bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary liver cancer in non‐cirrhotic liver. Epidemiological study based on autopsies performed in Trieste, Italy and Kurume, Japan
Authors: GIARELLI LUIGI , MELATO MAURO , ZANCONATI FABRIZIO , MUSSE MOHAMED MOALLIN , LAURINO LICIA , OKUDA KUNIO , KOJIRO MASAMICHI
Published: March 2008

This study, aimed at elucidating the epidemiological features of primary liver carcinoma developing in non‐cirrhotic livers, was based on 25 103 autopsies performed between 1975 and 1984 in Trieste, Italy. These autopsies correspond to approximately 70% of all deaths that occurred in this area. Various factors allegedly related to carcinomas were analysed in reference to our previous study on cirrhotic livers and in comparison with 5603 autopsies in Kurume, Japan. There were 28 cases of hepatocellular carcinoma (HCC), 16 of cholangiocellular carcinoma (CCC) not associated with cirrhosis in Trieste, and 48 HCC and 19 CCC in Kurume. On the basis of our findings, it was concluded that cirrhosis, regardless of its cause, is the main pathogenetic factor in HCC; it is responsible for a much higher frequency (14.2:1) than in non‐cirrhotic livers, as well as for early occurrence of tumours (an average of 6 years earlier in cirrhotic liver) in Trieste. Patients in Trieste were older than those in Japan, and the frequency of HCC among all autopsies was much greater in the latter.

By contrast, the influence of cirrhosis on cholangiocellular carcinoma (CCC) was negligible, as such association appeared purely coincidental or absent. The incidence of CCC among autopsies was greater in Japan. Our data on CCC were not sufficient to demonstrate any clear aetiopathogenetic association between this tumour and alcohol abuse and hepatitis B virus (HBV) infection, except for a possible aetiological role of gallstones. The frequency of CCC relative to HCC was greater in Trieste than in Japan; the incidence of HCC was much less in Trieste, whereas CCC was more frequent in Japan.
Effects of arachidonic acid metabolites and interleukin‐1 on platelet activating factor production by hepatic sinusoidal endothelial cells from mice
Authors: MIZOGUCHI YASUHIRO , ICHIKAWA YUZO , KIOKA KIYOHIDE , KAWADA NORIFUMI , KOBAYASHI KENZO , YAMAMOTO SUKEO
Published: March 2008

The effects of interleukin‐1 (IL‐1) and arachidonic acid metabolites, prostaglandin (PG) E1, leukotriene (LT) B4 and LTC4, on the amount of platelet activating factor (PAF) produced and released by mouse hepatic sinusoidal endothelial cells were investigated. When hepatic sinusoidal endothelial cells were incubated with 1 μg/mL of calcium ionophore (CaI) A23187, PAF production increased until 20 min after the start of incubation, but when the cells were incubated with PGE1 and CaI A23187, PAF production was significantly suppressed. On the other hand, when hepatic sinusoidal endothelial cells were incubated with IL‐1β, LTB4 or LTC4 alone, PAF production significantly increased compared with that of the cells incubated without these substances. However, when the cells were incubated with PGE1 alone or with IL‐1β, LTB4 or LTC4 and CaI A23187, these effects were not observed. These results indicated that PAF produced by hepatic sinusoidal endothelial cells is affected by IL‐1 and arachidonic acid metabolites, suggesting that immune and inflammatory reactions in these cells may be regulated by chemical mediators produced by the cells themselves.
High prevalence of antibody to hepatitis C virus in heavy drinkers with chronic liver diseases in Japan
Authors: SHIMIZU SATOSHI , KIYOSAWA KENDO , SODEYAMA TAKESHI , TANAKA EIJI , NAKANO MASAYUKI
Published: March 2008

To investigate the prevalence of antibody to hepatitis C virus (anti‐HCV) in heavy drinkers with liver disease in Japan, we tested serum samples from 113 heavy drinkers with liver disease and 121 without liver disease. All were negative for HBsAg with no history of blood transfusion. These subjects had consumed more than 80 g of ethanol daily for 5 years or more. Findings for anti‐HCV determined by recombinant immunoblot assay testing were positive in 14 (35.9%) of the 39 patients with liver cirrhosis, 14 (58.3%) of the 24 patients with hepatocellular carcinoma and in 8 (53.3%) of the 15 patients with chronic hepatitis. The anti‐HCV positive rate in the drinkers with these liver diseases was significantly higher than in those with such disorders as fatty liver (0/10), hepatic fibrosis (0/22), and alcoholic hepatitis (0/3), as well as in the alcoholics without liver disease (5/121, 4.2%). Considering histologic findings in the anti‐HCV positive cirrhotics, the occurrence of lymph follicle formation (71.4%), piecemeal necrosis (78.6%) and loose fibrosis (64.3%) were observed to a significantly higher extent than in cirrhotics who were negative for anti‐HCV. These findings suggest that advanced chronic liver disease among heavy drinkers in Japan, especially of hepatocellular carcinoma, is closely associated with HCV infection. In the livers of heavy drinkers who were positive for anti‐HCV, histologic findings indicated the possibility of viral infection.
Characterization of mucin in the hepatic bile of patients with intrahepatic pigment stones
Authors: YAMASAKI TORU , NAKAYAMA FUMIO , TAMURA SHINRI , ENDO MASAHIKO
Published: March 2008

To investigate the relationship between biliary mucin and ductular stone formation, mucin was isolated from hepatic bile using gel filtration on Sepharose CL‐4B. The bile was obtained from 14 patients with stones in various sites of the biliary tract. The hexose content in the excluded fraction was significantly higher in patients with intrahepatic ductular stones (68.7 ± 20.5μg/mL; mean ± s.d.) than in those with gall‐bladder stones or extrahepatic ductular stones (23.8 ± 8.1 μg/mL, 33.3 ± 9.5 μg/mL; P < 0.05), suggesting a higher concentration of mucin in the bile of patients with intrahepatic ductular stones. Ion‐exchange chromatography on DEAE‐Sephacel showed that most mucin from each material was negatively charged and electrophoretic studies indicated that it was composed mainly of high molecular weight (> 106), sulfated glycoprotein. These results suggested that the mucin content of hepatic bile might have an important relation to the development of intrahepatic ductular stones.
Verapamil decreases ethanol‐induced gastric acid secretion in rats
Authors: LYONS HERNANDO , LEUNG YING‐KIT , BAKRI AKIRUL , LEE PING‐CHEUNG , LEBENTHAL EMANUEL
Published: March 2008

The present study examined the effect of verapamil, a calcium channel blocker, on gastric acid secretion and circulating gastrin levels in rats after ethanol challenge. Normal saline or verapamil were given intraperitoneally to different groups of rats at 1 min, 1 h or 2 h before the administration of ethanol. One hour later, gastrin and gastric acid concentrations were determined. Regression analysis revealed the relationship between gastric acid output and serum gastrin levels in the group receiving saline intraperitoneally and ethanol orogastrically and the group receiving saline both intraperitoneally and orogastrically is similar. The slope of the regression line of the ethanol‐challenged group treated with verapamil, however, was significantly lower than the slopes of the other two groups (P < 0.001). Furthermore, verapamil decreased gastrin levels and acid output significantly in the ethanol‐challenged group (P < 0.01). When given 10 min prior to ethanol challenge, verapamil had a greater acid suppression effect than when given 60 or 120 min before the challenge. Verapamil at 20 mg/kg was more effective in acid secretion than at 10 mg/kg bodyweight, when administered 60 min before ethanol challenge.
The ion exchange properties of human post‐mortem caecal and colonic mucus: The effect of sodium butyrate
Authors: DUNCAN CHRISTINE E. , TASMAN‐JONES CLIFFORD
Published: March 2008

This study examined Na+/H+ ion exchange of caecal and colonic mucus. Two distinct Na+/H+ ion exchange populations of caecal mucus were identified, one group being a cation exchanger and the other an anion exchanger, suggesting that caecal mucus has ampholyte properties responsive to changing physical and chemical properties of luminal contents. Mucus from the colon was consistently an anionic exchanger—this may aid water and electrolyte absorption in the colon. When mucus was incubated with sodium butyrate, the Na+/H+ ion exchange properties of the mucus were decreased.
Gastrointestinal symptoms and masticatory dysfunction
Authors: MERCIER PAUL , POITRAS PIERRE
Published: March 2008

One hundred and forty‐two female patients consulting a prosthodontic clinic for masticatory disturbances and suffering from mandibular ridge atrophy were systematically interrogated for the presence of digestive symptoms. Eighty‐five subjects (60% of the studied population) reported current digestive complaints; 32 had abdominal pain (burning sensation, bloating or cramps), 12 presented stool transit alteration (constipation or diarrhoea) and 41 reported both abdominal pain and stool transit abnormalities. A prospective evaluation of the digestive symptoms was obtained following surgical reconstruction of the atrophic mandibular ridge and insertion of functional dental prostheses to correct masticatory dysfunction. One year after jaw surgery, 62 of 73 patients (85%) initially complaining of abdominal pain reported symptomatic improvement of their condition, while a marked amelioration in stool habits was noted in 34 of 53 patients (64%) initially suffering intestinal transit alteration. The high incidence of digestive complaints in our patients with dental deficits and the improvement of these symptoms after jaw reconstruction support a case for masticatory failure in the development of digestive symptoms.
Prevalence of anti‐HCV among Chinese patients with acute and chronic liver disease
Authors: LEE SHOU‐DONG , WANG YUAN‐JEN , LIN HAN‐CHIEH , WU JAW‐CHING , CHAN CHO‐YU , HUANG YI‐SHIN , TSAI YANG‐TE , LO KWANG‐JUEI
Published: March 2008

To assess whether the hepatitis C virus plays an important role in Chinese patients with acute and chronic liver disease, antibodies to HCV (anti‐HCV) were measured by enzyme immunoassay in 67 patients with type A and B acute viral hepatitis, 165 patients with non‐A, non‐B (NANB) hepatitis, 438 patients with chronic hepatitis, 200 patients with postnecrotic liver cirrhosis, 72 patients with alcoholic liver disease, 55 patients with non‐alcoholic fatty liver, 24 patients with toxic and drug‐induced hepatitis, and 20 patients with other chronic liver diseases. Anti‐HCV was not detected in sera from patients with type A and B acute viral hepatitis, toxic and drug‐induced hepatitis, primary biliary cirrhosis, Wilson's disease, or lupoid hepatitis. The anti‐HCV prevalence was found to be highest in patients with NANB hepatitis (59% in sporadic and 73.2% in transfusion‐associated), 16.4% in non‐alcoholic fatty liver, 5.6% in alcoholic liver disease, 6.8% in chronic hepatitis, and 16% in postnecrotic liver cirrhosis. In patients with chronic hepatitis, the anti‐HCV prevalence was significantly higher in HBsAg‐negative (15/34, 44.1%) than in HBsAg‐positive cases (15/404, 3.7%; P<0.0001). The results indicate that HCV is a major agent of NANB hepatitis and plays an important role in HBsAg‐negative chronic liver disease in Taiwan.
Prevalence of hepatitis C infection in Hong Kong
Authors: CHAN G. C. B. , LIM W. , YEOH E. K.
Published: March 2008

A study of a cross‐section of the Hong Kong Chinese population was done to investigate the seroprevalence of hepatitis C. Healthy subjects were random visitors of a health exhibition, while clinical subjects were recruited from an outpatient liver disease clinic, sexually transmitted disease clinics, dialysis centres and drug rehabilitation centres. A total of 910 subjects were tested. The assay kits were from Abbott and Ortho laboratories. Of the general population, 0.5% was found to be positive for antibody to hepatitis C (anti‐HCV). Suspected chronic non‐A non‐B patients, parenteral drug abusers and haemophiliacs shared a common high (up to 70%) prevalence of anti‐HCV. Sexual partners of index patients, homosexuals and female prostitutes as well as hepatitis B carriers had 0% prevalence. It was concluded that parenteral and blood product exposures were the two main risk factors for hepatitis C.
Anti‐HCV antibody in Chinese cirrhotic patients with or without hepatocellular carcinoma: Relation to multitransfusion
Authors: CHANG WEN‐YU , WANG LIANG‐YEN , CHUANG WAN‐LONG , CHEN SHINN‐CHERNG , LU SHENG‐NAN , YOU SAN‐LIN
Published: March 2008

To investigate the positive rates of antibodies to hepatitis C virus (anti‐HCV) in Chinese cirrhotic patients with or without hepatocellular carcinoma and to evaluate the influence of blood transfusion on the prevalence of anti‐HCV in such patients, a longitudinal study in 30 cirrhotic patients (17 combined with hepatocellular carcinoma) was carried out. Five patients (16.7%) were anti‐HCV positive before transfusion. The positive rate of anti‐HCV in HBsAg‐positive patients and HBsAg‐negative patients was 9.5% (2/21) and 33.3% (3/9), respectively. The positive rates in cirrhotic patients with or without hepatocellular carcinoma were 23.5% (4/17) and 7.7% (1/13), respectively. The positive rate of anti‐HCV increased significantly after multitransfusion, and the estimated infectivity of blood products was 6.1 patients per 1000 units of blood products. It was concluded that the aetiological role of hepatitis C virus on liver cirrhosis and hepatocellular carcinoma in the endemic area of hepatitis B virus is not so important as in Western countries, and transfusion might result in an overestimated pathogenic effect of hepatitis C virus in cirrhotic patients and patients with hepatocellular carcinoma.
A retrospective study on the patterns of sequential fluctuation of serum alpha‐fetoprotein level during progression from liver cirrhosis to hepatocellular carcinoma
Authors: IMAEDA TAKEYOSHI , DOI HIDETAKA
Published: March 2008

The patterns of sequential fluctuation of serum alpha‐fetoprotein levels were analysed in 218 patients with liver cirrhosis in whom the serum alpha‐fetoprotein levels were regularly and serially measured for more than 1 year.

In the group of patients with persistently abnormal high values (> 50 ng/mL) over a follow‐up period of more than 1 year, the incidence of the subsequent development of hepatocellular carcinoma was statistically and significantly higher (44%) compared to the other groups which showed normal (< 20 ng/mL) or low abnormal levels (21–50 ng/mL) (16%), and transient abnormal high levels (> 50 ng/mL for a period of less than 1 year, mostly within 5 months) or fluctuated repeatedly between normal and transient abnormal high levels (23%).

Hepatocellular carcinoma developed in 48 patients more than 2 years after the diagnosis of liver cirrhosis, and the fluctuating patterns of serum alpha‐fetoprotein levels were analysed in these patients.

The serum alpha‐fetoprotein levels in 10 of these 48 patients stayed below 50 ng/mL until about 2.0–10.0 months before the detection of hepatocellular carcinoma and then increased steadily until the time of hepatocellular carcinoma detection. In these 10 patients, the monthly increasing ratios were approximately 1.6–4.8 times the previous values.
Possible factors affecting the cholesterol nucleation time in human bile: A filtration study
Authors: KIYOSAWA RAITA , CHIJIIWA KAZUO , HIROTA ICHIO , NAKAYAMA FUMIO
Published: March 2008

This study examined the hypothesis that filtration through the MW 300 kD cut‐off membrane (XM‐300) may influence factors affecting the cholesterol nucleation time (the appearance time of cholesterol monohydrate crystal). Differences in biliary lipids, biliary protein, mucous glycoprotein and vesicular composition were examined before and after the XM‐300 filtration in control and cholesterol gallstone patients. The nucleation time in the cholesterol gallstone patients was significantly faster than that in the control patients. However, the nucleation time in the gallstone patients was significantly prolonged following the XM‐300 filtration resulting in a similar value to that of the control patients. No differences in concentrations of total protein, mucous glycoprotein or lipids composition were observed. The nucleation time did not correlate with the total lipid concentration, the concentrations of biliary mucous glycoprotein or total protein. The prolonged nucleation time of gallstone bile by the XM‐300 filtration was primarily ascribed to the removal of vesicles, which was confirmed by gel chromatography. It was concluded that vesicles greater than MW 300 kD are primarily responsible for the rapid nucleation time.
Evaluation of fibronectin as a marker of malignant ascites
Authors: SIDDIQUI R. A. , KOCHHAR R. , SINGH V. , RAJWANSHI A. , GOENKA M. K. , MEHTA S. K.
Published: March 2008

The aim of the study was to assess the accuracy of fibronectin, a glycoprotein, for the diagnosis of malignant ascites and to compare it with conventional parameters. Ascitic fluid samples from 50 patients, 25 with intra‐abdominal malignancy and 25 without it were analysed for total protein concentration, fluid/serum protein ratio, glucose concentration, leucocyte count, pH, fibronectin concentration (by ELISA) and for malignant cell cytology. Twenty‐two of the 25 patients with ascites and intra‐abdominal malignancy had documented peritoneal metastases in group A. The 25 patients with non‐malignant ascites constituted group B. Mean values of ascitic fluid fibronectin, for groups A and B were 538 ± 46μg/mL and 60 ± 4.92μg/mL, respectively (P<0.001). Within the group with malignant ascites, patients who had positive malignant cytology (n= 12) exhibited a significantly higher ascitic fluid fibronectin concentration than patients with negative cytology (P<0.05). While mean ascitic fluid protein concentration showed a significant difference (P<0.01) between the two groups, there was no difference in respect to ascitic fluid pH, glucose concentration and leucocyte count. Malignant cell cytology was positive in 54.5% of group A patients with no false positive report in group B. The diagnostic accuracy for differentiating malignant from non‐malignant ascites was 100% for a fibronectin value of ≥ 110 μg/mL as compared with 78.7% for ascitic fluid protein concentration ≥ 0.5 g/dL, 57.4% for leucocyte count ≥ 1000/mm3, 59.6% for pH < 7.45 and 78.7% for malignant cell cytology.
A prospective randomized double blind trial comparing prednisolone and 4‐aminosalicylic acid enemas in acute distal ulcerative colitis
Authors: SHARMA M. P. , DUPHARE H. V. , DASARATHY S.
Published: March 2008

A prospective double blind and randomized study was conducted to compare 4‐aminosalicylic acid (4‐ASA) and prednisolone‐21‐phosphate enemas in inducing remission in patients with acute distal ulcerative colitis. Patients with ulcerative colitis distal to the splenic flexure as assessed by flexible colonoscopy, barium enema and histology were included in the study. Of 40 consecutive patients, 20 were randomized to each of the two treatment groups. Clinical evaluation was done weekly; sigmoidoscopy and histology were performed at entry and at the end of 4 weeks. Therapy was discontinued in four patients treated with prednisolone enemas due to worsening of symptoms. The clinical improvement was significant in the remaining patients (P<0.001) and was similar in the two groups P > 0.1). Sigmoidoscopic and histological improvement were better with 4‐ASA than with prednisolone enemas. No adverse effects were observed in any of the patients treated. The present study suggests that 4‐ASA is a safe and effective treatment for inducing remission in acute distal ulcerative colitis.
Role of endogenous platelet‐activating factor in caerulein‐induced acute pancreatitis in rats: Protective effects of a PAF‐antagonist
Authors: FUJIMURA KAZUYO , KUBOTA YOSHITSUGU , OGURA MAMI , YAMAGUCHI TAKASHI , BINNAKA TAKESHI , TANI KAZUHIRO , KITAGAWA SHIN‐ICHI , MIZUNO TAKAKO , INOUE KYOICHI
Published: March 2008

The role of endogenous platelet‐activating factor (PAF) in the pathogenesis of acute pancreatitis was investigated by determining whether CV‐6209, a selective PAF‐antagonist, confers protection against caerulein‐induced acute pancreatitis in rats. Continuous intravenous infusion of caerulein (5 μg/kg x h) induced time‐dependent increase in serum pancreatic enzymes, pancreatic weight, and protein content of the pancreas, and produced histologic evidence of acute pancreatitis. Pretreatment with CV‐6209 (1 mg/kg) significantly inhibited the elevation of serum pancreatic enzymes, pancreatic weight, and protein content of the pancreas. Caerulein‐induced tissue oedema and recruitment of leucocytic cells were markedly ameliorated with CV‐6209. Platelet‐activating factor may be released endogenously and may play a role during acute pancreatitis.
Abdominal migraine: A cause of abdominal pain in adults?
Authors: LONG D. E. , JONES S. C. , BOYD N. , ROTHWELL J. , CLAYDEN A. D. , AXON A. T. R.
Published: March 2008

Eighty‐five patients with non‐organic abdominal pain, were interviewed with the help of a questionnaire. Those who responded to a high fibre diet were excluded from the study. Twenty‐seven patients had multiple pains and 58 described a single pain, which was intermittent in 39. A detailed analysis of the symptoms and family history of the latter group suggested that in 19 patients the symptoms might have been caused by abdominal migraine. Six of these 19 had typical migraine‐associated symptoms during the attack, characteristic abdominal pain and a family or personal history of classical migraine.

Abdominal migraine should be considered in patients with non‐organic abdominal pain where symptoms are not typical of irritable bowel syndrome and when organic disease has been excluded.
Selectivity of serum immunoreactive prolyl 4‐hydroxylase as a marker for hepatic necrosis
Authors: NAGAI YOSHIKI , KATO MASATOSHI , TODA GOTARO
Published: March 2008

To investigate the selectivity of serum immunoreactive prolyl 4‐hydroxylase (S‐IRPH) as a marker for hepatic necrosis, sera were taken from patients with hepatic inflammation and hepatic necrosis. The concentration of immunoreactive prolyl 4‐hydroxylase in the sera was determined by radio‐immunoassay, and S‐IRPH and alanine aminotransferase (ALT) data were plotted. Patients with hepatic necrosis showed mainly prolyl 4‐hydroxylase elevation while patients with inflammation had both prolyl 4‐hydroxylase and alanine aminotransferase elevations. The addition of serum immunoreactive prolyl 4‐hydroxylase to current serum markers would be useful in investigating the pathophysiology of hepatocellular damage, particularly in differentiating between hepatic necrosis and inflammation.
FK 506 associated disorders in liver transplantation
Authors: NAZER HISHAM , AL‐SABBAN ESSAM , HARFI HARB , ANTONIUS JOHN , CUNHA ANTONIO MARTINS DA
Published: March 2008

Immunosuppressive regimens are usually required for patients receiving organ transplants. The development of a post‐transplant lymphoproliferative disorder is an infrequent complication of such therapy. FK 506 is a new immunosuppres‐sant agent that has recently been used in patients receiving organ transplantation. This report describes a 20 month old Saudi child who developed post‐transplant lymphoproliferative disorder while receiving FK 506 following liver transplantation. Such a complication has been recognized with cyclosporine but has not been well addressed as yet with FK 506. The child also developed progressive renal complications. There was also a difficulty in interpreting the results for IgM antibodies to different viruses. The overall features of progressive renal toxicity and those of lymphadenopathy, hepatosplenomegaly, fever, neutropenia and thrombocytopenia reversed following discontinuation of FK 506 therapy. It is concluded that all the above complications, though reversible, may well be linked to the new immunosuppressant agent FK 506.
A defective autologous mixed lymphocyte reaction in patients with idiopathic portal hypertension
Authors: TOKUSHIGE KATSUTOSHI , KOMATSU TATSUJI , OHZU KYOKO , YAMAUCHI KATSUMI , OBATA HIROSHI
Published: March 2008

The aetiology of idiopathic portal hypertension or hepatoportal sclerosis is unknown. In view of the indirect evidence for underlying immunologic abnormalities 14 patients (all middle‐aged females) were studied. Various auto‐antibodies were demonstrated in seven patients and high levels of serum immunoglobulins, either IgG, IgM or IgA were present in ten patients.

T cell responsiveness to stimulation with either autologous or allogeneic non‐T cells was examined in nine of 14 idiopathic portal hypertension patients and compared with responsiveness in patients with posthepatitic cirrhosis and splenomegaly, and healthy controls. Patients with cirrhosis had levels of T cell responsiveness which were not significantly different from those in healthy controls in both autologous and allogeneic mixed lymphocyte reactions. A distinctly reduced autologous mixed lymphocyte reaction was observed in all idiopathic portal hypertension patients.

These data indicate that, like many other autoimmune diseases, abnormal serological features and impaired autoreactive T cell responsiveness exist in patients with idiopathic portal hypertension.
Presentation and role of peritoneoscopy in the diagnosis of tuberculous peritonitis
Authors: SANDIKÇI M. U. , COLAKOGLU S. , ERGUN Y. , UNAL S. , AKKIZ H. , SANDIKÇI S. , ZORLUDEMIR S.
Published: March 2008

This study represents the clinical and laboratory features of 135 tuberculous peritonitis cases in whom peritoneoscopic investigation was used routinely. Disease was more common in women than men (1.5:1) and was most frequently encountered in the third and fourth decades in life. The most common presenting symptoms were abdominal distension (96%), abdominal pain (82%), weight loss (80%), weakness (76%), loss of appetite (73%) and fever (69%). The most common physical findings were ascites (96%), fever (75%) and abdominal tenderness (43%). One hundred and twenty‐nine cases (95.5%) showed exudative type tuberculous peritonitis with variable amounts of ascites and filmy adhesions. In six patients (4.5%) the disease was of the plastic (dry) type. Peritoneoscopic investigations of 139 patients suggested tuberculous peritonitis but four cases showed histologically proven malignancy (3%). Laparoscopic diagnoses of the remaining cases were confirmed by histology (97%). The laparoscopic appearance of scattered yellowish‐white nodules, approximately 1–5 mm in size, on the peritoneal surfaces, and filmy adhesions were suggestive of tuberculous peritonitis. A non‐fatal colon perforation occurred as a major complication. After antituberculous therapy patients were followed for at least 1 year. Peritoneoscopy with simultaneous biopsy is the ideal and most accurate diagnostic modality in the diagnosis of tuberculous peritonitis.
Choledocholithiasis treated by ethylenediaminetetraacetic acid infusion through an endoscopic nasobiliary catheter
Authors: LIN XI‐ZHANG , LIN CHING‐YIH , CHANG TING‐TSUNG , SHIN JENG‐SHIANN , LIOU TAI‐CHERNG , CHANG KUO‐KWAN
Published: March 2008

A 64 year old man was admitted to the National Cheng Kung University Hospital for obstructive jaundice. He had received cholecystectomy 5 years previously. Sonography revealed common bile duct stones. He was treated with endoscopic nasobiliary drainage (ENBD) for 5 days for concomitant cholangitis. The muddy pigment stones disappeared completely after 10 days of infusion of ethylenediaminetetraacetic acid (EDTA) via the ENBD tube. There were no adverse effects, and he was stone‐free 4 months later.
Fulminant hepatic failure and acute intravascular haemolysis as presenting manifestations of Wilson's disease in young children
Authors: WALIA B. N. S. , SINGH S. , MARWAHA R. K. , BHUSNURMATH S. R. , DILAWAR J. B.
Published: March 2008

The cases of three young children (mean age 5.8 years) in whom fulminant hepatic failure and acute intravascular haemolysis were the presenting manifestations of Wilson's disease are reported. Although diagnosis was made ante‐mortem and chelation therapy instituted, the course was relentlessly fatal in all three cases. This presentation of Wilson's disease at such a young age is noteworthy.
Duplex‐Doppler assessment of cirrhosis in patients with chronic compensated liver disease
Authors: CIONI GIORGIO , D'ALIMONTE PIERO , CRISTANI ALESSANDRO , VENTURA PAOLO , ABBATI GIANLUCA , TINCANI ENRICO , ROMAGNOLI RENATO , VENTURA EZIO
Published: March 2008

Portal venous flow velocity (PFV) was measured with duplex‐Doppler equipment in 50 normal subjects and in 117 patients with suspected chronic liver disease who showed no evidence of decompensation such as ascites, hepatic encephalopathy, jaundice or oesophageal bleeding. All the patients underwent percutaneous liver biopsy which demonstrated non‐cirrhotic liver disease in 58 cases (CH‐patients: steatosis 8, persistent chronic hepatitis 8, active chronic hepatitis 42) and liver cirrhosis in the other 59 cases (LC‐patients).

The normal subjects and the CH‐patients had similar values of max‐PFV and mean‐PFV (max‐PFV 26.7±3.2 and 25.7±3.4 cm/s respectively; mean‐PFV 22.9±2.8 and 22.4±3.8 cm/s respectively). The LC‐patients’ values (max‐PFV 19.3±3.5; mean‐PFV 16.9±2.9) were significantly lower than those of the normal subjects (P<0.001) and of the CH‐patients (P<0.001). Considering the normal max‐PFV to be in the range 20–33.1 cm/s (mean±2 s.d. of the normal subjects, 95% confidence limits), max‐PFV was reduced in 0/50 normal subjects, 1/58 CH‐patients and 39/59 LC‐patients (66.1% sensitivity; 98.2% specificity).

In conclusion, the duplex‐Doppler measurement of PFV is of great interest in the diagnostic study of patients with suspected chronic compensated liver disease and in the early diagnosis of cirrhosis. A low max‐PFV is a reliable pointer to liver cirrhosis, whereas a normal max‐PFV indicates a non‐cirrhotic liver disease but is less probative. Each centre should standardize normal PFV values in order to establish their own threshold value for diagnosing liver cirrhosis.
Prevalence of hepatitis C virus antibodies in chronic liver disease and hepatocellular carcinoma patients in India
Authors: RAMESH RAJAGOPAL , MUNSHI ANUPAMA , PANDA SUBRAT K.
Published: March 2008

The prevalence of antibodies to hepatitis C virus (HCV) was investigated in 129 patients with chronic liver disease (85 with chronic active hepatitis and 44 with cirrhosis) and 53 patients with hepatocellular carcinoma. The commercially available second generation anti‐HCV enzyme immunoassay kit was used. Antibodies to hepatitis C virus were detected in 16.2% of the patients with chronic liver disease and in 15.1% with hepatocellular carcinoma. Of the HCV positive patients in all groups 51.7% were positive for hepatitis B virus (HBV) markers indicating present or past infection. Prevalence of HBV markers in all the three groups (CAH, cirrhosis and HCC) was higher as compared with anti‐HCV prevalence. These results suggest that HCV infection may not be a major cause of chronic liver disease and hepatocellular carcinoma in India and indicate the presence of other aetiological agents.
The interferon‐α2b gene in Japanese patients with chronic viral hepatitis who developed antibodies after treatment with recombinant interferon‐α2a
Authors: HOSOI HITOSHI , IMAI MITSUNOBU , YAMANAKA MASAMI
Published: March 2008

DNA was extracted from leucocytes of 23 Japanese patients with chronic viral hepatitis who received treatment with recombinant interferon‐α2a (IFN‐α2a) and nine healthy controls, as well as eight human cell lines of Caucasian or African origin. A part of the gene encoding IFN‐α2 was amplified by polymerase chain reaction and the sequence of nucleotides 1–231 was determined. Interferon‐α2a, ‐α2b and ‐α2c genes were tested for in five clones each from a patient or control, or a cell line, based on adenine or guanine at nucleotide positions 68 and 101. The IFN‐α2b gene was detected in all 160 clones from 23 Japanese patients and nine controls, but the IFN‐α2a or ‐α2c gene was not found in any. Of five cell lines derived from Caucasians, four exhibited only the IFN‐α2b gene, while the remaining one exhibited both IFN‐α2a and ‐α2b genes. Of three cell lines derived from Africans, one each showed only the IFN‐α2b or ‐α2c gene, and the remaining one both IFN‐α2b and ‐α2c genes. The 23 patients with the IFN‐α2b gene and chronic viral hepatitis included 10 who developed antibodies against IFN after treatment with recombinant IFN‐α2a. These results indicated a distinct geographical distribution of the three IFN‐α2 genes, and suggested the use of a recombinant IFN‐α2 preparation in agreement with the IFN‐α2 gene possessed by the recipient to avoid antibody responses.
Mono‐arthritis in a chronic hepatitis B patient after α‐interferon treatment
Authors: CHAN G. C. B. , LEE S. S. , YEOH E. K.
Published: March 2008

A 28 year old woman with hepatitis B (HB) related chronic active hepatitis was treated with a 12 week course of α‐interferon (α‐IFN). She developed acute mono‐arthritis 1 week after completion of treatment. Her rheumatoid factor (RF) was positive before α‐IFN and fell steadily during therapy. This was followed by a rebound of RF level with the associated arthritis occurring 1 week after completion of the course of α‐IFN. In absence of any medication RF gradually fell and became negative at the end of 1 year. This observation is thought to be related to the immunomodulatory effect of α‐IFN either directly on RF production or indirectly through the control of hepatitis.
BOOK REVIEW
Authors: MICHAEL GRACEY
Published: March 2008

Human Nutrition: A Continuing Debate Edited by M. Eastwood, C. Edwards and D. Parry.
Hepatitis C as the cause of chronic non‐A, non‐B hepatitis: High sensitivity of simultaneous measurement of core and non‐structural antibodies
Authors: LIN R. , YATUHASHI H. , YANO M. , FARRELL G. C.
Published: March 2008

First generation serologic tests (ELISA‐1) for hepatitis C virus infection measure antibodies directed against a short non‐structural segment of the virus (anti‐c100‐3). A major disadvantage of this test is that it lacks sensitivity in the identification of hepatitis C virus among patients at risk of infection. Thus, only 70–90% of chronic non‐A, non‐B cases are ELISA‐1 positive. The present study set out to determine whether antibodies directed against the core region would be a more sensitive indicator of hepatitis C virus infection in patients with chronic non‐A, non‐B hepatitis. Sera were studied from 97 patients with raised serum alanine aminotransferase levels for more than 6 months in whom other causes of abnormal alanine aminotransferase were excluded. Using ELISA‐1, 85 sera (87%) were anti‐c100‐3 positive. Sera were then tested for presence of antibody directed against Po, a core peptide of a Japanese strain of hepatitis C virus, using an ELISA method. Eighty‐eight sera (91%) were anti‐Po positive. Among the 12 anti‐c100‐3 negative patients, six were anti‐Po positive. A second generation ELISA for anti‐HCV (ELISA‐2) incorporates a different antibody to the core region (c22‐3) in addition to an expanded non‐structural region, c200, which consists of c100‐3 plus c33c. With these tests, all sera but one were positive, including 11 of 12 ELISA‐1 negative and eight of nine anti‐Po negative sera. It is concluded that most patients considered to have chronic non‐A, non‐B hepatitis on exclusion and risk factor criteria have one or more markers of hepatitis C virus infection. Individual antibody tests against core or non‐structural regions appear to have similar sensitivities (85–90%), but the results supplement each other. Thus, the sensitivity of a commercially available second generation ELISA test (which combines one core and two non‐structural antibodies) approached 100% in this study and represents a major advance in the diagnosis of hepatitis C.
Analysis of cost‐effectiveness of different strategies for hepatocellular carcinoma screening in hepatitis B virus carriers
Authors: KANG J. Y. , LEE T. P. , YAP I. , LUN K. C.
Published: March 2008

A mathematical model was used to calculate the efficacy of screening to detect hepatocellular carcinoma at a resectable stage in hepatitis B virus carriers. Data relating to tumour incidence, efficacy of screening tests and tumour growth times were obtained from a literature review. Various tests were costed according to charges currently prevailing at the authors’ institution. The cost per early tumour detected is inversely proportional to tumour incidence. It is relatively low for populations with high incidences of hepatocellular carcinoma for example, male carriers over the age of 30. Both the costs and the proportions of early tumour detected increase with increasing frequency of screening. However, the use of ultrasonography at 10 monthly intervals or both ultrasonography and α‐fetoprotein estimation at yearly intervals will detect 90% of tumours early at a cost of S$20 000 (US$11 800) per early tumour detected. The results would be significantly altered if tumour growth times were markedly different from those reported in the literature.
Hypoechoic lesions in the ‘bright liver': A reliable indicator of fatty change. A prospective study
Authors: CATURELLI E. , SQUILLANTE M. M. , ANDRIULLI A. , CEDRONE A. , CELLERINO C. , POMPILI M. , MANOJA E. R. , RAPACCINI G. L.
Published: March 2008

The accuracy of ultrasonographic diagnosis of hypoechoic focal fatty change in the ‘bright liver’ was evaluated in 40 lesions found in 35 patients followed up for a mean period of 37.8 months. Patients with ultrasound and laboratory findings suggesting liver cirrhosis were excluded from the study.

All patients underwent a blind liver biopsy in order to verify the diagnosis of diffuse disease suggested by the finding of ‘bright liver'. No guided biopsy was performed on the focal lesions in order to establish the accuracy of ultrasound alone in recognizing focal fatty change.

Clinical, haematologic and echographic follow‐up confirmed the diagnosis in all cases. All histological specimens revealed liver steatosis, indicating a 100% sensitivity of ultrasonography in identifying non‐cirrhotic fatty liver with an accompanying focal change.

Increased echogenicity and hypoechoic focal changes are reliable indicators of fatty infiltration, making ultrasonography an acceptable, non‐invasive method for the diagnosis of liver steatosis.
Effect of naloxone on the haemodynamics and the outcome of experimental acute pancreatitis in dogs
Authors: SHEN J. , HUANG M. K. , WU F. L. , TANG W. H. , ZAO H. Y. , ZHANG H. , LUO M.D.
Published: March 2008

Endogenous opioid peptides may play a role in the genesis of pancreatic damage in acute pancreatitis. The effects of naloxone on the haemodynamic changes in acute pancreatitis were investigated by inducing it in dogs with pancreatic ductal injection of fresh trypsin‐bile mixture. In the control group (n= 8), acute pancreatitis was characterized haemodynamically by falls in the maximum positive and negative dP/dt (dP/dt), cardiac output (CO) and cardiac index (CI), and increases in the pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR) as well as an early reduction of pancreatic blood flow (PBF). In another set of eight dogs (naloxone group), naloxone was given intravenously 10 min after the induction of acute pancreatitis (80 μg/kg as a bolus + 80 μg/kg/h for 3 h). Compared with untreated dogs, naloxone significantly increased PBF and the dP/dtmax; prevented the significant decreases in CO and CI and increases in PVR and SVR, and reduced significantly the severity of pancreatitis, as assessed by both the histological staging and the mortality rate. These results suggest that naloxone limits the progression of acute pancreatitis from oedematous to haemorrhagic form. It is proposed that endogenous opioid peptides may play a role in the pathophysiology of acute pancreatitis.
Perforated peptic ulcer in Hong Kong and New South Wales
Authors: LAM S. K. , BYTH K. , NG M. M. T. , HUI W. M. , MCINTOSH J. , PIPER D. W.
Published: March 2008

Direct comparisons of ulcer perforation rates and trends between countries have not been made in the past. Data on hospital admissions for perforated peptic ulcer during 1 January 1979 to 31 December 1985 were collected in Hong Kong (5868 perforations) and New South Wales, Australia (1669 perforations). Age and sex specific rates per 100 000 population were calculated. In Hong Kong, annual duodenal ulcer and gastric ulcer perforation rates were 13–16 and under two per 100 000 population respectively. In New South Wales, the corresponding rates were between three and four and under two per 100 000 population, respectively. The male : female ratios for duodenal ulcer perforation were consistently about 5 : 1 in Hong Kong and 2 : 1 in New South Wales, and for gastric ulcer perforation about 2 : 1 and 1 : 1, respectively. The incidence of perforation increased with age, and there was a statistically significant rise, over time, in duodenal but not gastric ulcer perforation rates in persons aged over 60 years in New South Wales; similar trends were seen in Hong Kong. Thus duodenal ulcer perforation occurs five times more commonly in Hong Kong than in New South Wales and this is largely accountable for by the higher rates of duodenal ulcer perforation in Chinese than in Australian males. Such geographical differences can best be explained by the occurrence of multiple aetiological mechanisms in ulcer perforation. Furthermore, there appears to be an increased susceptibility and an appreciable rising trend for duodenal ulcer perforation to occur in the elderly.
Plasma disappearance of homologous and heterologous pancreatic enzymes in dogs
Authors: HAYAKAWA T. , KONDO T. , SHIBATA T. , KITAGAWA M. , NARUSE S.
Published: March 2008

Homologous and heterologous (human) pure pancreatic juice was infused into dogs to compare the behaviour of pancreatic enzymes in the circulation. This was achieved by estimating the magnitude of elevation and speed of disappearance of pancreatic enzymes in plasma. The half‐lives of the plasma enzymes did not differ significantly between dogs and humans. However the half‐lives of other enzymes (longest for amylase and shortest for trypsinogen) did differ. The magnitude of elevation expressed as a ratio of peak (5 min) to basal level was greatest for trypsinogen (28 times) and least for amylase (1.4 times). However, 289% and 410% of the initial lipase enzyme activity was recovered 5 min after infusion of dog and human pure pancreatic juice, respectively (44% when measured by immunoreactive human lipase activity). The excess recovery requires re‐evaluation of diagnostic value of turbidimetric activity of plasma pancreatic lipase.
Structural abnormalities of the cricopharyngeus muscle in patients with pharyngeal (Zenker's) diverticulum
Authors: COOK I. J. , BLUMBERGS P. , CASH K. , JAMIESON G. G. , SHEARMAN D. J.
Published: March 2008

Recent manometric and radiological studies suggest that the upper oesophageal sphincter has poor compliance in patients with a pharyngeal (Zenker's) diverticulum. To test the hypothesis that this phenomenon is related to structural changes within the cricopharyngeus muscle we examined, histologically, muscle strips from 14 patients with a Zenker's diverticulum and compared them with control tissue obtained at autopsy from 10 non‐dysphagic individuals. The cricopharyngeus muscle from patients and controls differed from inferior constrictor muscle by virtue of type 1 fibre predominance and greater fibre size variability. Ragged red fibres and nemaline bodies are a normal finding in the cricopharyngeus. Marked differences were observed in the cricopharyngeus muscle of Zenker's patients which demonstrated fibro‐adipose tissue replacement and fibre degeneration. It is concluded that these structural changes may account for the observed diminished upper oesophageal sphincter opening and dysphagia in patients with Zenker's diverticulum.
Double‐blind comparison of omeprazole 20 mg om and ranitidine 300 mg NOCTE in duodenal ulcer: A Taiwan multi‐centre study
Authors: WANG C‐Y. , WANG T‐H. , LAI K‐H. , SIAUW C‐P. , CHEN P‐C. , YANG K‐C. , TSAI Y‐T. , SUNG J‐L.
Published: March 2008

Two hundred and twenty‐six patients with endoscopically confirmed duodenal ulcers of ? 5 mm in diameter entered a double‐blind randomized trial comparing 20 mg omeprazole administered once daily in the morning with 300 mg ranitidine administered once daily at night. The patients were assessed endoscopically and symptomatically after 2 weeks, and those whose ulcers had healed terminated the study. Patients with unhealed ulcers continued treatment for a total of 4 weeks. Omeprazole produced significantly higher healing rates than ranitidine at both 2 weeks (57 vs 28%, P < 0.0001) and 4 weeks (93 vs 80%, P= 0.006). Similarly, significantly higher ‘effective healing rates’ (defined on the criteria established by the Japanese Society of Digestive Endoscopy) were observed with omeprazole compared with ranitidine at 2 and 4 weeks. After 2 weeks, there were significantly fewer reports of both day‐time and night‐time epigastric pain by omeprazole‐treated patients compared with ranitidine‐treated patients (22 vs 44%, P < 0.0001 for day‐time pain; 24 vs 35%, P= 0.025 for night‐time pain). Both drugs were well‐tolerated and no major adverse effects were recorded during either treatment. In conclusion, 20 mg omeprazole administered once daily was superior to 300 mg ranitidine administered once daily for duodenal ulcer healing and symptom relief.
Protective effects of a prostaglandin E1 oligomer on taurocholate‐induced rat pancreatitis
Authors: SAKAI Y. , HAYAKAWA T. , KONDO T. , SHIBATA T. , KITAGAWA M. , SOBAJIMA H. , NARUSE S. , OHNISHI S. T.
Published: March 2008

Effects of prostaglandin E (PGE) on acute pancreatitis have been controversial. This study shows the effects of PGE1 oligomer, MR‐356, on trypsin‐taurocholate‐induced acute pancreatitis in rats. Divided intraperitoneal doses of 0.6 mg/rat were administered, which increased 24 h survival rates when the oligomer was given both at 1 h before and after (group A) and immediately and 3 h after (group B) induction of pancreatitis. In group A MR‐356 significantly improved the survival rates at 18 h (94 vs 61%, P < 0.05) and 24 h (68 vs 33%, P <0.05) when compared with controls. MR‐356 improved the survival rates dose‐dependently up to 0.6 mg/rat when given by the same protocol of group A. In group B MR‐356 also improved the survival rate (72 vs 39%, P < 0.05) only at 24 h, while other parameters failed to improve. The present results suggest that the PGE1 oligomer may play a beneficial role in bile‐induced pancreatitis, probably through its proposed effects of stabilization of lysosomal membranes, maintenance of microcirculation and inhibition of protease in the pancreas.