bluuebunny/crossref_metadata_2025 huggingface dataset:
A topographic study of Helicobacter pylori density, distribution and associated gastritis
Authors: Misra Vatsala , Misra Sriprakash , Dwivedi Manisha , Singh Ü Premala Anthony , Bhargava Vanita , Gupta Suresh Chandra
Published: March 2003

Background and Aims
: The topographic distribution and density of Helicobacter pylori and associated gastritis in the stomach were studied in order to determine which biopsy sites are likely to provide the maximum yield so as to reduce the fallacious results due to sampling error.

Methods
: Fifty patients with upper gastrointestinal symptoms were studied. Eleven gastric biopsies from predetermined sites were obtained and subjected to ultra‐rapid urease test, imprint cytology and histology. Haematoxylin and eosin stain was used for defining gastritis and other associated histopathological details. Loeffler’s methylene blue stain was used to confirm the presence of H. pylori in imprint smears and histological sections.

Results
: All 50 patients had H. pylori infection and evidence of chronic gastritis at one or more of the 11 biopsy sites. Maximum and minimum percentage positivity were observed at A3 (antral lesser curvature) and B4 (corpus greater curvature), respectively. Various sites in decreasing order of percentage positivity were A3 > A2 > A1 > A4 > B3 > B1 > A5 > B6 > B5 > B2 > B4. Among the biopsies obtained from the corpus, B3 (corpus lesser curvature) was the site with maximum positivity. A3 and B4 had a statistically significant difference in percentage positivity (P < 0.0001) for H. pylori and gastritis. The maximum and minimum density scores of H. pylori and gastritis were found in A3 and the B4, respectively. A3 had a significantly higher (P < 0.0001) mean density score than any other site in the stomach. The difference in the grading of H. pylori between A3 and B3 (sites of maximum positivity in antrum and corpus) was statistically significant (P < 0.0001). A statistically significant (P < 0.001) positive correlation between increasing grades of H. pylori and gastritis was observed at the site of maximum density. Eighty per cent of the patients had antral predominant gastritis and in 82%, H. pylori was predominantly observed in antral biopsies.

Conclusion
: It is concluded that two biopsies taken from A3 are sufficient for confirmation of presence of H. pylori and associated gastritis for initiation of treatment. However, additional biopsies from B3 will help in deciding the topographic pattern of gastritis.
Real‐time ultrasonographic assessment of antroduodenal motility after ingestion of solid and liquid meals by patients with functional dyspepsia
Authors: Kusunoki Hiroaki , Haruma Ken , Hata Jiro , Tani Hiroshi , Okamoto Eiichi , Sumii Koji , Kajiyama Goro
Published: March 2003

Background and Aims
: Although antroduodenal motility has usually been studied by using manometric or scintigraphic methods, ultrasonography is an established, non‐invasive method to evaluate duodenogastric motility. We used ultrasonography to evaluate gastric motility in patients with functional dyspepsia.

Methods
: Sixty‐four patients with functional dyspepsia and 36 asymptomatic healthy subjects were given liquid and solid test meals. We investigated the gastric emptying rate, motility index, and duodenogastric reflux for the liquid meal and gastric emptying time, half‐emptying time, and motility index for the solid meal.

Results
: After the liquid meal, the gastric emptying rate and motility index were significantly lower and the duodenogastric reflux was significantly higher in functional dyspepsia patients than in healthy subjects. After the solid meal, gastric emptying time, half‐emptying time and the motility index were significantly lower in the patients than in the healthy subjects. Delayed gastric emptying of both meals occurred in only 20.3% of patients. Delayed emptying of the liquid or solid meal occurred in 62.5% of patients. In both groups, gastric emptying time of the solid meal was positively correlated with the motility index at 15 min post‐ingestion.

Conclusion
: In functional dyspepsia patients, delayed gastric emptying of a solid meal was related to antral hypomotility during the early postprandial phase. Ultrasonographic assessment of gastric motility in both liquid and solid meals may provide a better understanding of the pathogenesis of functional dyspepsia.
Acute hepatitis induced by Shou‐Wu‐Pian, a herbal product derived from Polygonum multiflorum
Authors: Park Gordon J‐H , Mann Stephen P , Ngu Meng C
Published: March 2003

Abstract Herbal preparations are widely available and generally regarded by the public as harmless remedies for a variety of medical ailments. We report the first case in Australia of acute hepatitis associated with the Chinese herbal medicine Shou‐Wu‐Pian, prepared from Polygonum multiflorum. Cholestatic hepatitis developed in a Chinese woman taking this preparation for the greying of her hair, and liver biopsy was consistent with a toxic reaction. Clinical and biochemical resolution occurred following cessation of the drug.
Subcellular redistribution of protein kinase C isozymes is associated with rat liver cirrhotic changes induced by carbon tetrachloride or thioacetamide
Authors: Jeong Da‐Hee , Lee Jae‐Hyun , Bae In‐Hwa , Jeong Kyu‐Shik , Jang Ja‐June , Lim In‐Kyoung , Kim Mi‐Ran , Lee Min‐Jae , Lee Yun‐Sil
Published: March 2003

Background and Aims: Protein kinase C (PKC) plays a key role in the alteration of signal transduction in the liver, which may contribute to the development of liver cirrhosis. The aim of the present study was to examine the subcellular redistribution of PKC isozymes in rat liver cirrhosis, which is induced by two different cirrhotic chemical agents, carbon tetrachloride (CCl4) and thioacetamide (TAA).

Methods and Results: Thioacetamide and CCl4 were administered to rats for 8 and 30 weeks, respectively before rats were killed and autopsies performed at 9, 20 and 30 weeks later. The TAA induced a fibrotic pattern in the liver that differed from that produced by CCl4, notably in the formation of fibrous connective tissue and the proliferation of bile ductule cells. Cholangiofibrosis and clear‐cell foci were also observed in TAA‐treated rats at 30 weeks. Histological examination revealed that severe cirrhotic changes were present 9 weeks after the commencement of CCl4 treatment and 30 weeks after TAA treatment.

Discussion: When the subcellular redistribution of PKC isozymes (PKCα, ‐β1, ‐δ, and ‐ɛ) was examined, all the PKC isozymes in CCl4‐treated rats were found to be translocated to the membrane fraction, which may mean PKC activation, and then downregulated by proteolytic degradation after 9 weeks of treatment, which coincided with peak cirrhotic changes. All rats treated with CCl4 recovered to the control level after 20 weeks of treatment. In the case of TAA‐treated rats, PKC isozymes were translocated to the particulate fraction of the liver after 9 weeks of treatment and this persisted in most of the rats for the duration of the experiment.

Conclusions: From these results, it would appear that PKC translocation preceded morphologic changes, and that an altered subcellular distribution of the PKC isozyme may be associated with the response to liver damage and carcinogenesis.
Generation of hepatitis C virus‐specific cytotoxic T lymphocytes from healthy individuals with peptide‐pulsed dendritic cells
Authors: Ito Akihiko , Kanto Tatsuya , Kuzushita Noriyoshi , Tatsumi Tomohide , Sugimoto Yoshiko , Miyagi Takuya , Takehara Tetsuo , Katayama Kazuhiro , Mochizuki Kiyoshi , Hiramatsu Naoki , Kasahara Akinori , Yoshiya Ikuto , Sasaki Yutaka , Hori Masatsugu , Hayashi Norio
Published: March 2003

Background and Aims: In hepatitis C virus (HCV) infection, cytotoxic T lymphocytes (CTL) are involved in liver inflammation and contribute to the reduction of viral load. Antibodies for HCV‐CTL precursor frequencies (CTLpf) are relatively low in chronic hepatitis C, and this may be related to the poor CTL response in vivo. The aim of this study was to assess the efficacy of dendritic cells (DC) as antigen‐presenting cells in CTL generation from low CTLpf.

Methods: To confirm the rationale of using DC to prime naive T cells, five HCV‐uninfected indi‐viduals were enrolled in the study. We obtained DC by maturation from peripheral progenitors under stimulation with granulocyte‐macrophage colony‐stimulating factor (GM‐CSF), interleukin (IL)‐4 and IL‐1α. Autologous T cells were cultured with DC or concanavalin‐A‐induced blasts loaded with four HCV‐derived peptides bearing human leukocyte antigen (HLA)‐A*0201 or ‐A24 motifs for 28 days under IL‐7 and IL‐2 stimulation. The lytic activity against peptide‐pulsed targets was assessed by using a [51Cr]‐releasing assay.

Results: The DC strongly expressed HLA class I, II, B7–1 and B7–2, but not phenotypic markers of T‐, B‐, natural killer (NK)‐cells or monocytes. The CD8‐positive, HLA‐class I‐restricted and HCV peptide‐specific CTL were generated with DC from HLA‐A antigen‐matched subjects, whereas no CTL activity was detected with concavalin (Con‐A) blasts. We were thus able to generate HCV specific CTL from naive precursors with peptide‐pulsed DC.

Conclusions: This DC‐based system can be used to generate CTL of desired antigen specificity, even from a source with low CTLpf.
Effect of Helicobacter pylori eradication on gastric mucosal phospholipid content and its fatty acid composition
Authors: Orihara Tadahiro , Wakabayashi Hiroyuki , Nakaya Atsuko , Fukuta Kanako , Makimoto Shinya , Naganuma Kotaro , Entani Akio , Watanabe Akiharu
Published: March 2003

Background and Aims: Whether Helicobacter pylori eradication alters gastric mucosal phospholipid contents and their fatty acid composition remains unclear. The aim of the present study was to clarify the effect of H. pylori eradication on gastric mucosal phosphatidylcholine (PC) content and its fatty acid composition.

Methods: Endoscopic biopsy specimens were taken from the antrum and body of each of 19 asymtomatic male volunteers for detection of H. pylori, histopathological assessment of gastritis, phospholipid determination and fatty acid analysis. All the subjects with H. pylori infection were treated with eradication therapy. Endoscopy and tissue sampling were repeated again 1 and 6 months after all treatment.

Results: In eight subjects, H. pylori infection was evident and was successfully eradicated. Pretreatment degrees of lymphocytes and plasma cells (inflammation) and polymorphonuclear neutrophils (activity) were greater in H. pylori‐positive subjects compared with H. pylori‐negative subjects (P < 0.001), whereas the degree of inflammation decreased (P < 0.001), and neutrophils had completely disappeared at 6 months after eradication. Moreover, the gastric mucosal PC contents at the antrum and body were unchanged within 1 month after cessation of treatment, but increased at 6 months after eradication (P < 0.05). At 6 months after cessation of treatment, H. pylori‐eradicated subjects had an increase (+ 30% at antrum, + 18% at body) in linoleic acid composition and a decrease (− 37%, − 43%) in arachidonic acid composition of PC at the antrum and body, respectively.

Conclusions: These findings suggest that H. pylori eradication reduces the production of various eicosanoids, resulting in the normalization of gastric mucosal PC content and its fatty acid composition, which may consequently cause the gastric mucosal hydrophobicity to be normalized.
Postoperative detection of α‐fetoprotein mRNA in blood as a predictor for metastatic recurrence of hepatocellular carcinoma
Authors: Minata Mutsuko , Nishida Naoshi , Komeda Toshiki , Azechi Hidemasa , Katsuma Hirokazu , Nishimura Takafumi , Kuno Masato , Ito Teruaki , Yamamoto Yuzo , Ikai Iwao , Yamaoka Yoshio , Fukuda Yoshihiro , Nakao Kazuwa
Published: March 2003

Background: We tested for the presence of α‐fetoprotein (AFP) mRNA by using nested RT‐PCR in the peripheral blood of hepatocellular carcinoma (HCC) patients who had undergone curative surgery, and investigated the occurrence of intrahepatic and/or extrahepatic metastasis thereafter, to reveal the optimal timing of blood sampling for the prediction of metastatic recurrence.

Methods: Twenty‐nine patients with HCC, who had been operated on were analyzed with RT‐PCR at several points during the clinical course, and examined for metastatic recurrence for 3–28 months (mean = 18.7 months) after surgery.

Results: The presence of AFP mRNA before surgery was significantly correlated with the tumor size (P = 0.017). Metastatic recurrence was associated with the postoperative detection of AFP mRNA (P < 0.001), but not with the preoperative and/or perioperative detection. Furthermore, AFP mRNA was detected in some cases that showed low serum AFP levels at recurrence. The recurrence‐free period after the detection of AFP mRNA varied from 1 to 12 months.

Conclusions: The postoperative detection of AFP mRNA is useful for the prediction of metastatic recurrence, and long‐term follow up with this method should be conducted.
Surveillance for hepatocellular carcinoma in patients with chronic viral hepatitis in the United States of America
Authors: Tong Myron J , Blatt Lawrence M , Kao Vincent WC
Published: March 2003

Background: Measurement of serum α‐fetoprotein (AFP) and abdominal ultrasound (US) examination are used for the early detection of hepatocellular carcinoma (HCC) in chronic liver disease patients. However, the accuracy and usefulness of these tests in a clinical setting in the United States of America have not been clarified.

Methods: We conducted a 7‐year prospective surveillance study by using both AFP and US to detect HCC in 602 patients with chronic viral hepatitis. Our main goal was to determine the optimal test for detection of early HCC. We also assessed the clinical outcome of HCC patients identified during this time period.

Results: Thirty‐one cases of HCC were detected. Serum AFP levels were elevated in 74% of HCC patients, but was also high in 10% of patients who did not develop HCC. The positive predictive value for AFP to detect HCC was only 12% or less for all AFP cut‐off values, and the maximum joint sensitivity and specificity as determined by receiver operator characteristic analysis was approximately 65 and 90%, respectively. Abdominal US identified all 31 cases of HCC. The positive predictive value for US examinations to detect HCC was 78%, while the sensitivity and specificity was 100 and 98%, respectively. After detection of HCC, 24 (77%) patients died within a mean of 16.7 ± 19.4 months.

Conclusions: Our study indicates that US examination was more accurate in detecting HCC. Because of its poor predictive value and low sensitivity, serum AFP should not be used as the only test for screening and surveillance for HCC.
Squamous papilloma of the esophagus: Long‐term follow up
Authors: Mosca Sandro , Manes Gianpiero , Monaco Roberto , Bellomo Patrizia F , Bottino Vincenzo , Balzano Antonio
Published: March 2003

Abstract Background and Aim: Squamous papilloma of the esophagus is a rare benign tumor; less than 200 cases have been reported in the literature. The prevalence of endoscopically diagnosed squamous papilloma of the esophagus has been reported in only a very few series, and varies from 0.01 to 0.43%. Clinical relevance and possible association with other pathological conditions, namely if it is a premalignant lesion, remain a matter of debate. The etiology is controversial, although a role of human papilloma virus has been recently proposed. The aim of this study was to try to determine the prevalence, clinical relevance, possible association with other pathological conditions of the upper digestive tract, and possible etiological role of human papilloma virus on our series of squamous esophageal papillomas.

Methods: Data from a total of 7618 upper gastrointestinal endoscopies consecutively performed in 4 years were obtained. A 4‐year follow up was carried out.

Results: Squamous esophageal papilloma was found in nine patients (0.01%). The mean size of polyps was 4 mm and the mean distance from the dental ridge was 25 cm. Only one patient had more than one polyp. Two patients had liver cirrhosis and three had peptic ulcer disease. All squamous esophageal papillomas were removed and tested for human papilloma virus with commercial available kits for in situ hybridization, but none was found positive.

Conclusion: Squamous papilloma of the esophagus is an uncommon disease that does not appear to predispose to esophageal cancer. No association was found with human papilloma virus.
Membranous obstruction of the inferior vena cava (obliterative hepatocavopathy, Okuda)
Authors: Okuda Kunio
Published: March 2003

Confusion prevails throughout the world regarding the definition and classification of the Budd–Chiari syndrome. The original patients (Budd and Chiari) described had hepatic vein thrombosis, but this syndrome now encompasses various hepatic venous outflow blocks, of which membranous obstruction of the inferior vena cava (IVC) is the most common. This author has been suggesting that the classical Budd–Chiari syndrome or hepatic vein thrombosis and membranous obstruction of IVC or primary thrombosis of IVC at its hepatic portion are epidemiologically, pathologically and clinically different, and that they should be treated as two clinical entities that are not to be mixed. The two diseases have a different onset, different clinical manifestations and a different natural history. Whereas hepatic vein thrombosis is a severe disease with an acute onset, IVC thrombosis presents mildly at onset, but it recurs and eventually turns into a fibrous occlusion of IVC of varying thickness or stenosis of a various degree. The fibrous IVC occlusion is found as a mysterious thin membrane, but is more often much thicker than a membrane, and therefore ‘membrane’ is a misnomer. Although the genesis is not established, formation of a thin membrane may be an outcome of recurrent thrombosis. The past congenital vascular malformation theory no longer holds, because the disease occurs mostly in adulthood, and transformation of thrombosis into a membrane has now been well documented pathologically as well as clinically. This author suggests that a term ‘obliterative hepatocavopathy’ replace membranous obstruction of IVC, the term ‘Budd–Chiari syndrome’ be abandoned, and that primary hepatic venous outflow block be divided into primary hepatic vein thrombosis and primary IVC thrombosis (obliterative hepatocavopathy).
Influence of Helicobacter pylori infection on the prevalence of reflux esophagitis in Japanese patients
Authors: Fujishiro Hirofumi , Adachi Kyoichi , Kawamura Akira , Katsube Tomoko , Ono Masahiro , Yuki Mika , Amano Kazutoshi , Ishihara Shunji , Kinoshita Yoshikazu
Published: March 2003

Background and Aim:

Reflux esophagitis is caused by esophageal motor dysfunction in patients with sufficient gastric acid secretion. Helicobacter pylori causes atrophic gastritis and influences gastric acid secretion. Hiatus hernia (HH) of the esophagus causes motor dysfunction in the lower esophagus. Therefore, this study aimed to test whether H. pylori infection, gastric mucosal atrophy and HH are predictive factors for reflux esophagitis.

Methods:

Helicobacter pylori infection was examined in 781 patients by the measurement of serum immunoglobulin (Ig)G antibody, bacteriological culture and histological examination of biopsy specimens. The prevalence of HH, endoscopically identified gastric mucosal atrophy (closed‐ or open‐type) and reflux esophagitis were investigated by reviewing endoscopic films. Investigated patients were divided into three age groups, under 49, 50–69, and over 70 years. The prevalence of esophagitis, H. pylori infection, gastric mucosal atrophy, and HH were compared to identify the possible predictive factors for reflux esophagitis by using logistic regression analysis.

Results:

Sixty‐nine patients with reflux esophagitis were found among the 781 investigated cases. The odds ratios of negative H. pylori infection, endoscopically identified closed‐type gastric mucosal atrophy, and HH for the prevalence of reflux esophagitis were 1.342, 1.751 and 5.527, respectively. These results indicated that the presence of H. pylori infection was only a weak negative risk factor, and that HH was the most reliable endoscopic predictive factor for reflux esophagitis.

Conclusion:

Helicobacter pylori infection is a weak negative risk factor for the prevalence of reflux esophagitis, while HH is the most reliable predictive factor.
Role of non‐alcoholic steatohepatitis in methotrexate‐induced liver injury
Authors: Langman Gerald , Hall Pauline De La M , Todd Gail
Published: March 2003

Background and Aims:Hepatotoxicity, especially liver fibrosis, is the major concern with long‐term, ‘low‐dose’ oral methotrexate (MTX) therapy for psoriasis. The histological features are non‐specific and resemble those of non‐alcoholic steatohepatitis (NASH). Moreover, most of the risk factors of MTX‐induced liver injury are also associated with NASH. In this study, we investigate whether NASH contributes to the prevalence and progression of MTX‐induced liver injury in patients receiving MTX for psoriasis.

Methods:Clinical details, including MTX dosage schedules and risk factors for liver injury, was documented for 24 patients on long‐term MTX therapy for psoriasis. Serial liver biopsies were graded according to the Roenigk classification scale and a recently proposed grading and staging system for NASH.

Results:Thirteen of the 17 patients who had a NASH‐like pattern of liver injury also had the risk factors for NASH obesity and/or diabetes, and all had progressive liver injury. The other four patients had no risk factors, but a mean cumulative dose of 6.5 g. Seven patients, who did not have a NASH‐like pattern of injury, had a mean cumulative dose of 3.8 g. There was a positive correlation between the cumulative dose, risk factors and progression when the biopsies were scored by the modified grading and staging classification for NASH, but not with the Roenigk system.

Conclusions:Non‐steatohepatitis, probably aggravated by MTX, is an important cause of liver injury in patients on long‐term, ‘low‐dose’ MTX treatment for psoriasis. In addition, MTX alone can cause a NASH‐like pattern of injury that is at least, in part, caused by a higher cumulative dose.
Synchronous primary adenocarcinoma, mucosa‐associated lymphoid tissue lymphoma and a stromal tumor in a Helicobacter pylori‐infected stomach
Authors: Kaffes Arthur , Hughes Louise , Hollinshead John , Katelaris Peter
Published: March 2003

Abstract We report the case of a 78‐year‐old man with Helicobacter pylori infection and three primary neoplasms of the stomach: adenocarcinoma, mucosa‐associated lymphoid tissue (MALT) lymphoma and a gastrointestinal stromal cell tumor. Helicobacter pylori infection is associated with gastric carcinoma and MALT lymphoma, although their simultaneous occurrence is rare. Gastrointestinal stromal cell tumors have not been associated with infection to date. This appears to be the first report of the synchronous occurrence of these three gastric tumors.

© 2002 Blackwell Publishing Asia Pty Ltd
Primary hepatic carcinoid tumor with metachronous lymph node metastasis after long‐term follow up
Authors: Iimuro Yuji , Deguchi Yasunori , Ueda Yoshihide , Tanaka Akira , Iwasa Yoko , Ishihara Maki , Mizuta Kazuhiko , Yamamoto Yuzo , Ikai Iwao , Shimahara Yasuyuki , Yamaoka Yoshio
Published: March 2003

A case of hepatic carcinoid tumor occurring in a 71‐year‐old man is reported. The tumor was diagnosed initially as a hepatocellular carcinoma, and was then shown after resection histologically to be a carcinoid tumor. The tumor cells formed small nests and trabeculae separated by fibrous septa and were positive for Grimelius staining. Immunohistochemically, most of the tumor cells stained positive with chromogranin A and neuron‐specific enolase. After a follow up for 5 years and 7 months, the patient developed tumors in lymph nodes between the remnant liver and the lesser curvature of the stomach with no tumors in other organs. Histologically, the tumor cells in the lymph nodes demonstrated a pattern of the immunostainings consistent with carcinoid tumor. After lymphadenectomy, the patient is free from recurrence in the regional lymph nodes for more than 1 year. This case is con‐sidered to be a primary hepatic carcinoid tumor with metachronous lymph node metastasis.
A new prebiotic from germinated barley for nutraceutical treatment of ulcerative colitis
Authors: Bamba Tadao , Kanauchi Osamu , Andoh Akira , Fujiyama Yoshihide
Published: March 2003

Abstract  A germinated barley foodstuff (GBF) containing glutamine‐rich protein and hemicellulose‐rich fiber was made from brewer's spent grain, by physical isolation. Our previous studies demonstrated that GBF supported maintenance of epithelial cell populations, facilitated epithelial repair, and suppressed epithelial nuclear factor κB‐DNA‐binding activity through generating increased short‐chain fatty acid (especially butyrate) production by luminal microflora, which includes Bifidobacterium and Eubacterium, thereby preventing experimental colonic injury. The fiber fraction also modulates stool water content because of its high water‐holding capacity. The patients with mild to moderate active ulcerative colitis who had been unresponsive to or intolerant of standard treatment received 20–30 g GBF, feeding daily in a non‐randomized, open‐label fashion. At 4 weeks, this treatment resulted in a significant clinical and endoscopic improvement. The improvement was associated with an increase in stool butyrate concentrations. These results indicate that GBF feeding is a potentially new, attractive prebiotic treatment in patients with ulcerative colitis. The potency of GBF on modulating microflora, as well as the high water‐holding capacity, may play an important role in treatment and prolongation of remission in ulcerative colitis.
The Hong Kong index of dyspepsia: A validated symptom severity questionnaire for patients with dyspepsia
Authors: HU WAYNE HC , LAM KWOK‐FAI , WONG YEUK HING , LAM CINDY LK , HUIi WAI MO , LAI KAM‐CHUEN , WONG BENJAMIN CY , LAM SHIU‐KUM
Published: March 2003

Abstract

Aim:
Locally validated symptom questionnaires are essential instruments in dyspepsia research. A symptom score for Chinese dyspeptics was developed. Multiple aspects of validity and reliability were assessed.

Methods:
Sixty‐five patients with endoscopy‐negative dyspepsia and 65 healthy controls were presented with a list of 24 previously determined common abdominal symptoms and asked to rate the severity in a five point Likert scale. Comprehensibility and relevance of symptoms were assessed. The questionnaire was administered 3 h later to assess for reproducibility. A locally validated Short Form‐36 quality‐of‐life questionnaire was also administered. Cisapride 5 mg thrice daily was prescribed to dyspeptic patients but not to the controls. The dyspepsia symptom and SF‐36 questionnaires were repeated after 3 weeks for patients under treatment. Global change in symptoms and the need for further medical care were assessed. Concept, content, construct and criterion validity, consistency and reproducibility of the dyspepsia symptom questionnaire were assessed.

Results:
All items were considered comprehensible by more than 90% of subjects. Relevance of individual symptoms to dyspeptic patients ranged from 10.8–76.9%. Twelve items were selected by logistic regression to account for most of the differences between control and dyspeptic patients. Test–retest reproducibility and internal consistency were good with the intraclass correlation coefficient of 0.89 and Cronbach's alpha coefficient of 0.90. A cut‐off score of equal to or greater than 16 was determined to discriminate between controls and dyspeptic patients. The dyspepsia score correlated negatively with all domains of the SF‐36 quality of life scale except physical functioning. The dyspepsia questionnaire also discriminated between patients who reported a subjective improvement in symptoms and those who reported no change or worsening.

Conclusions:
The dyspepsia symptom index was easy to understand, internally consistent and reproducible. It predicted global symptom change, and the symptom severity scores correlated negatively with quality of life.

© 2002 Blackwell Publishing Asia Pty Ltd
Safety of technology: Infection control standards in endoscopy
Authors: Ramakrishna Balakrishnan S
Published: March 2003

Abstract  Transmission of infection related to gastrointestinal endoscopy continues to be a subject of much discussion. The principles of infection control during endoscopy are reviewed. Guidelines set forth by a number of gastrointestinal endoscopy associations have emphasized the need for meticulous cleaning of endoscopes immediately after use, followed by appropriate disinfection, rinsing and drying. Most, if not all, episodes of transmission of infection during endoscopy are associated with lapses in cleaning and disinfection protocols. The need for universal compliance with infection control standards, and for the development of strategies to achieve such compliance, is highlighted.

© 2002 Blackwell Publishing Asia Pty Ltd
Endoscopic mucosal resection for esophageal and gastric cancers
Authors: Inoue Haruhiro , Fukami Norio , Yoshida Tatsuya , Kudo Shin‐Ei
Published: March 2003

Abstract  Better outcomes for digestive tract cancers are likely to be possible if the tumors are detected in their earliest stages, particularly when they exist as mucosal lesions without lymph node metastases. Early esophageal squamous cell cancers can be detected with high sensitivity and specificity by iodine staining. Only mucosal cancers are suitable for the curative approach of submucosal resection; the rate of metastasis is 4%, compared to a rate of metastasis of 35% in tumors with submucosal spread. In this review, the history of endscopic mucosal resection is reviewed, including the factors that have refined the technique and technical aspects crucial for effective results. The importance of adequate submucosal injection of dilute epinephrine in saline solution is particularly emphasized. The overall efficacy, low rate of complications and such practical aspects as post‐therapeutic care are discussed. In general, mucosal cancers of the gastrointestinal tract have no risk of lymph node metastases and can be curatively managed by refined endoscopic mucosal resection procedures.

© 2002 Blackwell Publishing Asia Pty Ltd
Advances in hepatitis C: What is coming in the next 5 years?
Authors: Locarnini Stephen A , Bartholomeusz Angeline
Published: March 2003

Abstract 
Hepatitis C virus (HCV) is a leading cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. Numerous advances have been made in the understanding of HCV replication, including detailed molecular characterization of its viral proteins and genomic RNA. The inability to grow HCV in cell culture had impeded the development of antiviral agents against this virus. To overcome this obstacle, a number of unique tools have been prepared, such as molecular clones that are infectious in the chimpanzee animal model of infection, and the development of a subgenomic replicon system in Huh7 cells. In addition, the major non‐structural proteins have been crystallized, thus enabling rational drug design directed to these targets. Current developments in antiviral agents are reviewed in the context of these potential new viral targets for the future treatment of HCV in chronically infected individuals.

© 2002 Blackwell Publishing Asia Pty Ltd
Cholangiocarcinoma: Recent progress. Part 1: Epidemiology and etiology
Authors: Okuda Kunio , Nakanuma Yasuni , Miyazaki Masaru
Published: March 2003

An attempt is made in this review to update the reader on recent developments and progress in the study of cholangiocarcinoma: a major primary carcinoma of the liver with a very poor prognosis. Knowledge of the cell biology and physiological functions of the cholangiocyte has recently so progressed that our understanding of cholangiocarcinogenetic mechanism is expected to follow. The first part of the review deals with semantic problems, temporal changes in the incidence of cholangiocarcinoma and geographic differences in epidemiology, etiologic factors (particularly opistorchiasis in Thailand and hepatolithiasis in the Far East), and discusses a recently disclosed role of hepatitis C virus infection (30% of cholangiocarcinoma patients have antibodies against hepatitis C virus in Japan).
Clinical course, predictive factors and prognosis in patients with cirrhosis and type 1 hepatorenal syndrome treated with Terlipressin: A retrospective analysis
Authors: Colle Isabelle , Durand François , Pessione Fabienne , Rassiat Emmanuel , Bernuau Jacques , Barrière Eric , Lebrec Didier , Valla Dominique‐Charles , Moreau Richard
Published: March 2003

Abstract Background and Aim: Terlipressin has been proposed to treat renal failure in patients with type 1 hepatorenal syndrome (HRS). However, the predictive factors for improved renal function and survival are unknown in patients with type 1 HRS treated with terlipressin. The aim of the present retrospective study was to investigate the predictive factors and prognosis of patients with type 1 HRS treated with terlipressin.

Methods: The clinical charts of 18 consecutive patients with cirrhosis and type 1 HRS treated with terlipressin were studied. The predictive factors for improved renal function and survival were identified using univariate analyses.

Results: Improved renal function, indicated by a significant decrease in serum creatinine (61 ± 4%), occurred in 11 (60%) patients. The only predictive factor for improved renal function was a Child–Pugh's score ≤13 at the time of diagnosis of HRS (P
= 0.02). Fifteen patients (83%) died at 45 days and the median survival was 24 days. Of the three patients who survived, two underwent successful orthotopic liver transplantation. Three predictive factors for survival were identified: absence of a precipitating factor for HRS (P
= 0.012); improved renal function during terlipressin therapy (P
= 0.05); and a dose of terlipressin ≥3 mg/day (P = 0.04).

Conclusions: In patients with type 1 HRS treated with terlipressin, patients with improved renal function had less severe cirrhosis (Child–Pugh >10 but ≤13) than patients without. The predictive factors for survival were the absence of a precipitating factor for HRS, the terlipressin‐induced improvement in renal function and a dose of terlipressin of at least 3 mg/day. These findings suggest that a randomized controlled trial investigating the effect of terlipressin on survival in patients with type 1 HRS should be performed.

© 2002 Blackwell Publishing Asia Pty Ltd
Longer survival in female than male with hepatocellular carcinoma
Authors: DOHMEN KAZUFUMI , SHIGEMATSU HIROHISA , IRIE KOJI , ISHIBASHI HIROMI
Published: March 2003

Aim: There is a limited amount of data regarding the gender difference in the survival in cases of hepatocellular carcinoma (HCC). The aim of the present study was to investigate the difference in the survival between males and females with HCC and the possible factors affecting the gender difference of survival in HCC.

Methods: Analyses were performed based on 704 consecutive patients with HCC observed for 12 years between January 1989 and December 2000 at the Internal Medicine Department, Saga Prefectural Hospital Koseikan, who were retrospectively enrolled in the study. The 1‐, 3‐, 5‐ and 7‐year survivals and various factors at the detection of HCC were compared between 487 male and 217 female patients with HCC using the Kaplan‐Meier method, Mantel‐Cox test, chi squared test and Fisher's exact analysis.

Results: There was a significant difference in survival between male and female patients with a 1‐, 3‐, 5‐ and 7‐year survival estimate of 67.7, 40.6, 23.8 and 8.7%versus 73.5, 50.3, 26.3 and 15.4%, respectively (P‐value: 0.0167). Of the clinical variables examined, the significant factors related to gender difference were found to be age, tumor size, the number of tumors, the presence of portal thrombosis and the type of follow‐up. Of the patients with HCC lesions measuring 3 cm or less in the greatest dimension or those with solitary HCCs, however, there was no significant difference in survival between both sexes. The patients were divided into three categories: closely followed‐up group (regular periodic follow‐up with monthly alpha‐fetoprotein measurements plus ultrasonography at least every 4 months); a non‐closely followed‐up group; and an incidental group (incidentally discovered due to related symptoms). The detection rates of HCC through the closely followed‐up, non‐closely followed‐up and incidental groups were 19.3%, 46.2% and 34.5% in men and 28.1%, 46.5% and 25.4% in women, respectively, which reached a significant difference between both sexes (P‐value: 0.0097).

Conclusion: The survival of female cases of HCC was longer than that of male cases. Disparities in the type of follow‐up for women in comparison to men exist and may contribute to gender disparities in survival. Women with a high risk for HCC tended to be better cared for during the follow‐up. To reduce gender disparities in survival, efforts should be directed at the earlier identification of HCC.
Increasing incidence of Crohn's disease in Victorian children
Authors: PHAVICHITR NOPAORN , CAMERON DONALD J S , CATTO‐SMITH ANTHONYG
Published: March 2003

Background: The incidence of Crohn's disease has been increasing in Western communities, but there are no published studies which have examined this change in children in Australia. The centralization of pediatric gastroenterology services in Victoria provides an opportunity to examine these changes within one state.

Methods: We undertook a retrospective study over a 31‐year period of all children aged 16 years or less initially diagnosed with Crohn's disease at either the Royal Children's Hospital, or Monash Medical Center, Melbourne, Victoria.

Results: We identified 351 patients who met the diagnostic criteria between 1971 and 2001. The incidence of Crohn's disease in children aged 16 years or less rose from 0.128 to 2.0 per 100 000 per year over the three decades (r = 0.964, P < 0.01). There was a disproportionate over‐representation of children from an urban background (incidence rate ratio 1.66, 95% CI 1.28–2.16). Children currently being diagnosed had on average a lower erythrocyte sedimentation rate (ESR) and higher albumin than in previous decades. The use of flexible endoscopy has increased markedly (1970s: 60%; 1990s: 96%, P < 0.05) and the proportion of children recognized at diagnosis with upper gastrointestinal and colonic involvement has increased significantly.

Conclusion: There has been a significant increase in the incidence of Crohn's disease in Victorian children. The pattern of disease has also changed with colonic disease now more frequent, and inflammatory indices less abnormal. The increased use of endoscopy has established the frequent involvement of the upper gastrointestinal tract.
Sun protection behaviours and the predictors of sunburn in young children
Authors: MORRIS J , McGEE R , BANDARANAYAKE M
Published: March 2003

Objective:

To explore the use of sun protection behaviours and the experience of sunburn in a sample of parents and their children in New Zealand.

Methodology:

Information was collected from 887 parents using postal questionnaires at the beginning of and during the summer.

Results:

Thirty per cent of the parents believed their child looked healthier with a suntan, and 40% intended to let their child get a suntan during the summer. Predictors of intention to tan included level of parental education, the child’s age, the child’s sensitivity to burning and experience of sunburn in the parent. At the end of the summer period, 29% of the children were reported as being sunburned. Predictors of sunburn in the child were the age of the child, experience of sunburn in the parent and use of sunscreen SPF15+ by the parent.

Conclusion:

Despite intense media coverage of the dangers of overexposure to the sun, it is clear that a significant proportion of children are still getting sunburned.
DNA polymorphism analysis in transfusion‐associated graft‐versus‐host disease
Authors: Warren LJ , Simmer K , Roxby D , Grist S , Seshadri R , Morley A
Published: March 2003

Abstract: During cardiac surgery for transposition of the great arteries at age 7 weeks, a female infant received blood, fresh frozen plasma and platelet transfusions. Eleven days postoperatively, she developed bloody diarrhoea, fever, an erythematous macular rash, hepatomegaly, seizures and pancytopaenia. A clinical diagnosis of transfusion related graft‐versus‐host disease (GVHD) was supported by skin histopathology. DNA polymorphism studies confirmed that circulating lymphocytes in peripheral blood and infiltrating cells in the skin were foreign in origin and were derived from transfused blood cells. No underlying immunodeficiency was identified. Treatment with steroids, cyclosporin and antithymocyte globulin was unsuccessful and death occurred 2 months after surgery.

The features of fever, rash, diarrhoea, liver dysfunction and pancytopaenia which characterize GVHD may mimic drug reactions or viral infection. In addition to histological features on skin biopsy, DNA polymorphism studies on skin and blood samples provide a unique and sensitive method to confirm GVHD. Irradiation of blood products should be considered for acutely compromised infants requiring urgent cardiac surgery.
Transverse cerebellar diameter on cranial ultrasound scan in preterm neonates in an Australian population
Authors: Swaminathan M , Davies MW , Davis PG , Betheras FR
Published: March 2003

Objective: Fetal measurement of transverse cerebellar diameter (TCD) has been shown to correlate well with gestational age (GA), even in the presence of growth retardation. The aim of this study was to define the normal range of TCD in preterm neonates in an Australian population between 23 and 32 weeks GA.

Methodology: Infants admitted to the Royal Women’s Hospital, Melbourne, having routine cranial ultrasound scans (< 1500 g and/or of gestational age ≤ 32 weeks at birth) had their TCD measured on a cranial scan performed during the first 3 days of life. The posterior fossa was examined through the asterion using a General Electric LOGIQ 500 scanner (GE Medical Systems, Waukesha, USA) and TCD measurement was taken in the coronal plane.

Results: 106 infants < 1500 g and/or of GA ≤ 32 weeks at birth had their TCD measured between 1 January 1997 and 30 November 1997. Transverse cerebellar diameter and associated 95% confidence intervals are described for infants between 23 and 32 weeks GA. The linear regression equation relating TCD and GA was: TCD (mm) = –12.9 + 1.61 × GA (weeks). R2 = 0.80, P < 0.001.

Conclusion: This is the only study of TCD measurement using cranial ultrasound in a group of preterm newborns, and forms the basis for nomograms of TCD which can be used as a tool to assist in the assessment of GA, even in growth‐retarded preterm newborns, and in the diagnosis of cerebellar hypoplasia.
Classical galactosaemia in Chinese: A case report and review of disease incidence
Authors: Cheung KL , Tang NLS , Hsiao KJ , Law LK , Wong W , Ng PC , Pang CP , Applegarth DA , Fok TF , Hjelm NM
Published: March 2003

Abstract: We report a case of galactose‐1‐phosphate uridyl transferase (GALT) deficiency in a full‐term Chinese neonate, who presented with atypical biochemical features of hyperammonaemia in addition to the classical presenting features of jaundice and lethargy after feeding. Red cell GALT activity was virtually absent in the patient while 50% of normal activity was found in parents and a sibling. Mutation screening excluded both Q188R and N314D as the causative mutation in GALT gene, which suggested a possible genetic segregation among ethnic groups. Data from a Taiwan screening program suggested that the incidence of the disease was approximately 1 in 400 000 in the Chinese population which was a sixth of that in Caucasian populations.
Liquid ventilation
Authors: Davies MW
Published: March 2003

Abstract: Research on using liquid ventilation to provide artificial respiration in mammals has been ongoing since the 1960s. The development of inert perfluorocarbon (PFC) liquids with high oxygen and carbon dioxide solubility has made gas exchange with liquid ventilation possible. In 1991 the technique of partial liquid ventilation was introduced where PFC are instilled into the lungs whilst continuing with conventional mechanical ventilation. Partial liquid ventilation has been shown to improve gas exchange and lung function with decreased secondary lung injury, in animal models of acute lung injury and surfactant deficiency. It has been used in uncontrolled trials in preterm neonates, and preliminary results are available from a randomized controlled trial of partial liquid ventilation in paediatric acute respiratory distress syndrome. Perfluorocarbons can also be used to deliver drugs to the lungs, to lavage inflammatory exudate and debris from the lungs, and as an intrapulmonary X‐ray contrast medium. Many questions about partial liquid ventilation remain unanswered particularly with regard to the dose of PFC required, its ideal method of administration and the long‐term effects. Partial liquid ventilation promises to be an exciting new therapy for infants and children with a variety of respiratory problems. The technique requires ongoing research and experimentation.
Resurgence of measles in Singapore: Profile of hospital cases
Authors: Goh DLM , Chew FT , Khor SH , Lee BW
Published: March 2003

Objective: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program.

Methodology: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055.9) seen at the emergency unit or as inpatients were included.

Results: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty‐five per cent of the cases occurred between January 1997 and March 1998. There was a bi‐modal age distribution with peaks in the very young (≤ 18 months) and those aged 16–20 years. The majority was unvaccinated (58/87). A proportion (11/87) demonstrated vaccine failure, most likely primary failures.

Conclusions: This changing measles epidemiology suggests lowering of herd immunity. ‘Catch up’ vaccinations in July– October 1997 given to school children aged 12–18 years (200 000 individuals or 82% of cohort), may have helped contain the outbreak. These results substantiated the need for a two‐dose policy and ‘catch‐up’ immunization program.
Pre‐excitation syndrome secondary to cardiac rhabdomyomas in tuberous sclerosis
Authors: Mas C , Penny DJ , Menahem S
Published: March 2003

Abstract: Rhabdomyomas are not uncommon in infants with tuberous sclerosis. We describe a neonate who presented with hydrops fetalis arising from a tachyarrhythmia during fetal life related to rhabdomyomas. After reversion of the arrhythmia, pre‐excitation was noted on an interval electrocardiogram. Following regression of the tumours, the delta wave disappeared with no further arrhythmias noted.
Neutrophil functions of Chinese neonates
Authors: Wan Tsk , Yeung Cy , Tam Ayc
Published: March 2003

Objective: To delineate neutrophil function of preterm and full‐term neonates of Chinese origin.

Methods: Chinese neonates admitted to two major Hong Kong neonatal units were randomly selected for the study. Candidacidal activity, phagocytosis, chemotaxis and nitroblue tetrazolium reduction scores were evaluated from blood.

Results: Except for chemotactic activity, the neutrophil functions of Chinese preterm neonates were similar to Chinese full‐term neonates. The candidacidal activity of males was significantly lower when compared with female neonates. Compared with adult controls, both term and preterm infants had similar phagocytic activities although their candidacidal activities and chemotactic index were significantly decreased. Neutrophil function of Chinese infants was nearer to that of adult controls than historically reported for western infants.

Conclusion: Preterm Chinese neonates had similar neutrophil function to full‐term infants. Neutrophil function of Chinese infants was more mature than that of western infants.