bluuebunny/crossref_metadata_2025 huggingface dataset:
Liver biopsy bleeding time: An unpredictable event
Authors: DILLON JOHN F. , SIMPSON KENNETH J. , HAYES PETER C.
Published: March 2008

The aim of this study was to observe the correlation between liver biopsy bleeding time, prothrombin time ratio and platelet count. The subjects were 51 consecutive patients referred for laparoscopic liver biopsy. The intervention was laparoscopy under local anaesthetic and liver biopsy with observation of post biopsy bleeding time. No correlation was found between observed liver biopsy bleeding time and platelet count or prothrombin time ratio. Thus, mild to moderate coagulopathy does not appear to be associated with prolonged bleeding following liver biopsy. Equally, normality of these coagulation studies does not indicate an absence of risk for post liver biopsy bleeding.
Hydrophilic bile salts and liposomes inhibit hydrophobic bile salt‐induced release of glycoprotein by guinea‐pig gall‐bladder
Authors: AIHARA NAOKI , TAZUMA SUSUMU , KAJIYAMA GORO
Published: March 2008

Abstract Bile salts can be cytotoxic to mucosal surfaces, because of their detergent properties. This is not normally seen under physiological circumstances in the gall‐bladder. To further study normal mucosal defence mechanisms, the present study was performed to examine the effects of liposomes and hydrophilic bile salts on hydrophobic bile salt‐induced release of radiolabelled glycoproteins from explants of guinea‐pig gall‐bladder. Glycoprotein release was correlated with the degree of hydrophobicity of bile salts, as determined by the retention factor in reversed‐phase high‐performance liquid chromatography. Hydrophobic bile salt‐induced release of glycoproteins was reduced by liposomes and hydrophilic bile salts. The inhibitory effect of liposomes was directly related to the degree of saturation of their fatty acyl chains, and that of hydrophilic bile salts was related to the degree of hydrophilicity. These findings suggest that vesicles and hydrophilic bile salts may play a cytoprotective role against membrane damage passively caused by hydrophobic bile salts in the biliary system, and that such damage may occur according to the quantitative and qualitative imbalance among these factors.
Study on the comparative immunogenicity of a recombinant DNA hepatitis B vaccine containing pre‐S components of the HBV coat protein with non pre‐S containing vaccines
Authors: YAP I. , GUAN R. , CHAN S. H.
Published: March 2008

Abstract A new recombinant hepatitis B vaccine (SCI‐B‐VAC), derived from Chinese hamster ovary (CHO) cells and consisting of both the major S protein and the minor pre‐S1 and pre‐S2 proteins of the viral coat were compared with two yeast‐derived vaccines containing only S proteins (B‐Hepavac II and Engerix‐B) for immunogenicity in human volunteers in a randomized controlled study. Two hundred and ninety‐five healthy subjects completed the 12 month follow up. There was no difference in the mean age and sex distribution among the three study groups. Seroconversion rates for all the three groups were similar at months 6, 9 and 12. However, hepatitis B surface antibody (anti‐HBs) geometric mean titres (GMT) were significantly higher with 10 μg SCI‐B‐VAC and 20 μg Engerix‐B than with 10 μg B‐Hepavac‐II at months 6, 9 and 12. SCI‐B‐VAC at month 6 also showed a significantly higher anti‐HBs GMT than Engerix‐B (295 vs 143 miu/mL, P < 0.02).
Chromosome 2p linkage analysis in hereditary non‐polyposis colon cancer
Authors: KOHONEN‐CORISH M. R. J. , DOE W. F. , ST. JOHN D. J. B. , MACRAE F. A.
Published: March 2008

Abstract Hereditary non‐polyposis colon cancer (HNPCC) comprises 2‐6% of the total colorectal cancer burden. Two families are described that show linkage between the HNPCC susceptibility gene and the markers D2S123 and D2S119 on chromosome 2p, producing multipoint lod scores of 3.62 and 3.83, respectively, in the largest pedigree. In our third family the multipoint lod scores for D2S123 and D2S119, ‐2.97 and ‐3.12, excluded localization of a susceptibility gene in this region indicating that there is at least one more gene that causes predisposition to HNPCC. The exclusion was based on at least one genotype for an individual who had multiple primary colon and extracolonic tumours and could not be considered to have had common forms of cancer. Our results therefore encourage further gene mapping to pursue the localization of additional HNPCC genes. These findings confirm the presence of the susceptibility gene for HNPCC, COCAl, on chromosome 2p. They allow the immediate identification of a subset of HNPCC families, and provide the means for presymptomatic testing of family members if sufficient number of members are available for study.
The effects of abdominal irradiation for seminoma of the testis on gastrointestinal function
Authors: YEOH ERIC , HOROWITZ MICHAEL , RUSSO ANTONIETTA , MUECKE TIMOTHY , ROBB TREVOR , CHATTERTON BARRY
Published: March 2008

Abstract To evaluate the long‐term effects of abdominal irradiation for the treatment of seminoma of the testis on gastrointestinal function, 15 randomly selected patients who had been treated for stage I seminoma of the testis 2‐10 years previously had the following parameters of gastrointestinal function evaluated: gastrointestinal symptoms; absorption of bile acid; vitamin B12; lactose and fat; gastric emptying; small intestinal and total gut transit; and intestinal permeability. Results were compared to those obtained in 18 normal volunteers.

There was an increased prevalence of gastrointestinal symptoms (P < 0.01) in the patients and stool frequency was above the control range in two of them. Gastric emptying was faster (P < 0.01) in the patients. There were no significant differences in vitamin B12, bile acid, lactose or fat absorption, small intestinal transit or whole gut transit between the two groups, although faecal fat excretion was greater than the control range in three of the patients. At least one parameter of gastrointestinal function was abnormal in 11 of the 15 patients. Patients with right‐sided seminoma had a greater bowel frequency when compared to those with left‐sided seminoma (P < 0.05). We conclude that mild abnormalities in gastrointestinal function occur frequently when abdominal irradiation is used to treat stage I seminoma.
Correlation between serum pepsinogen concentration and gastric acidity measured by 24 h pH monitoring
Authors: KINOSHITA YOSHIKAZU , YAMASHITA YUKIMASA , KITAJIMA NAOTO , TOJO MASHAHIDE , ITOH TOSHIO , FUKUZAKI HISASHI , CHIBA TSUTOMU
Published: March 2008

Abstract The relationship between the intragastric pH measured by 24 h pH monitoring system and the serum pepsinogen I/II ratio was studied in 68 cases. When pepsinogen I/II ratio was compared with pH 3.0 holding time (the percentage time during which the gastric pH is above 3.0), there was a negative correlation between these two parameters (correlation coefficient r= ‐0.62, P < 0.001). Furthermore, there was also a strong negative correlation between the early morning (from 03.00 to 06.00 h) gastric pH and pepsinogen I/II ratio (r= ‐0.76, P < 0.001). Accordingly, by simply measuring serum pepsinogen I and II, it may be possible to infer gastric acidity and to obtain the information concerning the early morning intragastric pH.
The role of gastrin and cholecystokinin in normal and neoplastic gastrointestinal growth
Authors: BALDWIN GRAHAM S.
Published: March 2008

Abstract Gastrin and cholecystokinin (CCK) act as growth factors for the gastric mucosa and the pancreas, respectively. CCK is also responsible, via the CCK‐A receptor, for the pancreatic hyperplasia observed following the feeding of protease inhibitors or pancreaticobiliary diversion. Hypergastrinaemia does not increase the incidence of spontaneous gastrointestinal carcinoma, but does stimulate the proliferation of gastric enterochromaffin‐like cells via the gastrin/CCK‐B receptor, with a consequent increase in the incidence of gastric carcinoids. Whether gastrin influences mutagen‐induced gastrointestinal carcinogenesis is still controversial, but CCK clearly enhances the induction by carcinogens of acinar tumours in the pancreas. While gastrin increases xenograft growth of 50% of gastrointestinal tumours tested, effects on the proliferation of gastrointestinal tumour cell lines in vitro have been more difficult to demonstrate, perhaps because many cell lines are already maximally stimulated by autocrine gastrin. Gastrin mRNA and progastrin, but not mature amidated gastrin, have been detected in all gastrointestinal cell lines tested. Although cell proliferation is inhibited by gastrin/CCK receptor antagonists, the spectrum of antagonist affinities is not consistent with binding to either CCK‐A or gastrin/CCK‐B receptors. Definition of the molecular structure of the receptor involved in the autocrine loop may lead to novel therapies for gastrointestinal cancer.
Haemodynamic effects of a combination of propranolol and clonidine in patients with post‐hepatitic cirrhosis
Authors: LIN HAN‐CHIEH , TSAI YANG‐TE , YANG MAY C‐M. , HOU MING‐CHIH , LEE FA‐YAUH , CHEN LING‐SHENG , LEE SHOU‐DONG
Published: March 2008

Abstract The haemodynamic effects of a combination of propranolol and clonidine were evaluated in 20 patients with post‐hepatitic cirrhosis. Haemodynamic measurements were taken before and 30 min after an intravenous injection of 0.1 mg/kg of propranolol. Thereafter, each patient was given an oral dose of 150 μg of clonidine and re‐measured 60 min later. In this series, eight patients were defined as ‘non‐responders’ (a decrease in hepatic venous pressure gradient of < 10%) after propranolol treatment. Of both the responders and non‐responders, propranolol caused expected decreases in the cardiac index and heart rate while mean arterial pressure remained unchanged. Of the propranolol responders, a significant decrease in hepatic venous pressure gradient was observed. After the addition of clonidine, in both the responders and non‐responders there was a further decrease in hepatic venous pressure gradient with a concurrent drop in mean arterial pressure, but cardiac index and heart rate remained unaltered. In conclusion, the combination of propranolol and clonidine in post‐hepatitic cirrhotic patients enhanced the reduction of portal pressure achieved by propranolol alone. The beneficial effects of the combination of the two in the reduction of portal pressure appeared to be similar in both the propranolol responders and non‐responders. However, the drop in mean arterial pressure following the addition of clonidine may be hazardous to cirrhotic patients.
Diagnosing ascites: Value of ascitic fluid total protein, albumin, cholesterol, their ratios, serum‐ascites albumin and cholesterol gradient
Authors: GUPTA R. , MISRA S. P. , DWIVEDI M. , MISRA V. , KUMAR S. , GUPTA S. C.
Published: March 2008

Abstract Ascitic fluid total protein, albumin, cholesterol, their ascites/serum ratios, serum‐ascites albumin and cholesterol gradients were measured for their ability to differentiate cirrhotic, malignant and tuberculous ascites in 76 patients. The mean ± s.d. ascitic fluid total protein, albumin, cholesterol, their respective ascitic fluid/serum ratios in cirrhotic ascites were lower than malignant and tuberculous groups (P < 0.001 for each). The difference between malignant and tuberculous groups was significant for ascitic fluid/serum total protein (P < 0.05) and ascitic fluid/serum albumin (P < 0.01) only. Mean serum‐ascites albumin gradient in cirrhotics was higher than in the malignant and tuberculous groups (P < 0.001 for each). The difference between malignant and tuberculous groups was significant (P < 0.01). Mean ± s.d. serum‐ascites cholesterol gradient in cirrhotics was higher than that in malignant and tuberculous groups (P < 0.001 for each). The difference between malignant and tuberculous groups was also significant (P < 0.01). Both serum/ascitic fluid total protein less than 0.5 and ascitic fluid cholesterol less than 55 mg/dL had 94% diagnostic accuracy for differentiating cirrhotic from malignant and tuberculous ascites. Serum ascitic fluid albumin gradient greater than 1.1 g/dL, ascitic fluid/serum albumin less than 0.65 and ascitic fluid albumin less than 2 g/dL had diagnostic accuracy of 92, 92 and 91%, respectively. Ascitic fluid total protein had diagnostic accuracy of 88%. None of the tests was able to differentiate between malignant and tuberculous ascites. Measurement of ascitic fluid cholesterol concentration is a simple method of differentiating cirrhotic from non‐cirrhotic ascites.
Hospitalization of Aboriginal adults for digestive disorders in Western Australia, 1989‐91
Authors: GRACEY MICHAEL , BOBONGIE FRANK
Published: March 2008

Abstract Hospital admission rates for many gastrointestinal, hepatobiliary and pancreatic diseases were much higher in Aboriginals aged 15 to > 65 years than among the rest of the population of that age in Western Australia in 1989–91. Alcohol‐related conditions were particularly prominent: the relative rate (RR) for alcoholic gastritis was > 30; for acute alcoholic hepatitis in young adults >20; for alcoholic cirrhosis at 30‐64 years the RR was about 4 to > 10; the RR for haematemesis and melaena was > 3; for acute pancreatitis at 30‐64 years the RR ranged from about 3 to 20. Admissions for cholelithiasis in Aboriginal males were 1.5‐2 times as frequent as in other males; for Aboriginal females the RR was >2; acute cholecystitis was much commoner in Aboriginal patients from 30 to 64 years of age than in other patients of the same age. Illnesses coded as ‘non‐infectious enteritis and colitis’ were the commonest diagnostic category in the International Classification of Diseases (ICD 9) classification of digestive system disorders among Aboriginal patients; admissions for these conditions occurred at double to more than seven times the rates that occurred in the same age groups in non‐Aboriginal patients. Many of these illnesses were probably due to undetected gastrointestinal infections and parasitic infestations. This study shows that Aboriginal adults have disproportionately high rates of morbidity from many diseases of the digestive system. The findings have important implications for clinical services as well as for the development of preventive and promotional health strategies for Aboriginal people.
Barrett's oesophagus and Helicobacter pylori
Authors: ABBAS ZAIGHAM , HUSSAINY AKBAR S. , IBRAHIM FARHAT , JAFRI S. M. WASIM , SHAIKH HIZBULLAH , KHAN A. HALEEM
Published: March 2008

Abstract In order to demonstrate the presence of Helicobacter pylori in the metaplastic epithelium of Barrett's oesophagus and to evaluate its possible association with this entity, we examined 29 cases of Barrett's oesophagus where concomitant antral biopsies were also available. These cases were compared with an equal number of age and sex matched controls of uncomplicated reflux oesophagitis. H. pylori was present in 11 of 29 cases of Barrett's oesophagus (38%). No increase in the frequency of H. pylori antral gastritis was found in patients of Barrett's oesophagus compared to the control group of uncomplicated reflux oesophagitis. The positivity of Barrett's oesophagus for H. pylori correlated with the presence of H. pylori antral gastritis (P < 0.05), although in two cases of H. pylori‐positive Barrett's oesophagus antral biopsies were negative for H. pylori. No difference was found in the severity of inflammatory and dysplastic changes of H. pylori‐ positive and H. pylori‐negative Barrett's oesophagus. Presence of H. pylori does not seem to alter the natural history of Barrett's oesophagus.
Classification of gastric lesions associated with portal hypertension
Authors: HASHIZUME MAKOTO , SUGIMACHI KEIZO
Published: March 2008

Abstract There are two gastric mucosal lesions which commonly occur in patients with portal hypertension; one is portal hypertensive gastropathy and the other is gastric varices. These lesions occasionally cause fatal haemorrhage. Several classifications for these lesions have been proposed, but none of them have been evaluated prospectively. We consider it better to classify portal hypertensive gastropathy into three stages including non‐specific redness, specific mosaic pattern and red spots. Gastric varices may be classified according to form, location and mucosal lesions. Prospective trials are needed to obtain more practical evidence for the accurate classification of these gastric lesions.
Management of symptomatic polycystic liver disease: Laparoscopy adjuvant with alcohol sclerotherapy
Authors: JENG KUO‐SHYANG , YANG FI‐SH , KAO CHIN‐ROA , HUANG SHIH‐HUNG
Published: March 2008

Abstract An 81 year old woman with extensive polycystic liver disease received laparoscopic unroofing and fenestration, followed by 95% ethanol sclerotherapy, resulting in almost complete disappearance of the cysts. Such a procedure can avoid complications of both the multi‐segmental liver resections and extensive fenestrations, and untoward reactions from a large amount of alcohol. In addition, it can achieve a satisfactory result. It is suggested that this procedure could be a safe and effective alternative to traditional open surgery in selective patients.
Society stress and peptic ulcer perforation
Authors: LAM SHIU‐KUM , HUI WAI‐MO , SHIU LING‐PO , NG MATTHEW MT
Published: March 2008

To examine the relationship between society stress and peptic ulcer perforation, time‐trend analysis was performed on the annual incidence of perforated peptic ulcer per 100 000 population in Hong Kong during the years 1962–85, when Hong Kong, as a developing city, went through significant socio‐economic and political changes, and the trend was correlated with specially designed and validated society stress scores estimated annually during the same period. The society stress scores were derived independently by two expert panels blinded to the purpose of the study, one selecting and categorizing negative news events for Hong Kong during this period, and the other weighing the categories and scoring the impact of the news on Hong Kong. The incidence of perforation increased significantly during the years and manifested three distinct peaks, which coincided with the worst economic recession in Hong Kong, the influx of mainlander Chinese and Vietnamese boat people, and the Sino‐British negotiation on the sovereignty of Hong Kong after 1997. Both linear and autoregression analysis, the latter taking into consideration point fluctuations in rates, showed that perforation rates correlated significantly with the society stress scores (r= 0.57, P < 0.002). The peak effects and the significant correlations indicate that an association exists between society stress and peptic ulcer perforation, and suggest that chronic society stress plays an important role in the aetiology of this condition, although the relatively low r value also suggests the presence of other aetiological factors.
Rat peripheral mononuclear cell thymidine kinase activity increases during liver regenerative processes after partial hepatectomy
Authors: MORIMOTO MANABU , NUMATA KAZUSHI , TANAKA KATSUAKI
Published: March 2008

Deoxythymidine kinase (TK; EC 2.7.1.21) activity in the liver has been used as a marker of liver regeneration after partial hepatectomy. In this study we examined TK activity of various organs, plasma and peripheral blood mononuclear cells (PMNC) in 70% partially hepatectomized rats. TK activity of lymph nodes, small intestine, heart, lung, kidney and thymus did not increase significantly during the course of the study, except for spleen at 72 h. On the other hand, PMNC‐TK and liver cystolic TK activity increased in a parallel fashion at all times after partial hepatectomy; they began to increase 12 h after surgery and peaked 48 h post‐surgery. Fractionation of PMNC into T cells and B cells revealed that both populations increased and peaked 48 h post‐surgery. Plasma TK peaked 12–24 h after surgery, then declined at 36, 48 and 72 h after partial hepatectomy. This change paralleled plasma levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). PMNC‐TK activity correlated significantly with liver cystolic TK activity 24 h (r = 0.743; P < 0.05) and 48 h (r = 0.708; P < 0.05) after partial hepatectomy. However, it did not correlate with plasma levels of TK, AST and ALT. The results indicate that in the early stage of liver regeneration PMNC‐TK may provide a marker of liver regenerative processes.
The long‐term efficacy of interferon alfa in chronic hepatitis C patients: A critical review
Authors: SARACCO GIORGIO , RIZZETTO MARIO
Published: March 2008

With current therapeutic regimens, sustained responses occur in no more than 25% of patients with chronic hepatitis C who are treated with interferon. Relapses occur usually within 6 months from therapy suspension, but clinical and virologic recurrencies can be observed as late as after 3 years of follow up. The rate of long‐term responses seems to depend on the dosage and the period of administration of interferon, but the best therapeutic protocol remains unknown. As a direct marker of permanent recovery is not available, indirect signs of disease resolution are: (i) continuously normal alanine aminotransferase levels; (ii) clearance of HCV‐RNA; (iii) disappearance of anti‐C100/NS4; and (iv) significant histological improvements assessed at least 2 years after therapy withdrawal. Known baseline predictive features of long‐term response are the absence of cirrhosis, low viraemic levels and infection with HCV of type III or IV genotype (Okamoto's classification). According to recent reports, the lower the heterogeneity of the hypervariable region of the envelope 2 gene of HCV, the higher the chance of a sustained remission. There is not yet any consensus on the efficacy of a second therapeutic course of interferon in inducing a permanent response, and controlled trials are needed to clarify this issue.
Sonographic patterns of radiolucent gall‐bladder stones for predicting successful shock‐wave lithotripsy
Authors: TSUCHIYA YUKIHIRO , SAITO HIROBUMI , SAITO NOBUHIKO , ABE ASAMI , UKAJI MINORU , KUNIYUKI HIROSHI , MIKAMI SIGERU , NATSUKI YUTAKA , NISHIARAI HIROMI , HANIYA KAZUO , TAKANASHI HIDEKI , OHTO MASAO
Published: March 2008

The aim of this study was to examine whether the sonographic patterns of gallstones are useful for predicting the outcome of piezoelectric shock‐wave lithotripsy. Pretreatment analysis of gallstones based on our sonographic classification was conducted on 115 patients with radiolucent solitary stones of 10–30 mm in diameter, monitored for at least a year after the first lithotripsy. All stones were categorized as type I with gradual attenuation of echoes: type Ia, the stone echo appears as a full moon, usually accompanied by comet‐tail artifacts beyond the stone itself (n= 55); type Ib, the stone echo showing the anterior half of the stone, seen as a half moon (n= 29); and type Ic, the stone echo seen as a crescent (n= 31). The most complete fragmentation, ‘pulverization', was achieved at a significantly higher rate for type Ia (51%) than for type Ib (14%, P < 0.005) and type Ic (7%, P < 0.0001) after significantly fewer shock‐waves (vs type Ib, P < 0.01; vs type Ic, P < 0.0001). The rate of complete clearance at 12 months after lithotripsy was significantly greater for type Ia (91%) than for type Ib (62%, P < 0.01) and type Ic (45%, P < 0.0001). Comparison of the sonographic and computed tomography (CT) patterns of stones revealed a close relationship between the two: the vast majority (98%) of type Ia showed the iso‐ or hypo‐dense, and the majority (90%) of type Ic the rimmed. We conclude that the sonographic patterns of radiolucent gallstones appear to provide another parameter for predicting fragmentation and clearance of the stones in lithotripsy treatment, and to be probably alternative to pretreatment CT.
Thrombomodulin expression of sinusoidal endothelial cells in chronic viral hepatitis
Authors: ZENIYA MIKIO , FUKATA HIROYUKI , TODA GOTARO
Published: March 2008

The expression of thrombomodulin on sinusoidal endothelial cells was studied using the immuno‐peroxidase method and both light and electron microscopy in patients with chronic viral hepatitis (type B: four cases; type C: 28 cases). Thrombomodulin was found on sinusoidal endothelial cells, especially on the surface in both type B and type C chronic hepatitis. There was no correlation between the level of thrombomodulin expression and clinical data including serum level of transaminase, and coagulating factors. The supernatant of liver tissue homogenate obtained from the patients showed a clear 80 kDa single band by western blotting. We concluded that the expression of thrombomodulin might be related to hepatic inflammatory responses in chronic viral hepatitis.
Hepatic sinusoidal cells and sinusoidal circulation
Authors: TANIKAWA KYUICHI
Published: March 2008

Ito cells, located in the space of Disse, extend their numerous long cytoplasmic processes to surround the sinusoidal wall. Conventional and immune electron microscopy demonstrates abundant microfilaments and a great amount of actin and myosin in these cytoplasmic processes. These morphological findings suggest the possibility of control of the sinusoidal circulation by their contraction. Two mechanisms may be involved in their contraction: namely nervous and humoral factors. Ito cells, often in close contact with the nerve endings, which contain many granules of substance P (SP), have numerous receptors for this peptide. Ito cells also have receptors for endothelin‐I (ET‐1), more commonly found in the periportal area of the hepatic lobule. Experimental studies using cultured Ito cells showed their contraction following treatment with ET‐1 or SP. These results suggest that Ito cells play an important role in the regulation of hepatic sinusoidal circulation.
Some factors associated with mortality in perforated peptic ulcer: A case‐control study
Authors: McINTOSH JEAN H. , BERMAN KAREN , HOLLIDAY FIONA M. , BYTH KAREN , CHAPMAN RENATA , PIPER DOUGLAS W.
Published: March 2008

This study examined the associations of individual coexisting illnesses, septicaemia, intra‐abdominal abscess, marital status, smoking and alcohol use, with mortality following perforation of peptic ulcer without pre‐operative evidence of haemorrhage. Patients who died in hospital following ulcer perforation (cases; n= 300) were compared with patients who survived following ulcer perforation (controls; n= 276) The controls were frequency‐matched to the cases on age, sex and perforation site. Data were analysed by logistic regression. Cardiac, respiratory, cerebrovascular, renal, liver and malignant diseases, and septicaemia and intra‐abdominal abscess were associated with mortality and the coexisting illnesses were significantly increased in cases compared to controls both on admission and at the end of hospital stay. During hospitalization, the odds of pneumonia decreased in cases, otherwise there was little change in strengths of associations over this period. Being widowed or never married was positively associated with mortality, and moderate alcohol use was negatively associated. In conclusion, this study identifies several coexisting illnesses, septicaemia and intra‐abdominal abscess as risk factors for mortality following ulcer perforation. The results suggest that, with little exception, the same level of mortality risk is associated with coexisting illnesses whether the beginning or end of hospital stay is used as the index time point.
Doppler ultrasound evaluation of acute effects of cigarette smoking on portal blood flow in man
Authors: RAPACCINI GIAN LUDOVICO , POMPILI MAURIZIO , MARZANO MARIA‐ADELAIDE , GRATTAGLIANO ANNA , CEDRONE AUGUSTO , ALIOTTA ANTONIO , PIGNATARO FRANCESCO , CATURELLI EUGENIO , CELLERINO CATERINA , GASBARRINI GIOVANNI
Published: March 2008

The acute systemic haemodynamic effects of cigarette smoking are well known, but there are no studies dealing with the possible smoke‐related acute changes of splanchnic circulation in man. In the present study we evaluated the acute effects of cigarette smoking on portal blood flow (PBF) in normal subjects by the use of Doppler ultrasound. Twenty‐three normal volunteers were asked to smoke two cigarettes with a known total nicotine content (1.1 mg each) in a supine position. Each cigarette was smoked during a 5 min period and a 5 min interval between the two cigarettes was allowed. Both mean PBF velocity and volume were evaluated at time 0 (basal values) and 8, 15, 30, 45 and 60 min after the first inhalation of the first cigarette. The basal mean PBF velocity (22 cm/s; 95% CI 20.9–24.2) was significantly decreased at 8 min (19 cm/s; 95% CI 17.9–20.8; P< 0.0007) and 15 min (20 cm/s; 95% CI 17.8–21.3; P< 0.005). Similarly, the PBF volumes at 8 min (710 mL/min; 95% CI 660–876; P< 0.002) and 15 min (750 mL/min; 95% CI 650–862; P< 0.005) were significantly lower than those measured at time 0 (850 mL/min; 95% CI 766–987). Both mean PBF velocity and volume measured at successive times did not differ significantly from basal values. The present study shows that cigarette smoking causes acute and transient reduction of PBF velocity and volume in normal subjects.
Case Report: Agranulocytosis induced by interferon‐α therapy for chronic hepatitis C
Authors: HIGASHI YOICHIRO , SAKAI KENJI , TADA SHUJI , MIYASE SHUICHI , NAKAMURA TAIZOU , KAMIO TAKIHIRO , HARAGUCHI OSAMU
Published: March 2008

A 60‐year‐old woman presented with chronic active hepatitis C whose HCV‐RNA genotype was II according to Okamoto's classification and serum HCV‐RNA concentration was 104 copies/mL. Agranulocytosis was induced 13 days from the commencement of interferon (IFN)‐α 2b (6 MU/day) therapy, so the IFN therapy was immediately discontinued. The agranulocytosis improved rapidly with the administration of a granulocyte colony stimulating factor (G‐CSF). The possibility that IFN was associated with maturational arrest of myeloid progenitor cells was considered. During the course of 3 years of follow‐up, her liver function has remained normal and serum HCV‐RNA remains negative.
Iron Metabolism and Liver Disease. Proceedings of a Festschrift for Professor June Halliday (Part 2)
Authors: POWELL LAWRIE W. , FARRELL GEOFFREY C.
Published: March 2008

This companion article to ‘Career Paths for Medical Research’ (F. Gasmenterol. Hepatol., issue 9) comprises the text of papers presented at the Symposium held as a Festschrift to celebrate the distinguished career and contributions of Professor June Halliday. The contributors include leading international, national and local experts in iron metabolism and their presentations are in the form of up‐to‐date reviews or, in some cases, original unpublished contributions to the field. As such, the proceedings represent a comprehensive ‘mini‐textbook’ of recent advances in iron metabolism with particular reference to iron storage disease. The articles should, therefore, be of wide interest to readers of the journal.
Morgagni: His book, vision and views on hepatic coma
Authors: CHEN THOMAS SN , CHEN PETER SY
Published: March 2008

The study of pathological anatomy reached a culmination in the magnum opus of Morgagni, The Seats and Causes of Diseases. It represented an innovative way of looking at the patient and his illness, a change that Foucault described as occurring in the 18th century. Physicians saw symptoms penetrating the body and converging upon an organ. We suggest that Morgagni and his fellow workers derived their vision from the practice of visual perspective discovered by Italian Renaissance artists. Perceiving in three dimensional terms, Morgagni added spatial depth to our understanding of disease. His acute vision was brilliantly displayed in his views of hepatic coma. He was among the first to provide the clinical‐pathological associations of acute liver failure. The limitations of gross morphology precluded a complete elucidation of the disorder.
Gastric metaplasia of regenerating duodenal mucosa and deformity of duodenal bulb: A correlative study
Authors: PAN SHIANN , LIEN GI‐SHIH , LIAO CHENG‐HSIUNG , CHEN SHENG‐HSUAN
Published: March 2008

The correlation between the presence and degree of gastric metaplasia of regenerating duodenal mucosa and the deformity of duodenal bulb was studied. Based on the endoscopically morphological patterns of bulb, the duodenal ulcers were divided into three types: type I, with a normal‐shaped bulb; type II, with a mildly deformed bulb; and type III, with a markedly deformed bulb. A total of 159 patients with active duodenal ulcers were scheduled to be treated with H2‐receptor antagonists. Of these patients, 124 proved to have a healed duodenal ulcer 4 weeks after initial treatment upon follow‐up endoscopic examinations. Two biopsies were taken from the centre of the ulcer scar when the ulcer was found to be healed for light microscopic study. Histologically, the degree of gastric metaplasia was divided into three grades: grades 0, 1 and 2. The results show that a healed duodenal ulcer with a normal‐shaped bulb is not frequently accompanied by gastric metaplasia. However, a healed ulcer with a markedly deformed bulb has a high incidence and degree of gastric metaplasia, which may be easily colonized by Helicobacter pylori and thus develop an environment of easy recurrence. Therefore, a cycle of healing and recurrence may exist in patients with a duodenal ulcer and a markedly deformed bulb. Eradication of H. pylori may be the best way to break this cycle.
Endemicity and clinical picture of liver disease due to obstruction of the hepatic portion of the inferior vena cava in Nepal
Authors: SHRESTHA SANTOSH M. , OKUDA KUNIO , UCHIDA TOSHIKAZU , MAHARJAN KRISHNA GOPAL , SHRESTHA SHOBHANA , JOSHI BISHNU L. , LARSSON STIG , VAIDYA YOGESH
Published: March 2008

Obstructive lesion of the hepatic portion of the inferior vena cava is common in Nepal. The clinical data on 150 patients who were seen at the Liver Unit, Bir Hospital, Kathmandu, in three years from 1990 to 1992 were analysed. Although the majority of patients were over 20 years of age, 25 patients were below 10 years of age; there were more males than females in this study. This disease accounted for 17% of 866 patients with chronic liver disease and for nearly one quarter of 267 biopsies performed on this patient group during the same period. Obstructive lesions of the inferior vena cava seem to be more common among poor people with malnutrition. Clinically, our patient group could be divided into acute (n= 27), subacute (n= 43) and chronic (n= 80) cases. The important clinical features are hepatomegaly and/or ascites and, in chronic cases, prominent dilated superficial veins over the body trunk with cephalad flow. Ultrasound is the most helpful diagnostic procedure, especially in subacute and chronic cases, as it frequently demonstrates caval obstruction, thrombosis, dilated hepatic veins and intrahepatic collaterals. Diagnosis is confirmed by cavography, which shows a caval obstruction of varying lengths at the cavo‐atrial junction or a marked narrowing of the hepatic portion of the vena cava. In subacute and chronic cases cavography also demonstrates collateral veins, such as the ascending lumbar, hemiazygos and azygos that drain into the superior vena cava. Chronic cases had periods of exacerbation often associated with bacterial infection. The aetiology of inferior vena cava obstruction at its hepatic portion is not known, but there seems to be a frequent association of bacterial infection with the disease.
Hepatic angiomyelolipoma and tuberous sclerosis
Authors: YEO W. , LEONG ASY , WARD SC , HUI PK , JOHNSON PJ
Published: March 2008

A patient with angiomyelolipoma of the liver, together with radiological evidence of pancreatic, renal and bony lesions characteristic of tuberous sclerosis, is described. Although the patient had no other clinical features of tuberous sclerosis, her daughter was found to suffer from the classical triad of this syndrome and also has had hepatic lipomatous lesions and bony involvement. This is the first histologically proven case of hepatic angiomyelolipoma associated with tuberous sclerosis.
Sequential changes in serum levels of individual bile acids in patients with chronic cholestatic liver disease
Authors: AZER SAMY A. , COVERDALE SHIRLEY A. , BYTH KAREN , FARRELL GEOFFREY C. , STACEY NEILL H.
Published: March 2008

In order to determine the value of serum bile acids in predicting the course of chronic cholestatic liver diseases, we measured individual serum bile acids serially, using high‐performance liquid chromatography, over a 4 year observation period in 12 patients with primary biliary cirrhosis and six patients with primary sclerosing cholangitis. The changes in individual serum bile acids and the ratios thereof, conventional liver tests and Child‐Turcotte and Mayo scores were compared between survivors (n= 10) and patients who underwent liver transplantation for (n= 3) or died of the liver disease (n= 5). Patients with a serum total chenodeoxycholic acid concentration at study entry that exceded 15 μmol/L were 10 times more likely to die or need a liver transplant in the following 4 years than those with chenodeoxycholic acid levels < 15 μmol/L (P< 0.05). None of the other biochemical parameters or clinicopathological scores could similarly discriminate between the two groups at entry. Time‐dependent analyses for the cholic acid/chenodeoxycholic acid ratio, serum total bilirubin and albumin concentrations and Child‐Turcotte and Mayo scores were able to differentiate between primary sclerosing cholangitis patients who died or were transplanted and those who were not, whereas age of the patients and other parameters did not. The taurocholic acid /taurochenodeoxycholic acid ratio fell during progression of primary biliary cirrhosis but rose in temporal relationship with primary sclerosing cholangitis. This differential pattern of change was unique compared with other clinical and laboratory indices. In conclusion, serum chenodeoxycholic acid levels and the cholic acid /chenodeoxycholic acid ratio in both diseases were independent indices that allowed for the prediction of survival or the need for liver transplantation. These indices are worthy of further examination in a larger group of patients as prognostic criteria for chronic cholestatic liver disease and in the assessment of the efficacy of therapeutic interventions, including liver transplantation.
Clinical and histological features of gastric antral vascular ectasia: Successful treatment with endoscopic laser therapy
Authors: NG IOL , LAI KC , NG M.
Published: March 2008

Gastric antral vascular ectasia is a rare but important cause of chronic gastrointestinal bleeding. We report five patients in whom endoscopic laser therapy successfully controlled repeated blood loss. The patients were elderly (age range: 61–84 years; mean age: 75 years) and three of them were female. Endoscopically, all patients presented with a characteristic antral appearance of either ectatic vascular ‘stripes’ radiating out from the pylorus, or multiple cherry‐red spots. In all patients, the gastric mucosal biopsy specimens showed dilatation of the capillaries with focal fibrin thrombi and fibromuscular hyperplasia. Marked improvement of both endoscopic and histological features was achieved with endoscopic laser treatment using Nd‐YAG laser photocoagulation. Its importance lies in its recognition and successful treatment with endoscopic laser therapy, which offers an effective and relatively safe alternative to surgery, particularly in elderly patients.
Polymerase chain reaction diagnosis of Helicobacter pylori in gastroduodenal diseases: Comparison with culture and histopathological examinations
Authors: LIN SHYR‐YI , JENG YEONG‐SHAN , WANG CHUNG‐KWE , KO FU‐TSONG , LIN KUANG‐YANE , WANG CHAUR‐SHINE , LIU JEAN‐DEAN , CHEN PAO‐HUEI , CHANG JAN‐GOWTH
Published: March 2008

Helicobacter pylori has been associated with a variety of upper gastrointestinal diseases. Histopathological examination and culture are considered to be the more specific tests in the diagnosis of H. pylori infection. In the present study, we evaluated the efficiency of a polymerase chain reaction (PCR) assay of the H. pylori urease A gene as a procedure in the diagnosis of gastric H. pylori infection in various gastroduodenal diseases. Biopsy specimens were obtained from the antral mucosa of 83 patients during endoscopic examination and were submitted to three tests for the detection of H. pylori infection. The detection rates of H. pylori using PCR, histopathological examination and culture were 84, 77 and 63%, respectively. When the infection was defined, by the agreement of culture and histopathological examination or by positive culture, the PCR assay had a sensitivity of 98.1% and a specificity of 84.6%. When the infection was defined by a positive result of either two of the three tests or by positive culture, the PCR assay had a sensitivity of 98.6% and a specificity of 85.7%. We conclude that the PCR assay is a valuable test for the diagnosis of H. pylori infection in gastroduodenal diseases.
The transjugular intrahepatic portosystemic stent‐shunt: A review of the literature and own experiences
Authors: RÖSSLE M. , HAAG K. , BLUM HE
Published: March 2008

The transjugular intrahepatic portosystemic stent‐shunt (TIPS) technique consists of a transhepatic puncture of the portal vein and stenting of the parenchymal tract between the hepatic and portal veins. Complications of both puncture and stenting are observed in approximately 5% of procedures. Most of the complications are without clinical consequences and the procedural mortality is very low in experienced hands (1%). During a 1 year follow up, 35% of patients were seen to develop stenosis and 15% developed occlusion of the stent‐shunt. However, in spite of the considerable incidence of stenosis/occlusion, the rate of variceal rebleeding is rare when patients are followed up carefully by duplex sonography, which allows accurate and early detection of shunt insufficiency. One of the major long‐term clinical problems of TIPS is the induction or worsening of hepatic encephalopathy. Although most patients respond to medical treatment, some develop debilitating encephalopathy or progressive liver failure. In these patients, reduction of shunt flow by the implantation of a reducing stent, or its occlusion with a balloon catheter, may be indicated. In conclusion, in spite of many complications, TIPS is relatively safe and efficient and hepatic encephalopathy is manageable in most cases.
Pedunculated extraluminal leiomyoma of the sigmoid colon
Authors: DAVID SURESH S. , SAMUEL JOSEPH J.
Published: March 2008

Leiomyoma of the colon is an extremely rare entity. Reports are those of sessile intraluminal lesions that are accessible to colonoscopy. This is a case report of a pedunculated extraluminal leiomyoma of the sigmoid colon which has not been previously reported.
Bile acids produce a generalized reduction of the catalytic activity of cytochromes P450 and other hepatic microsomal enzymes in vitro: Relevance to drug metabolism in experimental cholestasis
Authors: CHEN JIEZHONG , FARRELL GEOFFREY C.
Published: March 2008

In bile duct‐ligated male rats, there is a reduction of total hepatic microsomal cytochrome P450 (P450) levels and of NADPH‐cytochrome P450 reductase (P450‐reductase) activity, but the changes in activity of individual microsomal enzymes are nonuniform. We have proposed that the initial effect of cholestasis on microsomal proteins is a non‐specific reduction caused by bile acid‐mediated destruction, whereas the disproportionate lowering of male‐specific P450 enzymes results from secondary down‐regulation of some cytochrome P450 (CYP) genes. We report herein the results of experiments to test the first part of this hypothesis, at least as indicated by enzyme inhibition. Hepatic microsomal fractions from normal male rats were incubated at 37°C with increasing concentrations of a range of bile acids selected for their varying physicochemical properties. The endpoints were catalytic activity of three individual CYP proteins, CYP 2A1 (measured as testosterone 7α‐hydroxylase activity), 2C11 (testosterone 2α‐hydroxylase and 16α‐hydroxylase) and 3A2 (testosterone 6β‐hydroxylase), and the non‐CYP enzymes, steroid 17β‐dehydrogenase and P450‐reductase. With 0.25 mmol/L cholic acid, a concentration exceeded in serum following bile duct ligation, there was a significant reduction in the activity of all enzymes at 4 h. Cholic acid‐mediated inhibition was dose‐dependent and there was no difference in inhibitory activity towards the male sex‐dependent CYP 2C11 and 3A2 and the non‐sex‐dependent CYP 2A1 and other microsomal enzymes. Taurocholic acid was twice as potent an inhibitor as unconjugated cholic acid, the respective apparent I50 values being ∼0.6 mmol/L compared with ∼1.2 mmol/L. The dihydroxy bile acids, chenodeoxycholic acid and deoxycholic acid, were also more potent inhibitors than cholic acid, exhibiting I50 values in the range of 0.3–0.5 mmol/L, but the monohydroxy bile acid, lithocholic acid, was the most potent inhibitor (I50∼0.2 mmol/L). Thus, the inhibitory potential of bile acids towards microsomal enzymes was inversely related to their extent of hydroxylation, while taurine conjugation enhanced the inhibitory potential of cholic acid. These data confirm the potential of bile acids to inhibit the activity of microsomal enzymes in livers of bile duct‐ligated rats and indicate that such changes can occur with concentrations of bile acids that are physiologically relevant. Further, the results are consistent with the proposal that the disproportionately greater reduction of the male sex‐dependent CYP, 2C11 and 3A2, is not explained by a destructive mechanism.
A Tribute to June Halliday
Authors: POWELL LAWRIE W.
Published: March 2008

It is a particular honour and privilege to be asked to pay tribute to June Halliday on this occasion of her retirement from The Queensland Institue of Medical Research and The University of Queensland.
GASTROINTESTINAL HAEMORRHAGE
Authors: KAUSHIK SUNIL P. , D'ROZARIO JAMES M. , CHONG GUAN , BASSETT MARK L.
Published: March 2008

Abstract  A 66‐year‐old female, who had been taking low dose aspirin for approximately 6 months, was admitted to hospital with severe gastrointestinal bleeding. The source of bleeding could not be demonstrated despite gastroscopy, mesenteric angiography and 99m Tc‐labelled red blood cell scanning. Mesenteric angiography was repeated, demonstrating a site of bleeding in the proximal small intestine. Laparotomy revealed blood‐filled jejunal diverticulosis. Resection of the affected segment resulted in cessation of haemorrhage and the patient remains well in follow up. The present report illustrates a rare cause of gastrointestinal haemorrhage, the possible role of aspirin in causation and the difficulty in diagnosis of bleeding from jejunal diverticulosis.