bluuebunny/crossref_metadata_2025 huggingface dataset:
Aetiology and outcome of acute viral hepatitis in pregnancy
Authors: NAYAK NABEEN C. , PANDA SUBRAT K. , DATTA RAKESH , ZUCKERMAN ARIE J. , GUHA DIPAK K. , MADANAGOPALAN N. , BUCKSHEE KAMAL
Published: March 2008

Abstract The aetiologic types of sporadic acute viral hepatitis in 169 pregnant women were compared with those of 70 non‐pregnant women and 287 adult men. The majority of pregnant women (87.6%) came with acute hepatitis in the last trimester of pregnancy. Non‐A, non‐B (NANB) hepatitis accounted for 81.6% of hepatitis during pregnancy in comparison with 48.6% in non‐pregnant women and 57.1% in adult men. Hepatitis A was extremely uncommon during pregnancy. Hepatitis B infection accounted for 17% of all cases in pregnant women compared with 45% in controls. Acute viral hepatitis in pregnancy had a poor outcome as assessed by maternal and/or fetal mortality (28.5%). The outcome was equally bad in hepatitis NANB and hepatitis B. Pregnant women generally had significantly lower immunoglobulin levels in comparison with non‐pregnant women. In acute NANB hepatitis during pregnancy, serum IgG and IgM levels were lower and higher, respectively, compared with those in non‐pregnant women and pregnant women with acute hepatitis B. It is suggested that an immune suppression during pregnancy might be responsible for increased susceptibility to acute NANB viral hepatitis, which, by itself, seems to induce only a transient acute phase IgM response.
Effect of calcitonin on gall‐bladder volume in man
Authors: JONDERKO KRZYSZTOF , KOŃCA ADAM , GOŁAB TOMASZ , JONDERKO GERARD
Published: March 2008

The effect of increasing intravenous doses of synthetic salmon calcitonin (0.0044, 0.0088, 0.0175, and 0.0350 iu/kg per min) versus placebo on the fasted gall‐bladder volume was assessed in seven normal subjects according to a double‐blind study protocol. In addition, the action of calcitonin on meal‐induced gall‐bladder emptying was examined. Gall‐bladder volumes were measured by means of real‐time ultrasonography.

Calcitonin evoked a dose‐dependent relaxation of the fasted gall‐bladder. A statistically significant increase of the fasted gall‐bladder volume was observed with 0.0175 (23.4 ± 5.5 cm3 placebo versus 33.9 ± 7.7 cm3 calcitonin, P<0.001) and 0.0350 (21.4 ± 4.6 cm3 placebo versus 36.1 ± 8.4 cm3 calcitonin, P<0.01) iu/kg per min calcitonin, whereas a mean increase of the gall‐bladder volume amounted to 32.1% and 46.5%, respectively. A significant delay of the gall‐bladder emptying after calcitonin was reflected by a decrease of the ejection fraction: 23.2 ± 8.3% calcitonin versus 57.8 ± 6.9% placebo (P<0.02) at 20 min, and 40.5 ± 8.8% calcitonin versus 67.2 ± 3.8% placebo (P<0.02) at 30 min after the test meal.

Calcitonin is concluded to have a potent relaxing effect on the human gall‐bladder.
Transient abnormality in carbohydrate metabolism during enterically transmitted non‐A, non‐B acute viral hepatitis
Authors: GARG S. K. , DILAWARI J. B. , SINGH K. , SHARMA S.
Published: March 2008

Blood glucose, plasma insulin and free fatty acids (FFA) responses, during the 2 h oral glucose tolerance test (OGTT) with 75 g of dextrose, were measured in 30 consecutive patients with acute enterically transmitted non‐A, non‐B hepatitis. All of these parameters during the OGTT were compared with 10 age‐, sex‐ and weight‐matched healthy volunteers from the same community.

The fasting blood sugar, insulin and FFA were not different from normal controls (P > 0.05). According to the WHO criteria, the blood glucose response during OGTT in these patients was normal in 23%, impaired in 33% and diabetic in 43%. There was significant hyperinsulinaemia (P < 0.001) in patients with impaired and diabetic GGT and it persisted even at the end of 2 h.

None of the abnormal liver function tests correlated with blood sugar, insulin and FFA response during the OGTT.

All abnormal responses during the OGTT were, however, transient and returned to normal in all the patients after the recovery from acute hepatitis.
Motor mechanisms associated with slowing of the gastric emptying of a solid meal by an intraduodenal lipid infusion
Authors: HEDDLE R. , COLLINS P. J. , DENT J. , HOROWITZ M. , READ N. W. , CHATTERTON B. , HOUGHTON L. A.
Published: March 2008

The aim of this study was to define better the motor phenomena associated with the slowing of gastric emptying by a duodenal lipid infusion. Antral, pyloric and duodenal motility were recorded in 10 healthy subjects with a manometric assembly which incorporated multiple perfused side‐holes and a sleeve sensor positioned astride the pylorus. The gastric emptying of a standard solid meal and the distribution of the ingesta between the proximal and distal stomach were monitored with a radionuclide technique. A triglyceride emulsion was infused into the duodenum for 45 min once 25% of the meal had emptied. The infusion caused significant slowing in the rate of gastric emptying (P < 0.01). This slowing in gastric emptying was associated with the suppression of pressure waves in the distal antrum (P < 0.01) and proximal duodenum (P < 0.01), the induction of pressure waves isolated to a narrow pyloric segment (P < 0.01), and a redistribution of ingesta from the distal to proximal stomach. These findings suggest that pressure waves isolated to the pylorus, changes in the intragastric distribution of ingested food, and changes in proximal duodenal motility may all act in concert with changes in antral motility to regulate the gastric emptying of solids.
Continuing management of liver transplant patients after discharge
Authors: LYNCH STEPHEN V.
Published: March 2008

The management of liver transplant patients after discharge is a complex balance between immunosuppression and the side‐effects and toxicity of such medications. The Queensland Liver Transplant Service (QLTX) has performed 72 transplants in 67 patients; 49 patients (73%) are alive. The actuarial 1‐year survival rate is 72%. Death after the first year in patients transplanted for benign HBsAg negative disease has not occurred. The most common technical complications are biliary stenosis and hepatic artery thrombosis. Long‐term immunosuppression is with cyclosporin and low dose prednisolone. Regular trough cyclosporin levels and liver function tests are vital. The most limiting side‐effect of cyclosporin is nephrotoxicity. Constant vigilance, aggressive investigation, and management of pyrexia and biochemical liver dysfunction by the primary care physician in consultation with the transplant team will ultimately determine long‐term outcome. The principles and important details of the management of these patients by the QLTX are presented as a guide to referring practitioners.
Clinical and upper gastroendoscopic features of patients with dengue virus infection
Authors: WANG JIIN‐YU , TSENG CHIEN‐CHUNG , LEE CHI‐SHEI , CHENG KUO‐PIAO
Published: March 2008

Abstract Clinical observation was made on 238 dengue fever cases during an epidemic in Taiwan from September to November 1988. Dengue virus infection type 1 was responsible for all cases. The majority of patients had acute onset of fever with abdominal pain, diarrhoea, and vomiting. Gastrointestinal haemorrhage with manifestation of haematemesis and/or melena was observed in 28 (11.8%) of our patients. The clinical gastrointestinal features in patients with a peptic ulcer history were not different from those in patients without it. There was no significant difference in incidence of gastrointestinal manifestations between premedication and non‐premedication patients. Sixty‐six non‐premedication patients in our series were examined by gastroduo‐denoscopy. Haemorrhagic gastritis was the most common finding in 27 (40.9%) patients. The incidence of gastric and/or duodenal ulcerations was higher in patients with a peptic ulcer history compared with those without it (P<0.01). However, the incidence of upper gastrointestinal bleeding was similar between these two groups (19.2%vs 9.8%). Thrombocytopenia in patients with gastrointestinal haemorrhage was more prominent than in those without it (P<0.005). This implied that thrombocytopenia might be one of the predisposing factors for gastrointestinal haemorrhage.
Portal vein obstruction complicating intra‐arterial chemo‐infusion for hepatic metastases
Authors: TAKAYASU KENICHI , MAKUUCHI MASATOSHI , MORIYA YOSHIHIRO
Published: March 2008

Abstract In three patients with colon cancer and liver metastases who had received intra‐arterial chemo‐infusion of fluorouracil (5FU) and mitomycin C and/or cis‐diamminedichloroplatinum (CDDP), intrahepatic portal vein thrombosis (PVT) was incidentally demonstrated by computerized tomography (CT) 6, 1 and 7 months respectively after the cessation of administration of anti‐cancer agents. One patient developed complete PVT in the whole liver as shown by follow‐up CT 6 months after a diagnosis of pre‐existing sclerosing cholangitis, and died from rupture of oesophageal varices. In the remaining two patients, PVT was found incidentally by follow‐up CT in the right portal vein (Case 2) and the right anterior portal vein (Case 3) respectively; it spontaneously recanalized in Case 2 and was still present in Case 3 2 months later. PVT seems to be one of the complications of hepatic arterial chemo‐infusion and its possibility must be borne in mind in such patients, even though the exact interval between the arterial chemo‐infusion and occurrence of PVT could not be determined.
Hepatic encephalopathy due to a large intrahepatic communication between the portal vein and inferior vena cava
Authors: IWAMOTO SHOZO , OKUDA KUNIO
Published: March 2008

AbstractA 59 year old man with cirrhosis presented with encephalopathy and hyper‐ammonaemia. Tl weighted magnetic resonance imaging demonstrated a large void tubular structure connecting the right posterior portal vein branch and the inferior vena cava through the right hepatic lobe inferiorly, and cine‐mode imaging showed a flow within this channel. Clearly in this patient a significant portion of the portal venous blood was being shunted into the inferior vena cava, causing encephalopathy. The exact origin of this channel is not known, but several possibilities are discussed. It is also predicted that similar previously unknown large intrahepatic shunts will be discovered increasingly with the availability of modern imaging techniques.
Protective effect of OK‐432 (streptococcal preparation) on murine fulminant hepatitis following mouse hepatitis virus infection
Authors: SHIRAI MUTSUNORI , WATANABE SEISHIRO , NISHIOKA MIKIO
Published: March 2008

The effects of OK‐432 (streptococcal preparation) on murine fulminant hepatitis were investigated. Hepatitis was induced by injection of mouse hepatitis virus type 2 (MHV‐2) at a strength of either 1 times 103 or 1 times 104 plaque‐forming units (PFU). Mice without OK‐432 treatment died within 5 days, whereas mice pre‐inoculated with OK‐432 showed survival rates of 50% (1 times 103PFU) or 10% (1 times 104PFU) after 60 days. Survival time was not prolonged if OK‐432 was injected after MHV‐2. Examined histologically, mice not treated with OK‐432 showed severe haemorrhagic necrosis of the liver, often panlobular. Treated mice showed less necrosis; the least necrosis was observed in those injected with OK‐432 before MHV‐2. In those mice injected first with OK‐432 and then with 1 times 103PFU of MHV‐2 that survived 7 days, autopsy showed a very slight and focal hepatic necrosis, with follicular infiltration by lymphocytes and macrophages. Mitogenic reaction of spleen cells was remarkably less than normal in mice with MHV‐2 injection. However, mice injected with OK‐432 before MHV‐2 (same treatment as mice showing high survival rates) showed relatively high reactivity in comparison with mice not treated with OK‐432.
Morphological and biochemical effects of intrahepatic alcohol injection in the rabbit
Authors: FESTI D. , MONTI F. , CASANOVA S. , LIVRAGHI T. , FRABBONI R. , ROVERSI C. A. , BERTOLI D. , BORELLI G. , MAZZELLA G. , BAZZOLI F. , ALDINI R. , BARBARA L. , RODA E.
Published: March 2008

The local and systemic effects, as well as the repair mechanisms, of sterile absolute ethyl alcohol injection were evaluated at a range of doses (0.1–2.0 mL/kg body weight) in rabbit liver in order to confirm the feasibility and safety of local treatment of tumours in man. Saline injection was used in the control animals. The animals were killed at varying intervals (range: 1–30 days after injection), and the liver was studied by gross and microscopic examination. The ethyl alcohol injection was well tolerated and did not induce significant systemic side‐effects. All doses could induce necrosis and none proved to be lethal. The alcohol injection produced an area of coagulation necrosis, the size of which appeared to be dose‐related, and which was surrounded by granulation tissue, gradually repairing the necrotic lesion; the adjacent tissue was intact, or had signs of mild steatosis. However, at higher doses (1.0 and 2.0 mL/kg bodyweight), necrotic lesions were observed in the liver both near and remote from the site of injection. Fine needle percutaneous alcohol injection is effective in producing necrotic lesions which appear to be dose‐related; at higher doses, however, an unpredictable intrahepatic diffusion may occur.
Hepatitis δ virus infection in different time periods in Japan
Authors: TAMURA I. , ICHIMURA H. , KODA T. , KATAYAMA S. , KURIMURA O. , KURIMURA T.
Published: March 2008

To investigate the prevalence of hepatitis δ virus (HDV) infection in different time periods between 1973 and 1988, antibody to hepatitis δ antigen (anti‐HD) was tested for in sera collected from 1088 cases with acute or chronic hepatitis B virus (HBV) infection treated at Kure National Hospital. Between 1979 and 1983, anti‐HD was first detected in 16% (four of 25 cases) of patients with acute hepatitis B, in 6.8% (11 of 161 cases) of asymptomatic HBV carriers and 26% (51 of 196 cases) of those with chronic liver disease. Except for this time period anti‐HD was hardly detected. These findings indicate that sporadic HDV infections existed in this area between 1979 and 1983.
Immunological profile of patients with non‐cirrhotic portal fibrosis
Authors: SARIN S. K. , NAYYAR A. K. , MALHOTRA P. , SHARMA B. K. , KUMAR R. , BROOR S. L.
Published: March 2008

The aetiopathogenesis of non‐cirrhotic portal fibrosis (NCPF), a common cause of portal hypertension in India, is not known. To study the immune status of NCPF patients and to see whether immunological mechanisms have a role to play, humoral and cell‐mediated immunological studies were carried out in 43 patients with NCPF and compared with equal number of matched healthy controls and 31 patients with compensated liver cirrhosis. Serum immunoglobulin A (IgA) and complement (C3, C4) levels were significantly (P < 0.001) lower in NCPF patients compared with controls and cirrhotics. There was no significant difference between the total or the relative concentration of the immunoglobulins and complements between NCPF patients and healthy controls, but, in patients with cirrhosis, concentration of all the immunoglobulins was higher. The cutaneous response to dinitrochlorobenzene was poorer in patients with NCPF, but the difference between cirrhotics and controls was not significant. A decrease in the suppressor/cytotoxic (T8) phenotype of lymphocytes in the peripheral blood and an increase in the ratio of helper/inducer (T4) and T8 lymphocytes was seen in patients with NCPF and cirrhosis. Although these results indicate definite immunological abnormalities in NCPF patients, their role in the pathogenesis of NCPF remains to be investigated.
Comparative efficacy of emergency endoscopic sclerotherapy for active variceal bleeding due to cirrhosis of the liver, non‐cirrhotic portal fibrosis and extrahepatic portal venous obstruction
Authors: BHARGAVA D. K. , DASARATHY S. , ATMAKURI S. P. , DWIVEDI M.
Published: March 2008

Patients with continued variceal bleeding due to portal hypertension (n= 202) were treated by endoscopic injection sclerotherapy after resuscitation. Portal hypertension was due to hepatic cirrhosis in 123, non‐cirrhotic portal fibrosis (NCPF) in 49 and extrahepatic portal venous obstruction (EHO) in 30 patients. Polidocanol 1% was injected intravariceally. An adequate sclerotherapy was carried out in 97% of patients.

Immediate haemostasis was achieved in 177 (88%) patients. Rebleeding occurred in 31 (17.5%) of 177 patients. By reinjection of varices, definitive control of bleeding occurred in 160 (79%) patients. There was no significant difference in terms of immediate control of bleeding in patients with different aetiologies of portal hypertension and hepatic functional status (Child's grade). Rebleeding episodes were lower in patients with EHO than cirrhosis of the liver and NCPF. Similarly, the Child's status significantly influenced the recurrence of bleeding which was lower in Child's A than B and B than C. The in‐hospital mortality was 18.6%. This was also significantly related to Child's status and aetiology of portal hypertension. Minor complications occurred in 10.4% of patients. It is concluded that endoscopic sclerotherapy as the first line of treatment is an effective and technically feasible procedure for the control of active variceal bleeding, regardless of the cause of portal hypertension. Furthermore, the results were influenced by the aetiology of portal hypertension and hepatic functional status.
Genetic aspects of Wilson's disease
Authors: FRYDMAN MOSHE
Published: March 2008

Wilson's disease is an autosomal recessive, inborn error of copper metabolism. The basic defect is unknown but decreased biliary excretion of copper is associated with copper accumulation and damage to the liver, brain and other organs with variable clinical expression. The gene for the disease has been mapped to band 14.1–21.1 of the long arm of chromosome 13, and an increasing number of flanking DNA markers has become available in recent years. Family studies using these markers offer the first diagnostic tool which is independent of copper metabolism. This method has been applied successfully for carrier detection in siblings of patients and has the potential to be used for prenatal diagnosis. The results of linkage studies in families of different ethnic origins suggest that the disease is associated with a mutation at a single chromosomal region. The assignment of the gene to chromosome 13 and the availability of closely linked markers are the first steps towards cloning of the disease gene and eventually may lead to determination of the basic metabolic defect.
Significance of hepatitis B core antigen in the liver in patients with chronic hepatitis B and its relation to hepatitis B virus DNA
Authors: YOO JAE YOUNG , KIM HAK YANG , PARK CHOONG KEE , KHANG SHIN KWANG , JEONG JIN WU , CHUNG WHAN KOOK , DIBISCEGLIE ADRIAN M. , HOOFNAGLE JAY H.
Published: March 2008

Liver biopsies from 52 patients with chronic hepatitis B were investigated for the presence and distribution of HBcAg and the results were compared with the status of hepatitis B virus deoxyribonucleic acid (HBV‐DNA). The patients consisted of 37 men and 15 women, aged 16–55 years (mean = 34 years). Serum alanine aminotransferase (ALT) was elevated in 50 patients (range: 18–969 U/L; mean = 290 U/L). Serological testing showed HBsAg in all, HBeAg in 45 (87%), and HBV‐DNA in 28 (54%). Liver biopsies demonstrated HBcAg in 35 (67%) patients. HBcAg was not only present in 31 of 45 (69%) patients who were seropositive for HBeAg, but also in four of seven (57%) with antibody to HBeAg (anti‐HBe). In 28 of 35 (80%) patients with HBcAg in the liver, serum HBV‐DNA was detected. However, no serum HBV‐DNA was detected in 17 patients who had no detectable HBcAg in the liver. The distribution of HBcAg in the liver was rather cytoplasmic and nuclear than nuclear alone. Among 33 patients with cytoplasmic HBcAg in the liver, 15 (45%) had an evidence of acute exacerbation of hepatitis with marked ALT elevation (range: 168–894 U/L; mean = 385 U/L) and nine patients showed severe chronic active hepatitis and confluent necrosis, histologically. These results indicate that the presence of HBcAg in the liver correlates with the amount of circulating hepatitis B virus as quantified by serum level of HBV‐DNA. The predominant cytoplasmic HBcAg in the liver may suggest the possibility of multiple episodes of acute exacerbation and more severe ongoing hepatitis during the clinical course.
Effect of genetic obesity and experimental diabetes on hepatic microsomal mixed function oxidase activities
Authors: ZALUZNY LOUISE , FARRELL GEOFFREY C. , MURRAY MICHAEL
Published: March 2008

In male rats, genetic obesity and experimental diabetes are associated with altered activities of several of the hepatic microsomal P‐450 isozymes concerned with steroid and xenobiotic oxidation. The present study examined the roles of insulin and ketonaemia in effecting these changes. In obese male Zucker rats, androstenedione 6β‐, 16α‐ and 16β‐hydroxylase activities (mediated by P450PCN‐E, P‐450UT‐A and P450PB‐B, respectively) were significantly decreased to 21%, 20% and 43% of lean control. Obesity was also associated with a significant decrease in the activities of N‐nitrosodimethylamine demethylase (P‐450j) and aniline p‐hydroxylase to about 70%. A similar decrease in total microsomal P‐450 was also observed. Androstenedione 7α‐hydroxylase activity (mediated by P‐450UT‐F) was unchanged in these animals.

In streptozotocin‐induced diabetic male Wistar rats, androstenedione 7α‐ and 16β‐hydroxylase activities were significantly elevated to 230% and 270% of control, respectively. Significant increases in the rates of N‐nitrosodimethylamine demethylase and aniline p‐hydroxylase were also noted in diabetic rat liver. In contrast, the activity of P‐450UT‐A was reduced to 30% of control and P‐450PCN‐E‐specific 6β‐hydroxylation was unchanged. Control of the diabetic state with insulin treatment reversed all the changes in P‐450‐mediated activities. Significant correlations were found between serum concentrations of insulin and catalytic activities of P‐450PB‐B, (ρ= ‐0.46), P‐450UT‐F (ρ= ‐0.65) and P‐450j (ρ= ‐0.71). Positive correlations of the same magnitude were also found between these mixed function oxidase activities and β‐hydroxybutyrate.

These studies provide further evidence that hormones and ketone bodies are involved, either directly or indirectly, in the alteration of hepatic P‐450‐mediated metabolism of sex steroids and foreign compounds. In particular, insulin appears to exert a negative control on P‐450j and P‐450PB‐B activities.
In vivo cell kinetics studies of the duodenum during and after healing of cysteamine‐induced duodenal ulcer in rats using bromodeoxyuridine incorporation
Authors: PAN SHIANN , OKAZAKI YUKINORI , TAKEMOTO TADAYOSHI
Published: March 2008

The present study investigated the defect of duodenal defence responsible for the tendency of recurrence of duodenal ulcer. Male Wistar rats were treated with cysteamine‐HCl subcutaneously to induce duodenal ulcer, and bromodeoxyuridine (BrdU) was given intraperitoneally 1 h before laparotomy. Serial tissue sections and immunocytochemical staining of BrdU were done to study the cell kinetics during and after healing. Deep ulcers developed in the proximal part of the duodenum 24 h after cysteamine injection, and the ulcer was replaced by scar tissue 1 week later. BrdU‐labelling index of normal duodenal mucosa in control rats was 30–34%. On the peripheral part of the regenerative mucosa, BrdU‐labelling index increased from 1.5% to 26–27%, 1–4 weeks after injection and remained at this level thereafter. On the central part, except the most central area, the labelling index remained at 0% until 3 weeks, and was 15% 6 weeks after cysteamine treatment. It never achieved the level seen in control normal mucosa. The labelling rate of fibrous cells in scar tissue decreased from 28% to nearly 0% 1–4 weeks after the injection. It is concluded that both the ulcer scar and the regenerative mucosa do not achieve a mature state in the initial scarred stage; they need more time to reach a relatively mature condition. Moreover, the regenerative mucosa will be the weak, easily damaged part of the duodenum.
Rhythms in morphology and function of hepatocytes
Authors: UCHIYAMA YASUO
Published: March 2008

In standard textbooks of histology, hepatocyte structure is described as being, for the most part, static. However, more than 50 years ago, it was reported that the glycogen content of rabbit hepatocytes varies significantly over 24 h. Since then, numerous investigators have confirmed this phenomenon in a variety of animals by use of morphological, histochemical and biochemical techniques, and it has been shown that the variation in glycogen content of hepatocytes corresponds with variations in enzymes related to glycogen metabolism. Moreover, there are also variations in most subcellular organelles and in many other proteins over 24 h. It is clear that circadian rhythms need to be taken into account in studies of morphology and function of hepatocytes.
Hepatic toxicity of Vitamin A and synthetic retinoids
Authors: FALLON MICHAEL B. , BOYER JAMES L.
Published: March 2008

Vitamin A and synthetic retinoids have recently been used increasingly in a variety of health related concerns. Hepatic toxicity is an uncommon but serious side‐effect of several Vitamin A derivatives which may lead to cirrhosis. This review will focus on the clinical and pathologic findings of hepatic involvement in chronic hypervitaminosis A and on the evidence concerning the potential hepatotoxicity of currently available synthetic retinoids.
Influence of piecemeal necrosis on the compensatory increase of mitochondrial respiratory enzymes of the tumour‐bearing liver: Clinical study of 53 surgical cases
Authors: MAKI ATSUHIKO , SAKAI YOSHIHARU , TANAKA AKIRA , YAMAOKA YOSHIO , OZAWA KAZUE , KAGE MASAYOSHI , KOJIRO MASAMICHI
Published: March 2008

The relationships between histological findings, adaptively increased cytochrome a(+a3) levels in chronic liver disease and complications after hepatectomy were studied in order to clarify the mechanism of mitochondrial derangement. The liver specimens of 53 hepatectomized patients were randomly evaluated by three independent hepatopathologists and were compared with cytochrome a(+a3) levels in the biopsied liver, the extent of operation and postoperative complications.

The cytochrome a(+a3) concentrations did not show any significant difference between cases of chronic hepatitis and liver cirrhosis nor groups classified by regeneration. Severity of piecemeal necrosis was categorized into three groups: group A—minimal (n= 20); group B—moderate (n= 19); and group C—severe (n= 14). There were significant differences (P < 0.01) in cytochrome a(+a3) concentrations between the groups (A: 99 ± 9; B: 135 ± 6; C: 155 ± 10 pmol/mg of mitochondrial protein). Extensive hepatectomy, involving segmentectomy or more, was frequently complicated (four of nine, 44.4%) in group C, whereas there were few complications (two of 16, 12.5%) in group A cases in which extensive hepatectomy was performed.

Evidence will be presented which will show that deranged liver function, as indicated by cytochrome a(+a3) levels, is closely correlated with piecemeal necrosis. This may be attributed to the damage of periportal hepatocytes which are the main sites of oxidative phosphorylation.
Management of complicated acute pancreatitis: Impact of computed tomography
Authors: FAN S. T. , CHOI T. K. , CHAN F. L. , LAI E. C. S. , WONG J.
Published: March 2008

Abstract The usefulness of computed tomography (CT) in guiding the management of 43 patients who had a complicated clinical course of acute pancreatitis was retrospectively studied. The CT scans were performed when patients had persistent fever, leucocytosis, hyperamylasaemia, palpable abdominal masses or when there was organ failure. The CT scans showed normal findings in six patients, features of pancreatic abscess in three patients, pseudocysts in three patients and inflammatory masses (a mixture of sterile inflammation and necrosis) in 31 patients. Patients with pancreatic abscesses underwent emergency laparotomy, drainage and debridement; patients with pseudocysts had delayed drainage unless complication occurred; patients with normal CT scan or findings of inflammatory masses were managed conservatively. For patients undergoing conservative management, repeated CT scanning and percutaneous aspiration of the inflammatory mass was performed when pancreatic sepsis was strongly suspected. By this approach, basing on careful clinical and CT scan surveillance, five patients with pancreatic sepsis (pancreatic abscess and localized abscess collection in pseudocyst) underwent emergency surgery and four survived, while 25 patients with inflammatory masses were successfully managed conservatively and some who may have been operated on clinical grounds were spared unnecessary early debridement surgery.
Induction and clinical utilization of lymphokine‐activated killer cells in patients with gastrointestinal tract cancers
Authors: TSUGITA MASASHI , YAMAUCHI KATSUMI , KOMATSU TATSUJI , SUZUKI HIROYOSHI , HANYU FUJIO
Published: March 2008

Abstract In 18 patients with cancers of the gastrointestinal tract, lymphokine‐activated killer (LAK) cell activity was studied and compared with that of healthy subjects. After cultivation with 103 iu/mL of recombinant interleukin‐2, the cytotoxicity of patients' lymphoid cells was increased from 13.6 ±6.8% to 76.2 ±19.5% against Daudi cells and from 12.8 ±8.1% to 76.2 ±19.5% against K‐562 cells.

Based on these results, autologous LAK cells were given to patients. LAK cells injected into subdermal metastatic tumours demonstrated a significant inhibitory effect on tumour growth in comparison with that of control tumour nodules. Of four patients with metastatic tumours in the liver, to whom LAK cells were administered via the hepatic artery, tumour size was reduced by about 25% (minor response) in one patient, with a decrease of computerized tomography attenuation in the tumours occurring in the other three patients.
Gastric acid response to modified sham feeding in patients with duodenal ulcer: Is increased vagal tone the cause of basal acid hypersecretion?
Authors: BROOR S. L. , THORAT V. K. , CHARI S. T. , MISRA S. P. , RAJU G. S.
Published: March 2008

Abstract In order to test the hypothesis that increased basal vagal tone causes basal acid hypersecretion in duodenal ulcer (DU), the effect of sham feeding on gastric acid secretion was studied in 26 patients with DU and 20 healthy controls. Basal acid output (BAO), sham feeding‐stimulated acid output (SAO) and peak histamine‐stimulated acid output (PAO) were significantly higher in DU patients compared with healthy controls (P < 0.01). The BAO/PAO ratio in DU patients (0.28 ±0.03) was not significantly different from that of healthy subjects (0.19 ±0.03), indicating that the higher BAO in DU patients group, as a whole, was due to a higher parietal cell mass. The basal subtracted response to sham feeding expressed as a fraction of secretory capacity [(SAO – BAO)/PAO], which correlates inversely with the basal vagal tone, was not significantly different in the patients and control subjects (0.27 ±0.03 versus 0.3 ±0.03; P > 0.05). Based on the data from the healthy controls, a ratio of BAO/PAO > 0.44 was defined as abnormal (using 95% confidence limits) and it indicated marked basal acid hypersecretion. Four of 26 DU patients had basal acid hypersecretion (that is, BAO/PAO > 0.44), but only two of them did not show an increase over their basal rate of secretion in response to sham feeding. All other DU patients, including two with marked basal acid hypersecretion, and all healthy controls showed an appreciable increase in their acid secretion in response to sham feeding. In contrast to some earlier reports, these observations suggest that increased basal vagal tone might not be the cause of marked basal acid hypersecretion in all patients as it was present in only two of four such patients.
Laurence‐Moon‐Biedl syndrome accompanied by congenital hepatic fibrosis
Authors: NAKAMURA FUKASHI , SASAKI HIROSHI , KAJIHARA HIROKI , YAMANOUE MICHIO
Published: March 2008

Abstract A 33 year old woman with mental deficiency, retinitis pigmentosa, obesity, and parental consanguinity (heredity) was diagnosed as having Laurence‐Moon‐Biedl syndrome. She also had diabetes mellitus, slight hepatic dysfunction, and hepatomegaly. Liver biopsy showed perilobular fibrosis and bile duct proliferation with cystic dilatation; these findings are consistent with those of congenital hepatic fibrosis.
Growing cavernous haemangioma of the liver: 11‐fold increase in volume in a decade
Authors: YOSHIDA JUNICHI , YAMASAKI SUSUMU , YAMAMOTO JUNJI , KOSUGE TOMOO , TAKAYAMA TADATOSHI , HASEGAWA HIROSHI , TAKAYASU KENICHI , MURAMATSU YUKIO , MORIYAMA NORIYUKI , HIROHASHI SETSUO
Published: March 2008

A 57 year old Japanese male was incidentally found to have a 7.5 cm diameter hepatic haemangioma. Eleven years later he was operated on because the haemangioma had grown into a 17 cm mass causing upper abdominal fullness. Volumetry on computerized tomograms disclosed that the haemangioma had grown from 123 cm3 to 1343 cm3 in volume. Quantitative documentation on growing hepatic haemangioma has been rare.
Assessment of serum and bile levels of CA19‐9 and CA125 in cholangitis and bile duct carcinoma
Authors: KER CHEN‐GUO , CHEN JONG‐SHYONG , LEE KING‐TEH , SHEEN PAI‐CHING , WU CHUNG‐CHIENG
Published: March 2008

In this study, CA19‐9 and CA125 in serum and bile were measured to evaluate their diagnostic value in cholangitis and bile duct carcinoma. Patients were classified into three groups: group A, the control group, had cholelithiasis without infection (n= 23), group B had acute cholangitis (n= 25) and group C had bile duct carcinoma without bacterial infection (n= 18). All patients had undergone surgery, and bile and serum of the patients were measured for the two tumour markers by radio‐immunoassay. The positivity rate for serum CA19‐9 was 4.4% in the control group, 28.0% in group B and 61.1% in group C. The positivity rates for serum CA125 in groups control, B and C were 0%, 4% and 27.78% respectively. The diagnostic accuracy for bile duct carcinoma was 67.4% for both CA19‐9 or CA125. The concentration of CA19‐9 in bile was more than 1200 ng/mL in 72% of patients with acute cholangitis, in 61.1% of all patients with bile duct carcinoma and 0% in the control group. The frequency of concentrations of CA125 in bile greater than 200 ng/mL was 38.89% in bile duct carcinoma and none was observed in the control or acute cholangitis groups. In conclusion, the concentration of CA19‐9 was increased not only by the tumour itself, but also by infection. In the diagnosis of bile duct carcinomas, the sensitivity of CA125 was low but its specificity was very high.
Recovery of the small intestine in coeliac disease on a gluten‐free diet: Changes in intestinal permeability, small bowel morphology and T‐cell activity
Authors: CUMMINS A. G. , PENTTILA I. A. , LABROOY J. T. , ROBB T. A. , DAVIDSON G. P.
Published: March 2008

Abstract Intestinal permeability was assessed before and 1, 2, 4, 8 and 12 weeks after commencing a gluten‐free diet (GFD) in eight coeliac subjects. Intestinal morphology was quantified in six coeliac subjects on a normal diet, six coeliac subjects on a GFD, and 21 normal subjects. T‐cell activity was measured in the eight coeliac subjects by soluble interleukin‐2 receptor (sIL‐2R) concentration (normal < 477 U/mL). Intestinal permeability was increased 10‐fold with a geometric mean value of 0.72 on a normal diet, and decreased to 0.17 at 4 weeks (P=0.04), to 0.07 at 8 weeks (P=0.010), and to 0.20 at 12 weeks (P=0.015) of a GFD. Two of the eight subjects showed a poor response to gluten withdrawal. Quantitative intestinal morphology showed no significant improvement after 3 to 6 months of a GFD. Mean ± s.d. sIL‐2R concentrations in the eight subjects were increased 5‐fold higher than control values at 1400 ± 530 U/mL on a normal diet and decreased to 750 ± 200 U/mL after 12 weeks of a GFD (P=0.004). We conclude that intestinal permeability improves rapidly in the majority of coeliac subjects after commencing a GFD, although some abnormal permeability and increased T‐cell activity persists. This may be due to varying degrees of gluten ingestion resulting in continued immune activation.
Effect of thiamine on glucose utilization in hepatic cirrhosis
Authors: HASSAN RASHIDA , QURESHI HUMA , ZUBERI SARWAR J.
Published: March 2008

Abstract Thiamine, an essential co‐enzyme, improves glucose utilization. Thiamine hydrochloride (50 mg per capita per day for 30 days), given to 25 patients with liver cirrhosis who had hyperglycaemia, produced a significant reduction (P < 0.001) in blood glucose levels. It is therefore suggested that thiamine supplements be given to cirrhotics with hyperglycaemia, to improve glucose utilization.
Fatal amoebic liver abscess: An autopsy study
Authors: AHMAD MANZOOR , KHAN AMIR H. , MUBARIK AZHAR
Published: March 2008

Abstract An autopsy study of 20 cases is presented. The mean age was 32 years (range: 14–45). Four cases (20%) presented with jaundice. Another four (20%) had continuous fever with abdominal pain. Six had loose motions with blood and mucus in the stools. The mean duration of illness was 7.2 days. All cases were thin and emaciated. Liver was grossly enlarged (mean weight: 2680 g). The abscess was single in all cases except one. The right lobe was involved in 15 cases, the left in four and both in one. The average size of abscess was 13 cm. The abscess had ruptured in the abdomen in 3 patients, for which laparotomy was performed. Pulmonary involvement was seen in 3 cases. Colon showed ulceration in half the patients. In 2 cases performation was also present. No cerebral involvement was present.

A number of interesting features emerged from this study. Although amoebic liver abscess is a common disease, its diagnosis can be missed due to unusual presentation. In the present study, diagnosis of viral hepatitis, carcinoma lung, bacillary dysentery and enteric fever with perforation were made, which probably contributed materially to fatal outcome.
Resection of hepatocellular carcinoma: Oligocentric origin of recurrent and multinodular tumours
Authors: LIANG XIAO‐HUAN , LONCAREVIC IVAN F. , TANG ZHAO‐YOU , YU YE‐QIN , ZENTGRAF HANSWALTER , SCHRÖDER CLAUS H.
Published: March 2008

Abstract The structure of integrated hepatitis B virus (HBV) DNA was analysed to determine the origin of recurrent and multinodular hepatocellular carcinoma (HCC). In 5 cases, recurrent tumours were compared with the respective primary tumours, all of which had chromosomally integrated viral DNA. In only one of these cases, an identical HBV DNA integration pattern was found, indicating a monocentric origin of primary and secondary tumour. In all other cases a polycentric origin was deduced. Particular features observed were: (i) the apparent absence of integrated viral DNA in a recurrent tumour; and (ii) an integration pattern identical to that of the primary tumour and a distinct new pattern in two different foci of multinodular recurrent HCC. For multinodular primary HCC one case was analysed and found to be of independent origin.
Hypotension and endoscopic stigmata of recent haemorrhage in bleeding peptic ulcer: Risk models for rebleeding and mortality
Authors: BRANICKI F. J. , COLEMAN S. Y. , LAM T. C. F. , SCHROEDER D. , TUEN H. H. , CHEUNG W. L. , PRITCHETT C. J. , LAU P. W. K. , LAM S. K. , HUI W. M. , LAM D. K. H. , TSE M. C. K. , WONG J.
Published: March 2008

Clinical and endoscopic data were collected prospectively in 1050 patients with bleeding peptic ulcer admitted between September 1985 and July 1989 to the care of one surgical team. Seventy‐nine patients underwent therapeutic endoscopy soon after admission and in 129 patients either immediate or early elective surgery was performed. Eight hundred and forty‐two patients, in whom therapeutic endoscopy was not performed at any stage, underwent initial conservative management and data from this latter group are now presented.

Shock on admission was defined as systolic blood pressure (BP) ≤ 100 mmHg on presentation. There were 10 deaths of 147 shocked patients (6.8%) compared with only 25 deaths of 695 patients (3.6%) not in shock (P<0.08). Bleeding recurred in 30 patients (20.4%) shocked on presentation but in only 96 (13.8%) with a BP > 100 mmHg (P<0.05). Twenty‐one of 358 patients (5.9%) with endoscopic stigmata of recent haemorrhage (ESRH) died, but only 14 of 484 patients (2.9%) without such stigmata (P<0.05) died. In shocked patients rebleeding was evident in 21 of 73 (28.8%) cases with ESRH but in only 9 of 74 (12.2%) patients in whom ESRH were absent (P<0.02). In the absence of fresh blood at endoscopy rebleeding occurred in 22 of 124 (17.8%) shocked patients and only 74 of 629 (11.8%) of those not shocked on presentation (P<0.07).

When ulcer size was documented rebleeding rates for ulcers ≤ 1 cm, ≤ 2 cm and > 2 cm in size were 54 of 485 (11.1%), 30 of 142 (21.2%) and 12 of 44 (27.3%) respectively. In shocked patients rebleeding occurred in 7 of 73 (9.6%) patients with an ulcer > 1 cm in size but in 17 of 44 (38.6%) patients in whom ulcer size was > 1 cm (P<0.001). When admission BP was > 100 mmHg corresponding rebleeding rates for ulcers ≤ 1 cm and > 1 cm size were 47 of 412 (11.4%) and 25 of 142 (17.6%) (P<0.06). Shock, large ulcer size and ESRH were each related to rebleeding, the highest rebleeding rates being seen with a combination of shock and ulcer size > 1 cm or ESRH.
A comparison of diagnostic tests to determine Helicobacter pylori infection
Authors: LIN S. K. , LAMBERT J. R. , SCHEMBRI M. , NICHOLSON L. , FINLAY M. , WONG C. , COULEPIS A.
Published: March 2008

Twenty‐five Helicobacter pylori positive and 25 H. pylori negative subjects as defined by culture and phase contrast microscopy of antral biopsy specimens obtained from routine upper endoscopy were studied. Antral biopsies were examined by rapid urease test, phase contrast microscopy, culture and histology. Venous blood was tested for H. pylori specific IgG antibodies by an ELISA technique. Within 7 days of endoscopy the patients also had a [14C]‐urea breath test. The sensitivity and specificity of the rapid urease test was 92%, the breath test 96% and 100%, histopathology 96% and 91% and serology 96% and 88%, respectively. The [14C]‐urea breath test performed over 1 h with sampling of subjects at 0, 0.5 and 1 h was an accurate and reliable method. Results expressed as counts per minute of the expired 14CO2 proved to be a simple method of assessing H. pylori status. A significant correlation between severity of histological antral gastritis and the amount of 14CO2 expired was observed. This study has shown that the non‐invasive 14C‐urea breath test and serology are highly sensitive and specific for the diagnosis of H. pylori infection.
Liver, lipoproteins and disease: I. Biochemistry of lipoprotein metabolism
Authors: KROON PAULUS A. , POWELL ELIZABETH E.
Published: March 2008

Cholesterol is a structural component of biological membranes and an immediate precursor for steroid hormones and bile acids. The liver is central to the production and removal of cholesterol‐rich lipoproteins and bile acids.

The basic biochemical aspects of hepatic lipoprotein and cholesterol metabolism and how abnormalities in liver function impair these metabolic pathways are reviewed.
Ascending infection of the biliary tract after surgical sphincterotomy and biliary stenting
Authors: SUNG J. Y. , LEUNG J. W. C. , SHAFFER E. A. , LAM K. , OLSON M. E. , COSTERTON J. W.
Published: March 2008

It has been widely accepted that there is an ascending route of bacterial infection of the biliary tract but there is a lack of direct evidence. This hypothesis was tested in an animal experiment using the cat as an animal model. The implantation of biliary stents and surgical sphincterotomy were performed in these animals, with sham controls. Stents bypassing the sphincter of Oddi with the tip in the duodenal lumen were colonized by duodenal micro‐organisms and the biliary tract was heavily contaminated. Blockage of these stents resulted in biliary obstruction. Stents implanted within the common bile duct, proximal to the sphincter were largely unaffected by biofilm formation. After surgical sphincterotomy the biliary tract was also contaminated but, in the absence of obstruction, the animals did not develop any symptoms. It was concluded that ascending infection by duodenal biliary reflux, via the sphincter of Oddi, is an important route of infection in the biliary system.
Effect of drinking on the outcome of cirrhosis in patients with hepatitis B or C
Authors: SHIOMI SUSUMU , KUROKI TETSUO , MINAMITANI SHIN , UEDA TADASHI , NISHIGUCHI SHUHEI , NAKAJIMA SHINYA , SEKI SHUICHI , KOBAYASHI KENZO , HARIHARA SHIGEYOSHI
Published: March 2008

Survival rates were calculated for 251 patients with cirrhosis of the liver but without hepatocellular carcinoma, primary biliary cirrhosis, or autoimmune cirrhosis who underwent laparoscopy during the past 21 years at the authors’ hospital. The survival rates were calculated by the Kaplan‐Meier method. Stored serum was assayed for hepatitis B surface antigen (HBsAg) and antibodies to the hepatitis C virus (HCV). Patients with alcoholic cirrhosis had significantly better survival rates than patients with HBsAg, HCV, or both. Differences in survival rates between patients with hepatitis B and C were insignificant. In both groups, habitual drinkers had a significantly lower survival rate. The results suggested that alcohol accelerates liver damage in subjects with viral hepatitis.
Responses to cholecystokinin octapeptide in patients with functional abdominal pain syndromes
Authors: ROBERTS‐THOMSON IAN C. , FETTMAN MARTIN J. , JONSSON JULIE R. , FREWIN DEREK B.
Published: March 2008

Clues to the pathogenesis of functional pain syndromes may be derived from the study of stimuli that precipitate or aggravate symptoms. In this study, cholecystokinin octapeptide (CCK‐8, 0.06 μ/kg) and placebo were given by intravenous infusion (5 min) in random order to control subjects and four groups of patients with unexplained abdominal pain. Induction of pain and nausea were assessed by linear analogue scales while sympathoadrenomedullary responses were assessed by serial changes in plasma concentrations of noradrenaline, adrenaline and dopamine. Scores for pain and nausea were low after infusion of placebo. After infusion of CCK‐8, pain scores were significantly higher in patients with spontaneous pain than in control subjects, but significant increases in nausea were restricted to patients with irritable bowel syndrome and a subgroup of patients with pain after cholecystectomy. Although some groups showed increases in plasma concentrations of catecholamines after the infusion of CCK‐8, the size of these increases was neither consistent among patients within each group nor predictive of scores of pain and nausea in individual subjects. Pain during the infusion of CCK‐8 was a feature common to patients with diverse functional pain syndromes, and did not appear to be attributable to activation of the sympathetic nervous system.