bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical experience in 126 patients with tissue‐proved proximal cholangiocarcinoma
Authors: WANG YUAN‐JEN , LEE SHOU‐DONG , SHYU JI‐KUAN , LO KWANG‐JUEI
Published: March 2008

Abstract The diagnosis and treatment of 126 consecutive patients with tissue‐proved cholangiocarcinoma which originates in or proximal to the common hepatic duct was reviewed. They are further divided into the hilar type and peripheral type tumours. The clinical presentations were commonly compatible with the hilar type tumour. However, the accurate pre‐operative diagnosis of the peripheral type tumour was difficult because of the frequent association with hepatolithiasis (43.3%) and the high prevalence of hepatocellular carcinoma (HCC) in Taiwan; 25% of these patients underwent surgery for chronic cholangitis and 12.5% for HCC rather than cholangiocarcinoma. Among the 40 (31.7%) patients who had tumour resections, 24 were hilar type and 16 were peripheral type. There were no operative deaths and the mean survival time was 36.1 months (27.9 months for the hilar types, 52.2 months for the peripheral types). Sixty‐three (50%) patients with hilar type tumours were only suitable for palliative procedures to relieve the jaundice. The 30‐day mortality rate was 50 and 33.3% for the patients who received non‐surgical and surgical drainages, but zero for the patients who had surgical bypasses. All the bypass patients experienced > 50% decrease of serum bilirubin, but this effect was obtained in less than half the patients receiving drainage procedures. Surgical resection significantly prolonged the survival (resection vs palliation vs no treatment = 36.1 vs 6.6 vs 3.6 months, P < 0.05), but no survival advantage was achieved in any of the palliative therapies. Five cases with tumour resection survived > 5 years. We conclude that surgical resection offers the best prognosis. For the majority of patients, however, a surgical bypass using cholangioenteric anastomosis achieved the most satisfactory palliation.
Role of actin and calmodulin in migration and proliferation of rabbit gastric mucosal cells in culture
Authors: WATANABE SUMIO , HIROSE MIYOKO , YASUDA TAKAHIRO , MIYAZAKI AKIHISA , SATO NOBUHIRO
Published: March 2008

Abstract The aim of this study was to develop a new cellular restoration model using primary cultured rabbit gastric mucosal cells, and to evaluate the role of cytoskeleton and calmodulin in this process. Confluent monolayer mucosal cell sheets consisting mainly of mucous cells were wounded, and a rotating silicon tip was used to make cell‐free areas of constant size. The process of restoration was monitored, and the cell‐free area was measured and analysed quantitatively.

Artificial wounds recovered in 36 h in controls; however, mucosal cell repair was inhibited by treatment with the actin inhibitor, cytochalasin B, and the calmodulin inhibitor, W‐7. In the process of restoration, bromodeoxyuridine (BrdU)‐positive cells appeared around the wound 24 h after injury and then disappeared after the complete repair. Because BrdU‐positive cells were never detected within 24 h after wounding, initial recovery of the wound occurred only by cell migration. Both the migration and the proliferation stage are seen with this model. This culture model is suitable for the analysis of gastric mucosal restoration. Present data are consistent with the hypothesis that the integrity of the cytoskeletal system is important for restoration after damage of the gastric mucosa.
Clinicopathologic study of 208 patients with early gastric cancer in Taiwan: A comparison between Eastern and Western countries
Authors: LIN JAW‐TOWN , WU MING‐SHIANG , WANG JIN‐TOWN , SHUN CHIA‐TUNG , CHEN CHIEN‐JEN , WANG TEH‐HONG
Published: March 2008

Abstract To investigate whether there are any differences between the clinicopathologic characteristics of early gastric cancer (EGC) patients in Eastern and Western countries, 208 Taiwanese patients with EGC were reviewed between 1964 and 1992. The incidence of cancer has increased slightly over the 29‐year period. Men were diagnosed with EGC frequently than women, and their mean age was 56 years. Epigastralgia (58.2%) was the most common symptom, whereas 5.8% of cancers were incidentally detected by endoscopy. Physical signs and laboratory tests were of limited value in making the diagnosis. Endoscopy was a better diagnostic aid than radiology. Tumours were frequently located in the lower third (53.2%) and middle third (43.3%) of the stomach. Cancers of the elevated type (17.8%) were less frequent than the depressed type (82.2%). Type IIc (31.2%) was the most common macroscopic type. The frequency of mucosal carcinoma (51.0%) was similar to submucosal carcinoma (49.0%). Mucosal carcinoma had less lymph node metastases (3.1%) than submucosal carcinoma (12.2%; P < 0.05), with an overall frequency of metastases of 7.5% (14/186). The 5‐year survival rate was 90.8%. The clinicopathologic characteristics of EGC in Taiwan were similar to those of Western countries and other Eastern countries. Improvement of diagnostic examinations and endoscopic surveillance of asymptomatic subjects may lead to early diagnosis and thus ensure a more favourable outcome.
Effects of an infusion of branched‐chain amino acids on neurophysiological and psychometric testings in cirrhotic patients with mild hepatic encephalopathy
Authors: HIGUCHI KIYOHIRO , SHIMIZU YUKIHIRO , NAMBU SHUJI , MIYABAYASHI CHIHARU , TAKAHARA TERUMI , SAITO SEIJI , HIOKI OSAMU , KUWABARA YOSHIHIRO , WATANABE AKIHARU
Published: March 2008

Abstract Psychotropic action of a branched‐chain‐enriched amino acid solution (Aminoleban) was quantitatively and visually examined in six cirrhotic patients with mild hepatic encephalopathy (grades I and II) using electrophysiological and psychometric methods. Neurophysiological effects of the amino acid solution were observed by comparing topographic spectrum analyses of electroencephalography (EEG) before and immediately after an intravenous 3 h infusion of the solution. The delta wave in the frontal region diminished from 61 ± 13 to 12 ± 4% (P < 0.01) and the alpha wave in the occipital region increased from 11 ± 3 to 51 ± 11% (P < 0.01). Latencies of the P3 wave in visual evoked potentials, which were topographically recorded in the occipital region, shortened from 220 ± 32 to 148 ± 19 ms (P < 0.01). Latencies of the P300 wave in event‐related potentials, which were topographically recorded in the centro‐temporal region, shortened from 493 ± 81 to 360 ± 93 ms (P < 0.05). Topographic reaction pattern of P300 was irregular toward the occipital or parietal region in cirrhotic patients. The EEG frequency power spectrum, illustrated by the colour density spectral array of computer‐aided polysomnography analysis, clearly showed a gradual increase of the alpha wave spectrum and a gradual decrease of the delta wave spectrum after initiation of the infusion. These immediate neurophysiological changes were confirmed by improvement of quantitative psychometric tests including number connection test, reaction time to sound, and digit symbol and block design tests of Wechsler Adult Intelligence Scale.

From the results, it was concluded that branched‐chain amino acids functioned as psychotropic drug for cirrhotic patients with mild hepatic encephalopathy.
T lymphocyte function in patients with malignant biliary obstruction
Authors: FAN S. T. , LO C. M. , LAI E. C. S. , YU W. C. , WONG J.
Published: March 2008

Abstract The T lymphocyte function in 59 patients with malignant biliary obstruction undergoing pre‐operative endoscopic drainage (group Ia, n= 24) or surgery (group Ib, n= 35) was evaluated by mitogen stimulation test with phytohaemagglutinin. The T lymphocyte function before endoscopic or surgical intervention was found to be impaired as compared with patients with gastric cancer (group II, n= 27) and with normal persons (group III, n= 19). Regression analysis showed a significant negative correlation between T lymphocyte function and the serum bilirubin level (correlation coefficient ‐ 0.3, P= 0.01) and a positive correlation with serum albumin level (correlation coefficient 0.34, P= 0.01) and serum transferrin level (correlation coefficient 0.45, P= 0.001). After 18 ± 3 days of endoscopic biliary drainage, the T lymphocyte function of group Ia patients did not change substantially. At postoperative day 14, there were more patients in both groups Ia and Ib having deterioration of T lymphocyte function than those with improvement. The incidence of postoperative sepsis was found to be significantly higher in patients with deterioration than those with improvement of T lymphocyte function (18/31 vs 7/26, P= 0.036). It is concluded that endoscopic biliary drainage and surgery could not reverse the T lymphocyte dysfunction in patients with malignant biliary obstruction.
Clinical value of tumour markers and serum‐ascites albumin gradient in the diagnosis of malignancy‐related ascites
Authors: CHEN SHEN‐JYH , WANG SUN‐SANG , LU CHI‐WEN , CHAO YEE , LEE FA‐YAUH , LEE SHOU‐DONG , WU SHWU‐LING , CHERNG KU‐LI , LO KWANG‐JUEI
Published: March 2008

Abstract To determine the clinical value of tumour markers in the diagnosis of malignancy‐related ascites (not including hepatocellular carcinoma), serum and ascitic fluid levels of carcinoembryonic antigen, cancer antigen 125, carbohydrate antigen 19–9, tissue polypeptide antigen and serum‐ascites albumin gradient were determined in 66 patients with cirrhotic ascites, 28 patients with hepatocellular carcinoma and ascites, and 29 patients with malignancy‐related ascites. Three tumour markers and serum‐ascites albumin gradient showed significant difference between patients with malignancy‐related ascites and those without: serum carcinoembryonic antigen (26.4 ± 31.5 vs 4.8 ± 4.6 ng/mL, P < 0.01), ascitic fluid carcinoembryonic antigen (118.4 ± 196.5 vs 2.0 ± 1.4 ng/mL, P < 0.01), ascitic fluid carbohydrate antigen 19–9 (12 933 ± 25 496 vs 23 ± 67 U/mL, P < 0.01), and serum‐ascites albumin gradient (1.1 ± 0.4 vs 2.0 ± 0.4 g/dL, P < 0.01). At the best cut‐off levels chosen from near 95% of the data in those without malignancy‐related ascites, the sensitivity, specificity and accuracy to diagnose malignancy‐related ascites were, respectively, 65.5%, 93.6%, 87.0% using serum carcinoembryonic antigen 10 ng/mL; 69.0%, 94.7%, 88.6% using ascitic fluid carcinoembryonic antigen 5 ng/mL; 65.5%, 93.6%, 87.0% using ascitic fluid carbohydrate antigen 19–9 50 U/mL; 62.1%, 98.9%, 90.2% using serum‐ascites albumin gradient < 1.1 g/dL. Although serum‐ascites albumin gradient offered the best diagnostic accuracy and specificity, its sensitivity was not good enough. Our study indicates that serum‐ascites albumin gradient and tumour markers are not sensitive parameters in the diagnosis of malignancy‐related ascites.
Hepatitis C and B virus infections in populations at low or high risk in Ho Chi Minh and Hanoi, Vietnam
Authors: NAKATA SUSUMU , SONG PHAM , DUC DAO DINH , QUANG NGUYEN XUAN , MURATA KAZUMOTO , TSUDA FUMIO , OKAMOTO HIROAKI
Published: March 2008

Abstract Inhabitants and patients of two cities in Vietnam were tested for antibodies to hepatitis C virus (anti‐HCV), hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti‐HBs). Anti‐HCV was detected in 43 (9%) of 491 individuals without liver disease in Ho Chi Minh, more frequently (P < 0.001) than in 18 (4%) of 511 in Hanoi. There was no apparent age‐specific distribution of anti‐HCV. Among inhabitants of both cities, HBsAg and anti‐HBs were frequent, detected in 10‐14% and 35‐37%, respectively; the prevalence of anti‐HBs increased in parallel with age. Among individuals at high risk, the prevalence of anti‐HCV was particularly high in drug users (58/67 or 87%) and patients on maintenance haemodialysis (15/28 or 54%) or with haemophilia (7/24 or 29%) in Ho Chi Minh, and in drug users in Hanoi (61/200 or 31%). Prevalence of HBsAg and anti‐HBs in high‐risk groups was not different from those in the general population. Screening of anti‐HCV in blood donors in Vietnam is of urgent necessity because blood supply is dependent on commercial blood donors, many of whom are drug users at high risk.
Analyses of proliferating cell nuclear antigen‐positive cells in hepatocellular carcinoma: Comparisons with clinical findings
Authors: NISHIMORI HIROSHI , TSUKISHIRO TAKASHI , NAMBU SHUJI , OKADA KAZUHIKO , SHIMIZU YUKIHIRO , MIYABAYASHI CHIHARU , HIGUCHI KIYOHIRO , WATANABE AKIHARU
Published: March 2008

AbstractProliferating tumour cells in 92 patients with hepatocellular carcinoma (HCC) were identified by an immunohistochemical method using a monoclonal antibody against proliferating cell nuclear antigen (PCNA). The rate of PCNA‐positive cells in HCC tissues was positively correlated with histological grade and the tumour size and T factor of the tumour.

In order to analyse the relationship between prognostic factors and cumulative survival rate after obtaining tumour specimens, 49 patients whose clinical courses could be followed after needle biopsy were selected for evaluation. These patients were treated by medical therapy alone. Analyses of prognostic factors by Cox's proportional hazard model revealed that the patient's prognosis was significantly correlated with PCNA‐positive rates as well as the tumour size and mode of therapy. Moreover, the cumulative survival rates were significantly (P< 0.001) higher in patients with rates of PCNA‐positive cells <15% than in those with ≧ 15%, even when tumour sizes were under 50 mm or tumours demonstrated the same degree of histological differentiation.

These findings indicate that the PCNA‐positive rate in biopsied tissues provides useful prognostic information in patients with HCC treated only by medical therapy.
Spontaneous bacterial peritonitis and culture negative neutrocytic ascites in patients with non‐alcoholic liver cirrhosis
Authors: AL AMRI SALEH M. , ALLAM ABDULKADIR R. , AL MOFLEH IBRAHIM A.
Published: March 2008

AbstractMedical records of 18 patients with spontaneous bacterial peritonitis (SBP) and 19 patients with culture negative neutrocytic ascites (CNNA) were reviewed. The diagnosis of SBP was based on a positive ascitic fluid culture, a polymorphonuclear cell count (PMN) greater than 250 cells/mm3and the absence of an intra‐abdominal source of infection. The diagnosis of CNNA was based on a PMN count greater than 250 cells/mm3, a negative ascitic fluid culture, the absence of an intra‐abdominal source of infection and no antibiotic treatment in the preceding 30 days. All patients in both groups had liver cirrhosis, which was mainly (62.2%) due to HBV infection. A single strain, mostly ‘a Gram‐negative’ bacillus, was recovered from the ascitic fluid culture in the vast majority of patients (83%) with SBP. There were no significant differences between the clinical data of both groups. However, the CNNA group had a significantly better Pugh score (Pvalue = 0.01) with a mean score of 9.42 ±2.24, compared to the SBP group (10.94 ±2.88). The only significant difference in the laboratory data was that the total bilirubin was higher in the SBP group (P0.01). Hospital mortality was significantly higher in the SBP patients compared to those with CNNA, 50 and 16%, respectively (P0.03). Recurrent ascitic fluid infection occurred in one of five patients who initially presented. In contrast no recurrence was documented in 12 patients with CNNA.

Spontaneous bacterial peritonitis is a serious complication of liver cirrhosis with significantly higher mortality than CNNA. A single organism, usually enteric, is the most common causative agent.
The effect of simvastatin and bezafibrate on bile composition and gall‐bladder emptying in female non‐insulin‐dependent diabetics
Authors: WILSON I. R. , HURRELL M. A. , PATTINSON N. R. , CHAPMAN B. A.
Published: March 2008

Abstract Female non‐insulin‐dependent diabetics have a high prevalence of gallstones. Treatment of hyperlipidaemia in these patients may modify the risk. Seventeen female non‐insulin‐dependent diabetics (age 35–65) were treated with simvastatin (n= 10) or bezafibrate (n= 7) and had the cholesterol saturation index (CSI) of bile and gall‐bladder emptying measured before and after 3 months therapy. In both groups, there was a significant reduction in serum cholesterol following treatment. The mean pretreatment cholesterol saturation indices of bile did not differ between the two groups but, after 3 months therapy, there was a highly significant difference in CSI between the bezafibrate group (2.0 ± 0.33) and the simvastatin group (1.1 ± 0.14) P < 0.002. Whereas the increase in the CSI (42%) observed with bezafibrate therapy was significant, the decrease in the simvastatin group (14%) was only significant in those whose pretreatment cholesterol saturation indices were elevated. Despite the differences in CSI observed between the two treatment groups, no changes in gall‐bladder emptying were detected.
Interleukin‐6 functions as an autocrine growth factor in a cholangiocarcinoma cell line
Authors: OKADA KAZUHIKO , SHIMIZU YUKIHIRO , NAMBU SHUJI , HIGUCHI KIYOHIRO , WATANABE AKIHARU
Published: March 2008

Abstract The tumour cells of a human cholangiocarcinoma cell line, HuCC‐T1, were found to express mRNA of interleukin‐6 (IL‐6) and to secrete a large amount of biologically active IL‐6 in the culture medium at the concentration of 22.6 ng/mL. Interleukin‐6 was demonstrated in the cytoplasm of the cells by immunohistochemical staining. Furthermore, these cells showed the presence of receptors for IL‐6 on the surface, and DNA synthesis of the cells was stimulated by the exogenous addition of recombinant human IL‐6 into the culture medium. The cell growth was significantly inhibited in the presence of anti‐human IL‐6 antibody in the culture medium. These findings indicate that IL‐6 is one of the autocrine growth factors of this cell line in vitro.
Gastric cytoprotection by amoxycillin in the rat
Authors: LAM SHIU‐KUM , CHO CHI‐HIN , CHEN BAO‐WEN , LAI KAM‐CHUEN , CHING CHI‐KONG , HO CHU‐SHEK , LI YI‐NONG
Published: March 2008

Abstract Amoxycillin in combination with anti‐ulcer agents has been shown to prolong duodenal ulcer remission. While this effect can be related to the eradication of Helicobacter pylori, it is not known if amoxycillin might possess cytoprotective properties. Protection against ethanol‐induced gastric mucosal damage by intragastric instillation of amoxycillin suspension (prepared from capsule form) and solution (from injection form, 100% pure amoxycillin), and by intraperitoneal injection of amoxycillin solution was studied using an ex vivo gastric chamber in the rat. Intragastric and intraperitoneal administration of amoxycillin dose‐dependently protected the rat gastric mucosa from damage by absolute ethanol. This protection was lost when the rats were pretreated with indomethacin. Gastric mucosal blood flow as measured by laser Doppler flowmetry and gastric acid output were unaffected by amoxycillin. Amoxycillin imparts gastric cytoprotection, and one possible mechanism is by the release of prostaglandins.
Nutritional support through percutaneous transhepatic internal drainage route in common bile duct cancer
Authors: SUDA T. , OZAWA T. , AOYAGI Y. , MORI S. , WATANABE M. , TSUKADA Y. , KAMIMURA T. , ASAKURA H.
Published: March 2008

Abstract A 69 year old female with a duodenal bulb obstruction due to direct invasion of common bile duct cancer who received total enteral nutrition through the route of percutaneous transhepatic internal drainage (PTID) was presented. The tip of PTID tube was placed over the duodeno‐jejunal flexure. Jejunal infusion of all nutrients and the bile juice through this route kept her in good nutritional condition until the terminal stage of primary disease. This procedure did not cause the infection of the biliary system. Major problems, tube obstruction and diarrhoea, were easily resolved with the selection of an appropriate infusion schedule and nutrient concentration. We conclude that nutritional support through the PTID route is a beneficial means for compromised patients without laparotomy or hospitalization.
Intracisternal thyrotropin‐releasing hormone‐induced vagally mediated gastric protection against ethanol lesions: Central and peripheral mechanisms
Authors: TACHÉ Y. , YONEDA M. , KATO K. , KIRÁLY A. , SÜTÖ G. , KANEKO H.
Published: March 2008

Abstract The vagus is involved in mediating gastric cytoprotection and adaptive cytoprotection. However, the central and peripheral mechanisms through which the vagus expresses its action are still poorly known. Medullary thyrotropin‐releasing hormone (TRH) plays an important role in the vagal regulation of gastric function. The stable TRH analogue, RX 77368, micro‐injected into the cisterna magna or the dorsal motor nucleus (DMN) of the vagus at a dose that did not influence gastric acid secretion prevented gastric injury induced by intragastric administration of 60% ethanol in conscious or urethane‐anaesthetized rats. The cytoprotective action of TRH is mediated through vagal cholinergic release of prostaglandin E2 (PGE2). Prostaglandin E2 action is unrelated to changes in gastric mucosal blood flow (GMBF). In addition, other peripheral mechanisms involve calcitonin gene‐related peptide (CGRP) contained in capsaicin sensitive afferent fibres and nitric oxide, both of which mediate the associated increase in GMBF induced by intracisternal injection of RX 77368. These data indicate that medullary TRH induces vagally mediated gastric protection against ethanol lesions. Its action is expressed through the muscarinic dependent release of PGE2 and nitric oxide, and efferent function of capsaicin‐sensitive afferent fibres releasing CGRP.
Effect of nicotine in migration and proliferation of rabbit gastric mucosal cells in a culture cell model
Authors: SATO N. , WATANABE S. , HIROSE M. , WANG X‐E. , MAEHIRO K. , MURAI T. , KOBAYASHI O. , NAGAHARA A. , OGIHARA T. , KITAMI N.
Published: March 2008

Abstract The aim of this study was to assess the effects of nicotine on the gastric epithelial restoration using primary cultured rabbit gastric mucosal cell model.

Confluent monolayer mucosal cell sheets consisting of mainly mucous cells were wounded using a rotating silicon tip. The process of restoration was monitored, and the size of wound was measured and analysed quantitatively.

Artificial wounds recovered in 36 h in controls. The nicotine treatment (10−5, 10−4 and 10−3 mol/L) did not cause any effects on the process of wound repair. Bromodeoxyuridine (BrdU) positive cells appeared around the wound 24‐36 h after injury and then disappeared after the complete repair in controls and also in nicotine‐treated groups. However, in the morphological observation, numerous vacuoles were detected in parietal cells of nicotine‐treated groups. This effect of nicotine was reversible by removing nicotine from the medium. Present data suggest that nicotine has no direct effects on the mucosal restoration but might have an effect on the structure and function of parietal cells.
Extracellular matrix constituents affect superficial gastric epithelial cell adhesion
Authors: RHODES D. , REVIS D. , LACY E. R.
Published: March 2008

Abstract The interfoveolar and upper gastric pit cells become necrotic and slough off after superficial luminal injury to the gastric mucosa. The subsequent rapid epithelial restitution of the wound is dependent on an intact basal lamina upon which viable mucous cells migrate. Several lines of evidence suggest that migrating mucous cells recognize specific moieties in the basal lamina which would then affect restitution and the ability of the gastric mucosa to be repaired. Therefore, this study examined the effect of three individual protein constituents of the extracellular matrix, laminin, fibronectin and type IV collagen as well as a synthetic basal lamina, Matrigel, on adherence of mucous cells isolated from guinea‐pig stomach to these substrates in culture. After 3 h, approximately 40% of the cells adhered to Matrigel, 25% to both collagen IV and fibronectin, but only about 10% to laminin and 3% to uncoated plastic substrates. Disruption of protein synthesis by pre‐incubation with cyclohexamide significantly reduced adherence to Matrigel and collagen IV but not laminin, fibronectin or plastic substrates. These results suggest that gastric mucous cells have multiple receptors for extracellular matrix proteins (ligands) which influence the adherence and probably the migration of these cells. Furthermore, some of these receptors are synthesized in response to moieties in the substrate itself.
Plasma endotoxin concentration and endotoxin binding capacity of plasma acute phase proteins in cirrhotics with variceal bleeding: An analysis by new methods
Authors: FUKUI HIROSHI , MATSUMOTO MUNESUKE , TSUJITA SHIGENOBU , TAKAYA AKIRA , KOJIMA HIDEYUKI , MATSUMURA MASAHIKO , TSUJII TADASU
Published: March 2008

Plasma endotoxin levels in 12 cirrhotics with bleeding from oesophageal varices and 50 cirrhotics without bleeding were measured by the chromogenic assay after the pretreatment of sample by perchloric acid (HClO4) and triethylamine. Endotoxin in cirrhotics with bleeding from varices was significantly higher than those without bleeding. In patients with bleeding, endotoxin increased for 3 days after the bleeding, first in the supernatant fraction and then in the precipitate fraction by HClO4 treatment. Peak plasma α1‐acid glycoprotein and haptoglobin were observed 3 days after the bleeding. Alpha 1‐antitrypsin gradually increased for 14 days. Transferrin did not markedly change. The endotoxin‐binding capacity of transferrin and α1‐acid glycoprotein increased immediately after bleeding and thereafter decreased, but that of α1‐antitrypsin tended to increase in the recovery period. In summary, the plasma endotoxin concentration and endotoxin‐binding capacity of α1‐acid glycoprotein and transferrin were shown to have increased after bleeding from varices by this new method. There may be a close relationship between endotoxaemia and acute phase reaction in this situation.
Correlation of serum HCV RNA and alanine aminotransferase levels in chronic hepatitis C patients during treatment with ribavirin
Authors: TONG MYRON J. , HWANG SHINN‐JANG , LEFKOWITZ MICHELLE , LEE SHOU‐DONG , CO RUTH L. , CONRAD ANDREW , SCHMID PETER , LO KWANG‐JUEI
Published: March 2008

to evaluate the effect of ribavirin on serum hepatitis C virus (HCV) RNA and alanine aminotransferase (ALT) levels, 22 patients with chronic HCV infection were treated with oral ribavirin 1200 mg daily in three divided doses for 4 weeks. At the end of 4 weeks treatment, the serum ALT decreased in all but one patient and became normal in three individuals. The mean pretreatment serum ALT was reduced significantly from 193 ± 45 i.u./L to 95 ± 16 i.u./L after 4 weeks therapy (P= 0.009). However, 8 weeks after cessation of treatment, the serum ALT rose to a mean value of 154 ± 21 i.u./L. The mean pretreatment serum HCV RNA was not significantly decreased at the end of 4 weeks treatment (7.0 × 105vs 4.1 × 105 copies/mL, P > 0.05). However, serum HCV RNA levels were decreased in 12 and increased in 10 patients at the end of 4 weeks therapy. Eight weeks after cessation of therapy, the serum HCV RNA of 22 patients rose to a mean value of 4.9 ± 105 copies/mL.

Six patients who continued to have elevated serum ALT and positive HCV RNA after the initial 4 weeks treatment received oral ribavirin at the same dosage for an additional 24 weeks. The serum ALT again decreased in all six patients during therapy, but rose to pretreatment values by 8 weeks after cessation of the treatment. In addition, no significant changes were noted in the mean serum HCV RNA levels during and after 24 weeks of ribavirin therapy.

Our results indicate that oral ribavirin only transiently lowered serum ALT values and did not efficiently suppress HCV synthesis in patients with chronic hepatitits C infection.
Interstitial tumour cell invasion in small hepatocellular carcinoma. Evaluation in microscopic and low magnification views
Authors: KONDO FUKUO , KONDO YOICHIRO , NAGATO YOSHINOBU , TOMIZAWA MINORU , WADA KATSUNORI
Published: March 2008

In order to study the process of hepatocellular carcinoma (HCC) development, and to search for a clue to histologic diagnosis of well‐differentiated HCC (wd‐HCC), interstitial invasion in small HCC was evaluated. The study material consisted of 35 cases of HCC that were smaller than 3 cm that comprised 17 cases of wd‐HCC, 18 cases of moderately or poorly differentiated classical HCC (cl‐HCC), and 20 cases of large regenerative nodules (LRN). Interstitial invasion was microscopically classified into three patterns: (i) crossing type, in which HCC was invading across fibrous septa of tumour nodules; (ii) longitudinal type, in which tumour cells were growing longitudinally within fibrous septa; and (iii) irregular type, in which the portal area was irregularly invaded by HCC. The crossing type was found in two cases (12%) of wd‐HCC and 10 cases (56%) of cl‐HCC while the longitudinal type was observed in 16 cases (94%) of wd‐HCC and eight cases (44%) of cl‐HCC. The irregular type was frequently seen in wd‐HCC (15 cases, 88%), and cl‐HCC (12 cases, 67%). No interstitial invasion was observed in LRN. Interstitial invasion could be recognized even in the low magnification view of histological specimens, with a detection rate of 59% (10 cases) in wd‐HCC and 72% (13 cases) in cl‐HCC.

These results suggest that evaluation of interstitial invasion is useful in diagnosing wd‐HCC independent of cellular atypia. In addition, such invasive growth is revealed to play an important role in destroying original hepatic architecture during its developmental process from the early to advanced stages.
Pathomorphological study of HCV antibody‐positive liver cirrhosis
Authors: SHIMAMATSU KAZUHIDE , KAGE MASAYOSHI , NAKASHIMA OSAMU , KOJIRO MASAMICHI
Published: March 2008

A morphological investigation was carried out to study the pathological features of liver cirrhosis caused by hepatitis C virus (HCV) infection. The materials consisted of liver specimens taken from 47 cases of anti‐HCV antibody‐positive liver cirrhosis (37 by surgery for hepatocellular carcinoma and 10 by autopsy), and from 21 cases of hepatitis B surface antigen‐positive liver cirrhosis as the control. Liver specimens containing more than 10 regenerative nodules were examined. In addition, a histometric study was conducted to determine the degree of fibrosis and the size of regenerative nodule using a computer image‐analysis system.

The results showed that the histological characteristics of HCV antibody‐positive liver cirrhosis are: (i) broadly expanded fibrous septa and small regenerative nodules; (ii) relatively strong inflammatory reaction and prominent lymphoid aggretation in the fibrous septum; and (iii) mild regenerative activity of the liver parenchyma, and infrequent liver cell dysplasia.

These findings may facilitate better understanding of the pathology of HCV antibody‐positive liver cirrhosis and more accurate pathological diagnosis by needle biopsy.
Clinical usefulness of an assay for hepatitis C virus core in the diagnosis of non‐A, non‐B hepatitis and monitoring of the response to interferon therapy
Authors: KAWANO SHIN‐ICHI , TANAKA MOTOHIKO , FUJIYAMA SHIGETOSHI , SATO SHINJIRO , TAURA YUKO , GOTO MASAFUMI , CHIKAZAWA HIDETO , SATO TATSUO
Published: March 2008

The clinical utility of a new JCC‐2 enzyme‐linked immunosorbent assay kit that detects and quantitates anti‐hepatitis C virus (anti‐HCV) core antibodies (anti‐HCc) was investigated. Serum samples were obtained from 102 patients with various non‐A, non‐B liver diseases, including 19 cases of chronic hepatitis type C who had been treated with interferon (IFN). The results of the anti‐JCC‐2 assay were significantly correlated with serum HCV‐RNA positivity. Patients who were HCV‐RNA positive exhibited a high rate of positivity for anti‐JCC‐2 (72.2% in acute hepatitis, > 90% in chronic liver diseases). The geometric mean of the anti‐JCC‐2 titre was not significantly different among different stages of chronic liver disease (among CPH, CAH and LC). The anti‐JCC‐2 titre decreased gradually in cases that became HCV‐RNA negative after IFN therapy. If HCV‐RNA positivity recurred, the anti‐JCC‐2 titre increased, indicating that serial measurements of the anti‐JCC‐2 titre are useful for monitoring the antiviral effect of IFN treatment. These results suggest that quantification of anti‐HCc by the anti‐JCC‐2 assay is superior to the semi‐quantification of circulating HCV‐RNA provided by monitoring of IFN therapy. Monitoring of HCV‐RNA status using reverse transcription‐nested polymerase chain reaction (RT‐nested PCR) is possible, but it is technically demanding and too expensive for routine clinical use.
Incidence of hepatitis C virus (HCV) antibodies and HCV‐RNA in blood donors and patients with liver diseases in the Inshore Area of the Yangtze River
Authors: ITO SUSUMU , YAO DENG‐FU , NII CHIYO , HORIE TAKAHIRO , KAMAMURA MASAKO , NISHIKADO TOMOKO , HONDA HIROHITO , SHIBATA HIROSHI , SHIMIZU ICHIRO , MENG XIAN‐YONG
Published: March 2008

The Nantong area is a high risk region for primary hepatocellular carcinoma (PHC) in the inshore area of the Yangtze River. However, no detailed data are available about hepatitis C virus (HCV) infection in this area. We examined the incidences of anti‐HCV and HCV‐RNA in blood donors with hepatitis B surface antigen (HBsAg)‐ and hepatitis B core antibody (HBcAb)‐negative and patients with chronic liver diseases in the Nantong area at Nantong Medical College, Jiangsu Province, the People's Republic of China. The incidences of HBV markers (HBsAg and/or HBcAb), anti‐HCV (C100‐3), second generation anti‐HCV, HCV‐RNA and any marker of HCV in the Nantong area were found to be: 0.0, 0.7, 0.4, 0.2 and 0.7% in donor bloods; 16.9, 0.0, 3.4, 15.7 and 16.9% in patients with acute hepatitis; 82.8, 2.7, 4.8, 7.5 and 10.2% in those with chronic hepatitis; 86.4, 4.5, 9.1, 4.5 and 11.4% in those with liver cirrhosis; 87.5, 6.3, 0.0, 0.0 and 6.3% in those with PHC; and 21.8, 1.3, 1.3, 0.0 and 1.3% in patients without liver diseases, respectively. Although the Nantong area is a high risk region for PHC, these data suggest that HCV infection is not an important aetiological factor for PHC in this area.
The pathology of liver injury induced by the chronic administration of alcohol and ‘low‐dose’ carbon tetrachloride in Porton rats
Authors: HALL PAULINE DE LA M. , PLUMMER JOHN L. , ILSLEY ANTHONY H. , AHERN MICHAEL J. , CMIELEWSKI PATRICIA L. , WILLIAMS RICHARD A.
Published: March 2008

We have previously established a model for micronodular cirrhosis by feeding Wistar rats alcohol, in the Lieber–DeCarli liquid diet, and exposing them to ‘low‐dose’ carbon tetrachloride (CCl4) vapour for 10 weeks. This study reports the spectrum of liver pathology seen in male Porton rats exposed to ‘low‐dose’ CCl4 vapour 5 nights/week, 6 h/night while being fed alcohol (300 kcal/L) in the Lieber‐DeCarli diet. Micronodular cirrhosis developed in all animals after 5–7 weeks of treatment. The simultaneous administration of silymarin, a putative hepatoprotective agent, in the liquid diet, did not alleviate or prevent the chronic liver injury. The histopathological features of the liver injury are described, with particular emphasis on the presence of small epithelial cells (‘progenitor or stem cell'), which appear to be playing a role in liver regeneration.
Effects of colchicine on the synthesis and transport of albumin: A combined electron cytochemical and autoradiographic study
Authors: IWAI MASAKI , ISHII YASUTAKA , TADA KAZUNOBU , KITAGAWA YOSHIHIRO , KASHIWADANI MOTOMU , KASHIMA KEI , IBATA YASUHIKO
Published: March 2008

We investigated the intracellular transport of albumin in the livers of rats treated with colchicine using immunoperoxidase study as well as combined immunoelectron microscopy and autoradiography with [3H]‐leucine. Immunoreaction of albumin was observed in all hepatocytes. Its subcellular location was in the rough endoplasmic reticulum, Golgi apparatus and lysosomes. After the injection of [3H]‐leucine through the portal vein, a combined technique revealed accumulated grains on the albumin‐positive Golgi apparatus or the albumin‐positive vesicles in the vicinity of the Golgi apparatus. These findings suggest that albumin transport from the Golgi apparatus to sinusoids is disturbed by colchicine. Enzyme histochemistry showed many acid phosphatase‐positive lysosomes in hepatocytes of the liver treated with colchicine. Albumin retained in the vicinity of the Golgi apparatus may be digested by lysosomes.

An in situ hybridization study with isotopes revealed the presence of silver grains for albumin mRNA in all hepatocytes of livers treated or untreated with colchicine; there was no significant difference in the number of silver grains in the two groups. Therefore, colchicine has very little effect on albumin synthesis in the liver.
Lack of association between cassava consumption and tropical pancreatitis syndrome
Authors: NARENDRANATHAN M. , CHERIYAN ASOK
Published: March 2008

Previous studies suggesting an association between use of tubers of cassava and tropical pancreatitis have been weak and conflicting. To test a possible association the cassava consumption of 40 consecutive cases of tropical pancreatitis syndrome were compared with age‐matched and sex‐matched healthy hospital visitors. The sociodemographic characteristics of the two groups were comparable. There was no association between cassava consumption and tropical pancreatitis syndrome (odds ratio = 0.56; 95% confidence interval = 0.21–1.45). Controlling for the possible confounding effects of low socio‐economic status and vegetarian diet did not alter the odds ratio. Testing for interaction also failed to show any effect modification of the association of cassava by economic status, chilli consumption or vegetarian diet. A significantly higher number of cases gave a positive family history of diabetes compared to the controls (odds ratio = 4.11; 95% confidence interval = 1.04–16.30; P= 0.04). In this case‐control study which had sufficient power to detect an odds ratio ? 3.5, there was no association between cassava consumption and tropical pancreatitis syndrome.
Mucosal pharmacokinetics and pilot study of short course of parenteral imipenem in the eradication of Helicobacter pylori
Authors: SUNG JOSEPH J. Y. , CHUNG S. C. SYDNEY , HOSKING SHORLAND W. , CHAN RAPHAEL C. Y. , LING THOMAS K. W. , YUNG MAN‐YEE , CHENG AUGUSTINE F. B. , LI ARTHUR K. C.
Published: March 2008

Abstract Eradication of Helicobacter pylori infection is known to reduce the incidence of duodenal ulcer recurrence. The most commonly used regimen for H. pylori infection is triple antimicrobial therapy for 1‐2 weeks. This treatment is associated with frequent side effects and hence unsatisfactory compliance. As in vitro data showed that H. pylori is sensitive to imipenem, the pharmacokinetics of this drug in the gastric milieu, and the clinical efficacy of imipenem with omeprazole in eradicating H. pylori infection were studied. Imipenem/cilastatin levels in serum, gastric secretion and gastric mucosa were assayed in four patients after intravenous injection of a bolus dose of 500 mg. The serum and gastric secretion levels of imipenem achieved were more than 10 times the minimum inhibitory concentration of the drug for H. pylori. Gastric mucosal levels of imipenem vary considerably with time, which probably indicates rapid elimination of the drug into the gastric lumen. In the second part of this study, imipenem/cilastatin was given intravenously for the first 2 days after diagnosis of H. pylori infection in patients with endoscopically confirmed duodenal ulcers. The patients were also treated with 4 weeks of omeprazole. Clearance of H. pylori was initially achieved at the end of 2 days in 20 out of 22 (91%) patients. However, when the biopsies were repeated at 8 weeks, recurrence of H. pylori infection was evident in 19 cases (86.3%) indicating a failure of eradication. It was concluded that imipenem/cilastatin in combination with omeprazole failed to eradicate H. pylori infection.
Ulcer recurrence among Filipino patients: Clinical profile and risk factors
Authors: ALVAREZ S. Z. , JUDAN E. , BAGSIC R. , PAYAWAL D. , PEÑA D. , SOLLANO J. , FERNANDEZ J.
Published: March 2008

Abstract Patients with endoscopic diagnosis of gastric and/or duodenal ulcers who eventually had endoscopic confirmation of ulcer healing after any anti‐ulcer medication were entered in a 3 year study to determine ulcer recurrence rate, onset of ulcer recurrence and factors associated with ulcer recurrence. Patients from two participating centres who are not on any maintenance treatment had endoscopic examinations at 3, 6 and 12 months after ulcer healing or at any time of symptom recurrence. There were 144 patients entered into the study. The 1 year recurrence rate observed among 125 Filipino patients who completed the study was 73% wherein 71% occurred within the first six months. This was comparable with those reported in the world literature. Thirty‐three per cent of those with recurrent ulcers were asymptomatic. The difference in the recurrence rate between gastric and duodenal ulcers was not statistically significant. The only risk factors found to be associated with ulcer relapse were history of smoking and alcohol intake. CLO test for Helicobacter pylori done in 45 patients with recurrent ulcers were all positive, suggesting a strong association between H. pylori and ulcer recurrence.
A single standard nocturnal dose of nizatidine enhances the healing of active duodenal ulcers among Chinese
Authors: CHEN TSENG‐SHING , CHANG FULL‐YOUNG , LEE SHOU‐DONG
Published: March 2008

Abstract Chinese people have a lower maximal acid output and gastrin response to meals compared to Western people. The aim of the present study was to assess the efficacy of a half‐single nocturnal dose of nizatidine (150 mg at bedtime [h.s.], n= 40) with a standard full dose given once nightly (300 mg h.s., n= 38) or twice daily (150 mg twice a day [b.i.d.], n= 43) in the treatment of Chinese patients with active duodenal ulcers. An endoscopy was performed upon entry and at 4 week intervals until the ulcer healed (up to 8 weeks). There is no statistical difference in healing rates after 4 weeks of treatment (52.5, 52 and 47% in nizatidine 150 mg h.s., 150 mg b.i.d. and nizatidine 300 mg h.s., respectively) whereas nizatidine 300 h.s. had a significantly higher healing rate compared to nizatidine 150 mg h.s. and b.i.d. after 8 weeks of treatment (89 vs 70 and 67%, P < 0.05) by uni‐ and multivariate analysis of clinical and endoscopic characteristics. Symptomatic response was not significantly different in these three treated groups. Our study suggested that a half‐single nocturnal dose of nizatidine is not ideal for the treatment of duodenal ulcer in Chinese patients, whereas a single standard nocturnal dose appears more effective than a twice‐daily regimen.
Plasma kallikrein clearance by the liver of chronic carbon tetrachloride‐treated rats
Authors: TOLEDO CARLOS F. , KOUYOUMDJIAN MARIA , LANZONI VALÉRIA P. , BORGES DURVAL R.
Published: March 2008

Abstract We have previously reported that the endocytosis of rat plasma kallikrein (RPK) by hepatocytes is a calcium‐independent and beta‐galactoside‐dependent mechanism. We now report the clearance of RPK by the liver of four groups of rats: normal, inflamed (48 h ex‐turpentine) and two groups chronically treated with CCl4 (52 mg/kg per week, intragastrically, for 9‐12 weeks). Each liver was isolated, exsanguinated and perfused at 37°C with 30 mL of BSA‐Krebs‐Henseleit‐bicarbonate medium containing 10 nmol/L RPK. Although all rats received the same mild CCl4 treatment, the liver histology showed that they evolved either to severe hepatitis (serum alanine aminotransferase [ALT] 4852 ± 885 U/L, parenchymatous necrosis in the perivenous region) or to compensated cirrhosis (serum ALT 209 ± 42 U/L, vigorous fibrous encircling regeneration nodules); neither jaundice nor ascites was noted. The results show that serum albumin was not altered among the groups and that: the acute‐phase response by itself (inflamed group) increased RPK clearance rate (3.01 ± 0.59 mL/min) as compared with the normal group (1.85 ± 0.14 mL/min); the CCl4 treatment, although induced an acute‐phase response, decreased (P < 0.01) RPK clearance rates (0.80 ± 0.11 mL/min hepatitis group and 0.98 ± 0.10 mL/min cirrhosis group). These findings suggest that the hepatic clearance rate of plasma kallikrein is an early indicator of liver injury.
Influence of ascites on the chemotaxis of granulocytes in patients with cirrhosis
Authors: HÖRING E. , OTTO D. , VON GAISBERG U.
Published: March 2008

Abstract Spontaneous bacterial peritonitis is a specific infectious complication in liver cirrhosis. The reasons for the preferred location of infection on the peritoneum are not clear. The aims of the present study were to ascertain whether hepatogenic ascites fluid is chemotactically effective, what part is played by complement factor C3 and whether there are inhibitors of chemotaxis in ascites. Chemotaxis of granulocytes in serum and ascites fluid was measured in 18 patients with cirrhosis and ascites and in 18 healthy individuals using the Boyden chamber method. In the patients, the chemotactic effect of serum was reduced significantly. Ascites fluid had lower chemotactic activity than autologous serum (P < 0.01), directly correlated to C3 levels (P < 0.025). There was a significant correlation between chemotaxis in serum and in ascites fluid (P < 0.005). Adding ascites fluid to serum led to reduction of chemotactic activity only in the patients (P < 0.025). In conclusion, the chemotactic effect of ascites fluid is considerably lower than that of serum and is proportional to local concentrations of C3. Chemotaxis‐inhibiting factors can also be identified in ascites fluid, their pathogenetic relevance being limited.
Haemodynamic effects of enalaprilat on portal hypertension in patients with HBsAg‐positive cirrhosis
Authors: CHIANG HUNG‐TING , CHENG JIN‐SHIUNG , LIN MIKE , TSENG WON‐SHEN , CHANG JINN‐MING , LAI KWOK‐HUNG
Published: March 2008

Abstract It has been suggested that enalaprilat inhibits the renin‐angiotensin‐aldosterone system in plasma and tissue; it may therefore reduce portal vascular pressure owing to secondary hyperaldosteronism in patients with liver cirrhosis. In order to evaluate this concept, 20 patients with hepatitis B surface antigen (HBsAg)‐positive liver cirrhosis and portal hypertension received an intravenous infusion of 2.5 mg of enalaprilat. Wedged hepatic venous pressure, free hepatic venous pressure and cardiac index were measured before, immediately after, and then 15 min, 30 min and 1 h after intravenous enalaprilat infusion. The mean pressure gradient between wedged hepatic venous pressure and free hepatic venous pressure was significantly decreased, by 13% immediately after, 18% at 15 min, 23% at 30 min and 13% at 1 h after infusion of enalaprilat. Thirteen patients experienced a decrease of hepatic venous pressure gradient (HVPG) greater than 5 mmHg, another three 3‐5 mmHg and the remaining four patients exhibited no significant change in HVPG. Systemic haemodynamic indices, including pulmonary arterial pressure, pulmonary capillary wedge pressure and central venous pressure, decreased significantly at 15 and 30 min after enalaprilat infusion (P < 0.01). Liver function, renal function and blood routine before and after enalaprilat infusion showed no significant changes. There were no adverse effects during or after enalaprilat infusion. We conclude that enalaprilat infusion can quickly and safely reduce the hepatic venous pressure gradient in patients with HBsAg‐positive cirrhosis.