bluuebunny/crossref_metadata_2025 huggingface dataset:
Comprehensive measurement of maternal satisfaction: The modified Mason Survey
Authors: Johnson Maree , Langdon Rachel , Yong Lian , Stewart Helen , Kelly Pauline
Published: March 2003

A three‐stage process was undertaken to identify and modify a tool that was capable of measuring the many aspects of maternal satisfaction relevant to Australian women. First, the scope of maternal satisfaction to be measured was defined by summarizing available literature and surveys purporting to measure maternal satisfaction (including surveys used in maternity services in New South Wales). The multidimensional nature of maternal satisfaction was confirmed, with 16 core aspects (common to the literature and local surveys) and nine additional unique aspects of maternal satisfaction being identified. Second, these core and additional aspects were used to examine the comprehensiveness of the Mason Survey, a survey recommended by the National Health and Medical Research Council of Australia for use in maternity services. Eighty‐eight per cent of the core and additional aspects (22/25) were found to be present in the Mason Survey. Third, an expert panel further modified the Mason Survey by removing items not applicable to the Australian context. The modified Mason Survey is a comprehensive measure of maternal satisfaction suitable for Australian women and capable of providing valuable information on the quality of services and future planning for maternity services.
Study of Queensland emergency department nurses’ actions and formal and informal procedures for clients who self‐harm
Authors: McAllister Margaret , Creedy Debra , Moyle Wendy , Farrugia Charles
Published: March 2003

Emergency department nurses are often required to assess and manage the needs of people who self‐harm. A survey of 352 nurses working within 23 major public and 14 major private emergency departments in Queensland, Australia, investigated the extent to which formal and informal procedures are available and the extent to which these procedures guide how nurses respond to clients who present with deliberate self‐harm. The Risk Assessment Questionnaire was developed and found that nurses are frequently called to respond to clients presenting because of deliberate self‐harm, but most have no formal training in this area. In some services there is a lack of formal and comprehensive procedures for assessment and treatment. Where procedures do exist, significant therapeutic areas related to assessment are not explored with clients. These findings have implications for continuing professional development activities, nursing education programs and clinical practice procedures.
Relationship between technological influences and caring attributes of Korean nurses
Authors: Noh Choon Hee , Arthur David , Sohng Kyeong Yae
Published: March 2003

With many well‐prepared nurse academics, a buoyant economy and an advanced health‐care system, it is timely that research addresses some of the features and characteristics of Korean nurses and communicates this to the English‐speaking world. This study focuses on Korean registered nurses and their views of themselves as carers in a modern technological environment. By collecting data from a sample of 560 registered nurses and using an instrument previously administered in an international sample, comparisons to normative data are presented and contrasted to recent reports. The instrument uses Likert items to measure caring attributes and technological influences. The results show that older, more experienced and more qualified Korean nurses tend to report significantly higher scores for caring attributes, yet approximately 80% of the sample were aged less than 30, 70% were unmarried, 70% had less than 6 years experience and 60% were diploma prepared. These results are discussed in the light of normative findings from the international study and, in the context of this unique homogeneous cultural sample, concern is expressed about the lack of senior role models and the apparent drain of senior professionals.
Evaluation of the extended role of the midwife: the voices of midwives
Authors: Watson Jennifer , Turnbull Bev , Mills Annie
Published: March 2003

It is not uncommon for midwives in Australian hospitals to order and interpret tests and initiate medications. The National Health and Medical Research Council only formally acknowledged these practices through recommendations in 1998. Successful extension of the midwife's role is assumed to be advantageous to the health‐care system in its ability to satisfy consumer demand for a less medicalized experience and to be cost effective. This paper presents the results of the first phase of a three‐phase fourth generation evaluation of the extended role of the midwife in two acute care settings in the Northern Territory, Australia. The results suggest that recognition of the extended role of the midwife has the potential to deliver high level continuous midwifery care to women, to increase work satisfaction for the midwives and to enhance professional autonomy and responsibility in the workplace. However, when compared with their counterparts in the United Kingdom and New Zealand, midwives in Australia continue to practice with considerable limitations placed on their autonomy.
Nursing discharge summaries of deceased patients with respiratory diseases
Authors: Akazawa Yoko , Satoh Hiroaki , Takiguchi Kazuyo , Yamashita Yuko T , Sekizawa Kiyohisa
Published: March 2003

To explore how nurses feel about deceased patients and end‐of‐life care, the nursing discharge summaries of 115 sequential patients who died in the respiratory division of a Japanese university hospital were reviewed. When compared to discharge summaries of patients with non‐malignant illness, a significantly higher percentage of discharge summaries of those with malignant illnesses documented support from family members (P = 0.0166), patient's hope for cure (P = 0.0206), and patient anxiety (P = 0.0258). As difficult situations stay with nurses as memories, it is important for both new graduates and skilled nurses to document their feelings in difficult clinical situations.
Nurses’ influence on quality of care in postoperative pain management: A phenomenological study
Authors: Söderhamn Olle , Idvall Ewa
Published: March 2003

The aims of this study were to describe a group of nurses’ influence on the quality of care in postoperative pain management and to elucidate the meaning of exercising this influence. Fifteen protocols, written by experienced clinical nurses, describing complex postoperative pain situations where the nurses’ actions influenced the outcome were analysed by using two different phenomenological methods. The results showed that the general meaning structure of the nurses’ influence on the quality of care in postoperative pain management consisted of (i) the nurses’ perception of an unsatisfactory situation concerning the pain management of the surgical patients; (ii) that the nurses personally intervened; and (iii) that they changed the outcome of the situation in a positive direction. The meaning of exercising this influence was interpreted as an aspiration to relieve the patients from their suffering by exercising professional skills and knowledge in a creative, problem‐solving, caring process.
Diachronous evolution of sub‐Himalayan piggyback basins, Nepal
Authors: Kimura Kazuo
Published: March 2003

The geomorphology and related geostructures in the region of the dun valleys in Nepal (e.g. the Deukhuri Dun, the Chitwan Dun, the Hetauda Dun and the Trijuga Dun) have been surveyed in order to understand the neotectonics along the Himalayan front. The sub‐Himalayan intermontane basins developed as piggyback basins located on the thrust‐sheet of the Himalaya Front Fault (HFF equivalent to the Frontal Churia Thrust, the Main Siwalik Thrust or the Main Frontal Thrust). Each piggyback basin is a result of the north‐northeast–south‐southwest crustal shortening between the Indian Shield and the Himalayas. The evolution of the dun valleys is recorded as current reversals between the Upper Siwalik Group and the basin fills. The Upper Siwalik Group formed as piedmont alluvial fans distributed along the foot of the Lesser Himalaya and/or the Inner Churia Range, and show predominantly southerly current directions. In contrast, the basin fills distributed along the southern margin of the dun valleys formed by north‐flowing drainage systems. The oldest basin fills of the piggyback basins appear to have commenced by the middle Pleistocene in the Deukhuri Dun and the Chitwan Dun, by the late Pleistocene in the Hetauda Dun, and by the latest Pleistocene in the Trijuga Dun. The diachronous evolution of the dun valleys suggest that the morphogenesis of the HFF zone was controlled by west‐to‐east propagation in late Quaternary time. These morphotectonics suggest the oblique‐slip thrusting of the HFF zone which can be related to the oblique convergence between the Indian Shield and the Himalayas, and/or the counter‐clockwise rotation of the Indian Subcontinent.
Rb–Sr and Sm–Nd isotopic studies of mafic igneous rocks from the Ryoke plutono‐metamorphic belt in the Setouchi area, Southwest Japan: implications for the genesis and thermal history
Authors: Okano Osamu , Sato Takeharu , Kagami Hiroo
Published: March 2003

Abstract Rb–Sr and Sm–Nd isochron ages were determined for whole rocks and mineral separates of hornblende‐gabbros and related metadiabases and quartz‐diorite from Shodoshima, Awashima and Kajishima islands in the Ryoke plutono‐metamorphic belt of the Setouchi area, Southwest Japan. The Rb–Sr and Sm–Nd whole‐rock‐mineral isochron ages for six samples range from 75 to 110 Ma and 200–220 Ma, respectively. The former ages are comparable with the Rb–Sr whole‐rock isochron ages reported from neighboring Ryoke granitic rocks and are thus due to thermal metamorphism caused by the granitic intrusions. On the contrary, the older ages suggest the time of formation of the gabbroic and related rocks. The initial 87Sr/86Sr and 143Nd/144Nd ratios of the gabbroic rocks (0.7070–0.7078 and 0.51217–0.51231 at 210 Ma, respectively) are comparable with those of neighboring late Cretaceous granites and lower crustal granulite xenoliths from Cenozoic andesites in this region. Because the gabbroic rocks are considered to be fragments of the lower crustal materials interlayered in the granulitic lower crust, their isotopic signature has been inherited from an enriched mantle source or, less likely, acquired through interaction with the lower crustal materials. The Sr and Nd isotopic and petrologic evidence leads to a plausible conclusion that the gabbroic rocks have formed as cumulates from hydrous mafic magmas of light rare earth element‐rich (Sm/Nd < 0.233) and enriched isotopic (ɛSr > 0 and ɛNd < 0) signature, which possibly generated around 220–200 Ma by partial melting of an upper mantle. We further conclude that they are fragments of refractory material from the lower crust caught up as xenoblocks by granitic magmas, the latter having been generated by partial melting of granulitic lower crustal material around 100 Ma.
Geochronological characterization and petrogenesis of granitoids in the Ryoke belt, Southwest Japan Arc: constraints from K–Ar, Rb–Sr and Sm‐Nd systematics
Authors: Yuhara Masaki , Kagami Hiroo , Nagao Keisuke
Published: March 2003

Abstract Rb–Sr and K–Ar chronological studies were carried out on granitic and metamorphic rocks in the Ina, Awaji Island and eastern Sanuki districts, Southwest Japan to investigate the timing of intrusion of the granitoids in the Ryoke belt. Intrusions of ‘younger’ Ryoke granitic magmas took place in the Ina district between 120 Ma and 70 Ma, and cooling began immediately after the emplacement of the youngest granitic bodies. Igneous activity in Awaji Island was initiated at 100 Ma and continued to 75 Ma. Along‐arc variations of Rb–Sr whole‐rock isochron ages suggest that magmatism began everywhere in the Ryoke and San‐yo belts at almost the same time (ca 120 Ma). The last magmatism took place in the eastern part of both belts. Rb–Sr and K–Ar mineral ages for the granitoids young eastwards. The age data suggest that the Ryoke belt was uplifted just after the termination of igneous activity. Initial Sr and Nd isotopic ratios for the Ryoke granitoids indicate that most were derived from magmas produced in the lower crust and/or upper mantle with uniform Sr and Nd isotopic compositions. Several granitoids, however, exhibit evidence of assimilation of Ryoke metamorphic rocks or older Precambrian crustal rocks beneath the Ryoke belt.
Shuffled‐cards structure and different P/T conditions in the Sanbagawa metamorphic belt, Sakuma‐Tenryu area, central Japan
Authors: Tagiri Michio , Yago Yoshiaki , Tanaka Atsushi
Published: March 2003

The Sanbagawa metamorphic terrain of the study area is divided into two units, the Shirakura and Sejiri units. The metamorphic thermal structure is interpreted on the basis of the degree of graphitization (GD) of carbonaceous material in pelitic schists. The areal variations of the metamorphic grade are presented by the distribution of GD calculated using the Lc and d002 of carbonaceous material. As a result, the two units are classified into four metamorphic zones, respectively: A1, A2, B1 and B2 for the Shirakura Unit; and I1, I2, II1 and II2 for the Sejiri Unit. The metamorphic grades of A1, A2, I1 and I2 are included in the chlorite zone, and that of B1, B2, II1 and II2 in the garnet zone of the Sanbagawa metamorphism. The degree of graphitization at the boundary between A2 and B1 zones is the same as that between I2 and II1 zones. Detailed study on the variation of GD suggests that the present‐day structure of the study area is best interpreted as a model of shuffled‐cards structure. An estimated minimum thickness of a stack of continuous cards is about 25 m. The compositions of garnet in pelitic schists and of amphibole in basic schists are different from those in the identical metamorphic range of the Shirakura and Sejiri units. It is suggested that rocks of the Shirakura Unit were metamorphosed under higher P/T conditions than those of the Sejiri Unit.
Management of hepatic encephalopathy
Authors: KIRCHEIS GERALD , HÄUSSINGER DIETER
Published: March 2003

Abstract  Hepatic encephalopathy (HE) is seen as a clinical manifestation of low grade chronic cerebral edema, which is accompanied by alterations in glioneural communication. Different factors such as ammonia, inflammatory cytokines, benzodiazepines and electrolyte imbalances may precipitate or aggravate glia edema, thereby explaining precipitation of HE episodes by a variety of unrelated factors. Recognition and rigorous treatment of these precipitating factors is the most important measure in HE therapy which may be augmented by dietary and medical approaches. Among these approaches, evidence for proven therapeutical efficacy in HE on the basis of placebo‐controlled trials is existing only for transplantation, protein restriction, administration of vegetable proteins, ornithine‐aspartate, oral branched‐chain amino acid treatment as well as lactulose enemas. The efficacy of oral lactulose has not been demonstrated on the basis of placebo‐controlled trials.

© 2002 Blackwell Publishing Asia Pty Ltd
Molecular adsorbent recirculating system: Albumin dialysis‐based extracorporeal liver assist device
Authors: KAPOOR DHARMESH
Published: March 2003

Abstract  Extracorporeal liver assist devices have been used for more than five decades to support patients with liver failure. Numerous modifications have been made to both biological as well as mechanical liver assist devices. Possibly, an ideal liver assist device would be one that would perform optimal detoxification and synthetic functions of the liver, be simple to set up and yet be cost‐effective. An albumin dialysis‐based device that uses a hybrid albumin‐impregnated membrane to get rid of albumin‐bound toxins that circulate in abundance in liver failure, called the molecular adsorbent recirculating system (MARS) has been in clinical use for nearly four years now. Results with the use of this device in both acute and acute‐on‐chronic liver failure have shown consistent improvement in biochemical profile, resolution of encephalopathy, correction in hemodynamics, reduction in intracranial pressure and some improvement in the synthetic function of the liver. In a number of studies, albeit of small sample size, survival advantage has also been observed. The timing of initiation of therapy with MARS, duration of treatment, frequency of sessions and ‘maintenance therapy’ are still some of the unresolved issues with the use of this device. Large multicentric trials on the use of this technique are expected to throw light on these issues and help optimize the potential of this liver assist device.

© 2002 Blackwell Publishing Asia Pty Ltd
Hepatocyte transplantation
Authors: GUPTA SANJEEV
Published: March 2003

Summary Repopulation of the liver with transplanted cells holds significant promise for developing novel therapies. The liver is a most suitable target for treating a variety of genetic, metabolic and acquired diseases. Liver disease, such as chronic viral hepatitis, constitutes an enormous burden worldwide. Advancing liver cell therapy requires insights into mechanisms of cell engraftment and proliferation, as well as unique requirements of specific diseases for correction by cell transplantation. This review highlights recent developments in the area of hepatocyte transplantation. Aspects concerning modulation of cell engraftment, regulation of gene expression and proliferation of transplanted cells are discussed. Other issues concern the current status of clinical applications of hepatocyte transplantation, as well as novel sources of cells that could benefit cell therapy in the future. The general conclusion is that cell therapy has become more practical in recent years and insights into how the normal liver and the diseased liver can be repopulated will offer effective ways to treat many disorders in the near future.

© 2002 Blackwell Publishing Asia Pty Ltd
Endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleed: Preliminary report of a randomized controlled trial
Authors: De Binay , Ghoshal Udaym , Das Tapas , Santra Amal , Biswas Pranab
Published: March 2003

Background: Prevention of variceal bleeding, a major cause of morbidity and mortality, is an important goal in the management of patients with portal hypertension (PHT). Although propranolol has been found useful in preventing the first episode of variceal bleeding (primary prophylaxis) in cirrhotic PHT, it has limitations which include side effects, contraindications, non‐compliance and failure in some patients. Endoscopic variceal ligation (EVL) has not been used for primary prophylaxis.

Methods: Thirty cirrhotic patients with PHT, grade III to IV oesophageal varices, hepatic venous pressure gradient ≥ 12 mmHg and no prior history of upper gastrointestinal bleeding were randomized to receive propranolol (to reduce their pulse rate by 25% from baseline, n = 15) and EVL (weekly to fortnightly until variceal eradication, n = 15). The two groups were comparable. All the patients in EVL group had variceal eradication during 3.8 ± 2.2 sessions.

Results: There was no major complication or interval bleeding. During a follow‐up period of 17.6 ± 4.7 months, varices recurred in three, two of which bled (successfully treated by EVL). In contrast, during this period of follow up one patient in the propranolol group had variceal bleeding (P = NS). Side effects of propranolol included symptomatic bradycardia requiring reduction of dose in one of 15 patients.

Conclusions: Although sample size in this study is small, it seems that EVL may be a good option for primary prophylaxis for variceal bleeding in patients with cirrhotic PHT; further studies on a larger number of patients and longer follow up are required.
Minimal role of GB virus‐C/hepatitis G virus in fulminant and subfulminant hepatitis in Taiwan
Authors: Liu Chun‐Jen , Kao Jia‐Horng , Lai Ming‐Yang , Chen Pei‐Jer , Chu Jan‐Show , Chen Wendy , Chen Ding‐Shinn
Published: March 2003

Background: The role of GB virus‐C/hepatitis G virus (GBV‐C/HGV) in fulminant hepatitis (FH) and subfulminant hepatitis (SFH) remains unclear.

Methods: Thirty‐two FH or SFH patients, with adequate clinical information and serum specimens, were studied. Serum samples were tested for hepatitis markers and genomes of hepatitis A–E viruses, as well as GBV‐C/HGV.

Results: Of the cases of FH/SFH studied, one (3%) was caused by anti‐tuberculosis agents, 26 (81%) had hepatotropic virus infection, and five (16%) had no identifiable cause. Of the 26 patients with hepatotropic virus infection, five had acute hepatitis B infection (one with acute hepatitis D virus (HDV) co‐infection), one had acute hepatitis C infection, 16 were hepatitis B surface antigen carriers with reactivation or superimposed by unidentified agent(s) (two had triple virus infections), three were hepatitis B carriers with HDV superinfection, and one had GBV‐C/HGV infection in addition to exposure to halothane. GBV‐C/HGV‐RNA was detected in only three of 32 patients (9%) and all had a history of blood transfusion or co‐existing causative factors. Of the 26 patients with hepatotropic virus infection, 18 were tested for antibodies against GBV‐C/HGV envelope protein and seven were reactive, suggesting past infection.

Conclusions: The role of GBV‐C/HGV in causing FH and SFH is minimal in Taiwan and HBV infection remains the major aetiology. These findings also suggest the existence of as yet unrecognized agents, responsible for such catastrophic illnesses.
Increased neutrophil chemotaxis in obstructive jaundice: An in vitro experiment in rats
Authors: Tsuji Kazuyuki , Kubota Yoshitsugu , Yamamoto Shin , Yanagitani Kaori , Amoh Yasuo , Takaoka Makoto , Ogura Mami , Kin Hideyuki , Inoue Kyoichi
Published: March 2003

Background and Aims: Changes in neutrophil functions in obstructive jaundice have been poorly understood. An in vitro experimental study was performed to evaluate the effect of obstructive jaundice on the functions of macrophages (secretion of neutrophil chemoattractants) and neutrophils (chemotaxis and superoxide anion generation).

Methods: Obstructive jaundice was produced in rats by 7 day bile duct ligation. Peripheral neutrophils and peritoneal macrophages were harvested from either normal, sham‐ligated or bile duct‐ligated rats and supernatants of the monolayers of the respective macrophages were prepared after stimulation with lipopolysaccharide. Neutrophil chemotaxis was evaluated with a modified Boyden method.

Results: The supernatant of the bile duct‐ligated rat macrophages showed a chemotactic effect on normal rat neutrophils with insignificant difference from the supernatant of the sham‐ligated rat macrophages. Chemotaxis of the bile duct‐ligated rat neutrophils towards the supernatant of the normal rat macrophages was significantly increased, compared with that of sham‐ligated rat neutrophils. Similarly, neutrophils from bile duct‐ligated rats showed significantly greater chemotaxis to formyl‐methionyl‐leucyl‐phenylalanine than the sham‐ligated rat neutrophils. Superoxide anion generation in response to formyl‐methionyl‐leucyl‐phenylalanine or phorbol myristate acetate was significantly increased in the bile duct‐ligated rats compared with the sham‐ligated rats.

Conclusions: The results suggest that the neutrophil is primed in terms of chemotaxis and superoxide anion generation in obstructive jaundice. How these activated neutrophils play a role in the inflammatory response to obstructive jaundice should be evaluated.
Extracorporeal support and hepatocyte transplantation in acute liver failure and cirrhosis
Authors: Riordan Stephen M , Williams Roger
Published: March 2003

The relative shortage of donor organs and lack of immediate availability mean that many patients with acute liver failure die before orthotopic liver transplantation can be performed. An effective temporary liver support system could improve the chance of survival with or without a transplant being ultimately carried out. Recent technological advances resulting in improved maintenance of hepatocyte viability and function in culture and bioreactor designs which facilitate adequate perfusion of the cellular component and removal of products of cellular metabolism have led to the development of a number of bioartificial devices for liver support. Three such devices have undergone preliminary clinical evaluation in the setting of acute liver failure, with a statistically significant reduction in raised intracerebral pressure along with improvements in consciousness level and some biochemical parameters associated with treatment with one of these. Several other devices with different characteristics have shown promise in vitro and/or in animal models but await clinical evaluation. Several new totally artificial systems have also been described, along with the emergence of isolated hepatocyte transplantation, with reports of successful ‘bridging’ to liver transplantation. Controlled trials on a multicentre basis in well‐defined patient groups and with standardized outcome measures will be required to properly evaluate the clinical value of each of these approaches to providing liver support in acute liver failure and cirrhosis. A better understanding of mechanisms underlying multiorgan failure and of factors inhibiting liver regeneration, thereby allowing a more targeted approach, will be essential to the further development of effective liver support strategies in these settings.
Superinfection of TT virus and hepatitis C virus among chronic haemodialysis patients
Authors: Ikeuchi Tetsu , Okuda Kunio , Yokosuka Osamu , Kanda Tatsuo , Kobayashi Susumu , Murata Motoi , Hayashi Haruyuki , Yokozeki Kazuo , Ohtake Yoshio , Kashima Takashi , Irie Yasubumi
Published: March 2003

Background
: The TT virus (TTV), a new DNA virus found in Japan from a patient with post‐transfusion hepatitis non‐A–non‐G, is frequently positive in the sera of patients with liver disease. It is not established whether this virus causes liver damage. We studied the frequency of superinfection of this virus and hepatitis C virus (HCV) known to be endemic among haemodialysis patients, and the possible deleterious effect of TTV on HCV‐induced chronic liver disease.

Methods
: We used primers from a conservative region in the TTV genome (Okamoto, 1998) to detect TTV. Sera from 163 dialysis patients positive for anti‐HCV and 77 dialysis patients negative for anti‐HCV (control) were tested.

Results
: TT Virus positivity was 35% among HCV antibody (anti‐HCV)‐positive patients and 45.4% among anti‐HCV‐negative patients. TT Virus positivity was unrelated to the length of haemodialysis or amounts of blood the patients had received in the past. More anti‐HCV‐positive patients had a history of transfusion, but TTV positivity was not as closely associated with transfusion as anti‐HCV positivity. The severity of chronic liver disease was estimated from peak serum alanine aminotransferase levels in the preceding 6 months. Among anti‐HCV positives, TTV‐positive patients tended to have less active disease; at least there was no indication that TTV superinfection aggravated chronic hepatitic C in long‐term dialysis patients. Four of 35 anti‐HCV‐negative, TTV‐positive patients had chronic active liver disease, while none of the anti‐HCV‐negative and TTV‐negative patients did.

Conclusions
: TT Virus infection is prevalent among haemodialysis patients. Its transmission occurs not only by blood transfusion, but also by non‐parenteral infection. Superinfection of TTV does not exert deleterious effects on the liver disease induced by HCV. However, it may cause chronic hepatitis in a limited number of patients, but remains dormant most of the time. Triple infection, HCV and TTV plus HBV or HGV (one case each), did not cause severe liver disease.
Endoscopic sphincter dilation in patients with bile duct stones: Immediate and medium‐term results
Authors: Ueno Norio , Ozawa Yoshifumi
Published: March 2003

Background
: Endoscopic sphincter dilation (ESD) is believed to successfully treat bile duct stones without serious procedure‐related complications.

Methods
: We evaluated the efficacy, safety and limitations of this relatively new procedure in a consecutive series of patients to establish the clinical role of this modality for treating bile duct stones. One hundred and forty‐three consecutive patients were treated by ESD between July 1995 and March 1998. The balloons used were a Maxforce 5‐Fr or Olbert 5‐Fr balloon‐tipped catheter with a maximal diameter of 8 mm. Mechanical lithotriptor (ML) or extracorporeal shock wave lithotripsy (ESWL) were used when stones were large and/or numerous and a Dormia basket or retrievable balloon catheter was used to extract the stones entirely. Procedure‐related symptoms and chemical data after the procedure were monitored during and after ESD at least until the following morning. To diagnose residual stones accurately, intraductal ultrasonography was routinely used.

Results
: Although the majority of patients complained of subtle pain during balloon inflation and demonstrated oozing during and after balloon inflation, the procedures were well tolerated. Complete stone extraction was achieved in 139 (97.2%) of the patients. Mechanical lithotriptor and ESWL were used to assist stone clearance in 79 (55.2%) and 23 (16.1%) patients, respectively. Mild pancreatitis occurred in six patients (4.2%). However, there were no other serious complications. Stone recurrence was identified in six patients and these stones were re‐extracted by subsequent ESD procedures.

Conclusions
: A high success rate for stone extraction and the relative safety of this procedure was confirmed. However, there was recurrence in a relatively high percentage of patients within a short period and this may be a forthcoming issue in ESD. Long‐term follow‐up observation and the establishment of countermeasures for stone recurrence seem to be essential.
C ASE R	EPORT: Clostridium septicum infection presenting as liver abscess in a case of choriocarcinoma with liver metastasis
Authors: Lee Chern‐Horng , Hsieh Sen‐Yung
Published: March 2003

Clostridium septicum is an anaerobic, Gram‐positive bacillus. Infection with this organism has a known association with malignant diseases, especially colon and haematological cancers. Clostridium septicum is rarely found to be a pathogen of liver abscess. Herein, we report the case of a female choriocarcinoma patient with liver metastasis in which C. septicum infection presented as a gas‐forming liver abscess. This case and previous reports indicate that once C. septicum is identified as a pathogen in liver abscess, metastatic liver tumours should be highly suspected.

© 1999 Blackwell Science Asia Pty Ltd
HELICOBACTER PYLORI IN GASTRIC CANCER
Authors: Simadibrata Marcellus , Yuwono Vera , Rani A. Azis
Published: March 2003

Objective

Helicobacter pylori (Hp) has a dominan role in gastroduodenale diseases i.e chronic active gastritis peptic ulcer and gastric cancer. The prevalence of gastric cancer in Indonesia from upper GI endoscopy examinations was 1.33‐4.2%. The prevalence of Hp infection in gastric cancer worlwide is between 52 ‐ 94%. Hp infection may lead chronic active gastritis to be dysplasia and then carcinoma. The aim of this study is to find the prevalence of Hp infection in gastric cancer, the relation between Hp and gastric cancer.

Material & Methods

The gastric cancer cases who were treated in Ciptomangunkusumo hospital and Abdiwaluyo hospital in 2 years (1998‐1999) were included in this study. As control we included chronic gastritis cases in the same years and same hospital. All of the patients were done endoscopical examination, mucosal biopsy for pathological examination or CLO test and serum Hp serology examination (IgG Helicobacter pylori). Hp infection was thought to be positive if minimally the pathological examination positive or both of CLO test & Hp serology positive. Exclusion if incomplete data, the patient refused to follow the study. Statistic chi‐square test or fisher test.

Result

We got 21 cases of gastric cancer and 78 cases of chronic gastritis. The most frequent characteristic of gastric cancer patients was age group 50‐59 yo(38.09%), male(80.95%), batak ethnic(38.09%), blood A group (50%). The symptom of the patients were upper GI bleeding (42.85%), abdominal mass (66.66%). Hp was positive in 17/21(80.95%) of gastric cancer patients and 17/78(21.79%) of chronic gastritis patients, respectively (p=0.000001).

Hp

positive in adenocarcinoma (52.38%), signet ring cell carcinoma (19.04%), carcinoid tumor (4.76%) & malt lymphoma (4.76%).

Conclusion

Hp infection is very frequent in gastric cancer.
PRESENCE OF HELICOBACTER PYLORI IN BILE AND BILE DUCT MALIGNACIES
Authors: Bulajic Milutin , Jovanovic Ivan , Lohr Matthias
Published: March 2003

Objective

To evaluate the role of H. p in biliary malignancies, in conjunctions with smoking and coffee consumption habits.

Material & Methods

89 patients (m = 41, f = 47; AGE 57.7 ± 16.4), referred to the clinic for diagnosis of hepatobiliary diseases. All the patients underwent full clinical workup, including anamnestic data on smoking and coffee consumption habits. The fast urease test on gastric biopsy specimens was done in all the cases. Bile was sampled during routine ERCP. The final diagnosis was established by surgery, pathohistology, and/or long term clinical follow‐up. DNA was extracted for nested PCR for H.p. urease A gene producing a 258 bp product.

Result

Bile duct malignancies were detected in 15/89 patients (16.8%). H.p was detected in bile by PCR in 12/15 patients (80%), and all of them were H.p. positive on fast urease test. In the remaining 74 patients (bile calculosis 48, cholangitis 17, miscellaneous 9) PCR detected H.p. in 36 patients (48.6%). The group of patient with biliary malignancies had approximately the same ratio smokers/nonsmokers as in the group of patients with other biliary pathology. However, when the patients with PCR for H.p. in bile were excluded, and the group stratified according to the duration and daily quantity of smoking, the group with tumors was made up by heavy, long term smokers (41.7%;>20 pack years) in comparison to the benign condition (13.85%). The duration of coffee consumption was without difference between the analyzed groups (approx. 30 years), but concerning the daily quantity of coffee, the group with biliary malignancies consumed larger amounts (>3 cup/day), in comparison to the other (66.7% vs 30.5 %, respectively).

Conclusion

There seems to be a strong link between bile duct malignancies and H.p. in bile. The conjuctional effect of smoking to biliary malignancies is based on both long duration and daily quantity, while the coffee consumption has a influence in term of daily amounts rather than duration.
ASCORBIC ACID EFFECT TO PURSUE HELICOBACTER PYLORI’S GROWTH: IN VITRO STUDIES
Authors: Pratomo Bogi , Achmad Harijono
Published: March 2003

Background

Ascorbic acid was known had a role as redox agent for biological oxidation and perform antioxidant function by removing free radicals. Because of its ability as an antioxidant ,hypothetically ascorbic acid could indirectly solve helicobacter pylori infection and prevented chronical gastritis become malignancy of the stomach. Purpose : To know the direct influence of ascorbic acid with different concentration to the growth of Helicobacter pylori.

Methods

Laboratory invitro experimental eksplorative. Simple randomized design research. This research design use one control,namely no ascorbic acid Helicobacter pylori. Independent variable used in this research was ascorbic acid with various dosage from 0,5 up to 500 mg. The dependent variable was Helicobacter pylori growth counted qualitative and quantitative. Controle variable used is BAP, liquid thioglicate seeding,anaerobic jar and dosage of Helicobacter pylori isolat malang 109 permililitre. Helicobacter pylori identification based on several criteria such as colonies,urease test, oxidase test,catalyst test ,lump sugar reaction,and microscopic observation by gram stain. Ascorbic acid whose concentration measured is inoculated by Helicobacter pylori, then incubated in the anaerobic jar for 48 hour. To see the growth of Helicobacter pylori, a qualitative counting is done with seeing snoring of the jar. Planting is done in BAP from clear test tube,then incubated in the anaerobic jar for 2 days after that we count the numbers of colonies of bacteries grow on BAP using total plate count. Such biochemical test and microscopic observation perform to prove the bacteries was Helicobacter pylori. To analyze the data,variant analysis,LSD,and analitic descriptive test was used.

Result

Qualitative count result shows that there is no Helicobacter pylori growth(giving scored 0), begin from the treatment group using concentration 125 mg up to 500 mg. In the quantitative count, the preventive ability of ascorbic acid 125 mg is 11,46 %, 300 mg is 32 %,400 mg is 49,4 % and 500 mg is 58,78 %. In ANOVA we get the number of colonies grow show a significant difference on the five treatment group (p< 0,05 ) . By LSD test, the helicobacter pylori with 500 mg ascorbic acid group shows significant decreasing of the colony numbers ( p < 0,05 ) compared to controling group and 125 mg ascorbic acid group.

Conclusions

The giving of ascorbic acid from the concentration of 400 mg up to 500 mg will decrease Helicobacter pylori growth.

Dosage of ascorbic acid 500 mg has the highest preventive ability compared with another group. This preventive mechanism probably concern with ability of ascorbic acid as antioxidant.
GENOTYPING OF VIRULENCE FACTORS IN H. PYLORI USING A MICROARRAY WITH FOCUS ON THE CAG PATHOGENICITY ISLAND
Authors: Sillèn Anna , Eriksson Lena , Engstrand Lars
Published: March 2003

Objective

The aim of this work was to identify genetic differences regarding virulence factors in Helicobacter pylori, including the cag pathogenicity island (PAI). Sixty strains isolated from patients belonging to case‐control study was analyzed H. pylori infection is associated with chronic gastritis, duodenal ulcer and gastric cancer. Vacuolating cytotoxin (VacA) producing strains of H. pylori are mostly isolated from patients with the more severe diseases. The CagA (cytotoxin associated gene A) protein is associated with cytotoxin production, and the corresponding gene cagA is found in ca. 60% of H. pylori strains. The CagA gene is located in the cag pathogenicity island, which is 38 kb in size and contains 28 open reading frames. The function of the CagA protein is still unknown. Hitherto, no study has been made to investigate if it actually is the cagA gene which determines the pathogenicity or if it can be one (or several) of the neighbouring genes.

Materials & Methods

The cases have adenocarcinoma and the controls have different non‐cancer GI diseases. We have set up a microarray system, which enables us to screen for genotypic differences for a large number of strains. The microarray consist of 45 PCR products spotted onto poly‐L‐lysine coated slides. These PCR products were amplified from all 28 predicted genes in the H. pylori cag PAI and from 17 other virulence genes. As template in the PCR reactions, DNA from the sequenced strain 26695 was used. The PCR primers were designed based on the public whole genome sequence from 26695 strains. The arrays were made by a GMS 417 Arrayer. Genomic DNA was prepared using bacteria from a whole agar plate. The DNA was digested by AluI and fluorescently labelled with Cy3‐dCTP by random priming. Hybridisation was performed o.n. and the arrays were then scanned for signals using the GMS 418 Array Scanner.

Results

Analysis of the clinical isolates showed a great variety in the genetic make‐up concerning the cag PAI. Strains that are cagA negative can still contain a large fragment of the PAI and vice versa. Partial deletions of the PAI was especially observed among the control strains. Furthermore, the array is sensitive enough to differentiate between the vacA gene subtypes (s1/s2 and m1/m2) which earlier have been made by PCR.

Conclusion

We have shown that it is very important to distinguish between a cagA negative strain and a cag PAI negative one. Statistics from these 155 strains will hopefully pinpoint which gene/‐s that is the real virulence determinant in the cag PAI ‐ if it is cagA or some other gene.
ROLE OF HELICOBACTER PYLORI INFECTION ON INFLAMMATION PATTERN OF GASTRITIS AMONG FUNCTIONAL DYSPEPTIC PATIENTS
Authors: Rani Abdul Aziz , Abdullah Murdani
Published: March 2003

Background

The presence of Helicobacter pylori (Hp) is closely related with inflammation of gastric mucosa associated with functional dyspepsia and peptic ulcer disease. While the correlation between Helicobacter pylori and peptic ulcer is accepted worldwide, the role of Hp in functional dyspepsia is still a debatable issue.

Aims

To describe the histological features and to determine if there are significant differences on the level of severity and activity of these histological findings compare to the gross endoscopic findings.

Methods

The histopathologic characteristic of gastric biopsy specimens taken from antrum and stained with Giemsa and Hematoxiline‐Eosin stain were investigated among 237 patients (M=122, F=115) diagnosed as dyspepsia. Grade and activity of gastritis was examined according to the Sydney System (chronic inflammation, neutrophilic infiltration, intestinal metaplasia and glandular atrophy). The presence of Hp was determined by histology. All the patients were from the private hospital in Jakarta.

Result

Clinical and histological data of 237 patients with dyspepsia was analyzed. Average age was 44.14 years (SD 13.69), male 51.5% (122/237), and female 48.5 % (115/237). One hundred and forty four (60.8%) patients with dyspepsia were Hp positive on histology and were significantly older than Hp negatives (46.77 +13.99 and 40.07+12.19). Peptic ulcer was diagnosed for 3.8 % (9/237) and being excluded. The density of Hp in the antrum and corpus were mild 56.5%/5.1%, moderate 3.8%/0.0%, and severe 0.4%/0.0%, consecutively. There were significant different in density of Hp infection in both sites. The present of Hp has a good correlation with the severity and activity of chronic inflammation, neutrophilic infiltration, intestinal metaplasia and glandular atrophy in the antrum and corpus as well (p<0.05).

Conclusion

The present of Hp has a good correlation with the severity and activity of chronic inflammation, neutrophilic infiltration, intestinal metaplasia and glandular atrophy in the antrum and corpus as well.
Burkitt’s lymphoma associated with Helicobacter pylori
Authors: Shannon Catherine , Vickers Chris , Field Andrew , Ward Robyn
Published: March 2003

The association between Helicobacter pylori infection and low grade mucosa‐associated lymphoid tissue lymphoma is now widely accepted. In this report, we describe the concurrent development of Burkitt’s lymphoma in the stomach of a 53‐year‐old male with perforated duodenal ulcer and positive H. pylori serology. The temporal relationship between these two events raises the possibility of a causal link between H. pylori infection and this lymphoproliferative disease. In describing this rare case of gastric Burkitt’s lymphoma, we consider the evidence that supports this possibility.
Perinatal transmission of hepatitis B virus and its prevention
Authors: Shiraki Kazuo
Published: March 2003

In order to prevent liver cirrhosis and hepatocellular carcinoma in later life, it is essential to prevent HBV infection in infants. If the mother is chronically infected with HBV and is also positive for HBeAg, 80–90% of the newborns become chronically infected, whereas if the mother is positive for anti‐HBe, only some newborns will develop acute hepatitis or fulminant hepatitis. It is necessary to screen pregnant women for HBsAg and prevent mother‐to‐infant infection of HBV, treating the infant with hepatitis B hyperimmune globulin at birth, followed by HBV vaccination. In highly endemic areas of HBV, universal HBV vaccination of all newborns is advisable.
Interferon monotherapy in chronic hepatitis B
Authors: Guan Richard
Published: March 2003

Interferon‐alpha (IFN‐α) has been the only approved agent for the treatment of chronic hepatitis B in most countries, but this is rapidly changing. It is expensive, associated with frequent and unpleasant side effects, has limited efficacy and is ineffective in subjects with no/mild liver necro‐inflammation. Loss of HBsAg and viral replication markers occur 6% and 20%, more often in IFN‐treated subjects than controls. The most important factors that will predict favourable response to IFN‐α therapy are elevated ALT and low serum HBV DNA levels. Chinese patients and children with active liver have similar response rates as Caucasian adults with equivalent ALT levels. Patients with HBeAg negative disease fare less well. Long‐term follow up has shown that most IFN responders maintained their response although very few people have complete eradication of HBV.
Transmission of hepatitis C virus in Asia: past and present perspectives
Authors: Kao Jia‐Horng , Chen Ding‐Shinn
Published: March 2003

Hepatitis C virus (HCV) infection is a major public health problem. The epidemiology of HCV infection in different parts of Asia is similar, with an average seroprevalence of hepatitis C antibody (anti‐HCV) less than 2.5% in healthy adults. The infection is rarely seen in children. The major routes of HCV transmission in Asia during the past few decades have been through administration of therapeutic blood products and injecting drug use, similar to the pattern observed in other parts of the world. However, obvious parenteral routes of transmission only account for 30–60% of anti‐HCV‐positive cases, depending on the geographic area. Other inapparent parenteral or per‐mucosal exposures, including medical intervention, tattooing, acupuncture, vertical and sexual transmission, accidental needlestick and household contact, are also possible routes of HCV transmission. Although screening of blood donors for anti‐HCV and improvements in infection control have significantly decreased the exposure to HCV, it is believed that HCV is still spreading in some areas of Asia because of the lack of routine screening of donated blood, injecting drug usage, traditional medicine practices or medical treatment under suboptimal hygienic conditions that involve blood contamination, and tattooing. Accordingly, until effective and safe immunoprophylaxis is available, interruption of transmission routes, such as implementation of blood donor screening for anti‐HCV, adequate sterilization of surgical instruments or the use of disposable medical instruments, especially needles and syringes, and avoidance of sharing personal grooming aids remains the mainstay to prevent HCV infection in Asia today.
Long‐term effects of interferon therapy on histology and development of hepatocellular carcinoma in hepatitis C
Authors: Omata Masao , Shiratori Yasushi
Published: March 2003

Chronic hepatitis C is a common disease that slowly progresses to cirrhosis and eventually to hepatocellular carcinoma (HCC). Histology offers an important insight into disease prognosis and treatment response. Biochemical and virological responses to interferon (IFN) therapy are associated with an improvement in liver histology during and shortly after treatment, but the impact of treatment on the history of a slowly progressive disease cannot be ascertained by evaluating results at the completion of treatment. Some recent studies showed that the severity of hepatic inflammation may be a major factor driving progression of chronic hepatitis C to cirrhosis, and that improving hepatic inflammation may be associated with regression or retardation of fibrosis, especially in patients with virological sustained response. Many recent studies have shown an inhibition of the development of decompensation and HCC after IFN therapy, but a randomized controlled study using a large number of subjects with a more than 5‐year observation period will be required to elucidate the exact role of antiviral therapy for the delay of decompensation or suppression of HCC.