bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatolithiasis in East Asia: Comparison between Japan and China
Authors: NAKAYAMA FUMIO , KOGA AKITOSHI , ICHIMIYA HITOSHI , TODO SATORU , SHEN KUI , GUO REN‐XUAN , ZENG XIAN‐JIU , ZHANG ZEHN‐HUAN
Published: March 2008

The incidence of hepatolithiasis is high throughout East Asia compared with the West, but the marked difference in the relative proportion of hepatolithiasis to all cholelithiasis cases exists even among countries of similar ethnic backgrounds. A retrospective study of cases was conducted in two areas in China with the aim of clarifying the presence of such regional difference in China itself. The relative proportion of hepatolithiasis was 21.2% in Shenyang, 9.2% in Beijing and 4.1% in Fukuoka, Japan. A significant difference in the location of stones was also found between Shenyang, Beijing and Fukuoka. Intra‐ and extrahepatic hepatolithiasis in all hepatolithiasis cases was 95% in Shenyang and 75% in Beijing. Involvement of both hepatic lobes was found in 73% in Shenyang and less than 60% in the other two, suggesting that hepatolithiasis of the old form or of an advanced stage still lingers in Shenyang.

In conclusion, regional differences in the proportion and the type of hepatolithiasis exist in China itself, as well as in the Chinese population in Taiwan, Hong Kong and Singapore, as previously reported. The possible contribution of environmental factors to the occurrence of hepatolithiasis is again emphasized.
A comparison of Doppler flowmetry with conventional assessment of acute changes in hepatic blood flow
Authors: GIBSON PETER R. , GIBSON ROBERT N. , DONLAN JOHN D. , JONES PENELOPE A. , COLMAN JOHN C. , DUDLEY FRANCIS J.
Published: March 2008

The validity and clinical relevance of Doppler flowmetry in measuring changes in regional blood flow are uncertain. In the present study we compared changes induced by ketanserin in regional splanchnic blood flow as measured by Doppler flowmetry with changes in conventionally measured systemic and in hepatic haemodynamic indices estimated pharmacokinetically using indocyanine green. Fourteen patients with alcoholic cirrhosis and portal hypertension were evaluated. On multivariate analyses, significant associations were noted for only three indices: changes in estimated hepatic blood flow were predicted jointly by changes in flow in the main and right portal veins and hepatic artery (R2= 0.80); changes in intrahepatic shunting (indocyanine green extraction) were predicted by changes in flow in the main and right portal veins (R2= 0.55); and changes in sinusoidal perfusion (indocyanine green clearance) were significantly predicted by changes in main portal vein flow alone (R2= 0.76). These data support the validity of Doppler flowmetry in quantifying change in regional blood flow, but highlight the limitations in its clinical application and interpretation. The association of changes in main portal vein flow with changes in sinusoidal perfusion has clinical potential but requires confirmation using other modulating drugs.
Influence of clinicopathological variables on CYP protein expression in human liver
Authors: GEORGE JACOB , BYTH KAREN , FARRELL GEOFFREY C.
Published: March 2008

Drug metabolism is usually impaired in malnourished patients with decompensated cirrhosis, but the separate influence of clinicopathological variables, including nutritional status, on the expression of hepatic cytochrome P450 proteins has not been well characterized. We determined the hepatic content of CYP1A2, CYP2C8/10, CYP2E1 and CYP3A proteins in 71 subjects, 21 with histologically normal livers and 50 with chronic liver disease, and then tested for potential relationships between patient variables and individual CYP proteins by multivariate linear regression analysis. Variables analysed included nutritional status (determined by experienced clinicians), serum albumin and bilirubin concentrations, prothrombin time, the grade of ascites and hepatic encephalopathy, and the Child‐Pugh score. Impaired nutrition and cachexia were associated with reductions of CYP2C8/10 levels of approximately 19 and 39%, respectively, relative to cases in which nutrition was replete. Similarly, CYP2E1 protein was reduced by approximately 13 and 26%, according to the apparent severity of nutritional impairment. In contrast, nutritional status did not contribute to variability in expression of CYP1A2 or CYP3A proteins. Of the clinicopathological variables analysed, only serum bilirubin was shown to have an independent influence on CYP protein content. Thus, elevated serum bilirubin concentrations were associated with significant declines in the contents of CYP1A2 and CYP2C8/10 but not CYP3A or CYP2E1. The mechanisms for the effects of nutritional status and serum bilirubin concentration on the levels of CYP proteins are unclear, but could be mediated by factors such as cytokines, dietary composition and alterations in the level of serum bile acids. Knowledge of the influence of clinicopathological factors and nutritional status on CYP expression should lead to more rational drug prescribing in patients with hepatic disease.
Changes in the localization of colorectal cancer: Implications for clinical practice
Authors: LOFFELD RJLF , PUTTEN ABMM , BALK A.
Published: March 2008

A hospital‐based study was performed in order to examine the subsite distribution of colorectal cancer diagnosed in 1992–93 in the Zaanstreek region. The localization was compared with tumours diagnosed in the years 1972–73 and 1982–83. The number of colorectal cancers has markedly increased, and a significant rise in localization of tumours proximal to the splenic flexure has occurred (32% in 1972–73 to 43% in 1992–93). There also appears to be greater incidence of colorectal cancer in women. A trend towards an increase of proximal localization of tumours in women was noted. Possible explanations for this phenomenon are discussed. The results of this study suggest the importance of improved diagnostic accuracy in colorectal cancer and, in addition, may have consequences for screening programmes.
Bowel preparation for colonoscopy: A randomized prospective trial comparing sodium phosphate and polyethylene glycol in a predominantly elderly population
Authors: THOMSON A. , NAIDOO P. , CROTTY B.
Published: March 2008

Many patients find polyethylene glycol‐based preparations (PEG) difficult to take because of the large volume of fluid they are required to consume. One hundred and sixteen predominantly elderly patients were randomized to receive either sodium phosphate (n= 61) or PEG (n= 55) bowel preparations before colonoscopy. Patients with a history of symptomatic ischaemic heart disease or cerebrovascular disease in the preceding 6 months, severe liver disease or heart failure, or serum creatinine above 200 μg/L were excluded from the study. Each patient filled in a questionnaire about the bowel preparation prior to the procedure. The colonoscopists, who were not aware which preparation had been used, were asked to complete a questionnaire about the quality of the bowel preparation after the procedure. The patients found the sodium phosphate preparation slightly more tolerable than PEG. Side effects were slightly more common with sodium phosphate. Neither difference was statistically significant. However, 91% of patients who had previously had PEG found sodium phosphate easier to take. Approximately 25% of patients in each group experienced at least one episode of incontinence. The colonoscopists found no difference in the overall quality of the bowel preparation. The amount of fluid in the colon was greater in patients prepared with PEG. As expected, patients taking sodium phosphate developed hyperphosphataemia (mean phosphate level before colonoscopy 1.56 mmol/L, normal 0.8–1.3). They also had a lower mean serum potassium level (3.8 mmol/L) than the PEG group (4.2 mmol/L). However, there were no clinically significant consequences. Sodium phosphate was a safe and effective bowel preparation for colonoscopy in this carefully selected group of patients. It was preferred by patients who had previously had PEG. Many elderly patients were found to develop faecal incontinence, irrespective of the type of bowel preparation used.
Herbal medicine ‘Sho‐saiko‐to’ induces tumour necrosis factor‐α and granulocyte colony‐stimulating factor in vitro in peripheral blood mononuclear cells of patients with hepatocellular carcinoma
Authors: YAMASHIKI MASAYOSHI , NISHIMURA AKIRA , NOMOTO MINORU , SUZUKI HIROYUKI , KOSAKA YOSHITANE
Published: March 2008

‘Sho‐saiko‐to’ (TJ‐9) is a Japanese herbal medicine that is commonly administered to patients with chronic viral liver disease in order to improve their overall physical condition and to prevent the development of liver cancer. The present in vitro study demonstrated that, by adding TJ‐9 to cell cultures, there were dose‐dependent increases in production levels of tumour necrosis factor‐α (TNF‐α) and granulocyte colony‐stimulating factor (G‐CSF) in peripheral mononuclear cells of patients with hepatocellular carcinoma accompanied by liver cirrhosis. Increases in the production of TNF‐α and G‐CSF in control cell cultures exposed to different herbal medicines were low, and this indicates the specificity of the responce increases in production of these cytokines to TJ‐9. TNF‐α and G‐CSF are known to play important roles in the biological defence mechanism. Administration of TJ‐9 may, therefore, be beneficial for patients afflicted with intractable liver diseases because it could mildly induce these cytokines.
Severe clinical rebound upon withdrawal of corticosteroid before interferon therapy: Incidence and risk factors
Authors: SHEEN I‐SHYAN , LIAW YUN‐FAN , LIN SHI‐MING , CHU CHIA‐MING
Published: March 2008

To analyse the incidence and risk factors of clinical rebound and hepatic decompensation during or upon withdrawal of prednisolone pretreatment before interferon (IFN) therapy, two series of Taiwanese patients with chronic viral hepatitis from two independent randomized controlled trials were compared. Group 1 included 41 patients with chronic hepatitis B who were pretreated with daily prednisolone (30 mg) for 3 weeks, 15 mg for 1 week and no prednisolone for 2 weeks prior to lymphoblastoid IFN therapy. Group 2 consisted of 59 patients with chronic hepatitis B who were pretreated with daily prednisolone (40 mg) for 2 weeks, 30 mg prednisolone for 2 weeks, 20 mg prednisolone for 2 weeks and no prednisolone for 2 weeks prior to IFNα‐2a therapy. Clinical rebound developed more frequently in group 2 (67.8%) than in group 1 patients (41.5%; P <0.01). The peak serum transaminase levels of group 1 and 2 patients during clinical rebound were similar. Icteric and symptomatic clinical rebound occurred in four (one cirrhotic) group 2 patients. The incidence of hepatic decompensation was 3.4% in group 2 patients, or 5.0% in group 2 patients with clinical rebound. Patients pretreated with a higher dose (40 mg) of prednisolone (odds ratio 3.0; 95% CI 1.3–6.6; P <0.01) and non‐cirrhotic patients (odds ratio 6.2; 95% CI 1.2–32.1; P < 0.02) tended to suffer from clinical rebound more frequently. However, once clinical rebound develops in cirrhotic patients, the relative risk of decompensation is 16 times that of non‐cirrhotic patients. These results suggest that clinicians should be cautious in prescribing a short course of corticosteroids for patients with chronic viral hepatitis, because hepatic decompensation might occur in Oriental people with or without cirrhosis.
Vasopressin plus oxygen vs vasopressin alone in cirrhotic patients with portal‐hypertensive gastropathy: Effects on gastric mucosal haemodynamics and oxygenation
Authors: IWAO TADASHI , TOYONAGA ATSUSHI , SHIGEMORI HIROYUKI , OHO KAZUHIKO , SUMINO MICHIHIRO , SATO MASAHIRO , TANIKAWA KYUICHI
Published: March 2008

The effects of vasopressin plus oxygen and vasopressin alone on gastric mucosal perfusion and oxygenation were studied using reflectance spectrophotometry and laser Doppler velocimetry in 23 cirrhotic patients with portal‐hypertensive gastropathy. The measurements were performed under basal conditions and after double‐blinded administration of placebo (n= 7), vasopressin (0.3 U/min; n= 8) or vasopressin (0.3 U/min) plus nasal oxygen (4 L/min; n= 8). No significant effects on gastric mucosal haemodynamics and oxygenation were observed after placebo. In contrast, vasopressin and vasopressin plus oxygen induced a similar reduction in haemoglobin content (‐26 ± 2 and ‐21 ± 4%, respectively P < 0.01) and laser Doppler signal (‐23 ± 2 and ‐22 ± 2%, respectively, P < 0.01). Although each treatment induced a significant reduction in oxygen saturation (‐21 ± 2 and ‐7 ± 1%, respectively P < 0.01), the effect was less pronounced in patients receiving the combination than in those receiving vasopressin alone (P < 0.01). These data suggest that vasopressin and vasopressin plus oxygen reduce gastric mucosal hyperaemia and that the oxygen supplement partially protects against gastric mucosal hypoxia during vasopressin infusion in cirrhotic patients with portal‐hypertensive gastropathy.
Analysis of HLA alleles in Japanese patients with cirrhosis due to chronic hepatitis C
Authors: HIGASHI YOICHIRO , KAMIKAWAJI NOBUHIRO , SUKO HIRONOBU , ANDO MASAYUKI
Published: March 2008

Hepatitis C virus (HCV) leads to chronic liver disease in at least 50–60% of infected people and approximately 40–50% of these patients will go on to develop cirrhosis due to chronic hepatitis C (HCV‐C). The pathogenic mechanisms that result in HCV‐C are unknown. Sixty Japanese patients with HCV‐C were examined for HLA‐A, B, C and DR alleles by serologic typing and for HLA‐DQB1 alleles by DNA typing using the polymerase chain reaction‐restriction fragment length polymorphism (PCR‐RFLP) method. As the control population, 293 healthy un‐related Japanese were used. The frequencies of HLA‐B61, Cw3, DR4, DQB1*0401 and DQB1*0402 were increased, while those of HLA‐DR9, DQB1*0301 and DQB1*0303 were decreased in the patients. The co‐ordinate increase in the frequency of HLA‐DR4, DQB1*0401 or 0402 and decrease in the frequency of DR9 or DQB1*0303 were suggestive of a strong linkage disequilibrium between HLA‐DR4 and DQB1*0401 or 0402 and between HLA‐DR9 and DQB1*0303, respectively. From the odds ratio (OR) analysis, the combinations of HLA‐Cw3+DR4‐DQB1*0401 or 0402, or HLA‐B61+DR4‐DQB1*0401 or 0402 increased the risk for developing HCV‐C when compared to each HLA allele alone. This suggested an additive effect for these classes I and II HLA allele combinations in HCV‐C. In contrast, HLA‐DR9‐DQB1*0303 and DQB1*0301 may confer resistance to this disease. These results suggest the existence of HLA‐linked susceptibility genes to HCV‐C.
Sonographically‐guided extracorporeal shockwave lithotripsy for pancreatic stones in patients with chronic pancreatitis
Authors: SCHREIBER F. , GURAKUQI GCH , PRISTAUTZ H. , TRAUNER M. , SCHNEDL W.
Published: March 2008

Over a 2 year period, 10 patients with pancreatic stones due to alcohol induced chronic pancreatitis (proven by endoscopic retrograde pancreatography) underwent extracorporeal shockwave lithotripsy. Prior to shockwave therapy, all patients underwent endoscopic sphincterotomy. Targeting of shockwave lithotripsy was exclusively performed under sonographic control. All patients were treated with a second generation electrohydraulic spark gap lithotriptor and fragmentation of concrements could be achieved in all cases. Complete duct clearance was confirmed in seven patients by endoscopic retrograde pancreatography in one session, with endoscopic fragment extraction by basket and/or balloon catheter. In three patients, balloon dilation of concomitant strictures located in the head of the pancreas was performed prior to fragment extraction. All stone‐free patients showed no further symptoms over the follow‐up period of 12 months. Three patients in whom complete extraction of fragments was not successful experienced minor symptoms over the 12 month follow‐up period.
Estimation of usefulness of N‐butyl‐2‐cyanoacrylate‐lipiodol mixture in transcatheter arterial embolization for urgent control of life‐threatening massive bleeding from gastric or duodenal ulcer
Authors: TOYODA HIDENORI , NAKANO SATOSHI , KUMADA TAKASHI , TAKEDA ISAO , SUGIYAMA KEIICHI , OSADA TOSHIMASA , KIRIYAMA SEIKI
Published: March 2008

We estimated the usefulness of a mixture of N‐butyl‐2‐cyanoacrylate (NBCA) with lipiodol for transcatheter arterial embolization (TAE) used to control massive bleeding from gastric or duodenal ulcer. Thirty patients who had gastric or duodenal ulcers and massive bleeding that was uncontrollable by endoscopic procedures were included in this study. All patients were subjected to TAE (without NBCA in 23 and with NBCA in seven patients). Coils and/or gelfoam were also used. The achievement of haemostasis, occurrence of rebleeding and the time taken for TAE were compared between patients who received TAE without and with NBCA. Eighteen of 23 patients (78.3%) who received TAE without NBCA and six of seven patients (85.7%) who underwent TAE with NBCA achieved complete haemostasis without rebleeding. The time for TAE was significantly shorter in patients who received NBCA compared with those who did not (P= 0.0095). TAE using NBCA or a combination of NBCA and coils achieved a rapid, complete embolization regardless of vascular distribution or arterial diameter. Thus NBCA is considered to be useful as a secondary embolization material in TAE that is urgently conducted to control massive bleeding from gastric or duodenal ulcers.
Portal‐systemic shunting in a patient with normal portal vein pressures and histological evidence of idiopathic portal hypertension
Authors: SUGIMURA TAKASHI , TSUJI YUJI , IBAYASHI HIROSHI , SAKAI HIRONORI , NAWATA HAJIME
Published: March 2008

Although idiopathic portal hypertension (IPH) is clinically characterized by portal hypertension and marked splenomegaly, we have experienced a case of spontaneous portal‐systemic shunt without splenomegaly in whom the liver histology resembled IPH but with normal portal pressure. We admitted a 64 year old man who had suffered from hepatic encephalopathy for 2 years. Laparoscopy revealed a dark grey liver with a sharp edge and a concave surface. Examination of a liver biopsy specimen revealed peri‐portal fibrosis consistent with IPH. A single, large, portal‐systemic shunt was identified by percutaneous transhepatic portography. The shunt arose from the left gastric vein and flowed through the left renal vein into the inferior vena cava. No varices were identified. There were no morphological changes in the hepatic or portal veins. Portal vein pressure was normal. There was a slight difference between the portal pressure and the wedged hepatic vein pressure, suggesting a presinusoidal block. This case raises important questions concerning the aetiology of IPH and the relationship between portal hypertension and the development of collateral venous circulation.
Control of colonic variceal haemorrhage with a somatostatin analogue
Authors: CHAKRAVARTY BJ , RILEY JW
Published: March 2008

A 64 year old caucasian male with known alcoholic liver disease presented with rectal bleeding. The patient bled repeatedly despite resuscitation. A sigmoid colectomy was performed following an angiogram. Large colonic, rectal and mesenteric variceal vessels were noted at surgery. Further bleeding postoperatively was rapidly controlled with octreotide infusion. Octreotide may be as useful in the control of colonic variceal bleeding as it is in the control of oesophageal variceal bleeding.
Paediatric liver transplantation: A 10 year experience in Taiwan
Authors: CHEN CHAO‐LONG , CHEN YAW‐SEN , CHIANG YUAN‐CHENG , CHENG YU‐FAN , HUANG TUNG‐LIANG , ENG HOCK‐LIEW
Published: March 2008

Between March 1984 and August 1994, 13 orthotopic liver transplantations were performed in 13 patients ≤ 25 years of age. The indications included Wilson's disease (n= 7), biliary atresia (n= 4), choledochal cyst (n=1) and hepatitis C cirrhosis (n=1). Technical variants included full‐size (n=11), reduced‐size (n=1) and living‐related (n=1) liver transplantation. These recent technical innovations have offered an expanded donor pool for earlier transplantation, shorter waiting times and excellent quality grafts. Surgical complications occurred in six patients; all required additional surgery. Biliary complications were encountered more commonly in our earlier patients. Our actuarial patient and graft survival rate is 92% at 2 years. The long‐term follow‐up of our liver‐transplanted Wilson's disease patients provides confirmatory evidence that orthotopic liver transplantation cures the underlying metabolic defect with complete normalization of biochemical abnormalities of copper metabolism, reversal of neurological impairments and the disappearance of Kayser‐Fleischer corneal rings. The high rate of patient survival and excellent rehabilitation indicate that with prudent clinical judgement, liver transplantation can be achieved with an acceptable rate of morbidity, mortality and cost in a setting where manpower and donor organs are very limited.
Risk factors for pancreatic cancer in Orientals
Authors: LEE CHI‐TE , CHANG FULL‐YOUNG , LEE SHOU‐DONG
Published: March 2008

In order to assess what the risk factors for patients with pancreatic cancer (PC) in Taiwan are, a retrospective study was undertaken among 282 consecutively enrolled inpatients with confirmed pancreatic cancer within the past 5 years. For comparison, 282 age‐ and sex‐matched controls were consecutively enrolled. A history of smoking, consumption of alcohol, diabetes mellitus, cholecystectomy and gastric surgery were thoroughly reviewed. Smoking and diabetes mellitus were very common among patients with pancreatic cancer compared with controls (P< 0.01). A significant linear trend towards an increased odds ratios (OR) for the development of PC with a higher level of smoking was seen (P<0.001). Diabetes mellitus (DM) also exhibited an increased risk (OR: 2.84; P<0.01), while this risk still existed among those patients who had a diabetic history of more than 3 years. Among 129 histologically established PC patients, smoking remained as a risk factor for PC, while the linear trend with an increasing OR with increasing levels of smoking was confirmed again (P<0.01). DM, particularly over the long‐term, was also a risk factor for those histologically established PC patients. In summary, cigarette smoking and existing diabetes mellitus are probable risk factors for the development of pancreatic cancer in Taiwan.
Case report: Portal‐systemic encephalopathy due to a congenital extrahepatic portosystemic shunt
Authors: KIRIYAMA MASATO , TAKASHIMA SHIGEKI , SAHARA HIROYUKI , KUROSAKA YOSHIYUKI , MATSUSHITA MASAHIRO , AKIYAMA TAKAYOSHI , TOMITA FUJIO , SAITO HITOSHI , KOSAKA TAKEO , KITA ICHIRO , KOJIMA YASUHIKO , TAKEGAWA SHIGERU
Published: March 2008

We present a case of portal‐systemic encephalopathy due to a congenital splenorenal shunt. A 69 year old woman was admitted to hospital because of recurrent episodes of disturbed consciousness. The present episode had begun 3 months prior to admission. Although the patient demonstrated mildly slurred speech, the remainder of her neurological examination was unremarkable. She showed no clinical signs of portal hypertension and her liver function, except for a serum hepaplastin test of 58% and an ICG retention rate of 28% at 15 min, was normal. Her serum ammonium level was 210 μg/dL. The venous phase of a superior mesenteric arteriogram revealed a splenorenal shunt and narrowing of the portal vein, which was 4 mm in diameter. The histological findings, demonstrated by a needle liver biopsy specimen, were consistent with mild fibrosis and lymphocytic infiltration. Following the diagnosis of a splenorenal shunt in the absence of liver cirrhosis, ligature of the shunt was performed with a splenectomy. The portal vein pressure after ligature of the shunt rose from 12.5 to 18.8 mmHg. This shunt was thought to be of congenital origin. The high preoperative serum ammonia concentration decreased to the normal range postoperatively and the serum hepaplastin test and ICG retention rate similarly improved postoperatively. A follow‐up superior mesenteric arteriogram was performed during the venous phase, demonstrating resolution of the shunt and decreased portal vein narrowing. The patient has suffered no further episodes of disturbed consciousness postoperatively.
Complications of percutaneous transhepatic catheterization of the portal venous system in patients with portal hypertension
Authors: OHTA MASAYUKI , HASHIZUME MAKOTO , KAWANAKA HIROFUMI , AKAZAWA KOUHEI , UENO KIICHIRO , TOMIKAWA MORIMASA , KISHIHARA FUMIAKI , TANOUE KAZUO , SUGIMACHI KEIZO
Published: March 2008

We report here complications of percutaneous transhepatic catheterization of the portal venous system in 170 Japanese patients with portal hypertension. All patients underwent percutaneous transhepatic portography and percutaneous transhepatic obliteration of oesophagogastric varices was also performed in 29 patients. After retraction of the catheter, the puncture canal was plugged with gelatin sponge in 150 subjects and with one steel coil in 20 others. The overall complication rate was 16.5%. Intraperitoneal bleeding occurred in 10.6% of patients and 2.9% required blood transfusion. In these patients with intraperitoneal bleeding, the gelatin sponge was used for plugging after retraction of the catheter, while in the 20 patients with a steel coil plug, haemoperitoneum never occurred. Right pleural effusion was recognized in 3.5% of patients, intraperitoneal bile leakage in 1.8% and deterioration of liver function due to arteriovenous fistula in 0.6%. By univariate and multivariate analyses, female gender was the only risk factor for intraperitoneal bleeding among 150 patients investigated by percutaneous transhepatic catheterization of the portal venous system with gelatin sponge plugging. Intraperitoneal bleeding is the most important complication in patients with portal hypertension; it is difficult to predict intraperitoneal bleeding before retraction of the catheter in patients for whom gelatin sponge is used. Thus, for patients undergoing percutaneous transhepatic catheterization of the portal venous system, close follow up is recommended.
Phylogenetic tree‐based epidemiological analysis of hepatitis C virus transmission in a region of Japan with a high prevalence of infection
Authors: HARA TOSHIYA , SETOGUCHI YOICHI , KAJIHARA SUSUMU , YAMAMOTO KYOSUKE , SAKAI TAKAHIRO , INOUE TAKATOSHI , OHBA KENICHI , MIZOKAMI MASASHI
Published: March 2008

Local clustering of hepatitis C virus (HCV) infection has been demonstrated in various regions in Japan. HCV genotypes have now been compared between infected individuals from districts of Saga prefecture with either a high (H district) or low (L district) prevalence of HCV‐seropositivity. The prevalence of HCV genotype 1b was significantly higher (P<0.001) in the H district (45/50; 90%) than in the L district (19/36; 52.8%). A phylogenetic tree was constructed based on the genomic sequences of viral isolates from 20 patients infected with genotype 1b in the H district. Almost all these HCV strains clustered in the same regions of the tree. With regard to risk factors for HCV transmission, the percentage of patients with a history of surgery was significantly higher in the H district than in the L district (58 versus 33.3%; P<0.05). Of 20 patients infected with similar strains of HCV in the H district, 16 (80%) had at least one parenteral risk factor associated with medical care. These results indicate an increased transmission of similar strains of HCV in the H district as a result of nosocomial infection.
Improvement of peripheral blood lymphocyte subsets in primary biliary cirrhosis after ursodeoxycholic acid therapy
Authors: IKEDA TAKAAKI , SATO CHIFUMI , NOGUCHI OSAMU , KOBAYASHI FUMIE , TOZUKA SHINICHI , SAKAMOTO SHIGEMI , MARUMO FUMIAKI
Published: March 2008

Immunological abnormalities frequently observed in patients with primary biliary cirrhosis are considered to be related to the pathogenesis of this disease. We performed a prospective trial to evaluate whether immune mechanisms play a role in the effectiveness of ursodeoxycholic acid (UDCA) therapy. Fifteen female patients with primary biliary cirrhosis were followed for 1 year and were then treated with UDCA (600 mg/day) for another year. Laboratory tests, including peripheral blood lymphocyte subsets assessed by dual colour fluorescence analysis using monoclonal antibodies against respective T cell markers, were evaluated at the beginning of the study, at the start of therapy and at the end of therapy. In primary biliary cirrhosis, the proportion of cytotoxic T cells, suppressor inducer T cells and αβ‐receptor bearing T cells were significantly lower than in healthy controls. No significant changes were observed in the proportions during the year before the therapy. These reductions, however, recovered to normal ranges after 1 year of UDCA therapy. These changes were associated with an improvement in the serum levels of aspartate aminotransferase, alkaline phosphatase, γ‐globulin and IgM. The close correlation between the improvement in the imbalance of lymphocyte subsets after the therapy and the clinical status suggests that an immunological process may play a role in the effectiveness of therapy in primary biliary cirrhosis.
UDP glucuronosyltransferase in the cirrhotic rat liver
Authors: DEBINSKI HENRY S , MACKENZIE PETER I , LEE C SOON , MASHFORD M LAURENCE , DANKS JANINE A , TEPHLY THOMAS R , GREEN MITCHELL , DESMOND PAUL V
Published: March 2008

In patients with cirrhosis, the elimination of drugs metabolized by glucuronidation is relatively preserved, in comparison with the metabolism of drugs by oxidation. This study explores this phenomenon at a molecular level. In cirrhotic rat livers the content of UDP‐glucuronosyltransferase (UGT) was examined by immunohistochemistry and immunoblotting using three antibodies: (i) a polyclonal antibody directed against a broad number of UGT isoforms from both family 1 and family 2; (ii) a family 2‐specific antibody; and a (iii) family 1‐specific antibody. The steady state mRNA level of UGT of a family 2 isoform was also detected by northern blot analysis. The results demonstrate normal or increased UGT protein by immunohistochemistry and immunoblot in cirrhotic livers compared with controls. This was accompanied by increased steady state mRNA encoding the UGT isoform UGT2B1. In contrast, an isoform of cytochrome P450 (CYP2C11) was reduced markedly in both immunohistochemical staining and immunoblot analysis. These results suggest that in cirrhosis there is a comparative increase or at least a maintenance of UGT enzyme content and that this most likely occurs at a pretranslational level.
Classical Kaposi's: A rare cause of gastrointestinal haemorrhage
Authors: CHAPMAN SM , BELL SJ , CHEN S. , COSOLO W.
Published: March 2008

Classical Kaposi's sarcoma (KS) is an indolent neoplasm involving mucocutaneous sites predominantly in elderly Mediterranean or Jewish persons. Whilst gastrointestinal involvement is common, it is usually asymptomatic. This case report presents a case of massive gastrointestinal haemorrhage in a patient with stable cutaneous disease and outlines options for the investigation and management of this rare complication.
CASE REPORT: Successful palliative treatment with intraperitoneal OK‐432 injection for epithelioid haemangioendothelioma presenting with intractable ascites
Authors: WEI SHU‐CHEN , YANG PEI‐MING , CHEN CHIEN‐HUNG , CHU JAN‐SHOW , CHEN DING‐SHINN
Published: March 2008

Epithelioid haemangioendothelioma is an unusual type of endothelium‐derived vascular tumour of borderline malignancy, which has high variability in clinical presentations, depending on the primary site of involvement. We report on a 20‐year‐old woman who presented with progressive abdominal fullness for 6 months. Multiple lung and liver nodules with pleural effusion and profuse ascites were found. The diagnosis of epithelioid haemangioendothelioma was made after wedge biopsy of the liver. The ascites was intractable and refractory to strong diuretic therapy and repeated paracentesis. Therefore, six courses of intraperitoneal injection of OK‐432 were administered. The ascites subsided to a minimal amount after treatment and the patient remained symptom‐free for approximately 8 months. The ascites recurred later and another three courses of intraperitoneal injection of OK‐432 were administered. The ascites disappeared again. The patient has remained symptom‐free since the end of the second period of treatment.
Cyclosporine therapy affects aminotransferase activity but not hepatitis C virus RNA levels in chronic hepatitis C
Authors: KAKUMU SHINICHI , TAKAYANAGI MASAHIRO , IWATA KAZUO , OKUMURA AKIHIKO , AIYAMA TOSHIYUKI , ISHIKAWA TETSUYA , NADAI MASAYUKI , YOSHIOKA KENTARO
Published: March 2008

Interferon (IFN) therapy is of proven efficacy in chronic hepatitis C, but it is not universally effective and is often limited by side effects. Cyclosporine A (CsA) is a potent immunosuppressant widely used in organ transplantation. We conducted a pilot study to determine whether CsA therapy could affect aminotransferase activity and hepatitis C virus RNA levels in patients with chronic hepatitis C. Cyclosporine A was administered to 10 patients (mean age of 59 years; male: female = 9:1) who did not respond to IFN therapy previously and who had elevated serum alanine aminotransferase (ALT) values for at least 6 months. All patients were positive for HCV‐RNA by RT‐PCR with genotype 1b. Their mean duration of hepatitis was 15 years. Oral CsA was given for 3 months in a dose that was increased at 1 month intervals from 1.5–2.0 to 2.0–3.0 and 3.0–4.0 mg/kg per day. All patients completed the treatment schedule, although two patients developed mild non‐symptomatic hypertension. Serum ALT levels gradually decreased in all but one patient. The mean percentage decrease was 59.5% at the end of therapy (from 153 ± 82 to 62 ± 48 IU/L; P < 0.02). The ALT levels fell to the normal range in five patients, although once therapy was discontinued the enzyme levels tended to return to pretreatment levels. Serum aspartate aminotransferase and g‐glutamyl transpeptidase levels similarly decreased. The serum HCV‐RNA titre, determined by competitive RT‐PCR, did not change in any patient throughout the study period. There were no appreciable alterations in other laboratory tests, such as serum creatinine levels and lymphocyte subsets, except for an increase in serum alkaline phosphatase levels. These findings suggest that CsA, even in a relatively low dose, reduces serum aminotransferase levels without serious side effects in patients with chronic‐hepatitis C, although an antiviral effect was not noted.
Duodenal erosions and ulcers in patients with pancreatobiliary obstruction
Authors: ABBAS ZAIGHAM , KHAN ABDUL HALEEM , JAFRI SM WASIM , HAMID SAEED SADIQ , SHAH SYED HASNAIN ALI , ABID SHAHAB , QURESHI JAZIBEH ALEEM
Published: March 2008

In order to determine whether obstructive pancreatobiliary lesions increase the risk of duodenal erosions and ulcers, the duodenal mucosa of patients with these lesions were prospectively examined before endoscopic retrograde cholangiopancreatography (ERCP). During the study period, 133 patients underwent ERCP for various reasons in the Department of Medicine, The Aga Khan University Hospital. One hundred and twenty‐three patients were eligible for final analysis. Sixty‐five patients with bilirubin ≥ 35 μmol/L and alkaline phosphatase ≥ 2.5 times normal levels along with radiological evidence of pancreatobiliary obstruction were included in the obstruction group. Fifty‐eight patients who did not fulfil these criteria were used in the control group. Acid peptic lesions, which included erosions and ulcers, were seen in 16 patients of the obstruction group and four patients of the control group (P=0.016, odds ratio (OR) = 4.41). Patients with carcinoma of the pancreas had a greater number of lesions than the rest of the obstruction group (P= 0.001, OR=8.75). Individual variables like age, sex, serum bilirubin, alanine aminotransferase, alkaline phosphatase, amylase levels, and duration of jaundice did not increase the vulnerability to acid peptic injury. The degree of obstruction multiplied by duration of jaundice (alkaline phosphatase x days) increased the susceptibility for duodenal disease (P=0.047). From this data it was concluded that patients with obstructive pancreatobiliary lesions are more prone to acid peptic duodenal lesions.
Gastric duplication: Endoscopic appearance and clinical features
Authors: POKORNY CHRISTOPHER S , COOK WARWICK J , DILLEY ANTHONY
Published: March 2008

The case of a 13‐year‐old female presenting with a 6 week history of significant vomiting resulting from a gastric duplication is described. At endoscopy, an antral mass which appeared to change in size and site with peristalsis was evident. Although rare, these lesions need to be considered in the differential diagnosis of patients presenting with symptoms suggestive of gastric outlet obstruction. However, in the majority of cases, the diagnosis is rarely made prior to surgery.
Ethnicity, socioeconomic status, transfusions and risk of hepatitis B and hepatitis C infection
Authors: AKBAR NURUL , BASUKI BASTAMAN , GARABRANT DAVID H , SULAIMAN ALI , NOER HM SJAIFOELLAH , MULYANTO
Published: March 2008

This study identifies the risk factors for hepatitis B virus (HBV) and hepatitis C virus (HCV) and measures the prevalence of hepatitis B surface antigen (HBsAg) and antibody to hepatitis C (anti‐HCV) in the general population of Jakarta. A population‐based sample of 985 people aged 15 and above was surveyed. Risk factors were identified through questionnaires and home visits. Serum was analysed for HBsAg, antibody to hepatitis B surface antigen (anti‐HBs), anti‐HCV, aspartate aminotransferase (AST) and alanine aminotransferase (ALT). The seroprevalence was: 4.0% (39/985) for HBsAg, 17.2% (170/985) for anti‐HBs, and 3.9% (38/985) for anti‐HCV. The risk factors for hepatitis B and hepatitis C infection had little in common. Low socioeconomic status was a strong risk factor for HBsAg (adjusted odds ratio (OR) 18.09; 95% confidence interval (CI) 2.35–139.50). In addition, the Chinese group has 2.97 higher risk of having HBV infection compared with the Malayan ethnic group (adjusted OR 2.97; 95% CI 1.22–7.83). There was moderate positive trend between family size and risk of HBsAg positivity (P= 0.130). Age over 50 (adjusted OR 14.72; 95% CI 4.35–49.89) and history of transfusion were significant risk factors for hepatitis C (adjusted OR 3.03; 95% CI 1.25–7.33). Hepatitis B and hepatitis C infections have different risk factors in Jakarta, a high risk in population for both diseases. Hepatitis B transmission is associated with low socioeconomic status, Chinese ethnic group and large family size, while hepatitis C is associated with an older age and a history of transfusions.
Functional and phenotypical activation of leucocytes in inflamed human colonic mucosa
Authors: OSHITANI NOBUHIDE , SAWA YOSHINORI , HARA JUNICHI , ADACHI KENJI , NAKAMURA SHIRO , MATSUMOTO TAKAYUKI , ARAKAWA TETSUO , KUROKI TETSUO
Published: March 2008

Infiltrating leucocytes are activated to generate reactive oxygen species or to produce several molecules in inflamed colonic mucosa. To clarify the phenotypical and functional properties of activating cells in colitic mucosa, 23 patients with ulcerative colitis and 13 controls were studied using a combined method for determining in situ nitroblue tetrazolium reducing activity and immunohisto‐chemical characterization. Antibodies 25F9 (anti‐macrophage), EG2 (anti‐eosinophil cationic protein), MAC387 (anti‐calprotectin, expressed by activated myeloid‐histiocytes lineage), and MAC‐1 (anti‐CD11b) were used. The proportion of EG2, calprotectin, and CD11b‐positive cells were significantly increased in inflamed mucosa. The proportion of EG2, calprotectin, and CD11b‐positive cells significantly correlated with the histological degree of inflammation. Proportion of EG2‐positive cells but not calprotectin nor CD11b‐positive cells was significantly correlated with nitroblue tetrazolium reducing activity. Aggregated cells reducing nitroblue tetrazolium seen in severely inflamed mucosa were found to be EG2 positive. Most of the calprotectin‐positive cells were 25F9 negative. In addition to activation of neutrophils and macrophages, eosinophil activation has been shown to be involved in inflamed colonic mucosa.
CASE REPORT: Clinical and virological analyses of a patient positive for hepatitis C virus‐RNA by branched DNA assay but negative for anti‐hepatitis C virus antibodies
Authors: SUZUKI FUMITAKA , CHAYAMA KAZUAKI , NAKAJIMA TAKEYUKI , KAWASAKI TSUNEHISA , KUMADA HIROMITSU , YOSHIMI TERUYA
Published: March 2008

Infection with hepatitis C virus (HCV) is usually diagnosed by the presence of antibodies against fusion proteins or peptides derived from different regions of the HCV genome. However, a subgroup of patients with HCV viraemia are seronegative for antibody against hepatitis C virus (anti‐HCV) by conventional antibody assays. We analysed serum samples from a patient with liver cirrhosis who tested negative for anti‐HCV by a second‐generation assay, but positive for HCV‐RNA by reverse transcription‐polymerase chain reaction (RT‐PCR) and branched DNA signal amplification. To identify possible mutations that could explain the failure of detection of anti‐HCV by second‐generation assay, PCR‐amplified DNA fragments of the core region derived from the serum were cloned and sequenced. Nucleotide (nt) and amino acid (aa) sequence analyses (nt 1–486, aa 1–162) showed no mutations revealing stop codons, frame‐shifts, deletions or insertions, but the presence of two amino acid substitutions (aa 75 and 91) when compared with HCV‐J, a prototype strain of genotype 1b isolated from a Japanese patient. One of these two mutations (aa 75) was situated in the second hydrophilic domain of the core peptide, but analysis of the hydropathy profile showed only a little change. The two mutations were identical to those identified in other Japanese HCV isolates. The serum immunoglobulin level and T and B cell counts were normal in our patient. Our data suggest that the absence of anti‐HCV in this patient was not due to mutations of major epitopes of HCV. Low‐dose prednisolone administration just after transfusion may have induced immunological tolerance against HCV in this patient.
All‐trans retinoic acid suppresses liver injury induced by Propionibacterium acnes and lipopolysaccharide in rats
Authors: MOTOMURA KENTA , SAKAI HIRONORI , ISOBE HIDEHIKO , NAWATA HAJIME
Published: March 2008

All‐trans retinoic acid (ATRA) has been reported to exert major effects on the immune system, including monocytes/macrophages. The present study was designed to determine whether ATRA would modulate macrophage‐associated liver injury induced by Propionibacterium acnes and lipopolysaccharide (LPS) in rats. All‐trans retinoic acid administration alleviated the liver injury and reduced the incidence of death following hepatic failure. Serum alanine aminotransferase (ALT) levels 5 h after, and survival rates within 12 h after the administration of LPS were significantly lower in the ATRA‐treated group (134 ± 119 IU/L and 72.7%) compared with the control group (713 ± 411 IU/L and 18.2%; P < 0.05). Histological findings supported these results. These effects may be due to suppression of tumour necrosis factor‐α (TNF‐α) and superoxide anions produced by activated macrophages. Serum levels of TNF‐α 1 h after LPS administration were significantly lower in the ATRA‐treated group (60.5 ± 7.0 ng/mL) as compared with the control group (105.2 ± 39.3 ng/mL; P < 0.05). Formazan deposition that was generated by the perfusion of the liver with nitroblue tetrazolium, also suggested suppression of the release of superoxide anions from hepatic macrophages. These results suggest that ATRA acts as an immunomodulator in liver injury by suppressing the activation of liver macrophages.
Lansoprazole and amoxycillin: Observations on the treatment of Helicobacter pylori infection
Authors: HAZELL STUART L , DASKALOPOULOUS GEORGE , MITCHELL HAZEL M , MASSEY DAN
Published: March 2008

Symptomatic patients (n=101) with Helicobacter pylori infection were enrolled into a double‐blind, double‐dummy study to assess the efficacy of lansoprazole plus amoxycillin in the treatment of H. pylori infection. Patients were randomized to either lansoprazole 30 mg once daily (days 0‐28) together with placebo (matched to amoxycillin) three times a day (days 0‐14) followed by either placebo or amoxycillin 500 mg three times daily (days 15‐28). Biopsy specimens for culture and histology were collected on days 0 and 56 or upon symptomatic relapse. Blood for serology was collected at days 0, 56 and 168. A [14C]‐urea breath test was performed on day 168. Eighty‐one (80.2%) patients completed the 56 day assessment. Of patients treated with lansoprazole plus amoxycillin, 35.1% (13/37) were cured of infection as assessed at day 56 (26.5% on an intention‐to‐treat basis), compared with 4.8% (2/42) of the placebo group (4% on an intention‐to‐treat basis). Recrudescence/re‐infection occurred in one patient upon re‐evaluation at day 168. Analysis of prognostic factors indicated that smoking and alcohol intake had little impact on the treatment outcome. Inflammation (both acute and chronic) improved in patients treated with lansoprazole plus amoxycillin. The relatively low efficacy of the treatment may relate to a single daily dose of lansoprazole (30 mg) being prescribed, treatment with amoxycillin being commenced 2 weeks after the initiation of lansoprazole or accurate assessment of treatment efficacy (both antral and body biopsy specimens taken).
Quality of ulcer healing influences the relapse of gastric ulcers in humans
Authors: NEBIKI HIROKO , ARAKAWA TETSUO , HIGUCHI KAZUHIDE , KOBAYASHI KENZO
Published: March 2008

The usefulness of dye‐contrast endoscopy for the evaluation of the quality of gastric ulcer healing and the prediction of relapse was investigated. Sixty consenting patients whose ulcers healed during 3 months of treatment underwent endoscopy for the identification of the pattern of mucosal regeneration. Patients were monitored for relapses for up to 18 months after antiulcer therapy had ended. The pattern of regeneration was flat in 24 patients, nodular in 25 and intermediate in 11. Internal hypoechoic areas seen by endoscopic ultrasonography were less common and histological maturity was better in the patient group with the flat pattern compared with the patient group with the nodular pattern of mucosal regeneration. Prostaglandin E, synthesis was highest in the group with the flat pattern of mucosal regeneration and the relapse rate was lowest in this group. We conclude that the evaluation of the quality of ulcer healing is possible and that findings in individuals may aid the prediction of relapse for particular patients.