bluuebunny/crossref_metadata_2025 huggingface dataset:
Casualization of the nursing workforce: A New Zealand perspective on an international phenomenon
Authors: Richardson Sandra , Allen Jan
Published: March 2003

A discussion of the increased use of ‘casual’ nursing staff (those nurses employed on a casual or ‘per diem’ basis) is presented. Reference is made to related literature, together with consideration of the implications associated with this trend. This issue has international significance, with the increased use of casual staff being widely recognised. A New Zealand perspective is included, with the provision of nursing care at Christchurch Hospital presented to illustrate certain aspects of the discussion. The impact of changing health‐care systems and increased emphasis on efficiency and accountability are identified. This change to workplace practice will inevitably affect nursing; possible future developments are considered.
Concept analysis of expertise of occupational health nurses applying Rodgers’s evolutionary model
Authors: Naumanen‐Tuomela Paula
Published: March 2003

The purpose of this study was to clarify the concept of expertise among occupational health nurses. The material consisted of 24 research articles and one theory article published between 1983 and 1997. These were analysed using Rodgers’s concept analysis model. The analysis revealed that the surrogate term was authority, and the related concepts were specialist, professional, practitioner and generalist. The attributes of the concept of expertise were associated with roles, profession, position, title and functions. The antecedents of the expertise were identified as knowledge and skills, education, training, experience, personal characteristics and work‐related opportunities. The consequences of the expertise were economic and health benefits. Most commonly, the expertise of occupational health nurses referred to clients, workplaces and health‐care units. Changes in the concept of expertise were also examined and a definition of expertise formed. Concept clarification is necessary for the development of occupational health education, practice and theory building.
Predictors of cardiac patients’ psychophysiological responses to caregiving
Authors: Weiss Sandra J , Puntillo Kathleen
Published: March 2003

Patients who are hospitalized for treatment of cardiac problems are at risk from life‐threatening cardiovascular changes related to autonomic nervous system (ANS) arousal. Physical care during hospitalization can increase ANS arousal, yet caregiving is an essential feature of patient treatment. The purpose of this study was to identify the degree to which a patient’s vulnerability to sensory stimuli, perceptions of previous caregiving and stressful events during hospitalization may contribute to ANS arousal during caregiving. Fifty‐nine patients, who were hospitalized for treatment of coronary artery or valvular disease, received a standardized protocol designed to simulate aspects of physical caregiving. Heart rate, incidence of arrhythmias, blood pressure and state anxiety were measured during the protocol to determine ANS arousal. Regression analyses provided evidence that sensory vulnerability was the most consistent predictor across all indices of arousal during caregiving. Previous caregiving experiences that were perceived as ‘negative’ by the patient also contributed to higher blood pressure and anxiety. Stressful hospital events involving the family predicted higher blood pressure during caregiving.
Anxiety, depression and functional capacity in older women with mitral valve stenosis
Authors: Shuldham Caroline , Goodman Helen , Fleming Sharon , Tattersall Kirsty , Pryse‐Hawkins Hayley
Published: March 2003

Mitral valve stenosis can lead to a range of symptoms that affect daily life. As many of the people with this problem are elderly, the difficulties resulting from age can be exacerbated by illness. A pilot descriptive study was designed to examine the differences in anxiety, depression and functional capacity in women with mitral valve stenosis who were aged over 60 years when compared to a similar group of volunteers who did not have any cardiac disease. Measurement was undertaken using the Hospital Anxiety and Depression scale, the SF‐36 Health Status questionnaire and the Functional Limitations Profile. Forty women were recruited to the study: 20 women with mitral valve stenosis and 20 volunteers. Each person was asked to complete the three questionnaires on one occasion only. Non‐parametric statistics were used for analysis. Patients fared worse than volunteers with significant differences between groups in respect of anxiety (P = 0.03), depression (P = 0.02) and overall function (P < 0.001), but not in physical (P = 0.52) or mental health (P = 0.32). Future research could focus on strategies that would help alleviate anxiety and depression and improve functional capacity in older women with mitral valve stenosis.
Evaluation of two automatic sphygmomanometers in Hong Kong: Implications for the future development of automated blood pressure monitors in clinical practice
Authors: Yung Paul Mb , Lau Bernard Wk
Published: March 2003

The application of automated devices in measuring patients' blood pressure has been widely adopted in nursing practice. This study compared blood pressure recordings of two automated blood pressure monitors which were commonly used in clinical settings in Hong Kong. Single‐arm recordings were obtained from 31 subjects with both devices. Ten blood pressure recordings were obtained for each subject, with half of the subjects taking five measurements from one device first and five measurements from the other device second, and vice versa. A total of 155 sets of measurements were available for analysis. The results indicated that there was no significant difference in the variation of systolic, diastolic, mean arterial pressure and heart rate between these two devices. Implications for future research and development of an improved automated blood pressure device are made.
Development of an assessment sheet for home care
Authors: Shimanouchi Setsu , Uchida Emiko , Kamei Tomoko , Sasaki Akiko , Shinoda Michiko
Published: March 2003

Reliable assessment instruments are essential for a new nursing care insurance system enacted in April 2000 in Japan, to ensure the quality of home care. We developed an assessment sheet based on a minimum data set and care assessment, previously developed by the Japan Visiting Nursing Foundation. This article describes the process of testing in practice, validation and revision of the assessment sheet and problem/need areas. One hundred and twelve subjects were initially visited in 48 home care agencies. The same nurse used the assessment sheet for the same client at the initial visit and one month later. After a refinement process, the assessment items and problem/needs areas were simplified. Documentation time for the assessment was significantly shortened. These assessment instruments help development of care plans by identifying client needs, utilization of social resources and evaluation of outcomes.
Developing and testing the Nutritional Form For the Elderly
Authors: Söderhamn Ulrika , Söderhamn Olle
Published: March 2003

Undernutrition among elderly patients is a significant problem in nursing care. The aims of this study were to develop and test an instrument for identifying actual and potential undernutrition among elderly patients in clinical nursing care. A Likert‐type scale consisting of 15 items was constructed. A consecutive sample of 56 elderly patients (>65 years) in a geriatric rehabilitation ward in western Sweden were interviewed with the instrument. The data were mainly analysed with non‐parametric statistical methods. The results showed that the instrument was a fairly reliable scale with a Cronbach's alpha coefficient of 0.72. Evidence of validity concerning face validity, criterion‐related validity—including concurrent and predictive validity—and construct validity was shown in the study group. Further testing is required if the instrument is to be used in clinical nursing care and research.
Differential impacts of coping strategies on the mental health of Chinese nurses in hospitals in Hong Kong
Authors: Wong Daniel Fu Keung , Leung Sharon Shui King , So Christopher Kwok On
Published: March 2003

This study examined the types of coping strategies used by hospital nurses in Hong Kong. The impacts of these coping strategies on the mental health of nurses were also investigated. Results showed that coping strategies were both situation‐specific and culture‐specific, with direct action coping, acceptance and positive thinking used more frequently than avoidance and alcohol. It was found that more than one‐third of the nurses were considered to be at risk of developing poor mental health, and the most frequent symptomatic complaints included anxieties and feelings of inadequacy in handling daily activities. Nurses who were mentally healthy used more direct action coping and positive thinking, and fewer avoidance strategies and drinking than did nurses who were at risk of developing poor mental health. Contrary to our hypothesis, nurses who adopted more acceptance strategies had poorer mental health. Implications of the study are discussed.
Inequalities in health: Evaluation and effectiveness in practice
Authors: Lazenbatt Anne , Orr Jean , O'Neill Eileen
Published: March 2003

This paper details the findings from a project that assessed the contribution made by nurses, midwives and health visitors to targeting health and social need. This is an important theme within the Northern Ireland Regional Strategy entitled ‘Health and well‐being into the next millennium: a regional strategy for health and social well‐being 1997–2002’, which is concerned with addressing inequalities in health status and social well‐being. In response to this initial survey, the paper also highlights the second phase of the project that was the development of an evaluation manual specifically designed to assist health‐care practitioners in establishing evaluation frameworks and in applying evaluation techniques and methods. The paper describes four research case studies that are intended to illustrate the kinds of evaluation methods necessary to cover the stages of evaluation, needs assessment, structure, process and outcome, and to reflect the experience of applied evaluation as it occurs in practice as opposed to how it appears in textbooks.
Carbon cycle and climate change during the Cretaceous inferred from a biogeochemical carbon cycle model
Authors: Tajika Eiichi
Published: March 2003

The carbon cycle and climate change during the Cretaceous are reconstructed by using a carbon cycle model, and discussed. The model takes into account the effects of the enhanced magma eruption and organic carbon burial rates, both of which characterize the carbon cycle during the Cretaceous. The result for the CO2 variation is roughly consistent with the pattern of paleoclimate change inferred from the geological record. The CO2 level during the mid‐Cretaceous is estimated to be 4–5 times the present atmospheric level, corresponding to a surface temperature of 20–21°C. The warm, equable Cretaceous resulted from the effects of tectonic forcing such as enhanced CO2 degassing, although the enhanced organic carbon burial has a tendency to decrease the CO2 level. The organic carbon burial rate during the Cretaceous is generally larger than those for the Cenozoic, and is characterized by three major peaks (~ 1.5–1.8 times the present‐day value) corresponding to the major oceanic anoxic events. In the case for the extensive mantle plume degassing, although the CO2 levels are only 10% higher than those for the standard case during 120–100 Ma, the causes for the enhanced CO2 levels would be quite different. If the globally averaged surface temperature had increased due to paleogeographic forcing effects, the greenhouse effect of CO2 (and thus the CO2 level) should be lower than the values estimated for the standard case. If the CO2 levels are similar to, but the surface temperature is higher than, those for the standard case, either the parameter β (an influence of the Himalayas–Tibetan Plateau on the global weathering today) may be unreasonably large or the dependence of the silicate weathering rate on the CO2 partial pressure and the surface temperature should be much weaker than those previously proposed.
Petrology of the diamond‐grade eclogite in the Kokchetav Massif, northern Kazakhstan
Authors: Okamoto K. , Liou J. G. , Ogasawara Y.
Published: March 2003

Abstract The Kokchetav Massif of northern Kazakhstan is unique because of the abundant occurrence of microdiamond inclusions in garnet, zircon and clinopyroxene of metasediments. In order to determine precise pressure–temperature (P–T) conditions, we have systematically investigated mineral inclusions and the compositions of major silicates in Ti–clinohumite–garnet peridotite and diamond‐grade eclogite from Kumdy–Kol. It was found that garnet peridotites from Kumdy–Kol contain assemblages of garnet, olivine, Ti–clinohumite and ilmenite. The garnet contains inclusions that are indicative of both ultrahigh pressure (UHP) and retrograde conditions. Inclusions of hydrous phases such as chlorite, amphibole and zoisite were formed at the post‐UHP stage. The study also found that eclogite from Kumdy–Kol contains albite–augite symplectites after omphacitic pyroxene. The core of pyroxene (sodic augite) contains high K2O (up to 1wt%; average 0.24wt%). Phengite is included in the core. Applying the K2O‐in‐augite geobarometry, which is based on recent experiments, and the garnet–clinopyroxene (Grt–Cpx) geothermometer for peak metamorphism, the eclogites yield P–T estimates of > 6 GPa and > 1000 °C, and the diamond‐grade eclogites yield lower temperature estimates at 900–1000 °C and 5 GPa.
Non‐cirrhotic portal hypertension versus idiopathic portal hypertension
Authors: OKUDA KUNIO
Published: March 2003

Abstract  Portal hypertension occurs in a number of disorders other than cirrhosis and they are collectively called non‐cirrhotic portal hypertension (NCPH). The common causes of NCPH include idiopathic portal hypertension (IPH), non‐cirrhotic portal fibrosis (NCPF) and extrahepatic portal venous thrombosis (EHPVT). Other causes include schistosomiasis, hepatic venous outflow tract obstruction, veno‐occlusive disease and congenital hepatic fibrosis. Patients with IPH and EHPVT present with upper gastrointestinal bleeding, splenomegaly, ascites after gastrointestinal bleeding, features of hypersplenism, growth retardation and jaundice due to portal biliopathy. The diagnosis is usually made by abdominal ultrasound, upper gastrointestinal endoscopy, normal liver function tests and normal liver histology. Variceal bleeding in NCPH has lower mortality as compared with cirrhosis because of better liver functions in NCPH. Treatment for NCPH includes primary prophylaxis for variceal bleeding and prevention of repeat bleeding using drugs like β‐blockers, endoscopic sclerotherapy and endoscopic band ligation of varices. In patients with uncontrolled variceal bleeding or symptomatic hypersplenism, porto‐systemic shunt surgery or splenectomy are required.

© 2002 Blackwell Publishing Asia Pty Ltd
Combination and newer therapies for chronic hepatitis B
Authors: SCHALM SW , DE MAN RA , JANSSEN HLA
Published: March 2003

Abstract Worldwide the need for effective therapy for chronic hepatitis B is similar to that for chronic hepatitis C. Current licensed treatment for chronic hepatitis B (interferon (IFN)‐α, lamivudine) does not significantly alter the natural history of the disease because the frequency of sustained response is too low; however, a sustained response to antiviral therapy improves survival. Conversion of active chronic hepatitis B to the inactive hepatitis B carrier state (persistently HBeAg‐negative, HBV‐DNA < 105 copies/mL and alanine aminotransferase (ALT) normal) is the major therapeutic goal. If present 6–12 months after stopping treatment, a sustained response is assumed. Clinical benefit is also likely if HBV‐DNA levels < 105 copies/mL and ALT normality are being maintained long‐term by antiviral therapy. New drugs are adefovir, entecavir, and pegylated IFN. The two nucleoside analogs are active against lamivudine‐resistant hepatitis B and are as yet not associated with resistance. Peg‐IFN has higher efficacy than standard IFN; its tolerance is similar. Combination therapy appears most effective: IFN–lamivudine combination for induction of a sustained response, and lamivudine–adefovir for long‐term antiviral therapy. Uncertainty exists whether the additional effect outweighs the burden of adverse effects and cost. Chronic hepatitis B affects a rather heterogeneous patient population. Differentiation based on HBeAg status is fading with emergence of categorization based on disease stage and immune competence.

© 2002 Blackwell Publishing Asia Pty Ltd
Polyethylene glycol–interferon: Current status in hepatitis C virus therapy
Authors: WEDEMEYER HEINER , WIEGAND JOHANNES , CORNBERG MARKUS , MANNS MICHAEL P
Published: March 2003

Abstract  In chronic hepatitis C infection, combination therapy with interferon (IFN)‐α and ribavirin leads to sustained virological response rates of 40–45%. However, treatment outcome is still disappointing in patients infected with hepatitis C virus (HCV) genotype 1, high viral load or advanced liver fibrosis. Due to significant side‐effects of therapy, dose reductions and discontinuations of therapy are frequent and lead to further decreased response rates. The development of modified IFN is the latest step to improve treatment options for chronic hepatitis C. Conjugation of the polymer polyethylene glycol (PEG) to IFN extends half‐life in comparison to conventional IFN and thereby increases antiviral activity. It allows once‐weekly dosing and increases sustained response rates without changing the safety profile. The PEG–IFN monotherapy is twice as effective as IFN‐α three times weekly. The combination of PEG‐interferon and ribavirin improves the overall sustained response rates to 54–56% and represents the new standard therapy for patients with chronic hepatitis C infection in most patients.

© 2002 Blackwell Publishing Asia Pty Ltd
Non‐cirrhotic portal fibrosis
Authors: SARIN SK
Published: March 2003

Abstract Non‐cirrhotic portal hypertension (NCPH) comprises of diseases having an increase in portal pressure (PP) due to intraheptic or prehepatic lesions, in the absence of cirrhosis. The lesions are generally vascular, either in the portal vein, its branches or in the perisinusoidal area. Because the wedged hepatic venous pressure (WHVP) is near normal, measurement of intravariceal or intrasplenic pressure is needed to assess portal pressure. The majority of the diseases included in the category of NCPH are well characterized disease entities where portal hypertension (PHT) is a late manifestation and hence, these are not discussed. Two diseases which present only with features of PHT and are common in developing countries are NCPF and extra‐hepatic portal vein obstruction (EHPVO). Non‐cirrhotic portal fibrosis is a syndrome of obscure etiology, characterized by ‘Obliterative portovenopathy’ leading to PHT, massive splenomegaly, repeated well tolerated episodes of variceal bleeding and anemia in young adults from low socio‐economic strata of life. The hepatic parenchymal functions are nearly normal. Jaundice, ascites and hepatic encephalopathy are rare. Management of variceal bleeding remains the main concern as nearly 85% of patients with NCPF present with variceal bleeding. Endoscopic variceal ligation or sclerotherapy are equally effective in about 90–95% of the patients. Gastric varices are seen in about 25% patients and a bleed from them can be managed with cyanoacrylate glue injection or surgery. Other indications for surgery include failure of endoscopic therapy to control acute bleed and symptomatic hypersplenism. The prognosis of patients with NCPF is good and 5‐years survival rates in patients in whom variceal bleeding can be controlled is about > 95%.

© 2002 Blackwell Publishing Asia Pty Ltd
Copper metabolic defects and liver disease: Environmental aspects
Authors: PANKIT ANAND N , BHAVE SHEILA A
Published: March 2003

Abstract  Copper (Cu) is an essential trace element for many biological processes. Cu homeostasis is generally well maintained by inbuilt controls in intestinal absorption, biliary excretion and intrahepatic storage. Copper deficiency disorders are rare. Acute Cu toxicity occurs occasionally in accidental poisoning with Cu sulfate. Chronic Cu toxicity in the form of liver cirrhosis and damage to other organs is seen classically in Wilson's Disease (genetic abnormality of Cu metabolism) and in the presumed environmental disorder Indian Childhood Cirrhosis (ICC). The clinical, epidemiological and treatment aspects of ICC are described. The evidence linking ICC to environmental Cu is (i) greatly increased hepatic Cu; (ii) early introduction of Cu contaminated milk boiled or stored in brass vessels; (iii) dramatic decline in ICC throughout the country coincident with change in feeding vessels; and (iv) continued long‐term remission in d‐penicillamine‐treated patients after withdrawl of the drug. The nature and role of a second factor in the causation of ICC remains unclear, although a genetic predisposition is strongly suspected. Scattered reports of an ICC‐like illness from the West (Idiopathic Cu Toxicosis, Endemic Tyrolean Infantile Cirrhosis), suggest that different mechanisms (environmental, genetic or both) can lead to the same end stage liver disease—‘ecogenetic’ disorders.

© 2002 Blackwell Publishing Asia Pty Ltd
The role of aflatoxins and hepatitis viruses in the etiopathogenesis of hepatocellular carcinoma: A basis for primary prevention in Guinea–Conakry, West Africa
Authors: TURNER PAUL C , SYLLA ABDOULAYE , DIALLO MAMADOU S , CASTEGNARO JEAN‐JACQUES , HALL ANDREW J , WILD CHRISTOPHER P
Published: March 2003

Abstract  Aflatoxins and hepatitis B virus (HBV) are major risk factors for hepatocellular carcinoma (HCC) in South‐east Asia and Africa, parts of the world where this cancer is most prevalent. Exposure to both factors is endemic, occurring from early in life. There is evidence from both epidemiological studies and animal models that the two factors can act synergistically to increase the risk of HCC, but the underlying cellular and molecular mechanisms of interaction are as yet undefined. One possiblity suggested by studies in HBV transgenic mice is that chronic liver injury alters the expression of carcinogen metabolizing enzymes, thus modulating the level of binding of aflatoxin to DNA. Primary prevention of HCC in high incidence areas of the world should primarily be focused on provision of the safe, effective vaccine against HBV. However, measures to reduce the high levels of aflatoxin exposure, where chronic HBV infection is currently epidemic, would also significantly contribute to reducing HCC incidence. In Guinea–Conakry, West Africa, surveys of HBV infection and aflatoxin exposure have established baseline data for the implementation of a community‐based intervention study. This study will evaluate the effectiveness of improving the post‐harvest processing and storage of the groundnut crop, a major source of aflatoxins, using aflatoxin‐albumin adducts as the outcome measurement.

© 2002 Blackwell Publishing Asia Pty Ltd
CASE REPORT: Post‐biopsy liver cyst: A rare complication of liver biopsy
Authors: Poddar Ujjal , Chawla Yogesh , Dilawari Jang , Kataria Rajendra , Behera Arunanshu , Suri S
Published: March 2003

Liver biopsy rarely leads to complications in a non‐cirrhotic liver. We describe here a case of a biliary cyst of the liver that developed after a liver biopsy. It was successfully treated with surgery.
Non‐transferrin‐bound iron and hepatic dysfunction in African dietary iron overload
Authors: Mcnamara Lynne , Macphail A , Mandishona Eberhard , Bloom Peter , Paterson Alan , Rouault Tracey , Gordeuk Victor
Published: March 2003

Background: Circulating iron is normally bound to transferrin. Non‐transferrin‐bound iron (NTBI) has been described in most forms of iron overload, but has not been studied in African dietary iron overload. This abnormal iron fraction is probably toxic, but this has not been demonstrated.

Methods: High‐pressure liquid chromatography was used to assay serum NTBI in 25 black African subjects with iron overload documented by liver biopsy and in 170 relatives and neighbours. Levels of NTBI were correlated with indirect measures of iron status and conventional liver function tests.

Results: Non‐transferrin‐bound iron (> 2 μmol/L) was present in 43 people, 22 of patients of whom underwent liver biopsy and 21 relatives and neighbours. All but four of these had evidence of iron overload on the basis of either liver biopsy or elevated transferrin and serum ferritin concentrations. Among all 195 subjects, the presence of NTBI in serum was independently related to elevations in alanine and aspartate aminotransferase activity and bilirubin concentration. This relationship between serum NTBI and hepatic dysfunction was confirmed in the subgroup of 25 subjects with iron overload documented by liver biopsy. Non‐transferrin‐bound iron correlated significantly with elevations in alanine and aspartate aminotransferase activities after adjustment for hepatic iron grades, inflammation and diet.

Conclusions: Non‐transferrin‐bound iron was found to be commonly present in African patients with dietary iron overload and to correlate with transferrin saturation and serum ferritin concentration. The independent relationship between NTBI and elevated liver function tests suggests that it may be part of a pathway leading to hepatic injury.
Discovery of vitamin B12in the liver and its absorption factor in the stomach: A historical review
Authors: Okuda Kunio
Published: March 2003

This review describes the early chronological events in the pursuit of a treatment for pernicious anaemia, and the subsequent discovery of vitamin B12and the intrinsic factor. It details Castle’s experiments which established the theory of extrinsic and intrinsic factors as hemopoietic principles, and describes the studies on purification of the anti‐pernicious anaemia principle from liver tissue that terminated in the crystallization of vitamin B12and identification of its coenzyme forms. Biochemical purification and characterization of the intrinsic factor secreted by the gastric parietal cells, and two other vitamin B12proteins, R‐binder (transcobalamin I, haptocorrin), and transcobalamin II, are discussed in detail. The biochemical reactions in micro‐organisms and humans in which vitamin B12is involved are then briefly reviewed, and finally and briefly the immunological basis of pernicious anaemia is discussed.
Effect of ursodeoxycholic acid on autoimmune‐associated chronic hepatitis C
Authors: Nakamura Kimihide , Yoneda Masashi , Takamoto Shujiro , Nakade Yukiomi , Yokohama Shiro , Tamori Keisuke , Aso Kazunobu , Matui Tomoko , Sato Yoichi , Aoshima Masaru , Makino Isao
Published: March 2003

Background: Hypergammaglobulinaemia and various auto‐antibodies which are commonly seen in autoimmune hepatitis are also found in patients with chronic hepatitis C. We recently reported that ursodeoxycholic acid (UDCA) improved liver function tests and immunoserological markers in patients with type I autoimmune hepatitis. The aim of this study was to prospectively evaluate the efficacy of UDCA on autoimmune‐associated chronic hepatitis C.

Methods: Immunoglobulin G (IgG), anti‐nuclear antibodies (ANA) and anti‐smooth muscle antibodies (ASMA) were determined in 95 patients with chronic hepatitis C. All patients were positive for hepatitis C virus RNA. Autoimmune‐associated chronic hepatitis C (C‐AIH) was defined by elevated serum IgG level (≥ 2.0 g/dL) and high titres of ANA and/or ASMA (≥ 1 : 160). Nine (9%) of 95 patients were diagnosed as C‐AIH. All the C‐AIH patients and 30 of the remaining 86 chronic hepatitis C patients without autoimmune features (CHC) were treated with UDCA (600 mg/day) for 1 year.

Results: Autoimmune‐associated chronic hepatitis C patients included one man and eight women and their AIH scores, as defined by the International Autoimmune Hepatitis Group, were significantly higher than the CHC patients. Before UDCA therapy, there were no significant differences in aspartate aminotransferase (AST), alanine aminotransferase (ALT) and γ‐glutamyl transpeptidase (γ‐GTP) levels between C‐AIH and CHC patients. However, after 1 year UDCA therapy, AST, ALT and γ‐GTP were significantly lower in C‐AIH patients (P < 0.05) than in CHC patients. In C‐AIH, ANA titres in seven of nine patients and ASMA titres in five of seven patients were reduced after 1 year UDCA treatment.

Conclusions: These results suggest that UDCA is a useful therapeutic agent for autoimmune‐associated chronic hepatitis C.
Colonic tuberculosis: Clinical features, endoscopic appearance and management
Authors: Misra Sri Prakash , Misra Vatsala , Dwivedi Manisha , Gupta Suresh
Published: March 2003

Background: Although rare in the West, colonic tuberculosis is not an uncommon disease in developing countries. However, the clinical manifestations and radiological appearance of the disease are non‐specific. In recent years, colonoscopy has been found to be very useful in diagnosing patients with colonic tuberculosis.

Methods: Clinical features, colonoscopic findings, histology and response to treatment were recorded in 50 patients with colonic tuberculosis.

Results: Abdominal pain, fever, anorexia, weight loss and diarrhoea were the common symptoms. The colonoscopic features consisted of ulcers (92%), nodules (88%), deformed caecum and ileocecal valve (42%), strictures (25%), multiple fibrous bands (8%) and polypoid lesions (6%). Segmental tuberculosis and lesions simulating carcinoma were seen in 22 and 16% of patients, respectively. Histological examination of the colonic biopsy specimens showed well‐formed, non‐caseating granulomas in 18%, collection of loosely arranged epithelioid cells in 40% and chronic non‐specific inflammatory changes in 42% of the patients. Six patients needed surgical intervention. The other 44 patients responded well to anti‐tuberculous therapy and became asymptomatic.

Conclusions: It is concluded that colonoscopy is a useful method for diagnosing colonic tuberculosis. It is suggested that if the clinical picture and colonoscopic appearance are suggestive of tuberculosis and target biopsies reveal non‐caseating granulomas, a collection of loosely arranged epithelioid cells, or even non‐specific changes, then a therapeutic trial of anti‐tuberculous drugs should be given and continued if there is clinical improvement.
Anti‐neutrophil cytoplasmic antibodies in patients with chronic liver diseases: Prevalence, antigen specificity and predictive value for diagnosis of autoimmune liver disease
Authors: Lindgren Stefan , Nilsson Stefan , Nässberger Lennart , Verbaan Hans , Wieslander Jörgen ,   MEMBERS OF THE SWEDISH INTERNAL MEDICINE LIVER CLUB (SILK)
Published: March 2003

Background
: Anti‐neutrophil cytoplasmic antibodies (ANCA) against proteinase 3 are diagnostic of Wegener’s granulomatosis, but ANCA occur also in patients with other inflammatory disorders, such as ulcerative colitis, primary sclerosing cholangitis (PSC) and autoimmune hepatitis. As their predictive value for autoimmune liver disease remains unknown, we analysed the prevalence and antigen specificity of ANCA in patients with various chronic liver diseases (CLD).

Methods
: We studied sera from 100 patients with primary biliary cirrhosis (PBC), from 76 with PSC and from 279 with various CLD, consecutively drawn during a 5‐year period at the time of liver biopsy. The ANCA were detected by indirect immunofluorescence (IIF) while the antigen specificity was characterized by ELISA by using lactoferrin, neutrophil elastase, cathepsin G and BPI (bactericidal/permeability increasing protein) as antigens.

Results
: In PBC, ANCA were detected by IIF in 39 patients (39%). The antigen reactivity by ELISA was lactoferrin in seven, elastase in 15, BPI in 20 and cathepsin G in four patients. Four patients had reactivity against more than one antigen. In PSC, IIF demonstrated ANCA in 49 patients (65%). The antigen reactivity was lactoferrin in 17, elastase in 14, BPI in 20 and cathepsin G in four patients. Twelve patients showed reactivity against more than one antigen. In CLD, ANCA were observed in sera from 55 patients (20%). Nineteen of 45 patients (42%) with autoimmune liver disease were ANCA positive versus 36/234 (15%) with non‐autoimmune liver disease (P = 0.0002). Among IIF‐positive patients, antibody reactivity against lactoferrin was noted in 14, elastase in 28, BPI in 25 and cathepsin G in five patients. Twenty‐one patients had reactivity against more than one antigen. Elastase and BPI antibodies occurred more frequently in patients with autoimmune compared to non‐autoimmune liver disease (P < 0.01).

Conclusions
: Anti‐neutrophil cytoplasmic antibodies are prevalent in patients with chronic liver diseases, but although they occur more frequently in patients with autoimmune liver disease their specificity and sensitivity for autoimmune liver disease is low. The predominant antigens are lactoferrin, elastase and BPI, but the correlation between IIF findings and ELISA reactivity against these antigens is weak.
Role of mucosal blood flow: A conceptional review in gastric mucosal injury and protection
Authors: Kawano Sunao , Tsuji Shingo
Published: March 2003

The present article overviews the role of gastric mucosal blood flow (MBF) in gastric mucosal injury and protection. The MBF maintains the structure and function of the stomach and, thereby, is closely associated with the pathogenesis and the healing of gastrointestinal lesions. Gastric blood flow was regulated and modified by systemic and also local metabolic factors, such as prostaglandin, leukotrienes and other endogenous chemical mediators, in the mucosa. In the present article, we review the role of endothelin (ET) and nitric oxide (NO) in the development of gastric mucosal injury and protection via mucosal microcirculation. Endothelin‐1 was increased under various stressful conditions and caused microcirculatory disturbances resulting in mucosal injury. Inhibitors of NO aggravated mucosal injury induced by ethanol, which produced mucosal congestion. Thus, regionally disturbed gastric circulation is closely associated with the pathogenesis of ethanol‐ and non‐steroidal anti‐inflammatory drug‐induced gastric lesions. The endothelium‐derived vasoactive substances ET and NO regulate gastric mucosal microcirculation and an imbalance of endothelium‐derived factors may play an important pathophysiological role in the development of gastric lesions.
Clinical significance of urokinase‐type plasminogen activator activity in hepatocellular carcinoma
Authors: Itoh Takashi , Hayashi Yoshitake , Kanamaru Taichi , Morita Yasushi , Suzuki Satoshi , Wang Weiping , Zhou Li , Rui Jing‐An , Yamamoto Masahiro , Kuroda Yoshikazu , Itoh Hiroshi
Published: March 2003

Background and Methods
: The plasminogen activation system plays a crucial role in the process of cancer invasion and metastasis. To evaluate the most effective factor in the invasion, metastasis and prognosis of hepatocellular carcinoma (HCC), we examined urokinase‐type plasminogen activator (uPA), plasminogen activator inhibitor (PAI)‐1, PAI‐2 and uPA activity by enzyme‐linked immunosorbent assays (ELISA) in HCC tissues obtained from 46 patients. The results were compared with the patients’ clinicopathological features and prognoses.

Results
: Of the clinicopathological features, only histological portal involvement or intrahepatic metastasis, or both (INV), was significantly correlated to the disease‐free survival rates (DFS; P < 0.05). The levels of uPA, PAI‐1 and PAI‐2 antigens were significantly associated with INV and histological grade. The DFS was not different, however, between cases with uPA, PAI‐1 and PAI‐2 values above and below the median. The high levels of uPA activity were closely related to INV (P < 0.001), and the activity gradually raised histological grades (P < 0.0001). The DFS was significantly different between patients with uPA activity below and above the median (0.70 ng/mL; P = 0.0092); it was also significantly different between such patients without INV (P < 0.05).

Conclusions
: Urokinase‐type plasminogen activator activity may be the most sensitive factor affecting HCC invasion in the plasminogen activation system and a strong predictor for the recurrence of HCC. We suggest that cases with uPA activity of more than 0.70 ng/mL should be carefully followed up for possible HCC recurrence.
Late biliary tract complications after orthotopic liver transplantation: Diagnostic and therapeutic role of endoscopic retrograde cholangiopancreatography
Authors: Mosca Sandro , Militerno Giuseppe , Guardascione Maria Anna , Amitrano Lucio , Picciotto Francesco P , Cuomo Oreste
Published: March 2003

Background
: Biliary tract complications are frequent after orthotopic liver transplantation. Late biliary tract complications occurring after T‐tube removal mostly include stones and strictures which may be associated with sepsis and worsening of the liver function. Endoscopic retrograde cholangiopancreatography (ERCP) has a role in the diagnosis and therapy of these complications. The aim of our study was to report our experience of endoscopic diagnosis and treatment of late biliary tract complications in liver‐transplanted patients.

Methods and Results
: One hundred and thirty‐six adult liver‐transplanted patients have been followed since 1988. Seventeen patients (12.5%) needed a total of 30 ERCP because of evidence of clinical and/or biochemical cholestases: eight with biliary stricture; six with biliary stones; one with both stricture and stones; and two with normal ERCP findings. Interventional endoscopic procedures included 14 sphincterotomies, six stone removals, seven biliary balloon dilatations, seven biliary stent placements, 11 biliary stent replacements, seven nasobiliary catheter placements and one mechanical lithotripsy. No complications were seen. In all cases, ERCP was able to identify the location, entity and dimension of the late biliary tract complication, thus allowing a therapeutic strategy to be used. Two patients had medical cholestasis. Forty‐seven per cent of patients with late biliary tract complications could definitely be cured by ERCP alone. The ERCP improved the patients’ condition to allow subsequent surgery in five patients (33%).

Conclusions
: These results confirms that ERCP is a valuable diagnostic tool and should be considered as the first step in the non‐surgical management of late biliary tract complications after orthotopic liver transplantation.
Asian perspectives on viral hepatitis A
Authors: Lee Shou‐Dong
Published: March 2003

Abstract Recent decades have witnessed a marked decline in the prevalence of hepatitis A virus (HAV) infection in Asian populations, especially in children. This is attributable to general improvements in socio‐economic status and hygiene, which have, in turn, made a large population of young adults susceptible to the disease. The HAV infection rarely results in death and mortality is age‐dependent. According to previous reports, it may be more severe in persons with underlying chronic liver disease (CLD). Because most parts of Asia are areas of endemic hepatitis B and C virus infection, where chronic hepatitis B and C are the most important causes of CLD, it is therefore imperative for patients with CLD to be protected against HAV infection. Several studies have been conducted into the success of immunization against HAV in different risk groups. Given the increasing potential for HAV epidemics and the success and safety of the HAV vaccines, mass immunization against the infection seems possible and rational in Asia.
Non‐steroidal anti‐inflammatory drug toxicity in the upper gastrointestinal tract
Authors: Sung Jjy , Russell Ri , Yeomans N , Chan Fkl , Chen Sl , Fock Km , Goh Kl , Kullavanijaya P , Kimura K , Lau Cs , Louw J , Sollano J , Triadiafalopulos G , Xiao Sd , Brooks Peter
Published: March 2003

Abstract Non‐steroidal anti‐inflammatory drug (NSAID) toxicity in the upper gastrointestinal tract is the most common serious drug‐induced toxicity reported to drug regulatory authorities. In the last two decades, the rediscovery of H. pylori, development of potent ulcer‐healing drugs and specific Cox‐II inhibitors have opened new horizons in the management of NSAID toxicity. A Working Party composed of gastroenterologists and rheumatologists in the Asia‐Pacific region met in Cairns, Australia, in 1999 to review the literature and develop appropriate guidelines. Recommendations were made based on the latest existing evidence. The importance of clinical events as study endpoints was emphasized. While differences exist between NSAIDs and aspirin, most studies have shown that advanced age, history of peptic ulcer disease, serious concomitant illnesses and coprescription of NSAID/aspirin with anticoagulants and steroids are high risk factors. These patients should be considered for prophylactic anti‐ulcer therapy. Helicobacter pylori infection may aggravate the toxicity of NSAIDs and, in selected cases, should be treated before NSAID/aspirin is prescribed. Proton pump inhibitors and misoprostol are the most promising agents in preventing gastric and duodenal ulcers. When NSAID/aspirin needs to be continued in patients who develop an NSAID‐related ulcer, proton pump inhibitors offer the best healing effect. With the discovery of cyclo‐oxygenase isoforms (Cox‐I and Cox‐II), preferential and specific Cox‐II inhibitors have been developed. While early clinical data have suggested promising anti‐inflammatory effects and improved safety profile in the gastrointestinal tract, several key issues on long‐term safety remain unresolved. The use of potent anti‐ulcer therapy, treatment of H. pylori infection and the development of Cox‐II inhibitor will change the scenario of NSAID/aspirin‐related gastrointestinal toxicity in the next millennium.
Sequence‐motif analysis of 5′‐untranslated region of GB virus‐C in Japanese patients
Authors: Kanda Tatsuo , Yokosuka Osamu , Kawal Shigenobu , Imazeki Fumio , Saisho Hiromitsu
Published: March 2003

Background
: GB Virus C (GBV‐C) is considered to belong to the Flaviviridae; however, the structures of the N‐terminal end of its putative polyprotein are not well known. The internal ribosomal entry site (IRES) at the 5′‐untranslated region of GBV‐C and an initiating codon at nucleotides (nt) 552–554 have been proposed. We investigated the validity of this proposal.

Methods
: The 5′‐untranslated region of GBV‐C was amplified from serum samples of 17 Japanese patients. Polymerase chain reaction‐amplified products were directly sequenced and the obtained sequences were analysed by comparing them with the IRES structure of other viruses.

Results
: Fifteen of the 17 (88%) GBV‐C strains in our patients were classified as being Asian type. The box‐A‐like sequence (UUUC) and box‐B‐like sequence (AUCAUGG) observed in the IRES of picornaviruses were highly conserved in all the strains. Based on pair‐wise comparisons with the multiple alignment data, overall sequence divergence for the 5′‐terminus was 2.9–12%. When compared with the proposed secondary structure of the IRES model, the sequence divergences of the Asian‐type GBV‐C were higher at the regions of loop structures and lower at the regions of double‐stranded RNA. The AUG codons, except for the one located at nt 552–554, produced truncated polyproteins or were not in‐frame with the putative protein.

Conclusions
: Our examination of the sequence motif of GBV‐C supports the proposal that the GBV‐C has common structural motifs for IRES at its 5′‐untranslated region and the AUG codon at nt 552–554 may be an initiating codon.
Vasoactive intestinal polypeptide appears to be one of the mediators in misoprostol‐enhanced small intestinal transit in rats
Authors: Chang Full‐Young , Doong Ming‐Luen , Chen Tseng‐Shing , Lee Shou‐Dong , Wang Paulus S
Published: March 2003

Abstract Background and Aims: Prostaglandin analogs have the pharmacologic effect of speeding up small intestinal transit (SIT). It remains unknown whether some gut peptides also mediate this enhancement. We studied the effect of misoprostol on rat SIT and looked at the role of vasoactive intestinal polypeptide (VIP) release during its action.

Methods: A group of rats initially received oral misoprostol treatment of 1, 10, 50 and 100 μg/kg, respectively. By using orally fed charcoal as a motility marker, the SIT was assessed at 30 min following oral misoprostol treatment. Another group of rats received misoprostol as an intraperitoneal injection in similar doses to the group above. The small intestinal transit was computed for this group at 30 min following misoprostol injection via an instilled radiochromium motility marker that went through a previously placed intraduodenal catheter. The plasma VIP level was measured by using a radioimmunoassay kit.

Results: Neither charcoal evaluated transit nor the plasma VIP level was influenced by the lower doses of oral misoprostol treatment (1 and 10 μg/kg), whereas other doses enhanced SIT and diminished the plasma VIP level (P < 0.01). The similar effects on radiochromium computed SIT (P < 0.01) and plasma VIP levels were obtained in tubed rats following misoprostol intraperitoneal treatment. The SIT results correlated negatively with plasma VIP levels.

Conclusions: Enhanced SIT and diminished VIP levels are found in rats following misoprostol treatment. It appears that inhibited VIP release is one of the mechanisms in misoprostol‐enhanced SIT.
Helicobacter pylori infection among Japanese children
Authors: Kurosawa Michiko , Kikuchi Shogo , Inaba Yutaka , Ishibashi Teruo , Kobayashi Fumimune
Published: March 2003

Background

In Japan, there are few reports describing Helicobacter pylori infection among young children. The aim of the present study was to identify risk factors associated with H. pylori in school‐aged children.

Methods

Subjects were first–grade students of three elementary schools (n = 310) and second–grade students of a junior high school (n = 300). Personal information, such as student’s medical history, parent’s history, family size, sibshipsize and household pets, was collected from guardians using a questionnaire. Saliva samples and personal information were collected twice (1995 and 1996). By using the saliva samples, H. pylori IgG antibody was measured using a commercial kit. To analyze the risk factors for H. pylori infection, sex‐ and age‐adjusted odds ratios (OR) were calculated using a multiple logistic model.

Results

Among the children, factors related to Helicobacter antibody in saliva included spending a longer period of time in a nursery school or kindergarten (OR = 4.0) and a maternal history of stomach disease (OR = 2.8). Birth order (OR = 2.2), sleeping situation (OR = 2.3) and sibshipsize (OR = 1.6) were not factors that were significantly related to Helicobacter antibody in the saliva. Chewing food for the infant, family size, rooms in the household, sharing a bedroom during childhood, pets, a past history and a paternal history were not related to positivity.

Conclusions

The results indicate that transmission is person‐to‐person, mainly through close contact with other children and intrafamilial infection. Helicobacter pylori infection seems to occur frequently early in life, probably before 6 years of age.