesophageal varices (grade III‐IV) were seen more frequently in patients without spontaneous shunt.
Effects of ethanol and its metabolites on collagen synthesis by cultured rat liver cells
Authors: TSUTSUMI MIKIHIRO , TAKADA AKIRA , TAKASE SHUJIRO , SHIMANAKA KOSHI , ENYAMA KEIKO
Published: March 2008

Abstract The effects of ethanol and its metabolites on collagen synthesis in cultured rat Ito cells and hepatocytes were studied. In cultured Ito cells, collagen synthetic ability reached peak values after incubation for 24 h and after 8 h in cultured hepatocytes. The distribution patterns of 14C‐activity in each collagen fraction were quite different between the two cell types. About 80% of the activity was found in the degraded collagen fraction in the cultured hepatocytes, indicating a rapid turn‐over of collagen protein in this cell type. In the Ito cells, the activity in the intact collagen was about 50%. Ethanol and its metabolites added to the incubation medium did not stimulate collagen synthesis in either cell type; rather, they inhibited it. Collagen metabolism in the cells to which ethanol or its metabolites had been added was slower than in the control medium. These results indicate that the pathogenesis of alcoholic liver fibrosis is not simple and that interaction or modulation of cell function in different types of cells should be considered when examining the mechanisms of fibrogenesis in alcoholic liver fibrosis.
Morphological and immunohistochemical assessment of intrahepatic bile duct development in the rat
Authors: GALL JOHN A. M. , BHATHAL PRITHI S.
Published: March 2008

Abstract The hypotheses that intrahepatic bile ducts are derived either by a transformation of periportal liver cells or by dichotomous branching of the extrahepatic bile ducts were investigated in fetal and postnatal rat livers by histological and immunohistochemical methods using an antiserum to prekeratin which, in the liver, binds to biliary epithelial cells (BEC). In conventionally stained sections, bile duct development was observed to begin in the 19 day fetus around the larger branches of the portal vein, with the formation of lumina surrounded by cuboidal or elongated hepatoblast‐like cells on the portal aspect and readily distinguished hepatoblasts on the lobular aspect. At 21 days, these structures had developed into canals of Hering lined jointly by recognizable liver cells and BEC. The number of canals of Hering per portal tract peaked at 22 days’ gestation and diminished in number at birth and over the ensuing 56 h, with a concomitant increase in fully formed ducts. Bile ducts lined completely by BEC were first found at 20 days. Immunohistochemically, prekeratin antigens were first detected at 20 days in duct‐like structures not only in phenotypic BEC but also in adjacent cells with an hepatoblast phenotype. Such intermediate cells were present until birth. These findings support the view that intrahepatic bile ducts develop by a reorganization and modulation of the periportal hepatoblasts to BEC.
Ulcerative colitis in Karachi
Authors: QURESHI HUMA , ZUBERI SARWAR J. , BANATWALA NAJMUDDIN , ANWAR AFTAB , SHAMSI ZIAUDDIN , KHAN M. NAEEMULLAH
Published: March 2008

Abstract Experience of 189 patients with non‐specific ulcerative colitis has been reviewed. The majority of patients was in the 21–30 year age group, and neither sex predominated. Seventy‐two percent had mild to moderate disease. The disease was mainly confined to the left colon (60%) and 13% had total colitis.
Relationship between morphine responses and sphincter of Oddi motility in undefined biliary pain after cholecystectomy
Authors: ROBERTS‐THOMSON I.C. , PANNALL P.R. , TOOULI J.
Published: March 2008

Abstract In 150 patients with undefined biliary pain after cholecystectomy, responses to morphine were compared with responses to morphine combined with neostigmine. The relationship between rises in plasma levels of aspartate aminotransferase (AST) after morphine or morphine‐neostigmine and sphincter of Oddi motility as assessed by endoscopic manometry was also examined. When compared with morphine‐neostigmine, patients given morphine alone showed a similar frequency (30% versus 33%) of increases in plasma levels of AST (> twice the upper limit of the reference range) but had less abdominal pain and a lower frequency of similar increases in plasma levels of amylase (4% versus 25%). Of 92 patients who consented to endoscopic manometry of the sphincter of Oddi, satisfactory manometric records were obtained in 84, 31 with and 53 without increases in AST after morphine or morphine‐neostigmine. Those showing rises in AST had a higher frequency of abnormal manometric records (81% versus 57%, P = 0.025), higher basal pressures in the sphincter of Oddi (P = 0.0001) and higher pressures within ducts (P = 0.02). There was a significant correlation between sphincter basal pressures and intraduct pressures (r = 0.51, P<0.0001). Rises in plasma AST after morphine are similar to those after morphine‐neostigmine and are influenced by, or linked to, factors which determine sphincter basal pressures and intraduct pressures.
HTLV‐1 associated myelopathy in an HTLV‐1 and HBV double carrier family: Report of a case and the mode of vertical transmission of both viruses
Authors: NAKAMURA F. , KAJIHARA H. , NAKAMURA M. , SASAKI H. , KUMAMOTO T. , OKADA K.
Published: March 2008

Abstract Osame et al. first described human T cell lymphotropic virus type 1 (HTLV‐1) associated myelopathy (HAM) as a new clinical entity in 1986. A 23 year old female diagnosed as having HAM whose family had a high frequency of double virus infection with HTLV‐1 and hepatitis B virus (HBV) gave reason to suspect mother‐to‐child transmission of both viruses. No clear coincidence in the mode of transmission of HTLV‐1 and HBV was found. It is presumed that the mechanism of infection with HTLV‐1 and HBV differ slightly.
Hepatic microsomal protein and cytochrome P‐450 in BALB/c mice infected with Leishmania
Authors: AL‐MOFLEH I. A. , AL‐KHUWAITIR S. A. , MAHMOUD A. A. , KYEGOMBE D. B. , AL‐TUWAIJRI A. S.
Published: March 2008

The effects of infection of mice with Leishmania major on liver microsomal protein and cytochrome P‐450 were examined. The levels of hepatic microsomal protein and cytochrome P‐450 were monitored at 6, 7, 9 and 12 weeks post‐infection. The results indicated that the amount of hepatic microsomal protein and cytochrome P‐450 were unchanged throughout the course of infection with L. major, despite the high degree of parasite proliferation in Kupffer cells and marked reduction in phagocytosis. The current results clearly indicate that Leishmania‐induced macrophage suppression has no inhibitory effect on hepatic microsomal protein and cytochrome P‐450.
Atrial natriuretic peptide, plasma renin activity, plasma volume, systemic vascular resistance and cardiac output in patients with cirrhosis
Authors: VINEL J. P. , DENOYEL P. , VIOSSAT I. , CALES P. , CAUCANAS J. P. , CHABRIER P. E. , ESQUERRE J. P. , BRAQUET P. , PASCAL J. P.
Published: March 2008

The present study aimed to assess relationships between plasma levels of atrial natriuretic peptide (ANP) and plasma volume, systemic vascular resistances, cardiac output and plasma renin activity in patients with cirrhosis. Thirty patients were included: eight with no history of liver disease were used as controls; 22 patients had biopsy‐proven alcoholic cirrhosis without ascites (n=11) and with ascites (n=11). Mean ANP plasma level was significantly higher in both groups of cirrhotic patients than in controls (P<0.05). In the control group, ANP and plasma renin activity were inversely correlated (P<0.05) but no correlation was found in cirrhotic patients. In the group of patients with ascites, ANP plasma levels were inversely correlated to plasma volume (P<0.05) and to cardiac output (P<0.01) and directly correlated to systemic vascular resistances (P<0.01). Using multiple regression analysis, ANP remained correlated only with systemic vascular resistances (P<0.05). These results suggest that cirrhotic patients have high plasma levels of ANP whether or not they have ascites. In the light of current knowledge of ANP actions, the relationships between ANP plasma levels and plasma volume, cardiac output, and systemic vascular resistances are paradoxical in cirrhotic patients with ascites. ANP does not seem to play a critical role in the pathogenesis of sodium and water retention observed in these patients.
Benign recurrent intrahepatic cholestasis in a Chinese girl
Authors: LAU J. Y. N. , LOK A. S. F. , LAI C. L. , WU P. C. , LIN H. J.
Published: March 2008

A 15 year old Chinese girl presented with features of benign recurrent intrahepatic cholestasis, confirmed by liver biopsies performed during attack and remission. Her only younger brother also has features of this syndrome. Serial biochemistry monitoring during a recent attack demonstrated that a rise in the serum bile acids preceded the clinical onset of symptoms and the rise in serum bilirubin and ductal enzymes by 8 weeks. Whether this earlier rise in serum bile acids is related to the pathogenetic mechanism of this syndrome remains to be elucidated.
Diagnosis of small hepatocellular carcinoma by computed tomography: Correlation of CT findings and histopathology
Authors: TSUNETOMI SHIGEYUKI , OHTO MASAO , IINO YASUO , SHINAGAWA TAKASHI , KIMURA KUNIO , MORITA MASAHIRO , SAISHO HIROMITSU , TSUCHIYA YUKIHIRO , HIROOKA NOBORU , OKUDA KUNIO
Published: March 2008

The diagnostic value of computed tomography (CT) scans in small hepatocellular carcinoma (HCC) (<5 cm) was studied in 82 patients. Dynamic scan was also made in 66 of them. Combined unenhanced and enhanced scans detected 87% of the lesions > 2 cm, but the detection rate was only 25% for lesions <1.5 cm. Diagnostic failure was due to isodensity of the mass and to technical artefacts. Diagnosis of the surrounding capsule and internal septa (partition) and demonstration of the typical pattern of density enhancement by dynamic scan proved useful in differentiating HCC from secondary cancers. On unenhanced CT, the density of the interior was subject to the histological changes of tumour such as bleeding, necrosis and fatty metamorphosis. Similarly, enhanced CT showed density changes suggestive of these histological changes. Dynamic scan proved particularly useful for lesions <3 cm because the typical density enhancement was frequently demonstrated in the arterial phase. It was concluded that unenhanced CT combined with dynamic scan has a high diagnostic value in small HCC and reflects histological changes.
Interferon receptors during treatment of chronic hepatitis B with interferon
Authors: NAKAJIMA SHINYA , KUROKI TETSUO , KURAI OSAMU , KOBAYASHI KENZO , YAMAMOTO SUKEO
Published: March 2008

The in vitro binding of 125I‐labelled human α‐interferon to peripheral blood mononuclear cells from 13 patients with chronic hepatitis B during interferon therapy was assayed in order to identify changes in the number of interferon receptors during treatment. Nine patients were treated with human α‐interferon (Hu α‐IFN) or human β‐interferon (Hu β‐IFN) daily for 4 weeks. During therapy, receptor sites per cell decreased by 40%. Two weeks after therapy ceased, this number had returned to the pretreatment level. The other four patients were given Hu α‐IFN daily for 2 weeks, no injections for 2 weeks, and daily injections for 2 weeks. During both periods of therapy, receptor sites decreased by 40%. The number increased to 94% of the pretreatment level 1 week after the first period and to 101% 2 weeks later. It was 80% 1 week after the second period of injections and 108% 2 weeks later.
Long‐term survivors after hepatectomy for hepatocellular carcinoma
Authors: TSUNODA TSUKASA , SEGAWA TOHRU , ETO TOSHIFUMI , IZAWA KUNIHIDE , TSUCHIYA RYOICHI
Published: March 2008

Abstract Sixteen long‐term (more than 5 years) survivors after hepatic resection performed for hepatocellular carcinoma (HCC) from 1970 to 1988, were reviewed. The mean age of the patients was 51 years. There were 11 males and 5 females. HBs antigen was positive in 9 patients. Liver cirrhosis was associated with 11 patients but its severity was designated as Child's A in all patients except one. The mean tumour diameter was 2.8 cm and was relatively small. At the first operation, limited procedures (i.e. partial hepatectomy and subsegmentectomy) were employed in 87.5% of patients. A large percentage of tumours were located in S5 and S6 segments. A recurrence of HCC occurred in 9 patients after the first resection. A second resection was carried out in 7 patients, in 2 of which a third resection was done. Transcatheter arterial embolization (TAE) was performed on 4 patients. These results show that, in addition to detection of small tumours and early resection, repeated operation or TAE for treatment of recurrent HCC was important in achieving long‐term survival after HCC resection.