bluuebunny/crossref_metadata_2025 huggingface dataset:
Chromosomal localization of the human urokinase plasminogen activator receptor and plasminogen activator inhibitor type‐2 genes: Implications in colorectal cancer
Authors: WEBB GRAHAM , BAKER MARK S. , NICHOLL JILLIAN , WANG YAO , WOODROW GRAEME , KRUITHOF EGBERT , DOE WILLIAM F.
Published: March 2008

Abstract Activation of the proenzyme of urokinase (uPA) on the surface of cancer cells has been implicated in the initiation of focal proteolytic mechanisms that permit invasion and metastasis by colon cancers. The activity of uPA on the cell surface appears to be a function of the number of uPA‐specific receptors (uPAR) and the extent of inhibition of uPA by plasminogen activator inhibitors (PAI). The mapping of the genes coding for uPAR, and for PAI‐2, was performed to determine whether their chromosomal localization suggested their involvement in the genetic alterations associated with cancer cell DNA.

This study confirms the localization of the human urokinase plasminogen activator receptor gene to chromosome 19q and, using in situ hybridization, provides a precise localization to chromosome 19q13.2. In addition, our results confirm the previous allocation of the human plasminogen activator inhibitor‐2 gene to a location 18q21.3 → 18q21.1, a location that corresponds to the commonest (>70%) somatic deletions found in colorectal carcinomas. The mapping of the uPAR and PAI‐2 genes enables the elucidation of their possible involvement in the genetic alterations that determine the invasive and metastatic phenotypes in colorectal cancer.
Transjugular liver biopsy: Comparison with percutaneous liver biopsy
Authors: MENG HONG‐CHIANG , LIN HAN‐CHIEH , HUANG CHENG‐CHUN , LIAO DONG‐MING , LEE FA‐YAUH , LEE SHOU‐DONG , TSAI YANG‐TE , LO KWANG‐JUEI
Published: March 2008

Abstract A transjugular liver biopsy was performed on 60 patients. Specimens were successfully obtained from 57 (95%) patients. Specimens obtained from cirrhotic patients were frequently small‐sized/fragmented. The wedge hepatic venous pressure and hepatic venous pressure gradient were higher in patients with small‐sized/fragmented specimens than those with non‐fragmented specimens (16.3 ± 6.4 vs 12.3 ± 4.9 and 10.9 ± 6.2 vs 7.3 ± 3.4 mmHg, P <0.05, respectively). During the same period of time, percutaneous liver biopsies were consecutively performed on 277 patients. The liver specimens by transjugular method were generally smaller (0.63±0.58 vs 1.50±0.86 cm, P <0.001) and more fragmented (63%vs 16%, P <0.01) than those obtained by percutaneous method. Biopsy specimens obtained for diagnosis by the former method were inadequate from 6 (10%) patients and by the latter route were inadequate from 7 (2%) patients. Subcapsular haematoma in one patient was associated with the transjugular liver biopsy. Minor complications occurred in three patients: neck haematoma in two and paroxysmal supraventricular tachycardia during the procedure in one. In comparison, percutaneous liver biopsy was followed by minor complications in 20 patients and major complications in four patients. It is concluded that transjugular liver biopsy is a safe, valuable and alternative procedure to obtain liver specimens, especially in patients who were contraindicated for percutaneous liver biopsy.
A correlative study on the mechanism of adaptive cytoprotection against ethanol‐induced gastric lesion formation in rats
Authors: KO J. K. S. , CHO C. H. , OGLE C. W.
Published: March 2008

Abstract The protective effect of mild irritants against the subsequent gastric injury induced by necrotizing agents has been termed ‘adaptive cytoprotection'. In this study, the possible pathway and mechanisms of adaptive cytoprotection induced by 20% ethanol were investigated. An ex‐vivo gastric chamber preparation was used. The gastric mucosa was exposed to 20% ethanol before subsequent administration of 100% ethanol 15 min later. Subdiaphragmatic vagotomy or drug pretreatment was carried out in order to elucidate the mechanisms of adaptive cytoprotection by 20% ethanol. The results showed that 20% ethanol pre‐exposure significantly protected the gastric mucosa against damage caused by 100% ethanol. This protective action was completely abolished by atropine or lidocaine pretreatment, whereas vagotomy and hexamethonium failed to have a significant influence. The cytoprotective effect, however, was independent of the gastric secretory volume, titratable acid content, luminal soluble mucus level and gastric mucosal blood flow. Exposure of only half the gastric mucosa to the mild irritant resulted in the protection of both sides of the mucosa. All these findings indicate that the adaptive cytoprotection of 20% ethanol involves the participation of chemoreceptors and muscarinic receptors in the gastric mucosa. An internal enteric reflex arc, with transmission of signals within the gastric mucosa, may also contribute to the cytoprotective process of the mild irritant.
The Loeffler's methylene blue stain: An inexpensive and rapid method for detection of Helicobacter pylori
Authors: MISRA V. , MISRA S. P. , DWIVEDI M. , GUPTA S. C.
Published: March 2008

Abstract Loeffler's methylene blue, commonly used as a counter‐stain for acid fast bacilli, was used to detect Helicobacter pylori in paraffin sections and touch smears of gastric mucosal biopsies from 15 patients with duodenal ulcer and 35 with non‐ulcer dyspepsia, and the results were compared with the modified Giemsa stain. The time taken to stain smears by Loeffler's methylene blue was approximately 10 min and the results correlated well with those stained by the modified Giemsa stain. However, the Loeffler's methylene blue method was found to be simpler, quicker and cheaper than the modified Giemsa stain.
Thrombocytopenia associated with platelet‐associated immunoglobulin G in alcoholic hepatitis
Authors: KAMISAKO TOSHINORI , SAIKA YASUSHI , ADACHI YUKIHIKO , ITOH TADASHI , FUJII RYOUICHI , YAMAMOTO TOSHIO
Published: March 2008

Abstract A 45 year old Japanese man with alcoholic hepatitis developed thrombocytopenia together with an increase in the level of platelet‐associated immunoglobulin G (PAIgG). Bone marrow aspiration revealed a normal nucleated cell count and a slight increase of megakaryocytes. After abstinence from alcohol, laboratory and symptomatic improvement occurred in association with a prompt increase in the platelet count and a corresponding decrease of PAIgG. These findings suggest that PAIgG may have been involved in the development of thrombocytopenia in this patient.
How Helicobacter pylori acquired its name, and how it overcomes gastric defence mechanisms
Authors: GOODWIN C. S.
Published: March 2008

Abstract At Royal Perth Hospital, Western Australia in April 1982, spiral bacteria were first cultured from a gastric biopsy specimen. Several important taxonomic features were identified which indicated that these bacteria represented a new genus. In October 1989 the new genus name Helicobacter was published. Helicobacter pylori overcomes gastric defence mechanisms by means of its powerful urease enzyme, by its spiral shape allowing it to penetrate mucus, by adherence to the gastric mucosa and by various mechanisms which enable it to evade the immune response.
Peptic ulcer in hepatic cirrhosis and renal failure
Authors: KANG J. Y.
Published: March 2008

Abstract The prevalence of peptic ulcer in cirrhotic patients is similar to that reported for the general population. Although gastric acid outputs ar normal or lower in cirrhotic subjects compared with non‐cirrhotics, the frequency of non‐response to histamine H2‐receptor antagonists is higher. Peptic ulcer disease in the cirrhotic seems to pursue a more virulent course compared with that in the non‐cirrhotic subject.

Peptic ulcer prevalences in patients dying of uraemia or in uraemic patients on maintenance dialysis treatment are comparable with those in the general population. However, the frequency of peptic ulcer, especially complicated ulcer, is increased following renal transplantation. Ulcer complications in this context are associated with a high mortality rate. Pre‐transplant risk factors for subsequent development of peptic ulcer remain to be identified and the value of histamine H2‐receptor antagonists in prophylaxis is as yet unproven.
Nitric oxide‐releasing non‐steroidal anti‐inflammatory drugs: A novel approach for reducing gastrointestinal toxicity
Authors: WALLACE J. L. , REUTER B. K. , CIRINO G.
Published: March 2008

Abstract The use of non‐steroidal anti‐inflammatory drugs (NSAID) for treatment of inflammatory conditions is significantly limited by the untoward effects of these compounds on the gastrointestinal tract. While the pathogenesis of ‘NSAID‐gastropathy’ is not completely understood, there is good evidence that the process is directly linked to suppression of prostaglandin synthesis and possibly to neutrophil adherence to the vascular endothelium. Pretreatment of rats with a nitric oxide (NO) donor (sodium nitroprusside) was found to significantly reduce the extent of gastric injury induced by flurbiprofen. We therefore tested the effects of a novel derivative of flurbiprofen. This compound contains a moiety similar to the NO‐releasing moieties found in many organic nitrates. This compound suppressed gastric prostaglandin synthesis as effectively as flurbiprofen, but caused significantly less haemorrhagic damage. The compound was also found not to induce small intestinal injury. Since the compound was found to exert anti‐inflammatory effects comparable with flurbiprofen, NO‐releasing NSAID may represent a novel class of drugs with markedly reduced gastrointestinal toxicity.
Involvement of endogenous nitric oxide in the inhibition by endotoxin and interleukin‐1β of gastric acid secretion
Authors: ESPLUGUES J. V. , MARTÍNEZ‐CUESTA M. A. , BARRACHINA M. D. , CALATAYUD S. , WHITTLE B. J. R.
Published: March 2008

Abstract Administration of Escherichia coli endotoxin abolished the acid secretory response induced by a bolus injection of pentagastrin in the continuously perfused stomach of the anaesthetized rat. Likewise, acid secretion stimulated by the continuous intravenous perfusion of pentagastrin was inhibited by administration of interleukin‐1β (IL‐1β). In both cases pretreatment with Ng‐nitro‐l‐arginine methyl ester (l‐Name) but not dexamethasone or indomethacin substantially restored the secretory responses to pentagastrin. The actions of l‐Name were reversed by the prior administration of l‐arginine but not by its enantiomer d‐arginine. Even though l‐Name increased blood pressure, this does not seem to be the mechanism by which endotoxin‐induced acid inhibition was prevented, since similar systemic pressor responses induced by phenylephrine had no such effect. The secretory response elicited by pentagastrin in the isolated lumen perfused stomach of the rat was not influenced by incubation (100 min) with IL‐1β. These observations suggest that the acute inhibition of acid responses to pentagastrin by endotoxin and IL‐1β involves nitric oxide (NO) synthesis from l‐arginine.
Aetiological factors of peptic ulcer: Perspectives of epidemiological observations this century
Authors: LAM S. K.
Published: March 2008

Abstract There are five known environmental, causative factors for peptic ulcer, namely, non‐steroidal anti‐inflammatory drugs (NSAID), Helicobacter pylori infection, cigarette smoking, environmental stress and dietary habit. There have been six factual, epidemiological observations on peptic ulcer this century: the rise and fall of ulcer frequency in Western societies; geographical variations in ulcer rates; in sex ratios; in duodenal: gastric ulcer ratios; and in placebo healing rates; and seasonal variation in ulcer frequencies. This report examines each of these epidemiological observations to see if each of the environmental factors can explain the observations. The secular trends and the variation in ulcer rates can be related to all the environmental factors. The sex ratios can be explained on the basis of cigarette smoking and environmental stress, whereas the duodenal: gastric ulcer ratios may be ascribed to NSAID use. Placebo healing and seasonal occurrence of ulcer is probably more related to environmental stress. Helicobacter pylori infection alone cannot explain the sex ratios, the duodenal: gastric ulcer ratios, the placebo healing and the seasonal occurrence of ulcer. Cigarette smoking or NSAID use alone does not tally with the seasonal variation of ulcer frequencies. Environmental stress alone does not fit into the recent fall of ulcer rates in Western countries. This report supports the concept of heterogeneity in peptic ulceration.
Comparison of brush before biopsy, suction cytology, brush after biopsy and endoscopic biopsy in the diagnosis of carcinoma oesophagus
Authors: SINGH TARANPREET , GUPTA NARENDAR M. , BHASIN DEEPAK K. , RAJWANSHI ARVIND , MALIK ASHOK K.
Published: March 2008

A study was conducted on 40 patients of carcinoma oesophagus to compare the diagnostic yield of brush before biopsy, suction cytology, brush after biopsy and endoscopic biopsy. The positive yield with brush before biopsy was 87.5%, with suction cytology 90%, with brush after biopsy 100% and with endoscopic biopsy 90%. Difference in the yield of brush after biopsy compared to other modalities was statistically insignificant (P <0.05). However, the quantitative yield of the material was significantly high (P <0.05) in the brush after biopsy compared to brush before biopsy. Of these three cytological modalities brush after biopsy appears to be the cytological technique of choice to be used as an adjunct to endoscopic biopsy.
Total paracentesis in non‐alcoholic cirrhotics with massive ascites: Mid‐term effects on systemic and hepatic haemodynamics and renal function
Authors: WANG SUN‐SANG , LU CHI‐WEN , CHAO YEE , LEE FA‐YAUH , CHEN TZEN‐WEN , LIN HAN‐CHIEH , LEE SHOU‐DONG , TSAI YANG‐TE , LO KWANG‐JUEI
Published: March 2008

Single total paracentesis (4.8–11 L) was performed in 23 patients with hepatitis B surface antigen (HBsAg)‐positive cirrhosis and massive ascites and its effects on systemic and hepatic haemodynamics and renal function were examined over 5 days. Severe hypotension occurred in six (26.1%) patients from 6 to 54 h after paracentesis. In the remaining 17 patients, compared to the baseline, there was an increase in the cardiac output (6.1 ± 0.3 vs 6.7 ± 0.3 L/min, P <0.001) and a decrease in right atrial pressure (8.8 ± 0.8 vs 4.3 ± 0.7 mmHg, P <0.001), systemic vascular resistance (1160 ± 61 vs 976 ± 50 dyne·s·cm −5, P <0.001), and wedged hepatic venous pressure 30 min after completion of paracentesis. After 5 days, right atrial pressure, systemic vascular resistance and wedged hepatic venous pressure returned to baseline, while the cardiac output dropped to a level lower than the baseline (5.7 ± 0.7 L/min, P<0.05). Hepatic venous pressure gradient had returned to baseline after 5 days. Serial tests of serum creatinine level showed an increase from day 3 (1.34 ± 0.14 vs 1.04 ± 0.10 mg/dL, P <0.05). On day 5, creatinine clearance (55.7 ± 5.4 vs 41.9 ± 5.3 mL/min, P <0.05) and effective renal plasma flow (351 ± 32 vs 293 ± 29 mL/min, P <0.05) were decreased, compared to the baseline. Based on these data, infusion of a volume expander may be necessary for total paracentesis to avoid systemic haemodynamic complications in non‐alcoholic cirrhosis.
High rate of mixed genotypes of hepatitis C virus in patients of an epidemic area in Japan
Authors: YAMADA MASAHIKO , FUKUDA YOSHIHIDE , IMOTO MASAMI , KOYAMA YASUO , HAYAKAWA TETSUO , TAKAYAMA TETSUO , NAGURA HIROSHI
Published: March 2008

The subjects of this study were 151 patients (69 males and 82 females) who underwent examination and liver biopsy owing to liver dysfunction in an epidemic area with hepatitis C. Second generation hepatitis C virus antibody (HCV Ab) was positive in 116 (76.8%) of 151 cases. HCV‐RNA was detected in 120 (79.5%) by polymerase chain reaction (PCR). In 7 (4.6%) cases, HCV Ab could not be found, but HCV‐RNA was detected. Three (2.0%) cases were positive for HCV Ab but negative for HCV‐RNA. On the basis of variation in nucleotide sequence within a restricted region in the putative core gene of HCV, HCV genotypes were classed into four types of I, II, III and IV by PCR. The genotypes were identified in 120 cases. Ninety‐eight (81.7%) cases carried one of the four types. Type II was found in 76 (63.3%) cases and type III in 22 (18.3%). The other 22 (18.3%) carried simultaneously two different genotypes (mixed type): 21 (17.5%) cases with type II + III and one (0.8%) case with type II + IV. In comparison with the incidence of HCV mixed types in cases with hepatitits C in a non‐epidemic area, carriers of mixed types were found at a significantly higher rate in the epidemic area. Liver biopsy of 120 cases with identified HCV genotypes in the epidemic area showed 93 cases of chronic active hepatitis, nine of chronic lobular hepatitis, 10 of chronic persistent hepatitis and eight of liver cirrhosis. No significant correlation could be detected between liver histology and HCV genotypes. Of the 120 cases, 63 (52.5%), 54 (45.0%) and 12 (10.0%) cases had past histories of folk remedies accompanying bleeding, operation and transfusion, respectively. The repetition of these medications may have caused a high ratio of carriers of the mixed genotypes of HCV.
Oesophageal perforation following endoscopic variceal ligation and balloon tamponade
Authors: HOU MING‐CHIH , LIN HAN‐CHIEH , CHANG FULL‐YANG , LEE FA‐YAUH , CHEN TSENG‐SHING , LEE SHOU‐DONG
Published: March 2008

Endoscopic variceal ligation (EVL) related complication is rarely reported. A case is presented of a 74 year old man with oesophageal variceal bleeding who developed oesophageal perforation following EVL and balloon tamponade. An oesophageal wall defect was induced by EVL and tissue repair was hindered by decompensated liver reserve and shock status; concomitant balloon tamponade precipitated oesophageal perforation. The case is reported to draw attention to oesophageal perforation after concurrent use of balloon tamponade and EVL.
Immune response after hepatitis A vaccination in haemodialysis patients: Comparison with hepatitis B vaccination
Authors: KURAMOTO I. , FUJIYAMA S. , MATSUSHITA K. , SATO T.
Published: March 2008

This study evaluates the immune response of 20 haemodialysis (HD) patients vaccinated with hepatitis A (HA) vaccine and eight patients vaccinated with hepatitis B (HB) vaccine. Twenty patients and 22 healthy adults were immunized three times (months 0, 1 and 6) intramuscularly with a 0.5 μg dose. All members of both groups were positive for the antibody to hepatitis A virus (anti‐HAV) after three vaccinations. The geometric mean titres at 7 months were similar in both groups. No serious side effects were observed. Eight of the HD patients with HA vaccination were injected with yeast‐derived hepatitis B vaccine. The three doses of 10 μg were administered intramuscularly at 0, 1 and 6 months. The occurrence of antibody to hepatitis B surface antigen (anti‐HBs) was late in HD patients and the anti‐HBs level in HD patients was lower than that in healthy subjects. These results indicate that this HA vaccine has good immunogenicity compared with the HB vaccine and that the standard three doses of HA vaccine given at 0, 1 and 6 months are safe and effective even in HD patients.
Cruveilhier‐Baumgarten syndrome: An efficient spontaneous portosystemic collateral preventing oesophageal varices bleeding
Authors: CATURELLI EUGENIO , POMPILI MAURIZIO , SQUILLANTE MARIA MADDALENA , SPERANDEO GIUSEPPE , CARUGHI STEFANO , SPERANDEO MARCO , PERRI FRANCESCO , ANDRIULLI ANGELO , CELLERINO CATERINA , RAPACCINI GIAN LUDOVICO
Published: March 2008

The protective role of large spontaeous portosystemic shunts in oesophageal varices bleeding due to portal hypertension in liver cirrhosis is still debated. A series of 20 consecutive patients with haemodynamically efficient collaterals involving the para‐umbilical‐epigastric venous route (evaluated by Echo‐Doppler flowmetry) is reported. All patients presented absent or mild oesophageal varices at endoscopy. During a mean follow‐up period of 23.5 months, no patient developed large varices or experienced variceal bleeding. Hepatic encephalopathy was present in 35% of patients. Haemodynamically efficient spontaneous portosystemic shunts may protect cirrhotic patients from the risk of oesophageal varices forming and bleeding. The diversion of large amounts of blood from portal to systemic circulation correlates with the higher trend of hepatic encephalopathy in these patients.
Incidence of Paneth cells in colorectal adenomas of Japanese descendants in Hawaii
Authors: WADA RYO , KUWABARA NORIYUKI , SUDA KOUICHI
Published: March 2008

The main purpose of the present study was to demonstrate the incidence of Paneth cells in colorectal tubular adenomas of Japanese descendants in Hawaii. Paneth cells were found in 73 of 322 adenomas (22.7%) of Japanese descendants in Hawaii. The incidence of Paneth cells in adenomas located from the caecum to the transverse colon was significantly higher than that of adenomas from the descending colon to the rectum. The same trend of a higher incidence of Paneth cells in adenomas from the caecum to the transverse colon was observed in Japanese descendants and Caucasian residents in Hawaii and in native Japanese. The incidence of Paneth cells in adenomas of Japanese descendants in Hawaii was higher than that of native Japanese, and also that of Caucasian residents was higher than that of native Japanese.
Figure connection test: A universal test for assessment of mental state
Authors: DHIMAN RADHA KRISHAN , SARASWAT VIVEK A. , VERMA MEERA , NAIK SUBHASH R.
Published: March 2008

Abstract The number connection test (NCT), which assesses the extent of organic brain damage, has been used extensively to evaluate mental state in portasystemic encephalopathy, but has certain inherent limitations. It cannot be performed by illiterates and those unfamiliar with Roman alphanumeric notations. We, therefore, devised a figure connection test (FCT) based on the subject's identification of figures rather than alphabets or numerals. Four variations each of FCT‐A (A1‐A4) and FCT‐B (B1‐B4) employing different motifs were developed and compared with four variations each of NCT‐A (A1‐A4) and NCT‐B (B1‐B4) in groups of healthy volunteers with differing educational status. These volunteer groups were as follows: postgraduates 64; graduates 66; subgraduates 75; and illiterates 45. Significant differences in mean scores of various tests were observed between these normal groups. Control values of the tests for these groups have been standardized and can serve as nomograms. The effect of educational attainments on performance of FCT and other psychometric tests was analysed and trail‐making tests were validated for serial use.

The FCT was then prospectively validated on 70 patients (classified for comparison with controls according to educational status as follows: postgraduates 7; graduates 21; subgraduates 32; and illiterates 10) with cirrhosis of liver without overt encephalopathy, to detect subclinical hepatic encephalopathy. NCT‐A was abnormal in 31.7%, NCT‐B in 38.3%, FCT‐A in 42.9% and FCT‐B in 28.6% of patients. Taken together these tests diagnosed subclinical hepatic encephalopathy in 34 (48.5%) patients. We conclude that FCT is as useful as NCT in detecting psychomotor performance defects in cirrhotic patients without overt encephalopathy.
Triple therapy for the eradication of Helicobacter pylori and reduction of duodenal ulcer relapse: Comparison of 1 week and 2 week regimens and recrudescence rates over 12 months
Authors: CHEN TSENG‐SHING , TSAY SHYH‐HAW , CHANG FULL‐YOUNG , LEE SHOU‐DONG
Published: March 2008

Abstract The aim of this study is to assess the relationship between Helicobacter pylori and the relapse of duodenal ulcer, and also to evaluate the differences in efficacy and side effects between 1 week and 2 week triple therapy. Sixty‐two patients with active duodenal ulcer, which healed within 8 weeks of nizatidine treatment, were randomly allocated to one of two groups. Group 1 (n= 29) received no drugs, Group II (n= 33) received triple threapy for 1 week (IIa, n= 16) or 2 weeks (IIb, n= 17). Eleven patients whose ulcer did not heal after an 8 week nizatidine treatment period were randomly assigned into Group IIa (n= 5) and IIb (n= 6). Seven patients whose ulcer recurred after discontinuation of nizatidine were allocated to receive 2 weeks of triple therapy. All patients received endoscopy 6 weeks after entry, and again at 3, 6 and 12 months unless both ulcer recurrence and H. pylori infection were found. The frequency of ulcer relapse 6 weeks after the active duodenal ulcer had healed was 83% (24/29) in Group I, 13% in Group IIa and 14% in Group IIb. The cumulative rate of recurrence was significantly higher in Group I than in Group II (90 vs 30% at 12 months, P < 0.01). Ulcer relapse was associated with persistence of H. pylori infection (P < 0.0001). No statistical difference was found between the 1 week and 2 week regimens in ulcer relapse rate (30 vs 30% in 1 year), H. pylori eradication rate (86 vs 100%), incidence of side effects (48 vs 53%) or recrudescence rate (17 vs 23%). Our study suggests that a 1 week regimen and a 2 week regimen are equally effective in the eradication of H. pylori and reduction of ulcer recurrence in 1 year.
Laparoscopic cholecystectomy in the elderly: Analysis of pre‐operative risk factors and postoperative complications
Authors: IDO KENICHI , SUZUKI TAKANORI , KIMURA KEN , TANIGUCHI YUSHI , KAWAMOTO CHIAKI , ISODA NORIO , NAGAMINE NOBUHIKO , IOKA TATSUYA , KUMAGAI MACHIO
Published: March 2008

A retrospective study was conducted of two groups of patients over (group 1, n= 57) and under (group 2, n= 655) the age of 70 years who underwent laparoscopic cholecystectomy (LC). The pre‐operative physical status and systemic complications, operation time, postoperative complications, postoperative hospital stay and other clinical features of the two groups were compared. The incidence of pre‐operative complications in group 1 was significantly higher than that in group 2 (P < 0.05). Postoperatively no severe complication was found in any patient. Group 1 showed significantly prolonged operation time and postoperative hospital stay compared with group 2 (P < 0.05). The difference between the groups in the intra‐operative treatment time and postoperative treatment is attributed to the greater prevalence of common bile duct stone in group 1 as there was little difference between the groups in the postoperative recovery after exclusion of these patients. No pulmonary complications, which are associated with LC, were observed; the postprocedure pain was slight and the period of bedrest was short. If complications associated with pneumoperitoneum can be prevented, this surgery is an excellent measure to improve the quality of life of even elderly patients with cholecystolithiasis.
The importance of the pylorus as a regulator of solid and liquid emptying from the stomach
Authors: TREACY PJ , JAMIESON GG , DENT J.
Published: March 2008

The role of the pylorus in the control of gastric emptying of liquids and digestible solids was investigated in the present study by pylorus excision in six pigs. The pylorus was left intact in another six pigs. Antro‐pyloro‐duodenal motility was recorded by a sleeve sensor and side holes. Liquid emptying was significantly more rapid in pylorus excised than in pylorus intact animals, during intraduodenal infusion of isosmolar dextrose (712 mL vs 107 mL), fatty acid (402 mL vs 46 mL), amino acids (752 mL vs 112 mL), 25% dextrose (392 mL vs 51 mL) and 3 normal saline (705 mL vs 157 mL). In pylorus excised animals, in contrast to pylorus intact animals, the manometric pattern of isolated pyloric pressure waves at the distal stomach was rarely seen (P < 0.05). In a second series of experiments, pylorus excised animals emptied significantly more (P < 0.04) meat over 120 min (181 g) than pylorus intact animals (80 g), but the proportion of particle sizes emptied was unaltered. In the pig, localized pyloric contractions are important for retardation of gastric emptying when nutrient or hyperosmolar solutions enter the duodenum. By contrast, the pylorus is unimportant in determining the size of solid particles emptied from the stomach.
Acute pancreatitis associated with brucellosis
Authors: ODEH MAJED , OLIVEN ARIE
Published: March 2008

Acute pancreatitis developed in a patient with acute brucellosis due to Brucella melitensis. To the best of our knowledge this is only the second reported case of acute pancreatitis associated with Brucella infection.
Granulomatous hepatitis associated with scrub typhus
Authors: CHIEN RONG‐NAN , LIU NAI‐JEN , LIN PAUL Y , LIAW YUN‐FAN
Published: March 2008

A 56 year old patient with scrub typhus infection having unusual presentation of hepatic injury resembling acute hepatitis is described. The clinical features of fever, headache, eschar, lymphadenopathy, lymphocytosis and high Rickettsia tsutsugamushi immunofluorescence titres confirmed the diagnosis of scrub typhus. Acute hepatitis was proven by hepatic biochemical tests and liver biopsy. The patient had a complete recovery soon after antibiotic treatment. The presentation of this case suggests that scrub typhus infection should be included in the list of differential diagnosis of acute hepatitis or granulomatous hepatitis, at least in the Asian Pacific region where scrub typhus still prevails.
Role of endotoxin in the hepatic microvascular inflammatory response to ethanol
Authors: MCCUSKEY RS , NISHIDA J , EGUCHI H , MCDONNELL D , BAKER GL , EKATAKSIN W , KRASOVICH MA , RUDI V , SEITZ HK , URBASCHEK B , URBASCHEK R
Published: March 2008

Kupffer cells (KC) and gut‐derived bacterial endotoxin have been implicated in the aetiology of alcoholic liver disease. Using in vivo microscopic methods, we have shown that ethanol ingestion in mice causes a dose dependent increase in leucocyte adhesion and endothelial cell swelling in hepatic sinusoids. Activation of KC is elicited at low doses while depression occurs at high doses and with chronic exposure. The responses are exacerbated in the presence of endotoxaemia or sepsis and are not seen in endotoxin‐resistant animals, implicating a role for endotoxin in the ethanol‐induced inflammatory response. In addition, the responses are abolished with anti‐TNFα suggesting that TNFα is a primary mediator of these events. Nitric oxide (NO) initially appears to play an important role in these events by stabilizing the TNFα ‐mediated hepatic microvascular inflammatory response to acute ethanol ingestion, thereby helping to protect the liver from ischaemia and leucocyte induced oxidative injury. Finally, an ongoing clinical study has confirmed a mild systemic endotoxaemia in patients hospitalized for alcoholic liver disease. All of these results support important roles for endotoxin, cytokines, nitric oxide and sinusoidal lining cells in the pathophysiology of liver injury resulting from ethanol alone or in combination with infection.
Control of iron absorption
Authors: ANDERSON GREGORY J.
Published: March 2008

Intestinal iron absorption plays an essential role in body iron homeostasis, although the mechansim by which iron moves across the cells of the intestinal epithelium and the way in which this process is regulated are poorly understood. Signals to alter iron absorption are received from the body by cells of the intestinal crypt and these signals are translated into an absortion response after the cells have migrated up the villus and differentiated into mature absorptive enterocytes. The intracellular iron concentration of the crypt cell may play an important role in the regulation of this process. Biochemical investigations on the mechanism of iron absorption have met with only limited success and a molecular understanding of this mechanism appears most likely to come from the identification of the genes affected in various inherited disturbances of iron absorption in several mammalian species.
Studies on the hypomethylation of c‐myc, c‐Ha‐ras oncogenes and histopathological changes in human gastric carcinoma
Authors: FANG JING‐YUAN , ZHU SHUN‐SHI , XIAO SHU‐DONG , JIANG SHAO‐JI , SHI YAO , CHEN XIAO‐YU , ZHOU XIAO‐MEI , QIAN LIAN‐FANG
Published: March 2008

In order to study the status of DNA methylation of specific oncogenes and the relationship between them and the pathological changes in gastric carcinoma, we analysed the methylated status of c‐myc, c‐Ha‐ras oncogenes by Southern blot hybridization. Genomic DNA from cancerous, paracancerous and non‐cancerous areas of surgically resected specimens were examined in 22 cases of advanced human gastric carcinoma. Specimens were digested by the restriction endonucleases MspI/HpaII, which are able to cleave between methylated and non‐methylated cytosine at their nucleotide recognition site the DNA 5′‐CCGG sequence, and were hybridized with c‐myc, c‐Ha‐ras oncogene probes. Moreover, the corresponding pathological changes in gastric carcinoma were observed. The results showed that c‐myc, c‐Ha‐ras oncogenes from cancerous (10/22, 5/10) and paracancerous areas (13/22, 4/10) were hypomethylated and that there was no significant relationship between them and the histopathological changes.
Risk factors of peptic ulcer disease: Different impact of Helicobacter pylori in Dutch and Japanese populations?
Authors: SCHLEMPER RONALD J. , VAN DER WERF SJOERD DJ , VANDENBROUCKE JAN P. , BIEMOND IZÄK , LAMERS CORNELIS BHW
Published: March 2008

Helicobacter pylori, non‐steroidal anti‐inflammatory drugs, family history, blood group O, hyperpepsinogenaemia A, alcohol and smoking have been reported to be risk factors for peptic ulcer disease. The strength of causal risk factors may differ in different populations. In 215 Japanese and 493 Dutch employees of similar age, gender and type of occupation, a structured history was obtained using a questionnaire and fasting serum samples were analysed for IgG antibodies to H. pylori and pepsinogen A all in the same laboratory. A past ulcer history was verified through case notes. We found that H. pylori seropositivity, a high serum pepsinogen A and a family history of ulcer disease were significant and independent risk factors for peptic ulcer disease. For H. pylori seropositivity there was a 20‐fold increased risk among the Dutch and an eight‐fold increased risk among the Japanese. The seroprevalence of H. pylori was 90% in 20 Dutch subjects with a verified ulcer history and 95% in 41 Japanese ulcer subjects; it was 29% in Dutch non‐ulcer subjects and 70% in Japanese non‐ulcer subjects. The cumulative difference in risk to develop peptic ulcer disease at the age of 48 years between H. pylor‐infected and ‐uninfected subjects was 24.5–3.0 = 21.5% for the Japanese and 11.8–0.5 = 11.3% for the Dutch. Duodenal ulcer disease was associated with a high coffee consumption only among the Japanese population, where this habit was much less prevalent than among the Dutch. In conclusion, the characterization of peptic ulcer risk factors as weak or strong has no universal basis: the present study shows that from a diagnostic point of view H. pylori appears to be a weaker risk factor for peptic ulcer disease in a society with a higher seroprevalence. However, from an aetiological point of view, H. pylori has an even greater impact on ulcer morbidity in the Japanese than in the Dutch population.
OMEPRAZOLE AND COMPLICATED GASTRO‐OESOPHAGEAL REFLUX DISEASE
Authors: JASPERSEN D. , SCHWACHA H. , SCHORR W. , BRENNENSTUHL M. , RASCHKA C. , HAMMAR CH
Published: March 2008

Abstract  Suppression of acid secretion with omeprazole is highly effective for the healing of oesophagitis. The aims of the present study were to determine whether recovery of gastro‐oesophageal reflux disease in patients with stricture improves dysphagia and decreases the dilatation need and to compare the efficacy of omeprazole versus H2‐receptor antagonists. Thirty‐eight patients with peptic stricture (grade IV oesophagitis) and erosive oesophagitis underwent endoscopic dilatation and were randomized to omeprazole (40 mg daily; n = 20) versus ranitidine (150 mg twice daily; n=18). Healing was proven endoscopically and patients were interviewed for dysphagia relief. Patients were assessed for relapse by endoscopy 6 months later. The follow‐up period was a further 6 months. Patients received maintenance treatment with 40 mg omeprazole daily or ranitidine 150 mg twice daily and the total duration of treatment was 1 year. At 6 months, omeprazole produced a highly significant (P < 0.0001) greater rate of oesophagitis healing and highly significant (P < 0.0001) fewer dilatations compared with H2‐receptor antagonists (18 (90%) patients vs five (28%) patients, respectively; 3.5 vs 9.0 dilatations/patient). At 12 months, not one of the 18 successfully treated patients from the omeprazole group had relapsed. The two remaining patients required further dilatation and 40 and 60 mg omeprazole daily for healing. In comparison, all patients on ranitidine had to undergo further bougienage. In conclusion, omeprazole is a safe and effective maintenance treatment for preventing relapse of complicated reflux oesophagitis.
PEPTIC ULCER: PATHOGENESIS, HEALING AND ANTI‐ULCER DRUGS
Authors: KIMURA KEN , IDO KENICHI , TANIGUCHI YUSHI , SUZUKI TSUTOMU , YOSHIDA YUKIO , KAWANO SUNAO , TSUJI SHINGO
Published: March 2008

Abstract  At present, the evaluation of anti‐ulcer drugs is generally accomplished simply by calculating the cumulative healing rate at a certain point of time during treatment, which does not implicate any analysis of the healing speed of the ulcer. If the cumulative healing rate of an ulcer is expressed as a function of drug administration time, t, then it will be possible to calculate parameters concerning the healing speed of ulcers and thus evaluate drug efficacy as the time series analysis of the cumulative healing rate. A new method of evaluating anti‐ulcer drugs by a statistical analysis of healing speed is proposed. A non‐linear regression analysis was performed between two variables, t (time of drug administration: week) and y (non‐healing rate: %), to obtain the exponential function y = Ae−kt. The theoretical values calculated from the exponential equation were in close proximity to the observed values. With this analysis, four parameters concerning the healing speed were defined, namely the healing rate constant, the initiation time of healing, the half‐life of non‐healing rate and the time necessary for 50% healing. With this method, the efficacy of drugs on peptic ulcer healing was dynamically analysed, the non‐healing rate (y) being expressed as an exponential function of length of time (t) of treatment, thus obtaining digital parameters for healing speed.
Frequency and factors influencing portal hypertensive gastropathy and duodenopathy in cirrhotic portal hypertension
Authors: GUPTA R , SARASWAT VA , KUMAR M , NAIK SR , PANDEY R
Published: March 2008

Portal hypertensive gastropathy and duodenopathy are distinct clinical and endoscopic entities. Data on factors influencing the development of these lesions are still emerging. Data on portal hypertensive duodenopathy are scarce. We prospectively studied 230 patients with liver cirrhosis and oesophageal varices attending the liver clinic of the Sanjay Gandhi Post Graduate Institute of Medical Sciences. One hundred and forty‐two patients had no history of upper gastrointestinal bleeding, while the remainder had bled in the past. Endoscopic appearances were recorded before starting patients on a sclerotherapy programme. Forty‐four patients were re‐evaluated after variceal eradication. The frequency of portal hypertensive gastropathy (PHG) and duodenopathy (PHD) was 61 and 14%, respectively. Mild PHG was present in 85% and was severe in the rest. Portal hypertensive duodenopathy was mild in 50%, while in the other half it was severe. There was no relationship of PHG and PHD to: (i) a history of upper gastrointestinal bleed; (ii) size of oesophageal varices; (iii) aetiology of liver cirrhosis; or (iv) liver function status as assessed by Child Pugh's scores (P=NS for all). The prevalence of PHG was higher in those patients with oesophagogastric varices (74 of 107; 69%) compared with patients with oesophageal varices alone (68 of 123; 55%; P<0.05). However, no such increase in frequency of PHD was noted in patients with oesophagogastric varices. Sclerotherapy increased the frequency of PHG. Twenty‐four patients had PHG before starting sclerotherapy, while it was noted in 33 patients 1–3 months after variceal eradication (P< 0.05). In contrast, there was no increase in the prevalence of portal hypertensive duodenopathy after sclerotherapy (P=NS). There was no correlation between endoscopic and histological changes of PHG and PHD. In conclusion, PHG is quite frequent in patients with cirrhosis and its frequency increases with the presence of oesophagogastric varices and after sclerotherapy. However, the frequency of PHD is low and is not affected by the factors studied.
Detection of hepatocellular carcinoma after interferon therapy for chronic hepatitis C: Clinical study of 26 cases
Authors: SUGIURA NOBUYUKI , SAKAI YUZOH , EBARA MASAAKI , FUKUDA HIROYUKI , YOSHIKAWA MASAHARU , SAISHO HIROMITSU , OHTO MASAO , KONDO FUKUO
Published: March 2008

The clinical findings in 26 patients in whom hepatocellular carcinoma (HCC) was detected after the start of interferon (IFN) therapy for chronic hepatitis C were analysed. Histological study before IFN therapy showed that 34.6% of patients were categorized as stage 3 (septal fibrosis with architectural distortion; the 0–4 scale) and 80.8% demonstrated at least some evidence of septal fibrosis or more advanced features. The AFP levels examined before IFN therapy were more than 20 ng/mL in 13 patients (84.6% of those studied). One of 26 patients had a complete response to IFN therapy, while six of 26 patients had only a partial response. HCC was detected within 1 year after the start of IFN therapy in 76.9% of patients. Thus, the possibility of the early occurrence of HCC or its existence at the time of therapy should be seriously considered when IFN therapy is contemplated. Patients with stage 3 or 3–4 histology may already have a small undetectable HCC before IFN therapy. Thus, for this reason, every patient treated with IFN should be examined at short regular intervals for the development of HCC during and after IFN therapy.
Prognostic factor analysis of fulminant and subfulminant hepatic failure in an area endemic for hepatitis B
Authors: HUO TEH‐IA , WU JAW‐CHING , SHENG WEN‐YUNG , CHAN CHO‐YU , HWANG SHINN‐JANG , CHEN TRONG‐ZONG , LEE SHOU‐DONG
Published: March 2008

In order to determine the criteria in selecting candidates for orthotopic liver transplantation (OLT), we assessed the aetiology and prognostic indicators in 61 patients with fulminant or subfulminant hepatitis during the past 13 years. Several previously reported models of high risk predictors were not suitable for a large portion of our patients with different aetiological and ethnic backgrounds. In the present study, serological markers of various hepatitis viruses were tested and clinical parameters were compared between survivors and non‐survivors. Multiple virus infection and multifactorial causes were important in the pathogenesis (48%) of acute liver failure. Among the 13 clinical parameters, six were considered significant on univariate analysis: prothrombin time prolongation (P< 0.001), total bilirubin, creatinine and α‐fetoprotein (P< 0.01), age and cholesterol (P< 0.05). With stepwise logistic regression using most discriminatory cut‐off values, an age of > 43 years (P= 0.0001), total bilirubin levels of > 23 mg/dL (P< 0.005) and prothrombin time prolongation > 19 s (P< 0.0001) were independent predictors of non‐survival. When applied to determine the index of poor prognosis, the sensitivity, specificity, positive predictive value, negative predictive value and predictive accuracy were 100, 67, 95, 100 and 95%, respectively, in the presence of any one of these prognostic factors. We conclude that these indicators may be useful for selecting patients with acute liver failure indicated for OLT.
Review Article: New insights into the mechanisms of hepatic transport and bile secretion
Authors: ERLINGER SERGE
Published: March 2008

The transport processes responsible for bile flow are reviewed. Canalicular bile acid‐dependent flow is the result of active transport of bile acids by the hepatocyte into bile canaliculi. Bile acids are taken up by at least two transport systems whose mRNA have been expressed in Xenopus oocytes: (i) a Na+‐dependent system, named NTCP, and (ii) a Na+‐independent system, named OATP. Bile acids are then secreted into bile by two other transport systems, an ATP‐dependent system and an ‘electrogenic’ voltage‐dependent system. It is not known whether these two systems are mediated by the same protein or by two different proteins. Canalicular bile acid‐independent flow is mainly the result of the secretion of glutathione into bile. The canalicular membrane also contains several proteins of the multi drug resistance (MDR) family. MDR1 is responsible for biliary secretion of cationic drugs. MDR3 (mdr 2 in mice) plays a major role in the secretion of phospholipids. A third MDR‐related protein has been shown recently to be the canalicular carrier of organic anions, such as bilirubin and dyes (the canalicular multiple organic anion transporter, or cMOAT). Biliary epithelial cells secrete a bicarbonate‐rich solution, mostly in response to secretin. This secretion depends upon the presence, on the apical membrane of these cells of the CFTR, a chloride channel activated by cAMP and of a chloride/bicarbonate exchanger. Knowledge of these transport systems should allow a better understanding of the mechanisms involved in cholestasis.
Review:Eradication of Helicobacter pylori. Problems and recommendations
Authors: HUANG JIA‐QING , HUNT RICHARD H
Published: March 2008

The successful isolation ofHelicobacter pylorifrom the stomachs of patients with gastritis and peptic ulcer has revolutionized our concepts of the pathogenesis of gastritis, peptic ulcer, gastric cancer and gastric B cell lymphoma. Eradication ofH. pyloriheals gastritis andH. pylori‐related peptic ulcer. After a successful cure ofH. pyloriinfection, virtually no recurrence of duodenal ulcer is seen. However, treatment to cure the infection has proved difficult. Numerous clinical trials have been attempted, but as yet no ideal regimen has been identified. Monotherapies have many drawbacks and should be avoided. Dual therapies combining a proton pump inhibitor (PPI) and an antimicrobial agent provide higher eradication rates than those involving two antimicrobial agents. Bismuth‐based triple therapies are more effective than dual therapies in eradicatingH. pyloriinfection. However, poor compliance and frequent adverse effects have made these combinations less favourable in clinical practice. Proton pump inhibitor‐based triple therapies have shown more consistent and higher eradication rates with a short duration of treatment, good patient compliance, fewer side effects, prompt symptom relief and fast ulcer healing. Results from PPI‐based quadruple therapies are promising; however, large multicentre clinical trials are needed to confirm the effect and the complex regimen again may compromise compliance outside of the clinical trial setting. Eradication ofH. pyloriinfection is cost‐effective in the long‐term management of peptic ulcer disease compared with maintenance therapy with antisecretory drugs.