bluuebunny/crossref_metadata_2025 huggingface dataset:
Endotoxin affects the expansion modes of liver macrophages after partial hepatectomy
Authors: NAKANO ISAO , IMOTO MASAMI , FUKUDA YOSHIHIDE , KOYAMA YASUO , SATAKE TATSUO
Published: March 2008

We studied the effect of increased endotoxin levels on the expansion modes of liver macrophages after two‐thirds partial hepatectomy using anti‐endotoxin polymyxin B. The expansion consists of dual modes: local proliferation and immigration. Local proliferation of mature cells was evaluated by the S‐phase proportion measured by flow cytometric DNA analysis. This proportion (11.8 ± 1.3% before hepactectomy) decreased to 6.0 ± 1.1% at 12 h and reached a maximum of 21.9 ± 2.7% on the 5th day after hepatectomy. In polymyxin B treated rats, the proportion reached a maximum of 21.1 ± 1.6% at 48 h without any preceding decrease. Immigration of macrophage precursors was evaluated by the decreasing proportion of latex beads‐containing cells that were marked as resident liver macrophages by injection of latex beads before hetatectomy. This proportion (98.7 ± 0.2% before hepatectomy) was significantly decreased to 90.5 ± 1.6% at 48 h. In polymyxin B treated rats, however, the proportion showed no significant decrease within 3 days. These results indicate that endogenous endotoxin, which suppresses the local proliferation and promotes extrahepatic recruitment, regulates the number of liver macrophages in regenerating rat liver.
Significance of different conjugate forms of bilirubin in the formation of pigment gallstones
Authors: KEIDA YUICHI , NAKANO TOORU , TABATA MASAHISA , SHIMIZU SHUJI , NAKAYAMA FUMIO
Published: March 2008

The aim of the present study was to analyse bile samples from cases with gallstones by high performance liquid chromatography according to the type of stones present, with special reference to the glucoside and xyloside conjugates of bilirubin, and to investigate their deconjugation. The composition of bilirubin conjugates in bile was similar between cholesterol and black pigment stones except that the total bilirubin concentration was about 5 times higher in black pigment stone cases with haemolysis. Unconjugated bilirubin was higher in brown pigment stone cases than in cholesterol stone cases, although total bilirubin concentration was lower in the former. In addition, in brown pigment stone cases, bile contained statistically less bilirubin diglucuronide and more bilirubin diglucoside and monoglucoside than in bile with cholesterol stones (P<0.05). Glucoside and xyloside conjugates are also major components, regardless of the types of gallstones present, accounting for as much as 18 to 25%. Incubation experiment revealed that bilirubin diglucuronide was more readily deconjugated than bilirubin diglucoside or bilirubin monoglucoside monoxyloside. Therefore, glucuronide conjugates were likely to be the main source of unconjugated bilirubin in the formation of pigment gallstones.
Metabolic phenotypes and colorectal neoplasia
Authors: FETTMAN MARTIN J. , BUTLER ROSS N. , McMICHAEL ANTHONY J. , ROBERTS‐THOMSON IAN C.
Published: March 2008

Abstract It now appears likely that the development of colonic adenomas and carcinomas involves a series of steps in which environmental or endogenous carcinogens induce or promote neoplasia through the accumulation of multiple, specific genetic mutations. Genetic predisposition to this process may take the form of inherited defects in control of cellular proliferation as in familial polyposis coli, or genetically determined polymorphism which affects enzyme activities relevant to the production or detoxication of carcinogens. Genetic effects may also influence levels of hormones and/or their target cell receptors which regulate the metabolic and proliferative activity of colonocytes. This review highlights data suggesting a role for polymorphism associated with xenobiotic acetylation, hydroxylation, and conjugation with glutathione in the metabolism of potential carcinogens, as well as for dehydroepiandrosterone in the metabolic control of cell proliferation. The study of genetically determined polymorphism in colorectal cancer may provide new insights into the epidemiology of cancer and result in new methods for the detection of higher risk groups.
Radiological appearance of pancreatic calculi in tropical versus alcoholic chronic pancreatitis
Authors: CHARI S. , JAYANTHI V. , MOHAN V. , MALATHI S. , MADANAGOPALAN N. , VISWANATHAN M.
Published: March 2008

Tropical and alcoholic forms of chronic pancreatitis differ in their clinical, aetiological and epidemiological features. We compared the radiological appearances of pancreatic calculi seen on plain roentgenogram of the abdomen of 89 patients with tropical calcific pancreatitis (TCP) and 32 patients with alcoholic calcific pancreatitis (ACP) seen in Madras, Southern India.

While TCP was characterized by the frequent occurrence of large, discrete, dense calculi, patients with ACP had typically small, speckled calculi with irregular, hazy margins. The calculi in TCP resembled those described for hereditary pancreatitis. This is the first report comparing the radiological appearances of TCP and ACP patients seen at the same centre.
A clinical, endoscopic and pathological study of ulcer‐carcinoma: Report of 210 cases*
Authors: XU CAI‐PU , LIU FENG‐XIAN , ZHAO SHI‐MIN
Published: March 2008

A multicentre retrospective study of ulcer‐carcinoma was carried out in 16 hospitals in China, with the aim of examining the correlation between pre‐cancerous lesions and malignant change associated with benign gastric ulcer. Malignant change occurred at 2% over a variable period of 6 months to 15 years. About two‐thirds of the ulcer cancers were found to be tubular adenocarcinoma.
Induction of allogeneic tumour‐ and lymphokine‐activated lymphocytes against hepatocellular carcinoma
Authors: YASUMURA SATOSHI , HIGUCHI KIYOHIRO , HIOKI OSAMU , OKADA KAZUHIKO , TSUKISHIRO TAKASHI , TSUCHIDA TOSHIHIRO , MIYAGIWA MIKI , NAMBU SHUJI , YASUYAMA TOSHIFUMI , INOUE KYOICHI , WATANABE AKIHARU
Published: March 2008

For clinical application of adoptive immunotherapy against hepatocellular carcinoma (HCC), it is not easy to prepare tumour specific effector cells such as cytotoxic T lymphocytes (CTL). To induce potent and broad‐spectrum effectors, allogeneic cultured hepatoma cell lines (JHH‐4 and HuH‐6) were used as stimulators of peripheral blood lymphocytes (PBL) instead of autologous HCC cells. Allogeneic tumour‐ and lymphokine‐activated killer cells (ATLAK) were generated by a mixed culture of lymphocytes and allogeneic cultured tumour cells with recombinant interleukin‐2 (rIL‐2). The tumour‐killing activity of ATLAK induced by HuH‐6 was confirmed against HuH‐6 and other different HCC cell lines (JHH‐2, HuH‐7 and PLC). These activated lymphocytes were significantly more potent than lymphokine‐activated killer cells (LAK) in [51Cr]‐releasing assay. The JHH‐4 stimulated ATLAK was reactive not only with JHH‐4 but also with JHH‐2. The lysis of allogeneic targets could be partially inhibited by anti‐CD8 and anti‐CD3 but not by anti‐CD4. Anti‐tumour cytotoxicity in these cultures might be mediated by CD3+CD56‐ and CD3+CD56+ effectors. These results imply that adoptive immunotherapy for HCC with ATLAK may be more feasible than that with LAK.
Evaluation of hepatic transport function by hepatobiliary scintigraphy
Authors: TAKIKAWA HAJIME , TOMITA JUN , SEKIYA YUSHI , MIYAKI KAZUHIKO , YAMANAKA MASAMI , NIIO YASUO , KUNIYASU YOSHIO , SUGIYAMA YUICHI
Published: March 2008

The transport kinetics of [99mTc]‐pyridoxyl‐5‐methyltryptophan were studied by three‐compartment model analysis for hepatobiliary scintigraphy in 45 patients with chronic viral liver diseases. Three‐compartment model analysis was studied using the time‐activity curves of the regions of the heart, liver, and biliary tract and intestine (excretory compartment). The k12 (hepatic uptake rate constant), k21 (hepatic efflux rate constant), and ke1 (hepatic excretion rate constant) were calculated by the nonlinear least‐squares method. Among the three parameters obtained by model analysis, k12 values more prominently differed among diseases and correlated well with blood tests such as total bilirubin, total bile acids, or 15 min retention of ICG. In conclusion, three‐compartment model analysis of the hepatic handling of [99mTc]‐pyridoxyl‐5‐methyltryptophan is useful in evaluating hepatic transport function. k12 is the most sensitive parameter for this.
Beta‐2‐microglobulin and Helicobacter pylori infection in uraemic dialysed patients
Authors: CONZ P. A. , DANTE S. , BERNARDINI D. , BERTONCELLO V. , GRECA G. LA , BEVILACQUA P. A.
Published: March 2008

Chronic gastritis in patients with chronic renal failure may have different causes and mechanisms. Recent observations suggest that severe gastritis often found in uraemic patients might be related to Helicobacter pylori (HP) infection. In chronic gastritis HP has been found in the mucus and on the epithelial cell surface of gastric foveolas. Significant infiltration of the subepithelial gastric layer by polymorphonuclear leucocytes has been described. Moreover, beta‐2‐microglobulin deposits have been found by immunohistochemical methods in the subepithelial layer of gastric mucosa of uraemic dialysed patients with active chronic gastritis and HP infection. Similar findings have also been demonstrated in gastric biopsies from patients with HP positive active chronic gastritis and normal renal function. Since HP infection is associated with significant leucocyte infiltration, it is hypothesized that the inflammatory process causes the release of beta‐2‐M from the surface of the leucocytes and its subsequent deposition at gastric level.
Hepatocellular carcinoma with an unusual papillary vesicular appearance
Authors: NG IRENE O. L. , LAI EDWARD C. S.
Published: March 2008

A resected hepatocellular carcinoma with grossly papillary, whitish cut surfaces and ‘vesicles’ in a noncirrhotic but hepatitis B surface antigen positive liver is described. This appearance has not previously been reported in the literature. Such an unusual appearance may lead to an erroneous diagnosis by both surgeons and pathologists. Histological features and possible mechanisms for the unusual gross appearance are discussed.
Long‐term follow‐up of hepatitis B vaccination in susceptible hospital personnel
Authors: CHAN CHO‐YU , LEE SHOU‐DONG , TSAI YANG‐TE , LO KWANG‐JUEI
Published: March 2008

Two hundred and sixty‐seven susceptible hospital personnel who had been randomly divided into three groups to receive different doses (5 μg, 2 μg or 1 μg) of a plasma‐derived hepatitis B vaccine on a four‐dose schedule were investigated annually for 4 years. Of them, 251 were vaccine responders. The percentages of persistence of antibody to hepatitis B surface antigen (anti‐HBs) in these 3 groups were 95.5% (84/88), 92.3% (72/78) and 95.3% (81/85), respectively (P > 0.05). During the follow‐up period, 12 of 21 (57.1%) responders with low anti‐HBs titres (10–100 miu/mL) and 3 of 48 (6.3%) responders with medium anti‐HBs titres (101–1000 miu/mL) were found to be anti‐HBs seronegative, while none of the 182 candidates with high anti‐HBs levels (> 1000 miu/mL) lost their anti‐HBs. The 4 year cumulative rate of natural booster in the responders was 11.6% (29/251). None of the candidates became HBsAg positive during the follow‐up period. This study revealed that low dose hepatitis B vaccine can provide satisfactory immunogenic response and long‐term efficacy in Chinese adults and that the persistence of immunogenicity is not related to the vaccine dose but to the candidate's own initial anti‐HBs response.
Safety and feasibility of percutaneous ultrasound guided puncture of the gall‐bladder for crystal analysis
Authors: HOSKING S. W. , HACKING C. N. , HERBETKO J. , DEWBURY K. C.
Published: March 2008

The safety and feasibility of ultrasound guided percutaneous aspiration (USPA) of bile, for bile crystal analysis was assessed critically. Forty‐four patients about to undergo elective cholecystectomy underwent intended transhepatic USPA 1 h before their operation. At laparotomy a careful inspection for bile and blood leakage was made and a further sample of gall‐bladder bile collected.

Successful USPA occurred in 40 of the 44 patients. The four unsuccessful cases each had a gall‐bladder packed with stones and contained virtually no bile. Three patients developed bile leak after transperitoneal (n= 2) and transhepatic (n= 1) puncture of the gall‐bladder and another patient lost 100 mL of blood. Microscopic analysis of paired bile samples confirmed that gall‐bladder bile (as opposed to hepatic bile) had always been aspirated.

Ultrasound guided percutaneous aspiration of bile offers a simple and promising alternative to duodenal intubation, but considerable experience is required before it can be recommended as its replacement.
Duplex‐Doppler ultrasonography in the evaluation of cirrhotic patients with portal hypertension and in the analysis of their response to drugs
Authors: CIONI GIORGIO , D'ALIMONTE PIERO , ZERBINATI FABIO , VENTURA PAOLO , CRISTANI ALESSANDRO , VIGNOLI ANNALISA , ROMAGNOLI RENATO , VENTURA EZIO
Published: March 2008

Sixteen patients (15 males, aged 48–70) affected by liver cirrhosis and oesophageal varices were subjected to duplex‐Doppler ultrasonographic study (DDUS). Four patients (three with a portal thrombosis and one with a hepatofugal portal flow) were excluded from the subsequent pharmacological test. The twelve remaining patients took part in a double blind cross‐over study that evaluated the variations of heart rate (HR), mean systemic arterial pressure (SAP), portal vein diameter (PVD), maximal and mean portal flow velocity (PFV) after the administration of either 40 mg of propranolol or placebo per os, on two consecutive days. Propranolol caused no significant variation in mean SAP and in PVD, whereas it reduced the HR from 67.7±8.0 to 58.4±7.0 beats/min (mean±s.d.; P<0.001); the maxPFV dropped from 18.2±5.4 to 14.0±3.7 cm/s (P<0.001) and the meanPFV dropped from 15.3±4.1 to 13.2±3.1 cm/s (P<0.005). No significant variation was observed with placebo. After propranolol administration eight patients exhibited a significant maxPFV decrease, whereas the other four patients exhibited only a drop in HR, suggesting either drug inefficacy, inappropriate dosage or inadequate duration of treatment. DDUS is the only non‐invasive method for the examination of the portal vein system. When pharmacological treatment of portal hypertension is contemplated, DDUS is of great interest: not only does it identify the patients with portal thrombosis or hepatofugal flow (in which cases beta‐blocker therapy seems potentially dangerous and porta‐ caval shunts are not always feasible), it can also evaluate the effects of the drugs proposed on portal haemodynamics.
Duodenal ulcer in China
Authors: TOVEY F. I.
Published: March 2008

The author visited China in 1981 and 1984 and obtained data comparing the incidence of duodenal ulcer in the rice eating districts of the south with the incidence in the wheat, maize and millet eating areas of the north. The evidence suggested a higher prevalence of duodenal ulcer in the rice eating areas than in the wheat eating areas, and a low prevalence in association with millet eating. However, the differences were less marked than between similar rice and wheat eating areas of India. It is suggested that the lower prevalence of duodenal ulcer in the wheat eating areas of north India compared with the rice eating areas of south India may be due in part to the mucosal protective effect of wheat bran in the unrefined wheat that is used in making chappatis. In China white refined flour is used in the making of steamed bread with the loss of any protective effect of wheat bran.
Multiple venous thromboses and membranous obstruction of inferior vena cava in association with hereditary protein C deficiency: A case report
Authors: DHIMAN R. K. , SARASWAT V. A. , RADHAKRISHNAN S. , PARASHAR A. , AGARWAL D. K. , NAIK S. R.
Published: March 2008

A forty year old male presented with multiple dilated venous channels over the whole body involving both inferior and superior vena caval territories, along with features of chronic liver disease and portal hypertension. On investigation, he was found to have membranous obstruction of the inferior vena cava (MOIVC) as well as obstruction of both brachiocephalic and right subclavian veins and ‘hereditary protein C deficiency'. He was managed successfully by percutaneous transluminal balloon angioplasty for the inferior vena cava (IVC) obstruction and was doing well on follow‐up.
Effects of α1 and β‐adrenergic antagonists and 5‐hydroxytryptamine receptor antagonist on portal‐systemic collateral vascular resistance in conscious rats with portal hypertension
Authors: KOSHY A. , SEKIYAMA T. , HADENGUE A. , CERINI R. , BRAILLON A. , LEBREC D.
Published: March 2008

In order to study the acute effects of pharmacological agents on the vascular resistance of portal‐systemic collaterals, a model of total portal vein occlusion with 100% portal‐systemic shunts was developed in the conscious rat. The haemodynamic effects of several vaso‐active substances were evaluated in this model and compared with those obtained after saline administration. Prazosin (0.5 mg), an α1‐adrenergic antagonist, significantly reduced mean arterial pressure by 29%, portal pressure from 13.8 ± 1.0 (mean ± s.e.m.) to 10.1 ± 0.4 mmHg and portal tributary blood flow (radioactive microspheres) from 13.6 ± 2.1 to 11.7 ± 1.2 mL/min. It also decreased portal‐systemic vascular resistance from 95 ± 16 to 73 ± 9 dyn s/cm5 x 103. Propranolol (4 mg), a β‐adrenergic antagonist, significantly reduced mean arterial pressure by 12% and portal pressure from 15.5 ± 1.2 to 13.3 ± 0.9 mmHg while reducing portal tributary blood flow from 14.6 ± 1.5 to 11.0 ± 1.7 mL/min and increasing portal systemic collateral vascular resistance from 88 ± 7 to 103 ± 8 dyn s/cm5 x 103. Ketanserin (0.25 mg/kg), a 5‐hydroxytryptamine receptor antagonist, reduced portal pressure from 15.8 ± 1.0 to 13.3 ± 0.7 mmHg at a dose that did not alter mean arterial pressure or portal tributary blood flow. It achieved this by reducing portal‐systemic collateral vascular resistance from 90 ± 14 to 74 ± 13 dyn s/cm5 x 103. Saline had no significant effect on systemic and splanchnic haemodynamics. This study shows that ketanserin decreases vascular resistance of portal‐systemic collaterals while propranolol increases it. Thus, it is suggested that collateral vascular resistance is accessible to pharmacological manipulation.
Hypercholesterolaemia in patients with hepatocellular carcinoma
Authors: HWANG S‐J. , LEE S‐D. , CHANG C‐F. , WU J‐C. , TSAY S‐H. , LUI W‐Y. , CHIANG J‐H. , LO K‐J.
Published: March 2008

Ninety‐one (11.4%) subjects with hypercholesterolaemia (serum cholesterol level more than 250 mg/dL) of 792 Chinese patients with hepatocellular carcinoma (HCC) were studied in Taiwan. All 91 patients had large tumours greater than 7 cm in diameter and a tumour volume greater than 50%; 56 (61%) of these patients manifested tumour involvement in both lobes of the liver. The HCC patients with hypercholesterolaemia had significantly higher mean serum levels of albumin, triglyceride and α‐fetoprotein (AFP) compared with age‐sex‐tumour volume matched HCC patients without hypercholesterolaemia. The associated incidence of hypoglycaemia in hypercholesterolaemic HCC patients was significantly higher than in HCC patients without hypercholesterolaemia (15/90 vs 4/90; P= 0.01). There was no significant difference in the survival analysis between HCC patients with and without hypercholesterolaemia. Eight and 11 of hypercholesterolaemic HCC patients had their tumours surgically resected and received transcatheter hepatic arterial chemoembolization (TAE), respectively. Serum cholesterol levels fell to the normal range after treatment and rose to abnormal levels again when tumours recurred after surgery or progressively enlarged after TAE. The change in pattern of serum cholesterol was parallel to the change in serum AFP. Serum cholesterol levels may serve as another marker in identifying tumour recurrence and the presence of a viable tumour mass in hypercholesterolaemic HCC patients who have received surgical resection or TAE.
Hydroxyl radical formation in human gastric juice
Authors: NALINI S. , RAMAKRISHNA B. S. , MOHANTY A. , BALASUBRAMANIAN K. A.
Published: March 2008

The hydroxyl radical is the most potent free radical derived from oxygen, and has been implicated in damage caused to the gastroduodenal mucosa. The ability of human gastric juice to generate hydroxyl radicals has been investigated in 54 adults with endoscopically normal gastroduodenal mucosa and in 39 patients with chronic duodenal ulcer. Hydroxyl radical production was measured by the formation of formaldehyde from dimethylsulfoxide. Unlike other body fluids, this reaction could proceed without the extraneous addition of catalysts such as hydrogen peroxide (H2O2), ascorbate and iron. Measurement of H2O2, iron and ascorbate showed that these catalysts are already present in the gastric juice. There was no significant difference in the concentration of these components in gastric juice between normal subjects and patients with duodenal ulcer, except that H2O2 levels were slightly higher in duodenal ulcer patients. Although generation of free radicals has been investigated in other body fluids, this is the first reported case regarding the production of these active species in normal human gastric juice. Since hydroxyl production is not significantly enhanced in duodenal ulcer, we suggest that attention may be turned to mucosal antioxidant defences in this disease.
Correlation between CA19‐9 production in vitro and histological grades of differentiation in vivo in clones isolated from a human pancreatic cancer cell line (SUIT‐2)
Authors: IWAMURA T. , TANIGUCHI S. , KITAMURA N. , YAMANARI H. , KOJIMA A. , HIDAKA K. , SETOGUCHI T. , KATSUKI T.
Published: March 2008

The production of carcino‐embryonic antigen (CEA) and carbohydrate antigen 19‐9 (CA19‐9) were investigated in 28 clones isolated from a human pancreatic cancer cell line (SUIT‐2) and related to in vitro morphology of the clones and in vivo tumorigenicity. Clones of fusiform and polygonal cells could be morphologically distinguished in confluent cultures. There was no significant difference in CEA production between fusiform‐cell clones (2.10 ± 2.70 ng/L x 106 per 24 h) and polygonal‐cell clones (6.01 ± 7.30 ng/L x 106 per 24 h), but polygonal‐cell clones had higher production of CA19‐9 (1176.1 ± 1628.4 U/L x 106 per 24 h) than fusiform (6.0 ± 7.3 U/L x 106 per 24 h; P < 0.01). Production of CA19‐9 in vitro correlated with the histological grade of differentiation in vivo in nude mice (r= 0.73, P < 0.001), but CEA production did not. The polygonal‐cell clones developed well‐differentiated carcinomas in vivo and produced significantly more CA19‐9 (P < 0.001) than fusiform‐cell clones, which generally developed into poorly differentiated tubular adenocarcinomas in vivo. This cell line may provide an appropriate system for further studies of the biology and therapy of pancreatic cancer.
Long‐term follow‐up of dilatation treatment of oesophageal strictures
Authors: FRASER A. G. , NICHOLSON G. I.
Published: March 2008

A review of the endoscopy records of 100 consecutive patients with oesophageal strictures was undertaken to determine the effectiveness of endoscopic dilatation therapy. The follow‐up period from presentation ranged from 6 to 72 (mean 39 months) and the symptom‐free period after the last dilatation ranged from 3 to 66 months (mean 29 months). Three hundred and fifty procedures were performed with no perforations and minimal morbidity. Eighty‐one patients who had been followed for at least 12 months since their last dilatation were free of significant dysphagia. Of these 81 patients, 77% became symptom‐free within 1 year, and 88% within 2 years. Only 35 patients required more than three dilatations; 30 patients required one dilatation and 35 required two to three dilatations. Age, sex, the presence of Barrett's oesophagus, or the oesophageal lumen diameter at presentation was not significantly correlated with outcome.
Liver transplantation for primary sclerosing cholangitis versus primary biliary cirrhosis: A comparison of complications and outcome
Authors: STRASSER S. , SHEIL A. G. R. , GALLAGHER N. D. , WAUGH R. , McCAUGHAN G. W.
Published: March 2008

Abstract Primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC) are the most common cholestatic disorders in adulthood requiring hepatic transplantation. Although they run similar courses, they may have different problems before and after transplantation. The aim of this study was to compare pre‐ and post‐transplant complications and outcomes in these two similar but distinct patient groups. One hundred and seventeen adult patients underwent liver transplantation at our institution over a 6 year period, including 19 with PSC and 20 with PBC. Pre‐transplant there were no significant differences in age, liver biochemistry, haematology or Child‐Pugh scores between the two groups. The mean duration of disease before transplant was longer in PSC patients (11.7 vs 6.5 years; P < 0.05). The prevalence of septic cholangitis was greater in PSC (58 vs 5%; P < 0.01) as was the requirement for surgical or radiological interventional procedures, excluding cholecystectomy (53 vs 0%; P < 0.01). At transplantation, four patients with PSC had previously unrecognized cholangiocarcinoma. In the pre‐transplant period these four patients had uncontrolled biliary sepsis at the time of transplant vs five of 15 PSC patients without cholangiocarcinoma. Postoperatively, PSC patients had a greater prevalence of intra‐abdominal sepsis requiring surgical or radiological intervention (42 vs 5%; P < 0.05). In comparison, patients with PBC had a high prevalence of skeletal complications (30 vs 10%; P < 0.05) particularly avascular necrosis (15 vs 0%). The prevalence of chronic rejection was similar in both groups (15%). Overall survival was higher in PBC patients (85 vs 63%; P < 0.05). The prevalence of postoperative intra‐abdominal sepsis requiring surgical or radiological intervention was higher in those patients with PSC who died (six of seven) compared to survivors (two of 12), (P < 0.001). Postoperative uncontrolled intra‐abdominal sepsis directly contributed to more deaths in PSC patients (four of seven vs 0%). In conclusion, despite many similarities with PBC, PSC patients have higher prevalence of pre‐ and postoperative intra‐abdominal sepsis that may contribute to poorer survival. In contrast PBC patients have excellent survival rates after a liver transplant, although bony complications are increased.
Biliary bile acids in the gall‐bladder and the common bile duct of patients with anomalous pancreaticobiliary ductal junction
Authors: SHIMADA KAZUO , CHIJIIWA KAZUO , YANAGISAWA JIRO , NAKAYAMA FUMIO
Published: March 2008

The high incidence of biliary tract carcinoma in patients with anomalous pancreaticobiliary ductal junction (APBDJ) with or without choledochal cyst (CC) has been well documented. Twenty‐two patients with APBDJ were divided into three groups: Group A, four patients not associated with CC and biliary tract carcinoma; Group B, 13 patients with CC but without biliary tract carcinoma; and Group C, five patients with biliary tract carcinoma (four with and one without CC). Profiles of bile acids in the gall‐bladder and/or common bile duct were analysed in these patients and compared with those in the control patients with cholecystlithiasis to examine the hypothesis that the levels of deoxycholic acid (DCA) and lithocholic acid (LCA) are elevated in patients with APBDJ because these secondary bile acids are mutagenic. Bile acids were quantified by gas—liquid chromatography. Total bile acid concentration in the gall‐bladder bile was significantly lower in any group with APBDJ than that of controls. In the gall‐bladder, increased proportion of chenodeoxycholic acid (CDCA) in Groups A and B, decreased proportion of DCA in Group B and increased proportion of cholic acid (CA) in Group C were found in bile. In the bile duct, total bile acid concentration and proportion of DCA were significantly low in bile from Group C and decreased proportion of DCA and increased proportion of CDCA were found in bile from Group B. In both the gall‐bladder and hepatic bile, proportion of LCA was not significantly different between any intergroups. Thus no increase of DCA and LCA was found in either the bile from the gall‐bladder and the bile duct of APBDJ patients. It is concluded that bile acid plays little role, if any, in the pathogenesis of biliary tract carcinoma in patients with APBDJ.
Subcutaneous seeding of small hepatocellular carcinoma after fine needle aspiration biopsy
Authors: YAMADA NOBUO , SHINZAWA HARUHIDE , UKAI KATSUAKI , WAKABAYASHI HIROTO , TOGASHI HITOSHI , TAKAHASHI TSUNEO , SEO NOBUO , ISHIYAMA SHUICHI , TSUKAMOTO MASARU , FUYAMA SHIGEMI
Published: March 2008

Ultrasonically guided fine needle (21 gauge) aspiration biopsy (FNAB) was performed on a patient with a hepatocellular carcinoma (HCC) measuring 1.5 × 1.5 cm in segment VI of the liver. The tumour was located just beneath the liver surface. Subsegmentectomy of segment VI was performed. Twelve months after the biopsy and 10 months after the operation, levels of alpha‐fetoprotein (AFP) and protein induced by Vitamin K absence or antagonist‐II (PIVKA‐II) increased gradually without any evidence of recurrence of HCC in the liver. Thirteen months after the biopsy, the patient palpated a hard subcutaneous nodule 1.5 cm in diameter in the right lower anterior chest wall at the insertion site of the biopsy needle. A subcutaneous tumour was excised and histological examination revealed moderately differentiated HCC. The levels of AFP and PIVKA‐II normalized thereafter. These tumour markers were therefore useful for diagnosing the subcutaneous nodule as a metastatic HCC. The patient is currently doing well without further recurrence of HCC or needle‐tract seeding 23 months after subsegmentectomy and 11 months after excision of the subcutaneous tumour.
Hepatocellular carcinoma in a cirrhotic liver becoming detectable within a month
Authors: EZAKI TAKAHIRO , YOSHIDA YASUNORI , OKAMURA TAKESHI , SHIRAKUSA TAKAYUKI
Published: March 2008

A case of hepatocellular carcinoma (HCC) in a cirrhotic liver which became detectable within a month is reported here. The patient was admitted for treatment of oesophageal varices due to Child's C grade liver cirrhosis. A hepatic angiogram was performed before the treatment and showed no neovasculature. After undergoing variceal treatment by injection sclerotherapy, the patient underwent another angiogram 28 days later in order to measure the efficacy of the treatment. The second angiogram revealed the emergence of small multiple neovasculatures throughout the entire liver. From the angiographic findings, those tumours were considered to be HCC. The present report suggests that small HCC latent in a cirrhotic liver can thus acquire neovasculature within a short period of time.
Immunoreactive‐somatostatin concentrations of the human stomach and mood state in patients with functional dyspepsia: A preliminary case–control study
Authors: KANEKO H. , MITSUMA T. , FUJII S. , UCHIDA K. , KOTERA H. , FURUSAWA A. , MORISE K.
Published: March 2008

Immunoreactive‐somatostatin (ir‐SS) concentrations of the gastric mucosa and mood state in patients with functional dyspepsia were examined. The subjects were 12 patients with upper abdominal discomfort, nausea and/or vomiting (motility disorder group) and 14 patients complaining of upper abdominal pain (ulcer‐like disorder group) for more than a month without any organic upper‐gastrointestinal tract disease proven by endoscopy. These patients were compared with either an age‐ and sex‐matched group of asymptomatic outpatients without any organic disease (control group: n= 26) or to a group of patients with peptic ulcer (n= 19). Somatostatin concentrations of the stomach were measured by radio‐immunoassay, and the mood state of each subject was assessed by Manifest Anxiety Scale (MAS) and Self‐rating Depression Scale test. Immunoreactive‐somatostatin concentrations of the gastric mucosa were significantly higher in the ulcer‐like disorder group than in the peptic ulcer, motility disorder or control group, and gastric juice levels were higher in the ulcer‐like disorder group. The psychometric tests showed that the motility disorder group was more depressive than the ulcer‐like disorder group, but there were no differences between the motility disorder, ulcer‐like disorder and peptic ulcer group in MAS scores or environmental factors. These results indicate that there may be two different subgroups in functional dyspepsia influenced by both ir‐SS concentration of the stomach and/or mood state.
Measurement of occult upper gastrointestinal tract blood loss: A direct comparison of radiochromium and haem‐porphyrin assay techniques
Authors: YOUNG G. P. , JOHN D. J. B. ST , LYNCH N. M. , McHUTCHISON J. G. , BARRACLOUGH D.
Published: March 2008

Faecal haem‐porphyrin assay by the HemoQuantTM method has many practical advantages over the well‐validated, radiochromium (51Cr‐tagged red cell) method for measuring gastrointestinal blood loss. Because haem may be absorbed but the chromic ion is not, the two measures were directly compared in low‐grade bleeding from the proximal gastrointestinal tract. Blood loss was measured by both methods simultaneously in 40 patients with osteoarthritis before and during medication with aspirin preparations. Mean (geometric) daily blood loss before aspirin usage measured 0.60 mL by radiochromium (range 0.13–1.62) and 0.47 mL (0.14–1.40) by HemoQuantTM (P= 0.042). On aspirin, bleeding rose to 1.57 mL/day (0.43–4.85) by radiochromium and to 0.72 mL/day (0.23–3.0) by HemoQuantTM (P≤ 0.0001). The two measures correlated well, r= 0.847 (P≤ 0.0001), but the regression coefficient was 0.417, reflecting the lower estimates of bleeding by HemoQuantTM. In four normal subjects who ingested 51Cr‐labelled red cells (26–41 mL) over 3 days, recovery of 51Cr was complete (103 ± 2%, ± s.e.), but recovery of haem‐porphyrins was only 63 ± 13% (P= 0.01), presumably because of absorption of haem. Although faecal haem‐prophyrin assay is of considerable clinical utility, it is a quantitative index rather than an absolute measure when low amounts of bleeding originate from the proximal gastrointestinal tract.
Low prevalence of hepatitis C virus infection in patients with auto‐immune hepatitis type 1
Authors: TANAKA EIJI , KIYOSAWA KENDO , SEKI TAKESHI , MATSUMOTO AKIHIRO , SODEYAMA TAKESHI , FURUTA SEIICHI , KUMAGAI TOSHIKO , KOHARA MICHINORI
Published: March 2008

Hepatitis C virus (HCV) antibodies were measured in 28 patients with auto‐immune hepatitis type 1 using six different assay kits, three for C100–3 antibody and three for second generation HCV antibody, and two confirmatory tests to determine the prevalence of HCV infection in auto‐immune hepatitis. These patients were confirmed to have human leucocyte antigen DR 4 or 2 which is susceptible to auto‐immune hepatitis in Japanese. Of the 28 patients, four (14.3%) were positive for HCV antibody in all assays and reacted positively in at least one of the two confirmatory tests, indicating a true positive finding. Eight were positive for HCV antibody only by the Ortho ELISA kit and were negative in both confirmatory tests. The cut‐off level for these results was low and became negative soon after the patients received corticosteroid treatment. Thus, these eight patients are presumed to be false‐positive reactors. Hepatitis C virus RNA was detected in the serum of two of the four patients with HCV antibody and in none of 24 patients without HCV antibody. No significant difference was observed between the patients with and without HCV antibody in terms of clinical background, liver function tests and auto‐antibodies. Our results showed that the prevalence of a past or present HCV infection in patients with auto‐immune hepatitis in Japan is low; thus, auto‐immune hepatitis is thought to be distinct from hepatitis type C. However, it is also suggested that HCV infection can potentially trigger auto‐immune hepatitis.
Ultrastructural filament organization of hepatocyte cytoplasm revealed by embedment‐free sections of rat liver
Authors: KEEGAN ANDREW , BATEY ROBERT
Published: March 2008

The cytoplasmic matrix of rat liver cells was examined by embedment‐free electron microscopy of polyethylene glycol (PEG) embedded tissue from which the PEG had been removed subsequently. Non‐ionic detergent extraction of fresh blocks of tissue permitted the major cytoskeletal components to be visualized in relatively thick embedment‐free sections. Immunolabelling confirmed the presence of the major cytoskeletal proteins (actin, cytokeratin and tubulin) in these sections. Hence, this method permits the examination of the ultrastructural organization of the cytoskeleton of the hepatocyte in blocks of fresh hepatic tissue.
Natural history of chronic hepatitis B virus infection: New light on an old story
Authors: CHEN DING‐SHINN
Published: March 2008

Chronic hepatitis B virus (HBV) infection is one of the most common persistent virus infection in man. It causes significant morbidity and mortality, and therefore is important. Extensive studies on clinicopathologic studies and long‐term follow up on hepatitis B surface antigen (HBsAg) carriers have largely disclosed the natural history of chronic HBV infection.

The infection easily becomes chronic when contracted in early infancy. As high as 90% of babies born to HBV carrier mothers will also become HBsAg carriers. Once chronic infection is established, it is refractory, and HBsAg carriage usually persists for life. However, the chronic infection is not monotonous, it actually evolves from an HBV replicative phase to a non‐replicative phase. The host responds differently and with more complexity in different phases. The virus‐host interactions, divided into three phases, virus tolerance, virus clearance and residual HBV integrated phases, result in a heterogeneous variety of hepatic lesions. The first two phases occur when HBV is actively replicating, and the last corresponds to the non‐replicative phase. The high HBV level (and hence HBV gene products) renders the host's immune system tolerant to the virus, and the infected host does not exert an effort to get rid of the virus. At this stage, the liver is nearly normal, and the host is asymptomatic. However, later in the replicative phase, the HBV replication begins to wane, and the immune tolerance is no longer maintained. Hepatitis B core antigen/hepatitis B e antigen (HBcAg/HBeAg)‐specific cellular immune responses result in lysis of the infected liver cells; the liver then begins to have active disease as revealed by the presence of lobular hepatitis. The asymptomatic carrier may then start to have symptoms of hepatitis. After a variable period, usually in years, the host eventually gets rid of active viral replication and only residual incomplete HBV genome integrated to host chromosomes is found. The carrier is now HBeAg negative/anti‐HBe positive, serum HBV DNA decreases to very low levels, and the disease becomes qulescent at this stage.

The outcome of the host is determined by the hepatic lesions caused by HBV‐host interactions mentioned above, with cirrhosis and hepatocellular carcinoma (HCC) as the major sequelae of chronic HBV infection. Although HCC is usually preceded by HBV‐induced cirrhosis, this is not always the case. Cirrhosis and HCC may develop independently, with cirrhosis as the most important precipitating factor or cofactor of HCC. A significant proportion of HBsAg carriers, particularly the males, will eventually die of these sequelae.
BOOK REVIEWS
Authors: Jones D. Brian
Published: March 2008

Book reviews in this article:

Drug‐induced Hepatic Injury 2nd edn. Edited by B. H. C. Stricker. Elsevier Science Publishers, Amsterdam,

Gastrointestinal Bleeding. Edited by Choichi Sugawa, Bernard M. Schuman and Charles E. Lucas. Igaku‐Shoin

Atlas of Laparoscopic Surgery. Edited by E. J. Reddick, W. B. Saye and J. D. Corbitt, Jr. Raven

Manual of Gastroenterology Procedures. Edited by Douglas A. Drossman.

Hepatic Transport and Bile Secretion: Physiology and Pathophysiology. Edited by Nicola Tavoloni and Paul D. Berk.

Motility Disorders of the Gastrointestinal Tract. Principles and Practice. By S. Anuras
Cytomegalovirus infection after liver transplantation in children
Authors: MELLON A. , SHEPHERD R. W. , FAOAGALI J. L. , BALDERSON G. , ONG T. H. , PATRICK M. , CLEGHORN G. J. , LYNCH S. , STRONG R.
Published: March 2008

Post‐liver transplant cytomegalovirus (CMV) infection (seroconversion or virus isolation) and CMV disease (infection plus clinical signs and symptoms) were studied in relation to pretransplant recipient and donor serology, age, nutritional status and the effect of paediatric versus adult (reduced size) grafts. Of 70 children receiving 79 transplants, 26 (37%) had evidence of CMV infection, and eight (11.5%) had evidence of CMV disease, four of whom died. The primary infection rate (where the recipients were CMV negative) was 71% with mortality of 7% with most receiving a CMV‐positive graft. The active secondary infection rate (reactivation or reinfection, where the recipients were CMV positive) was 60% with mortality of 12.5%. No significant differences in infection or disease rates were found comparing malnourished versus well‐nourished patients, or between those who received whole or reduced‐size grafts. The high prevalence of CMV infections supports the view that clinical signs alone are inadequate to direct investigations for CMV. Both primary and active secondary CMV infection can result in serious morbidity and mortality in children receiving liver transplants. These data do not support the strategy of providing immunoprophylaxis to seronegative recipients only, at least in paediatric liver transplantation.
Concomitant adenosquamous carcinoma of the common bile duct and early adenocarcinoma of the gall‐bladder
Authors: HAYASHI NAOKO , YAMAGUCHI YASUO , OGAWA MICHIO
Published: March 2008

We report a 59 year old male with obstructive jaundice and a clinical diagnosis of carcinoma of the midportion of the common bile duct. Examination of the surgical specimen revealed a small tumour in the neck of the gall‐bladder. Histologic examination revealed the tumour in the common bile duct was an adenosquamous carcinoma whereas that in the gall‐bladder was an early papillary adenocarcinoma. Thus, this is a rare case of the simultaneous development of adenosquamous carcinoma and early papillary adenocarcinoma in the biliary tree.
Implications of isolated HBsAg positivity: Hepatitis B virus variant and immune incompetence
Authors: WU J.‐S. , NII S.‐L. , CHOU W.‐H. , SHEU L. , LIU W.‐T. , CHEN C.‐Y. , TANG B.‐H. , LU C.‐F.
Published: March 2008

In order to study the implications of isolated hepatitis B surface antigen (HBsAg) positivity, 24 041 serum samples from schoolchildren aged 6–12 years were tested for HBsAg, antibody to HBsAg (anti‐HBs) and antibody to hepatitis B core antigen (anti‐HBc) by radio‐immunoassay. Five hundred and sixty‐two (2.3%) of the 24 041 cases were positive for HBsAg but negative for both anti‐HBs and anti‐HBc. The second and third testings were performed 1–4 and 5–9 months after the initial testing. The cases of group (V), those who lost HBsAg within 9 months, had low titres of HBsAg and were negative for both hepatitis B e antigen (HBeAg) and antibody to HBeAg (anti‐HBe); the cases of group (H), those who remained isolated HBsAg positive in the last testing, had high titres of HBsAg and were positive for HBeAg. Hepatitis B virus (HBV) DNA were detected by polymerase chain reaction method using oligonucleotide primers derived from C and pre‐C regions in 20 sera of group (V) and 11 sera of group (H). However, using primers from the S region, HBV DNA was detected in only 11 sera of group (H), but in none of 20 sera of group (V). On sequencing of HBV DNA from each two sera of both groups, nucleotide and amino acid sequences of C and pre‐C regions with high homology to that of the HBV‐adr strain were obtained from sera of both groups and also for S regions in group (H) but not in group (V). It is concluded that isolated HBsAg positivity could be ascribed to (i) HBV‐variant with probable mutation in the S region — (H); and (ii) immune incompetence of the host — (H); with prevalence rates of 2.17 and 0.087%, respectively, in the mass screening survey.
Intrafamilial transmission of hepatitis C virus
Authors: GOTO MASAFUMI , FUJIYAMA SHIGETOSHI , KAWANO SHIN‐ICHI , TAURA YUKO , SATO SHINJIRO , SATO TATSUO , AKAHOSHI MOTOO
Published: March 2008

Abstract The intrafamilial transmission pattern of hepatitis C virus (HCV) was examined in 118 family members of 61 index patients with type C chronic liver disease using anti‐HCV antibodies and HCV RNA assay. The study subjects consisted of eight parents, 49 spouses, 50 children, eight siblings and three other relatives. The positivity rates of anti‐C100, anti‐JCC, second‐generation anti‐HCV and HCV RNA were 6.8, 12.7, 12.7 and 11.0%, respectively. Positivity in one or more anti‐HCV antibody assay was detected in 3/24 (12.5%) father‐child pairs, 3/17 (17.6%) mother‐child pairs, 2/8 (25%) sibling pairs, 6/38 (15.8%) husband‐wife pairs and 2/13 (15.4%) wife‐husband pairs. In spouses, positivity for anti‐HCV antibody or HCV RNA was observed after 40 years of age. None of 11 spouses married < 15 years was positive for any anti‐HCV assay or HCV RNA. In spouses whose age was > 50 years and duration of marriage was > 25 years, anti‐HCV or HCV RNA was frequently detected (32.0%). However, when seven pairs involving four spouses, one mother‐daughter pair and two sibling pairs were subtyped, the same HCV subtypes were found in only four pairs (type II in three pairs and type III in one pair). Further, the agreement rate between anti‐HCV and HCV RNA was > 90%. These results suggest that intrafamilial transmission of HCV, revealed by the subtyping method, is considered lower than the percentage of positivity for anti‐HCV antibodies or HCV RNA in family members of patients with type C chronic liver disease. Thus, the intrafamilial transmission of HCV seems to be quite rare and much less common than that of HBV.
HCV infection and its clinical features in recipients of blood screened for HCV (C100‐3) antibody
Authors: ITO SUSUMU , HONDA HIROHITO , HIBINO SHINGO , NII CHIYO , KAMAMURA MASAKO , NISHIKADO TOMOKO , FUJIKAWA HARUNOBU , SAIJO TETSUYA , OKAMURA SEISUKE , SHIMIZU ICHIRO
Published: March 2008

Abstract After adoption of the anti‐hepatitis C virus (C100‐3) test, the incidences of definite and suspected cases of post‐transfusional hepatitis (PTH) were 3.3% (7/209) and 7.2% (15/209), respectively. Four patients with definite PTH and seven patients with suspected PTH became positive for hepatitis C virus (HCV)‐related antibodies or HCV‐RNA after transfusion. These cases that became positive for anti‐HCV or HCV‐RNA showed a peak of alanine aminotransferase (ALT) more than 4 weeks after operation. Only rare cases that showed ALT peaks within 4 weeks after operation became positive for HCV‐related antibodies or HCV‐RNA. The peak ALT levels in cases showing positive conversion tended to be higher than those in cases showing no conversion. Judging from these results, cases of suspected PTH include those of transient liver disease attributable to surgery as well as clear cases of HCV infection. Thus new diagnostic criteria are required including data on HCV antibodies or HCV‐RNA.