bluuebunny/crossref_metadata_2025 huggingface dataset:
Zinc sulphate solution enema decreases inflammation in experimental colitis in rats
Authors: Chen Bao‐Wen , Wang Hua‐Hong , Liu Jian‐Xiang , Liu Xin‐Guang
Published: March 2003

Background
: It has been reported that zinc sulphate contributes an anti‐inflammatory action in many animal models; however, the impact of zinc in colitis remains unclear. The aim of the present study was to examine the role of zinc sulphate in experimental colitis.

Methods
: Colitis was induced by 2,4,6‐trinitrobenzenesulphonic acid (TNB) in rats. Beginning at the first day of TNB colitis, the rats were treated with a zinc sulphate enema once daily for 6 days. The rats were examined 8 days later.

Results
: The TNB induced severe colitis as evidenced by increased mucosal lesion area, mucosal myeloperoxidase (MPO) activity and prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) levels. Six days after the application of the zinc sulphate enema, the mucosal lesion area, MPO activity, PGE2 and LTB4 levels all decreased significantly. Mucosal superoxide dismutase activity remained unchanged after zinc treatments.

Conclusions
: Our data suggest that zinc sulphate enemas have an anti‐inflammatory action on experimental colitis.

© 1999 Blackwell Science Asia Pty Ltd
Influence of endoscopic variceal ligation on oesophageal motility
Authors: Chen Sam‐Ming , Lo Gin‐Ho , Lai Kwok‐Hung , Jeng Jing‐Shiung , Shen Ming‐Tse , Huang Rong‐Long , Chang Chia‐Fu , Lin Chiun‐Ku , Wang E‐Ming
Published: March 2003

Background: To determine the change of oesophageal manometry in patients with oesophageal varices before and after oesophageal variceal ligation (EVL).

Methods: Forty‐five patients who had liver cirrhosis and oesophageal varices with high risk of bleeding were managed by EVL. Oesophageal manometry was performed just prior to the ligation and 4–6 weeks after obliteration of varices. Another 45 age‐ and sex‐matched patients without hepatic, oesophageal or systemic disease served as the control group.

Results: At 5 cm above the lower oesophageal sphincter (LES), the amplitude of the contractive wave was significantly lower in patients before EVL (56.9 ± 31.8 vs 80.1 ± 30.1, P < 0.05) and returned to the level of control subjects after EVL (76.5 ± 37.0 vs 80.1 ± 30.1, P > 0.05). At 10 cm above LES, the amplitude of the contractive wave was significantly lower in patients before and after EVL than the control group (54.3 ± 29.2 vs 68.1 ± 29.5, 54.2 ± 26.0 vs 68.1 ± 29.5, respectively, P < 0.05). The percentage of tertiary waves was significantly higher in patients before and after EVL than in the control group (31.4 ± 36.6 vs 5.8 ± 15.1, 26.9 ± 32.9 vs 5.8 ± 15.1, respectively, P < 0.05). However, no significant swallowing disturbance was noted in patients after EVL. There was significantly greater LES length in patients before EVL (4.0 ± 0.9 vs 3.4 ± 0.7, P < 0.05) but there was no significant difference in the LES length after EVL as compared with the control group. Eighty‐six per cent (39/45) of patients developed para‐oesophageal varices and 31% (14/45) developed new varices 6 months after variceal obliteration. However, there was no significant difference in manometry at the time of variceal obliteration between patients with variceal recurrence and those without.

Conclusions: The presence of varices affected oesophageal motility. However, such abnormality had little clinical significance. Endoscopic variceal ligation normalized oesophageal motility and may not induce abnormal oesophageal motility. The manometric change can not be used to predict the recurrence of varices in cirrhotic patients after variceal obliteration.
HELICOBACTER PYLORI INFECTION AMONG KINDERGARTEN CHILDREN IN MATARAM
Authors: Sumarsidi Didacus , Gunawan Stephanus , Sumoharjo Suwignyo , Muttaqin Zainul , Astiti Luh Gde Sri , Rosalina Rina
Published: March 2003

Objective

The prevalence of Helicobacter pylori infection in developing countries is relatively high due to the improper hygiene and sanitation. In the developing countries the infection started in very early age. The prevalence of Anti‐Helicobacter pylori among blood donor in Mataram is among the highest in Indonesia. The objective of this study is to measure antibody to Helicobacter pylori in Kindergarten children using Passive Hemaglutination (PHA) method that had been proven to have a high sensitivity and specificity compared to the results of Helicobacter pylori culture.

Material and Method

The venous blood were drawn from 441 kindergarten children aged 3 ‐ 7 years old, consist of 207 female and 234 male. The sera was assayed for antibody to Helicobacter pylori using Passive Hemaglutination Method (PHA) consist of glutaraldehyde fixed type O human erythrocyte coated with purified outer antigen of Helicobacter pylori.

Result

Anti‐Helicobacter pylori was positive using PHA in 216 children (49.4%), consist of 111 female (53.5%) and 107 male (45.7%). Statistic analysis shows no statistically significant difference in Anti‐Helicobacter pylori prevalence between male and female (chi square p>0.05). Children from relatively high social economic level showed lower Anti‐Helicobacter pylori (41.01%) compared with children from lower socioeconomic level (55,13%) and the difference is statistically significant (chi square p < 0.05).

Conclusion

In Mataram Helicobacter pylori infection were acquired at very early age so that in preschool age almost 50% of the children have been infected with Helicobacter pylori. The prevalence of Helicobacter pylori infection is higher in the low socioeconomic compared to high socioeconomic level.
PROFILE OF PEPTIC ULCER DISEASE IN THE ELDERLY
Authors: Kahna Sudeep , Joshi Anoop , Ahuja Vineet , Sharma. M.p
Published: March 2003

Background

Peptic ulcer disease has protean manifestations in various age groups

Aim

To compare the clinical presentation and outcome of peptic ulcer disease in the elderly ( >60 year) with age group less than 60 years.

Methods

This was a single center prospective study. The study subjects comprised of patients of peptic ulcer disease divided into 2 groups: ,<60 year and > 60 year. A total of 40 patient of endoscopically proven peptic ulcer were included with 20 patient in each age group. Detection of Helicobacter pylori was done by C14 urea breath test (UBT) and rapid urease test (RUT). Eradication therapy for Hp was given to patients who were either RUT or UBT positive. At the end of 6 weeks after completion of eradication regime endoscopy was repeated to look for ulcer healing and Hp eradication. A repeat endoscopy at 6 months was done for checking recurrence of ulcer or Hp.

Results

Conclusions

There is no increases prevalence of gastric ulcer in the elderly. Ina elderly, peptic ulcer disease presents more often with bleeding. There are no significant differences in eradication and recurrence rates of H. pylori in elderly as compared to the younger age group.
ENDOSCOPIC AND HISTOPATHOLOGIC PICTURE OF GASTRIC MUCOSA IN GASTRITIS PATIENT WITH HELICOBACTER PYLORI INFECTION
Authors: G Siregar , Hakim Zain Lukman , P Tarigan , S Pardede , G Tambunan
Published: March 2003

Background

Helicobacter pylori (HP) can colonise beneath layer of mucous on the surface of gastric epithelial cell caused chronic infection more than 95% at antrum (chronic antral inflammation) besides corpus with spreading inequitably. This inflammation can cause gastric lesion as a Gastritis Gastric Ulcer (GU), Duodenal Ulcer (DU) or cancer. Absence of chronic antral inflammation (increased number of mononuclear cells in lamina propria) is a highly specific methode to exclude HP infection.

Objective

To investigated endoscopic mucosal lesion in Gastritis and histologic picture of gastric mucosal HP infection

Method

This study was performed in 50 patient with gastroscopic lesion with Gastritis and CLO test positive HP was evaluated by modified Giemsa staining and gastritis by Hematoxiline and eosin (H and E) staining in the antrum and corpus.

Result

Reported in the Third Western Pacific Helicobacter Congress, June 22‐24 Bali Indonesia.
CagA NEGATIVE STATUS IS ASSOCIATED WITH A HIGH RATE OF RECURRENCE OF H. PYLORI FOLLOWING ERADICATION IN INDIAN PATIENTS WITH DUODENAL ULCER
Authors: Ahuja Vineet , Arur Swathi , Kumar Dinesh , Sharma. M.p
Published: March 2003

Background and Aim

High prevalence of H. pylori (Hp) in developing countries may result in high reinfection rates. The study was aimed to determined the reinfection rate and duodenal ulcer (DU) reccurence and to determine whether they correlated with Cag A status of Hp isolates.

Methods

106 patients with DU proven by endoscopy and who were positive for Hp (rapid urease test C‐14 urea breath test, and culture) were given triple therapy for Hp eradication. Patients were followed post eradication at 3 months and then every 6 month with endoscopy and tests for Hp. Cag A positivity was determined by polymerase chain reaction.

Results

106 patients had a mean follow up of 15.3 month (3‐48 months). 74 (70%) of the 106 patients were found to be Hp negative after therapy. 19 (26%) of these 74 patients were againt found to be Hp positive with a recurrence rate of 14.6% per year. Duodenal ulcer recurred in 14 of these 19 patients (73.6%) and in none of 55 non reinfected patients. Cag A status was determined in 44 patients. Of the 33 patients in which Cag A was negative ulcer recurred in 5 (45.5%) patients. (p value < 0.07).

Conclusion

There was a high rate of recurrence of H. pylori and duodenal ulcer following Hp eradication. Cag A negative status in Hp isolates is associated with a higher rate of recurrence.
FUNCTIONAL MUTATION OF P53 GENE DETECTED BY NOVEL YEAST ASSAY IN THE STOMACH OF MONGOLIAN GERBIL INFECTED WITH H.P
Authors: Sugiyama T. , Ishizuka J. , Asaka M.
Published: March 2003

Aim:

Helicobacter pylori (Hp) is a definite carcinogen in human gastric cancer and is proven to induce gastric cancer in Mongolian gerbil (MG) infected with H. pylori. Major disadvantage in MG model is to lack specific reagents and genetic informations for investigation. In this study, we cloned p53 gene of MG and established a functional mutation assay by using yeast system and detected it in the stomach of MG infected with H. pylori.

Methods:

1) RNA was extracted from MG liver and p53 cDNA was cloned by RT‐PCR and RACE methods. 2) cDNA of p53 in the stomach, intestine and other tissues were amplified by RT‐PCR and was transfected into yeast IG397 with pLSGP53 vector. After transfection, cDNA of p53 was ligated in the vector by homologous recombination and produced p53 protein in yeast. 3) The stomach of MG infected with H. pylori up to 142 weeks was studied.

Results:

1) p53 protein of MG had 76.2% homology to human p53, 61.4% in N‐terminal, 87.8% in DNA binding domain and 72.2% in C‐terminal. 2) Functional mutation rate (red yeast colony) of p53 in stomach, intestine, liver, brain without H. pylori infection were less than 10%. 3) Two of 16 stomachs infected with H. pylori showed significantly high percentage of red colony, 117 week‐infected MG. 4) p53 cDNA with red yeast colonies derived from 106 week‐infected MG stomach was sequenced and they showed clonal mutation.

Conclusion:

One of 16 stomachs infected with H. pylori demonstrated clonal mutation of p53 and lost the transcriptional activity of wild type p53. This novel assay is useful for detecting a functional mutation of p53 of MG infected with H. pylori
Increase in CD95 (Fas/APO‐1)‐positive CD4+ and CD8+ T cells in peripheral blood derived from patients with autoimmune hepatitis or chronic hepatitis C with autoimmune phenomena
Authors: Ogawa Shin , Sakaguchi Kohsaku , Takaki Akinobu , Shiraga Kunihiro , Sawayama Tomoyuki , Mouri Hirokazu , Miyashita Manabi , Koide Norio , Tsuji Takao
Published: March 2003

Background
: The expressions of CD95 (Fas/APO‐1) and Bcl‐2 are determinants of apoptosis in normal lymphocytes, and abnormalities in their expressions might contribute to the induction of autoimmunity. In this study, we examined the expressions of CD95 and Bcl‐2 on freshly isolated T and B cells from patients with autoimmune hepatitis (AIH) or chronic hepatitis C associated with autoimmune phenomena (CH‐C(AI)).

Methods
: The CD95 and Bcl‐2 expressions within CD4+ T, CD8+ T, and CD19+ B cell subsets were analysed by two‐colour flow cytometry.

Results
: The surface expression of CD95 was significantly high in both the CD4+ T and CD8+ T cell subsets derived from the patients with AIH and those with CH‐C(AI), compared with expression in patients with CH‐C and normal subjects. The increase in CD95 expression was associated with the phenotypic conversion of naive CD45RO– to primed CD45RO+ CD4+ T cells. Bcl‐2 was detected in the vast majority of peripheral T and B cells. There was no significant difference in the percentage of Bcl‐2‐positive cells in the CD4+ T cell, CD8+ T cell and CD19+ B cell subsets among the patient groups and normal subjects.

Conclusions
: These results indicate that an increase in CD4+ T cells expressing CD45RO and CD95 marks an important subset of AIH and CH‐C(AI) patients. These expanded CD95+ CD45RO+ primed T cells most likely reflect a continuous antigen‐specific or non‐specific activation of T lymphocytes, and/or the persistent presence of activated lymphocytes as a consequence of abnormalities in the peripheral deletion of activated lymphocytes. These persistently activated lymphocytes might play a role in the induction of autoimmunity in AIH and CH‐C(AI).
Predictors of the efficacy of interferon therapy for patients with chronic hepatitis C before and during therapy: how does this modify the treatment course?
Authors: Shiratori Yasushi , Omata Masao
Published: March 2003

Antiviral therapy for hepatitis C virus (HCV) infection should be based on the natural history of HCV infection; there is a sequential, but slow, progression from chronic hepatitis to cirrhosis, leading to death from either liver failure or hepatocellular carcinoma (HCC). The risk of HCC development increases in association with the advance of fibrosis, and antiviral therapy can reduce this risk. More than 30 indices have been proposed as ‘predictors’ of favourable response to IFN therapy: host factors (age, gender, duration of HCV‐infection, alcohol intake, hepatic iron stores, platelet count, histological staging of the liver disease), viral factors (HCV RNA levels in serum, HCV subtype, diversity of the hypervariable region, mutation of non‐structure 5A gene), and IFN factors (dose, duration of treatment, type, treatment regimens i.e. every day vs three times a week, escalating dose regimen). Before starting IFN therapy, HCV subtype and pretreatment HCV RNA load, as well as the fibrotic stage of the liver, should be determined. The response to IFN therapy should be monitored by the HCV RNA status in serum during therapy, and the treatment regimen modified, or discontinued as required. A sustained virological response should be checked at more than 3 months after the completion of therapy. Even though the risk of HCC is markedly reduced in sustained responders, it is possible to develop HCC several years after completion of IFN therapy.
Role of apoptosis in Helicobacter pylori‐associated gastric mucosal injury
Authors: Suzuki Hidekazu , Ishii Hiromasa
Published: March 2003

Apoptosis, a programmed cell death, was ignored, just like Helicobacter pylori, only to reappear recently. However, the number of current publications dealing with apoptosis or H. pylori has increased exponentially. Although gastric epithelial apoptosis is a programmed physiological event in the superficial aspect of the mucosa and is important for healthy cell turnover, H. pylori infection reportedly promotes such a cell death sequence. Because apoptosis regulates the cycle of cell turnover in balance with proliferation, dysregulation of apoptosis or proliferation evoked by H. pylori colonization would be linked to the gastric carcinogenesis. In other words, a reduced level of apoptosis could contribute to the generation of gastric cancer. Herein, we review apoptosis as well as its associated pathological events, such as hyperproliferation, in H. pylori‐colonized gastric mucosa.
Role of serum C‐reactive protein as a marker of hepatocellular carcinoma in patients with cirrhosis
Authors: Lin Zu‐Yau , Wang Liang‐Yen , Yu Ming‐Lung , Chen Shinn‐Cherng , Chuang Wan‐Long , Hsieh Ming‐Yuh , Tsai Jung‐Fa , Chang Wen‐Yu
Published: March 2003

Background
: The usefulness of C‐reactive protein (CRP) as a tumour marker in patients with hepatocellular carcinoma (HCC) is controversial. The purpose of this study was to determine whether CRP estimation could be used to identify patients with HCC among those with cirrhosis.

Methods
: Serum levels of CRP and α‐fetoprotein (AFP) were investigated in 122 previously untreated patients with cirrhosis and HCC. Another 76 patients with cirrhosis alone were also investigated as controls.

Results
: Of the subjects tested, 47.5% of patients with HCC and 39.5% of controls had elevated CRP values (> 6 μg/mL). Although using elevated CRP and/or AFP (> 20 ng/mL) as a criterion showed a significant difference between controls and patients with multiple nodular, massive, or diffuse type HCC (all P < 0.005), the clinical application of this criterion was limited because of low specificity (58%) and accuracy (all < 73%). By using receiver‐operating characteristic curves no valuable threshold value of CRP was found to discriminate various types of HCC, except for distinguishing the diffuse type from controls. The CRP value of 12 μg/mL could be used as the cut‐off value to differentiate diffuse‐type HCC from controls (sensitivity 82.4%, specificity 82%, accuracy 82.1%, P < 0.005).

Conclusions
: Serum CRP is not a good marker for HCC. However, very high values of CRP in patients with cirrhosis may suggest the presence of a diffuse‐type HCC.
Budd–Chiari syndrome: Our experience of 71 patients
Authors: Singh V , Sinha Sk , Nain Ck , Bambery P , Kaur U , Verma S , Chawla Yk , Singh K
Published: March 2003

Background
: Hepatic venous outflow obstruction (Budd–Chiari syndrome) is frequently encountered as a cause of portal hypertension at our centre.

Methods and Results
: We studied the clinical presentation, therapeutic modalities and outcome of 71 patients with hepatic venous outflow obstruction between 1992 and 1997. Twenty‐seven patients presented with acute disease, while 44 had chronic presentation. Abdominal pain, distension, jaundice and upper gastrointestinal bleeding were the commonest presenting symptoms. The majority of patients had distended veins, hepatomegaly, splenomegaly, ascites and ankle oedema. The diagnosis was made on the basis of inferior vena cavography/functional hepatography and pulsed Doppler ultrasonography and/or liver biopsy in 39 patients and pulsed Doppler ultrasonography and/or liver biopsy in 32 patients. Pulsed Doppler ultrasonography accurately detected the site of the block in 31 of 39 patients (79.4%). The obstruction was in the hepatic vein in 20 patients, in the inferior vena cava in 10, and in both in 41 patients. Aetiologically, four had pregnancy‐related disease, four tumour‐related, three hypercoagulable states, 18 inferior vena cava membranes and 42 were idiopathic. Of 30 patients in whom liver biopsy was carried out, eight had centrizonal congestion and necrosis, 13 had mixed features and nine had established cirrhosis. Seven patients underwent a shunt operation and surgical membranotomy was carried out in one. Three patients (4.2%) died in the hospital.

Conclusions
: Hepatic venous outflow obstruction is a common problem; patients present with abdominal pain, distension, jaundice, distended veins, ascites and ankle oedema. Chronic presentation is more frequent. Pulsed Doppler ultrasound, venography and liver biopsy are very helpful in diagnosis.
Oesophageal pH monitoring in infants: Elimination of gastric buffering does not modify reflux index
Authors: Hegar Badriul , Vandemaele Kris , Arana Albaro , Vandenplas Yvan
Published: March 2003

Background
: Oesophageal pH monitoring is considered to be the gold standard investigation in the diagnosis of gastro‐oesophageal reflux disease. Results of pH monitoring in regurgitating infants, however, may be within normal ranges. Therefore it was hypothesized that prolonged buffering of gastric acidity caused by milk‐feeding may falsely normalize the pH data. Therefore, it may be relevant to omit the periods of gastric acid buffering in the analysis of the oesophageal pH monitoring data.

Methods
: Combined gastric and oesophageal pH monitoring (Digitrapper Mark III, two‐channel antimony electrode, Synectics) was performed in 90 consecutive infants, 0.5–10 months old, who were referred to the unit by outdoor paediatricians for pH measurement. The data were analysed in three different ways. The reflux index (RI), or the percentage time that the pH in the oesophagus was < 4.0, was calculated in three different ways: (i) the total duration of the investigation; (ii) excluding 90‐min postprandial periods, starting from the beginning of a feeding; and (iii) excluding all periods with a gastric pH > 4.0, which are the periods of gastric buffering with a theoretical impossibility of recording an oesophageal pH < 4.0.

Results
: The mean duration of the pHmetries was 19.20 ± 2.01 h (A; mean ± 1 SD), with a RI of 5.38 ± 5.39% (B; median 3.45%). If the 90‐min postprandial periods were not considered, the mean duration decreased to 12.21 ± 2.41 h (C; P(A vs C) < 0.001), with an oesophageal RI of 6.82 ± 6.57% (D; median: 4.65; P(B vs D) = NS; r (B vs D) = 0.97). If all periods with a gastric pH > 4.0 were elminated, the duration available for analysis of the data with a gastric pH < 4.0 was 12.53 ± 4.00 h (E; P(A vs E) < 0.001; P(C vs E) = NS), with an oesophageal RI of 7.06 ± 7.52% (F; median: 4.50; P(B vs D vs F) = NS; r(B vs F), (D vs F) = 0.96).

Conclusion
: Overall the data do not support a benefit from including periods of gastric buffering in the routine analysis of oesophageal pH monitoring data. Therefore standard oesophageal pH monitoring should be with a single electrode and should not include periods of gastric buffering.
Clinical relapse in Whipple's disease despite maintenance therapy
Authors: Garas George , Abrugiato Robert , Forbes Geoff M
Published: March 2003

Abstract Whipple's disease is a multisystem disorder that was first reported just over 100 years ago. Only recently, the bacillus responsible for the condition was identified and subsequently cultured. However, differences of opinion remain regarding the best antibiotic regimen and duration of therapy at primary diagnosis and there is also great uncertainty about the management of disease relapse. We report a case of clinical relapse of Whipple's disease in a man who was on a prolonged therapy with trimethoprim‐sulfamethoxazole. We describe his management and review the literature on the treatment of this condition, with particular reference to the recurrence of the disease.
Overexpression of c‐H‐ras p21 is correlated with vascular endothelial growth factor expression and neovascularization in advanced gastric carcinoma 1
Authors: Kim Young‐Bae , Han Jee Young , Kim Tae Sook , Kim Pum Soo , Chu Young Chae
Published: March 2003

Background and Aims

ras Gene and its product (p21) have been reported to be associated with vascular endothelial growth factor (VEGF), which is one of the most important angiogenic factors, and tumor‐associated angiogenesis. We tried to evaluate the correlation between the expression of c‐H‐ras gene product p21 and angiogenesis in advanced gastric carcinoma.

Methods

Immunohistochemical expression of c‐H‐ras p21 and VEGF was examined in 49 advanced gastric adenocarcinomas. In addition, double immunohistochemical staining was performed using anti‐CD34 and anti‐Ki‐67 antibodies, and the intratumoral microvessel densities and their endothelial proliferative labeling indices were then counted to evaluate the degree of angiogenesis.

Results

The expression of c‐H‐ras p21 was demonstrated in 43 out of 49 gastric adenocarcinomas (87.8%). It did not correlate with histologic type, depth of invasion or metastasis. However, the degree of c‐H‐ras p21 expression was correlated with VEGF. In addition, the degree of c‐H‐ras p21 expression was correlated with increased intratumoral microvascular density and endothelial proliferative activity.

Conclusions

We suggest that c‐H‐ras oncogene product p21 contributes to the upregulation of tumor‐associated angiogenesis by the increased production of VEGF in advanced gastric carcinomas. Therefore, treatment involving the targeting of ras oncogene could inhibit solid tumor growth by suppressing tumor‐associated angiogenesis.
Non‐steroidal anti‐inflammatory drugs with different cyclooxygenase inhibitory profiles that prevent aberrant crypt foci formation but vary in acute gastrotoxicity in a rat model 1
Authors: Brown Wendy A , Skinner Stewart A , Malcontenti‐Wilson Caterina , Misajon Aileen , Dejong Tanya , Vogiagis Daphne , O’Brien Paul E
Published: March 2003

Background

Standard non‐steroidal anti‐inflammatory drugs (NSAIDs) reduce the risk of colorectal cancer; however, their use as preventive agents is limited by their inherent toxicity. Drugs that selectively inhibit cyclooxygenase‐2 (COX‐2) may be useful in this setting as they are supposedly less toxic. No study has directly compared the ability of standard NSAIDs and selective COX‐2 inhibitors to inhibit colorectal cancer at clinically relevant doses.

Methods

Aberrant crypt foci (ACF) were induced in Sprague–Dawley rats by using 1,2‐dimethylhydrazine (DMH). Test agents or vehicle were then administered for 3 weeks, twice daily through orogastric gavage. At the end of this period, the number and multiplicity of ACF were determined. The agents tested at equivalent anti‐inflammatory doses were: sulindac and indomethacin (standard NSAIDs), meloxicam (selective COX‐2 inhibitor), celecoxib (specific COX‐2 inhibitor) and sulindac sulfone (no known COX activity). Acute gastrotoxicity of NSAID in rats was compared by using quantitative histology.

Results

All test agents reduced the number of ACF. There was a 42% reduction with indomethacin, 46% with sulindac, 46% with meloxicam, 22% with celecoxib and 36% with sulindac sulfone. Only the COX‐2 inhibitors caused no significant gastrotoxicity in rats.

Conclusions

Cyclooxygenase‐2 inhibitors are potentially ideal chemopreventive agents as they inhibit ACF and are not gastrotoxic.
Lupus–like syndrome with submassive hepatic necrosis associated with hepatitis A
Authors: Segev Amit , Hadari Ruth , Zehavi Tanya , Schneider Mordechai , Hershkoviz Rami , Mekori Yoseph A
Published: March 2003

Abstract Hepatitis A is a common self‐limited liver disease. However, 15% of patients may have some complications. Autoimmune hepatitis that is triggered by viral hepatitis has been reported. We hereby describe an unrecognized association of hepatitis A with a full blown lupus‐like syndrome manifested by the appearance of arthralgia, exudative pleural effusion with the presence of lupus erythematosus cells and autoantibodies. All these findings disappeared after a short course of steroid treatment. The case is presented and the literature is reviewed.
Cavernous hemangioma of the liver with giant cyst formation: Degeneration by apoptosis?
Authors: Hanazaki Kazuhiro , Koide Naohiko , Kajikawa Shoji , Ushiyama Toshiki , Watanabe Tomofumi , Adachi Wataru , Amano Jun
Published: March 2003

Abstract Cavernous hemangioma of the liver with cyst formation is a very rare condition. A case of cavernous hemangioma of the liver with unilocular giant cyst formation undergoing surgical removal is reported. Notably, the patient also had Budd–Chiari syndrome with an obstructing lesion in the inferior vena cava. The cystic degeneration of the hemangioma implied a relationship with apoptosis. This is the first reported case of Budd–Chiari syndrome caused by advanced cystic degeneration of hepatic cavernous hemangioma.
Risk of alanine aminotransferase flare‐up among asymptomatic hepatitis C virus RNA carriers: A 10‐year follow‐up study
Authors: Tsuji Kenichirou , Yamasaki Kazumi , Yamanishi Mikio , Kawakami Masuhiro , Shirahama Satoshi
Published: March 2003

Aims: The aim of this study was to determine the cumulative rate of flare‐up of serum alanine aminotransferase (ALT) level during a 10‐year follow‐up period, and characterize the clinical, virologic features in 120 hepatitis C virus (HCV) RNA‐positive asymptomatic carriers with persistently normal ALT levels for 6 months.

Results: All flare‐up cases occurred during the first 5 years of the present study, 27.4% of carriers showed ALT flare‐up during this period, but none in the second half of the study. Multivariate analysis showed that C100–3 antibody (Ab) and anti‐human T cell leukemia virus (HTLV)‐I Ab were two independent and significant predictors of ALT flare‐up in hepatitis C virus (HCV) RNA asymptomatic carriers (P = 0.04, P = 0.03, respectively). Liver biopsy was performed in 44 patients (11 with flare‐up of ALT level, whereas 33 had normal ALT levels). Histological features of chronic hepatitis with lymphoid infiltration in the portal tracts were commonly observed in all specimens, and no differences were noted between the flare‐up ALT group and the persistently normal ALT group.

Conclusions: Our results indicated that flare‐up of ALT levels in asymptomatic HCV‐RNA carriers with normal ALT levels occurs during the first 5 years of diagnosis, and that the presence of C100–3 and anti‐HTLV‐I antibodies are good predictors of a transient rise in ALT.
Autoimmune liver disease in children
Authors: Yachha Surender K , Srivastava Anshu , Chetri Kamal , Saraswat Vivek A , Krishnani Narendra
Published: March 2003

Background and Aim:

Autoimmune liver disease (AILD) in children progresses to cirrhosis and liver failure if not diagnosed and managed in time. We prospectively analyzed our patients with liver disease for autoimmune etiology and their outcome with treatment.

Methods:

All patients with liver disease were evaluated with liver function tests, abdominal ultrasonography, endoscopy, liver biopsy, viral markers and investigations for Wilson’s disease. Immunoglobin (Ig)M hepatitis A virus, hepatitis E virus (HEV) and IgM hepatitis B core antibody were tested if acute viral hepatitis was suspected. Antinuclear antibody (ANA), antismooth muscle antibody (SMA), and liver kidney microsomal antibody (anti‐LKM‐1) were done in all cases. Autoimmune liver disease was diagnosed when one or more autoantibodies tested positive (> 1:40), and no other etiology of liver disease was identified. We also applied criteria proposed by the International Autoimmune Hepatitis Group. Cases diagnosed to have AILD were treated with immunosuppressive drugs.

Results:

Autoimmune liver disease constituted 3.9% (6/153; median age and duration of illness 8.5 years and 3 months, respectively) of chronic liver disease cases. Four patients had acute hepatitis‐like presentation. Of the six cases, two each were ANA and SMA + ; one was anti‐LKM‐1 +, and the other was positive for both SMA and anti‐LKM‐1. Three of the patients achieved remission with combination therapy of oral prednisolone (OP) and azathioprine (AZT), and one with only OP. The other two patients were not treated. Two of the patients in remission have been weaned off from immunosuppressive therapy, and one is in a withdrawal phase. Another patient, while in biochemical remission developed superimposed anicteric acute HEV infection.

Conclusion:

Although AILD is uncommon in children, its search is rewarding, as remission is achieved with immunosuppressive therapy. Superimposed acute viral hepatitis can occur in endemic areas.
Diagnostic value of serum type IV collagen test in comparison with platelet count for predicting the fibrotic stage in patients with chronic hepatitis C
Authors: Murawaki Yoshikazu , Koda Masahiko , Okamoto Kinnya , Mimura Kenichi , Kawasaki Hironaka
Published: March 2003

Background and Aim: The serum type IV collagen test is now used as a diagnostic aid for the detection of liver fibrosis and cirrhosis. Recently, a platelet count has been reported to be a useful marker for assessing the fibrotic stage in chronic hepatitis C. The aim of this study was to compare the usefulness of the serum type IV collagen test and platelet count for diagnosing the fibrotic stage in chronic hepatitis C patients.

Methods: The diagnostic values were assessed by the use of receiver operating characteristic (ROC) analysis in 165 patients with chronic hepatitis C, with the exception of those patients with cirrhosis.

Results: The serum type IV collagen level increased, and the platelet count decreased significantly with the progression of fibrosis staging. As judged from ROC curves, the serum type IV collagen test was more useful than the platelet count for differentiating moderate or severe fibrosis from no or mild fibrosis. At a cut‐off value of 110 ng/mL, the serum type IV collagen test had an overall diagnostic accuracy of 75%, while at a cut‐off value of 16 × 104/mm3, the platelet count had a diagnostic accuracy of 70%. The serum type IV collagen test and platelet count were similar in differentiating severe fibrosis from no, mild or moderate fibrosis. Both serum type IV collagen (at a cut‐off value of 130 ng/mL) and platelet count (at a cut‐off value of 14 × 104/mm3) had a diagnostic accuracy of 73%.

Conclusion: The serum type IV collagen test was slightly superior to the platelet count for assessing the fibrotic stage in patients with chronic hepatitis C.
Disease recurrence after liver transplantation in Western Australia
Authors: YUSOFF IAN F , HOUSE ANTHONY K , FERGUSON JOHN , GARAS GEORGE , HEATH DUGAL , MITCHELL ANDREW , JEFFREY GARY P
Published: March 2003

Background and Aim Orthotopic liver transplantation (OLT) is now the accepted therapy for end‐stage chronic liver disease. Long‐term survival is now expected in the majority of patients and, consequently, disease recurrence has emerged as a major concern. Our aim was to document the rate of disease recurrence after liver transplantation for conditions other than hepatitis C, in patients followed up by the Western Australian Liver Transplant Service (WALTS).

Methods The case notes of all post‐OLT patients followed up by WALTS were reviewed. Patients were excluded if survival was less than 3 months post‐OLT; OLT was performed for hepatitis C alone or follow up was unavailable. Detection and definition of disease recurrence depended on pretransplant diagnosis, and were based on patient interview, biochemical, immunological and serological tests. Radiological and histological confirmation were obtained where clinically indicated.

Results Eighty‐seven patients were identified (89 OLTs performed). The overall rate of recurrence was 10%. Recurrence rates by disease were: primary sclerosing cholangitis (17%), primary biliary cirrhosis (12%), autoimmune hepatitis (17%), hepatitis B (40%) and alcoholic liver disease (4%). Alcohol use relapse after transplantation occurred in 25%. The overall survival post‐OLT was 87%, with a mean follow up of 53 months. Survival in patients with recurrent disease was 89%.

Conclusions Disease recurrence after OLT does occur, but overall, it is relatively uncommon. Recurrence rates vary significantly and depend, in part, on indication for OLT. With medium‐term follow up, recurrent disease does not have an effect on mortality.
Biliary guidewire facilitates bile duct biopsy and endoscopic drainage
Authors: HIGASHIZAWA TOSHIHIKO , TAMADA KIICHI , TOMIYAMA TAKESHI , WADA SHINICHI , OHASHI AKIRA , SATOH YUKIHIRO , GOTOH YASUHIKO , MIYATA TAKAMITSU , IDO KENICHI , SUGANO KENTARO
Published: March 2003

Background: The introduction of a guidewire through bile duct strictures may facilitate transpapillary bile duct biopsy and subsequent biliary drainage.

Methods: Endoscopic bile duct biopsy was attempted in 61 patients with bile duct strictures. After the introduction of a guidewire into the bile duct, biopsy forceps were inserted via the papilla. Both devices were inserted through the working channel (3.2 mm in diameter) of a conventional duodenoscope. After the procedure, an endoscopic naso‐biliary drainage catheter was advanced along the guidewire. The success rate of inserting the biopsy forceps, the sensitivity of the biopsy, and the success rate of endoscopic biliary drainage after the biopsy were analyzed prospectively.

Results: The final diagnosis was malignant strictures in 50 patients and benign strictures
in 11. The success rate of inserting biopsy forceps without performing endoscopic
papillary balloon dilation was 85%. The sensitivity of the biopsy for primary
bile duct cancer (83%) was significantly higher (P < 0.05) than that of pancreatic cancer (47%). All patients had successful endoscopic biliary drainage after the procedure.

Conclusion: A previously placed guidewire facilitates insertion of biopsy forceps and endoscopic biliary drainage. The histological diagnosis of cancer is more likely with bile duct cancer than with pancreatic cancer.

© 2002 Blackwell Science Asia Pty Ltd
Accelerated reversal of carbon tetrachloride‐induced cirrhosis in rats by the endothelin receptor antagonist TAK‐044
Authors: ANSELMI KRISTIN , SUBBOTIN VLADIMIR M , NEMOTO EDWIN , GANDHI CHANDRASHEKHAR R
Published: March 2003

Background
: A multifunctional mediator, endothelin (ET)‐1 is implicated in the pathophysiology of liver cirrhosis. Carbon tetrachloride (CCl4)‐induced cirrhosis in rats resolves upon termination of CCl4 treatment. We determined the hepatic ET‐1 system during such reversal and assessed whether ET‐1 receptor antagonism enhances this process.

Methods
: Cirrhosis was induced in rats by CCl4 treatment for 8 weeks. Treatment with an ETA/ETB antagonist TAK‐044 (10 mg/kg per day) was then started and determinations were made at 1, 2 and 4 weeks.

Results
: After termination of CCl4 treatment, accelerated normalization of liver architecture and portal hypertension occurred in TAK‐044‐treated rats compared with saline‐treated rats. The increased hepatic hydroxyproline concentration and collagen I mRNA expression also declined to greater extents in the TAK‐044‐treated group. Higher collagenase activity in cirrhosis decreased in saline‐treated rats, but did not reach basal values. In TAK‐044‐treated rats, collagenase activity tended to increase at weeks 2 and 4. Increased ET‐1 concentration and ETA receptor density declined to normal values in both groups. In contrast, increased ETB receptor density did not change in saline‐treated rats, but decreased to control values in TAK‐044‐treated rats.

Conclusions
: Our results emphasize the role of ET‐1 in chronic liver disease and strongly indicate the potential for ET‐1 receptor antagonists in its treatment.

© 2002 Blackwell Publishing Asia Pty Ltd
Diagnosis of common bile duct calculi with intraductal ultrasonography during endoscopic biliary cannulation
Authors: KUBOTA YOSHITSUGU , TAKAOKA MAKOTO , YAMAMOTO SHIN , SHIBATANI NOBUYUKI , SHIMATANI MASAAKI , TAKAMIDO SHOICHIROH , IMAI YOSHIHITO
Published: March 2003

Background: Choledocholithiasis can be difficult to diagnose, even with direct cholangiography. We examined the role of biliary intraductal ultrasonography in detecting common bile duct stones that had been overlooked during endoscopic retrograde cholangiopancreatography.

Methods: Eighty consecutive patients who underwent endoscopic retrograde cholangiography for suspected choledocholithiasis with negative results were evaluated with intraductal ultrasonography (20 MHz) for the presence of biliary concrements. The diagnostic criterion for stones was a strong‐echo structure with acoustic shadowing. Materials of low amplitude echoes without acoustic shadowing were considered sludge.

Results: Intrabile duct scanning was successful in all patients. Of the 80 patients, 20 (25%) had ultrasonic evidence of common bile duct stones. The stones measured 5 mm or less on ultrasound and their presence was confirmed macroscopically during endoscopic (17 patients) or laparoscopic (three patients) bile duct clearance. Another 37 patients (46%) had biliary sludge alone and have been followed up uneventfully.

Conclusions: Biliary intraductal ultrasonography may become a useful adjunct to establish the diagnosis of occult bile duct concrements and a guide to appropriate therapeutic selection during endoscopic biliary cannulation.
Hepatitis B virus genotypes and clinical manifestation among hepatitis B carriers in Thailand
Authors: SUGAUCHI FUMINAKA , CHUTAPUTTI ANUCHIT , ORITO ETSURO , KATO HIDEAKI , SUZUKI SEIJI , UEDA RYUZO , MIZOKAMI MASASHI
Published: March 2003

Abstract Background: Hepatitis B virus (HBV) genotypes have distinct geographic distributions. The aim of the present study was to evaluate the distribution of HBV genotypes and their clinical relevance in Thailand.

Methods: Hepatitis B virus genotypes among 107 hepatitis B carriers residing in Thailand were evaluated using serologic and genetic methods. They were clinically classified into asymptomatic carriers with normal serum alanine transaminase (ALT) levels and patients with chronic liver disease, such as those with chronic hepatitis (CH), liver cirrhosis (LC) and hepatocellular carcinoma (HCC).

Results: Hepatitis B virus genotype distribution among the 107 patients was 25.2% for genotype B, 72.0% for genotype C and 2.8% for genotype D. The serum ALT levels, HBV‐DNA and hepatitis B e antigen positivity were significantly higher in carriers infected with genotype C HBV than in those infected with genotype B (P < 0.05). The proportion of genotype B HBV was higher in asymptomatic carriers than in patients with CH and those who developed liver disease, such as LC and HCC (45.5, 16.9 and 25.0%, respectively; P < 0.05). In contrast, the proportion of genotype C HBV was higher in patients who developed liver disease and CH than in asymptomatic carriers (68.7, 83.0 and 50.0%, respectively; P < 0.05). Phylogenetic analysis based on entire genome sequences revealed three HBV isolates, which were classified into a subgroup of genotype C in isolates from South‐East Asian countries.

Conclusions: Genotypes B and C are the predominant types among hepatitis B carriers residing in Thailand and those genotypes influence the clinical manifestation in carriers with chronic hepatitis B infection.
Role of hepatitis C virus in the development of hepatocellular carcinoma: Transgenic approach to viral hepatocarcinogenesis
Authors: Koike Kazuhiko , Moriya Kyoji , Kimura Satoshi
Published: March 2003

Abstract Overwhelming lines of epidemiologic evidence have indicated that chronic infection with hepatitis C virus (HCV) poses a major risk towards the development of hepatocellular carcinoma (HCC). It remains controversial whether HCV plays a direct role in the pathogenesis of HCV‐associated HCC or whether it merely serves an indirect role. Using the transgenic mouse model established by us, it has become evident that the core protein of HCV confers oncogenic potential. The findings in our studies indicate that HCV is directly involved in hepatocarcinogenesis, albeit other factors, such as continued cell death and regeneration associated with chronic hepatitis, may also play a role. Taken together, our results indicate that there could be a mechanism for the development of HCC in persistent hepatitis virus infection that is distinct from the pathogenesis of other cancers, like colorectal cancer. Thus, although accumulation of a set of genetic aberrations may also be necessary for a multistage development of HCC, HCV core protein, to which an oncogenic potential is ascribed, may allow some stages to be skipped in hepatocarcinogenesis. The possibility that infection with HCV may be capable of inducing HCC in the absence of a complete set of genetic aberrations would help explain the unusually high incidence and multicentric nature of HCC developing in chronic hepatitis C.

© 2002 Blackwell Publishing Asia Pty Ltd
Effect of colestimide on absorption of unconjugated bile acids in the rat jejunum
Authors: ONISHI TOSHIKI , SANO NAOYO , TAKIKAWA HAJIME
Published: March 2003

Background: Colestimide is a newly developed bile acid‐binding resin in Japan, but its bile acid‐binding properties have not been studied.

Methods: The absorption of unconjugated bile acids (5 mmol/L) in the ligated rat jejunum was compared in the presence and absence of colestimide. Furthermore, bile acid adsorption by colestimide was also studied in vitro.

Results: All bile acids were efficiently absorbed in the jejunum and the cumulative absorption during 120 min was 29–63%. The absorption of chenodeoxycholate, lithocholate, deoxycholate and ursodeoxycholate was dose‐dependently inhibited by 2.5 and 5 mg colestimide, whereas the absorption of cholate was not inhibited, even in the presence of 5 mg colestimide. Adsorption of bile acids by colestimide in vitro was approximately 60% for chenodeoxycholate, lithocholate, deoxycholate and ursodeoxycholate, whereas the adsorption of cholate was low (16%).

Conclusions: Jejunal absorption of ursodeoxycholate was inhibited by colestimide to a similar extent as other dihydroxy bile acids, whereas that of cholate was not inhibited under the same conditions.
Expression of scavenger receptor class B type I in gallbladder columnar epithelium
Authors: JOHNSON MAGNUS SC , SVENSSON PER‐ARNE , BORÉN JAN , BILLIG HÅKAN , CARLSSON LENA MS , CARLSSON BJÖRN
Published: March 2003

Background

The lipid content of bile may be modified by the gallbladder epithelium. Recent studies indicate that cholesterol can be absorbed from bile and that this can be enhanced by apolipoprotein (apo) A‐I. SR‐BI is a multifunctional receptor capable of binding a wide array of native or modified lipoproteins, phospholipid or bile acid micelles. As apo A‐I is a ligand for scavenger receptor class B type I (SR‐BI) we have characterized the expression of this receptor in murine gallbladder.

Methods

Reverse transcription–polymerase chain reaction (RT‐PCR), immunoblotting and immunohistochemistry were used to study SR‐BI expression in murine gallbladders. SR‐BI expression was also used to examine gallbladders from high‐fat‐fed wild‐type and apo B‐100 transgenic mice.

Results

SR‐BI and SR‐BII mRNA are expressed in gallbladder. SR‐BI immunoreactivity was localized to the columnar epithelium of the gallbladder. Immunoreactive SR‐BI in gallbladder had an estimated molecular weight of 57 kDa, in contrast to the expected 82 kDa. Deglycosylation experiments indicated that the size difference between the two forms of the receptor is due to post‐translational modification. Fat feeding of apo B transgenic mice resulted in gallstone formation but had no effect on the abundance of SR‐BI.

Conclusions

Gallbladder epithelial cells express SR‐BI. This opens the possibility that SR‐BI may influence the modification of bile in the gallbladder.
Hepatorenal syndrome in patients with cirrhosis
Authors: MOREAU RICHARD
Published: March 2003

Abstract
 Type 1 hepatorenal syndrome (HRS) is a severe complication of end‐stage cirrhosis. Type 1 HRS is an acute functional renal failure (i.e. glomerular hypofiltration) with no other explanation than the presence of the circulatory and neurohumoral alterations associated with severe chronic liver disease. Plasma volume expansion does not improve renal function. In contrast, administration of the vasopressin analog terlipressin, a splanchnic and systemic vasoconstrictor, may improve renal function and be used while awaiting liver transplantation.

© 2002 Blackwell Publishing Asia Pty Ltd