bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of iron stores and liver disease on the serum concentration of transferrin, haemopexin and caeruloplasmin
Authors: BATEY R. G. , MUIR A. W.
Published: March 2008

Serum concentrations of transferrin, haemopexin and caeruloplasmin have been measured in patients with haemochromatosis and other liver disorders, and the levels compared with those in a control group. Patients with cirrhosis or extrahepatic portal hypertension had normal concentrations of the three proteins except when hepatic decompensation was evident. In decompensated cirrhosis serum albumin and haemopexin levels were reduced. Untreated haemochromatosis, characterized by excessive hepatic iron stores on biopsy, was associated with a significant reduction in the serum concentration of all three proteins. Reductions were documented in both cirrhotic and non‐cirrhotic haemochromatosis. The results document an effect of elevated hepatic iron stores on hepatic protein metabolism and suggest the need for further studies on the regulation of hepatic metalloprotein metabolism.
Identification of intrahepatic lymphocyte subpopulations in patients with drug‐induced allergic hepatitis
Authors: ONJI MORIKAZU , KUMON IZUMI , MIYAOKA HIROAKI , KANAOKA MITSUO , HORIIKE NORIO , OHTA YASUYUKI
Published: March 2008

Intrahepatic lymphocyte subpopulations were studied in eight cases of drug‐induced allergic hepatitis (DIAH) by the immunoenzymatic technique using monospecific T cell antibodies and other reagents. In peripheral blood, the CD4: CD8 ratio in DIAH was higher than that in normal controls. In liver tissue, CD8 positive lymphocytes were predominant, and these cells were attached to the surface of hepatocytes. Leu 7, CD4 and CD11 positive lymphocytes were scarce and were not attached to hepatocytes. HLA‐class I was displayed on the cell membrane of hepatocytes. These results suggest that cytotoxic T cells, which are CD8 positive, CD4 negative and CD11 negative, may play an important role in the pathogenesis of liver cell injury in patients with DIAH.
Serum enzyme pattern in acute liver disease: Relation to type of cell death
Authors: GIBSON P. R. , COLMAN J. C. , WOOD L. J. , DUDLEY F.J.
Published: March 2008

To examine the hypothesis that different histological forms of liver cell death result in a characteristic serum enzyme pattern, the serum concentration of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactic dehydrogenase (LD) enzymes were measured in three aetiologically distinct groups of patients with acute hepatocellular injury. Thirty patients had serologically confirmed acute viral hepatitis B, twenty had histologically proven ischaemic hepatitis and five had paracetamol hepatotoxicity. Serum AST and ALT levels were similar in the patients with viral and ischaemic hepatitis, but the serum LD was significantly higher (P < 0.001) in the ischaemic hepatitis group. The pattern of enzyme elevation in the patients with paracetamol hepatotoxicity was similar to that found in ischaemic hepatitis. AST/LD and ALT/LD ratios, which were greater than 2 and 3 respectively, usually distinguished the patients with viral hepatitis from those with ischaemic hepatitis or paracetamol hepatotoxicity. Because of differences in the clearance of these enzymes from the serum it is likely that the AST/LD ratio will prove of greater discriminatory value and that this will be most evident early in the patient's clinical course and become progressively less with time.
Collagenous colitis: Clinical and histological spectrum in ten patients
Authors: STEADMAN CHARLES , TEAGUE CLINTON , KERLIN PAUL , HARRIS OWEN , HOURIGAN KEVIN , SAMPSON JOHN
Published: March 2008

Collagenous colitis is characterized by the presence of a thick subepithelial collagen band in the colonic mucosa. The condition was diagnosed on rectal biopsy in 10 patients (one male, nine females) who presented with watery diarrhoea. Although rectal mucosal erythema was present in three and ulceration in two, the mucosa was of normal endoscopic appearance in five of the patients. There was marked variability in the thickness of the submucosal collagen band, both between and within individuals. Empirical drug therapy included sulphasalazine, glucocorticoids and antidiarrhoeals. All patients reported symptomatic improvement.
Palliative treatment of malignant ascites by intraperitoneal bleomycin after dialytic ultrafiltration with haemofilter
Authors: LAI KAR NENG , LEUNG JOSEPH W. C. , CHENG PAUL N. M. , LAI FERNAND MAC‐MOUNE
Published: March 2008

Dialytic ultrafiltration with haemofilter was performed in 16 patients with malignant ascites refractory to treatment with sodium restriction, diuretic and systemic chemotherapy. A continuous flow of ascitic fluid at a rate of 300–400 ml/min through a haemofilter was maintained by a blood pump. The protein‐rich ascitic fluid was re‐infused into the peritoneal cavity with sodium and water removed. An average of 5.2 1 of filtrate was removed over a mean interval of 3.5 h. Bleomycin (60 mg) was administered intraperitoneally following the procedure. Complete response was observed in six patients (37.25%) and partial response occurred in four (25%). The remaining patients showed no response. Complications of the dialytic ultrafiltration procedure and toxicity of intraperitoneal administration of bleomycin were minimal. The technique of dialytic ultrafiltration is simple, safe and cost‐effective and could be used as an adjuvant therapy for intraperitoneal chemotherapy.
Alcoholic Liver Disease. Pathobiology, Epidemiology and Clinical Aspects.
Authors: JOHNSON R. D.
Published: March 2008

Alcoholic Liver Disease. Pathobiology, Epidemiology and Clinical Aspects. Edited by Pauline Hall. Edward Arnold
Primary immunodeficiency presenting with gastrointestinal disease in the tropics
Authors: ROSS I. N. , MATHAN V. I.
Published: March 2008

Thirteen patients with hypogammaglobulinaemia were detected in a group of 1300 patients with chronic diarrhoea and malabsorption. Panhypogammaglobulinaemia was present in ten, selective IgA deficiency in two and in one deficiency of IgA and IgM. Functional antibodies were decreased but still detectable. Nodular lymphoid hyperplasia was present in jejunal mucosal biopsies in five and plasma cells were reduced or undetectable in eight. Epithelial lymphocytes were increased. There were only mild abnormalities in in vitro lymphocyte function. While the prevalence of Giardia lamblia was high in the immunodeficient subjects, the prevalence of other gastrointestinal parasites, pathogenic bacteria, or rotavirus, was not high. The pathogenesis of malabsorption in these patients was not clear. Overall morbidity in these immunodeficient patients was similar to that in reports from temperate countries, in spite of their living in an environment with a high prevalence of pathogens.
Rapid response to cisplatin and doxorubicin in hepatocellular carcinoma complicated by hepatitis B virus reactivation
Authors: OLWENY CHARLES L. M. , JOHNSON RICHARD
Published: March 2008

A young adult male with very advanced hepatitis B virus (HBV) associated hepatocellular carcinoma was treated 3 weekly with a combination of doxorubicin (30 mg/m2 per day for 3 days by i.v. bolus) and cisplatin (90 mg/m2 on the fourth day by i.v. infusion) and underwent a rapid partial response. However, the treatment resulted in the reactivation of HBV as evidenced by a rise in HBV‐DNA. This is probably related to chemotherapy‐induced immunodepression followed by a rebound phenomenon upon cessation of therapy. This observation calls for close surveillance of HBV positive patients on cytotoxic and/or immuno‐suppressive therapy.
Infectious mononucleosis in Japan: Comparison with acute viral hepatitis type A
Authors: KATO KATSUMOTO , SANO HIROSHI , KATADA NAOYUKI , NISHIMURA DAISAKU , TAKEICHI MASAYUKI , KANZAKI MASAKI , HAYAKAWA TETSUO , KOYAMA YASUO
Published: March 2008

In order to clarify the characteristics of infectious mononucleosis hepatitis (IMH) in Japan, 20 cases with IMH treated at Kamo Hospital during the past 6 years (Group I) were analysed in comparison with cases of acute viral hepatitis, especially type A. The test for heterophil antibody was positive in only two cases. During the same period 209 cases were treated for acute viral hepatitis (type A: 77 cases = Group A; type B: 61 cases; type non‐A, non‐B: 71 cases). In Group I the common clinical symptoms and signs were headache, sore throat and lymph node swelling; jaundice was not as common as in Group A. GOT and GPT activities increased moderately in the acute stage, but they were significantly lower than those in Group A. LDH, AP, GGT and LAP activities were disproportionately higher to GPT activity in Group I. Liver biopsy in the convalescent stage showed that lipofuscin deposition and sinusoidal mononuclear cell infiltration were more prominent in Group I, while sinusoidal neutrocyte infiltration and focal necrosis at periportal areas were more common in Group A. Differential diagnosis of the two diseases could be made using these clinical features and histological findings. However, immunological differentiation is required for specific diagnosis because some features such as fever, prolonged elevation of thymol turbidity test, atypical lymphocytes in peripheral blod and predilection for young people were observed in both groups. Furthermore, the present study indicated that IMH is no longer rare and most cases do not demonstrate heterophil antibody in Japan.
Bile acid composition in primary hepatocellular carcinoma
Authors: NAKAYAMA FUMIO , YANAGISAWA JIRO , MIYAZAKI HIROSHI , ITOH MASAHIRO
Published: March 2008

Bile acid composition in human primary hepatocellular carcinoma (HCC) tissues from eight non‐hyperbilirubinaemic patients was compared with that in the neighbouring liver tissues. Quantitation of bile acids was carried out using selected ion monitoring. Significant amounts (>14 pmol/mg liver) of bile acids were found to be present in HCC tissues of all patients. In four patients, the concentration of chenodeoxycholic acid was higher in HCC than the corresponding neighbouring liver tissues, whereas those of other bile acids were less. The ratio of cholic to chenodeoxycholic acid was lower in HCC than in adjacent liver tissues in seven out of eight patients. This may indicate predominant synthesis of chenodeoxycholic acid in HCC tissues. The large inter‐individual variation in bile acid concentration and composition of HCC tissues may result from the grade of anaplasia of HCC cells. 3β‐Hydroxy‐5‐cholenoic acid, thought to be excreted in increased amounts in the urine of HCC patients, was shown to be a minor constituent of HCC tissues and of the neighbouring liver tissues in most patients, indicating that the C26‐hydroxylation pathway plays a minor role. Unusual bile acids, such as 23‐nor‐3α,7α,12α‐trihydroxy‐5β‐cholanoic, 3β,7β‐dihydroxy‐5β‐cholanoic, 7‐oxo‐3α,12α‐dihydroxy‐5β‐cholanoic and 12‐oxo‐3α,7α‐dihydroxy‐5β‐cholanoic acids, were found in trace amounts in HCC tissues but their significance is not clear at present.
Sensitivity and specificity of capillary blood HBsAg as a surrogate marker for HBeAg in pregnant women
Authors: LANSANG M. A. , DOMINGO E. O. , LINGAO A. L. , WEST S. K. , ALISAGO E.
Published: March 2008

Infants at high risk of acquiring hepatitis B virus (HBV) infection from their hepatitis B e antigen (HBeAg)‐positive mothers are prime targets for early HBV immunization. The usefulness of fingerprick blood of pregnant women as a surrogate marker to identify infants who would need immunization soon after birth was evaluated. Using HBeAg from venous blood as the standard, the detection of hepatitis B surface antigen (HBsAg) by reverse passive haemagglutination in capillary blood yielded an overall sensitivity of 97% and a specificity of 96% for detecting HBeAg at a cutoff titre of 22.5. Pregnant women with a capillary HBsAg titre of 22.5 or greater are 24 times more likely to infect their babies, while the chances of transmitting HBV infection with a titre lower than the cutoff point are almost nil. When the cost of HBV vaccine eventually comes down to levels suitable for public health use, a cutoff titre of 22.5 is suggested in order to identify infants who should be vaccinated soon after birth.
Efficacy and safety of hepatitis B vaccination in haemodialysis patients
Authors: FUJIYAMA SHIGETOSHI , YOSHIDA KEN , SAGARA KATSURO , SATO TATSUO , NISHIMURA YOHKO , SHIMADA HIDEKATA
Published: March 2008

Antibody response to vaccination with hepatitis B vaccine was evaluated in 39 haemodialysis patients. Three injections of 20 μg of the vaccine were given at time 0, 1 and 6 months. The seroconversion rate for the antibody to hepatitis B surface antigen (anti‐HBs) was 2.6% at 1 month, 15.4% at 2 months, 33.3% at 4 months, 41.0% at 6 months and 59.0% at 7 months (males 53.6%, females 72.7%). Thus, with three injections, the seroconversion rate was significantly smaller and antibody titres were lower compared with 348 healthy control subjects. No correlation was observed between the anti‐HBs seroconversion rate and lymphocyte subsets (OKT4/OKT8). When two additional injections were given at 9 and 10 months to 19 haemodialysis patients with an S/N ratio (the ratio of ct/min in the sample to mean ct/min in negative controls) smaller than 10 at 7 months, 16 patients (84.2%) developed anti‐HBs and elevated antibody titres. Accordingly, the response rate of all haemodialysis patients 12 months after the first injection was elevated to 92.3% and was as high as that in normal subjects. At 24 months, the response rate had gradually declined to 64.1% accompanied with lowered antibody titres. There were no serious side effects.

From these results, it was concluded that the most effective dose and schedule for optimal hepatitis B immunization and booster injections should be decided in haemodialysis patients with low antibody titres.
Analysis of bilirubin conjugates in human bile by column liquid chromatography—Changes in their composition in hepatobiliary diseases
Authors: YAMASHITA MASAKI , ADACHI YUKIHIKO , YAMAMOTO TOSHIO
Published: March 2008

Bilirubin in human bile was analysed by high performance liquid chromatography (HPLC), and seven peaks were identifiable. There was no difference in the proportion of bilirubin between the B bile and C bile from healthy humans obtained by the Meltzer‐Lyon method. HPLC coupled with nuclear magnetic resonance spectroscopy on bilirubin after diazotization permitted differentiation between endovinyl and exovinyl conjugates of bilirubin.

In patients with Gilbert's syndrome, type II Crigler‐Najjar syndrome, and haemolytic anaemia, the proportion of bilirubin diglucuronide (BDG) in the C bile decreased, and that of bilirubin monoglucuronide (BMG) increased. In patients with type II Crigler‐Najjar syndrome, marked elevations in BMG and bilirubin IXα and decreases in bilirubin monoglucuronide monoglucoside diester (BGG) and bilirubin monoglucuronide monoxyloside diester (BGX) were observed. In normal subjects and patients with unconjugated hyperbilirubinaemia, the diazobased indirect‐reacting bilirubin levels in blood and the proportion of BMG in bile were in good correlation. In patients with acute hepatitis, chronic hepatitis, and liver cirrhosis, there was no difference in the bilirubin composition in bile as compared to normal subjects, except for slight elevations in BGG observed in patients with chronic hepatitis and liver cirrhosis. In gallbladder bile obtained from patients with cholelithiasis, bilirubin IXα increased, suggesting some deconjugation of BDG.
Fulminant hepatitis in infants in Taiwan: Strong association with hepatitis B e antigen‐negative but antibody‐positive maternal hepatitis B surface antigen carriage
Authors: HSU HEY‐CHI , CHANG MEI‐HWEI , LEE CHING‐YUN , CHEN DING‐SHINN
Published: March 2008

This study examined the virologic profiles and pathologic features in 10 infants with fulminant hepatitis and aged 2–7 months. Nine male infants were related to hepatitis B virus infection: as evidenced by positive anti‐HBc IgM (4 cases); positive serum HBsAg, and/or liver HBcAg (4 cases); or born to an HBsAg carrier mother (1 case). Only one female infant had presumed non‐A non‐B fulminant hepatitis, but none had hepatitis A. The mothers of eight infants with HBV‐ralated fulminant hepatitis were all positive for serum HBsAg, and most (5/6) were negative for HBeAg but positive for anti‐HBe. These findings suggest that infants born to HBsAg carrier mothers, particularly those who are negative for HBeAg, may contract fulminant hepatitis B in infancy in Taiwan. Six infants studied had massive hepatic necrosis and all died, whereas four had submassive or bridging hepatic necrosis and all survived, suggesting a close correlation between the extent of liver necrosis and the patient's outcome. None of the infants had hepatocyte HBsAg, although four had cytoplasmic HBcAg. Anti‐HBc IgM was commonly detected (4/6), in sharp contrast to the constant negativity in infants who had contracted an asymptomatic HBV infection. These findings suggest that cytoplasmic HBcAg and anti‐HBc IgM may be related to the occurrence of severe liver disease.
Simultaneous determination of multiple markers of primary liver cancer:Diagnostic significance
Authors: WU JIAN‐WEN , MENG XIAN‐YONG , XU KE‐CHENG , SHI YI‐CAI , WEI QUN
Published: March 2008

Simultaneous determination of serum levels of specific γ‐glutamyltransferase isoenzyme II (GGTII) and alkaline phosphatase isoenzyme I (ALPI), α1‐antitrypsin (αAT) and α‐fetoprotein (AFP) was carried out in 101 patients with primary liver cancer (PLC), 60 with liver cirrhosis, 66 with chronic hepatitis, 14 with benign space occupying lesion of the liver and 100 normal subjects. The positivity rates for GGTII, ALPI, α1AT and AFP in patients with PLC were 85.1%, 24.8%, 75.1% and 76.2% respectively; significantly higher than those in the other patients and normal subjects. In the PLC group, the positivity rates for combined determination of AFP and GGTII or α1AT were 93.1% and 92.1% respectively, significantly higher than single determination of AFP. The results of simultaneous determination of GGTII, ALPI, α1AT and AFP in the area of PLC patients showed that the sensitivity of at least one positive marker was as high as 98% and the specificity of at least two positive markers was 94.3%. Of PLC patients with AFP ≤ 50 ng/ml; ≤ 200 ng/ml and ≤ 400 ng/ml, 91.7%, 93.8% and 90.5% respectively, were diagnosed with combined determination of GGTII, ALPI and α1AT. Thus, simultaneous determination of GGTII, ALPI, α1AT and AFP is useful in the diagnosis of PLC, especially PLC with negative AFP or slightly increased AFP.
The close relationship between interleukin‐1 and fibroblast proliferating factor from peripheral mononuclear cells of patients with chronic hepatitis and liver cirrhosis
Authors: NIITSU YOSHIRO , KOHGO YUTAKA , BUNYA MANABU , KOHDA KYUHEI , ITOH NOBUYUKI , OHWADA MINORU , MORITA KOHETSU , MATSUURA KUNIHIKO , WATANABE NAOKI , URUSHIZAKI ICHIRO
Published: March 2008

The role of peripheral mononuclear cells (PMNC) was investigated in patients with hepatic fibrosis of chronic hepatitis or liver cirrhosis. PMNC from these patients released more fibroblast proliferating factor (FPF) in the conditioned medium than those PMNC from normal subjects in response to PHA stimulation. Production of FPF by PMNC from CAH patients was also observed in response to liver specific protein (LSP) which might act as a naturally occurring antigen in vivo.

Analysis of FPF on gel permeation chromatography revealed two active components with molecular weight of 60000 (FPF‐1) and 18000 (FPF‐II). Both FPF‐I and FPF‐II exerted thymocyte proliferating activity, but not cytotoxic T cell line (CTLL) proliferating activity, indicating that they are closely related to interleukin‐1 (IL‐1).

Isoelectrofocusing of FPF‐I and FPF‐II disclosed that each factor consisted of two peaks at similar pI: 5.3 and 7.0. Taking account of the fact the IL‐1 consisted of two molecular forms of pI—5.4 (IL‐1α) and 7.0 (IL‐1β)—FPF‐II is considered to be IL‐1, which is a mixture of IL‐1α and IL‐1β, and FPF‐I is probably the aggregated form of FPF‐II.

This assumption was further supported by the evidence that macrophages, which are the major source of IL‐1 in patients with chronic hepatitis or liver cirrhosis, also released significantly higher amounts of FPF than those from normal subjects in response to stimulation by lipopolysaccharide. It was therefore concluded that in chronic hepatitis and liver cirrhosis, production of an IL‐1, or a factor similar to IL‐1, by PMNC is increased in response to mitogen or LPS.
The relationship between duck hepatitis B virus infection and duck liver diseases in Qitong, China
Authors: WANG QUAN‐YING , YANG GUANG‐XIAO , YE WEI‐FA
Published: March 2008

The relationship between duck hepatitis B virus (DHBV) infection and duck liver diseases was analysed by spot and gel blot hybridization in sera and liver tissues. One hundred and forty ducks were obtained from Qitong county in China. The DHBV‐infected rate was 65.7% and the incidence of duck liver diseases was 70%. The state of DHBV DNA was free in the hepatocytes. The detection rate of DHBV DNA in liver was higher than in serum. The results showed that Qitong duck liver diseases are closely correlated to DHBV infection. The incidence of Qitong duck liver diseases and the DHBV infection rate were different in various species of ducks. Qitong ducks have several hepatic pathological changes as seen in human beings. Therefore, Qitong ducks are most appropriate as an experimental model for human HBV infection.
IMPROVED ANIMAL MODELS FOR HALOTHANE HEPATITIS
Authors: RICE S.A. , MAZE M. , SMITH C.M.
Published: March 2008

Halothane hepatotoxicity in Fischer 344 Rats pretreated with isoniazid

Halothane hepatotoxicity in guinea pigs.

SUCRALFATE AND ASPIRIN INDUCED GASTRIC BLOOD LOSS

Palliation of Pancreatic Carcinoma

'USER FRIENDLY COLONIC TRANSIT ASSESSMENT
Diurnal variations in serum levels, urinary excretion and renal clearances of pepsinogen A and C*
Authors: KATE R.W. TEN , PALS G. , DONKER A.J.M. , ERIKSSON A.W. , MEUWISSEN S.G.M.
Published: March 2008

Diurnal variations in serum levels, urinary excretion and renal clearances of pepsinogen A and pepsinogen C were investigated in eight healthy volunteers during a consecutive 63‐h observation period. Both serum pepsinogen A and pepsinogen C levels proved to be stable and unaffected by meals. Urinary excretion of pepsinogen A, and thus pepsinogen A clearance by the kidney, increased during the day. These changes might be related to food intake. Pepsinogen C and creatinine excretion were constant throughout the day as were the renal clearances of these substances. It is concluded that the kidney plays an important role in maintaining stable serum pepsinogen A levels despite changes in release of pepsinogen A into the circulation during the day. Changes in urinary excretion of pepsinogen A might reflect more accurately short‐term changes in gastric secretory activity than do serum levels. The handling of pepsinogen C by the kidney needs further investigation.
Observations on peptic ulcer in Shan Dong, China
Authors: ZHAO XIAN‐CUN , LI JUN‐MAN , PENG WAN‐CHENG
Published: March 2008

The study consisted of 10 994 inpatients with peptic ulcer in Shan Dong province. The ratio of duodenal to gastric ulcer was 1.59 : 1. The ratio of males to females was 6.8 : 1 for duodenal ulcer and 4.6 : 1 for gastric ulcer. The highest incidence was in adolescence and young adults and the presentation occurred more commonly in winter. A study of blood groups revealed that there was no relationship between blood group and duodenal or gastric ulcer. The majority (71.9%) of patients with peptic ulcer had complications of upper gastrointestinal bleeding, perforation or gastric outlet obstruction. Bleeding and obstruction were equally common in gastric and duodenal ulcer, but perforation was more common in gastric ulcer.
Endoscopic ethanol sclerotherapy in non‐variceal gastrointestinal bleeding
Authors: EDMUNDS S.E.J. , LAURENCE B.H.
Published: March 2008

Upper gastrointestinal bleeding still causes significant morbidity and mortality in spite of an aggressive medical and surgical approach. Endoscopic methods of treatment promise early and effective non‐surgical control of bleeding. Endoscopic injection of ethanol has been used to control gastrointestinal bleeding in a prospective study of 28 high risk patients. Twenty‐two had chronic ulcers (12 duodenal, 10 gastric) and six had angiodysplastic lesions (three gastric, three caecal). The 22 patients with chronic peptic ulcers were either elderly (median age 69 years) or had serious associated medical disorders (73%); 64% presented with shock. Primary haemostasis was achieved in all, but two re‐bled from their ulcer. Surgery was required in one patient who re‐bled 48 h after treatment and in one patient with an ulcer which perforated 45 days after injection; three patients with chronic ulcers refractory to medical therapy also underwent surgery. One patient developed a closed perforation of an antral ulcer after treatment which settled with conservative management; two patients died from causes unrelated to their ulcer. It is concluded that ethanol sclerosis is a safe, effective method for controlling bleeding from chronic peptic ulcers and angiomatous malformations.
BOOK REVIEWS
Authors: JAMIESON GLYN G. , KAMATH K.R.
Published: March 2008

Vascular Disease of the Gut: Pathophysiology, Recognition and Management.

Diets for Sick Children.
A morphologic study of gastric carcinoma in southern India
Authors: RAMAKRISHNA B. , KURIAN S. , MATHAN M.M. , BHAKTAVIZIAM A.
Published: March 2008

A detailed histologic and histochemical analysis of resected specimens of stomach showed that in southern India the intestinal type of gastric carcinoma was the most prevalent. This suggests that this region is a high risk area for gastric carcinoma. A minority of patients (16%) were below 40 years of age but the prevalence of chronic gastritis or intestinal metaplasia was not higher in this age group. Possible factors contributing to the aetiology are discussed.
Clinical utility of a simple quantitative determination of hepatitis B e antigen
Authors: KURAI KIYOHIKO , IINO SHIRO , OKA HIROSHI , NAITO SHIGEKO , TSUDA FUMIO
Published: March 2008

The titre of serum hepatitis B e antigen (HBeAg) was determined by using a simple quantitative system which is a slight modification of a commercially available enzyme immunoassay, and the relationship of serum HBeAg titre, hepatitis B virus (HBV)‐associated DNA polymerase activity and HBV DNA level was evaluated. The HBeAg titre was found to have a significant correlation with DNA polymerase activity (r= 0.8153) and HBV DNA level (r= 0.8001). In 12 acute exacerbations of hepatitis in 10 patients with chronic type B hepatitis, these three parameters were found to be elevated either prior to or concurrent with the elevation of serum alanine aminotransferase, and the HBeAg titre peaked either simultaneously with or 1–4 weeks after the peaks of DNA polymerase activity and HBV DNA level, with average time lags of 1.00 weeks (s.d. = 1.29) and 1.08 weeks (s.d. = 1.25), respectively. Quantified HBeAg can be considered as a serum marker indicative of HBV replication, as is the case with DNA polymerase and HBV DNA. Furthermore, the HBeAg assay has the advantages of simplicity and low cost and it does not require special equipment. Therefore, quantification of HBeAg should be employed widely in clinical practice.
Atrial natriuretic peptide in alcoholic cirrhosis
Authors: WOOD LAURENCE J. , MASSEY DENISE , COLMAN JOHN C. , DUDLEY FRANCIS J.
Published: March 2008

Sodium retention in cirrhosis could result from a deficiency of atrial natriuretic peptide (ANP) or end‐organ resistance to ANP. Venous levels of α‐human ANP (αhANP) measured in 19 alcoholic cirrhotics by radio‐immunoassay were in the higher end of the normal range (29.7 pg/ml, s.d. = 17.2) and tended to increase with development of ascites or varices. Arterial levels of αhANP were not related to right atrial pressure but were related inversely to pulse rate. There was significant splanchnic (mean = 37.2%, s.d. = 19.5) and non‐splanchnic clearance (mean = 30.3%, s.d. = 17.1) of αhANP. The percentage extraction of αhANP across the splanchnic bed (%E ANP splanchnic) was not related to portal pressure, effective hepatic plasma flow or degree of intrahepatic shunting. The %E ANP splanchnic increased as functional liver cell mass (antipyrine clearance) decreased (r= 0.592, P= 0.034). Despite increased splanchnic clearance, αhANP levels increased with a fall in functional liver cell mass presumably due to increased release. Renal sodium retention in cirrhosis does not involve a deficiency of αhANP but increased end‐organ resistance needs to be excluded.
Monthly variation in frequency of active duodenal ulcer and maximal acid output
Authors: HUI WAI‐MO , LAM SHIU‐KUM
Published: March 2008

The frequency of duodenal ulcer has been reported to vary seasonally. It is not known whether gastric acid secretion of patients with this condition has similar seasonal variation. During 1981–85, 1864 patients (mean age 38.0 years, s.d. = 24.2, males comprising 67.1%) with newly diagnosed active duodenal ulcer were documented endoscopically. Of these 626 patients (mean age 38.5 years, s.d. = 15.0, males comprising 71.4%) agreed to have their basal acid output (BAO) and pentagastrin‐stimulated maximal acid output (MAO) measured. Time series analysis using the frequency domain approach identified that the monthly frequencies of duodenal ulcer over the 5‐year period occurred in cycles of 12 months. Multiple comparison using Duncan's procedure identified the occurrence of a significant peak in November and December. MAO varied significantly (P < 0.04) with season with two peaks, one occurring in February and another in July. Month‐adjusted MAO was significantly higher (P < 0.001) in male than in female patients. BAO showed no significant variation by month. It is concluded that active duodenal ulceration and MAO manifest significant variation by month, but their peaks do not coincide, indicating that acidity is unlikely to be a major factor responsible for the frequency of duodenal ulcer peaking in winter. These results also suggest that it is advisable to adjust for seasonal variation when MAO is compared among groups of duodenal ulcer patients.
Nutritional support in acute pancreatitis
Authors: CHOUDHURI G. , TANDON R. K.
Published: March 2008

Acute pancreatitis is a catabolic condition requiring adequate nutritional support to avoid severe nitrogen loss. Providing nutrition to the patients with acute pancreatitis is, however, limited by the fact that oral feeding may stimulate the pancreas and aggravate the pancreatitis. Hence, total parenteral nutrition (TPN) is recommended for such patients but that too has limitations apart from its prohibitive cost. At the same time, therefore, enteral feeds have been developed, which provide adequate nutrition and are fairly well tolerated by these patients. Based on the available studies, a rational scheme of managing acute pancreatitis has been recommended. Patients with moderately severe acute pancreatitis who are malnourished or are likely to develop complications requiring surgery should be supported with total parenteral nutrition from an early stage. All patients with severe acute pancreatitis should, on the other hand, be supported with total parenteral nutrition from the beginning, but enteral nutrition via a jejunostomy should be commenced as early as possible since such patients often run a protracted course and giving them TPN might become exorbitantly expensive and impractical. Mixed or polymeric feeds are tolerated well from the sixth or seventh postoperative day but in an occasional patient elemental diet via the jejunostomy may become necessary.
Synergism of chronic alcoholism and hepatitis B infection in liver disease
Authors: CHUNG HAU‐TIM , LAI CHING‐LUNG , WU PUI‐CHEE , LOK ANNA S. F.
Published: March 2008

Abstrat

One hundred and fifty‐seven patients with alcoholic liver disease were studied. Hepatitis B surface antigen (HBsAg) was positive in 20.4% of the patients. Those who were positive for the HBsAg presented at an earlier age, had a lower albumin level, a higher globulin level, a more prolonged prothrombin time, were more likely to have features of cirrhosis in the liver biopsy, and were probably more likely to suffer from hepatic encephalopathy in the follow‐up compared with those negative for HBsAg. The mortality of subjects was low both on admission and during follow‐up. It is concluded that chronic alcoholism and hepatitis B virus infection act synergistically in producing more severe liver damage and causing cirrhosis at a younger age compared with chronic alcoholism alone. One possible reason for the low mortality of the patients might have been their relatively good nutritional status.
Anti‐pre‐S antibodies in different groups of patients with hepatitis B virus infection
Authors: IRSHAD M. , GANDHI B. M. , ACHARYA S. K. , JOSHI Y. K. , TANDON B. N.
Published: March 2008

Abstrat

The anti‐pre‐S antibody in the samples of sera from normal healthy persons and patients with different clinical types of liver diseases due to hepatitis B virus (HBV) infection was detected by a newly established enzyme‐linked immunosorbent assay technique. This test is a blocking assay where anti‐pre‐S antibody in the patient's serum blocks subsequent addition of horse radish peroxidase‐labelled polymerized human serum albumin (pHSA) to the pHSA‐receptor site of HBsAg molecules fixed on a solid surface. Anti‐pre‐S activity was not detected in any from 95 healthy persons who were negative for all HBV‐markers or from 105 healthy HBV carriers. In 12 sera from HBV vaccine recipients, anti‐pre‐S activity was noted in higher proportions compared with anti‐HBs, after both the second and third doses of vaccine. Anti‐pre‐S activity was detected in small proportions of HBsAg positive sera from acute viral hepatitis (4.2%) and chronic active hepatitis (10%). In subacute viral hepatitis patients, the anti‐pre‐S antibody was totally absent. However, anti‐pre‐S activity was recorded in high proportions of HBsAg‐positive sera from patients with cirrhosis of liver (57.2%) and fulminant hepatitis (41.6%). The anti‐pre‐S antibodies were assumed to be implicated in the clearance of HBV particles from circulation without causing tissue damage.
Duodenoscopic sphincterotomy for acute suppurative cholangitis
Authors: TANDON R. K. , SARASWAT V. A. , KAPUR B. M. L. , VASHISHT S.
Published: March 2008

Fifteen patients (eight males, seven females; age range: 23–76 years) presenting with acute suppurative cholangitis underwent endoscopic retrograde cholangiography and sphincterotomy within 1–10 days of hospitalization. Cholangitis was due to common duct stones in all patients; all but one of them had their gall‐bladders in situ. All of them had fever, jaundice, abdominal pain, leucocytosis and deranged liver function while 26.6% were in shock, 13.3% in coma and 40% in azotaemia. Cardiac or other associated diseases caused 21% of the patients to be high risk candidates for surgery. An adequately sized sphincterotomy was done in 14 (93.3%) patients; in eight of them it was immediately followed by a successful stone extraction while in another four patients either the stone passed out spontaneously (one patient) or was retrieved by a repeat basketing. Thus, the common bile‐duct was cleared of stones in 80% patients. Of 14 patients with satisfactory sphincterotomy, 11 (73.3%) had a dramatic clinical improvement, two (14.3%) had a somewhat delayed benefit and one patient died due to unrelieved cholangitis. Ten patients subsequently underwent elective cholecystectomy while three patients continue to have their gall‐bladders in situ. There has been no recurrence of biliary tract symptoms in these 13 patients during the subsequent 3–26 months (mean follow‐up: 15.1 months). It is concluded that urgent duodenoscopic sphincterotomy is rewarding in patients with acute suppurative cholangitis when it is performed early.
Influence of posture on transient lower oesophageal sphincter relaxation and gastro‐oesophageal reflux in the dog
Authors: LITTLE ANDREW F. , COX MICHAEL R. , MARTIN CHRISTOPHER J. , DENT JOHN , FRANZI STEPHEN J. , LAVELLE ROGER
Published: March 2008

Abstrat

The hypothesis that suppression of transient lower oesophageal sphincter relaxation (TLOSR) in recumbent postures in the dog is dependent upon the sensing of a gastric pool of liquid in proximity to the lower oesophageal sphincter was examined. Constant gastric insufflation with air (80 ml/min) was used to evoke TLOSR in unsedated, fasting animals. Oesophageal motility was monitored with a perfused manometric sleeve catheter assembly. Gastro‐oesophageal flow was recognized manometrically and by oesophageal pH recording. TLOSR occurred significantly less frequently in three recumbent positions (right lateral, left lateral and supine) than when the dog stood on four legs, but was more likely to be associated with acid reflux when they occurred in recumbent positions. Aspiration of the gastric pool was found to have no effect on triggering of TLOSR although it reduced the frequency with which acid reflux was associated with TLOSR. It is concluded that the low rate of occurrence of TLOSR in recumbent positions is unlikely to be explained by the presence of a gastric pool of liquid in proximity to the lower oesophageal sphincter.
LETTER TO THE EDITOR
Authors: Johnson R. B. , Hetzel P. A. S. , La Brooy J. T. , Shearman D. J. C. , Davidson G. P. , Propert D. N.
Published: March 2008

Immunoglobulin allotype and serum antigliadin antibodies in coeliac disease
Acute viral hepatitis: An aetiological study of 253 patients
Authors: RASSAM S. W. , GOUDEAU A. M. , DUBOIS F. , AL‐KHOURY B. N. , AL‐DEEN J. A. MUHYEE , SADIK A. M.
Published: March 2008

Two hundred and fifty‐three cases of acute viral hepatitis admitted to Ibn Al‐Khateeb Infectious Disease Hospital, Baghdad, were studied prospectively regarding the viral aetiological agent. The most common cause was infection with one of the non‐A, non‐B viruses (51%). The second most common cause was infection with the hepatitis B virus (32%); two of these patients had hepatitis δ‐co‐infection. Hepatitis A virus was responsible for 15% of the cases, and hepatitis δ‐virus superinfection in 2% of the cases.
Plasma human atrial natriuretic peptide levels in patients with liver cirrhosis
Authors: UEMURA KAZUYUKI , OGUCHI HISAO , KIYOSAWA KENDO , FURUTA SEIICHI
Published: March 2008

Plasma levels of human atrial natriuretic peptide (hANP) were investigated in patients with liver cirrhosis, and the relationships between plasma hANP levels and the following factors were studied: presence of ascites, serum and urine electrolytes, plasma renin activity, angiotensin I and II, aldosterone, catecholamines, prostaglandin derivatives, conventional liver function tests and circulating blood volume.

Plasma hANP level was significantly (P < 0.05) elevated in patients with ascites (mean = 58.6 pg/mL, s.e.m. = 8.8) compared with cases without ascites (mean = 36.6 pg/mL, s.e.m. = 2.6). With the disappearance of ascites, the level fell to normal in most cases. Urine sodium excretion was positively correlated with plasma hANP in patients without ascites, but not in patients with ascites. The plasma hANP level was disproportionately high for the rate of urinary Na excretion in cirrhotics with ascites. The plasma hANP level was not correlated with any of the other factors such as blood volume, renin‐angiotensin‐aldosterone levels, catecholamines and liver function tests.

These results suggest that plasma hANP levels are elevated in cirrhotic patients especially with ascites, but the natriuretic response of the kidney to this raised hANP level can be impaired in patients with liver cirrhosis and ascites.
Plasma membrane fluidity in isolated rat hepatocytes: A comparative study using DPH and TMA‐DPH as fluorescent probes
Authors: BENEDETTI ANTONIO , FERRETTI GIANNA , CURATOLA GIOVANNA , BRUNELLI EUGENIO , JÉZÉQUEL ANNE MARIE , ORLANDI FRANCESCO
Published: March 2008

The study of membrane fluidity is a rapidly expanding field of research and its interest in hepatology has been stressed recently. The present study is the first report concerned with the determination of membrane fluidity of isolated rat hepatocytes. The data have been compared with those obtained in plasma membrane fractions and subfractions (basolateral or canalicular) derived from homogenates. The fluorescent probes used to measure the fluidity were diphenylhexatriene (DPH) a ‘classical’ probe, and its derivative trimethylammoniodi‐phenxylhexatriene (TMA‐DPH) at 25°C and at 37°C. The values obtained with DPH were lower than those with TMA‐DPH, probably due to the localization of the probes in different regions of the phospholipid bilayer. In addition, DPH revealed significant differences in the fluorescence polarization values obtained in isolated hepatocytes compared with membrane fractions, which was in contrast to TMA‐DPH, where the respective values were of the same order of magnitude. This behaviour is probably due to the mobility of DPH in the membrane core and its rapid internalization into the cell, whereas TMA‐DPH remains anchored for a long time on the cell surface. These findings suggest that TMA‐DPH is a better probe than DPH for measuring the fluorescence polarization of whole isolated hepatocytes and that the use of different probes might be of help in exploring different zones of the membrane bilayer.
Applications of molecular genetics to gastrointestinal and liver diseases. II. Clinical relevance
Authors: SUMMERS KIM M.
Published: March 2008

Abstract The use of DNA probes within or near disease genes is becoming increasingly important in clinical medicine. Probes are available for prenatal and carrier diagnosis for several of the more than 100 genetic diseases of the gastrointestinal tract and liver. These include familial adenomatous polyposis, haemochromatosis, cystic fibrosis, α1‐antitrypsin deficiency and the hereditary porphyrias. This review uses examples drawn from such diseases to show the relevance of these approaches to the clinician.
Changing aetiologic patterns of acute viral hepatitis in Taiwanese children
Authors: HUANG LI‐MIN , CHANG MEI‐HWEI , HONG JIN‐YANG , LEE CHIN‐YUN , CHEN DING‐SHINN
Published: March 2008

Abstract During 1981–86, 76 children were diagnosed as having acute viral hepatitis at the Department of Pediatrics, National Taiwan University Hospital, which is a major referral centre for hepatitis in children in northern Taiwan. The majority (64%) of children had acute hepatitis B which had occurred mainly during infancy. Perinatal transmission from a hepatitis B e negative surface antigen (HBsAg) carrier mother or infection through blood transfusion from a donor who had escaped notice by a less sensitive screening test (reverse passive haemagglutination test) for HBsAg were the two important modes of transmission of hepatitis B virus.

The number of cases of acute hepatitis B declined after 1984, with the beginning of the nation‐wide hepatitis B vaccination programme. Due to an outbreak of hepatitis A in northern Taiwan in 1982, the number of cases of hepatitis A peaked that year. Subsequently, cases of acute hepatitis A decreased remarkably. Better socio‐economic conditions and improved hygiene might have contributed to the marked decrease of viral hepatitis A. The frequency of non‐A, non‐B hepatitis remained stable during the study period.

It is possible to conclude that the aetiologic pattern of acute hepatitis in Taiwanese children changed during the past 6 years: clinical cases of hepatitis A and B decreased, probably because of more effective control of hepatitis A and B virus infections, whereas the control of non‐A, non‐B virus apparently requires further efforts.
Gall‐bladder and sphincter of Oddi response to cholecystokinin in the Australian possum
Authors: IANNOS J. , SACCONE G. T. P. , BUSHELL M. , BAKER R. A. , TOOULI J.
Published: March 2008

The effects of cholecystokinin octapeptide (CCK‐OP) on the gall‐bladder (GB) and sphincter of Oddi (SO) of the Australian brush tailed possum were examined in 45 anaesthetized animals. CCK‐OP (20–640 ng/kg) consistently caused the GB to contract in a dose‐dependent manner (Kruskal Wallis P<0.05). In 20 animals, the same dose range of CCK‐OP produced an excitatory response in the SO, increasing the SO motility index (MI = frequency of contractions x mean peak amplitude) dose‐dependently (Kruskal Wallis P < 0.05). In five animals, an inhibitory response, that is, a decrease in MI, was recorded, with 640 ng/kg of CCK‐OP producing a 50% decrease in MI. In the remaining 20 animals, variable responses of both excitation and inhibition were elicited within the same animal. The action of CCK‐OP on the SO and GB was not modified by atropine, phentolamine or propranolol. Tetrodotoxin (TTX) reversed the inhibitory responses of the SO to CCK‐OP such that responses were excitatory (sign test P<0.05). TTX did not alter the response of the GB to CCK‐OP. It is concluded that CCK‐OP acts directly on smooth muscle receptors of the GB. In the SO, its action is mediated via non‐cholinergic, non‐noradrenergic inhibitory neurons and also by a direct excitatory action on the smooth muscle of the SO.
Acute cholangitis after endoscopic sphincterotomy: Complications of expectant treatment
Authors: LAI E. C. S. , CHOI T. K. , FAN S.T. , WONG J.
Published: March 2008

Two elderly patients who had endoscopic sphincterotomy (EST) for their common duct stones developed acute cholangitis and, one of them also developed acute pancreatitis after the procedure. Despite the presence of an adequate sphincterotomy which allows subsequent spontaneous stone elimination, transient ductal obstruction during stone migration through the sectioned papilla is probably accountable for their complications. From the present reported experience, it is clear that expectant treatment of common duct stone after EST can be associated with definite hazards. Immediate biliary decompression with either active instrumental extraction or, when not feasible, insertion of nasobiliary catheter, should be performed to prevent these complications in selected patients.
Multiplicity of newly established monoclonal antibodies against hepatocellular carcinomas
Authors: OHZU KYOKO , HASEGAWA KIYOSHI , YAMAUCHI KATSUMI , OBATA HIROSHI
Published: March 2008

Abstract To identify tumour‐associated cell surface antigens of human hepatocellular carcinoma (HCC), we established three monoclonal antibodies against a well established human HCC line, hu‐H2. One of these, designated as KY‐1, reacted with several HCC lines and a majority of peripheral blood lymphocytes. A second monoclonal antibody, KY‐2, reacted only with HCC cell lines but not with others. With this KY‐2 antibody, which was highly specific for HCC, HCC tissue was positively stained. A third monoclonal antibody, KY‐3, reacted with HCC lines and many other malignant cell lines, but not with non‐malignant cells.

These results indicate that at least three different tumour‐associated molecules are expressed on human HCC.