bluuebunny/crossref_metadata_2025 huggingface dataset:
Central nervous system infections by members of thePseudallescheria boydiispecies complex in healthy and immunocompromised hosts: epidemiology, clinical characteristics and outcome
Authors: Kantarcioglu A. Serda , Guarro Josep , De Hoog G. S.
Published: March 2008

Infections caused by members of thePseudallescheria boydiispecies complex are currently among the most common mould infections. These fungi show a particular tropism for the central nervous system (CNS). We reviewed all the available reports on CNS infections, focusing on the geographical distribution, infection routes, immunity status of infected individuals, type and location of infections, clinical manifestations, treatment and outcome. A total of 99 case reports were identified, with similar percentage of healthy and immunocompromised patients (44% vs. 56%;P = 0.26). Main clinical types were brain abscess (69%), co‐infection of brain tissue and/or spinal cord with meninges (10%) and meningitis (9%). The mortality rate was 74%, regardless of the patient’s immune status, or the infection type and/or location. Cerebrospinal fluid culture was revealed as a not very important tool as the percentage of positive samples forP. boydiicomplex was not different from that of negative ones (67% vs. 33%;P = 0.10). In immunocompetent patients, CNS infection was preceded by near drowning or trauma. In these patients, the infection was characterised by localised involvement and a high fatality rate (76%). In contrast, CNS infection in immunocompromised patients was presented as rapidly progressive disseminated lesions at various degrees of evolution. Major risk factors for CNS infection were the aspiration of polluted water in near‐drowning episodes in immunologically intact patients and medical immunosuppression in the remaining patient groups. As the therapeutic options were poor, the treatment was difficult in general and the prognosis was poor.
Assessment of the lightcycler PCR assay for diagnosis of invasive aspergillosis in paediatric patients with onco‐haematological diseases
Authors: Cesaro S. , Stenghele C. , Calore E. , Franchin E. , Cerbaro I. , Cusinato R. , Tridello G. , Manganelli R. , Carli M. , Palù G.
Published: March 2008

A reliable diagnosis of invasive aspergillosis (IA) is hampered by the difficulty in obtaining suitable tissue samples. To evaluate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the LightCycler PCR for the diagnosis of IA, 536 blood samples were collected over a 22‐month period from 62 paediatric patients (median age 10 years, range 1–18) considered at risk of IA. The galactomannan antigen (GM) and fungal DNA were assessed on serial blood samples. IA was diagnosed in eight of 62 patients (13%): proven, five, probable, three. Sensitivity, specificity, PPV and NPV of LightCycler PCR varied according to the number of positive samples used to define positivity: 88%; 37%; 17% and 95% for single sample positivity; and 63%, 81%, 33% and 94% for serial sample positivity respectively. The concordance between positivity of LightCycler PCR assay and the diagnosis of IA was 79%. The single positivity of LightCycler PCR assay showed a good sensitivity for the diagnosis of IA in paediatric patients. The high NPV makes LightCycler PCR a promising tool in addition to GM testing to design a strategy of pre‐emptive antifungal therapy, although further validation studies are needed.
Duodenal mucosal histology and histochemistry in active, treated and healed duodenal ulcer: Correlation with duodenal prostaglandin E2 production
Authors: PUGH S. , JAYARAJ AP , BARDHAN KD
Published: March 2008

We investigated whether impaired duodenal mucosal prostaglandin E2 (PGE2) production previously observed in duodenal ulcer (DU) was a primary pathophysiological abnormality or secondary to mucosal architectural changes that accompany ulceration. One hundred patients were studied: at endoscopy, paired duodenal biopsies were taken in patients with normal endoscopies and from the ulcer edge or scar and background mucosa in active or healed DU. One of the pair of biopsies was used to estimate PGE2 synthesis ability, the other was processed for histology and histochemistry. The following features graded: goblet cell numbers and staining with Periodic acid‐Schiff reagent (PAS), epithelial staining with PAS, villous atrophy, columnar cell height, inflammatory cell infiltrate and micro‐erosions and gastric metaplasia taken as a whole. Patients were found to have normal endoscopy (n= 31), active untreated DU (n= 20), active DU on treatment with either cimetidine or ranitidine (n= 13), healed DU on maintenance treatment (n= 27) and healed DU off treatment (n= 9). Active duodenal ulceration was found to be associated with decreased numbers of goblet cells, loss and blunting of villi, increased columnar cell height, increased epithelial cell PAS staining and with gastric metaplasia. After healing, only villous blunting remained. These changes were present, but less marked, at sites removed from the ulcer and were not apparent in the patient groups with healed ulcers. A strong correlation between overall gastric metaplasia and epithelial cell PAS staining and the reduced ability to synthesize PGE2 (P < 0.001) was only apparent when biopsies from all patients were grouped together, but not within individual patient subgroups. There was no consistent correlation between PGE2 generation and individual parameters of pathological change in the duodenum.

We conclude that, although inflammatory and mucosal changes may contribute, the evidence suggests that the impaired PGE2 generation in DU disease is, to a large extent, independent of histological and histochemical features.
Does Crohn's disease need differentiation from tuberculosis?
Authors: JAYANTHI V. , ROBINSON RJ , MALATHI S. , RANI B. , BALAMBAL R. , CHARI SURESH , TAGHURAM K. , MADANAGOPALAN N. , MAYBERRY JF
Published: March 2008

Crohn's disease (CD) and tuberculosis (TB) of the gastrointestinal tract pose major diagnostic problems for clinicians where these conditions coexist. Clinically and radiologically, the diseases are similar. In the West, TB is considered in the differential diagnosis of all suspected cases of CD, particularly among Asian migrants. Earlier age of presentation, perianal disease and enteric fistulae favour a diagnosis of CD. Aphthoid ulceration, pseudopolyps and filliform mucosa at endoscopy are suggestive of CD and a negative tuberculin test is useful. The final diagnosis depends largely on histopathology and the presence or absence of acid fast bacilli. Tuberculosis is more common in developing countries and intestinal TB frequently coexists with pulmonary tuberculosis. TB is known to affect all age groups and fistulous communication, although uncommon, does occur. In addition to radiology and endoscopy, laparotomy may be required to establish the diagnosis. In developing countries, CD is uncommon and remains largely a diagnosis of exclusion. A trial of anti‐tuberculosis therapy may often be prescribed before definitely diagnosing CD. The development of molecular biology techniques has led to a revival of interest in mycobacteria as a possible aetiological agent in CD. DNA from Mycobacterium paratuberculosis and Mycobacterium kansaii have both been identified in CD cases but the significance of this finding has not been established. However, in the near future polymerase chain reaction will become increasingly useful in differentiating CD from intestinal TB because it allows the amplification and identification of very small quantities of mycobacterium DNA.
Chronic liver disease: Do alcohol and hepatitis C virus interact?
Authors: COOKSLEY WGE
Published: March 2008

In chronic liver disease, alcoholism and hepatitis C virus (HCV) frequently coexist, and it is widely believed that they interact to result in more severe disease. However, the issue is far more complex and that view may be incorrect. Newer HCV assays cast doubt on the earlier results. Data acquired in one country are often at variance with those from other countries, suggesting that other factors may be involved in the variability of the disease. Further comparison of histologically different groups of individuals with excess alcohol intake is unlikely to shed further light on the issue unless information on the duration and quantity of alcohol consumption and the duration of HCV infection is available. The net evidence is that HCV and alcohol produce different histological appearances in the precirrhosis stage, with the end result cirrhosis often being indistinguishable, regardless of aetiology. Nevertheless, even with both aetiologies, progression is slow and only a minority of people develop cirrhosis despite the combination of HCV and heavy alcoholism. As yet there is no definite evidence that cirrhosis develops more frequently or sooner if both HCV and alcohol are present. Although the majority of the evidence suggests that these insults are probably additive, there is a possibility that alcohol and HCV do interact in the pathogenesis of chronic liver disease. Further studies will be necessary, however, to clarify their relationship.
Correlation between transmucosal potential difference and morphological damage during aspirin injury of gastric mucosa in rats
Authors: COOK GREGORY A. , ELLIOTT SUSAN L. , SKELJO MARYANNE V. , GIRAUD ANDREW S. , YEOMANS NEVILLE D.
Published: March 2008

The potential difference (PD) that is maintained across healthy gastric mucosa is thought to be due to asymmetric ion pumping combined with resistance to back‐diffusion of the separated charge. However, the structures that are responsible for this have not been clearly defined. This study examined the temporal changes in PD in rat stomach after injury by a single dose of aspirin. Multiple linear regression was used to compare this with the time course of several parameters of histological damage: (i) the per cent mucosal length showing superficial (confined to surface and gastric pits), deep (involving the isthmus or deeper in oxyntic glands) and total damage; (ii) the number of discrete erosions; and (iii) the total area of erosions per cm sectioned. Mucosal PD fell during the first 30–60 min after aspirin. Superficial damage appeared early and was already recovering by this time. The time course of deep damage more closely matched the alterations in PD and stepwise regression analysis showed that this could be predicted by the amount of deep damage alone (P < 0.001). Changes in transmucosal PD after acute aspirin injury probably reflect damage to structures in the oxyntic glands and not just the breaking of the surface and pit cell ‘barrier’.
Pre‐ and postoperative nutritional care in liver transplantation in children
Authors: SHEPHERD ROSS W
Published: March 2008

Orthotopic liver transplantation (OLT) is now a definitive treatment option for most cases of endstage liver disease (ESLD) in children. Efforts now focus on active supportive treatment to maintain, if not improve, the patient's clinical status before OLT and to ensure normal patterns of growth and development after OLT. Malnutrition adversely affects the outcome of OLT and is probably the single area in pre‐operative management where the largest potential improvement can be made. Our studies indicate significant abnormalities of protein energy metabolism and body composition in children referred for OLT. We have shown that the use of enteral formulae, enriched with branched‐chain amino acids, have significant advantages. Other adjunctive therapy, such as growth hormone, is the subject of current investigation. Following transplantation, catch‐up weight and growth does occur with the advent of normal liver functioning, but patients at continuing risk for undernutrition, such as those with rejection and/or chronic infection, need to be targeted for specific nutritional therapy.
Case report: Paucity of interlobular bile ducts in Chinese children
Authors: CHIU HSIU‐HUI , CHANG MEI‐HWEI , CHEN CHI‐LONG , HSU HONG‐YUAN , NI YEN‐HSUAN
Published: March 2008

Sixteen Chinese children with cholestasis since early infancy were diagnosed to have paucity of interlobular bile ducts (PILBD) or its equivalent. Twelve children belonged to the syndromic group of PILBD and four children belonged to the non‐syndromic group. A definite histological diagnosis of bile duct paucity was established in only two children (aged 4 and 9 months) during the first percutaneous needle biopsy. In the remaining 14 children a varying degree of bile duct destruction was evident in the follow up percutaneous or wedge liver biopsies. The evolving changes were characterized by inflammatory infiltration near or at the ductal wall, the presence of dysmorphic ductules, the degeneration of ductal epithelia and a progressive decrease of interlobular bile ducts. Of 10 children who underwent laparotomy for definite diagnosis, kasai operation was performed in two of them. In the syndromic PILBD group, all children, including two paired siblings, had at least three of five major clinical features. Hypoplasia of the extrahepatic biliary tree was found in five children and atresia of the extrahepatic bile duct was found in one. Three of six children studied were shown, by polymerase chain reaction, to have cytomegalovirus infection in the liver. This study demonstrates that bile duct paucity is a result of progressive bile duct destruction. A definitive diagnosis is difficult to make in early infancy. Thus, the careful evaluation of extrahepatic features in cholestatic children and follow‐up liver biopsies are indicated. Although the pathogenetic mechanism of PILBD is unknown, bile duct destruction is the common pathway leading to paucity of bile ducts irrespective of syndromic or non‐syndromic types.
Case report: Liver function abnormalities in a severe case of hyperreactio luteinalis
Authors: SENTURK HAKAN , ERDINÇCL SEVAL , TASYUREKLI MUSTAFA , MERT ALI , ARVAS MACIT , SEN CIHAT
Published: March 2008

Rare causes of liver dysfunction in pregnancy may pose a challenge to the consulting gastroenterologist or hepatologist from both the diagnostic and therapeutic standpoints. We describe here liver function abnormalities in a case of hyperreactio luteinalis with light and electron microscopic findings.
Effects of leminoprazole, omeprazole and sucralfate on indomethacininduced delayed healing of kissing gastric ulcers in rats
Authors: TSUKIMI Y. , NOZUE C. , OKABE S.
Published: March 2008

We have examined whether or not repeated treatment with indomethacin delays the healing of kissing gastric ulcers induced in rats. The effects of leminoprazole, omeprazole and sucralfate on any delay in ulcer healing caused by indomethacin were also determined in relation to myeloperoxidase activity. Kissing gastric ulcers were induced by luminal application of an acetic acid solution. Indomethacin significantly delayed ulcer healing in a dose‐dependent manner. Leminoprazole and omeprazole decreased the size and depth of ulcers, the healing of which was delayed by indomethacin, while sucralfate only decreased the ulcer depth. Histological studies showed that indomethacin inhibited tissue contraction and regeneration of the ulcerated mucosa. Leminoprazole and omeprazole prevented the inhibition of these parameters. The myeloperoxidase (MPO) activity of the ulcer portion in animals treated with indomethacin was markedly higher than in the control group. Both leminoprazole and omeprazole, but not sucralfate, significantly reduced MPO activity in contrast to the control value (in the presence of indomethacin). There was a significant relationship between the ulcerated area and myeloperoxidase activity. These results suggested that: (i) leminoprazole and omeprazole prevent the indomethacin‐induced delay in ulcer healing by promoting tissue contraction and regeneration of the ulcerated mucosa; (ii) sucralfate prevents the indomethacin‐induced delay in ulcer healing via the promotion of the formation of granulation tissue; and (iii) MPO activity will be useful to biochemically ensure the healing state of ulcers.
Cold activation of complement in sera from patients with persistent hepatitis C virus infection on interferon therapy
Authors: AIKAWA TATSUYA , KIMURA IZUMI , KOJIMA MAKI , UENO CHISATO , MIYAMOTO KUNIKO , TANGO TOSHIRO , TANAKA NAOMI
Published: March 2008

The loss of haemolytic activity in sera during storage at low temperature (the cold activation of complement) was observed in 136 of 184 (74%) patients with chronic liver disease associated with hepatitis C virus (HCV) infection. This was more frequent than observed in the three of 40 (8%) patients with chronic hepatitis B (P < 0.001) or none in 43 normal controls (P < 0.001). Of 103 patients with chronic hepatitis C who had completed a full course of recombinant interferon‐α2a therapy (total dose: 516×106U), 40 responded completely and 21 responded partially, as judged by the normalization or decrease of alanine aminotransferase levels 6 months after the completion of therapy; 42 patients did not respond at all. The cold activation of complement persisted in five (13%) complete responders, less often than in 33 (79%) non‐responders (P < 0.001). At the completion of interferon therapy, the cold activation of complement persisted in 12 of 54 patients despite the normalization of alanine aminotransferase. Spontaneous exacerbation of hepatitis occurred in seven of 12 (58%) patients with cold activation, which was more frequent than in the four of 42 patients (10%) without it (P < 0.01). The cold activation of complement disappeared along with the loss of HCV‐RNA in five of six responders during the 6 month period after the completion of interferon therapy, while both cold activation and HCV‐RNA persisted in all eight non‐responders. These results indicate that the cold activation of complement may be useful as a marker of HCV viraemia for monitoring the response to interferon in patients with HCV infection.
Microheterogeneity of serum transferrin in the diagnosis of hepatocellular carcinoma
Authors: SUZUKI YASUFUMI , AOYAGI YUTAKA , MORI SHIGEKI , SUDA TAKESHI , NAITOH AKIRA , ISOKAWA OSAMU , YANAGI MASAHIKO , IGARASHI HIROTAKA , ASAKURA HITOSHI
Published: March 2008

Heterogeneous reactivity of human serum transferrin (Tf) with lectins was analysed using patient sera to determine whether it can be used to distinguish patients with hepatocellular carcinoma (HCC) from those with liver cirrhosis (LC). Microheterogeneity of Tf was analysed by crossed immunoaffinity electrophoresis (CIAE) with concanavalin A (Con A) and Lens culinaris agglutinin (LCA). Sample sera from 58 patients with HCC, 43 patients with LC and 10 normal controls were used in this study and the results were evaluated statistically. The increments of Con A‐non‐reactive (C1) and ‐weakly reactive (C2) species of Tf were observed in HCC compared with those of LC and Norm. Significant increase in the combined percentage of Con A‐ C1 + C2 species was also revealed in HCC (35.5 ± 8.5%, mean ± s.d.) compared with those of LC (29.1 ± 6.8%; P < 0.001) and normal controls (17.1 ± 2.3%; P < 0.001). The elevation of LCA‐reactive (L2) species of Tf was recognized in HCC (8.2 ± 3.8%) in comparison with those of LC (4.8 ± 3.1%; P<0.001) and normal controls (1.3 ± 1.7%; P < 0.001). The increment of C1+C2 species and/or L2 species of Tf was observed in 78% (sensitivity) of patients with HCC. The specificity, the positive predictive value and the overall accuracy were 81, 88 and 72%, respectively. Positive ratio of C1+C2 and/or L2 species was 77 and 70% in alpha‐fetoprotein low and ‐high producing HCC patients, respectively. These results indicate that the microheterogeneity analysis of human serum Tf is useful for distinguishing patients with HCC from those with LC and normal controls.
An analysis of the relationship between bile duct stones and periampullary duodenal diverticula
Authors: CHANDY GEORGE , HART WENDY J , ROBERTS‐THOMSON IAN C
Published: March 2008

Previous studies have suggested a relationship between bile duct stones and periampullary duodenal diverticula. The aim of the present study was to examine this association in more detail, including step‐wise logistic regression to identify independent predictors for the presence of diverticula. Clinical, endoscopic and radiological data were analysed from 794 consecutive subjects with bile duct stones; 44 with primary duct stones (without gall‐bladder stones) and 750 with bile duct stones associated with current or previous gall‐bladder stones. Frequencies of diverticula in subjects with bile duct stones were compared with those in age‐matched controls who had undergone upper gastrointestinal endoscopy using a side‐viewing endoscope (n = 100) or who had undergone endoscopic retrograde cholangiopancreatography (ERCP) for pancreatic cancer (n = 100). The frequencies of diverticula in subjects with primary duct stones (70%) and bile duct stones with current or previous gall‐bladder stones (25%) were significantly higher than in both control groups (7 and 8%, respectively). When subjects with bile duct stones were analysed by step‐wise logistic regression, age and bile duct diameter were independent predictors of the presence of diverticula, but diverticula were unrelated to gender, mode of presentation, number of bile duct stones and outcome after endoscopic sphincterotomy. A significant association exists between duodenal diverticula and bile duct stones, perhaps because diverticula predispose to stone formation through the combined effects of bile stasis and bacterial contamination of bile.
CASE REPORT: Radiological and endoscopic management of bile leak following laparoscopic cholecystectomy
Authors: SAMMAK BASSAM M , YOUSEF BUSHRA A , GALI MOHAMED H , KARAWI MOHAMED A AL , MOHAMED ABDULRAHMAN E
Published: March 2008

Due to the ever increasing popularity of laparoscopic cholecystectomy (LC), many radiologists and gastroenterologists have noticed an epidemic of bile duct injuries due to subsequent complications. We report on five cases of post‐LC minor bile duct injuries and document our preliminary experience in their management. Although the majority of minor bile leaks resolve spontaneously, particularly if a surgical drain has been left in situ, percutaneous drainage (PD) can be used alone or in addition to endoscopic management to treat symptomatic bile leaks and biloma formation. Bile leaks without associated abdominal collections should be first identified by endoscopic cholangiography followed by sphincterotomy and/or stenting. Surgery should only be reserved for cases of major bile duct injury if PD and endoscopic management have failed initially.
Effects of octreotide on liver regeneration and tumour growth in the regenerating liver
Authors: DAVIES N , YATES J , KYNASTON H , TAYLOR BA , JENKINS SA
Published: March 2008

The ability of the liver to regenerate following resection is remarkable. However, there is evidence to suggest that tumour growth within the regenerating liver is significantly increased. As octreotide (a synthetic analogue of somatostatin) inhibits the growth and development of hepatic tumour in rats, we have investigated its effects on liver regeneration, liver blood flow, hepatic reticuloendothelial system activity and tumour growth in the rat following partial hepatectomy (PH). Octreotide significantly inhibited liver regeneration in the rat 1 and 2 weeks following PH when compared with controls (regeneration index: 1.0 and 1.14 cf. 1.14 and 1.4, respectively). There was no significant difference in hepatic arterial or portal venous blood flow following PH in control or octreotide‐treated rats. However, portal pressure was significantly reduced in octreotide‐treated rats. Hepatic reticuloendothelial system activity was significantly increased in octreotide‐treated rats compared with control animals 1 and 2 weeks after hepatectomy (uptake of radiolabelled technetium‐99m albumin colloid: 2.2 and 3.9 cf. 1.6 and 1.9). The growth of both HSN (fibrosarcoma) and K12‐Tr (colonic adenocarcinoma) cells in the regenerating liver was significantly decreased by octreotide treatment compared with controls (median percentage hepatic replacement: HSN control 71.3%, Octreotide 8.4%, K12‐Tr Control 38.3%, Octreotide 4.5%). The results of the present study demonstrate that octreotide inhibits both liver regeneration and tumour growth following PH, possibly via a similar mechanism.
Functional ablation of afferent nerves aggravates dextran sulphate sodium‐induced colonic damage in rats
Authors: DOMEK MATTHEW J , BLACKMAN EDWARD I , KAO JOHN , ZHANG XIANG Y , IWATA FUMIHIRO , SENO KYOJI , LEUNG FELIX W
Published: March 2008

Dextran sulphate sodium (DSS) is an oral agent capable of inducing chronic diarrhoea and colonic inflammation and necrosis in rats. The role of the afferent nerves in this model of colonic mucosal damage is not known. The hypothesis that functional ablation of the capsaicin‐sensitive afferent nerves will aggravate DSS‐induced colonic damage in rats was tested. Capsaicin pretreatment was used to ablate afferent nerve function and DSS was administered in the drinking water. Control rats received vehicle pretreatment and water without DSS. There were significant correlations between diarrhoea score, mucosal neutrophil infiltration, mucosal necrosis, and anaemia. Capsaicin pretreatment increased diarrhoea score and colonic mucosal neutrophil infiltration in the rats with colonic damage after 2 or 14 days of DSS. In addition, it induced anaemia and mortality in rats after 14 days of DSS. The data supports the hypothesis that functional ablation of the capsaicin‐sensitive afferent nerves aggravates the colonic damage induced by DSS.
Management of ascites in cirrhosis
Authors: BATALLER RAMÓN , ARROYO VICENTE , GINÈS PERE
Published: March 2008

Ascites is one of the earliest and most common complications of patients with cirrhosis. A typical circulatory dysfunction characterized by arterial vasodilation, high cardiac output and stimulation of vasoactive systems is commonly present in these patients and is associated with a poor prognosis. The treatment of ascites has been based on the combination of a low‐sodium diet and the administration of diuretics. The reintroduction of paracentesis and the recent introduction of the transjugular intrahepatic portosystemic shunt (TIPS) are the most relevant innovations in the treatment of ascites during the past two decades, although controlled trials in large series of patients are needed to delineate whether TIPS is a safe and useful treatment for these patients.
Assessment of energy status and fructose metabolism of liver in obstructive jaundice by 31P magnetic resonance spectroscopy
Authors: KAINUMA OSAMU , ASANO TAKEHIDE , IKEHIRA HIROO , OGAWA ERI , ISONO KAICHI
Published: March 2008

The effect of cholestasis on hepatic energy status and fructose metabolism in jaundiced rats and patients was investigated using 31P magnetic resonance spectroscopy. Rats with obstructive jaundice (OJ group) were studied 7 days after bile duct ligation. Drainage rats were studied at 3 days (DR3 group) and 7 days (DR7 group) after the relief of 1 week obstruction of the common bile duct. In the bile duct ligated rat, the β‐adenosine triphosphate (ATP)/Pi (inorganic phosphate) ratio was significantly lower than in sham‐operated controls. This ratio recovered rapidly in the DR3 and DR7 groups. The maximum increase in the phosphomonoester peak (PMEmax) after an intravenous bolus of fructose was significantly reduced in both the OJ and DR3 groups, and was accompanied by a decrease in hepatic fructokinase activity. The PMEmax and the fructokinase activity recovered in the DR7 group. In a clinical study, the β‐ATP/Pi ratio in six healthy volunteers was comparable to that of 15 patients with obstructive jaundice, regardless of their biliary drainage status. The PMEmax in all patients (serum bilirubin ≥ 5 mg/dL), irrespective of biliary drainage, was significantly lower than in volunteers. Furthermore, the PMEmax in four of the eight patients with biliary drainage (serum bilirubin < 5 mg/dL) was lower than in volunteers. It is concluded that while energy status in jaundiced patients is well maintained, fructose phosphorylation is inhibited and recovery is delayed after the relief of obstruction compared with serum bilirubin. For the non‐invasive evaluation of damaged liver function in jaundice, 31P magnetic resonance spectroscopy is a useful technique.
The effect of cisapride on oral and intravenous glucose tolerance in normal subjects
Authors: WISHART JUDITH M , HOROWITZ MICHAEL , CAMPBELL JOANNE , JONES KAREN L
Published: March 2008

Cisapride is used widely for the treatment of diabetic gastroparesis. There is some evidence that cisapride may influence insulin secretion. The aim of this study was to evaluate the effect of cisapride on plasma concentrations of glucose, insulin and C‐peptide in response to oral and intravenous glucose loads. Twelve normal subjects took cisapride and placebo, each for 10 days using a randomized, double‐blind, crossover design. In each treatment phase, the plasma glucose, insulin and C‐peptide response to intravenous (0.5 g/kg) and oral (75 g) glucose loads was evaluated on separate days. Gastric emptying of the oral glucose load was also measured. After the intravenous glucose load, plasma concentrations of C‐peptide were higher (P < 0.01) on cisapride when compared with placebo (e.g. peak C‐peptide 2.08 ± 0.25 nmol/L vs 1.78 ± 0.22 nmol/L, P < 0.01) while there was no significant difference in plasma glucose or insulin. Cisapride had no effect on the rate of gastric emptying of the oral glucose load. Mean plasma concentrations of insulin and C‐peptide were higher after oral glucose on cisapride than placebo, but these differences were not significantly different. These observations indicate that cisapride may increase glucose‐stimulated insulin secretion.
Selective depletion of neutrophils by a monoclonal antibody, RP‐3, suppresses dextran sulphate sodium‐induced colitis in rats
Authors: NATSUI MASAAKI , KAWASAKI KATSUTOSHI , TAKIZAWA HIDEAKI , HAYASHI SHUN‐ICHI , MATSUDA YASUNOBU , SUGIMURA KAZUHITO , SEKI KEIICHI , NARISAWA RINTARO , SENDO FUJIRO , ASAKURA HITOSHI
Published: March 2008

Administration of dextran sulphate sodium to animals induces acute colitis characterized by infiltration of large numbers of neutrophils into the colonic mucosa, which histologically resembles human active ulcerative colitis. It has been reported that neutrophils and the reactive oxygen metabolites produced by them are involved in the progress of ulcerative colitis. This study was intended to clarify their roles by using this animal model. First, possible sources and species of reactive oxygen metabolites were determined using luminol‐dependent chemiluminescence with addition of enzyme inhibitors and reactive oxygen metabolite scavengers. Next, to examine whether neutrophils and hypochlorous acid derived from them contribute to tissue injury, we administered RP‐3, a monoclonal antibody capable of selectively depleting neutrophils, and taurine, a hypochlorous acid scavenger, to rats treated with dextran sulphate sodium. Addition of azide, taurine, catalase, superoxide dismutase and dimethyl sulphoxide into colonic mucosal scrapings significantly inhibited chemiluminescence production, but allopurinol and indomethacin had no effects. These results suggest that excessive hypochlorous acid, hydrogen peroxide, superoxide anion and hydroxyl radical are generated by the inflamed colonic mucosa. Intraperitoneal injections of RP‐3 significantly suppressed bleeding, tissue myeloperoxidase activity, chemiluminescence production and erosion formation. On the other hand, administration of taurine tended to inhibit bleeding and erosion formation to some extent, although it could not significantly suppress them. These data suggest that neutrophils play an important role in the development of this colitis and that hypochlorous acid might be one of the causes of tissue injury induced by neutrophils.
Helicobacter pylori infection and the risk of gastric cancer among the Korean population
Authors: KIM HAK Y , CHO BYUNG D , CHANG WOONG K , KIM DONG J , KIM YONG B , PARK CHOONG K , SHIN HYUNG S , YOO JAE Y
Published: March 2008

Helicobacter pylori infection has been associated with chronic atrophic gastritis, a precursor of gastric cancer. We conducted a prospective, case‐controlled study to investigate whether H. pylori infection increases the risk of gastric cancer in Korean people with a high risk of gastric cancer. We enrolled 160 gastric cancer patients who were confirmed by endoscopic biopsy during 1994 and 160 age‐matched control subjects with non‐ulcer dyspepsia were compared to document the relationship between H. pylori infection and gastric cancer. The presence of H. pylori infection was determined by the rapid urease test and/or histology by Wright‐Giemsa staining. The overall presence of H. pylori infection was 60% in gastric cancer patients and 51.9% in age‐matched control subjects (odds ratio 1.39; 95% confidence interval 0.894–2.17; P= 0.143). Carcinomas of cardia, body and antrum were not associated with H. pylori infection (odds ratio 1.43, 1.69 and 1.29, respectively; 95% confidence interval, 0.271–7.52, 0.787–3.62 and 0.689–2.43, respectively; P= 0.178, 0.177 and 0.642, respectively) nor was the intestinal or diffuse type of cancer (odds ratio 1.39 and 1.40, respectively; 95% confidence interval 0.791–2.45 and 0.681–2.87, respectively; P= 0.250 and 0.835, respectively). Gender was not a risk for gastric cancer. In contrast to previous studies, these results do not provide evidence of H. pylori infection for gastric carcinogenesis in Korea.
Hepatocellular carcinoma in the caudate lobe: Early diagnosis and active treatment may result in long‐term survival
Authors: LU CHING‐LIANG , WU JAW‐CHING , CHIANG JEN‐HUEY , LUI WING‐YIU , CHAU GAR‐YANG , LEE SHOU‐DONG
Published: March 2008

Hepatocellular carcinoma (HCC) in the caudate lobe is rare and the prognosis of patients with HCC in the caudate lobe has been reported to be poor. Resection for HCC in the caudate lobe has carried a higher rate of surgical risk and early recurrence. The effect of transcatheter arterial embolization (TAE) in treating HCC in the caudate lobe remains unknown. With the wide application of modern diagnostic modalities, we can now detect HCC at an earlier stage for active treatment (surgery or TAE). The aim of the present study was to analyse the effect of different treatments for HCC in the caudate lobe. From 1985 to 1994, 15 patients with HCC in the caudate lobe were retrospectively studied. Another 264 consecutive patients with newly diagnosed HCC treated by TAE were selected as the control group. Two patients underwent surgical resection and survived well without recurrence after 43 and 136 months, respectively. Ten patients underwent TAE and their survival rate was similar to that of the 264 consecutively TAE‐treated controls with HCC not in the caudate lobe (P=0.19). The 1, 3 and 5 year survival rates for TAE‐treated patients in the caudate lobe were 67.7, 31.1 and 12.6%, respectively, while in controls these figures were 53.0, 18.4 and 9.1%, respectively. Two of the three patients receiving supportive treatment died within 1 month after diagnosis. Those patients having a smaller solitary tumour without intrahepatic metastasis tended to survive longer. In conclusion, HCC in the caudate lobe does not always indicate a poor prognosis so long as early detection and active treatment (surgery or TAE) are available. Transcatheter arterial embolization may act as an alternative treatment modality for patients with HCC in the caudate lobe.
Colonic retinoblastoma protein and proliferation in cancer and non‐cancer patients#
Authors: KOHN GERALD J , SCHWARTZ HENRY J , RUEBNER BORIS H , WONG ANNA J , LAWSON MICHAEL J
Published: March 2008

Both suppressor oncogene and proliferative activity are believed to indicate colon cancer risk. The retinoblastoma (Rb) gene is a suppressor oncogene affecting cell differentiation. Retinoblastoma gene inactivation is associated with tumour development. However, the relation of the Rb protein to cell proliferation and colon tumour formation is unknown. Retinoblastoma protein quantity was correlated with proliferative activity in flat, unaffected mucosa specimens from 36 cancer patients, 21 non‐cancer control subjects and in 29 tumour tissue samples from cancer patients. Nuclear Rb protein was measured by using automated CAS‐200 image analysis of monoclonal antibody labelled frozen sections from fresh, surgically removed tissue. All colon cells within 15 whole crypts were imaged. Proliferative activity was also measured by using image analysis with Ki‐67 monoclonal antibody. Retinoblastoma protein content correlated directly with proliferative activity in flat mucosa of non‐cancer control subjects (r= 0.63; P < 0.001; n= 21). A significant correlation was also found in flat mucosa specimens of non‐metastatic (Duke's stages A and B) cancer patients (r=0.52; P < 0.01; n= 22). However, Rb protein did not correlate with proliferation in flat mucosa from metastatic (Duke's stages C and D) cancer patients (r=0.03; NS; n=14) or in cancer tissue (r=0.068; NS; n=29). Mucosal Rb protein in the colon normally increases as proliferation increases. Dissociation between Rb protein and colon proliferation may occur in flat mucosa in patients with a higher risk of metastatic tumour growth. Future studies comparing Rb protein quantity and proliferative activity may help identify high‐risk colon cancer patients.
CASE REPORT: Primary hepatic lymphoma associated with chronic liver disease
Authors: HIGUCHI TAKAKAZU , NOMOTO KAZUHIKO , MORI HIRAKU , NIIKURA HARUO , OMINE MITSUHIRO , SEKIYAMA KAZUHIKO , YOSHIBA MAKOTO , FUJITA RIKIYA
Published: March 2008

We report on a case of primary hepatic lymphoma that developed in a patient with chronic hepatitis C. Given that Japan is an area endemic for both hepatitis B and C viruses, we reviewed 51 Japanese cases of primary hepatic lymphoma, addressing the question as to whether the Japanese cases have unique characteristics and whether there is a causal relationship to the presence of chronic liver disease. Primary hepatic lymphoma most commonly affected middle‐aged males. Presenting symptoms and physical findings were non‐specific. Aminotransferases tended to stay in the low range compared with marked increases in lactate dehydrogenase. Sixteen patients (31%) had chronic liver disease, eight had liver cirrhosis and eight had chronic hepatitis, suggesting that there is a possible aetiological link between chronic liver disease and primary hepatic lymphoma.
Hepatitis B infection and changes in interferon‐α and ‐γ production in patients with systemic lupus erythematosus in Taiwan
Authors: LU CHING‐LIANG , TSAI SHIH‐TZU , CHAN CHO‐YU , HWANG SHINN‐JANG , TSAI CHANG‐YOUH , WU JAW‐CHING , LU RUEY‐HWA , LIN BAO‐CHERNG , LEE SHOU‐DONG
Published: March 2008

According to previous reports, the prevalence of hepatitis B virus (HBV) infection in patients with systemic lupus erythematosus (SLE) is varied. There has been no report on Taiwan, a hyperendemic area for HBV infection. Furthermore, impaired production of interferon (IFN) in peripheral blood mononuclear cells (PBMC) has been reported to be potentially pathogenic to both chronic HBV infection and SLE. However, the production of IFN in patients with both diseases coexisting is unknown. The aims of this study were to evaluate the prevalence of HBV infection in lupus patients in Taiwan and to measure the production of IFN in patients with both diseases coexisting. One hundred and seventy‐three consecutive lupus patients and a control group of 692 ageand sex‐matched healthy subjects were included for evaluation of the prevalence of HBsAg. Four groups of subjects (patients with SLE and HbsAg, SLE, chronic hepatitis B and normal controls) were selected for evaluation of the in vitro production of IFN‐α and ‐γ. Six (3.5%) of the 173 SLE patients were positive for HBsAg, which was significantly lower than that of controls (14.7%; P< 0.0001). Patients with coexistent SLE and chronic HBV infection had less lupus activity, including less proteinuria (P= 0.02) and a lower serum titre of anti‐double stranded DNA antibodies (anti‐dsDNA; P= 0.04), than HBsAg‐negative lupus patients. The in vitro production of IFN‐α in patients with chronic hepatitis B was significantly lower than in those patients with SLE or in the normal control group (P<0.01). The yields of IFN‐α and ‐γ in patients with coexistent SLE and chronic HBV infection were significantly different from those patients with SLE alone (P<0.05), but close to those of patients with chronic HBV infection. In conclusion, the prevalence of HBsAg carriers is significantly lower in lupus patients in Taiwan. Patients with coexistent SLE and chronic HBV infection had less lupus activity. Interferon‐α and ‐γ may play a role in the above phenomenon.
Seroepidemiological study on hepatitis delta virus infection in the Irabu Islands, Okinawa, Japan
Authors: SAKUGAWA HIROSHI , NAKASONE HIROKI , SHOKITA HAYASHI , KAWAKAMI YUKO , NAKACHI NORIYA , ADANIYA HIROSHI , MIZUSHIMA TAKUJI , NAKAYOSHI TOMOFUMI , KINJO FUKUNORI , SAITO ATSUSHI , TAIRA MASAAKI , TAKAESU HITOSHI , ONGA NAOKIYO
Published: March 2008

A seroepidemiological study was performed to clarify the prevalence of hepatitis delta virus (HDV) infection among the general population in the Irabu islands, Okinawa, Japan. Of 2028 healthy people examined who had received their annual health check‐up in 1994–95, 195 (9.6%) were positive for hepatitis B surface antigen (HBsAg). Of these 195 HBsAg‐positive individuals, 46 (23.6%) showed a positive reaction for antibody to HDV (anti‐HDV). The positivity rate of anti‐HDV among HBsAg‐positive subjects tended to increase with age up to 50–59 years of age. The prevalence of anti‐HDV also varied among the seven districts in the islands (0–63.3%). None of the anti‐HDV‐positive subjects was included in the high risk group for parenterally transmitted diseases. The unusually high prevalence of anti‐HDV among HBsAg‐positive individuals, particularly in the older age groups, seemed to reflect the natural prevalence or previous HDV infection, rather than a current or imported infection of HDV. Although the great majority of HBsAg‐positive subjects with anti‐HDV were asymptomatic, abnormally high values of serum transaminases were more frequently seen in these subjects compared with HBsAg‐positive subjects without anti‐HDV.
Susceptibility of experimental autoimmune hepatitis in transgenic mice overexpressing the c‐H‐ras gene
Authors: TSUNEMATSU SATOSHI , SAITO HIDETSUGU , TADA SHINICHIRO , EBINUMA HIROTOSHI , TSUCHIYA MASAHARU , KUMAGAI NAOKI , MORIZANE TOSHIO , NOMURA TATSUJI , ISHII HIROMASA
Published: March 2008

Results from a recent study of ours have demonstrated the significant role of the wild‐type ras gene in the development of hepatocellular carcinoma in rasH2 mice having prototype human c‐H‐ras genes. Chronic cell death and regeneration have been considered to work as co‐carcinogens with wild‐type ras gene overexpression in this model. To elucidate a role of gene overexpression in the occurrence of chronic inflammation, we tried to induce inflammation in the liver of rasH2 mice by immunizing them with the supernatant of a freshly prepared syngenic liver homogenate. Immunization resulted in a dense inflammatory infiltrate in the portal tract and focal necrosis with spots of fatty or foamy degeneration in the transgenic mouse liver; however, these observations were less frequently observed in non‐transgenic mouse liver. Monocytes, granulocytes and plasma cell infiltration were observed in the livers of transgenic mice. An immunohistochemical study showed that CD3‐positive lymphocytes also infiltrated the liver. The inflammatory infiltrate was still present in the transgenic liver 24 weeks after the last injection, but little infiltrate was observed at the same time in non‐transgenic mice. No hepatic tumours could be produced over the 6 months duration of the study and the results are only preliminary. However, these results do suggest that overexpression of wild‐type ras is partially responsible for the occurrence of autoimmune chronic hepatitis.
An overview of gastrointestinal and hepatobiliary diseases in Thailand
Authors: KULLAVANIJAYA PINIT
Published: March 2008

This review article discusses the present state of gastrointestinal and hepatobiliary diseases in Thailand. Comparisons are made with Western countries and more specific diseases such as hepatoma, cholangiocarcinoma and liver abscesses are also described.
Past, present and future of gastroenterology in Japan: The 100th anniversary of the Japanese Society of Gastroenterology in 1998
Authors: SATO NOBUHIRO , AOKI TERUAKI , TAKEMOTO TADAYOSI
Published: March 2008

The Japanese Society of Gastroenterology (JSGE) will celebrate the centenary of its foundation in 1998. A variety of plans and projects are being prepared by the JSGE centennial celebration committee. In this article, the history of the JSGE is briefly described, and several projects, including the international symposium currently being planned, are introduced. The future prospects of our Society will also be described.
Increased prevalence of Helicobacter pylori infection among patients affected with intestinal‐type gastric cancer at non‐cardiac locations
Authors: WU MING‐SHIANG , CHEN SHU‐YUAN , SHUN CHIA‐TUNG , LEE WEI‐JEI , WANG HSIU‐PO , WANG TEH‐HONG , CHEN CHIEN‐JEN , LIN JAW‐TOWN
Published: March 2008

Previous data on the association of Helicobacter pylori infection with gastric cancer by demographic or histological features are inconsistent due to a univariate analysis of limited case numbers. The aim of the present study was to determine such an association by the use of a large series of patients and multiple variables analysis. The serum IgG antibodies against H. pylori were measured in 397 patients with histologically verified gastric cancer. A multiple logistic regression analysis was used to define the association between seropositivity and demographic or tumour characteristics of gastric cancer. The overall seropositivity of H. pylori was 63%. In univariate analysis, the prevalence was significantly lower among patients with cardia (50%) or diffuse‐type (56.6%) cancers than those with non‐cardia (64.8%) or intestinal‐type (70.3%) cancer (P<0.05 and P<0.01, respectively). There was no statistical difference between H. pylori infection rate and gender, age or tumour stage. A multiple logistic regression analysis showed tumour location and histology remained significant factors associated with seropositivity of H. pylori with an odds ratio of approximately 2.0. Analysis of combined histology and location revealed that patients with intestinal‐type cancer at non‐cardia locations had the highest odds ratio of 3.93 (95% confidence interval (CI): 1.55–10.0) compared with the lowest odds ratio of 0.69 (95% CI: 0.30–1.62) in diffuse cardia cancer (P< 0.005). Our data indicate H. pylori infection in gastric cancer is independently affected by the histological subtype and by tumour location.
Enteral branched‐chain amino acids increase the specific activity of jejunal glutaminase and reduce jejunal atrophy
Authors: McCAULEY ROSALIE D , HEEL KATHRYN A , HALL JOHN C
Published: March 2008

Branched‐chain amino acid (BCAA)‐enriched nutrient solutions reduce gut atrophy associated with parenteral nutrition. We hypothesized that this effect was mediated by phosphate‐dependent glutaminase. Thirty male Wistar rats (300–350 g) underwent a standardized surgical procedure and were then randomized into three groups to receive 6 days of ad libitum enteral nutrition. The animals were fed a solution of conventional nutrients, a solution of conventional nutrients enriched with 2.0% BCAA or a solution of conventional parenteral nutrients enriched with 2.5% glutamine. When compared with rats fed conventional nutrients, rats fed BCAA and glutamine had less jejunal atrophy (P< 0.05) and a greater specific activity of phosphate‐dependent glutaminase in the jejunum (131%; P< 0.05). It is concluded that enteral BCAA reduce atrophy of the jejunum via the generation of glutamine.